WorldWideScience

Sample records for perianal disease prior

  1. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease.

    Science.gov (United States)

    Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

    2009-07-28

    To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 +/- 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 +/- 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

  2. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease

    Science.gov (United States)

    Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

    2009-01-01

    AIM: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn’s disease (CD). METHODS: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. RESULTS: A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. CONCLUSION: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients. PMID:19630105

  3. Extramammary Perianal Paget’s Disease

    Directory of Open Access Journals (Sweden)

    M.N. Al Hallak

    2009-11-01

    Full Text Available Perianal Paget’s disease is a rare malignancy. It is rarely isolated and often associated with an underlying adenocarcinoma. It usually presents with anal itchiness and discomfort and can be misdiagnosed as hemorrhoids. Once the diagnosis of perianal Paget’s disease is granted, extensive work-up to find an underlying primary malignancy is crucial. Surgery is the standard modality of treatment of extramammary Paget’s disease (EMPD with recurrence rates of 44–60%. Other different treatment modalities including radiotherapy, laser therapy, topical and systemic chemotherapy and the new emerging, promising photodynamic therapy are in the field of study. A 76-year-old man was referred to our hospital with a one-year history of anal itchiness and intermittent rectal bleeding. Skin shave and punch biopsies from the perianal area were reported back as perianal Paget’s disease with no underlying adenocarcinoma. The immunohistochemical stains were positive for cytokeratin 7 but also positive for cytokeratin 20 and CEA which indicated the essentiality of extensive investigations to find a primary malignancy. Skin exam showed no primary source. The investigations were unable to find the primary malignancy. Given the results of immunohistochemical stains we recommended local perianal Paget’s disease resection. The intraoperative frozen section showed adenocarcinoma around the anal sphincter. Ten days later the patient underwent an abdominoperineal resection and the final pathology report showed extensive adenocarcinoma in three quadrants of the perianal area with focal involvement of the rectal mucosa. We recommended an adjuvant chemotherapy with FOLFOX following surgery given the bulkiness of the disease. We conclude that once perianal Paget’s disease is diagnosed, an extensive work-up should be done to find the underlying primary malignancy. Immunohistochemical stains are helpful in raising the suspicion of underlying primary malignancy

  4. Role of magnetic resonance imaging in the management of perianal Crohn's disease.

    Science.gov (United States)

    Gallego, Jose C; Echarri, Ana

    2018-02-01

    Perianal fistulas are a major problem in many patients with Crohn's disease. These are usually complex fistulas that adversely affect patients' quality of life, and their clinical management is difficult. Medical treatment sometimes achieves cessation of discharge and closure of the external opening; however, it is difficult to assess the status of the rest of the fistula tract. Magnetic resonance imaging is the method of choice with which to evaluate the condition of perianal fistulas and allows for assessment of the status of inaccessible areas. Magnetic resonance imaging also allows the clinician to evaluate other perianal manifestations of Crohn's disease that differ from the fistulas. This imaging technique is therefore a fundamental means of patient monitoring. When used in conjunction with assessment of the patient's morphological findings, it provides information that allows for both quantification of disease severity and evaluation of the response to treatment. New types of magnetic resonance sequences are emerging, such as diffusion, perfusion, and magnetisation transfer. These sequences may serve as biomarkers because they provide information reflecting the changes taking place at the molecular level. This will help to shape a new scenario in the early assessment of the response to treatments such as anti-tumour necrosis factor drugs. • MRI is the method of choice with which to evaluate perianal fistulas. • In perianal Crohn's disease, MRI is a fundamental means of patient monitoring. • The usefulness of the Van Assche score for patient monitoring remains unclear. • New MRI sequences' diffusion, perfusion, and magnetisation transfer may serve as biomarkers.

  5. Assessing the activity of perianal Crohn's disease: comparison of clinical indices and computer-assisted anal ultrasound.

    Science.gov (United States)

    Losco, Alessandra; Viganò, Chiara; Conte, Dario; Cesana, Bruno Mario; Basilisco, Guido

    2009-05-01

    Assessing perianal disease activity is important for the treatment and prognosis of Crohn's disease (CD) patients, but the diagnostic accuracy of the activity indices has not yet been established. The aim of this study was to determine the accuracy and agreement of the Fistula Drainage Assessment (FDA), Perianal Disease Activity Index (PDAI), and computer-assisted anal ultrasound imaging (AUS). Sixty-two consecutive patients with CD and perianal fistulae underwent clinical, FDA, PDAI, and AUS evaluation. Perianal disease was considered active in the presence of visible fistula drainage and/or signs of local inflammation (induration and pain at digital compression) upon clinical examination. The AUS images were analyzed by calculating the mean gray-scale tone of the lesion. The PDAI and gray-scale tone values discriminating active and inactive perianal disease were defined using receiver operating characteristics statistics. Perianal disease was active in 46 patients. The accuracy of the FDA was 87% (confidence interval [CI]: 76%-94%). A PDAI of >4 and a mean gray-scale tone value of 117 maximized sensitivity and specificity; their diagnostic accuracy was, respectively, 87% (CI: 76%-94%) and 81% (CI: 69%-90%). The agreement of the 3 evaluations was fair to moderate. The addition of AUS to the PDAI or FDA increased their diagnostic accuracy to respectively 95% and 98%. The diagnostic accuracy of the FDA, PDAI, and computer-assisted AUS imaging was good in assessing perianal disease activity in patients with CD. The agreement between the techniques was fair to moderate. Overall accuracy can be increased by combining the FDA or PDAI with AUS.

  6. Perianal Dermatitis.

    Science.gov (United States)

    Agulló-Pérez, Alfredo-Daniel; Hervella-Garcés, Marcos; Oscoz-Jaime, Saioa; Azcona-Rodríguez, Maialen; Larrea-García, Mónica; Yanguas-Bayona, Juan-Ignacio

    Perianal complaints are often consulted in dermatology clinics, and in many cases, a conclusive diagnosis is not easily made. The aim of this study was to study and identify the epidemiological, clinical, and contact allergy features of patients with perianal dermatitis who attended at a contact dermatitis unit in a tertiary hospital in Spain. Adult patients with long-lasting (>4 weeks) perianal dermatitis were recruited during the past 10 years for investigation and follow-up. Every patient underwent a diagnostic workup consisting of dermatological exploration and patch tests with the standard and specific series, as well as the patients' own products. General surgical exploration was also performed in some patients. One hundred twenty-four patients were included. The MOAHLFA index was as follows: 43.5, 0, 4.8, 11.3, 1.6, 8.1, and 75. The main final diagnoses were allergic contact dermatitis (32.3%), psoriasis (24.2%), irritant contact dermatitis (17.7%), and lichen simplex (neurodermatitis) (10%). Eighty-one patients (66.1%) showed 1 or more positive reactions, and in 52 patients (43%), positive reactions relevant to the present disease were found. Contact allergy in patients with long-lasting perianal complaints is frequent. It is mandatory for these patients to be referred to a dermatologist for an adequate evaluation and patch testing. Methylchloroisothiazolinone/methylisothiazolinone seems as the most common allergen implicated in perianal contact dermatitis.

  7. MRI predictors of treatment response for perianal fistulizing Crohn disease in children and young adults

    Energy Technology Data Exchange (ETDEWEB)

    Shenoy-Bhangle, Anuradha; Nimkin, Katherine; Gee, Michael S. [Massachusetts General Hospital for Children, Harvard Medical School, Department of Radiology, Boston, MA (United States); Goldner, Dana; Israel, Esther J. [Massachusetts General Hospital for Children, Harvard Medical School, Department of Pediatrics, Boston, MA (United States); Bradley, William F. [Analog Devices, Lyric Labs, Cambridge, MA (United States)

    2014-01-15

    Magnetic resonance imaging (MRI) is considered the imaging standard for diagnosis and characterization of perianal complications associated with Crohn disease in children and adults. To define MRI criteria that could act as potential predictors of treatment response in fistulizing Crohn disease in children, in order to guide more informed study interpretation. We performed a retrospective database query to identify all children and young adults with Crohn disease who underwent serial MRI studies for assessment of perianal symptoms between 2003 and 2010. We examined imaging features of perianal disease including fistula number, type and length, presence and size of associated abscess, and disease response/progression on follow-up MRI. We reviewed imaging studies and electronic medical records. Statistical analysis, including logistic regression, was performed to associate MR imaging features with treatment response and disease progression. We included 36 patients (22 male, 14 female; age range 8-21 years). Of these, 32 had a second MRI exam and 4 had clinical evidence of complete response, obviating the need for repeat imaging. Of the parameters analyzed, presence of abscess, type of fistula according to the Parks classification, and multiplicity were not predictors of treatment outcome. Maximum length of the dominant fistula and aggregate fistula length in the case of multiple fistulae were the best predictors of treatment outcome. Maximum fistula length <2.5 cm was a predictor of treatment response, while aggregate fistula length ≥2.5 cm was a predictor of disease progression. Perianal fistula length is an important imaging feature to assess on MRI of fistulizing Crohn disease. (orig.)

  8. MRI predictors of treatment response for perianal fistulizing Crohn disease in children and young adults

    International Nuclear Information System (INIS)

    Shenoy-Bhangle, Anuradha; Nimkin, Katherine; Gee, Michael S.; Goldner, Dana; Israel, Esther J.; Bradley, William F.

    2014-01-01

    Magnetic resonance imaging (MRI) is considered the imaging standard for diagnosis and characterization of perianal complications associated with Crohn disease in children and adults. To define MRI criteria that could act as potential predictors of treatment response in fistulizing Crohn disease in children, in order to guide more informed study interpretation. We performed a retrospective database query to identify all children and young adults with Crohn disease who underwent serial MRI studies for assessment of perianal symptoms between 2003 and 2010. We examined imaging features of perianal disease including fistula number, type and length, presence and size of associated abscess, and disease response/progression on follow-up MRI. We reviewed imaging studies and electronic medical records. Statistical analysis, including logistic regression, was performed to associate MR imaging features with treatment response and disease progression. We included 36 patients (22 male, 14 female; age range 8-21 years). Of these, 32 had a second MRI exam and 4 had clinical evidence of complete response, obviating the need for repeat imaging. Of the parameters analyzed, presence of abscess, type of fistula according to the Parks classification, and multiplicity were not predictors of treatment outcome. Maximum length of the dominant fistula and aggregate fistula length in the case of multiple fistulae were the best predictors of treatment outcome. Maximum fistula length <2.5 cm was a predictor of treatment response, while aggregate fistula length ≥2.5 cm was a predictor of disease progression. Perianal fistula length is an important imaging feature to assess on MRI of fistulizing Crohn disease. (orig.)

  9. Surgical Treatment of Perianal Fistulizing Crohn’s Disease: From Lay-Open to Cell-Based Therapy—An Overview

    Directory of Open Access Journals (Sweden)

    Gianluca Pellino

    2014-01-01

    Full Text Available Background. Perianal Crohn’s disease (CD can be challenging. Despite the high incidence of fistulizing CD, literature lacks clear guidelines. Several medical, surgical, and combined treatment modalities have been proposed, but evidences are scarce. Methods. We searched the literature to assess the facets of perianal CD, with particular focus on complex fistulae. Disease epidemiology, classification, diagnosis, activity scoring systems, and medical-surgical treatments were assessed. Results. Perianal fistulizing CD is common, frequently associated with upper gastrointestinal and colorectal CD. Complex fistulas often require repeated treatments. Continence is a major concern when dealing with repeated procedures. A prudent pathway is to resolve active sepsis and to limit damages, delaying a definitive treatment to the time when acute phase has been controlled. The improved diagnostic techniques allow better preoperative planning and are useful in monitoring the response to treatment. Besides newer devices, cell-based treatments are promising tools which have recently enriched the treatment portfolio. However, the need for proctectomy is still disturbingly high in CD patients with complex perianal fistulae. Conclusions. Perianal CD can impair quality of life and lead to need for proctectomy. A staged approach is reasonable. Treatment success can be improved by multimodal treatment and collaborative management by experienced gastroenterologists and surgeons.

  10. Temporary Fecal Diversion in the Management of Colorectal and Perianal Crohn’s Disease

    Directory of Open Access Journals (Sweden)

    Rudolf Mennigen

    2015-01-01

    Full Text Available Aim. To evaluate the results of temporary fecal diversion in colorectal and perianal Crohn’s disease. Method. We retrospectively identified 29 consecutive patients (14 females, 15 males; median age: 30.0 years, range: 18–76 undergoing temporary fecal diversion for colorectal (n=14, ileal (n=4, and/or perianal Crohn’s disease (n=22. Follow-up was in median 33.0 (3–103 months. Response to fecal diversion, rate of stoma reversal, and relapse rate after stoma reversal were recorded. Results. The response to temporary fecal diversion was complete remission in 4/29 (13.8%, partial remission in 12/29 (41.4%, no change in 7/29 (24.1%, and progress in 6/29 (20.7%. Stoma reversal was performed in 19 out of 25 patients (76% available for follow-up. Of these, the majority (15/19, 78.9% needed further surgical therapies for a relapse of the same pathology previously leading to temporary fecal diversion, including colorectal resections (10/19, 52.6% and creation of a definitive stoma (7/19, 36.8%. At the end of follow-up, only 4/25 patients (16% had a stable course without the need for further definitive surgery. Conclusion. Temporary fecal diversion can induce remission in otherwise refractory colorectal or perianal Crohn’s disease, but the chance of enduring remission after stoma reversal is low.

  11. Perianal Abscess

    Directory of Open Access Journals (Sweden)

    Luke Walls-Smith

    2018-01-01

    Full Text Available History of present illness: 31-year-old male with history of human immunodeficiency virus (HIV presented with complaints of pain and redness to the right inner buttock; vital signs were within normal limits. On exam, he had an 8 cm x 2.5 cm area of induration, fluctuance, erythema, and tenderness to the right buttock along the gluteal cleft. There was no induration, tenderness, or purulent drainage noted on rectal exam. Significant findings: Computed Tomography (CT of the Pelvis with intravenous (IV contrast revealed a 5.7 cm x 2.4 cm air-fluid collection in the right perianal soft tissue along the right gluteal cleft, with surrounding fat stranding, consistent with a perianal abscess with cellulitis. Discussion: Perianal abscess typically presents as severe pain in the anorectal area that is constant and unrelated to bowel movement. Physical exam signs include perianal erythema with an associated palpable, often fluctuant, mass.1 However, physical examination may not adequately differentiate between a perianal abscess and perirectal abscess.2 A pelvic CT with IV contrast can be used to differentiate between a perianal abscess, which is located beneath the skin of the anal canal and does not transverse the external sphincter, and a perirectal abscess, which is located beyond the external anal sphincter. Ultrasound is emerging as a possible alternative imaging modality; however magnetic resonance imaging (MRI and CT scans remain the modalities of choice. 3, 4, 5, 6 Recommended treatment for uncomplicated perianal abscesses is prompt drainage to avoid fistula formation, whereas complicated perirectal abscesses require a surgical consult.7 Patients younger than 40 and non-diabetics both have an increased risk (>2 and 2.69-fold, respectively of fistula formation and chronic perianal abscess.8 Antibiotics are recommended for patients at risk of future infection, but have not been shown to reduce the incidence of fistula formation.9

  12. Perianal hidradenoma papilliferum

    Directory of Open Access Journals (Sweden)

    Eduardo Rosetti Filho

    2018-01-01

    Full Text Available Hidradenoma papilliferum is a benign cystic tumor originated in apocrine sweat glands of the anogenital region. It is common in vulvar topography and rare in the perianal region. A well-documented case of a patient with slow-growing perianal nodulation without pain or other symptoms is reported. The histological study shows a hidradenoma papilliferum. The article reviews the topic and discusses the importance of the differential diagnosis of proctological conditions. A biopsy is mandatory in anal lesions of unusual presentation. Resumo: O hidradenoma papilífero é um tumor cístico benigno originado nas glândulas sudoríparas apócrinas da região anogenital, sendo comum em topografia vulvar e raro na região perianal. Relata-se um caso bem documentado de paciente com nodulação perianal de crescimento lento, sem dor ou outros sintomas, cujo estudo histológico revelou se tratar de hidradenoma papilífero. O artigo revisa o tema e discute a importância do diagnóstico diferencial das afecções proctológicas, sendo a biópsia obrigatória em lesões anais de apresentação não-usual. Keywords: Acrospiroma, Hidradenoma papilliferum, Anal canal, Perianal, Palavras-chave: Acrospiroma, Hidradenoma papilífero, Canal anal, Perianal

  13. Paracoccidioidomicosis perianal asociada a lepra lepromatosa: Presentación de un caso clínico Perianal paracoccidioidomycosis associated with lepromatous leprosy: A clinical case report

    Directory of Open Access Journals (Sweden)

    M A Reyes

    2008-06-01

    Full Text Available Se presenta el caso de un paciente alcoholista con una ulceración perianal y manifestaciones cutáneas de enfermedad de Hansen. La biopsia de la lesión perianal y otros estudios arribaron al diagnóstico de una forma diseminada de paracoccidioidomicosis, así como también las biopsias cutáneas y los estudios baciloscópicos fueron diagnósticos de lepra lepromatosa. La respuesta a la terapéutica fue satisfactoria con desaparición de las lesiones cutáneas. La disminución de la respuesta inmunológica celular genera un terreno propicio para la infección de estos gérmenes y al compartir área endémica la asociación entre ambas patologías puede ocurrir.Lepra and Paracoccidioidomycosis are endemic diseases in Argentina. We report a case of a patient with an unusual perianal ulceration and cutaneous manifestations of Hansen's disease. The biopsy of perianal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, as well as skin biopsy and baciloscopic finding diagnostic of Lepromatous Leprosy. The main portal of entry of paracoccidioides is the lung. Hematogenous dissemination of the fungus may occur at this time, with the establishment of metastatic foci in any organ. Anal and perianal lesions are present only in 1.3 to 2.4% of the patients. The pathogenesis of anal lesions remains unclear, it may be secondary from a systemic or a local disease. The patient response to the therapeutic was notable, with disappearance of lesions up to the third month of started itraconazole orally 400 mg/day leading just atrophy scars in perianal areas. The treatment of Hansen's disease was made according to OMS guidelines for multibacillary disease.

  14. Effect of childbirth on the course of Crohn's disease; results from a retrospective cohort study in the Netherlands

    Directory of Open Access Journals (Sweden)

    Albers Lisette

    2011-01-01

    Full Text Available Abstract Background Pregnant women with Crohn's disease needs proper counselling about the effect of pregnancy and childbirth on their disease. However, Literature about the effect of childbirth on Crohn's disease is limited. This study examined the effect of childbirth on the course of Crohn's disease and especially perianal Crohn's disease. Methods This is a retrospective cohort study which was performed in a tertiary level referral hospital in the Netherlands. From the IBD database, female patients aged 18-80 years in 2004 were selected. Data analysis took place in the years 2005 and 2006. Eventually, 114 women with at least one pregnancy after the diagnosis of Crohn's disease were eligible for the study. Differences between groups were analyzed using Wilcoxon Mann Whitney tests and Chi-square analysis with 2 × 2 or 2 × 3 contingency tables. Two-tailed values were used and p values Results 21/114 women (18% had active luminal disease prior to pregnancy, with significantly more pregnancy related complications compared to women with inactive luminal disease (Odds ratio 2.8; 95% CI 1.0 - 7.4. Caesarean section rate was relatively high (37/114, 32%, especially in patients with perianal disease prior to pregnancy compared to women without perianal disease (Odds ratio 4.6; 95% CI 1.8 - 11.4. Disease progression after childbirth was more frequent in patients with active luminal disease prior to pregnancy compared to inactive luminal disease (Odds ratio 9.7; 95% CI 2.1 - 44.3. Progression of perianal disease seems less frequent after vaginal delivery compared with caesarean section, in both women with prior perianal disease (18% vs. 31%, NS and without prior perianal disease (5% vs 14%, NS. There were no more fistula-related complications after childbirth in women with an episiotomy or second degree tear. Conclusion A relatively high rate of caesarean sections was observed in women with Crohn's disease, especially in women with perianal disease

  15. Perianal atypical leiomyoma: A case report.

    Science.gov (United States)

    Sun, Pingliang; Ou, Hailing; Huang, Shen; Wei, Longxiang; Zhang, Sen; Liu, Jiali; Geng, Shuguang; Yang, Kun

    2017-12-01

    Reports on perianal atypical leiomyoma, a perianal tumor, are rare. We confirmed a perianal atypical leiomyoma by its clinical presentation, magnetic resonance imaging findings, and immunohistochemistry. A 28-year-old female with a perianal mass found more than 4 years ago. The 5cm_4cm_4cm sized mass was located on the left side of the anus and vagina; The magnetic resonance imaging (MRI) scan revealed: A 4.1cm × 5.2cm × 4.9cm sized round mass was observed on the left side of the circumference. Perianal atypical leiomyoma. anal peripheral mass resection was performed under lumbar anesthesia. The postoperative course was uneventful, healing, the patient was discharged. Perianal atypical leiomyomas are benign tumors, but with the clinically atypical leiomyoma, it is sometimes difficult to distinguish between potential malignant smooth muscle tumors,and there may be malignant changes. Surgery should ensure complete resection, and to avoid postoperative recurrence, there should be a regular follow-up.

  16. Granular cell tumor on perianal region: a case report.

    Directory of Open Access Journals (Sweden)

    Kesici Ugur

    2013-07-01

    Full Text Available Granular cell tumor (GCT was first described by Abrikossoff in 1926. GCT is a rarely seen soft tissue tumor and is generally benign. While the tumor can be seen in all parts of the body it is generally located on the head and neck region, and especially on the tongue. GCT is rarely seen in the anal-perianal region. In accordance with literature this case was reported because it was thought to be the 27th anal-perianal located GCT case. In this case report, approximately 0,5-1 cm pedunculated polypoid lesion was determined in the perianal region during the physical examination of a 23 year old female patient who applied with palpable mass complaint in the perianal region. Lesion in the patient was totally excited with healthy skin-subcutaneous tissue under local anesthesia. A benign granular cell tumor was detected in the histopathological examination. Positive staining was monitored immunohistochemically with S-100 and neuron specific enolase (NSE. GCT is a rarely seen tumor in the anal-perianal region and its malign transformation rate is very low. Even lesions seen in the perianal region have clinically a benign appearance, a histopathological examination should be conducted and also GCT should be kept in mind during diagnosis. Malign-benign separation of these lesions is difficult so histopathological examination should be conducted with great care. Large local excision in the treatment provides curative treatment. But for those presenting malign transformation further examination must be performed for metastasis. After the treatment local recurrence and metastasis should be considered carefully. Prognosis of metastatic disease is very bad.

  17. [Perianal and rectal ulcers due to abuse of paracetamol-codeine suppositories].

    Science.gov (United States)

    Wagner, G; Sand, C; Sachse, M M

    2015-03-01

    A 61-year-old woman presented with a progressive perianal ulcer which had developed 4 months ago. Upon further examination, another ulcer of the rectum was detected. Anorectal malignancies, viral infections or primary inflammatory bowel disease were not found. It could be demonstrated that the ulcers were induced by paracetamol and codeine suppositories. After discontinuation of these suppositories, the perianal ulcers healed almost completely within 3 weeks. The pathogenesis of paracetamol-induced ulcers is unknown. However, dose-dependent vasoconstriction is a possible explanation.

  18. Magnetization transfer ratio for the assessment of perianal fistula activity in Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Pinson, C.; Dolores, M.; Cruypeninck, Y.; Koning, E.; Dacher, J.N.; Savoye-Collet, C. [Rouen University Hospital-Charles Nicolle, Department of Radiology, Rouen cedex (France); Savoye, G. [Rouen University Hospital-Charles Nicolle, Department of Gastroenterology, Rouen cedex (France)

    2017-01-15

    Assessment of perianal fistulas is important to guide management of Crohn's disease (CD). Our objectives were to analyze the feasibility of magnetization transfer (MT) imaging to assess fistulas and to evaluate its contribution in assessing disease activity. During 15 months, all patients referred for perianal fistulas in CD underwent 3T-MRI including diffusion, T2/T1-weighted gadolinium-enhanced sequences and MT sequences (one with an off-resonance saturation pulse of 800 and one with 1200 Hz). We collected Van Assche score, fistula activity signs by analyzing T2, diffusion and contrast enhancement. We calculated MT ratio (MTR) with a ROI in the largest fistula. Twenty-nine patients (mean 34.9 years, range 17-53) were included. Van Assche score was 11.7, range 4-21. In 22 patients, the fistula presented with a bright T2 and diffusion signal with contrast enhancement, and was characterized as active. Mean MTR was respectively 47.2 (range 12-68) and 34.3 (range 11-57) at 800 and 1200 Hz. MTR at 800 Hz was significantly lower in non-active (34, range 12-55) than in active fistulas (51, range 24-68) (p < 0.02). MTR is feasible for the assessment of fistulas in CD and in the future could be used to help identify active and non-active fistulas. (orig.)

  19. Endometriosis mimicking the perianal fistula tract: Case report

    Directory of Open Access Journals (Sweden)

    Gül Türkcü

    2014-09-01

    Full Text Available Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. Nowadays, in many cases, although routine use of episiotomy perineal endo metriosis is extremely rare. A 36 year old female patient was referred to our hospital with complaints of pain in the perianal region for five months. On physical examination, stiffness was palpated and then magnetic resonance im aging (MRI was performed. MRI is compatible with fistula tract. The lesion was excised and the histopathological appearance correspond to endometriosis. Perianal endo metriosis is rare in the perianal region and in the clinic mimicking perianal fistulas and malignancy should be kept in mind in the differential diagnosis

  20. Anoperineal disease in Hidradenitis suppurativa: MR imaging distinction from perianal Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Monnier, Louise; Amara, Nedjoua; Hoeffel, Christine [Hopital Maison Blanche, Department of Radiology, Reims (France); Dohan, Anthony [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Radiology, Paris (France); Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France); Zagdanski, Anne-Marie [Saint Louis Hospital, Department of Radiology, Paris (France); Drame, Moustapha [Hopital Robert Debre, Department of Statistics, Reims (France); Soyer, Philippe [Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France)

    2017-10-15

    To determine whether Hidradenitis suppurativa (HS)-related anoperineal disease can be distinguished from Crohn's disease (CD) using MRI. Pelvic MRI of 23 HS and 46 CD patients with anoperineal disease between 2007 and 2014 were independently analysed by two radiologists. For diagnosis of HS, sensitivity, specificity and positive likelihood ratios (LRs) of inflammatory features and of their anatomical distribution were calculated and compared to those of CD. In HS, fistulae were less present (P =.033) and less frequently involved the sphincters (P =.001) than in CD. Granulomas were more frequent (P =.0005). For anterior/inguinal and posterior localizations, sensitivity, specificity and LR for diagnosis of HS were 70% (49.1, 84.4), 87% (74.3, 93.9), 5.3 (2.41, 11.79) and 57% (36.8, 74.4), 93% (82.5, 97.8), 8.67 (2.74, 27.41), respectively. Combination of signs including posterior involvement, absence of rectal wall thickening and bilaterality of features yielded specificity of 100% (95% CI: 92.3-100) for HS. Although MRI presentations of anoperineal disease may overlap between CD and HS, specific diagnosis of HS is possible with a combination of three features: absence of features' predominance in perianal area, absence of rectal wall thickening and bilaterality of features. (orig.)

  1. Perianal nodular hidradenocarcinoma. Case report.

    Science.gov (United States)

    Sierra Montenegro, Ernesto; Sierra Luzuriaga, Gastón; Leone Stay, Gaetano; Salazar Menéndez, Vilma; Quiñonez Auria, Carlos

    2010-01-01

    Eccrine glands (sweat glands) appear in all sites of the skin and are more abundant in hands and feet. Nodular hidradenocarcinoma (NH) is a rare malignant and aggressive tumor of the eccrine glands. The objective of this study is to report a case of perianal hidradenocarcinoma. We present the case of a 75-year-old female with diabetes, hypertension, and hypothyroidism. Physical examination revealed a small perianal tumor that was palpated near the anal canal. Biopsy was done. Pathology report revealed perianal hidradenoma. Rectosigmoidoscopy was normal. Computed tomography showed 1-cm adenopathies in inguinal and right iliac regions. Extensive resection of the tumor was done. Definitive pathology report was malignant eccrine acrospiroma. The patient underwent adjuvant chemotherapy in the Oncology Service and died 1 month later. In patients with a first symptom of metastases in the inguinal region, suspicion must be directed to the anal canal.

  2. Incidence of fistula after management of perianal abscess

    Directory of Open Access Journals (Sweden)

    Riyadh Mohamad Hasan

    2016-10-01

    Full Text Available Background: Perianal fistula is among the most common anorectal diseases encountered in adults, men are more prone to be affected than women. There is a close relationship of abscess and fistula in etiology, anatomy, pathophysiology, therapy, complications and morbidity, it is appropriate to consider them as one entity. Aim of study: To determine the incidence of fistula formation and recurrent abscess in a sample of Iraqi patients in Baghdad and decide whether primary fistulotomy should be performed at the time of incision and drainage of perianal abscesses. Patients and methods: A retrospective study of 68 patients with perianal abscess operations conducted in Baghdad. They underwent incision and drainage under either local or general anesthesia at Al-Kindy Teaching Hospitals and private hospitals over a 15-year period from January 2000 to December 2015. Their ages ranged from 20 to 68 years (40.21 ± 1.34 males (63/68 (92.64% were more than females (5/68 (7.35%. Patients were treated with incision over the abscess under anesthesia and drainage of the abscess was done. The patients were followed up for an average 18 months (range 12–24 months after abscess drainage or until a fistula appeared and abscess recurrence. Results: The study group comprised of 68 (92.64% patients with perianal abscess with a median age 39 years (range 20–68 years. The mean follow-up period was identified to be 18 months (range 12–24 months. Males (63/68 (92.64% were more than females (5/68 (7.35%. The incidence of fistula formation after follow up, the patients with perianal abscess after incision and drainage was 31/68 (45.58% and males (30/31 (44.11% were more than females (1/31 (1.47%. The most common site was posterior then left lateral position. The percentage of patients with recurrent abscess n = 6 (8.82%were lower than fistula formation n = 31 (45.58%. The percentage of males n = 4/6 (5.88% were more than females 2/6 (2.94%. Conclusions: The

  3. Lemierre’s syndrome following perianal abscess: A case report

    Directory of Open Access Journals (Sweden)

    Qusai Aljarrah

    Full Text Available Introduction: Lemierre’s syndrome (LS is a rare and life-threatening condition characterized by suppurative thrombophlebitis of the internal jugular vein (IJV, and a history of head and neck (H&N sepsis. LS is usually caused by Fusobacterium necrophorum, which is part of the normal flora in the oro-pharynx, and the digestive and urogenital tracts. We here report the first case of LS following perianal sepsis. Presentation of case: A 60-year-old man with a painful left neck swelling, dysphagia and worsening sepsis was referred from a peripheral unit where he had an incision and drainage of a perianal abscess a week earlier. Urgent Doppler ultrasound and computed tomographic scans demonstrated suppurative thrombophlebitis of the left IJV, and the patient was subsequently commenced on intravenous Piperacillin/Tazobactam and heparin. The symptoms gradually improved, and the patient was eventually discharged on the 10th day. Discussion: Vigilant examination of the H&N region searching for a primary source is paramount, but LS following infections in the gastrointestinal or uro-genital tracts has also been described. A high index of suspicion is required for diagnosis, especially in patients with unresolving pharyngitis with a unilateral neck swelling, and septicaemia. Early resuscitation and treatment with broad-spectrum parenteral antimicrobials are important for favourable outcome. Conclusion: LS is well known to specialists in the H&N region, but other disciplines like general surgery, urology, or obstetrics and gynaecology might also rarely encounter the disease. We present a case of LS complicating a perianal abscess that was successfully treated with good outcome. Keywords: Lemierre’s syndrome, Thrombophlebitis, Internal jugular vein, Perianal abscess, Sepsis

  4. Mucinous adenocarcinoma arising from recurrent perianal fistula in patient with Crohn's disease: case report

    Directory of Open Access Journals (Sweden)

    Suelene Suassuna Silvestre de Alencar

    2014-07-01

    Full Text Available Introduction: Anal carcinoma is a rare variant of epithelial tumors of the anal canal. When associated with chronic and active anal fistulas, usually this is an aggressive cancer that has difficult diagnosis and poor prognosis. Anal fistulas are a common manifestation of Crohn's disease (CD. This study aims to report a case of mucinous adenocarcinoma originating from recurrent perianal fistula in patients with CD. Case report: A man of 43 years, with melanoderma, complaining of perianal tumors, anal pain and mucopurulent secretion, the patient was diagnosed with fistulae. Colonoscopy revealed a chronic inflammatory process associated with villous polypoid lesion in the colonic and rectal mucosa. In a new episode, where it was diagnosed, chronic colitis of rectum and sigmoid was being prescribed sulfasalazine with improvement. There were relapses and the patient underwent repeated fistulectomias. After investigation, CD was diagnosed. Computed tomography (CT of abdomen and pelvis showed multiple perineal and gluteal collections, and the patient underwent abdominoperineal resection of the rectum. Anatomopathological exam showed invasive mucinous adenocarcinoma. A new CT showed residual growth of the lesion. The patient was referred to the oncology referral service, where chemotherapy and radiotherapy were planned. The patient developed unfavorably, and his death occurred two months after treatment. Resumo: Introdução: Carcinoma anal é uma rara variante de tumores epiteliais do canal anal. Quando associado a fístulas anais crônicas e ativas, geralmente é um câncer agressivo que possui difícil diagnóstico e mau prognóstico. Fístulas anais são uma manifestação comum da doença de Crohn (DC. Este estudo tem como objetivo relatar um caso de adenocarcinoma mucinoso originado de fístula perianal recidivante em paciente com DC. Relato de caso: Homem de 43 anos, com melanoderma e queixas de tumorações na região perianal, dor anal e secre

  5. Carcinoma basocelular perianal: relato de caso e revisão da literatura Perianal basal cell carcinoma: case report and literature review

    Directory of Open Access Journals (Sweden)

    Daniel C. Damin

    2007-09-01

    Full Text Available O Carcinoma basocelular (CBC é a mais freqüente das neoplasias epiteliais, localizando-se preferencialmente em áreas expostas ao sol. A ocorrência deste tumor na região perianal é extremamente rara. Neste artigo, relatamos um caso de CBC perianal. Apresentamos também uma revisão da literatura médica sobre o tema, salientando as características clínicas e histopatológicas, bem como o tratamento preconizado para esse tipo de tumor.Basal Cell Carcinoma (BCC is the most common skin cancer. It is preferentially found in sun-exposed areas and it is extremely rare at perianal region. In this article, we report a case of perianal BCC. In addition, we present a review of the medical literature on this subject, outlining clinical and histologic characteristics of this type of tumor as well as the choices of treatment.

  6. The Clinical Features and Predictive Risk Factors for Reoperation in Patients With Perianal Crohn Diseases; A Multi-Center Study of a Korean Inflammatory Bowel Disease Study Group

    Science.gov (United States)

    Lee, Jae Bum; Yoon, Seo-Gue; Park, Kyu Joo; Lee, Kang Young; Kim, Dae Dong; Yoon, Sang Nam

    2015-01-01

    Purpose Perianal lesions are common in Crohn disease, but their clinical course is unpredictable. Nevertheless, predicting the clinical course after surgery for perianal Crohn disease (PCD) is important because repeated operations may decrease patient's quality of life. The aim of this study was to predict the risk of reoperation in patients with PCD. Methods From September 1994 to February 2010, 377 patients with PCD were recruited in twelve major tertiary university-affiliated hospitals and two specialized colorectal hospitals in Korea. Data on the patient's demographics, clinical features, and surgical outcomes were analyzed. Results Among 377 patients, 227 patients were ultimately included in the study. Among the 227 patients, 64 patients underwent at least one reoperation. The median period of reoperation following the first perianal surgery was 94 months. Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively. In multivariate analysis (Cox-regression hazard model), reoperation was significantly correlated with an age of onset less than 20 years (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.07-3.48; P = 0.03), history of abdominal surgery (HR, 1.99; 95% CI, 1.08-3.64; P = 0.03), and the type of surgery. Among types of surgery, fistulotomy or fistulectomy was associated with a decreased incidence of reoperation in comparison with incision and drainage (HR, 0.19; 95% CI, 0.09-0.42; P < 0.001). Conclusion Young age of onset and a history of abdominal surgery were associated with a high risk of reoperation for PCD, and the risk of reoperation were relatively low in fistulotomy or fistulectomy procedures. PMID:26576395

  7. Modern Treatments and Stem Cell Therapies for Perianal Crohn’s Fistulas

    Directory of Open Access Journals (Sweden)

    Alghalya Khalid Sulaiman Al-Maawali

    2016-01-01

    Full Text Available Crohn’s disease (CD is a complex disorder with important incidence in North America. Perianal fistulas occur in about 20% of patients with CD and are almost always classified as complex fistulas. Conventional treatment options have shown different success rates, yet there are data indicating that these approaches cannot achieve total cure and may not improve quality of life of these patients. Fibrin glue, fistula plug, topical tacrolimus, local injection of infliximab, and use of hematopoietic stem cells (HSC and mesenchymal stem cells (MSC are newly suggested therapies with variable success rates. Here, we aim to review these novel therapies for the treatment of complex fistulizing CD. Although initial results are promising, randomized studies are needed to prove efficacy of these approaches in curing fistulizing perianal CD.

  8. Perianal Ulcer and Diabetes Insipidus: A Rare Presentation of Langerhans Cell Histiocytosis in an Adult Male

    Directory of Open Access Journals (Sweden)

    Ng Chong Beng

    2017-07-01

    Full Text Available Langerhans cell histiocytosis (LCH, previously known as Histiocystosis X, is a rare idiopathic disease caused by a build-up of langerhan cells in the body. LCH has a heterogenous form of clinical presentation and presents with varying degree of severity. The severity often depends on the disease burden. LCH can manifest as a unifocal disease, multifocal-unisystem or multifocal-multisystem disease with the latter being more fatal than the rest. Risk organ involvement confers a grim prognosis. Perianal lesions are extremely rare skin manifestation of LCH with only few cases reported in the past. Vinca-alkaloids and steroid therapy have been shown to be effective in a large percentage of those presenting with LCH. This case report highlights the diagnosis and management of LCH presenting as a painful perianal ulcer in the background of newly diagnosed diabetes insipidus.

  9. MRI in evaluation of perianal fistulae

    International Nuclear Information System (INIS)

    Sofic, Amela; Beslic, Serif; Sehovic, Nedzad; Caluk, Jasmin; Sofic, Damir

    2010-01-01

    Fistula is considered to be any abnormal passage which connects two epithelial surfaces. Parks’ fistulae classification demonstrates the biggest practical significance and divides fistulae into: intersphincteric, transsphincteric, suprasphincteric and extrasphincteric. Etiology of perianal fistulae is most commonly linked with the inflammation of anal glands in Crohn’s disease, tuberculosis, pelvic infections, pelvic malignant tumours, and with the radiotherapy. Diagnostic method options are: RTG fistulography, CT fistulography and magnetic resonance imaging (MRI) of pelvic organs. We have included 24 patients with perirectal fistulae in the prospective study. X-rays fistulography, CT fistulography, and then MRI of the pelvic cavity have been performed on all patients. Accuracy of each procedure in regards to the patients and the etiologic cause have been statistically determined. 29.16% of transphincteric fistulae have been found, followed by 25% of intersphincteric, 25% of recto-vaginal, 12.5% of extrasphincteric, and 8.33% of suprasphincteric. Abscess collections have been found in 16.6% patients. The most frequent etiologic cause of perianal fistulae was Crohn’s disease in 37.5%, where the accuracy of classification of MRI was 100%, CT was 11% and X-rays 0%. Ulcerous colitis was the second cause, with 20.9% where the accuracy of MRI was 100%, while CT was 80% and X-rays was 0%. All other etiologic causes of fistulae were found in 41.6% patients. MRI is a reliable diagnostic modality in the classification of perirectal fistulae and can be an excellent diagnostic guide for successful surgical interventions with the aim to reduce the number of recurrences. Its advantage is that fistulae and abscess are visible without the need to apply any contrast medium

  10. Leiomioma perianal. Reporte de un caso

    Directory of Open Access Journals (Sweden)

    Yorlenis C Uzcátegui R

    2014-09-01

    Full Text Available Los leiomiomas perianales son tumoraciones derivadas de células mesenquimales distribuidas por todo el cuerpo. Histológicamente se han clasificado en tres subtipos: vascular, no vascular y epiteloide. El subtipo vascular puede ser sólido, cavernoso o venoso. Los leiomiomas son raros en adultos, con incidencia de 0,1 %, generalmente se presentan entre la cuarta a sexta década de la vida con predominio en mujeres en caso de ser benignos. La forma de presentación más frecuente es un nódulo palpable, próximo al ano e indoloro. El diagnóstico se realiza según criterios histológicos e inmunohistoquímicos, además son útiles la ecografía endoanal y RMN. La exéresis es la primera opción terapéutica. Se presenta caso de paciente femenino de 41 años de edad, quien consulta por presentar nódulo palpable perianal derecho, con dolor a la palpación, de ocho meses de evolución, con valores normales de marcadores tumorales, el ultrasonido revela a nivel perianal derecho imagen sólida, hipocrómica (con tejido lineal fibroso, mide 4.82x 6.7x 6.87cm, la RMN muestra lesión ocupante de espacio en la misma ubicación, Doppler Color sin vascularización. Se efectuó exéresis de leiomioma en fosa isquiorectal derecha de 4x6 cm. El estudio anatomopatológico reportó leiomioma perianal subtipo epitelial. En el presente estudio se reporta un caso muy poco frecuente de leiomioma perianal doloroso, exponiendo las características clínicas e histológicas del mismo

  11. Surgical approach to extensive hidradenitis suppurativa in the perineal/perianal and gluteal regions.

    Science.gov (United States)

    Balik, Emre; Eren, Tunc; Bulut, Türker; Büyükuncu, Yilmaz; Bugra, Dursun; Yamaner, Sümer

    2009-03-01

    Verneuil's disease, or hidradenitis suppurativa, is a chronic suppurative disease with a tendency to sinus formation, fibrosis, and sclerosis. It is a disease of the apocrine sweat glands and may arise from each of the localizations where apocrine glands are prominent: axilla, nipples, umbilicus, perineum, groin, and buttocks. Extensive hidradenitis suppurativa of the perineal/perianal and the gluteal regions constitute a serious social problem. In this study, we present our experience with stage III extensive hidradenitis suppurativa cases, including our treatment methods and patient outcomes. A retrospective review of the medical records from January 1990 to July 2003 of 15 patients was performed. Fifteen patients underwent treatment for extensive hidradenitis suppurativa in the gluteal, perineal/perianal, and inguinal areas with total surgical excision. All patients were men (100%) and their mean age was 42.5 (range, 23-66) years. The patients underwent a total number of 21 operations. In 11 patients wounds were left open for secondary healing, and the mean time for complete wound healing in this group was 12.2 (range, 9.5-22) weeks. Two patients underwent primary wound closure by the application of rotation flaps, and their complete healing times were observed to be approximately 2 weeks. Delayed skin grafting was used for the remaining two patients in whom the wounds had been left open after the initial operation. In this group, complete wound healing took a total of 8 weeks. Only one diverting colostomy was needed in a patient in the delayed skin-grafting group. Squamous cell carcinoma was diagnosed in the specimens of one patient treated with total excision followed by the application of a rotation flap. This patient had had complaints of gluteal discharge for approximately 30 years. The cancer recurred after 6 months in the perianal region and immediate abdominoperineal resection was performed. He died during the second postoperative month due to systemic

  12. Multimodal treatment of perianal fistulas in Crohn's disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial.

    LENUS (Irish Health Repository)

    de Groof, E Joline

    2015-08-20

    Currently there is no guideline for the treatment of patients with Crohn\\'s disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs.

  13. Lesion mimicking perianal abscess in an immunocompromised patient: Report of a case

    Directory of Open Access Journals (Sweden)

    Aranzazu Calero-Lillo

    2014-01-01

    CONCLUSION: Intramuscular administration of drugs should be avoided in patients with thrombocytopenia. Gluteal region is connected to perianal area through the sciatic notch. Usually perianal abscess in immunocompromised patients arise from proctologic origin, but other causes may be taken into account.

  14. An Unusual Presentation of Lung Cancer Metastasis: Perianal Abscess

    Directory of Open Access Journals (Sweden)

    Murat Kilic

    2014-06-01

    Full Text Available Lung cancer is one of the most commonly diagnosed cancers in both men and women. Although the most frequent sites of distant metastasis of lung cancers are the pleura, liver, adrenal glands, skeletal system and brain, perianal region has been rarely reported as a metastasis site. A male patient was admitted to our emergency room with a long standing perianal abscess. During abscess drainage, a mass was noticed at the base of the abscess pouch, and thus a biopsy was taken. Pathologically, it was reported as a metastasis of squamous cell carcinoma, therefore some radiological  investigations and endoscopic procedures were performed to determine the primary focus of cancer. A pulmonary mass was revealed in PET/CT, and was considered as primary tumor. Both primary and metastatic perianal tumors can be rarely presented as an abscess formation. In this situation, a biopsy should be performed from the lesion to avoid misdiagnosis.

  15. An Unusual Presentation of Lung Cancer Metastasis: Perianal Abscess

    OpenAIRE

    Murat Kilic

    2014-01-01

    Lung cancer is one of the most commonly diagnosed cancers in both men and women. Although the most frequent sites of distant metastasis of lung cancers are the pleura, liver, adrenal glands, skeletal system and brain, perianal region has been rarely reported as a metastasis site. A male patient was admitted to our emergency room with a long standing perianal abscess. During abscess drainage, a mass was noticed at the base of the abscess pouch, and thus a biopsy was taken. Pathologically, it w...

  16. The operative management of children with complex perianal Crohn's disease.

    Science.gov (United States)

    Seemann, Natashia M; King, Sebastian K; Elkadri, Abdul; Walters, Thomas; Fish, Joel; Langer, Jacob C

    2016-12-01

    Perianal Crohn's disease (PCD) can affect both quality of life and psychological wellbeing. A subset of pediatric patients with complex PCD require surgical intervention, although appropriate timing and treatment regimens remain unclear. This study aimed to describe a large pediatric cohort in a tertiary center to determine the range of surgical management in children with complex PCD. A retrospective review of children requiring operative intervention for PCD over 13 years (2002-2014) was performed. PCD was divided into simple and complex based on the type of surgical procedure, and the two groups were compared. The 57 children were divided into two groups: the simple group (N=43) underwent abscess drainage ± seton insertion alone, and the complex group (N=14) underwent loop ileostomy ± more extensive surgery. In the complex group, females were more predominant (57% of complex vs 30% of simple), and the average age at diagnosis was lower. Anti-TNF therapy was utilized in 79.1% of simple and 100% of complex PCD. All 14 complex patients underwent a defunctioning ileostomy, with 7 requiring further operations (subtotal colectomy=4, proctocolectomy ± anal sparing=5, plastic surgery reconstruction with perineal flap/graft=4). Complex PCD represents a small but challenging subset of patients in which major surgical intervention may be necessary to alleviate the symptoms of this debilitating condition. retrospective case study with no control group - level IV. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Usefulness of magnetic resonance in the evaluation of perianal fistulas

    International Nuclear Information System (INIS)

    Campo, M.; Isusi, M.; Oleaga, L.; Grande, D.; Fernandez, G.; Tardaguila, F.

    2003-01-01

    Our aim was to confirm the usefulness of magnetic resonance in the evaluation of perianal fistulas, and in conjunction with a thought anatomical review of affected areas. This would allow for the building of a proper surgical plan, which would necessarily differ according to the fistula's complexity. We studied 75 patients with perianal fistulas and performed 81 MR studies by means of axial, sagittal and coronal T1 and T2 sequences. Fistula type, degree, etiology and correlation to surgical findings were all studied. Fifty-five patients underwent surgical treatment, and 26 underwent a more conservative treatment with MR follow-up. Ninety-nine fistulas were observed and classified according to norms set down by St. James University Hospital. Of the 55 cases submitted to surgery, 46 showed concordance between the surgical report and MR, whose sensitivity was 84%. In 9 patients, there was no correlation. In the study of perianal fistulas, it is important to establish both the fistulous tract and relationship to the sphincter complex. MR permits an identification of the sprinter complex and a more precise anatomical localization of the fistulous trajectory. It is also capable of differentiating between fibrosis and abscess. Therefore, MR is an appropriate technique for the study of perianal fistulas and related surgical planning. (Author) 6 refs

  18. An open prospective study evaluating efficacy and safety of a new medical device for rectal application of activated carbon in the treatment of chronic, uncomplicated perianal fistulas

    DEFF Research Database (Denmark)

    Zawadzki, Antoni; Johnson, Louis Banka; Bohe, Måns

    2017-01-01

    PURPOSE: It has been proposed that biological/chemical substances in the intestine might play a role in the occurrence and deterioration of perianal fistulas. Elimination of such unidentified factors from the lower gastrointestinal tract might offer a new strategy for the management of anal...... fistulas. The aim of this study was to evaluate the clinical effects on non-Crohn's disease perianal fistula healing, and the safety and tolerability of a new medical device that applies high-purity, high-activity granular activated carbon locally into the rectum twice daily of patients with perianal...... fistulas without any concomitant medication. METHODS: An open, single-arm, prospective study with active treatment for 8 weeks and an optional follow-up until week 24 ( ClinicalTrial.gov identifier NCT01462747) among patients with chronic, uncomplicated perianal fistulas scheduled for surgery was conducted...

  19. Sensitivity of perianal tape impressions to diagnose pinworm (Syphacia spp.) infections in rats (Rattus norvegicus) and mice (Mus musculus).

    Science.gov (United States)

    Hill, William Allen; Randolph, Mildred M; Mandrell, Timothy D

    2009-07-01

    We determined the sensitivity of perianal tape impressions to detect Syphacia spp. in rats and mice. We evaluated 300 rat and 200 mouse perianal impressions over 9 wk. Pinworm-positive perianal tape impressions from animals with worm burdens at necropsy were considered as true positives. Conversely, pinworm-negative perianal tape impressions from animals with worm burdens were considered false negatives. The sensitivity of perianal tape impressions for detecting Syphacia muris infections in rats was 100%, and for detecting Syphacia obvelata in mice was 85.5%. Intermittent shedding of Syphacia obvelata ova is the most probable explanation for the decreased sensitivity rate we observed in mice. We urge caution in use of perianal tape impressions alone for Syphacia spp. screening in sentinel mice and rats.

  20. Perianal pain as a presentation of lumbosacral neurofibroma: a case report.

    Science.gov (United States)

    Moghaddasi, Mehdi; Aghaii, Mahboubeh; Mamarabadi, Mansoureh

    2014-12-01

    Rectal and perianal pain is a common problem. Most people have experienced it at least once in their lifetime. It usually manifests as mild discomfort, but sometimes the pain can be so severe that it is incapacitating. A 59-year-old woman admitted with a 2-year history of paroxysmal perianal pain underwent a full work-up including proctoscopy, sigmoidoscopy, full colonoscopy, and barium enema that were unremarkable. Lumbosacral magnetic resonance imaging with and without gadolinium showed an intradural-extramedullary lesion at the level of L5. The pathologic diagnosis was a neurofibroma. She underwent surgery, and after a few weeks she felt well and medication was no longer needed for her paroxysmal pain. Although one should consider the usual causes of colorectal pain such as hemorrhoids, anal fissure, proctalgia fugax, and chronic perianal pain syndrome, we should keep in mind that some referral pain may mimic local pathologies and should be evaluated properly.

  1. Rectal duplication cyst presenting as perianal sepsis: report of two cases and review of the literature.

    Science.gov (United States)

    Flint, Richard; Strang, Jane; Bissett, Ian; Clark, Matthew; Neill, Mischel; Parry, Bryan

    2004-12-01

    Recurrent perianal sepsis is a difficult problem to manage in colorectal surgical practice. One cause is rectal duplication cyst, a rare congenital lesion that is easily overlooked. Many cases have associated congenital defects, especially musculoskeletal anomalies, and may provide a clue to the underlying condition. Early diagnosis is important because these cysts do not resolve spontaneously and may undergo malignant change. We present two cases of middle-aged females who presented with perianal sepsis secondary to rectal duplication cyst. The first case had numerous surgical procedures for a perianal fistula during a ten-year period. She had associated sacral anomalies consistent with Currarino syndrome. The second case presented with a perineal mass after a bout of perianal inflammation. Both cases had the entire cyst surgically excised. There were no complications postoperatively and no recurrence at follow-up. Histopathology revealed no malignancy in the cyst. Rectal duplication cyst is a rare cause of recurrent perianal sepsis that should be considered in difficult cases, especially in those with associated musculoskeletal anomalies. Complete surgical excision is the preferred treatment to prevent recurrence and the risk of malignant degeneration.

  2. Normal anatomy of the anal wall and perianal spaces: An EUS, MRI and cadaveric correlative study

    International Nuclear Information System (INIS)

    Chung, Soo Young; Ryu, Sie Tae; Park, Ki Soon; Lee, Yul; Bae, Sang Hoon; Kang, Heung Sik

    1994-01-01

    To understand the normal endosonographic anatomy of the perianal spaces, and to evaluate the diagnostic efficacy and limitation of endorectal sonography(EUS), correlative study with MRI, cadaveric sectional image and cadaveric MRI were performed. EUS images of the normal 6 perianal spaces (pelvirectal, ischiorectal, intersphincteric, subcutaneous, central, submucous space) which were bounded by internal and external anal sphincters, rectal wall and levator ani muscle were correlated with MRI in 10 normal persons, cadaveric sectional images and cadaveric MRI in 2 cadavers. Pelvirectal space located superior to levator ani muscle could be demonstrable only on anterior wall scan but could not be visualized on lateral or posterior wall scan on EUS. Five perianal spaces located inferior to levator ani muscle were well seen on anterior, lateral, and posterior wall EUS. MRI was superior to EUS in the evaluation of pelvirectal and ischiorectal spaces but equal or inferior to EUS in the evaluation of intersphincteric, subcutaneous, central and submucous spaces. EUS was valuable in the evaluation of perianal spaces inferior to levator ani muscle but was limited in the evaluation of perianal spaces superior to levator ani muscle

  3. Colostomy for Perianal Sepsis With Ecthyma Gangrenosum in Immunocompromised Children.

    Science.gov (United States)

    Vuille-dit-Bille, Raphael N; Berger, Christoph; Meuli, Martin; Grotzer, Michael A

    2016-01-01

    Perianal sepsis with ecthyma gangrenosum is a severe and potentially mutilating complication in immunocompromised children. Therapies include antimicrobial treatment, incision and drainage, generous tissue debridement, and skin transplantation. We describe 3 children with acute lymphoblastic leukemia having sepsis with Pseudomonas aeruginosa in febrile neutropenia and severe perianal infections treated relatively early with a protective colostomy. Indications for colostomy were nonhealing wounds, and ceaseless pain. All patients showed a rapid reduction of pain. Complete wound healing was seen in 2 patients, and considerable pain reduction and increased quality of life were seen in a third patient during palliative care. These results suggest that a protective colostomy should be considered early in the management of immunocompromised children with ecthyma gangrenosum.

  4. Mucinous Adenocarcinoma Arising in Chronic Perianal Fistula: Good Results with Neoadjuvant Chemoradiotherapy Followed by Surgery

    Directory of Open Access Journals (Sweden)

    Marisa D. Santos

    2014-01-01

    Full Text Available Chronic perianal fistulas are a common clinical condition. However, their evolution to adenocarcinoma is rare. We report the case of a 48-year-old man with perianal chronic fistulas, who developed two perianal ulcerated lesions near the external orifices of the fistulas, which extended proximally as a pararectal tumor. No intestinal lesion was seen at endoscopic examination. Histopathological biopsy indicated mucinous adenocarcinoma. Staging was performed by pelvic magnetic resonance imaging (MRI and thoracoabdominal CT scan. The patient underwent a laparoscopic colostomy followed by neoadjuvant chemoradiotherapy and then laparoscopic abdominoperineal resection followed by adjuvant therapy. We have seen a favorable outcome with no recurrence at 3 years of follow-up.

  5. Management of acute perianal sepsis in neutropenic patients with hematological malignancy.

    Science.gov (United States)

    Baker, B; Al-Salman, M; Daoud, F

    2014-04-01

    In neutropenic patients with acute perianal sepsis in the setting of hematological malignancy, the classical clinical features of abscess formation are lacking. Additionally, the role of surgical intervention is not well established. In this review, we discuss the challenges and controversy regarding diagnosis and optimal management when clear surgical guidelines are absent. In the literature, there is great diversity in the surgical approach to these patients, which leads to a high percentage of diagnostic errors, risks of complications, and unnecessary interventions. We review the literature and assess whether surgical intervention produces better outcomes than a non-surgical approach. Studies published on perianal sepsis in neutropenic cancer patients were identified by searching PubMed using the following key words: "perianal sepsis/abscesses, anorectal sepsis/abscess, neutropenia, hematological malignancy, cancer". No randomized or prospective studies on the management of acute perianal sepsis in hematological malignancies were found. The largest retrospective study and most comprehensive clinical data demonstrated that 42% of patients were treated successfully without surgical intervention and without morbidity or mortality related to treatment chosen. Small retrospective studies advocated surgical intervention, while the majority of successes were in a non-operative treatment. It is difficult to formulate a conclusion given the small retrospective series on management of neutropenic patients with hematological malignancies. While there is no evidence mandating a routine surgical approach in this category of patients, non-surgical management including careful follow-up to determine whether the patient's condition is deteriorating or treatment has failed is an acceptable approach in selected patients without pathognomonic features of abscess. Comprehensive and well-designed prospective studies are needed to firmly establish the guidelines of treatment

  6. Efficacy of Argentum-Quartz Solution in the Treatment of Perianal Fistulas: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Tomasello Giovanni

    2015-12-01

    Full Text Available Abstract Background: Nowadays, an optimal and effective medical surgery remains the gold standard for perianal fistulas. Hereby we reported preliminary results in favor of using Argentum-quartz solution for both primary and recurrent perianal fistulas. Methods: Three patients with intersphincteric and extrasphincteric fistulas were enrolled. Argentum-quartz solution was administrated twice a week for a period of 4 weeks, followed by a pause of 8 days and then another 4 weeks of treatment, totally 16 administrations. After treatment, all patients were monitored for a 4-month follow-up. Results: Complete closures of 2 extrasphincteric fistulas and a partial closure with absence of inflammation and superative phenomena in the intrasphincteric fistula were both manifested. Conclusion: Selective treatment of perianal fistulas with an argentum-quartz solution is safe and effective, and may represent a reliable alternative.

  7. Development of perianal ulcer as a result of acute fulminant amoebic colitis.

    Science.gov (United States)

    Torigoe, Takayuki; Nakayama, Yoshifumi; Yamaguchi, Koji

    2012-09-14

    We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS). The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy administered at another hospital. On admission, we observed a giant ulcer in the perianal region. At first, cytomegalovirus colitis was suspected by blood investigations. Ganciclovir therapy was initiated; however, the patient developed necrosis of the skin around the anus during therapy. We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion. Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae, indicating a final diagnosis of acute fulminant amoebic colitis. The patient's postoperative course was favorable, and proctectomy of the residual rectum was performed 11 mo later. Amoebic colitis is one of the most severe complications affecting patients with AIDS. Particularly, acute fulminant amoebic colitis may result in a poor prognosis; therefore, staged surgical therapy as a less invasive procedure should be considered as one of the treatment options for these patients.

  8. Recurrent Perianal Sinus in Young Girl Due To Pre‑sacral ...

    African Journals Online (AJOL)

    A young girl presented in our outpatient department with pus discharging from perianal sinus for the past 2 years. In addition, she was also having continuous dull pain in the lower abdomen along with constipation. Two years back, she was operated for this problem with misdiagnosis as fistula‑in‑ano. After 1 year period of ...

  9. An unusual case of adult-onset multi-systemic Langerhans cell histiocytosis with perianal and incident thyroid involvement

    Directory of Open Access Journals (Sweden)

    Ozen Oz Gul

    2017-02-01

    Full Text Available Langerhans cell histiocytosis (LCH is a rare sporadic disease characterized by histiocytic neoplastic infiltration of various organ systems and a wide spectrum of clinical manifestations, ranging from benign and self-limiting to lethal. Herein, we report a rare case of adult-onset multi-systemic LCH in a 36-year-old male patient with an initial perianal presentation and incidental finding of subsequent thyroid gland involvement in the follow-up period. The patient with a history of perianal LCH treated with surgical excision and local radiotherapy was referred to our Endocrinology Department upon detection of hypermetabolic nodular lesions in the left lateral lobe of thyroid gland on positron emission tomography–computed tomography (PET/CT scan in the nineth month of follow-up. Current evaluation revealed euthyroid status, a hypoechoic solid lesion of 13 × 9 mm in size with irregular borders in the left thyroid lobe on thyroid USG and cytologic assessment of thyroid nodule. The patient was diagnosed with suspected, oncocytic lesion, Hashimoto thyroiditis or LCH. The patient underwent total thyroidectomy and pathological assessment confirmed the diagnosis of Langerhans cell histiocytosis. Assessments in the sixth month of postoperative follow-up revealed euthyroid status with no thyroid tissue remnants or pathological lymph node on thyroid USG. In view of the multifocal lesions indicating multi-system disease, a systemic chemotherapy protocol with combination of prednisone (PRED and vinblastine (VBL has been planned by the hematology department.

  10. Malignant melanoma arising from a perianal fistula and harbouring a BRAF gene mutation: a case report

    International Nuclear Information System (INIS)

    Martinez-Cadenas, Conrado; Lozoya, Rafael; Boldó, Enrique; Bosch, Nuria; Peñas, Lucas; Flores-Couce, Esther; Ochoa, Enrique; Munárriz, Javier; Aracil, Juan P; Tajahuerce, Marcos; Royo, Ramón

    2011-01-01

    Melanoma of the anal region is a very uncommon disease, accounting for only 0.2-0.3% of all melanoma cases. Mutations of the BRAF gene are usually absent in melanomas occurring in this region as well as in other sun-protected regions. The development of a tumour in a longstanding perianal fistula is also extremely rare. More frequent is the case of a tumour presenting as a fistula, that is, the fistula being a consequence of the cancerous process, although we have found only two cases of fistula-generating melanomas reported in the literature. Here we report the case of a 38-year-old male who presented with a perianal fistula of four years of evolution. Histopathological examination of the fistulous tract confirmed the presence of malignant melanoma. Due to the small size and the central location of the melanoma inside the fistulous tract, we believe the melanoma reported here developed in the epithelium of the fistula once the latter was already formed. Resected sentinel lymph nodes were negative and the patient, after going through a wide local excision, remains disease-free nine years after diagnosis. DNA obtained from melanoma tissue was analysed by automated direct sequencing and the V600E (T1799A) mutation was detected in exon 15 of the BRAF gene. Since fistulae experience persistent inflammation, the fact that this melanoma harbours a BRAF mutation strengthens the view that oxidative stress caused by inflammatory processes plays an important role in the genesis of BRAF gene mutations

  11. Malignant melanoma arising from a perianal fistula and harbouring a BRAF gene mutation: a case report

    Directory of Open Access Journals (Sweden)

    Tajahuerce Marcos

    2011-08-01

    Full Text Available Abstract Background Melanoma of the anal region is a very uncommon disease, accounting for only 0.2-0.3% of all melanoma cases. Mutations of the BRAF gene are usually absent in melanomas occurring in this region as well as in other sun-protected regions. The development of a tumour in a longstanding perianal fistula is also extremely rare. More frequent is the case of a tumour presenting as a fistula, that is, the fistula being a consequence of the cancerous process, although we have found only two cases of fistula-generating melanomas reported in the literature. Case Presentation Here we report the case of a 38-year-old male who presented with a perianal fistula of four years of evolution. Histopathological examination of the fistulous tract confirmed the presence of malignant melanoma. Due to the small size and the central location of the melanoma inside the fistulous tract, we believe the melanoma reported here developed in the epithelium of the fistula once the latter was already formed. Resected sentinel lymph nodes were negative and the patient, after going through a wide local excision, remains disease-free nine years after diagnosis. DNA obtained from melanoma tissue was analysed by automated direct sequencing and the V600E (T1799A mutation was detected in exon 15 of the BRAF gene. Conclusion Since fistulae experience persistent inflammation, the fact that this melanoma harbours a BRAF mutation strengthens the view that oxidative stress caused by inflammatory processes plays an important role in the genesis of BRAF gene mutations.

  12. A Rare Case of Anal and Perianal Chemical Burn in a Child due to Potassium Permanganate Crystals.

    Science.gov (United States)

    Dash, Suvashis; Bhojani, Jatin; Sharma, Sharadendu

    2018-02-09

    Many chemicals used as medical treatments can cause chemical burns as an untoward side effect. One of such chemicals is potassium permanganate. It is a caustic chemical used as a disinfectant. The most common sites of burn by potassium permanganate are exposed sites like the face and hands. Chemical burns in the perianal and anal region are rare in clinical practice and even sparser in the pediatric age group. In this article, we report a case of perianal and anal chemical burn in an 18-month-old, male child, caused by potassium permanganate crystal applied wrongly for the treatment of pinworm infestation. As a chemical burn in this region can have serious complications, it is necessary to be vigilant when using such chemicals in these cases. Early and timely management in such cases leads to good outcomes. This is the first of such cases of chemical burn caused by potassium permanganate in the anal and perianal region.

  13. The NOD2 Single Nucleotide Polymorphism rs72796353 (IVS4+10 A>C) Is a Predictor for Perianal Fistulas in Patients with Crohn's Disease in the Absence of Other NOD2 Mutations.

    Science.gov (United States)

    Schnitzler, Fabian; Friedrich, Matthias; Wolf, Christiane; Stallhofer, Johannes; Angelberger, Marianne; Diegelmann, Julia; Olszak, Torsten; Tillack, Cornelia; Beigel, Florian; Göke, Burkhard; Glas, Jürgen; Lohse, Peter; Brand, Stephan

    2015-01-01

    A previous study suggested an association of the single nucleotide polymorphism (SNP) rs72796353 (IVS4+10 A>C) in the NOD2 gene with susceptibility to Crohn's disease (CD). However, this finding has not been confirmed. Given that NOD2 variants still represent the most important predictors for CD susceptibility and phenotype, we evaluated the association of rs72796353 with inflammatory bowel disease (IBD) susceptibility and the IBD phenotype. Genomic DNA from 2256 Caucasians, including 1073 CD patients, 464 patients with ulcerative colitis (UC), and 719 healthy controls, was genotyped for the NOD2 SNP rs72796353 and the three main CD-associated NOD2 mutations rs2066844, rs2066845, and rs2066847. Subsequently, IBD association and genotype-phenotype analyses were conducted. In contrast to the strong associations of the NOD2 SNPs rs2066844 (p=3.51 x 10(-3)), rs2066845 (p=1.54 x 10(-2)), and rs2066847 (p=1.61 x 10(-20)) with CD susceptibility, no significant association of rs72796353 with CD or UC susceptibility was found. However, in CD patients without the three main CD-associated NOD2 mutations, rs72796353 was significantly associated with the development of perianal fistulas (p=2.78 x 10(-7), OR 5.27, [95% CI 2.75-10.12] vs. NOD2 wild-type carriers). Currently, this study represents the largest genotype-phenotype analysis of the impact of the NOD2 variant rs72796353 on the disease phenotype in IBD. Our data demonstrate that in CD patients the IVS4+10 A>C variant is strongly associated with the development of perianal fistulas. This association is particularly pronounced in patients who are not carriers of the three main CD-associated NOD2 mutations, suggesting rs72796353 as additional genetic marker for the CD disease behaviour.

  14. Perianal abscess and fistula in children in Zaria.

    Science.gov (United States)

    Ameh, Emmanuel A

    2003-06-01

    Perianal abscess (PAA) and fistula-in-ano (FIA) are not uncommon in children, but reports from tropical Africa are uncommon. In a period of 17 years, 17 children aged 12 years and below were treated for these conditions in Zaria, Nigeria. There were 14 boys and 3 girls, aged 4 months-12 years (median 3 years), Eight had PAA (median age 3 years), 5 ischiorectal abscess (median age 5 years) and 4 FIA (median age 10 months). FIA followed pull through for anorectal malformation in 2 patients and in one it was preceded by PAA. PAA was associated with chronic fissure-in-ano in one patient and uncontrolled diabetes mellitus in one. One 16-month girl with an ischiorectal abscess developed severe perineal necrotising fascitis and separation and retraction of the anorectum. Escherichia coli was cultured in 2 patients with abscesses and staphylococcus aureus in another 2. Culture was sterile in 7 patients with abscesses. Treatment was by adequate incision and drainage for abscesses. Fistulectomy was the treatment for FIA, but in one patient a diversion colostomy was performed in addition as the fistula was a high one. The child who developed necrotising fascitis had debridement and diversion colostomy. FIA recurred in one patient necessitating repeat fistulectomy. Although the number of patients is small, perianal sepsis appears to be less common in our environment compared to developed countries. Some differences are highlighted.

  15. Carcinoma basocelular de la región perianal: reporte de un caso y revisión de la literatura

    Directory of Open Access Journals (Sweden)

    L.A. Espino-Urbina

    2013-01-01

    Full Text Available La literatura reporta una incidencia anual de 5,900 casos de carcinoma anal en países desarrollados. Estos involucran a 3 zonas anatómicas distintas: carcinoma del canal anal; carcinoma perianal (antes denominado carcinoma del margen anal, ubicado a una distancia menor a 5 cm de este y carcinoma de la piel perianal (a más de 5 cm de distancia del margen anal. El carcinoma basocelular de la región perianal es una neoplasia poco común (0.27% de todos los carcinomas basocelulares diagnosticados cuyo tratamiento en la inmensa mayoría de las veces es la resección con márgenes libres de enfermedad; debe de diferenciarse de la variante basaloide epidermoide del carcinoma debido a su buen pronóstico y casi nulo potencial de diseminación.

  16. Rectal duplication as an unusual cause of chronic perianal fistula in an adult: report of a case.

    Science.gov (United States)

    Altinli, Ediz; Balkan, Tolga; Uras, Cihan; Dogusoy, Gulen; Akcal, Tarik; Balcisoy, Umit

    2004-01-01

    Duplication of the rectum is a rare embryologic event, but it should be considered as a possibility when perianal fistulas and abscesses remain resistant to conventional standard surgical treatment modalities over the long term. We report the case of a 57-year-old woman who underwent many operations over 30 years for persistent perianal fistulas. After radiological assay by computed tomography, fistulography, and barium enema studies, we performed surgery to remove a cystic mass in the retrorectal region, which was subsequently found to be a rectal duplication. The patient had an uneventful postoperative course and has been asymptomatic for 3 years.

  17. 3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound.

    Science.gov (United States)

    Felt-Bersma, Richelle J F; Vlietstra, Maarten S; Vollebregt, Paul F; Han-Geurts, Ingrid J M; Rempe-Sorm, Vera; Vander Mijnsbrugge, Grietje J H; Molenaar, Charlotte B H

    2018-04-04

    Perianal fistula surgery can damage the anal sphincters which may cause faecal incontinence. By measuring regional pressures, 3D-HRAM potentially provides better guidance for surgical strategy in patients with perianal fistulas. The aim was to measure regional anal pressures with 3D-HRAM and to compare these with 3D-EUS findings in patients with perianal fistulas. Consecutive patients with active perianal fistulas who underwent both 3D-EUS and 3D-HRAM at a clinic specialised in proctology were included. A group of 30 patients without fistulas served as controls. Data regarding demographics, complaints, previous perianal surgical procedures and obstetric history were collected. The mean and regional anal pressures were measured with 3D-HRAM. Fistula tract areas detected with 3D-EUS were analysed with 3D-HRAM by visual coding and the regional pressures of the corresponding and surrounding area of the fistula tract areas were measured. The study was granted by the VUmc Medical Ethical Committee. Forty patients (21 males, mean age 47) were included. Four patients had a primary fistula, 19 were previously treated with a seton/abscess drainage and 17 had a recurrence after previously performed fistula surgery. On 3D-HRAM, 24 (60%) fistula tract areas were good and 8 (20%) moderately visible. All but 7 (18%) patients had normal mean resting pressures. The mean resting pressure of the fistula tract area was significantly lower compared to the surrounding area (47 vs. 76 mmHg; p < 0.0001). Only 2 (5%) patients had a regional mean resting pressure < 10 mmHg of the fistula tract area. Using a Δ mean resting pressure ≥ 30 mmHg difference between fistula tract area and non-fistula tract area as alternative cut-off, 21 (53%) patients were identified. In 6 patients 3D-HRAM was repeated after surgery: a local pressure drop was detected in one patient after fistulotomy with increased complaints of faecal incontinence. Profound local anal pressure drops are found

  18. Bilateral V-Y flap for a perianal basal cell carcinoma: A case report

    Directory of Open Access Journals (Sweden)

    José P. Rivera-Chavarría

    2016-01-01

    Conclusion: Treatment modalities include early wide local excision to clear margins, ensuring further local recurrence and distant metastasis. The use of local V-Y advancement fasciocutaneous flaps may be another valid option for the reconstruction of perianal skin defects, with less morbidity than other flaps described in the literature.

  19. Usefulness of magnetic resonance in the evaluation of perianal fistulas; Utilidad de la resonancia magnetica en la valoracion de las fistulas perianales

    Energy Technology Data Exchange (ETDEWEB)

    Campo, M.; Isusi, M.; Oleaga, L.; Grande, D. [Hospital de Basurto. Bilbao (Spain); Fernandez, G.; Tardaguila, F. [Clinica POVISA. Vigo (Spain)

    2003-07-01

    Our aim was to confirm the usefulness of magnetic resonance in the evaluation of perianal fistulas, and in conjunction with a thought anatomical review of affected areas. This would allow for the building of a proper surgical plan, which would necessarily differ according to the fistula's complexity. We studied 75 patients with perianal fistulas and performed 81 MR studies by means of axial, sagittal and coronal T1 and T2 sequences. Fistula type, degree, etiology and correlation to surgical findings were all studied. Fifty-five patients underwent surgical treatment, and 26 underwent a more conservative treatment with MR follow-up. Ninety-nine fistulas were observed and classified according to norms set down by St. James University Hospital. Of the 55 cases submitted to surgery, 46 showed concordance between the surgical report and MR, whose sensitivity was 84%. In 9 patients, there was no correlation. In the study of perianal fistulas, it is important to establish both the fistulous tract and relationship to the sphincter complex. MR permits an identification of the sprinter complex and a more precise anatomical localization of the fistulous trajectory. It is also capable of differentiating between fibrosis and abscess. Therefore, MR is an appropriate technique for the study of perianal fistulas and related surgical planning. (Author) 6 refs.

  20. Successful Treatment of a Severe Case of Fournier's Gangrene Complicating a Perianal Abscess

    Directory of Open Access Journals (Sweden)

    Ioannis Papaconstantinou

    2011-01-01

    Full Text Available A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier's gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier's gangrene is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy.

  1. Vaginoperineal Fistula as a Complication of Perianal Surgery in a Patient with Sjögren’s Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Kemal Beksac

    2014-01-01

    Full Text Available Forty-seven-year-old woman with Sjögren’s syndrome had been operated on because of transsphincteric perianal fistula secondary to perianal abscess. Vaginal wall injury occurred during the course of the operation and injured tissue was repaired primarily. Three months later, patient suffered from the recurrence of perianal fistula symptoms and fistulectomy was performed once again under antibiotic suppression. Several months later, perineal discharge continued, and, therefore, patient was admitted to the hospital for the third time and a fistulotomy was performed. Two months after the third operation, patient was admitted with leukorrhea and a perineovaginal fistula was detected. This time, not only her surgical problem but also her immune system disorder was considered in the preoperative workup. Then, patient was hospitalized for the fourth time and “fistulectomy/perineoplasty” was performed successfully. We believe that patients with autoimmune disorders with or without medical treatment may have healing problems during the course of surgical processes and therefore such medical problems must be taken into consideration by the surgeons.

  2. Outcome of peri-anal surgeries without use of prophylactic antibiotics, in terms of post operative wound infection

    International Nuclear Information System (INIS)

    Asif, M.; Mirza, A.A.; Saeed, A.

    2017-01-01

    To determine the outcome of perianal surgeries without use of antibiotics in terms of post operative infection. Study Design: Descriptive study. Place and Duration of study: Department of general surgery, Pakistan Atomic Energy Commission General Hospital, from Jan 2014 to Jun 2015. Material and Methods: All patients, both male and female admitted for hemorrhoidectomy, fistulectomy and lateral internal sphincterotomy for Anal Fissure with minimum 02 months follow-up were included in the study through non probability consecutive sampling technique. The selected patients were not administered any antibiotics pre or postoperatively. All these patients were followed up for any post-operative surgical site infection up to 02 months. Patients were advised only to take pyodine sitz bath regularly. Results: One hundred and eighty two patients were selected for the study. Patients mean age was 48.0 +- 11.4 years. 68.68% were male and 31.3% were female patients. In our study most frequent clinical presentation was hemorrhoids (37.9.0%), followed by anal fissure (33.5%). Least frequent clinical presentation was of anal fistula (28.57%). None of the patients developed surgical site infection post operatively. Conclusions: In our study we found that there was no additional beneficial role of prophylactic antibiotics in perianal surgeries Perianal surgeries can safely be performed without the use pre or post-operative antibiotics there by significantly reducing health care expenses. (author)

  3. Anal sphincter responses after perianal electrical stimulation

    DEFF Research Database (Denmark)

    Pedersen, Ejnar; Klemar, B; Schrøder, H D

    1982-01-01

    By perianal electrical stimulation and EMG recording from the external anal sphincter three responses were found with latencies of 2-8, 13-18 and 30-60 ms, respectively. The two first responses were recorded in most cases. They were characterised by constant latency and uniform pattern, were...... not fatigued by repeated stimulation, were most dependent on placement of stimulating and recording electrodes, and always had a higher threshold than the third response. The third response was constantly present in normal subjects. It had the longest EMG response and the latency decreased with increasing...... stimulation to a minimum of 30-60 ms. This response represented the clinical observable spinal reflex, "the classical anal reflex". The latencies of the two first responses were so short that they probably do not represent spinal reflexes. This was further supported by the effect of epidural anaesthesia which...

  4. Total antioxidative capacity and zinc concentration in dogs suffering from perianal tumours

    Directory of Open Access Journals (Sweden)

    Brodzki Adam

    2015-09-01

    Full Text Available The aim of the study was to determine total antioxidative capacity (TAC and zinc concentration in serum of dogs suffering from perianal tumours just before the start of the antihormonal treatment (AHT and one and six months later. The study was performed on 45 dogs divided into two groups: control group suffering from non-malignant tumours (N = 24 and a group with malignant neoplastic changes (N = 21. Serum TAC and zinc concentrations were measured using photometric and atomic absorption spectrophotometric methods. Six months after the start of the AHT, TAC was significantly lower by 10.6% in dogs with malignant tumours when compared to controls (P = 0.03. In the non-malignant group, serum zinc concentration was higher before the treatment than in the malignant group, while the opposite results were observed six months later (P < 0.001. In the non-malignant group, gradually decreasing values of serum zinc concentration at each stage of the investigation were observed, while the opposite results were obtained in the malignant group (P < 0.05. The obtained results indicate that malignant neoplastic process is associated with significantly reduced TAC. Determination of serum zinc concentration in dogs with non-malignant and malignant perianal tumours may have practical diagnostic and prognostic values and may serve towards increasing the effectiveness of AHT monitoring.

  5. Megalourethra with Y-Type Duplication of Urethra Presented as Perianal Fistula: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Shashi Verma

    2015-01-01

    Full Text Available Megalourethra with Y-type duplication is an extremely rare anomaly. We report here one such case, diagnosed with retrograde urethrogram, which was done from both penile meatus and perianal opening simultaneously. Patient was successfully treated by laser optical internal urethrotomy (OIU, excision of duplicated urethra, and reduction urethroplasty in a single stage.

  6. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease

    DEFF Research Database (Denmark)

    Ruemmele, F M; Veres, G; Kolho, K L

    2014-01-01

    immunomodulator based maintenance therapy. The experts discuss several factors potentially predictive for poor disease outcome (such as severe perianal fistulizing disease, severe stricturing/penetrating disease, severe growth retardation, panenteric disease, persistent severe disease despite adequate induction...

  7. Morbidity in early Parkinson's disease and prior to diagnosis

    DEFF Research Database (Denmark)

    Frandsen, Rune; Kjellberg, Jakob; Ibsen, Rikke

    2014-01-01

    BACKGROUND: Nonmotor symptoms are probably present prior to, early on, and following, a diagnosis of Parkinson's disease. Nonmotor symptoms may hold important information about the progression of Parkinson's disease. OBJECTIVE: To evaluated the total early and prediagnostic morbidities in the 3......, poisoning and certain other external causes, and other factors influencing health status and contact with health services. It was negatively associated with neoplasm, cardiovascular, and respiratory diseases. CONCLUSIONS: Patients with a diagnosis of Parkinson's disease present significant differences...

  8. Perianal injectable bulking agents as treatment for faecal incontinence in adults. (Update)

    DEFF Research Database (Denmark)

    Maeda, Yasuko; Laurberg, Søren; Norton, Christine

    2013-01-01

    BACKGROUND: Faecal incontinence is a complex and distressing condition with significant medical and social implications. Injection of perianal bulking agents has been used to treat the symptoms of passive faecal incontinence. However, various agents have been used without a standardised technique...... evaluation of outcomes and thus it is difficult to gauge whether the improvement in incontinence scores matched practical symptom improvements that mattered to the patients. AUTHORS' CONCLUSIONS: One large randomised controlled trial has shown that this form of treatment using dextranomer in stabilised...

  9. Evaluation of the inflammatory response induced by different materials in the treatment of perianal fistulas: experimental study in rats

    Directory of Open Access Journals (Sweden)

    Mariana Ocampos Galvão

    2016-01-01

    Full Text Available The medical literature has no study evaluating the effectiveness of different materials used as setons in the treatment of perianal fistulas; therefore, there is no evidence of availability of a more effective material than others for this purpose. Objective: To evaluate the inflammatory response induced by different materials used as seton in perianal fistulas in rats. Method: Thirty Wistar rats, which were initially submitted for the construction of a perianal fistula by passing transfixing steel wire into the anal canal, were used. The rats were kept for 30 days; after this period, and with confirmation of the formation of the perianal fistula, the setons were introduced (10 rats – cotton thread #0; 10 rats – rubber; and 10 rats – silastic; after 30 days the animals were euthanized, and then the area of the fistula repaired by the seton was resected, and the material retrieved was submitted to histological analysis. The results were analyzed statistically. Results: The mean degree of inflammatory process observed by histological analysis after 30 days was 2.3 for the cotton group; 1 for the rubber group; and 1.2 for the silastic group. Conclusion: A greater inflammatory response was observed in the group treated with a cotton seton. In the remaining groups, a lower inflammatory response, with equal intensity for rubber and silastic-treated rats, was noted. Resumo: Não foram encontrados na literatura médica estudos que avaliassem a eficácia dos diferentes materiais utilizados como sedenho no tratamento de fístulas perianais, portanto, não havendo evidências de que haja um material mais eficaz do que outro para esta finalidade. Objetivo: avaliar a resposta inflamatória induzida por diferentes materiais utilizados como sedenhos em fístulas perianais em ratos. Método: foram utilizados 30 ratos Wistar, os quais foram inicialmente submetidos à criação de fístula perianal pela passagem de fio de aço transfixante no canal anal

  10. Efficacy and safety of certolizumab pegol in an unselected crohn's disease population: 26-week data of the FACTS II survey.

    Science.gov (United States)

    Vavricka, Stephan R; Schoepfer, Alain M; Bansky, Georg; Binek, Janek; Felley, Christian; Geyer, Martin; Manz, Michael; Rogler, Gerhard; de Saussure, Philippe; Sauter, Bernhard; Scharl, Michael; Seibold, Frank; Straumann, Alex; Michetti, Pierre

    2011-07-01

    Certolizumab pegol (Cimzia, CZP) was approved for the treatment of Crohn's disease (CD) patients in 2007 in Switzerland as the first country worldwide. This prospective phase IV study aimed to evaluate the efficacy and safety of CZP over 26 weeks in a multicenter cohort of practice-based patients. Evaluation questionnaires at baseline, week 6, and week 26 were completed by gastroenterologists in hospitals and private practices. Adverse events were evaluated according to World Health Organization (WHO) guidelines. Sixty patients (38F/22M) were included; 53% had complicated disease (stricturing or penetrating), 45% had undergone prior CD-related surgery. All patients had prior exposure to systemic steroids, 96% to immunomodulators, 73% to infliximab, and 43% to adalimumab. A significant decrease of the Harvey-Bradshaw Index (HBI) was observed under CZP therapy (12.2 ± 4.9 at week 0 versus 6.3 ± 4.7 at week 6 and 6.7 ± 5.3 at week 26, both P < 0.001). Response and remission rates were 70% and 40% (week 6) and 67% and 36%, respectively (week 26). The complete perianal fistula closure rate was 36% at week 6 and 55% at week 26. The frequency of adverse drug reactions attributed to CZP was 5%. CZP was continued in 88% of patients beyond week 6 and in 67% beyond week 26. In a population of CD patients with predominantly complicated disease behavior, CZP proved to be effective in induction and maintenance of response and remission. This series provides the first evidence of CZP's effectiveness in perianal fistulizing CD in clinical practice. Copyright © 2010 Crohn's & Colitis Foundation of America, Inc.

  11. Fistulizing Crohn's disease: Diagnosis and management.

    Science.gov (United States)

    Gecse, Krisztina; Khanna, Reena; Stoker, Jaap; Jenkins, John T; Gabe, Simon; Hahnloser, Dieter; D'Haens, Geert

    2013-06-01

    Fistulizing Crohn's disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn's disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery.

  12. A case of lymphogranuloma venereum of 20 years' duration. Isolation of Chlamydia trachomatis from perianal lesions.

    Science.gov (United States)

    Dan, M; Rotmensch, H H; Eylan, E; Rubinstein, A; Ginsberg, R; Liron, M

    1980-01-01

    Chlamydia trachomatis was isolated from perianal lesions in a patient in whom lymphogranuloma venereum had been diagnosed 20 years previously. Treatment with tetracycline resulted in a pronounced improvement. Although C trachomatis is known to persist for a long time in the host, isolation of the micro-organism from infected tissues after such a prolonged period has not previously been reported. Images PMID:7427708

  13. Differentiating Crohn's disease from intestinal tuberculosis at ...

    African Journals Online (AJOL)

    patients with non-caseating granulomas, as these suggest a very real possibility of ITB. ... There were no significant differences in smoking status, symptom duration or perianal disease. ..... CD, requires a degree of immune competence. This is ...

  14. Prospective Evaluation of Acute Toxicity and Quality of Life After IMRT and Concurrent Chemotherapy for Anal Canal and Perianal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Han, Kathy; Cummings, Bernard J.; Lindsay, Patricia; Skliarenko, Julia; Craig, Tim [Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Le, Lisa W. [Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Brierley, James; Wong, Rebecca; Dinniwell, Robert; Bayley, Andrew J.; Dawson, Laura A.; Ringash, Jolie [Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Krzyzanowska, Monika K.; Moore, Malcolm J.; Chen, Eric X. [Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Easson, Alexandra M. [Department of Surgical Oncology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario (Canada); Kassam, Zahra; Cho, Charles [Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Kim, John, E-mail: John.Kim@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada)

    2014-11-01

    Purpose: A prospective cohort study was conducted to evaluate toxicity, quality of life (QOL), and clinical outcomes in patients treated with intensity modulated radiation therapy (IMRT) and concurrent chemotherapy for anal and perianal cancer. Methods and Materials: From June 2008 to November 2010, patients with anal or perianal cancer treated with IMRT were eligible. Radiation dose was 27 Gy in 15 fractions to 36 Gy in 20 fractions for elective targets and 45 Gy in 25 fractions to 63 Gy in 35 fractions for gross targets using standardized, institutional guidelines, with no planned treatment breaks. The chemotherapy regimen was 5-fluorouracil and mitomycin C. Toxicity was graded with the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3. QOL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR29 questionnaires. Correlations between dosimetric parameters and both physician-graded toxicities and patient-reported outcomes were evaluated by polyserial correlation. Results: Fifty-eight patients were enrolled. The median follow-up time was 34 months; the median age was 56 years; 52% of patients were female; and 19% were human immunodeficiency virus—positive. Stage I, II, III, and IV disease was found in 9%, 57%, 26%, and 9% of patients, respectively. Twenty-six patients (45%) required a treatment break because of acute toxicity, mainly dermatitis (23/26). Acute grade 3 + toxicities included skin 46%, hematologic 38%, gastrointestinal 9%, and genitourinary 0. The 2-year overall survival (OS), disease-free survival (DFS), colostomy-free survival (CFS), and cumulative locoregional failure (LRF) rates were 90%, 77%, 84%, and 16%, respectively. The global QOL/health status, skin, defecation, and pain scores were significantly worse at the end of treatment than at baseline, but they returned to baseline 3 months after treatment. Social functioning and appetite scores were

  15. Intersphincteric proctectomy with end-colostomy for anorectal Crohn's disease results in early and severe proximal colonic recurrence.

    Science.gov (United States)

    de Buck van Overstraeten, Anthony; Wolthuis, Albert M; Vermeire, Séverine; Van Assche, Gert; Rutgeerts, Paul; Penninckx, Freddy; D'Hoore, André

    2013-07-01

    Perianal Crohn's disease (CD) represents a more aggressive phenotype of inflammatory bowel disease and often coincides with proctocolitis. This study aims to assess the outcome of patients undergoing proctectomy with end-colostomy. A retrospective outcome analysis of 10 consecutive patients who underwent intersphincteric proctectomy with end-colostomy between February 2007 and May 2011 was performed. All patients suffered from refractory distal and perianal CD. The proximal colon was normal at endoscopy. All data were extracted from a prospectively maintained database. The main outcome parameter was disease recurrence and need for completion colectomy. Severe and early endoscopic recurrence in the proximal colon occurred in 9/10 patients at a median time interval of 9.5 months (range: 1.9-23.6 months). Despite protracted medical treatment, completion colectomy was necessary in 5 patients. One patient, who underwent a second segmental colectomy with a new end-colostomy, showed again endoscopic recurrence and is currently treated with anti-TNF agents. Intersphincteric proctectomy with colostomy seems to be an ineffective surgery for perianal CD with coexisting proctitis and results in a high risk of recurrence of the disease in the remaining colon. Therefore, despite a normal appearance of the proximal colon, a proctocolectomy with end-ileostomy seems to be the surgical approach of choice in these patients. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  16. Ulcerative colitis presenting as leukocytoclastic vasculitis of skin

    OpenAIRE

    Akbulut, Sabiye; Ozaslan, Ersan; Topal, Firdevs; Albayrak, Levent; Kayhan, Burcak; Efe, Cumali

    2008-01-01

    A number of cutaneous changes are known to occur in the course of inflammatory bowel diseases (IBD), including pyoderma gangrenosum, erythema nodosum, perianal disease, erythematous eruptions, urticaria, and purpura. However, occurrence of skin manifestations prior to the development of ulcerative colitis is a rare occasion. Here, we report a case of ulcerative colitis associated with leukocytoclastic vasculitis in which the intestinal symptoms became overt 8 mo after the development of skin ...

  17. A CONTROVERSIAL ON THE DIAGNOSIS OF CHRONIC BULLOUS TYPE MUCOCUTANEOUS DISEASE INVOLVING ORAL MUCOSA (A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Isadora Gracia

    2006-04-01

    Full Text Available A case of chronic bullous type mucocutaneous disease involving oral mucosa was reported from a 56 years old man with never healing oral ulcers and wound on the perianal skin for three years. There were also red and black spots on the limb and back skin and a lesion on nail. Painful oral lesion consisted of mucous erosion, desquamative gingivitis, and sloughing area on palate and tongue. The patient is diabetic. The first perianal skin diagnosis was granulomatous candidasis with differential diagnosis pemphigus vegetates and acuminarum condiloma. However the histopathologic examination did not support these diagnosis. After several histopathologic examinations, the latest perianal skin diagnosis was lichen planus with differential diagnosis granulomatous vasculitis, bowenoid papulosis and pyodema gangrenosum. Other skin diagnosis was erythema multiforme. Oral diagnosis was mucous membrane pemphigoid with differential diagnosis lichen planus, Behçet's syndrome and erythema multiforme. Oral histopathologic examinations showed a sub-epithelial blister, which supported mucous membrane pemphigoid. A lip balm, prednisone 5 mg oral rinse and multivitamins were given but oral improvement started after blood sugar level was controlled. Conclusion: It is not yet known whether skin and oral mucous lesions are from the same disease or not.

  18. Ulcerative colitis presenting as leukocytoclastic vasculitis of skin.

    Science.gov (United States)

    Akbulut, Sabiye; Ozaslan, Ersan; Topal, Firdevs; Albayrak, Levent; Kayhan, Burcak; Efe, Cumali

    2008-04-21

    A number of cutaneous changes are known to occur in the course of inflammatory bowel diseases (IBD), including pyoderma gangrenosum, erythema nodosum, perianal disease, erythematous eruptions, urticaria, and purpura. However, occurrence of skin manifestations prior to the development of ulcerative colitis is a rare occasion. Here, we report a case of ulcerative colitis associated with leukocytoclastic vasculitis in which the intestinal symptoms became overt 8 mo after the development of skin lesions.

  19. Early Diagnosis and Hematopoietic Stem Cell Transplantation for IL10R Deficiency Leading to Very Early-Onset Inflammatory Bowel Disease Are Essential in Familial Cases

    Directory of Open Access Journals (Sweden)

    Neslihan Edeer Karaca

    2016-01-01

    Full Text Available Alterations of immune homeostasis in the gut may result in development of inflammatory bowel disease. A five-month-old girl was referred for recurrent respiratory and genitourinary tract infections, sepsis in neonatal period, chronic diarrhea, perianal abscess, rectovaginal fistula, and hyperemic skin lesions. She was born to second-degree consanguineous, healthy parents. Her elder siblings were lost at 4 months of age due to sepsis and 1 year of age due to inflammatory bowel disease, respectively. Absolute neutrophil and lymphocyte counts, immunoglobulin levels, and lymphocyte subsets were normal ruling out severe congenital neutropenia and classic severe combined immunodeficiencies. Quantitative determination of oxidative burst was normal, excluding chronic granulomatous disease. Colonoscopy revealed granulation, ulceration, and pseudopolyps, compatible with colitis. Very early-onset colitis and perianal disease leading to fistula formation suggested probability of inherited deficiencies of IL-10 or IL-10 receptor. A mutation at position c.G477A in exon of the IL10RB gene, resulting in a stop codon at position p.W159X, was identified. The patient underwent myeloablative hematopoietic stem cell transplantation from full matched father at 11 months of age. Perianal lesions, chronic diarrhea, and recurrent infections resolved after transplantation. IL-10/IL-10R deficiencies must be considered in patients with early-onset enterocolitis.

  20. Radioiodine therapy in patients with Graves' disease and the effects of prior carbimazole therapy.

    Science.gov (United States)

    Karyampudi, Arun; Hamide, Abdoul; Halanaik, Dhanapathi; Sahoo, Jaya Prakash; Kamalanathan, Sadishkumar

    2014-09-01

    The use of radioiodine as the first line of treatment in Graves' disease is restricted in India because of its limited availability and an unrealistic risk perception associated with it. Additionally, the effectiveness of radioiodine ablation in Graves' disease is influenced by many factors. Prior medical antithyroid therapy is one such important factor. To analyze the efficacy of low dose radioiodine therapy (5 mCi) in treatment of naive patients of Graves' disease in comparison to that in which it was already primed with an antithyroid drug, carbimazole. A non-randomized, interventional study conducted in the Department of Medicine and Endocrinology of a tertiary care institute in South India. The study had two groups; Group A (36 treatment naive, uncomplicated Graves' disease patients) and B (34 Graves' disease patients on carbimazole prior to radioiodine therapy). Both groups had baseline clinical, biochemical evaluation and were reassessed at 3 and 6 months for evaluating the clinical status for possible documentation of cure. The cure rate was 61.1% in drug naive group and 58.8% in pretreated group at 6 months following radioiodine (P = 0.845). Higher baseline 999m technicium (99m Tc) uptake, male gender, BMI and higher baseline free thyroxine (fT4) level predicted treatment failure following radioiodine therapy. Administration of carbimazole prior to low dose radioiodine therapy does not alter the efficacy of radioiodine. Low fixed dose (5 mCi) of radioactive iodine may be a safe and effective primary therapeutic option in Graves' disease patients pretreated with antithyroid drugs.

  1. Patterns of Failure for Rhabdomyosarcoma of the Perineal and Perianal Region

    International Nuclear Information System (INIS)

    Casey, Dana L.; Wexler, Leonard H.; LaQuaglia, Michael P.; Meyers, Paul A.; Wolden, Suzanne L.

    2014-01-01

    Purpose: To analyze prognostic factors and patterns of failure for rhabdomyosarcoma of the perineal and perianal region (PRMS), with an emphasis on radiation therapy for locoregional control. Methods and Materials: Detailed records of all 14 patients treated for PRMS at Memorial Sloan-Kettering Cancer Center between 1998 and 2012 were reviewed. The Kaplan-Meier method was used to assess the event-free survival (EFS) and overall survival (OS), and a competing-risks analysis was used to assess the cumulative incidence of local, regional, and distant failures. Results: Median age was 15.8 years (range, 1.1-31.9 years). High-risk features were identified: 9 of 14 patients (64%) had group 3 disease and 3 of 14 (21%) had group 4; 11 of 14 tumors (78%) were alveolar; 12 of 14 tumors (86%) were ≥5 cm; and 9 of 14 patients (64%) had involved lymph nodes (N1). Of those aged ≥10 years at diagnosis, 9 of 10 (90%) had alveolar histology, all had tumors ≥5 cm, and 8 of 10 (80%) presented with N1 disease. The rates of local, regional, and distant failure at 5 years were 17%, 31%, and 52%, respectively. Although 3 of the 4 patients with regional failure received nodal irradiation, only one of the nodal failures occurred in the radiation therapy field. The 5-year EFS was 33%, and OS was 39%. Age ≥10 years was associated with poor outcomes: EFS was 13% in patients aged ≥10 years, compared with 75% in those aged <10 years (P=.04); the OS was 13% in patients aged ≥10 years, compared with 100% in those aged <10 years (P=.04). Conclusions: Patients with PRMS, especially those aged ≥10 years, present with poor prognostic features and continue to have poor outcomes. Given the high incidence of regional node recurrence, we recommend prophylactic ilioinguinal lymph node irradiation for all patients aged ≥10 years. For children aged <10 years, nodal evaluation is essential to determine the role for lymph node irradiation

  2. Peri-anal surgery under saddle block anaesthesia comparing three different doses of hyperbaric 0.75% bupivacaine

    International Nuclear Information System (INIS)

    Ali, L.; Alam, W.; Abbas, M.A.; Ali, U.

    2017-01-01

    To compare three doses of hyperbaric 0.75% bupivacaine and measuring time for home readiness after day care perianal surgery under saddle block anaesthesia. Study Design: Non randomized controlled trial. Place and Duration of Study: The study was conducted at the department of Anaesthesia, CMH Rawalpindi from Jun 2014 to Apr 2015. Material and Methods: In this study 90 patients who presented for perianal day care surgery, were divided in three equal groups. Group A received 7.5 mg, group B 6.0 mg and group C 4.5 mg of hyperbaric 0.75% bupivacaine. Intrathecal injection was given in L4-5 space by 25 G spinal needle in sitting position. Lithotomy position was made after five minutes. After surgery patients were monitored in recovery room. After fulfilling ambulatory and discharge criteria patients were allowed to go home with attendants. Time of intrathecal injection, assessment of above criteria and time of discharge were noted and analyzed. Results: Male patients were 85.6% and females were 14.4%. Mean time of surgery was 48 +- 10.59 min. Mean time of discharge in minutes for group A was 235.86 +- 49.38, for group B 217.7 +- 42.49 and for group C 205.76 +- 32. Time of discharge was significantly different between group A and group C (p=0.02). While it was not significantly different between group A and group B (p=0.29) and between group B and group C (p=0.819). Conclusion: Lower dose of hyperbaric bupivacaine can reduce the time for home readiness compared to higher dose. Time of discharge is mainly dependent on time to micturate after saddle block anaesthesia. (author)

  3. Perianal implantation of bioengineered human internal anal sphincter constructs intrinsically innervated with human neural progenitor cells.

    Science.gov (United States)

    Raghavan, Shreya; Miyasaka, Eiichi A; Gilmont, Robert R; Somara, Sita; Teitelbaum, Daniel H; Bitar, Khalil N

    2014-04-01

    The internal anal sphincter (IAS) is a major contributing factor to pressure within the anal canal and is required for maintenance of rectoanal continence. IAS damage or weakening results in fecal incontinence. We have demonstrated that bioengineered, intrinsically innervated, human IAS tissue replacements possess key aspects of IAS physiology, such as the generation of spontaneous basal tone and contraction/relaxation in response to neurotransmitters. The objective of this study is to demonstrate the feasibility of implantation of bioengineered IAS constructs in the perianal region of athymic rats. Human IAS tissue constructs were bioengineered from isolated human IAS circular smooth muscle cells and human enteric neuronal progenitor cells. After maturation of the bioengineered constructs in culture, they were implanted operatively into the perianal region of athymic rats. Platelet-derived growth factor was delivered to the implanted constructs through a microosmotic pump. Implanted constructs were retrieved from the animals 4 weeks postimplantation. Animals tolerated the implantation well, and there were no early postoperative complications. Normal stooling was observed during the implantation period. At harvest, implanted constructs were adherent to the perirectal rat tissue and appeared healthy and pink. Immunohistochemical analysis revealed neovascularization. Implanted smooth muscle cells maintained contractile phenotype. Bioengineered constructs responded in vitro in a tissue chamber to neuronally evoked relaxation in response to electrical field stimulation and vasoactive intestinal peptide, indicating the preservation of neuronal networks. Our results indicate that bioengineered innervated IAS constructs can be used to augment IAS function in an animal model. This is a regenerative medicine based therapy for fecal incontinence that would directly address the dysfunction of the IAS muscle. Copyright © 2014 Mosby, Inc. All rights reserved.

  4. Characteristics and management of patients with inflammatory bowel disease between a secondary and tertiary hospitals: a propensity score analysis

    Directory of Open Access Journals (Sweden)

    Ki Hwan Song

    2018-04-01

    Full Text Available Background/Aims : This study aimed to compare the clinical characteristics and management patterns of inflammatory bowel disease (IBD patients in a secondary hospital (SH with those in tertiary referral centers (TRC. Methods : Data from IBD patients in SH and 2 TRCs were retrospectively reviewed. The cumulative thiopurine use rate was compared between hospitals after controlling for different baseline characteristics using propensity score matching. Results : Among the total of 447 patients with IBD, 178 Crohn's disease (CD and 269 ulcerative colitis (UC patients were included. Regarding initial CD symptoms, patients from SH were more likely to show perianal symptoms, such as anal pain or discharge (56.6% vs. 34.3%, P=0.003, whereas those from TRCs more often had luminal symptoms, such as abdominal pain (54.9% vs. 17.1%, P<0.001, diarrhea (44.1% vs. 18.4%, P<0.001, and body weight loss (9.8% vs. 1.3%, P=0.025. Complicating behaviors, such as stricturing and penetrating, were significantly higher in TRCs, while perianal disease was more common in SH. Ileal location was more frequently observed in TRCs. For UC, SH had a more limited extent of disease (proctitis 58.8% vs. 21.2%, P<0.001. The cumulative azathioprine use rate in SH was significantly lower than that in TRCs in both CD and UC patients after controlling for disease behavior, location, and perianal disease of CD and extent of UC. Conclusions : The clinical characteristics and management of the IBD patients in SH were substantially different from those in TRCs. Thiopurine treatment was less commonly used for SH patients.

  5. The development of a magnetic resonance imaging index for fistulising Crohn's disease

    NARCIS (Netherlands)

    Samaan, M. A.; Puylaert, C. A. J.; Levesque, B. G.; Zou, G. Y.; Stitt, L.; Taylor, S. A.; Shackelton, L. M.; Vandervoort, M. K.; Khanna, R.; Santillan, C.; Rimola, J.; Hindryckx, P.; Nio, C. Y.; Sandborn, W. J.; D'Haens, G.; Feagan, B. G.; Jairath, V.; Stoker, J.

    2017-01-01

    Magnetic resonance imaging (MRI) is the gold standard for assessment of perianal fistulising Crohn's disease (CD). The Van Assche index is the most commonly used MRI fistula index. To assess the reliability of the Van Assche index, and to modify the instrument to improve reliability and create a

  6. Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's disease.

    Science.gov (United States)

    Safroneeva, E; Vavricka, S R; Fournier, N; Pittet, V; Peyrin-Biroulet, L; Straumann, A; Rogler, G; Schoepfer, A M

    2015-10-01

    The impact of early treatment with immunomodulators (IM) and/or TNF antagonists on bowel damage in Crohn's disease (CD) patients is unknown. To assess whether 'early treatment' with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to 'late treatment', which was defined as treatment initiation after >2 years from the time of CD diagnosis. Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications. The 'early treatment' group of 292 CD patients was compared to the 'late treatment' group of 248 CD patients. We found that 'early treatment' with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio (HR) 0.496, P = 0.004 for IM; HR 0.276, P = 0.018 for TNF antagonists]. Furthermore, 'early treatment' with IM was associated with reduced risk of undergoing intestinal surgery (HR 0.322, P = 0.005), and perianal surgery (HR 0.361, P = 0.042), as well as developing any complication (HR 0.567, P = 0.006). Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication. © 2015 John Wiley & Sons Ltd.

  7. Anorectal complications and function in patients suffering from inflammatory bowel disease: a series of patients with long-term follow-up

    NARCIS (Netherlands)

    Lam, T.J.; van Bodegraven, A.A.; Felt-Bersma, R.J.F.

    2014-01-01

    Aim: The aim of this study is to describe the long-term course of anorectal complains and function in a single centre cohort patients suffering from inflammatory bowel disease (IBD) with perianal lesions. Methods: Between 1993 and 2000, 56 IBD patients (43 Crohn's disease and 13 ulcerative colitis)

  8. Extramammary Paget’s disease of the scrotum

    Directory of Open Access Journals (Sweden)

    Guang-Dar Juang

    2011-07-01

    Full Text Available Extramammary Paget’s disease is an uncommon intra-epidermal malignant neoplasm that arises in area rich in apocrine glands. Common sites of occurrence include the vulva, perianal region, perineum, and scrotum. The lesion may be accompanied by an invasive adenocarcinoma or adenocarcinoma in situ of the apocrine glands. Generally, the prognosis is poor. Herein, we report two cases of extramammary Paget’s disease, one involving the penoscrotal area with bilateral inguinal and pelvic lymph node metastases, the other involving the scrotal area without metastases.

  9. Effect of phenotype on health care costs in Crohn's disease: A European study using the Montreal classification.

    Science.gov (United States)

    Odes, Selwyn; Vardi, Hillel; Friger, Michael; Wolters, Frank; Hoie, Ole; Moum, Bjørn; Bernklev, Tomm; Yona, Hagit; Russel, Maurice; Munkholm, Pia; Langholz, Ebbe; Riis, Lene; Politi, Patrizia; Bondini, Paolo; Tsianos, Epameinondas; Katsanos, Kostas; Clofent, Juan; Vermeire, Severine; Freitas, João; Mouzas, Iannis; Limonard, Charles; O'Morain, Colm; Monteiro, Estela; Fornaciari, Giovanni; Vatn, Morten; Stockbrugger, Reinhold

    2007-12-01

    Crohn's disease (CD) is a chronic inflammation of the gastrointestinal tract associated with life-long high health care costs. We aimed to determine the effect of disease phenotype on cost. Clinical and economic data of a community-based CD cohort with 10-year follow-up were analyzed retrospectively in relation to Montreal classification phenotypes. In 418 patients, mean total costs of health care for the behavior phenotypes were: nonstricturing-nonpenetrating 1690, stricturing 2081, penetrating 3133 and penetrating-with-perianal-fistula 3356 €/patient-phenotype-year (P<0.001), and mean costs of surgical hospitalization 215, 751, 1293 and 1275 €/patient-phenotype-year respectively (P<0.001). Penetrating-with-perianal-fistula patients incurred significantly greater expenses than penetrating patients for total care, diagnosis and drugs, but not surgical hospitalization. Total costs were similar in the location phenotypes: ileum 1893, colon 1748, ileo-colonic 2010 and upper gastrointestinal tract 1758 €/patient-phenotype-year, but surgical hospitalization costs differed significantly, 558, 209, 492 and 542 €/patient-phenotype-year respectively (P<0.001). By multivariate analysis, the behavior phenotype significantly impacted total, medical and surgical hospitalization costs, whereas the location phenotype affected only surgical costs. Younger age at diagnosis predicted greater surgical expenses. Behavior is the dominant phenotype driving health care cost. Use of the Montreal classification permits detection of cost differences caused by perianal fistula.

  10. Neoplasia intra-epitelial grau III da vulva e da região perianal tratada com vulvectomia superficial: relato de caso High-grade vulvar and perianal intraepithelial neoplasia treated with skinning vulvectomy: a case report

    Directory of Open Access Journals (Sweden)

    Walquíria Quida Salles Pereira Primo

    2003-05-01

    Full Text Available A neoplasia intra-epitelial vulvar grau III (NIV III se manifesta de modo visível, portanto, acessível à biópsia e, por conseguinte, ao diagnóstico histológico. Há duas formas precursoras do câncer vulvar: a NIV associada ao papiloma vírus humano (HPV e a NIV associada ao líquen simples crônico, hiperplasia de células escamosas e líquen escleroso, não tratados. Porém, pode existir sobreposição das duas formas. O termo papulose bowenóide, apesar de ser desencorajado, define uma das formas clínicas da NIV, que se apresenta como lesões pigmentadas, verruciformes, papulares e múltiplas. A NIV III está associada com HPV em mais de 80% dos casos e em 40% das vezes, nota-se envolvimento perianal. O seu tratamento é muito difícil e pode ocorrer recorrência em qualquer tempo e por muitos anos. Embora não exista tratamento padrão definido, os trabalhos apontam para a cirurgia, respeitando margem de segurança, como o mais adequado.High-grade vulvar intraepithelial neoplasia (VIN III is a visible lesion; therefore, it is accessible to biopsy and thus, to a histological diagnosis. There are two forms of vulvar cancer precursors: VIN caused by human papillomavirus (HPV and VIN associated with untreated lichen simplex chronicus, squamous cell hyperplasia, and lichen sclerosus. There may be overlap of the two forms. The term bowenoid papulosis, although discouraged, identifics a clinical form of VIN III. Such lesion appears as pigmented, wart-like growths or papules. VIN III is associated with HPV in more than 80% of the cases, and there is perianal involvement in 40% of the times. Vulvar intraepithelial neoplasia is difficult to cure and relapses can occur at any time for many years. Although there is no defined standard treatment, studies point to surgery, respecting a free margin, as the most adequate one.

  11. Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study

    NARCIS (Netherlands)

    van der Have, Mike; Belderbos, Tim D. G.; Fidder, Herma H.; Leenders, Max; Dijkstra, Gerard; Peters, Charlotte P.; Eshuis, Emma J.; Ponsioen, Cyriel Y.; Siersema, Peter D.; van Oijen, Martijn G. H.; Oldenburg, Bas

    2014-01-01

    Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended. To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield. A multicentre

  12. Screening prior to biological therapy in Crohn's disease : Adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study

    NARCIS (Netherlands)

    van der Have, Mike; Belderbos, Tim D. G.; Fidder, Herma H.; Leenders, Max; Dijkstra, Gerard; Peters, Charlotte P.; Eshuis, Emma J.; Ponsioen, Cyriel Y.; Siersema, Peter D.; van Oijen, Martijn G. H.; Oldenburg, Bas

    2014-01-01

    Background: Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended. Aims: To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield.

  13. Intrathecal dexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries: A randomised double-blind controlled study

    Directory of Open Access Journals (Sweden)

    S S Nethra

    2015-01-01

    Full Text Available Background and Aim: The newer trend in regional anaesthesia for ambulatory anorectal surgeries advocate use of lower dose of local anaesthetic, providing segmental block with adjuvants such as opioids and α2 agonists to prolong analgesia. The current study investigated effects of addition of 5 μg of dexmedetomidine to 6 mg of hyperbaric bupivacaine on duration of analgesia, sensory and motor block characteristics for perianal ambulatory surgeries. Methods: This study is a prospective randomised controlled double blind study. Forty adult patients between 18 and 55 years of age were divided into 2 groups. Group D received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml with injection dexmedetomidine 5 μg in 0.5 ml of normal saline and Group N received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml with 0.5 ml of normal saline. The parameters assessed were time to regression of sensory blockade, motor blockade, ambulation, time to void, first administration of analgesic. Statistical analysis was done using appropriate tests. Results: Time for regression of sensory level and time for first administration of analgesic were prolonged in Group D (430.05 ± 89.13 min, 459.8 ± 100.9 min, respectively in comparison to Group N (301.10 ± 94.86 min, 321.85 ± 95.08 min, respectively. However, the duration of motor blockade, time to ambulation, and time to void were also significantly prolonged in Group D (323.05 ± 54.58 min, 329.55 ± 54.06 min, 422.30 ± 87.59 min than in Group N (220.10 ± 63.61 min, 221.60 ± 63.84 min, 328.45 ± 113.38 min. Conclusion: Intrathecal dexmedetomidine 5 μg added to intrathecal bupivacaine 6 mg as adjuvant may not be suitable for ambulatory perianal surgeries due to prolongation of motor blockade.

  14. Clinical Factors and Disease Course Related to Diagnostic Delay in Korean Crohn's Disease Patients: Results from the CONNECT Study.

    Directory of Open Access Journals (Sweden)

    Chang Mo Moon

    Full Text Available Diagnostic delay frequently occurs in Crohn's disease (CD patients because of diagnostic limitations. However, diagnostic delay and its related factors remain poorly defined. Therefore, we aimed to identify the predictors associated with diagnostic delay and to evaluate the impact of diagnostic delay on clinical course in a Korean CD patient cohort. We performed a multicenter retrospective analysis of 1,047 CD patients registered in the Crohn's Disease Clinical Network and Cohort study in Korea. The mean interval of diagnostic delay was 16.0 ± 33.1 months. Multivariate analysis showed that older age at diagnosis (≥40 years (p = 0.014, concomitant upper gastrointestinal (UGI disease (p = 0.012 and penetrating disease behavior at diagnosis (p = 0.001 were positively associated with long diagnostic delay (≥18 months. During the longitudinal follow-up, long diagnostic delay was independently predictive of further development of intestinal stenosis (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.07-1.93; p = 0.017, internal fistulas (HR, 1.62; 95% CI, 1.12-2.33; p = 0.011, and perianal fistulas (HR, 1.38; 95% CI, 1.06-1.80; p = 0.016. However, as for the risk of abscess formation, bowel perforation, and CD-related abdominal surgery, no significant association with diagnostic delay was observed. Older age at diagnosis, UGI involvement, and penetrating behavior are associated with long diagnostic delay in Korean CD patients. Moreover, diagnostic delay is associated with an increased risk of CD-related complications such as intestinal stenosis, internal fistulas, and perianal fistulas.

  15. Clinical experience with infliximab therapy in 100 patients with Crohn's disease.

    Science.gov (United States)

    Farrell, R J; Shah, S A; Lodhavia, P J; Alsahli, M; Falchuk, K R; Michetti, P; Peppercorn, M A

    2000-12-01

    The aim of this study was to assess our clinical experience with infliximab, a monoclonal antitumor necrosis factor antibody, following its approval for treatment of refractory Crohn's disease (CD). We followed 100 consecutive patients with CD (53 women and 47 men; mean age, 41 yr) who received a total of 233 infliximab (5 mg/kg) infusions. Adverse events were noted and clinical response assessed every 2 wk for 6 months after each infusion using the Harvey Bradshaw Index (HBI) for active disease, the Perianal Disease Activity Index (PDAI) for fistulous disease, and steroid withdrawal rates for steroid-sparing efficacy. Indications for therapy were active disease (n = 57), perianal fistulous disease (n = 33), and steroid dependency (n = 10). Significant infusion reactions occurred in 16 patients (6.9% of infusions) including anaphylactic shock in one patient. Fourteen patients experienced infectious adverse events, 13 of whom were on concurrent steroids. Sixty percent of patients with active disease experienced > or = 50% HBI reduction at 2 wk; mean duration of response, 8.2 wk. Three of 26 first-time nonresponders with active disease (12%) responded to a second infusion. Sixty-nine percent of patients with fistulous disease experienced >50% reduction in their PDAI at 2 wk; mean duration of response, 10.9 wk. Four of 10 steroid-dependent patients (40%) discontinued steroid therapy, one of whom recommenced steroid therapy at 24 wk. Our clinical response rates mirror the efficacy reported in the controlled trials for active and fistulous disease. Steroid-sparing efficacy was seen in 40% of steroid-dependent patients. Concurrent steroids did not reduce the risk of significant infusion reactions (6.9%), but did increase the risk of infections.

  16. Correlation of transcranial Doppler ultrasonography with MRI and MRA in the evaluation of sickle cell disease patients with prior stroke

    International Nuclear Information System (INIS)

    Kogutt, M.S.; Goldwag, S.S.; Gupta, K.L.; Kaneko, K.; Humbert, J.R.

    1994-01-01

    We prospectively evaluated a group of patients with sickle cell disease and a clinical history of prior stroke, comparing transcranial Doppler sonography (TCD) to both magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) to determine its efficacy for the detection of flow abnormalities associated with prior cerebral infarction. Using MRI as the standard examination, there was 94 % sensitivity and 30 % specificity, and using MRA as the standard examination, there was 91 % sensitivity and 22 % specificity. We concur with other reports that the transcranial Doppler examination is a highly sensitive study. In our group of sickle cell disease patients with prior stroke, TCD reliably detected flow abnormalities that correlated to areas of prior cerebral infarction. (orig.)

  17. Periodontitis and gingivitis in inflammatory bowel disease: a case-control study.

    Science.gov (United States)

    Vavricka, Stephan R; Manser, Christine N; Hediger, Sebastian; Vögelin, Marius; Scharl, Michael; Biedermann, Luc; Rogler, Sebastian; Seibold, Frank; Sanderink, René; Attin, Thomas; Schoepfer, Alain; Fried, Michael; Rogler, Gerhard; Frei, Pascal

    2013-12-01

    The oral cavity is frequently affected in patients with inflammatory bowel disease (IBD), especially in patients with Crohn's disease (CD). Periodontitis is thought to influence systemic autoimmune or inflammatory diseases. We aimed to analyze the relationship of periodontitis and gingivitis markers with specific disease characteristics in patients with IBD and to compare these data with healthy controls. In a prospective 8-month study, systematic oral examinations were performed in 113 patients with IBD, including 69 patients with CD and 44 patients with ulcerative colitis. For all patients, a structured personal history was taken. One hundred thirteen healthy volunteers served as a control group. Oral examination focussed on established oral health markers for periodontitis (bleeding on probing, loss of attachment, and periodontal pocket depth) and gingivitis (papilla bleeding index). Additionally, visible oral lesions were documented. Both gingivitis and periodontitis markers were higher in patients with IBD than in healthy control. In univariate analysis and logistic regression analysis, perianal disease was a risk factor for periodontitis. Nonsmoking decreased the risk of having periodontitis. No clear association was found between clinical activity and periodontitis in IBD. In only the CD subgroup, high clinical activity (Harvey-Bradshaw index > 10) was associated with 1 periodontitis marker, the loss of attachment at sites of maximal periodontal pocket depth. Oral lesions besides periodontitis and gingivitis were not common, but nevertheless observed in about 10% of patients with IBD. IBD, and especially perianal disease in CD, is associated with periodontitis. Optimal therapeutic strategies should probably focus on treating both local oral and systemic inflammation.

  18. Efficacy and safety of certolizumab pegol induction therapy in an unselected Crohn's disease population: results of the FACTS survey.

    Science.gov (United States)

    Schoepfer, Alain M; Vavricka, Stephan R; Binek, Janek; Felley, Christian; Geyer, Martin; Manz, Michael; Rogler, Gerhard; de Saussure, Philippe; Sauter, Bernhard; Seibold, Frank; Straumann, Alex; Michetti, Pierre

    2010-06-01

    Switzerland was the first country to approve certolizumab pegol (Cimzia, CZP) for the treatment of patients with moderate to severe Crohn's disease (CD) in September 2007. This phase IV study aimed to evaluate the efficacy and safety of CZP in a Swiss multicenter cohort of practice-based patients. Baseline and Week 6 evaluation questionnaires were sent to all Swiss gastroenterologists in hospitals and private practices. Disease activity was assessed with the Harvey-Bradshaw Index (HBI) and adverse events were evaluated according to WHO guidelines. Fifty patients (31 women, 19 men) were included; 56% had complicated disease (stricture or fistula) and 52% had undergone prior CD-related surgery. All patients had prior exposure to systemic steroids, 96% to immunomodulators, 78% to infliximab, and 50% to adalimumab. A significant decrease in HBI was observed at Week 6 (versus Week 0) following induction therapy with CZP 400 mg subcutaneously at Weeks 0, 2, and 4 (12.6 +/- 4.7 Week 0 versus 6.2 +/- 4.4 Week 6, P < 0.001). Response and remission rates at Week 6 were 54% and 40%, respectively. We identified 8/11 CD patients undergoing a 50% fistula response (P = 0.021). The frequency of adverse drug reactions attributed to CZP was 6%. CZP was continued in 80% of patients beyond Week 6. In a population of CD patients with complicated disease behavior, CZP induced a response and remission in 54% and 40% of patients, respectively. This series provides the first evidence of the effectiveness of CZP in perianal fistulizing CD.

  19. Penetrating Disease, Narcotic Use, and Loop Ostomy Are Associated with Ostomy and IBD-related Complications After Ostomy Surgery in Crohn's Disease Patients.

    Science.gov (United States)

    Hirsch, Ayal; Yarur, Andres J; Dezheng, Hou; Rodriquez, Dylan; Krugliak Cleveland, Noa; Ali, Tauseef; Hurst, Roger D; Umanskiy, Konstantin; Hyman, Neil; Colwell, Janice; Rubin, David T

    2015-10-01

    For medically refractory or obstructive Crohn's disease (CD), ostomy surgery remains an important therapeutic option. Outcomes and complications of this approach have not been well described in the era of biological therapies. Our study aims to characterize CD patients undergoing ostomy creation and assess outcome predictors. We performed a retrospective chart review of CD patients who underwent ostomy creation in our center from 2011 to 2014. Data collected include patient demographics, detailed disease- and surgery-related variables, and clinical outcomes after 26 weeks of follow-up. Of the 112 patients, 54 % were female, the median age was 39 years (range 19-78), the median disease duration was 13 years (range 0-50), 54 % had ileo-colonic disease, 55 % had stricturing phenotype, and 59 % had perianal disease. Sixty-two percent received end ostomies, and 38 % received loop ostomies. The leading indications for surgery were stricturing, fistulizing, and perianal disease (35 %). Forty-three (38 %) patients had 76 major complications, including dehydration (22 cases), intra-abdominal infection (16), and obstruction (14). Increased major postoperative complications correlated with penetrating disease (p = 0.02, odds ratio [OR] = 5.52, 95 % confidence interval [CI] = 1.25-24.42), the use of narcotics before surgery (p = 0.04, OR = 2.54, 95 % CI = 1.02-6.34), and loop ostomies (p = 0.004, OR = 4.2, 95 % CI = 1.57-11.23). Penetrating phenotype, the use of narcotics before surgery, and loop ostomies are associated with major complications in CD patients undergoing ostomy creation. These findings may influence risk management of CD patients needing ostomies.

  20. Tumores perianais provocados pelo herpes simples Perianal tumors provoked by herpes simplex

    Directory of Open Access Journals (Sweden)

    Sidney Roberto Nadal

    2007-03-01

    Full Text Available O Herpes simplex (HSV é um DNA vírus que provoca afecções perianais, sendo considerada a causa mais comum das úlceras na região. Apesar da forma ulcerativa ser a mais conhecida, a literatura relata o aparecimento de lesões tumorais, nodulares ou hipertróficas relacionadas ao vírus. O exame proctológico mostra tumores dolorosos, achatados, com superfície recoberta por ulceração rasa e com bordas bem delimitadas, elevadas e lobuladas, localizados na margem anal e/ou no sulco interglúteo, algumas vezes imitando condilomas virais ou carcinoma. A anamnese revela instalação insidiosa com crescimento lento e progressivo, além da história de tratamentos anteriores para úlceras herpéticas. O diagnóstico diferencial com carcinoma impõe a realização de biópsia para confirmação histológica. Esse exame revela hiperplasia epitelial moderada e denso processo inflamatório com linfócitos e plasmócitos. Células gigantes e multinucleadas são observadas na epiderme. Os testes imunohistoquímicos sugerem o HSV. A opção terapêutica inicial deve ser o tratamento medicamentoso. Importante definir o diagnóstico etiológico para aliviar o desconforto e evitar operação radical desnecessária, e introduzir medicação anti-retroviral nos portadores do HIV para melhora da imunidade.Herpes simplex is a DNA virus which provokes perianal lesions, and it is the most frequent etiology of anal ulcer. Despite the ulcerative herpes being known worldwide, literature relates a tumoral, or nodular, or hypertrophic form related to this virus. Proctological examination showed nodules with a verrucous appearance and an ulcerated surface at the anal margin, sometimes mimicking viral condylomas or carcinomas. Anamnesis reveals insidious installation, slow growth and prior treatments for herpetic ulcers. The differential diagnoses with cancer allow us to perform biopsies for histological confirmation. This exam reveals mild epithelial hyperplasia and

  1. Evolution of disease phenotype in adult and pediatric onset Crohn’s disease in a population-based cohort

    Science.gov (United States)

    Lovasz, Barbara Dorottya; Lakatos, Laszlo; Horvath, Agnes; Szita, Istvan; Pandur, Tunde; Mandel, Michael; Vegh, Zsuzsanna; Golovics, Petra Anna; Mester, Gabor; Balogh, Mihaly; Molnar, Csaba; Komaromi, Erzsebet; Kiss, Lajos Sandor; Lakatos, Peter Laszlo

    2013-01-01

    AIM: To investigate the evolution of disease phenotype in adult and pediatric onset Crohn’s disease (CD) populations, diagnosed between 1977 and 2008. METHODS: Data of 506 incident CD patients were analyzed (age at diagnosis: 28.5 years, interquartile range: 22-38 years). Both in- and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database, which included incident patients diagnosed between January 1, 1977 and December 31, 2008 in adult and pediatric onset CD populations. Disease phenotype according to the Montreal classification and long-term disease course was analysed according to the age at onset in time-dependent univariate and multivariate analysis. RESULTS: Among this population-based cohort, seventy-four (12.8%) pediatric-onset CD patients were identified (diagnosed ≤ 17 years of age). There was no significant difference in the distribution of disease behavior between pediatric (B1: 62%, B2: 15%, B3: 23%) and adult-onset CD patients (B1: 56%, B2: 21%, B3: 23%) at diagnosis, or during follow-up. Overall, the probability of developing complicated disease behaviour was 49.7% and 61.3% in the pediatric and 55.1% and 62.4% in the adult onset patients after 5- and 10-years of follow-up. Similarly, time to change in disease behaviour from non stricturing, non penetrating (B1) to complicated, stricturing or penetrating (B2/B3) disease was not significantly different between pediatric and adult onset CD in a Kaplan-Meier analysis. Calendar year of diagnosis (P = 0.04), ileal location (P < 0.001), perianal disease (P < 0.001), smoking (P = 0.038) and need for steroids (P < 0.001) were associated with presence of, or progression to, complicated disease behavior at diagnosis and during follow-up. A change in disease location was observed in 8.9% of patients and it was associated with smoking status (P = 0.01), but not with age at diagnosis. CONCLUSION: Long

  2. Ciliated median raphe cyst of perineum presenting as perianal polyp: a case report with immunohistochemical study, review of literature, and pathogenesis.

    Science.gov (United States)

    Sagar, Jayesh; Sagar, Bethani; Patel, Adam F; Shak, D K

    2006-03-05

    Median raphe cyst is a very rare, benign congenital lesion occurring mainly on the ventral aspect of the penis, but can develop anywhere in the midline between the external urethral meatus and anus. We report a case of median raphe cyst in the perineum presenting as a perianal polyp in a 65-year-old, English white male with exceptionally rare ciliated epithelium. According to our knowledge, this is the third such case of ciliated median raphe cyst in the English literature. This case, also the first case of ciliated median raphe cyst in the perineum location, focuses on pathogenesis of median raphe cyst.

  3. Ciliated Median Raphe Cyst of Perineum Presenting as Perianal Polyp: A Case Report with Immunohistochemical Study, Review of Literature, and Pathogenesis

    Directory of Open Access Journals (Sweden)

    Jayesh Sagar

    2006-01-01

    Full Text Available Median raphe cyst is a very rare, benign congenital lesion occurring mainly on the ventral aspect of the penis, but can develop anywhere in the midline between the external urethral meatus and anus. We report a case of median raphe cyst in the perineum presenting as a perianal polyp in a 65-year-old, English white male with exceptionally rare ciliated epithelium. According to our knowledge, this is the third such case of ciliated median raphe cyst in the English literature. This case, also the first case of ciliated median raphe cyst in the perineum location, focuses on pathogenesis of median raphe cyst.

  4. A Brief Review of Viral and Bacterial Sexually Transmitted Diseases in Colorectal Practice

    Directory of Open Access Journals (Sweden)

    Nabi

    2015-12-01

    Full Text Available Context Sexually transmitted diseases (STDs are a common source of presentation to colorectal surgeons. Clinicians need to remain mindful of the possibility of STDs when faced with atypical clinical presentations. This article aims to provide surgeons with a synopsis of common pathogens, their clinical presentations, diagnostic investigations and treatment regimens. Evidence Acquisition The most common bacterial pathogens include Chlamydia trachomatis and Neisseria gonorrhea with synchronous infections at presentation occurring frequently. Patients often present with proctitis. Gonorrhea patients can also experience bloody purulent perianal discharge. Less common bacterial pathogens include syphilis, chancroid and donovanosis. The commonest STD worldwide remains human papillomavirus. Given its vast array of subtypes its manifestations include benign hyperproliferative lesions like perianal warts and extend to anal intraepithelial neoplasia and squamous cell carcinoma. Other important viral infections of the anorectum include human immunodeficiency virus and subsequent acquired immune deficiency disease as well as herpes simplex virus and molluscum contangiosum. Results Debate exists whether the increasing incidence of STDs affecting the anorectum reported in western literature represents a real increase or a reflection of greater patient and clinician recognition and reporting. Conclusions Regardless, a broad understanding of common bacterial and viral pathogens remains important part of modern colorectal practice. Remaining mindful of the manifestations of these common pathogens, options for diagnosis and management are important in disease control to limit the impact of these pathogens across the wider community.

  5. Mucosal healing with thalidomide in refractory Crohn's disease patients intolerant of anti-TNF-α drugs: report of 3 cases and literature review.

    Science.gov (United States)

    Scribano, Maria Lia; Cantoro, Laura; Marrollo, Marzia; Cosintino, Rocco; Kohn, Anna

    2014-07-01

    Thalidomide is an oral immunomodulatory and anti-inflammatory drug with antitumor necrosis factor-α (TNF-α) activity. Several case reports and some clinical trials have demonstrated its efficacy in the treatment of refractory Crohn's disease (CD). We report the effect and tolerability of thalidomide in 3 patients with moderate-to-severe CD who were not responsive to anti-TNF-α therapies, and review the relevant literature. The first case is of a 28-year-old female affected by Crohn's colitis complicated by a severe fistulizing perianal disease; she was treated with infliximab, adalimumab, and certolizumab pegol, which were stopped because of intolerance. The second case is of a 39-year-old female with fistulizing ileocolitis complicated by severe arthralgias and perianal disease with loss of response to infliximab and intolerance of certolizumab pegol. The third case is of a 39-year-old male with gastric and ileocolonic CD refractory to immunosuppressors and intolerant of infliximab. All the 3 cases achieved complete clinical remission and endoscopic healing of mucosal lesions at a low dose of thalidomide (50 to 150 mg/d). In our CD patients who experienced loss of response or were unable to tolerate anti-TNF-α drugs, thalidomide was an effective and well-tolerated therapy for inducing and maintaining long-term remission.

  6. Infliximab dependency in children with Crohn's disease

    DEFF Research Database (Denmark)

    Duricova, D; Pedersen, N; Lenicek, M

    2009-01-01

    BACKGROUND: Recently, infliximab dependency has been described. AIM: To assess frequency of ID in 82 consecutive Crohn's disease children treated with infliximab 2000-2006 and to describe clinical and genetic predictors of long-term infliximab response. METHODS: A phenotype model of infliximab...... dependency was used to assess treatment response: 'immediate outcome' (30 days after infliximab start)--complete/partial/no response. 'Long-term outcome': (i) prolonged response: maintenance of complete/partial response; (ii) infliximab dependency: relapse .../partial response. In long-term outcome, 22% maintained prolonged response, 12% had no response, while 66% became infliximab dependent. Perianal disease and no previous surgery were associated with infliximab dependency (OR 5.34, 95% CI: 1.24-22.55; OR 6.7, 95% CI: 1.67-26.61). No association was found with studied...

  7. Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Kotze

    2011-09-01

    Full Text Available There is no consensus on the ideal anesthesia for hemorrhoidectomy in ambulatory facilities. Spinal anesthesia and venous propofol associated with local perianal block (combined anesthesia are frequently used, and their direct costs may be crucial for the anesthesia type selection. The objective of this study was to compare the direct costs of anesthesia-related materials in hemorrhoidectomy between these two anesthetic techniques.Retrospective and cross-section analysis, comparing the direct costs of the materials of spinal and venous anesthesia with propofol associated with local perianal block, in hemorrhoidectomy. Twenty patients were included, ten submitted to each anesthesia type (five from each gender. The mean age in the spinal anesthesia group was 46.5 years and in the combined anesthesia group, 42.5 years (p=0.334. The mean cost of anesthesia-related materials was R$ 58.50 (R$ 36.48 - R$ 85.79 in the first group versus R$ 190.31 (R$ 98.16 - R$ 358.51 in the second - 69.27% difference between them (pNão há consenso sobre a técnica anestésica de escolha para hemorroidectomias em regime ambulatorial. A raquianestesia e a anestesia combinada (venosa com propofol + local são frequentemente utilizadas, e os custos das mesmas podem ser determinantes na escolha do melhor tipo de anestesia. O objetivo deste trabalho foi avaliar e comparar os custos diretos dos materiais anestésicos utilizados em hemorroidectomias entre essas duas técnicas. Foi feito um estudo retrospectivo e transversal, comparativo entre os custos diretos dos materiais anestésicos entre a raquianestesia e a anestesia venosa com poropofol associada ao bloqueio perianal local, em hemorroidectomias. Foram analisados 20 pacientes, 10 operados com cada técnica anestésica (5 de cada gênero. A média de idade do grupo da raquianestesia foi de 46,5 anos e do grupo da anestesia combinada foi de 42,5 anos (p=0,334. O custo médio do procedimento anestésico no primeiro grupo

  8. Correlation set analysis: detecting active regulators in disease populations using prior causal knowledge

    Directory of Open Access Journals (Sweden)

    Huang Chia-Ling

    2012-03-01

    Full Text Available Abstract Background Identification of active causal regulators is a crucial problem in understanding mechanism of diseases or finding drug targets. Methods that infer causal regulators directly from primary data have been proposed and successfully validated in some cases. These methods necessarily require very large sample sizes or a mix of different data types. Recent studies have shown that prior biological knowledge can successfully boost a method's ability to find regulators. Results We present a simple data-driven method, Correlation Set Analysis (CSA, for comprehensively detecting active regulators in disease populations by integrating co-expression analysis and a specific type of literature-derived causal relationships. Instead of investigating the co-expression level between regulators and their regulatees, we focus on coherence of regulatees of a regulator. Using simulated datasets we show that our method performs very well at recovering even weak regulatory relationships with a low false discovery rate. Using three separate real biological datasets we were able to recover well known and as yet undescribed, active regulators for each disease population. The results are represented as a rank-ordered list of regulators, and reveals both single and higher-order regulatory relationships. Conclusions CSA is an intuitive data-driven way of selecting directed perturbation experiments that are relevant to a disease population of interest and represent a starting point for further investigation. Our findings demonstrate that combining co-expression analysis on regulatee sets with a literature-derived network can successfully identify causal regulators and help develop possible hypothesis to explain disease progression.

  9. Comparative study of two doses of intrathecal dexmedetomidine as adjuvant with low dose hyperbaric bupivacaine in ambulatory perianal surgeries: A prospective randomised controlled study

    Directory of Open Access Journals (Sweden)

    K Sudheesh

    2015-01-01

    Full Text Available Background and Aims: Dexmedetomidine (DMT, as intrathecal adjuvant has been shown to successfully prolong duration of analgesia but delay the motor recovery. Hence, this study was designed to find out the dose of DMT which can provide satisfactory analgesia without prolonging motor block. Methods: A total of 50 patients scheduled for elective perianal surgeries were randomly allocated to Groups C or D (n = 25. Group D received hyperbaric bupivacaine 0.5% 4 mg + DMT 5 μg and Group C received hyperbaric bupivacaine 0.5% 4 mg + DMT 3 μg intrathecally. Onset and duration of sensory and motor blockade, duration of analgesia, time for ambulation and first urination were recorded. Adverse effects if any were noted. Results: Demographic characters, duration of surgery were comparable. The onset of sensory block to S1 was 9.61 ± 5.53 min in Group C compared to 7.69 ± 4.80 min in Group D (P = 0.35. Duration of sensory (145.28 ± 83.17 min – C, 167.85 ± 93.75 min – D, P = 0.5 and motor block (170.53 ± 73.44 min – C, 196.14 ± 84.28 min, P = 0.39 were comparable. Duration of analgesia (337.86 ± 105.11 min – C, 340.78 ± 101.81 min – D, P = 0.9 and time for ambulation (252.46 ± 93.72 min – C, 253.64 ± 88.04 min – D, P = 0.97 were also comparable. One patient in each group had urinary retention requiring catheterization. No other side effects were observed. Conclusion: Intrathecal DMT 3 μg dose does not produce faster ambulation compared to intrathecal DMT 5 μg though it produces comparable duration of analgesia for perianal surgeries.

  10. Inter-observer agreement for Crohn's disease sub-phenotypes using the Montreal Classification: How good are we? A multi-centre Australasian study.

    Science.gov (United States)

    Krishnaprasad, Krupa; Andrews, Jane M; Lawrance, Ian C; Florin, Timothy; Gearry, Richard B; Leong, Rupert W L; Mahy, Gillian; Bampton, Peter; Prosser, Ruth; Leach, Peta; Chitti, Laurie; Cock, Charles; Grafton, Rachel; Croft, Anthony R; Cooke, Sharon; Doecke, James D; Radford-Smith, Graham L

    2012-04-01

    Crohn's disease (CD) exhibits significant clinical heterogeneity. Classification systems attempt to describe this; however, their utility and reliability depends on inter-observer agreement (IOA). We therefore sought to evaluate IOA using the Montreal Classification (MC). De-identified clinical records of 35 CD patients from 6 Australian IBD centres were presented to 13 expert practitioners from 8 Australia and New Zealand Inflammatory Bowel Disease Consortium (ANZIBDC) centres. Practitioners classified the cases using MC and forwarded data for central blinded analysis. IOA on smoking and medications was also tested. Kappa statistics, with pre-specified outcomes of κ>0.8 excellent; 0.61-0.8 good; 0.41-0.6 moderate and ≤0.4 poor, were used. 97% of study cases had colonoscopy reports, however, only 31% had undergone a complete set of diagnostic investigations (colonoscopy, histology, SB imaging). At diagnosis, IOA was excellent for age, κ=0.84; good for disease location, κ=0.73; only moderate for upper GI disease (κ=0.57) and disease behaviour, κ=0.54; and good for the presence of perianal disease, κ=0.6. At last follow-up, IOA was good for location, κ=0.68; only moderate for upper GI disease (κ=0.43) and disease behaviour, κ=0.46; but excellent for the presence/absence of perianal disease, κ=0.88. IOA for immunosuppressant use ever and presence of stricture were both good (κ=0.79 and 0.64 respectively). IOA using MC is generally good; however some areas are less consistent than others. Omissions and inaccuracies reduce the value of clinical data when comparing cohorts across different centres, and may impair the ability to translate genetic discoveries into clinical practice. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

  11. Pancreatic-specific autoantibodies to glycoprotein 2 mirror disease location and behaviour in younger patients with Crohn’s disease

    Directory of Open Access Journals (Sweden)

    Bogdanos Dimitrios P

    2012-08-01

    Full Text Available Abstract Background Glycoprotein 2 (GP2 was discovered as the major autoantigen of Crohn’s disease (CD-specific pancreatic autoantibodies (PAB. We investigated anti-GP2 IgA and IgG antibodies as novel serological parameters in CD and assessed their association with distinct disease phenotypes. Methods Anti-GP2 and anti-Saccharomyces cerevisiae (ASCA IgA and IgG were detected by ELISA employing recombinant human GP2 and phosphopeptidomannan, respectively and PAB by indirect immunofluorescence (IIF in 271 sera, 169 with CD and 102 with ulcerative colitis (UC. As healthy controls 160 adult blood donors and 65 children were included. Results Anti-GP2 IgG and/or IgA were more prevalent in CD (51/169, 30.2% than in UC (9/102, 8.9% patients and in controls (9/225, 4% (p  Conclusions Anti-GP2 IgG and IgA, constituting novel CD specific autoantibodies, appear to be associated with distinct disease phenotypes identifying patients at a younger age, with ileocolonic location, and stricturing behaviour with perianal disease.

  12. Gut microbiota and inflammatory bowel disease: the role of antibiotics in disease management.

    Science.gov (United States)

    Kerman, David H; Deshpande, Amar R

    2014-07-01

    Imbalances in the composition and number of bacteria in the gut microbiota have been implicated in inflammatory bowel disease (IBD), and modulation of the gut microbiota by probiotics and antibiotics in IBD has been an active area of research, with mixed results. This narrative review summarizes the findings of relevant publications identified using the PubMed database. Although antibiotics have been associated with an increased risk of IBD development and flares, several meta-analyses demonstrate that antibiotics are efficacious for the induction of remission and treatment of flares in patients with IBD. Data supporting their use include a large number of antibiotic studies in Crohn's disease and evidence suggests antibiotics are efficacious in both Crohn's disease and ulcerative colitis, although there are fewer studies of the latter. For Crohn's disease, antibiotics have been shown to be useful for the induction of remission and in the postoperative management of patients undergoing surgery. Additionally, patients with fistulizing disease, particularly perianal, can benefit from antibiotics administered short term. Both antimicrobials and probiotics have been shown to be useful for the treatment of pouchitis. Additional randomized controlled trials are needed to further elucidate the role of bacteria in IBD and to better inform clinicians about appropriate antibiotic therapies.

  13. Pharmaceutically treated anxiety but not depression prior to cancer diagnosis predicts the onset of cardiovascular disease among breast cancer survivors

    NARCIS (Netherlands)

    Schoormans, Dounya; Van De Poll-franse, Lonneke; Vissers, Pauline; Van Herk-sukel, Myrthe P. P.; Pedersen, Susanne S.; Rottmann, Nina; Horsbøl, Trine; Dalton, Susanne; Denollet, Johan

    2017-01-01

    PURPOSE: To examine the associations between pharmaceutically treated anxiety and depression present in the year prior to breast cancer diagnosis and the risk of incident cardiovascular disease (CVD), while controlling for traditional cardiovascular risk factors and clinical characteristics in a

  14. Prophylactic antibiotic therapy prior to dental treatment for patients with end-stage renal disease.

    Science.gov (United States)

    Werner, C W; Saad, T F

    1999-01-01

    In the United States, there is a large and growing population of patients undergoing dialysis because of end-stage renal disease (ESRD). These patients present special management considerations for dentists, including antibiotic prophylaxis for the prevention of bacterial endocarditis (BE). ESRD patients, particularly those with an arteriovenous shunt for hemodialysis access, are predisposed to valvular endocarditis. Thus, BE prevention is the primary goal of antibiotic prophylaxis prior to dental or other invasive procedures in these patients. Bacteremia may predispose to infection of synthetic vascular access grafts, although this form of endovascular infection in ESRD patients has not been as well-characterized as BE. Antibiotic prophylaxis may be of some benefit for prevention of synthetic graft infections as well as BE. Poor dentist and physician compliance with BE prophylaxis regimens, as well as errors in dosing, timing, or duration of prophylaxis, have been reported. These problems are of particular concern in the treatment of chronically ill patients. In this article, we review the rationale for prophylactic antibiotic therapy prior to dental procedures in ESRD patients with vascular access. We also elaborate on the current American Heart Association guidelines for BE prophylaxis, and address special considerations for ESRD patients.

  15. Rare occurrence of metastasis from lung cancer to the anus: case report and review of the literature.

    Science.gov (United States)

    Al-Tarakji, Mohannad; Feilchenfeldt, Jonas; Haidar, Abdulrazzaq; Szabados, Lajos; Abdelaziem, Sherif; Sayed, Ali; Toro, Adriana; Di Carlo, Isidoro

    2016-06-08

    Anal metastases from lung cancer are infrequent, and there are only 10 published cases. Life expectancy is no longer than 1 year after diagnosis because of the typically advanced stage of disease. Treatment, which is typically inefficient, is administered with the intent to cure or avoid local complications. We report a case of a patient with non-small cell lung cancer presenting with perianal metastasis mimicking an abscess. Because perianal masses may be misdiagnosed, patients with lung and other cancers should be evaluated for metastatic disease.

  16. Defining the Most Appropriate Delivery Mode in Women with Inflammatory Bowel Disease: A Systematic Review.

    Science.gov (United States)

    Foulon, Arthur; Dupas, Jean-Louis; Sabbagh, Charles; Chevreau, Julien; Rebibo, Lionel; Brazier, Franck; Bouguen, Guillaume; Gondry, Jean; Fumery, Mathurin

    2017-05-01

    High cesarean section (CS) rates are observed in patients with inflammatory bowel disease (IBD), but limited data are available to support this decision. We conducted a comprehensive review to evaluate the most appropriate mode of delivery in women with IBD according to disease phenotype and activity, as well as surgical history. We searched MEDLINE (source PubMed) and international conference abstracts, and included all studies that evaluated digestive outcome after delivery in patients with IBD. A total of 41 articles or abstracts were screened, and 18 studies were considered in this review, with sample sizes ranging from 4 to 229 patients and follow-up ranging from 2 months to 7.7 years. Pooled CS rates in patients without Perianal Crohn's disease (PCD), healed PCD or active PCD, were 27%, 43%, and 46%, respectively. Regarding the median rate of new PCD (3.0% [IQR, 1.5-11.5] versus 6.5% [0-19.7]) or PCD recurrence (13.5% [3.2-32.7] versus 45% [0-58]), no increase was observed in patients with vaginal delivery compared to CS, but for patients with an active disease, worsening of symptoms was noted in two-thirds of cases. Episiotomy, perianal tears, and instrumental delivery did not influence the incidence of PCD. In patients with ileal pouch anal anastomosis, uncomplicated vaginal delivery seemed to moderately influence pouch function, with no significant difference in terms of overall continence, daytime, or night-time stool frequency, or incontinence. However, these parameters seemed negatively impacted by a complicated vaginal delivery. New long-term data from well-designed studies are needed, but our review suggests that systematic CS in patients suffering from IBD should probably be limited to women at risk of perineal tears and obstetric injuries, with an active PCD, or with ileal pouch anal anastomosis.

  17. [Cutaneous involvement in chronic inflammatory bowel disease : Crohn's disease and ulcerative colitis].

    Science.gov (United States)

    Richter, L; Rappersberger, K

    2016-12-01

    Over recent decades, both the incidence and prevalence of chronic inflammatory bowel disease have continued to rise in industrialized countries; the disease is frequently associated with extracutaneous involvement and comorbidity. The purpose of this work was to investigate the frequency and specificity of mucocutaneous manifestations in Crohn's disease (CD) and ulcerative colitis (UC). An extensive search in peer-reviewed journals via PubMed was performed; presented is a summary and analysis of various studies and data, including data of patients treated at our department. CD and UC are frequently associated with mucocutaneous symptoms; however, primary/specific disease-associations are exclusively seen in CD patients. These include peri-anal and -stomal fistulas and ulcerations, "metastatic" Crohn's disease as well as oral granulomatous disease. Moreover, in both CD and UC, there occur several other inflammatory skin conditions such as erythema nodosum, pyoderma gangrenosum, hidradenitis suppurativa, chronic oral aphthous disease, Sweet syndrome, pyostomatitis vegetans, and bowel-associated dermatosis-arthritis syndrome. Malnutrition syndromes (zinc and vitamin deficiencies) are only rarely observed. On skin and oral/genital mucous membranes various different inflammatory manifestations may be observed during the course of CD or UC. However, most data about a direct pathogenic relationship of the gastrointestinal and dermatologic disorders are quite heterogeneous or even contradictory. Nevertheless, knowledge of these conditions and their possible association with CD and UC could be crucial for early diagnosis and initiation of an appropriate therapy and thus be essential to prevent secondary tissue damage.

  18. Use of antibiotics in the treatment of Crohn's disease.

    Science.gov (United States)

    Scribano, Maria Lia; Prantera, Cosimo

    2013-02-07

    Many data coming from animal models and clinical observations support an involvement of intestinal microbiota in the pathogenesis of Crohn's disease (CD). It is hypothesized in fact, that the development of chronic intestinal inflammation is caused by an abnormal immune response to normal flora in genetically susceptible hosts. The involvement of bacteria in CD inflammation has provided the rationale for including antibiotics in the therapeutic armamentarium. However, randomized controlled trials have failed to demonstrate an efficacy of these drugs in patients with active uncomplicated CD, even if a subgroup of patients with colonic location seems to get benefit from antibiotics. Nitroimidazole compounds have been shown to be efficacious in decreasing CD recurrence rates in operated patients, and the use of metronidazole and ciprofloxacin is recommended in perianal disease. However, the appearance of systemic side effects limits antibiotic long-term employment necessary for treating a chronic relapsing disease. Rifaximin, characterized by an excellent safety profile, has provided promising results in inducing remission of CD.

  19. Use of antibiotics in the treatment of Crohn’s disease

    Science.gov (United States)

    Scribano, Maria Lia; Prantera, Cosimo

    2013-01-01

    Many data coming from animal models and clinical observations support an involvement of intestinal microbiota in the pathogenesis of Crohn’s disease (CD). It is hypothesized in fact, that the development of chronic intestinal inflammation is caused by an abnormal immune response to normal flora in genetically susceptible hosts. The involvement of bacteria in CD inflammation has provided the rationale for including antibiotics in the therapeutic armamentarium. However, randomized controlled trials have failed to demonstrate an efficacy of these drugs in patients with active uncomplicated CD, even if a subgroup of patients with colonic location seems to get benefit from antibiotics. Nitroimidazole compounds have been shown to be efficacious in decreasing CD recurrence rates in operated patients, and the use of metronidazole and ciprofloxacin is recommended in perianal disease. However, the appearance of systemic side effects limits antibiotic long-term employment necessary for treating a chronic relapsing disease. Rifaximin, characterized by an excellent safety profile, has provided promising results in inducing remission of CD. PMID:23429474

  20. Evaluation of the macula prior to cataract surgery.

    Science.gov (United States)

    McKeague, Marta; Sharma, Priya; Ho, Allen C

    2018-01-01

    To describe recent evidence regarding methods of evaluation of retinal structure and function prior to cataract surgery. Studies in patients with cataract but no clinically detectable retinal disease have shown that routine use of optical coherence tomography (OCT) prior to cataract surgery can detect subtle macular disease, which may alter the course of treatment or lead to modification of consent. The routine use of OCT has been especially useful in patients being considered for advanced-technology intraocular lenses (IOLs) as subtle macular disease can be a contraindication to the use of these lenses. The cost-effectiveness of routine use of OCT prior to cataract surgery has not been studied. Other technologies that assess retinal function rather than structure, such as microperimetry and electroretinogram (ERG) need further study to determine whether they can predict retinal potential in cataract patients. There is growing evidence for the importance of more detailed retinal evaluation of cataract patients even with clinically normal exam. OCT has been the most established and studied method for retinal evaluation in cataract patients, but other technologies such as microperimetry and ERG are beginning to be studied.

  1. Crohn Disease: Epidemiology, Diagnosis, and Management.

    Science.gov (United States)

    Feuerstein, Joseph D; Cheifetz, Adam S

    2017-07-01

    Crohn disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. For this review article, we performed a review of articles in PubMed through February 1, 2017, by using the following Medical Subject Heading terms: crohns disease, crohn's disease, crohn disease, inflammatory bowel disease, and inflammatory bowel diseases. Presenting symptoms are often variable and may include diarrhea, abdominal pain, weight loss, nausea, vomiting, and in certain cases fevers or chills. There are 3 main disease phenotypes: inflammatory, structuring, and penetrating. In addition to the underlying disease phenotype, up to a third of patients will develop perianal involvement of their disease. In addition, in some cases, extraintestinal manifestations may develop. The diagnosis is typically made with endoscopic and/or radiologic findings. Disease management is usually with pharmacologic therapy, which is determined on the basis of disease severity and underlying disease phenotype. Although the goal of management is to control the inflammation and induce a clinical remission with pharmacologic therapy, most patients will eventually require surgery for their disease. Unfortunately, surgery is not curative and patients still require ongoing therapy even after surgery for disease recurrence. Importantly, given the risks of complications from both Crohn disease and the medications used to treat the disease process, primary care physicians play an important role in optimizing the preventative care management to reduce the risk of complications. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  2. Ibrutinib for chronic graft-versus-host disease after failure of prior therapy.

    Science.gov (United States)

    Miklos, David; Cutler, Corey S; Arora, Mukta; Waller, Edmund K; Jagasia, Madan; Pusic, Iskra; Flowers, Mary E; Logan, Aaron C; Nakamura, Ryotaro; Blazar, Bruce R; Li, Yunfeng; Chang, Stephen; Lal, Indu; Dubovsky, Jason; James, Danelle F; Styles, Lori; Jaglowski, Samantha

    2017-11-23

    Chronic graft-versus-host disease (cGVHD) is a serious complication of allogeneic stem cell transplantation with few effective options available after failure of corticosteroids. B and T cells play a role in the pathophysiology of cGVHD. Ibrutinib inhibits Bruton tyrosine kinase in B cells and interleukin-2-inducible T-cell kinase in T cells. In preclinical models, ibrutinib reduced severity of cGVHD. This multicenter, open-label study evaluated the safety and efficacy of ibrutinib in patients with active cGVHD with inadequate response to corticosteroid-containing therapies. Forty-two patients who had failed 1 to 3 prior treatments received ibrutinib (420 mg) daily until cGVHD progression. The primary efficacy end point was cGVHD response based on 2005 National Institutes of Health criteria. At a median follow-up of 13.9 months, best overall response was 67%; 71% of responders showed a sustained response for ≥20 weeks. Responses were observed across involved organs evaluated. Most patients with multiple cGVHD organ involvement had a multiorgan response. Median corticosteroid dose in responders decreased from 0.29 mg/kg per day at baseline to 0.12 mg/kg per day at week 49; 5 responders discontinued corticosteroids. The most common adverse events were fatigue, diarrhea, muscle spasms, nausea, and bruising. Plasma levels of soluble factors associated with inflammation, fibrosis, and cGVHD significantly decreased over time with ibrutinib. Ibrutinib resulted in clinically meaningful responses with acceptable safety in patients with ≥1 prior treatments for cGVHD. Based on these results, ibrutinib was approved in the United States for treatment of adult patients with cGVHD after failure of 1 or more lines of systemic therapy. This trial was registered at www.clinicaltrials.gov as #NCT02195869. © 2017 by The American Society of Hematology.

  3. Pre-travel advice concerning vector-borne diseases received by travelers prior to visiting Cuzco, Peru.

    Science.gov (United States)

    Mejia, Christian R; Centeno, Emperatriz; Cruz, Briggitte; Cvetkovic-Vega, Aleksandar; Delgado, Edison; Rodriguez-Morales, Alfonso J

    2016-01-01

    Peru is an increasingly popular tourist destination that poses a risk to travelers due to endemic vector-borne diseases (VBDs). The objective of our study was to determine which factors are associated with receiving pre-travel advice (PTA) for VBDs among travelers visiting Cuzco, Peru. A cross-sectional secondary analysis based on data from a survey among travelers departing Cuzco at Alejandro Velazco Astete International Airport during the period January-March 2012 was conducted. From the 1819 travelers included in the original study, 1717 were included in secondary data analysis. Of these participants, 42.2% received PTA and 2.9% were informed about vector-borne diseases, including yellow fever (1.8%), malaria (1.6%) and dengue fever (0.1%). Receiving information on VBDs was associated with visiting areas endemic to yellow fever and dengue fever in Peru. The only disease travelers received specific recommendations for before visiting an endemic area for was yellow fever. Only 1 in 30 tourists received information on VBD prevention; few of those who traveled to an endemic area were warned about specific risks for infectious diseases prior to their trip. These important findings show that most tourists who travel to Peru do not receive PTA for the prevention of infectious and VBD, which can affect not only the travelers but their countries of origin as well. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  4. Transrectal ultrasonography of anorectal disease: advantages and disadvantages

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Ju [Dept. of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2015-01-15

    Transrectal ultrasonography (TRUS) has been widely accepted as a popular imaging modality for Epub ahead of print evaluating the lower rectum, anal sphincters, and pelvic floor in patients with various anorectal diseases. It provides excellent visualization of the layers of the rectal wall and of the anatomy of the anal canal. TRUS is an accurate tool for the staging of primary rectal cancer, especially for early stages. Although magnetic resonance imaging is a modality complementary to TRUS with advantages for evaluating the mesorectum, external sphincter, and deep pelvic inflammation, three-dimensional ultrasonography improves the detection and characterization of perianal fistulas and therefore plays a crucial role in optimal treatment planning. The operator should be familiar with the anatomy of the rectum and pelvic structures relevant to the preoperative evaluation of rectal cancer and other anal canal diseases, and should have technical proficiency in the use of TRUS combined with an awareness of its limitations compared to magnetic resonance imaging.

  5. Diagnosis and management of fistulizing Crohn's disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Rogler, Gerhard; Hahnloser, Dieter

    2009-01-01

    , are mostly asymptomatic and do not require intervention. By contrast, perianal fistulas can be painful and abscesses may develop that require surgical drainage with or without seton placement, transient ileostomy, or in severe cases, proctectomy. This Review describes the epidemiology and pathology...

  6. A CLINICAL STUDY ON PERI ANAL TUBERCULOSIS IN S.V.R.R.G.G. HOSPITAL TIRUPATI

    Directory of Open Access Journals (Sweden)

    Sobha Rani

    2015-09-01

    Full Text Available Tuberculosis around the anus is a rare form of extra pulmonary tuberculosis It is necessary to recognize it due to a specific treatment. (1 Perianal tuberculosis is an uncommon condition; it may not be easily distinguishable from the other inflammatory anal diseases. Undiagnosed cases are associated with high recurrence rates. Perianal tuberculosis can have varied presentation, frequently mimicking other common as well as rare diseases. Ano pe rianal tuberculosis may be associated with abdominal tuberculosis either as an extension of the original lesion or due to its spread via the lymphatics. AIMS & OBJECTIVES OF STUDY : To study the prevalence of ano - perianal tuberculosis in patients attending surgery OPD, SVRR Government General Hospital, Tirupati. To prevent recurrence and morbidity due to peri anal tuberculosis by early detection and intervention with anti tuberculous drugs . MATERIALS AND METHODS : STUDY DESIGN : Prospective study . STUDY SETTING : The present study was conducted at Department of General Surgery, SVRR Government General Hospital, and Tirupati. After getting institutional approval, written and informed consent was taken from each patient. PERIOD OF STUDY : 12 months . SAMPLE SI ZE : 142 patients who attended Surgery OP and were admitted in General Surgery ward, SVRR Government General Hospital, Tirupati with anal and perianal lesions like anal fistulae, perianal suppurations, growths, ulcers during the study period. INCLUSION CRIT ERIA : Age more than 15 years , Both men and women are included , Both sputum positive and negative for AFB , Both HIV positive and negative patients , All Anal and perianal (more than 3cm and within 3cm of anal verge lesions are included , Willingness of the p atient to participate in the study . EXCLUSION CRITERIA : Age less than 15 years , Patients who are not willing to participate in the study . CONCLUSION : Tuberculosis was responsible for 11% cases in recurrent fistula - in - ano

  7. Diagnosis and treatment of fistulising Crohn's disease

    DEFF Research Database (Denmark)

    Hvas, Christian Lodberg; Dahlerup, Jens Frederik; Jacobsen, Bent Ascanius

    2011-01-01

    . Definitive surgical closure of perianal fistulas using an advancement flap may be attempted, but this procedure is associated with a high risk of relapse. Colostomy and proctectomy are the ultimate surgical treatment options for fistulas. Intestinal resection is almost always needed for the closure...

  8. A changing trend in the management of patients with newly diagnosed Crohn's disease.

    LENUS (Irish Health Repository)

    Qasim, A

    2012-02-01

    BACKGROUND: Epidemiologic shift with rising incidence of Crohn\\'s disease (CD) has been reported in recent studies. AIMS: To determine disease behaviour and therapeutic interventions undertaken in newly diagnosed patients with CD. METHODS: Patients diagnosed with CD between January 2006 and June 2008 were included. Disease type, location, degree of involvement and type of therapeutic interventions were recorded. RESULTS: A total of 78 patients were included. Colonic, ileo-colonic, terminal ileal and isolated small bowel disease were present in 37, 27, 9 and 5 patients, respectively. Disease phenotype was inflammatory, stenosing and fistulising in 42, 30 and 6 patients, respectively. Surgery was required in 22 patients, including right hemicolectomy (n = 8), subtotal colectomy (n = 4), segmental colonic resection (n = 2), segmental small bowel resection (n = 2), appendectomy (n = 2) and perianal surgery (n = 4). Fourteen patients underwent surgery at the time of diagnosis. Laparoscopic surgery was performed in 14 patients. CONCLUSIONS: A significant proportion of newly diagnosed patients with CD underwent surgical intervention on their first admission to hospital. This may signify a changing trend in the management approach.

  9. Video-Assisted Anal Fistula Treatment: Pros and Cons of This Minimally Invasive Method for Treatment of Perianal Fistulas

    Directory of Open Access Journals (Sweden)

    Michal Romaniszyn

    2017-01-01

    Full Text Available Purpose. The purpose of this paper is to present results of a single-center, nonrandomized, prospective study of the video-assisted anal fistula treatment (VAAFT. Methods. 68 consecutive patients with perianal fistulas were operated on using the VAAFT technique. 30 of the patients had simple fistulas, and 38 had complex fistulas. The mean follow-up time was 31 months. Results. The overall healing rate was 54.41% (37 of the 68 patients healed with no recurrence during the follow-up period. The results varied depending on the type of fistula. The success rate for the group with simple fistulas was 73.3%, whereas it was only 39.47% for the group with complex fistulas. Female patients achieved higher healing rates for both simple (81.82% versus 68.42% and complex fistulas (77.78% versus 27.59%. There were no major complications. Conclusions. The results of VAAFT vary greatly depending on the type of fistula. The procedure has some drawbacks due to the rigid construction of the fistuloscope and the diameter of the shaft. The electrocautery of the fistula tract from the inside can be insufficient to close wide tracts. However, low risk of complications permits repetition of the treatment until success is achieved. Careful selection of patients is advised.

  10. Incidence, disease phenotype at diagnosis, and early disease course in inflammatory bowel diseases in Western Hungary, 2002-2006.

    Science.gov (United States)

    Lakatos, Laszlo; Kiss, Lajos S; David, Gyula; Pandur, Tunde; Erdelyi, Zsuzsanna; Mester, Gabor; Balogh, Mihaly; Szipocs, Istvan; Molnar, Csaba; Komaromi, Erzsebet; Lakatos, Peter Laszlo

    2011-12-01

    Recent trends indicate a change in the epidemiology of inflammatory bowel diseases (IBD), with previously low incidence areas now reporting a progressive rise in the incidence. Our aim was to analyze the incidence and disease phenotype at diagnosis in IBD in the population-based Veszprem Province database, which included incident patients diagnosed between January 1, 2002 and December 31, 2006. Data of 393 incident patients were analyzed (ulcerative colitis [UC]: 220, age-at-diagnosis: 40.5 years; Crohn's disease [CD]: 163, age-at-diagnosis: 32.5 years; and indeterminate colitis [IC]: 10). Both hospital and outpatient records were collected and comprehensively reviewed. Adjusted mean incidence rates were 8.9/10(5) person-years for CD and 11.9/10(5) person-years in UC. Peak onset age in both CD and UC patients was 21-30 years old. Location at diagnosis in UC was proctitis in 26.8%, left-sided colitis in 50.9%, and pancolitis in 22.3%. The probability of proximal extension and colectomy after 5 years was 12.7% and 2.8%. The disease location in CD was ileal in 20.2%, colonic in 35.6%, ileocolonic in 44.2%, and upper gastrointestinal in four patients. Behavior at diagnosis was stenosing/penetrating in 35.6% and perianal in 11.1%. Patients with colonic disease were older at diagnosis compared to patients with ileal or ileocolonic disease. In a Kaplan-Meier analysis, probability of surgical resection was 9.8%, 18.5%, and 21.3% after 1, 3, and 5 years of disease duration, respectively. The incidence of IBD in Veszprem Province in the last decade was high, equal to that in high-incidence areas in Western European countries. Early disease course is milder compared to data reported in the literature. Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.

  11. Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study.

    Science.gov (United States)

    van der Have, Mike; Belderbos, Tim D G; Fidder, Herma H; Leenders, Max; Dijkstra, Gerard; Peters, Charlotte P; Eshuis, Emma J; Ponsioen, Cyriel Y; Siersema, Peter D; van Oijen, Martijn G H; Oldenburg, Bas

    2014-10-01

    Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended. To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield. A multicentre retrospective study was conducted in Crohn's disease patients in whom infliximab or adalimumab was started between 2000 and 2010. Screening included tuberculin skin test, interferon-gamma release assay or chest X-ray for tuberculosis. Extended screening included screening for tuberculosis and viral infections. Patients were followed until three months after ending treatment. Primary endpoints were opportunistic and serious infections. 611 patients were included, 91% on infliximab. 463 (76%) patients were screened for tuberculosis, of whom 113 (24%) underwent extended screening. Screening for tuberculosis and hepatitis B increased to, respectively, 90-97% and 36-49% in the last two years. During a median follow-up of two years, 64/611 (9%, 3.4/100 patient-years) opportunistic infections and 26/611 (4%, 1.6/100 patient-years) serious infections were detected. Comorbidity was significantly associated with serious infections (hazard ratio 3.94). Although screening rates for tuberculosis and hepatitis B increased, screening for hepatitis B was still suboptimal. More caution is required when prescribing biologicals in patients with comorbid conditions. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  12. Anal Papilloma: An Exceptional Presentation of Fibrocystic Disease in Anogenital Mammary-Like Glands

    Directory of Open Access Journals (Sweden)

    Priya Subashchandrabose

    2015-01-01

    Full Text Available Previously ectopic breast tissue was thought to be derived from the caudal remnants of the primitive embryonic milk ridges; anogenital mammary-like glands are presently considered as normal constituents of the anogenital region. We report a case of young female, who presented with an anal papilloma. Histopathological examination revealed extensive fibrocystic changes in anogenital mammary-like glands. To date, a lot of benign changes and a wide range of benign and malignant neoplasms have been reported in these glands. However, extensive fibrocystic change of these glands in anal region is very rare. In addition, fibrocystic disease of anal mammary glands, masquerading clinically as an anal papilloma, has not been reported in literature. Hence, it is essential for clinicians and the pathologists to be aware of such a rare presentation. The features of fibrocystic disease in perianal region are also discussed.

  13. Anal Papilloma: An Exceptional Presentation of Fibrocystic Disease in Anogenital Mammary-Like Glands.

    Science.gov (United States)

    Subashchandrabose, Priya; Esakkai, Muthuvel; Venugopal, Palani; Kannaiyan, Ilavarasan; Srinivasan, Chitra; Reddy, Punuru Tejashwini; Ebenezer, Evelyn Elizabeth

    2015-01-01

    Previously ectopic breast tissue was thought to be derived from the caudal remnants of the primitive embryonic milk ridges; anogenital mammary-like glands are presently considered as normal constituents of the anogenital region. We report a case of young female, who presented with an anal papilloma. Histopathological examination revealed extensive fibrocystic changes in anogenital mammary-like glands. To date, a lot of benign changes and a wide range of benign and malignant neoplasms have been reported in these glands. However, extensive fibrocystic change of these glands in anal region is very rare. In addition, fibrocystic disease of anal mammary glands, masquerading clinically as an anal papilloma, has not been reported in literature. Hence, it is essential for clinicians and the pathologists to be aware of such a rare presentation. The features of fibrocystic disease in perianal region are also discussed.

  14. Sets of priors reflecting prior-data conflict and agreement

    NARCIS (Netherlands)

    Walter, G.M.; Coolen, F.P.A.; Carvalho, J.P.; Lesot, M.-J.; Kaymak, U.; Vieira, S.; Bouchon-Meunier, B.; Yager, R.R.

    2016-01-01

    Bayesian inference enables combination of observations with prior knowledge in the reasoning process. The choice of a particular prior distribution to represent the available prior knowledge is, however, often debatable, especially when prior knowledge is limited or data are scarce, as then

  15. Influence of antibiotic therapy prior to admission on the efficacy of classical methods for the diagnosis of meningococcal disease.

    Science.gov (United States)

    Nemescu, Roxana Elena; Iancu, Luminiţa Smaranda; Dorneanu, Olivia Simona; Ursu, Ramona Gabriela; Dorobăţ, Carmen Mihaela

    2014-01-01

    To assess the influence of preadmission antibiotic therapy on the results of the classical methods for bacteriological confirmation of meningococcal disease (MD). Retrospective study of the MD cases diagnosed in the "St. Parascheva" Universitary Clinical Infectious Diseases Iaşi between 1994 and 2011. The etiological diagnosis was made by identifying the meningococcus in the CSF (cerebrospinal fluid) in 71.9% of the 323 patients and by blood culture in 8%. Preadmission antibiotic therapy received 39% of the patients, thus the sensitivity of test was significantly reduced: direct examination from 64.6% to 43.2% (p antibiotic therapy significantly increased the ratio of cases in which meningococcus was not detected in CSF by any of the classical methods (44% compared to 17.9% in the cases without prior treatment). The proportion of cases in which meningococcal isolation was done by two methods decreased from 38.5% to 19.2%, and of those by all three methods from 16.9% to 5.6% (p antibiotic therapy also decreased the rate of positive blood cultures from 14.7% to 3.5% (Fisher's exact test, p = 0.009). Antibiotic treatment prior to admission significantly decreases the percentage of patients with MD in which meningococcal isolation can be done; this requires the use of a more sensitive diagnosis method (ex. qPCR).

  16. Partial regulatory T cell depletion prior to acute feline immunodeficiency virus infection does not alter disease pathogenesis.

    Directory of Open Access Journals (Sweden)

    S Rochelle Mikkelsen

    2011-02-01

    Full Text Available Feline immunodeficiency virus (FIV infection in cats follows a disease course similar to HIV-1, including a short acute phase characterized by high viremia, and a prolonged asymptomatic phase characterized by low viremia and generalized immune dysfunction. CD4(+CD25(hiFoxP3(+ immunosuppressive regulatory T (Treg cells have been implicated as a possible cause of immune dysfunction during FIV and HIV-1 infection, as they are capable of modulating virus-specific and inflammatory immune responses. Additionally, the immunosuppressive capacity of feline Treg cells has been shown to be increased during FIV infection. We have previously shown that transient in vivo Treg cell depletion during asymptomatic FIV infection reveals FIV-specific immune responses suppressed by Treg cells. In this study, we sought to determine the immunological influence of Treg cells during acute FIV infection. We asked whether Treg cell depletion prior to infection with the highly pathogenic molecular clone FIV-C36 in cats could alter FIV pathogenesis. We report here that partial Treg cell depletion prior to FIV infection does not significantly change provirus, viremia, or CD4(+ T cell levels in blood and lymphoid tissues during the acute phase of disease. The effects of anti-CD25 mAb treatment are truncated in cats acutely infected with FIV-C36 as compared to chronically infected cats or FIV-naïve cats, as Treg cell levels were heightened in all treatment groups included in the study within two weeks post-FIV infection. Our findings suggest that the influence of Treg cell suppression during FIV pathogenesis is most prominent after Treg cells are activated in the environment of established FIV infection.

  17. Partial regulatory T cell depletion prior to acute feline immunodeficiency virus infection does not alter disease pathogenesis.

    Science.gov (United States)

    Mikkelsen, S Rochelle; Long, Julie M; Zhang, Lin; Galemore, Erin R; VandeWoude, Sue; Dean, Gregg A

    2011-02-25

    Feline immunodeficiency virus (FIV) infection in cats follows a disease course similar to HIV-1, including a short acute phase characterized by high viremia, and a prolonged asymptomatic phase characterized by low viremia and generalized immune dysfunction. CD4(+)CD25(hi)FoxP3(+) immunosuppressive regulatory T (Treg) cells have been implicated as a possible cause of immune dysfunction during FIV and HIV-1 infection, as they are capable of modulating virus-specific and inflammatory immune responses. Additionally, the immunosuppressive capacity of feline Treg cells has been shown to be increased during FIV infection. We have previously shown that transient in vivo Treg cell depletion during asymptomatic FIV infection reveals FIV-specific immune responses suppressed by Treg cells. In this study, we sought to determine the immunological influence of Treg cells during acute FIV infection. We asked whether Treg cell depletion prior to infection with the highly pathogenic molecular clone FIV-C36 in cats could alter FIV pathogenesis. We report here that partial Treg cell depletion prior to FIV infection does not significantly change provirus, viremia, or CD4(+) T cell levels in blood and lymphoid tissues during the acute phase of disease. The effects of anti-CD25 mAb treatment are truncated in cats acutely infected with FIV-C36 as compared to chronically infected cats or FIV-naïve cats, as Treg cell levels were heightened in all treatment groups included in the study within two weeks post-FIV infection. Our findings suggest that the influence of Treg cell suppression during FIV pathogenesis is most prominent after Treg cells are activated in the environment of established FIV infection.

  18. Using autologous platelet-rich plasma for the treatment of complex fistulas

    Directory of Open Access Journals (Sweden)

    Almudena Moreno-Serrano

    Full Text Available Objective: This study aims to demonstrate the effectiveness and safety of autologous fibrin gel rich in platelet growth factors for the treatment of complex perianal fistulas. Material and methods: Prospective epidemiological study. Patients with complex perianal fistula or perianal fistula mere alteration of continence are included. identification of both holes and the journey, curettage of it and instillation of Vivostat PRF® in the way it is done to observe excess material by OFE. The variables analyzed were: age, sex, use of prior Seton clinic prevalent type of fistula, postoperative complications, fistula closure and impaired quality of life using the SF-36 test (v2. Results: From January 2011 to May 2013 have involved 23 patients, 12 men and 11 women, with an average age of 49 years and a minimum follow-up of 12 months. Two dropped out. 17 patients had low transsphincteric fistulas, 2 and 2 high transsphincteric intersphincteric with impaired continence. The most common symptom is the discharge. Twelve patients had a loose seton (62%, of which nine cured. Of all the patients we have operated the success rate is 62%. No patient developed incontinence after treatment. Only two reported a worse quality of life after surgery. Conclusion: This study demonstrates that there is a clear benefit to the use of Vivostat PRF® as a treatment for complex perianal fistulas. It is a highly reproducible technique with acceptable results and does not produce impairment of continence.

  19. Prior oral conditions in patients undergoing heart valve surgery.

    Science.gov (United States)

    Silvestre, Francisco-Javier; Gil-Raga, Irene; Martinez-Herrera, Mayte; Lauritano, Dorina; Silvestre-Rangil, Javier

    2017-11-01

    Patients scheduled for heart valve surgery should be free of any oral infectious disorders that might pose a risk in the postoperative period. Few studies have been made on the dental conditions of such patients prior to surgery. The present study describes the most frequent prior oral diseases in this population group. A prospective, observational case-control study was designed involving 60 patients (30 with heart valve disease and 30 controls, with a mean age of 71 years in both groups). A dental exploration was carried out, with calculation of the DMFT (decayed, missing and filled teeth) index and recording of the periodontal parameters (plaque index, gingival bleeding index, periodontal pocket depth, and attachment loss). The oral mucosa was also examined, and panoramic X-rays were used to identify possible intrabony lesions. Significant differences in bacterial plaque index were observed between the two groups ( p <0.05), with higher scores in the patients with valve disease. Probing depth and the presence of moderate pockets were also greater in the patients with valve disease than among the controls ( p <0.01). Sixty percent of the patients with valve disease presented periodontitis. Patients scheduled for heart valve surgery should be examined for possible active periodontitis before the operation. Those individuals found to have periodontal disease should receive adequate periodontal treatment before heart surgery. Key words: Valve disease, aortic, mitral, heart surgery, periodontitis.

  20. Survival End Points for Huntington Disease Trials Prior to a Motor Diagnosis.

    Science.gov (United States)

    Long, Jeffrey D; Mills, James A; Leavitt, Blair R; Durr, Alexandra; Roos, Raymund A; Stout, Julie C; Reilmann, Ralf; Landwehrmeyer, Bernhard; Gregory, Sarah; Scahill, Rachael I; Langbehn, Douglas R; Tabrizi, Sarah J

    2017-11-01

    Predictive genetic testing in Huntington disease (HD) enables therapeutic trials in HTT gene expansion mutation carriers prior to a motor diagnosis. Progression-free survival (PFS) is the composite of a motor diagnosis or a progression event, whichever comes first. To determine if PFS provides feasible sample sizes for trials with mutation carriers who have not yet received a motor diagnosis. This study uses data from the 2-phase, longitudinal cohort studies called Track and from a longitudinal cohort study called the Cooperative Huntington Observational Research Trial (COHORT). Track had 167 prediagnosis mutation carriers and 156 noncarriers, whereas COHORT had 366 prediagnosis mutation carriers and noncarriers. Track studies were conducted at 4 sites in 4 countries (Canada, France, England, and the Netherlands) from which data were collected from January 17, 2008, through November 17, 2014. The COHORT was conducted at 38 sites in 3 countries (Australia, Canada, and the United States) from which data were collected from February 14, 2006, through December 31, 2009. Results from the Track data were externally validated with data from the COHORT. The required sample size was estimated for a 2-arm prediagnosis clinical trial. Data analysis took place from May 1, 2016, to June 10, 2017. The primary end point is PFS. Huntington disease progression events are defined for the Unified Huntington's Disease Rating Scale total motor score, total functional capacity, symbol digit modalities test, and Stroop word test. Of Track's 167 prediagnosis mutation carriers, 93 (55.6%) were women, and the mean (SD) age was 40.06 (8.92) years; of the 156 noncarriers, 87 (55.7%) were women, and the mean (SD) age was 45.58 (10.30) years. Of the 366 COHORT participants, 229 (62.5%) were women and the mean (SD) age was 42.21 (12.48) years. The PFS curves of the Track mutation carriers showed good external validity with the COHORT mutation carriers after adjusting for initial progression. For

  1. Technetium-99m-HMPAO labeled leukocyte single photon emission computerized tomography (SPECT) for assessing Crohn's disease extent and intestinal infiltration.

    Science.gov (United States)

    Biancone, L; Schillaci, O; Capoccetti, F; Bozzi, R M; Fina, D; Petruzziello, C; Geremia, A; Simonetti, G; Pallone, F

    2005-02-01

    Scintigraphy using radiolabeled leukocytes is a useful technique for assessing intestinal infiltration in Crohn's disease (CD). However, limits of planar images include overlapping activity in other organs and low specificity. To investigate the usefulness of (99m)Tc-HMPAO (hexametyl propylene amine oxime) labeled leukocyte single photon emission computerized tomography (SPECT) for assessing CD lesions, in comparison with planar images. Twenty-two inflammatory bowel disease patients (19 CD; 2 ulcerative colitis, UC; 1 ileal pouch) assessed by conventional endoscopy or radiology were enrolled. Leukocytes were labeled with (99m)Tc-HMPAO. SPECT images were acquired at 2 h and planar images at 30 min and 2 h. Bowel uptake was quantitated in nine regions (score 0-3). Both SPECT and planar images detected a negative scintigraphy (score 0) in the UC patient with no pouchitis and a positive scintigraphy (score 1-3) in the 21 patients showing active inflammation by conventional techniques. SPECT showed a higher global score than planar images (0.71 +/- 0.09 vs 0.30 +/- 0.05; p < 0.001), and in particular in the right iliac fossa (p= 0.003), right and left flank (p < 0.001; p= 0.02), hypogastrium (p= 0.002), and mesogastrium (p < 0.001). SPECT provided a better visualization and a higher uptake than planar images in patients with ileal and ileocolonic CD (6.45 +/- 0.82 vs 2.8 +/- 0.55, p < 0.001; 5.5 +/- 1.6 vs 2.6 +/- 0.7, p= 0.03), and with perianal CD (6.6 +/- 1.6 vs 3.4 +/- 1.2; p= 0.03). (99m)Tc-HMPAO labeled leukocyte SPECT provides a more detailed visualization of CD lesions than planar images. This technique may better discriminate between intestinal and bone marrow uptake, thus being useful for assessing CD lesions within the pelvis, including perianal disease.

  2. Elicitation of expert prior opinion: application to the MYPAN trial in childhood polyarteritis nodosa.

    Directory of Open Access Journals (Sweden)

    Lisa V Hampson

    Full Text Available Definitive sample sizes for clinical trials in rare diseases are usually infeasible. Bayesian methodology can be used to maximise what is learnt from clinical trials in these circumstances. We elicited expert prior opinion for a future Bayesian randomised controlled trial for a rare inflammatory paediatric disease, polyarteritis nodosa (MYPAN, Mycophenolate mofetil for polyarteritis nodosa.A Bayesian prior elicitation meeting was convened. Opinion was sought on the probability that a patient in the MYPAN trial treated with cyclophosphamide would achieve disease remission within 6-months, and on the relative efficacies of mycophenolate mofetil and cyclophosphamide. Expert opinion was combined with previously unseen data from a recently completed randomised controlled trial in ANCA associated vasculitis.A pan-European group of fifteen experts participated in the elicitation meeting. Consensus expert prior opinion was that the most likely rates of disease remission within 6 months on cyclophosphamide or mycophenolate mofetil were 74% and 71%, respectively. This prior opinion will now be taken forward and will be modified to formulate a Bayesian posterior opinion once the MYPAN trial data from 40 patients randomised 1:1 to either CYC or MMF become available.We suggest that the methodological template we propose could be applied to trial design for other rare diseases.

  3. Perianal Dermatitis, Its Incidence, and Patterns of Topical Therapies in a Level IV Neonatal Intensive Care Unit.

    Science.gov (United States)

    Malik, Anuj; Witsberger, Emily; Cottrell, Lesley; Kiefer, Autumn; Yossuck, Panitan

    2018-04-01

     To define the incidence of perianal dermatitis (PD) and determine the usage pattern and cost efficacy of diaper products among neonates admitted to a level IV neonatal intensive care unit (NICU) including those with a diagnosis of neonatal abstinence syndrome (NAS).  A retrospective cohort study to evaluate neonates with PD based on number of orders for Aquaphor, Bagbalm, Desitin, Flanders, or Nystatin. Various demographic and clinical parameters were recorded. Usage patterns of these five products were analyzed, and their costs estimated. Subgroup analysis was performed among infants with NAS.  Of 1,241 admissions, 56.2% had at least one diaper product ordered during their NICU stay, while 52.6% had multiple products ordered. Only 23.0% of all neonates had appropriate documentation of PD. The most common product ordered first was Aquaphor (64.3%), followed by Desitin (19.2%). Note that 86% term NAS infants had PD compared with 28% term non-NAS infants. The estimated product cost was $14,139 over 2 years, averaging $20 per patient.  Over half of NICU neonates were exposed to one or more diaper products, usually without documented PD diagnosis. Term NAS infants had three times higher incidence of PD than term non-NAS infants. The cost of diaper product use was significant, and possibly underestimated due to lack of documentation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  4. Cardiovascular events in type 2 diabetes: comparison with nondiabetic individuals without and with prior cardiovascular disease. 10-year follow-up of the Hoorn Study.

    NARCIS (Netherlands)

    Becker, A.E.; Bos, G.; Vegt, F. de; Kostense, P.J.; Dekker, J.M.; Nijpels, G.; Heine, R.J.; Bouter, L.M.; Stehouwer, C.D.A.

    2003-01-01

    AIMS: We questioned whether prior cardiovascular disease has the same impact on risk of cardiovascular events as type 2 diabetes, and whether this differed between men and women. METHODS AND RESULTS: To address these issues we compared the 10-year risk of cardiovascular events among 208 Caucasian

  5. Cardiovascular events in type 2 diabetes : comparison with nondiabetic individuals without and with prior cardiovascular disease. 10-year follow-up of the Hoorn Study

    NARCIS (Netherlands)

    Becker, Annemarie; Bos, Griët; de Vegt, Femmie; Kostense, Piet J; Dekker, Jacqueline M; Nijpels, Giel; Heine, Robert J; Bouter, Lex M; Stehouwer, Coen D A

    AIMS: We questioned whether prior cardiovascular disease has the same impact on risk of cardiovascular events as type 2 diabetes, and whether this differed between men and women. METHODS AND RESULTS: To address these issues we compared the 10-year risk of cardiovascular events among 208 Caucasian

  6. Cardiovascular events in type 2 diabetes: comparison with nondiabetic individuals without and with prior cardiovascular disease - 10-year follow-up of the Hoorn Study

    NARCIS (Netherlands)

    Becker, A.; Bos, G.; de Vegt, F.; Kostense, P.J.; Dekker, J.M.; Nijpels, G.; Heine, R.J.; Bouter, L.M.; Stehouwer, C.D.A.

    2003-01-01

    Aims: We questioned whether prior cardiovascular disease has the same impact on risk of cardiovascular events as type 2 diabetes, and whether this differed between men and women. Methods and results: To address these issues we compared the 10-year risk of cardiovascular events among 208 Caucasian

  7. Prior Elicitation, Assessment and Inference with a Dirichlet Prior

    Directory of Open Access Journals (Sweden)

    Michael Evans

    2017-10-01

    Full Text Available Methods are developed for eliciting a Dirichlet prior based upon stating bounds on the individual probabilities that hold with high prior probability. This approach to selecting a prior is applied to a contingency table problem where it is demonstrated how to assess the prior with respect to the bias it induces as well as how to check for prior-data conflict. It is shown that the assessment of a hypothesis via relative belief can easily take into account what it means for the falsity of the hypothesis to correspond to a difference of practical importance and provide evidence in favor of a hypothesis.

  8. Comparison of single-dose and double-dose thallium-201 myocardial perfusion scintigraphy for the detection of coronary artery disease and prior myocardial infarction

    International Nuclear Information System (INIS)

    Blood, D.K.; McCarthy, D.M.; Sciacca, R.R.; Cannon, P.J.

    1978-01-01

    Thallium-201 myocardial perfusion scintigraphy was performed after exercise, 4 hours after exercise (redistribution) and after a separate rest injection in 87 patients undergoing coronary arteriography. Significant coronary lesions were present in 62 of the patients. Interpretation of the rest and redistribution scintiscans was the same in 69 patients, 45 of whom had coronary artery disease (CAD). In 16 of the 17 patients with CAD and differing interpretations, defects were present on redistribution scintiscans but not on rest scintiscans; 11 of these patients had evidence of prior transmural myocardial infarction and the other five had an occluded coronary artery supplying the region of the defect. Redistribution scintiscans were more sensitive than rest scintiscans for the detection of prior myocardial infarction (93% vs 54%; P < 0.01). The increased sensitivity was confined to the detection of prior inferior myocardial infarctions. In 36 of 38 patients with persistent perfusion defects on 4-hour redistribution scintiscans, either a prior infarction or an occluded coronary vessel was present. These data demonstrate that redistribution thallium-201 scintiscans may be substituted for conventional rest scintiscans, resulting in reduced cost and radiation exposure to the patients

  9. Pharmaceutically treated anxiety but not depression prior to cancer diagnosis predicts the onset of cardiovascular disease among breast cancer survivors

    DEFF Research Database (Denmark)

    Schoormans, Dounya; van de Poll-Franse, Lonneke; Vissers, Pauline

    2017-01-01

    PURPOSE: To examine the associations between pharmaceutically treated anxiety and depression present in the year prior to breast cancer diagnosis and the risk of incident cardiovascular disease (CVD), while controlling for traditional cardiovascular risk factors and clinical characteristics...... adjustment for depression, traditional cardiovascular risk factors, and clinical characteristics......., anxiety, and depression. By multivariable Cox regression analysis, we examined the risk associated with pharmaceutically treated anxiety and depression for developing CVD after cancer diagnosis, adjusting for age, pharmaceutically treated hypertension, hypercholesterolemia, and diabetes mellitus...

  10. Disease severity in familial cases of IBD.

    Science.gov (United States)

    Andreu, M; Márquez, L; Domènech, E; Gisbert, J P; García, V; Marín-Jiménez, I; Peñalva, M; Gomollón, F; Calvet, X; Merino, O; Garcia-Planella, E; Vázquez-Romero, N; Esteve, M; Nos, P; Gutiérrez, A; Vera, I; Cabriada, J L; Martín, M D; Cañas-Ventura, A; Panés, J

    2014-03-01

    Phenotypic traits of familial IBD relative to sporadic cases are controversial, probably related to limited statistical power of published evidence. To know if there are phenotype differences between familial and sporadic IBD, evaluating the prospective Spanish registry (ENEIDA) with 11,983 cases. 5783 patients (48.3%) had ulcerative colitis (UC) and 6200 (51.7%) Crohn's disease (CD). Cases with one or more 1st, 2nd or 3rd degree relatives affected by UC/CD were defined as familial case. In UC and CD, familial cases compared with sporadic cases had an earlier disease onset (UC: 33 years [IQR 25-44] vs 37 years [IQR 27-49]; p<0.0001); (CD: 27 years [IQR 21-35] vs 29 years [IQR 22-40]; p<0.0001), higher prevalence of extraintestinal immune-related manifestations (EIMs) (UC: 17.2% vs 14%; p=0.04); (CD: 30.1% vs 23.6%; p<0.0001). Familial CD had higher percentage of ileocolic location (42.7% vs 51.8%; p=0.0001), penetrating behavior (21% vs 17.6%; p=0.01) and perianal disease (32% vs 27.1%; p=0.003). Differences are not influenced by degree of consanguinity. When a sufficiently powered cohort is evaluated, familial aggregation in IBD is associated to an earlier disease onset, more EIMs and more severe phenotype in CD. This feature should be taken into account at establishing predictors of disease course. © 2013.

  11. Management of acute colorectal diseases in febrile neutropenic patients

    Directory of Open Access Journals (Sweden)

    Camila Perazzoli

    2014-07-01

    Full Text Available Patients with hematologic malignancies are susceptible to serious complications due to immunosuppression. Neutropenic-related infection is one of the major causes of morbidity and mortality in this group of diseases. Febrile neutropenia is a common complication of the hematologic neoplasm itself or chemotherapy, and has worse prognosis if prolonged (lasting more than 7 days or severe (neutrophil count below 500 cells per μL. Among the usual sites of infection, we highlight the neutropenic enterocolitis and perianal infection as gastrointestinal complications of greater interest to the colorectal surgeon. Although most cases respond to conservative treatment, a portion of patients will need surgery for complete recovery. Resumo: Os pacientes com neoplasias hematológicas estão sujeitos a uma séria de complicações devido à imunossupressão. Infecção é umas das principais causas de morbidade e mortalidade nesse grupo de doenças. A neutropenia febril é uma complicação frequente da própria doença onco-hematológica ou da quimioterapia, e apresenta pior prognóstico se prolongada (duração acima de 7 dias ou severa (contagem de neutrófilos inferior a 500 células por microlitro. Dentre os focos de infecção mais comuns destacamos a enterocolite neutropênica e a infecção perianal como complicações de maior interesse para o cirurgião colorretal. Apesar de grande parte dos casos apresentar boa resposta ao tratamento conservador, uma parcela de pacientes necessitará de cirurgia para completa recuperação. Keywords: Febrile neutropenia, Typhlitis, Anal canal, Palavras-chave: Neutropenia febril, Tiflite, Canal anal

  12. Comparing topical hydrocortisone cream with Hai's Perianal Support in managing symptomatic hemorrhoids in pregnancy: a preliminary trial.

    Science.gov (United States)

    Lim, Soo Soo; Yu, Chye Wah; Aw, Lin Da

    2015-02-01

    The prevalence of hemorrhoids among pregnant women is high in late pregnancy. This study was to evaluate the efficacy between drug treatment with Procort (topical hydrocortisone cream 1%) and mechanical treatment with a Hai's Perianal Support (HPS) toilet seat device in managing symptomatic hemorrhoids during the third trimester of pregnancy. A prospective randomized controlled study was conducted on 23 pregnant women with gestation above the 28th week and presented with symptomatic hemorrhoids. Pre- and post-interventional assessment was carried out to obtain data on symptoms of pain, itching, swelling, discomfort and bleeding associated with hemorrhoids. The control group was treated with topical hydrocortisone cream 1% and the test group was provided and taught to use a HPS, a posterior perineal support toilet seat device (Colorec). The results showed improvement in symptoms of pain, swelling, bleeding, itching and discomfort in both the test and control groups. However, statistically significant differences were found on symptoms of pain, swelling and discomfort between the test and control groups. There was also a statistically significant difference in well-being and overall improvement between the test and control groups. HPS has to a certain extent significantly reduced the symptoms of hemorrhoids in pregnancy and improved the well-being of pregnant women in comparison with topical treatment with hydrocortisone cream. However, more clinical trials need to be carried out to recomfirm the role of HPS in hemorrhoids in pregnancy. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  13. Morbidity prior to a Diagnosis of Sleep-Disordered Breathing

    DEFF Research Database (Denmark)

    Jennum, Poul; Ibsen, Rikke Falkner; Kjellberg, Jakob

    2013-01-01

    Sleep-disordered breathing (SDB) causes burden to the sufferer, the healthcare system, and society. Most studies have focused on cardiovascular diseases (CVDs) after a diagnosis of obstructive sleep apnea (OSA) or obesity hypoventilation syndrome (OHS); however, the overall morbidity prior...

  14. Smoking does influence disease behaviour and impacts the need for therapy in Crohn's disease in the biologic era.

    Science.gov (United States)

    Nunes, T; Etchevers, M J; Domènech, E; García-Sánchez, V; Ber, Y; Peñalva, M; Merino, O; Nos, P; Garcia-Planella, E; Casbas, A G; Esteve, M; Taxonera Samsó, C; Montoro Huguet, M; Gisbert, J P; Martín Arranz, M D; García-Sepulcre, M F; Barreiro-de Acosta, M; Beltrán, B; Alcaide Suárez, N; Saro Gismera, C; Cabriada, J L; Cañas-Ventura, A; Gomollón, F; Panés, J

    2013-10-01

    Recently, the notion that smoking may adversely affect Crohn's disease (CD) outcomes has been challenged by the suggestion that the widespread use of immunosuppressants and anti-TNF drugs might offset the adverse effects of tobacco. To reassess the influence of tobacco smoking on disease phenotype and complications on a time-dependent analysis, taking into account the different therapeutic interventions. We designed a retrospective cohort study of 3224 patients with Crohn's disease. The data were collected from the Spanish national inflammatory bowel disease registry (ENEIDA), including information regarding demographics, clinical characteristics, disease complications, therapeutic interventions and smoking status. Patients were classified as nonsmokers, smokers and former smokers, according to their present and past smoking habits. In the univariate analysis, smokers had more strictures (22.6% vs. 19.3%, P < 0.05) and less colonic involvement (7.2% vs. 10.9%, P < 0.05), and were more frequently under treatment with steroids (91.6% vs. 85.8%, P < 0.05), immunosuppressants (73.5% vs. 63.6% P < 0.05) or anti-TNF drugs (31.4% vs. 25.1%, P < 0.05) than nonsmokers. In the time-dependent multivariate analysis, smokers were found to have a significantly decreased survival free of stricturing disease (HR: 1.5, CI 95% 1.18-1.90) or perianal complications (HR: 1.50, CI 95% 1.01-1.46), and had a higher risk for requiring thiopurine therapy (HR: 1.20, CI 95% 1.05-1.30). These results suggest that, despite the widespread use of immunosuppressants and anti-TNF drugs, smokers with Crohn's disease still have a more severe disease course, with increased therapeutic requirements when compared with nonsmokers. © 2013 John Wiley & Sons Ltd.

  15. Hemorrhoids and anal fissures in inflammatory bowel disease.

    Science.gov (United States)

    D'Ugo, S; Stasi, E; Gaspari, A L; Sileri, P

    2015-12-01

    Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis.

  16. Comparing the new European cardiovascular disease prevention guideline with prior American Heart Association guidelines: an editorial review.

    Science.gov (United States)

    Ton, Van-Khue; Martin, Seth S; Blumenthal, Roger S; Blaha, Michael J

    2013-05-01

    Atherosclerotic heart disease and stroke remain the leading causes of death and disability worldwide. Cardiovascular disease (CVD) prevention can improve the well-being of a population and possibly cut downstream healthcare spending, and must be the centerpiece of any sustainable health economy model. As lifestyle and CVD risk factors differ among ethnicities, cultures, genders, and age groups, an accurate risk assessment model is the critical first step for guiding appropriate use of testing, lifestyle counseling resources, and preventive medications. Examples of such models include the US Framingham Risk Score and the European SCORE system. The European Society of Cardiology recently published an updated set of guidelines on CVD prevention. This review highlights the similarities and differences between European and US risk assessment models, as well as their respective recommendations on the use of advanced testing for further risk reclassification and the appropriate use of medications. In particular, we focus on head-to-head comparison of the new European guideline with prior American Heart Association statements (2002, 2010, and 2011) covering risk assessment and treatment of asymptomatic adults. Despite minor disagreements on the weight of recommendations in certain areas, such as the use of coronary calcium score and non-high-density lipoprotein cholesterol in risk assessment, CVD prevention experts across the 2 continents agree on 1 thing: prevention works in halting the progression of atherosclerosis and decreasing disease burden over a lifetime. © 2012 Wiley Periodicals, Inc.

  17. Pharmaceutically treated anxiety but not depression prior to cancer diagnosis predicts the onset of cardiovascular disease among breast cancer survivors.

    Science.gov (United States)

    Schoormans, Dounya; van de Poll-Franse, Lonneke; Vissers, Pauline; van Herk-Sukel, Myrthe P P; Pedersen, Susanne S; Rottmann, Nina; Horsbøl, Trine; Dalton, Susanne; Denollet, Johan

    2017-11-01

    To examine the associations between pharmaceutically treated anxiety and depression present in the year prior to breast cancer diagnosis and the risk of incident cardiovascular disease (CVD), while controlling for traditional cardiovascular risk factors and clinical characteristics in a population-based observational study. Adult 1-year breast cancer survivors (n = 7227), diagnosed between 01-01-1999 and 12-31-2010, with no history of CVD, were selected from the Netherlands Cancer Registry. Drug dispensing data were derived from the PHARMO Database Network and used as proxy for CVD, anxiety, and depression. By multivariable Cox regression analysis, we examined the risk associated with pharmaceutically treated anxiety and depression for developing CVD after cancer diagnosis, adjusting for age, pharmaceutically treated hypertension, hypercholesterolemia, and diabetes mellitus in the year prior to cancer diagnosis, tumor stage, and cancer treatment. During the 13-year follow-up period, 193 (3%) breast cancer survivors developed CVD. Women pharmaceutically treated for anxiety in the year prior to their cancer diagnosis had a 48% increased hazard for CVD [HR = 1.48; 95% CI 1.05-1.08] after full adjustment. This association was restricted to breast cancer survivors who were 65 years or younger. Depression was not associated with CVD risk [HR = 0.89; 95% CI 0.52-1.53]. Older age [HR = 1.06; 95% CI 1.05-1.08], hypertension [HR = 1.80; 95% CI 1.32-2.46], and hypercholesterolemia [HR = 1.63; 95% CI 1.15-2.33] were associated with an increased hazard for incident CVD, whereas hormone therapy [HR = 0.59; 95% CI 0.42-0.83] was protective. Anxiety present in the year prior to breast cancer diagnosis increases the risk of incident CVD in 1-year breast cancer survivors, after adjustment for depression, traditional cardiovascular risk factors, and clinical characteristics.

  18. External Prior Guided Internal Prior Learning for Real-World Noisy Image Denoising

    Science.gov (United States)

    Xu, Jun; Zhang, Lei; Zhang, David

    2018-06-01

    Most of existing image denoising methods learn image priors from either external data or the noisy image itself to remove noise. However, priors learned from external data may not be adaptive to the image to be denoised, while priors learned from the given noisy image may not be accurate due to the interference of corrupted noise. Meanwhile, the noise in real-world noisy images is very complex, which is hard to be described by simple distributions such as Gaussian distribution, making real noisy image denoising a very challenging problem. We propose to exploit the information in both external data and the given noisy image, and develop an external prior guided internal prior learning method for real noisy image denoising. We first learn external priors from an independent set of clean natural images. With the aid of learned external priors, we then learn internal priors from the given noisy image to refine the prior model. The external and internal priors are formulated as a set of orthogonal dictionaries to efficiently reconstruct the desired image. Extensive experiments are performed on several real noisy image datasets. The proposed method demonstrates highly competitive denoising performance, outperforming state-of-the-art denoising methods including those designed for real noisy images.

  19. Combining Magnetic Resonance Imaging (MRI) and Medical Infrared Thermography (MIT) in the pre- and per-operating management of severe Hidradenitis Suppurativa (HS).

    Science.gov (United States)

    Derruau, Stéphane; Renard, Yohann; Pron, Hervé; Taiar, Redha; Abdi, Ellie; Polidori, Guillaume; Lorimier, Sandrine

    2018-05-12

    Hidradenitis suppurativa (HS) is a chronic, inflammatory, and recurrent skin disease. Surgical excision of wounds appears to be the only curative treatment for the prevention of recurrence of moderate to severe stages. Magnetic resonance imaging (MRI) is a standard reference examination for the detection of HS peri-anal inflammatory fistula. In this case study, the use of real-time medical infrared thermography, in combination with MRI as appropriate imaging, is proposed. The aim is to assist surgeons in the pre- and peri-surgical management of severe perianal hidradenitis suppurativa with the intent to ensure that all diseased lesions were removed during surgery and therefore to limit recurrence. The results show that medical infrared thermography (MIT), coupled with MRI, could be highly effective strategy to address thermally distinguished health tissues and inflammatory sites during excision, as characterised by differential increases in temperature. Medical infrared thermography could be used to check the total excision of inflammatory lesions as a noninvasive method that is not painful, not radiant, and is easily transportable during surgery. Ultimately, this method could be complementary with MRI in providing clinicians with objective data on the status of tissues below the perianal skin surface in the pre- and per-operating management of severe hidradenitis suppurativa. Copyright © 2018 Elsevier B.V. All rights reserved.

  20. Endoluminal MR imaging of the rectum and anus: technique, applications, and pitfalls

    NARCIS (Netherlands)

    J. Stoker (Jacob); E. Rociu (Elena); A.W. Zwamborn; W.R. Schouten (Ruud); J.S. Lameris

    1999-01-01

    textabstractAnorectal diseases (e.g., fecal incontinence, perianal and anovaginal fistulas, anorectal tumors) require imaging for proper case management. Endoluminal magnetic resonance (MR) imaging has become an important part of diagnostic work-up in such cases.

  1. The effect of Atorvastatin therapy tumour necrosis factor- and vascular adhesion molecules in patients with type 2 diabetes mellitus with no prior history of coronary heart disease

    NARCIS (Netherlands)

    Soedamah-Muthu, S.S.; Charlton-Menys, V.; Bao, W.; Schalkwijk, C.G.; Stehouwer, C.D.A.; Colhoun, H.M.; Betteridge, D.J.; Durrington, P.; Hitman, G.; Neil, H.A.W.; Livingstone, S.J.; Fuller, J.H.; DeMicco, D.A.; Preston, G.M.

    2011-01-01

    We examined the effect of atorvastatin (and placebo) on tumour necrosis factor (TNF)a, soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular cell adhesion molecule-1 (sICAM-1) in patients with type 2 diabetes without prior cardiovascular disease (CVD) and investigated whether

  2. Clinical utility of carotid duplex ultrasound prior to cardiac surgery.

    Science.gov (United States)

    Lin, Judith C; Kabbani, Loay S; Peterson, Edward L; Masabni, Khalil; Morgan, Jeffrey A; Brooks, Sara; Wertella, Kathleen P; Paone, Gaetano

    2016-03-01

    Clinical utility and cost-effectiveness of carotid duplex examination prior to cardiac surgery have been questioned by the multidisciplinary committee creating the 2012 Appropriate Use Criteria for Peripheral Vascular Laboratory Testing. We report the clinical outcomes and postoperative neurologic symptoms in patients who underwent carotid duplex ultrasound prior to open heart surgery at a tertiary institution. Using the combined databases from our clinical vascular laboratory and the Society of Thoracic Surgery, a retrospective analysis of all patients who underwent carotid duplex ultrasound within 13 months prior to open heart surgery from March 2005 to March 2013 was performed. The outcomes between those who underwent carotid duplex scanning (group A) and those who did not (group B) were compared. Among 3233 patients in the cohort who underwent cardiac surgery, 515 (15.9%) patients underwent a carotid duplex ultrasound preoperatively, and 2718 patients did not (84.1%). Among the patients who underwent carotid screening vs no screening, there was no statistically significant difference in the risk factors of cerebrovascular disease (10.9% vs 12.7%; P = .26), prior stroke (8.2% vs 7.2%; P = .41), and prior transient ischemic attack (2.9% vs 3.3%; P = .24). For those undergoing isolated coronary artery bypass grafting (CABG), 306 (17.8%) of 1723 patients underwent preoperative carotid duplex ultrasound. Among patients who had carotid screening prior to CABG, the incidence of carotid disease was low: 249 (81.4%) had minimal or mild stenosis (duplex scanning and those who did not. Primary outcomes of patients who underwent open heart surgery also showed no difference in the perioperative mortality (5.1% vs 6.9%; P = .14) and stroke (2.6% vs 2.4%; P = .85) between patients undergoing preoperative duplex scanning and those who did not. Operative intervention of severe carotid stenosis prior to isolated CABG occurred in 2 of the 17 patients (11.8%) identified who

  3. Short-term Effects of Ambient Air Pollution on Emergency Department Visits for Asthma: An Assessment of Effect Modification by Prior Allergic Disease History

    Directory of Open Access Journals (Sweden)

    Juhwan Noh

    2016-09-01

    Full Text Available Objectives The goal of this study was to investigate the short-term effect of ambient air pollution on emergency department (ED visits in Seoul for asthma according to patients’ prior history of allergic diseases. Methods Data on ED visits from 2005 to 2009 were obtained from the Health Insurance Review and Assessment Service. To evaluate the risk of ED visits for asthma related to ambient air pollutants (carbon monoxide [CO], nitrogen dioxide [NO2], ozone [O3], sulfur dioxide [SO2], and particulate matter with an aerodynamic diameter <10 μm [PM10], a generalized additive model with a Poisson distribution was used; a single-lag model and a cumulative-effect model (average concentration over the previous 1-7 days were also explored. The percent increase and 95% confidence interval (CI were calculated for each interquartile range (IQR increment in the concentration of each air pollutant. Subgroup analyses were done by age, gender, the presence of allergic disease, and season. Results A total of 33 751 asthma attack cases were observed during the study period. The strongest association was a 9.6% increase (95% CI, 6.9% to 12.3% in the risk of ED visits for asthma per IQR increase in O3 concentration. IQR changes in NO2 and PM10 concentrations were also significantly associated with ED visits in the cumulative lag 7 model. Among patients with a prior history of allergic rhinitis or atopic dermatitis, the risk of ED visits for asthma per IQR increase in PM10 concentration was higher (3.9%; 95% CI, 1.2% to 6.7% than in patients with no such history. Conclusions Ambient air pollutants were positively associated with ED visits for asthma, especially among subjects with a prior history of allergic rhinitis or atopic dermatitis.

  4. [Perianal condylomes and diagnosis of syphilis].

    Science.gov (United States)

    Pedersen, Anders Elm; Knudsen, Troels Bygum; Sand, Carsten

    2012-01-30

    Syphilis is still a serious disease with diagnostic difficulties. In the present clinical case a patient had a routine serology screen for syphilis and HIV at a venerology clinic. He had previously presented with anogenital tumors, but the diagnosis was uncertain. A polymerase chain reaction (PCR) analysis was performed in addition to serology, and the diagnosis of syphilis in the secondary stage was confirmed. This case demonstrates how PCR technology can assist in the diagnosis of syphilis at early stages and underlines the importance of syphilis screening in homosexual men presenting with anogenital complaints.

  5. Response to baricitinib based on prior biologic use in patients with refractory rheumatoid arthritis

    Science.gov (United States)

    Genovese, Mark C; Kremer, Joel M; Kartman, Cynthia E; Schlichting, Douglas E; Xie, Li; Carmack, Tara; Pantojas, Carlos; Sanchez Burson, Juan; Tony, Hans-Peter; Macias, William L; Rooney, Terence P; Smolen, Josef S

    2018-01-01

    Abstract Objective RA patients who have failed biologic DMARDs (bDMARDs) represent an unmet medical need. We evaluated the effects of baseline characteristics, including prior bDMARD exposure, on baricitinib efficacy and safety. Methods RA-BEACON patients (previously reported) had moderate to severe RA with insufficient response to one or more TNF inhibitor and were randomized 1:1:1 to once-daily placebo or 2 or 4 mg baricitinib. Prior bDMARD use was allowed. The primary endpoint was a 20% improvement in ACR criteria (ACR20) at week 12 for 4 mg vs placebo. An exploratory, primarily post hoc, subgroup analysis evaluated efficacy at weeks 12 and 24 by ACR20 and Clinical Disease Activity Index (CDAI) ⩽10. An interaction P-value ⩽0.10 was considered significant, with significance at both weeks 12 and 24 given more weight. Results The odds ratios predominantly favored baricitinib over placebo and were generally similar to those in the overall study (3.4, 2.4 for ACR20 weeks 12 and 24, respectively). Significant quantitative interactions were observed for baricitinib 4 mg vs placebo at weeks 12 and 24: ACR20 by region (larger effect Europe) and CDAI ⩽10 by disease duration (larger effect ⩾10 years). No significant interactions were consistently observed for ACR20 by age; weight; disease duration; seropositivity; corticosteroid use; number of prior bDMARDs, TNF inhibitors or non-TNF inhibitors; or a specific prior TNF inhibitor. Treatment-emergent adverse event rates, including infections, appeared somewhat higher across groups with greater prior bDMARD use. Conclusion Baricitinib demonstrated a consistent, beneficial treatment effect in bDMARD-refractory patients across subgroups based on baseline characteristics and prior bDMARD use. Trial registration ClinicalTrials.gov (https://clinicaltrials.gov/), NCT01721044 PMID:29415145

  6. Constrained noninformative priors

    International Nuclear Information System (INIS)

    Atwood, C.L.

    1994-10-01

    The Jeffreys noninformative prior distribution for a single unknown parameter is the distribution corresponding to a uniform distribution in the transformed model where the unknown parameter is approximately a location parameter. To obtain a prior distribution with a specified mean but with diffusion reflecting great uncertainty, a natural generalization of the noninformative prior is the distribution corresponding to the constrained maximum entropy distribution in the transformed model. Examples are given

  7. Endoluminal MR imaging of the rectum and anus: technique, applications, and pitfalls

    NARCIS (Netherlands)

    Stoker, J.; Rociu, E.; Zwamborn, A. W.; Schouten, W. R.; Laméris, J. S.

    1999-01-01

    Anorectal diseases (e.g., fecal incontinence, perianal and anovaginal fistulas, anorectal tumors) require imaging for proper case management. Endoluminal magnetic resonance (MR) imaging has become an important part of diagnostic work-up in such cases. Optimal endoluminal MR imaging requires careful

  8. Short communication: risk factors for methicillin-resistant Staphylococcus aureus colonization among HIV patients at hospital admission.

    Science.gov (United States)

    Lee, Linda K; Win, Mar Kyaw; Veeraraghavan, Meyyur A; Wong, Chia Siong; Chow, Angela L; Leo, Yee-Sin

    2013-05-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen that has become increasingly prominent in hospitals and the community. HIV-positive patients may be one of the most MRSA-susceptible populations because of their immunocompromised status. At the Communicable Disease Centre, Tan Tock Seng Hospital, Singapore, we implemented a universal MRSA screening program and performed a case-control study to identify risk factors for MRSA colonization among 294 HIV patients at admission from January 2009 to January 2010. Among 54 HIV-positive patients who were MRSA positive at hospital admission, 16 (29.6%) were positive at the nares/axilla/groin (NAG; one combined swab), 14 (25.9%) were NAG and perianal positive, 3 (5.6%) were NAG and throat positive, 10 (18.5%) were NAG, perianal, and throat positive, 6 (11.1%) were throat positive, and 5 (9.3%) were perianal positive. Upon multivariate analysis, we found that age [odds ratio (OR)=1.04, 95% confidence interval (CI): 1.01-1.07, p=0.006] and CD4 count hospital admission.

  9. Fiber and colorectal diseases: Separating fact from fiction

    Science.gov (United States)

    Tan, Kok-Yang; Seow-Choen, Francis

    2007-01-01

    Whilst fruits and vegetables are an essential part of our dietary intake, the role of fiber in the prevention of colorectal diseases remains controversial. The main feature of a high-fiber diet is its poor digestibility. Soluble fiber like pectins, guar and ispaghula produce viscous solutions in the gastrointestinal tract delaying small bowel absorption and transit. Insoluble fiber, on the other hand, pass largely unaltered through the gut. The more fiber is ingested, the more stools will have to be passed. Fermentation in the intestines results in build up of large amounts of gases in the colon. This article reviews the physiology of ingestion of fiber and defecation. It also looks into the impact of dietary fiber on various colorectal diseases. A strong case cannot be made for a protective effect of dietary fiber against colorectal polyp or cancer. Neither has fiber been found to be useful in chronic constipation and irritable bowel syndrome. It is also not useful in the treatment of perianal conditions. The fiber deficit - diverticulosis theory should also be challenged. The authors urge clinicians to keep an open mind about fiber. One must be aware of the truths and myths about fiber before recommending it. PMID:17696243

  10. Crohn's disease in a Saudi outpatient population: Is it still rare?

    International Nuclear Information System (INIS)

    AlMofarreh, Mohammad A; Al Mofleh, Ibrahim A; AlJebreen Abdulrahman M; AlTeimi, Ibrahim N

    2009-01-01

    To determine the epidemiology of Crohn's disease (CD) in an outpatient clinic and compare it with data previously reported from different centers in the Kingdom of Saudi Arabia and outside. The medical records of all patients with CD seen in the clinic in the period from January 1993 through December 2007 were reviewed. The demographic, clinical data and methods of diagnosis were retrieved. Over a period of 15 years, we saw 133 Saudi patients with CD. They were predominantly young, with a median age of 26.2 years and male preponderance (2.3:1). The final diagnosis was established within 1 week of presentation in 47% of the patients. The leading symptoms were abdominal pain (88%), diarrhea (70%), bloating (61%), rectal bleeding (50%), weight loss (33%), constipation (24%) and perianal disease (23%). The diagnosis was established by endoscopy and histopathology. Ileocecal involvement was encountered in 40% of the patients. From the current study, it is obviously possible to diagnose a large proportion of patients with CD in a gastroenterology outpatient clinic. The data revealed a strikingly increased incidence of CD in a mainly young Saudi population in the past few years. (author)

  11. Unusual presentation of early lymphogranuloma venereum in an HIV-1 infected patient: effective treatment with 1 g azithromycin

    NARCIS (Netherlands)

    R.F. Nieuwenhuis; J.M. Ossewaarde (Jacobus); W.I. van der Meijden (Willem); H.A.M. Neumann (Martino)

    2003-01-01

    textabstractThe incidence of lymphogranuloma venereum (LGV) is low in the western world. Early LGV is characterised by bubonic disease following a painless papule or small ulcer. We report a white bisexual male who presented with a painful perianal ulcer, inguinal lymphadenitis,

  12. Diverting Ileostomy for the Treatment of Severe, Refractory, Pediatric Inflammatory Bowel Disease.

    Science.gov (United States)

    Maxwell, Elizabeth C; Dawany, Noor; Baldassano, Robert N; Mamula, Petar; Mattei, Peter; Albenberg, Lindsey; Kelsen, Judith R

    2017-09-01

    Diverting ileostomy is used as a temporizing therapy in patients with perianal Crohn disease; however, little data exist regarding its use for colonic disease. The primary aim of the present study was to determine the role of diversion in severe refractory colonic inflammatory bowel disease (IBD) in a pediatric population. Retrospective study of patients who underwent diverting ileostomy at The Children's Hospital of Philadelphia from 2000 to 2014 for the management of severe, refractory colonic IBD. Clinical variables were compared in the 1 year before ileostomy and 1 year after diversion. Surgical and disease outcomes including changes in diagnosis were reviewed through 2015. Twenty-four patients underwent diverting ileostomy for refractory colonic disease. Initial diagnoses were Crohn disease in 10 (42%), ulcerative colitis in 1 (4%), and IBD-unclassified in 13 patients (54%). Comparing data before and after surgery, there were statistically significant improvements in height and weight velocities, height velocity z score, blood transfusion requirement, hemoglobin, and hospitalization rates. Chronic steroid use decreased from 71% to 22%. At the conclusion of the study, 10 patients had undergone subsequent colectomy, 7 had successful bowel reanastomosis, and 7 remain diverted. Seven patients (29%) had a change in diagnosis. There were 13 surgical complications in 7 subjects, including prolapse reduction, stoma revision, and resection of ischemic bowel. In pediatric patients with refractory colonic IBD, diverting ileostomy can be a successful intervention to induce clinical stability. Importantly, diversion is a steroid-sparing therapy and allows additional time to clarify the diagnosis.

  13. Phenotypic concordance in familial inflammatory bowel disease (IBD). Results of a nationwide IBD Spanish database.

    Science.gov (United States)

    Cabré, Eduard; Mañosa, Míriam; García-Sánchez, Valle; Gutiérrez, Ana; Ricart, Elena; Esteve, Maria; Guardiola, Jordi; Aguas, Mariam; Merino, Olga; Ponferrada, Angel; Gisbert, Javier P; Garcia-Planella, Esther; Ceña, Gloria; Cabriada, José L; Montoro, Miguel; Domènech, Eugeni

    2014-07-01

    Disease outcome has been found to be poorer in familial inflammatory bowel disease (IBD) than in sporadic forms, but assessment of phenotypic concordance in familial IBD provided controversial results. We assessed the concordance for disease type and phenotypic features in IBD families. Patients with familial IBD were identified from the IBD Spanish database ENEIDA. Families in whom at least two members were in the database were selected for concordance analysis (κ index). Concordance for type of IBD [Crohn's disease (CD) vs. ulcerative colitis (UC)], as well as for disease extent, localization and behaviour, perianal disease, extraintestinal manifestations, and indicators of severe disease (i.e., need for immunosuppressors, biological agents, and surgery) for those pairs concordant for IBD type, were analyzed. 798 out of 11,905 IBD patients (7%) in ENEIDA had familial history of IBD. Complete data of 107 families (231 patients and 144 consanguineous pairs) were available for concordance analyses. The youngest members of the pairs were diagnosed with IBD at a significantly younger age (p<0.001) than the oldest ones. Seventy-six percent of pairs matched up for the IBD type (κ=0.58; 95%CI: 0.42-0.73, moderate concordance). There was no relevant concordance for any of the phenotypic items assessed in both diseases. Familial IBD is associated with diagnostic anticipation in younger individuals. Familial history does not allow predicting any phenotypic feature other than IBD type. Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  14. A Simulation of Pell Grant Awards and Costs Using Prior-Prior Year Financial Data

    Science.gov (United States)

    Kelchen, Robert; Jones, Gigi

    2015-01-01

    We examine the likely implications of switching from a prior year (PY) financial aid system, the current practice in which students file the Free Application for Federal Student Aid (FAFSA) using income data from the previous tax year, to prior-prior year (PPY), in which data from two years before enrollment is used. While PPY allows students to…

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

    Science.gov (United States)

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

    2014-05-01

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

  16. Describing a new syndrome in L5-S1 disc herniation: Sexual and sphincter dysfunction without pain and muscle weakness

    Directory of Open Access Journals (Sweden)

    Nezih Akca

    2014-01-01

    Full Text Available Context: Little seems to be known about the sexual dysfunction (SD in lumbar intervertebral disc herniation. Aims: Investigation of sexual and sphincter dysfunction in patient with lumbar disc hernitions. Settings and Design: A retrospective analysis. Materials and Methods: Sexual and sphincter dysfunction in patients admitted with lumbar disc herniations between September 2012-March 2014. Statistical Analysis Used: Statistical analysis was performed using the Predictive Analytics SoftWare (PASW Statistics 18.0 for Windows (Statistical Package for the Social Sciences, SPSS Inc., Chicago, Illinois. The statistical significance was set at P < 0.05. The Wilcoxon signed ranks test was used to evaluate the difference between patients. Results: Four patients with sexual and sphincter dysfunction were found, including two women and two men, aged between 20 and 52 years. All of them admitted without low back pain. In addition, on neurological examination, reflex and motor deficit were not found. However, almost all patients had perianal sensory deficit and sexual and sphincter dysfunction. Magnetic resonance imaging (MRI of three patients displayed a large extruded disc fragment at L5-S1 level on the left side. In fourth patient, there were not prominent disc herniations. There was not statistically significant difference between pre-operative and post-operative sexual function, anal-urethral sphincter function, and perianal sensation score. A syndrome in L5-S1 disc herniation with sexual and sphincter dysfunction without pain and muscle weakness was noted. We think that it is crucial for neurosurgeons to early realise that paralysis of the sphincter and sexual dysfunction are possible in patients with lumbar L5-S1 disc disease. Conclusion: A syndrome with perianal sensory deficit, paralysis of the sphincter, and sexual dysfunction may occur in patients with lumbar L5-S1 disc disease. The improvement of perianal sensory deficit after surgery was

  17. Autologous blood stem-cell transplantation in patients with advanced Hodgkin's disease and prior radiation to the pelvic site

    International Nuclear Information System (INIS)

    Koerbling, M.H.; Holle, R.; Haas, R.; Knauf, W.; Doerken, B.H.; Ho, A.D.; Kuse, R.; Pralle, H.; Fliedner, T.M.; Hunstein, W.

    1990-01-01

    Patients with relapsed Hodgkin's disease who respond to salvage therapy are successfully treated with cyclophosphamide, carmustine (BCNU), and etoposide (VP-16) (CBV) followed by autologus bone marrow transplantation (ABMT). Because of heavy pretreatment including radiation to the pelvic site, marrow harvest was not feasible in those patients. We therefore used blood-derived hemopoietic precursor cells as an alternative stem-cell source to rescue them after superdose chemotherapy. Hemopoietic precursor cells were mobilized into the peripheral blood either by chemotherapeutic induction of transient myelosuppression followed by an overshooting of blood stem-cell concentration, or by continuous intravenous (IV) granulocyte-macrophage colony-stimulating factor (GM-CSF) administration. The median time to reach 1,000 WBC per microliter, 500 polymorphonuclear cells (PMN) per microliter, or 20,000 platelets per microliter was 10, 20.5, and 38 days, respectively, for 50% of all patients. The platelet counts of two patients never dropped below 20,000/microL following autologous blood stem-cell transplantation (ABSCT), whereas two other patients had to be supported with platelets for 75 and 86 days posttransplant until a stable peripheral platelet count of 20,000/microL was attained. Among the 11 assessable patients, seven are in unmaintained complete remission (CR) at a median follow-up of 318 days. This is a first report on a series of ABSCTs in patients with advanced Hodgkin's disease proving that, despite prior damage to the marrow site, the circulating stem-cell pool is still a sufficient source of hemopoietic precursor cells for stem-cell rescue

  18. Inflammatory bowel disease in pregnancy

    Institute of Scientific and Technical Information of China (English)

    Dawn B Beaulieu; Sunanda Kane

    2011-01-01

    Crohn's disease and ulcerative colitis affect women in their child-bearing years. Family planning has come to be a common discussion between the gastroenterologist and the inflammatory bowel disease (IBD) patient.Disease control prior to desired conception and throughout pregnancy is the most important thing to keep in mind when caring for the IBD patient. Continued medical management during pregnancy is crucial in optimizing outcomes. Studies indicate that quiescent disease prior to conception infer the best pregnancy outcomes, similar to those in the general population.Active disease prior to and during pregnancy, can lead to complications such as pre-term labor, low birth weight, and small for gestational age infants. Although there are no definitive long term effects of pregnancy on IBD, there are some limited studies that suggest that it may alter the disease course. Understanding the literature and its limitations is important in the modern era of IBD care. Educating the patient and taking a team approach with the obstetrician will help achieve successful outcomes for mother and baby.

  19. Morbidity prior to a diagnosis of sleep-disordered breathing: a controlled national study.

    Science.gov (United States)

    Jennum, Poul; Ibsen, Rikke; Kjellberg, Jakob

    2013-02-01

    Sleep-disordered breathing (SDB) causes burden to the sufferer, the healthcare system, and society. Most studies have focused on cardiovascular diseases (CVDs) after a diagnosis of obstructive sleep apnea (OSA) or obesity hypoventilation syndrome (OHS); however, the overall morbidity prior to an SDB diagnosis has not been evaluated. The aim of this study was to identify morbidity prior to a SDB diagnosis to identify patients at risk for having/developing SDB. Using data from the Danish National Patient Registry (1998-2006), we identified all patients nationwide given a diagnosis of OSA (19,438) or OHS (755) in all hospitals and clinics. For each patient, we randomly selected 4 citizens matched for age, sex, and socioeconomic status from the Danish Civil Registration System Statistics. Patients with OSA or OHS presented with increased morbidity at least 3 years prior to their SDB diagnosis. The most common contacts with the health system (odds ratio [OR]/confidence interval [CI]) for OSA/OHS were due to musculoskeletal system (1.36[1.29-1.42]/1.35[1.05-1.74]); CVD (1.38[1.30-1.46]/1.80[1.38-2.34]); endocrine, nutritional, and metabolic diseases (1.62[1.50-1.76]/4.10[2.90-5.78]); diseases of the nervous system (1.62[1.0-1.76]/3.54[2.56-4.88]); respiratory system (1.84[1.73-1.96]/2.83[2.07-3.89]); skin and subcutaneous tissue (1.18[1.07-1.30]/2.12[1.33-3.38]); gastrointestinal (1.17[1.10-1.24]/NS); infections (1.20[1.08-1.33]/NS); genitourinary system (1.21[1.13-1.30]/NS); and ear, nose, and throat (1.44[1.32-1.56]/NS). Patients with SDB show significant morbidities several years prior to a diagnosis of OSA or OHS. OSA should be considered in all medical specialties as an important comorbidity. In our study, evidence points to particular emphasis for considering this diagnosis in endocrinology and metabolic specialties.

  20. Receiver Operating Characteristic Analysis for Classification Based on Various Prior Probabilities of Groups with an Application to Breath Analysis

    Science.gov (United States)

    Cimermanová, K.

    2009-01-01

    In this paper we illustrate the influence of prior probabilities of diseases on diagnostic reasoning. For various prior probabilities of classified groups characterized by volatile organic compounds of breath profile, smokers and non-smokers, we constructed the ROC curve and the Youden index with related asymptotic pointwise confidence intervals.

  1. External-beam boost prior to total-body irradiation in relapsed NHL transplant patients

    Energy Technology Data Exchange (ETDEWEB)

    Monson, Jedidiah M; Neuberg, Donna; Freedman, Arnold S; Tarbell, Nancy J; Nadler, Lee M; Mauch, Peter

    1995-07-01

    PURPOSE: To determine the impact of an external beam boost (EBB) on the outcome, relapse pattern and normal tissue toxicities of patients undergoing total-body irradiation (TBI) prior to bone marrow transplantation (BMT) for relapsed NHL. MATERIALS AND METHODS: Between 1982 and 1994, 299 patients at our institution underwent BMT for relapsed NHL. Patients underwent induction chemotherapy (CT) followed by conditioning with cyclophosphamide and 12 Gy TBI delivered in 6 fractions over 3 days. A total of 77 patients had persistent gross disease, defined as 2 cm or greater, after induction CT and received an EBB prior to BMT (EBB cohort). The median EBB dose was 28.8 Gy (range, 5-63), the median field size was 13 cm{sup 2} (range, 5-29.4) and the median time from EBB to BMT was 3 weeks (range, 1-20). A total of 222 patients were free of measurable disease or had disease measuring <2cm after CT and did not receive EBB (no-EBB cohort). To assess normal tissue toxicity, patients' simulation films and/or treatment records were reviewed for all 77 patients treated with local EBB and estimates were made of the percentage lung, heart and kidney in the radiation field. RESULTS: A total of 79 of 222 patients (36%) in the no-EBB cohort have relapsed; 33 of 77 patients (43%) in the EBB cohort have relapsed (p=0.28, by Fisher exact test). Median time to relapse after BMT was 54 months for the no-EBB cohort and 38 months for the EBB cohort (p=0.26, by log-rank test). The 3-year actuarial freedom from relapse (deaths in remission censored) was 59% for the no-EBB cohort (90% CI: 52-66%) and 51% for the EBB cohort (90% CI: 40-62%). Data on site of relapse was available for 101 of the 112 relapses (75 no-EBB, 26 EBB). For the no-EBB cohort 33 of 75 relapses (44%) were in sites of prior nodal disease only. For the EBB cohort, 12 of 26 relapses (46%) were in sites of prior nodal disease only, of these, only 6 (23%) were within the EBB treatment field. A total of 26 patients had thoracic

  2. Chromosomal differences between acute nonlymphocytic leukemia in patients with prior solid tumors and prior hematologic malignancies. A study of 14 cases with prior breast cancer

    International Nuclear Information System (INIS)

    Mamuris, Z.; Dumont, J.; Dutrillaux, B.; Aurias, A.

    1989-01-01

    A cytogenetic study of 14 patients with secondary acute nonlymphocytic leukemia (S-ANLL) with prior treatment for breast cancer is reported. The chromosomes recurrently involved in numerical or structural anomalies are chromosomes 7, 5, 17, and 11, in decreasing order of frequency. The distribution of the anomalies detected in this sample of patients is similar to that observed in published cases with prior breast or other solid tumors, though anomalies of chromosome 11 were not pointed out, but it significantly differs from that of the S-ANLL with prior hematologic malignancies. This difference is principally due to a higher involvement of chromosome 7 in patients with prior hematologic malignancies and of chromosomes 11 and 17 in patients with prior solid tumors. A genetic determinism involving abnormal recessive alleles located on chromosomes 5, 7, 11, and 17 uncovered by deletions of the normal homologs may be a cause of S-ANLL. The difference between patients with prior hematologic malignancies or solid tumors may be explained by different constitutional mutations of recessive genes in the two groups of patients

  3. Use of observation followed by outpatient stress testing in chest pain patients with prior coronary artery disease history: An evaluation of prognostic utility.

    Science.gov (United States)

    Khalil, Yasser; Schwartz, Melvin H; Pandey, Prasant S; Abdul Latif, Maida S; Matsumura, Martin E

    2015-06-01

    To determine the outcomes of patients with chest pain (CP) and prior history of coronary artery disease (CAD) managed with observation followed by outpatient stress myocardial perfusion imaging (MPI). Retrospective analysis of patients with CP managed with observation followed by outpatient stress MPI, comparing cardiovascular (CV) event rates stratified by CAD history. 375 patients were included: 111 with and 264 without a CAD history. All patients underwent outpatient stress MPI within 72 h of observation. MPI identified patients at risk for CV events. However, while patients with negative MPI and without a CAD history had very low rates of short- and long-term CAD events (0.8%, 0.8%, and 1.3% at 30 days, 1 year, and 3 years, respectively), event rates of those with a negative test but a CAD history were significantly higher (2.6%, 5.3%, and 6.6% at 30 days, 1 year and 3 years, respectively; p = 0.044 and p = 0.034 compared to CAD- patients at 1 year and 3 years, respectively). In a multivariable logistic regression model, a positive MPI proved to be an independent predictor of long-term CV events in patients with CP and prior CAD. Observation followed by stress MPI can effectively risk stratify CP patients with prior CAD for CV risk. These patients are at increased risk of CV events even after a low-risk stress MPI study. Patients presenting with CP and managed with a strategy of observation followed by a negative stress MPI warrant close short- and long-term monitoring for recurrent events.

  4. Atypical desquamation in a 2.5-year-old boy with Kawasaki disease: A case report.

    Science.gov (United States)

    Adib, Ali; Fazel, Ali; Nabavizadeh, Seyed Hesamedin; Alyasin, Sohaila; Kashef, Sara

    2017-02-01

    Kawasaki disease (KD) is a vasculitis that mostly affects children under 5 years of age. This article presents a 2.5-year-old boy who presented with 6 days of fever, generalized maculopapular rash, bilateral non-exudative conjunctivitis, cracked lips, right cervical lymphadenopathy, erythematous extremities, and perianal desquamation. Laboratory studies showed leukocytosis and sterile pyuria. Because diagnosis of KD was proved, oral acetylsalicylic acid with the anti-inflammatory dose and intravenous immunoglobulin were started for him. On the seventh day of admission time, he developed desquamation and erythema on the site of his right cervical lymphadenopathy as well as periungual scaling. About three weeks after starting the treatment, scaling of the cervical lymphadenopathy and periungual area stopped. Echocardiography was performed for him three times: at the time of diagnosis, four weeks, and 6 months later and revealed normal coronary arteries. We report this sign, desquamation on the site of cervical lymphadenopathy, as a new finding.

  5. Accommodating Uncertainty in Prior Distributions

    Energy Technology Data Exchange (ETDEWEB)

    Picard, Richard Roy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Vander Wiel, Scott Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-01-19

    A fundamental premise of Bayesian methodology is that a priori information is accurately summarized by a single, precisely de ned prior distribution. In many cases, especially involving informative priors, this premise is false, and the (mis)application of Bayes methods produces posterior quantities whose apparent precisions are highly misleading. We examine the implications of uncertainty in prior distributions, and present graphical methods for dealing with them.

  6. Significance of prior percutaneous revascularisation in patients with acute coronary syndromes: insights from the prospective PROSPECT registry.

    Science.gov (United States)

    Iñiguez, Andrés; Brener, Sorin J; Jiménez, Victor A; Maehara, Akiko; Mintz, Gary S; Xu, Ke; Weisz, Giora; Lansky, Alexandra J; De Bruyne, Bernard; Serruys, Patrick W; Stone, Gregg W

    2016-04-20

    Prior percutaneous coronary intervention (PCI) is increasingly encountered in acute coronary syndrome (ACS) patients, with uncertain significance. We sought to evaluate the impact of prior PCI in ACS patients. Patients with ACS enrolled in the prospective PROSPECT registry underwent three-vessel intravascular ultrasound and virtual histology evaluation after successful PCI of the culprit lesion(s). We identified patients with prior PCI (>6 months before index ACS) and compared their outcomes to those without prior PCI. Time-to-event for major adverse cardiac events (MACE) was estimated up to three years, and the independent association between prior PCI and MACE was evaluated in a multivariable model. Among 696 patients enrolled, 77 (11.1%) had prior PCI. They were older and more likely to have prior myocardial infarction, chronic kidney disease, and congestive heart failure. At three years, patients with prior PCI had significantly higher rates of cardiac death, rehospitalisation for worsening angina, and MACE (adjusted HR=1.73 [95% CI: 1.09, 2.75], p=0.02), independent of other comorbidities and intravascular ultrasound findings. Prior PCI was noted in over 10% of patients with ACS and was associated with higher mortality and morbidity, independent of other comorbidities. Prior PCI should be considered a high-risk feature when evaluating ACS patients.

  7. Hypofractionated stereotactic radiotherapy in five daily fractions for post-operative surgical cavities in brain metastases patients with and without prior whole brain radiation.

    Science.gov (United States)

    Al-Omair, Ameen; Soliman, Hany; Xu, Wei; Karotki, Aliaksandr; Mainprize, Todd; Phan, Nicolas; Das, Sunit; Keith, Julia; Yeung, Robert; Perry, James; Tsao, May; Sahgal, Arjun

    2013-12-01

    Our purpose was to report efficacy of hypofractionated cavity stereotactic radiotherapy (HCSRT) in patients with and without prior whole brain radiotherapy (WBRT). 32 surgical cavities in 30 patients (20 patients/21 cavities had no prior WBRT and 10 patients/11 cavities had prior WBRT) were treated with image-guided linac stereotactic radiotherapy. 7 of the 10 prior WBRT patients had "resistant" local disease given prior surgery, post-operative WBRT and a re-operation, followed by salvage HCSRT. The clinical target volume was the post-surgical cavity, and a 2-mm margin applied as planning target volume. The median total dose was 30 Gy (range: 25-37.5 Gy) in 5 fractions. In the no prior and prior WBRT cohorts, the median follow-up was 9.7 months (range: 3.0-23.6) and 15.3 months (range: 2.9-39.7), the median survival was 23.6 months and 39.7 months, and the 1-year cavity local recurrence progression- free survival (LRFS) was 79 and 100%, respectively. At 18 months the LRFS dropped to 29% in the prior WBRT cohort. Grade 3 radiation necrosis occurred in 3 prior WBRT patients. We report favorable outcomes with HCSRT, and well selected patients with prior WBRT and "resistant" disease may have an extended survival favoring aggressive salvage HCSRT at a moderate risk of radiation necrosis.

  8. Iterated random walks with shape prior

    DEFF Research Database (Denmark)

    Pujadas, Esmeralda Ruiz; Kjer, Hans Martin; Piella, Gemma

    2016-01-01

    the parametric probability density function. Then, random walks is performed iteratively aligning the prior with the current segmentation in every iteration. We tested the proposed approach with natural and medical images and compared it with the latest techniques with random walks and shape priors......We propose a new framework for image segmentation using random walks where a distance shape prior is combined with a region term. The shape prior is weighted by a confidence map to reduce the influence of the prior in high gradient areas and the region term is computed with k-means to estimate....... The experiments suggest that this method gives promising results for medical and natural images....

  9. The Prior-project

    DEFF Research Database (Denmark)

    Engerer, Volkmar Paul; Roued-Cunliffe, Henriette; Albretsen, Jørgen

    digitisation of Arthur Prior’s Nachlass kept in the Bodleian Library, Oxford. The DH infrastructure in question is the Prior Virtual Lab (PVL). PVL was established in 2011 in order to provide researchers in the field of temporal logic easy access to the papers of Arthur Norman Prior (1914-1969), and officially......In this paper, we present a DH research infrastructure which relies heavily on a combination of domain knowledge with information technology. The general goal is to develop tools to aid scholars in their interpretations and understanding of temporal logic. This in turn is based on an extensive...

  10. Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis: the HUNT Study.

    Science.gov (United States)

    Gabin, Jessica Mira; Tambs, Kristian; Saltvedt, Ingvild; Sund, Erik; Holmen, Jostein

    2017-05-31

    A lot of attention has been paid to the relationship of blood pressure and dementia because epidemiological research has reported conflicting evidence. Observational data has shown that midlife hypertension is a risk factor for cognitive decline and dementia later in life, whereas there is evidence that low blood pressure is predictive in later life. The aim of the present study was to examine the association between dementia and blood pressure measured up to 27 years (mean 17.6 years) prior to ascertainment. In Nord-Trøndelag County, Norway, incident dementia data were collected during 1995-2011, and the diagnoses were validated by a panel of experts in the field. By using the subjects' personal identification numbers, the dementia data were linked to data from the Nord-Trøndelag Health Study (the HUNT Study), a large, population-based health study performed in 1984-1986 (HUNT 1) and 1995-1997 (HUNT 2). A total of 24,638 participants of the HUNT Study were included in the present study, 579 of whom were diagnosed with Alzheimer disease, mixed Alzheimer/vascular dementia, or vascular dementia. Multiple logistic regression analyses were conducted to analyze the association between dementia and blood pressure data from HUNT 1 and HUNT 2. Over the age of 60 years, consistent inverse associations were observed between systolic blood pressure and all-cause dementia, mixed Alzheimer/vascular dementia, and Alzheimer disease, but not with vascular dementia, when adjusting for age, sex, education, and other relevant covariates. This was observed for systolic blood pressure in both HUNT 1 and HUNT 2, regardless of antihypertensive medication use. There was an adverse association between systolic blood pressure, pulse pressure, and Alzheimer disease in individuals treated with antihypertensive medication under the age of 60 years. Our data are in line with those in previous studies demonstrating an inverse association between dementia and systolic blood pressure in

  11. Transfer of residents to hospital prior to cardiac death: the influence of nursing home quality and ownership type.

    Science.gov (United States)

    Anic, Gabriella M; Pathak, Elizabeth Barnett; Tanner, Jean Paul; Casper, Michele L; Branch, Laurence G

    2014-01-01

    We hypothesised that among nursing home decedents, nursing home for-profit status and poor quality-of-care ratings, as well as patient characteristics, would lower the likelihood of transfer to hospital prior to heart disease death. Using death certificates from a large metropolitan area (Tampa Florida Metropolitan Statistical Area) for 1998-2002, we geocoded residential street addresses of heart disease decedents to identify 2172 persons who resided in nursing homes (n=131) at the time of death. We analysed decedent place of death as an indicator of transfer prior to death. Multilevel logistic regression modelling was used for analysis. Cause of death and decedent characteristics were obtained from death certificates. Nursing home characteristics, including state inspector ratings for multiple time points, were obtained from Florida's Agency for Healthcare Administration. Nursing home for-profit status, level of nursing care and quality-of-care ratings were not associated with the likelihood of transfer to hospital prior to heart disease death. Nursing homes >5 miles from a hospital were more likely to transfer decedents, compared with facilities located close to a hospital. Significant predictors of no transfer for nursing home residents were being white, female, older, less educated and widowed/unmarried. In this study population, contrary to our hypotheses, sociodemographic characteristics of nursing home decedents were more important predictors of no transfer prior to cardiac death than quality rankings or for-profit status of nursing homes.

  12. Prevalence and predictors of hospitalization in Crohn's disease in a prospective population-based inception cohort from 2000-2012.

    Science.gov (United States)

    Golovics, Petra A; Lakatos, Laszlo; Mandel, Michael D; Lovasz, Barbara D; Vegh, Zsuzsanna; Kurti, Zsuzsanna; Szita, Istvan; Kiss, Lajos S; Pandur, Tunde; Lakatos, Peter L

    2015-06-21

    To analyze the prevalence, length and predictors of hospitalization in the biological era in the population-based inception cohort from Veszprem province. Data of 331 incident Crohn's disease (CD) patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (median age at diagnosis: 28; IQR: 21-40 years). Both in- and outpatient records were collected and comprehensively reviewed. Probabilities of first CD-related hospitalization and re-hospitalization were 32.3%, 45.5%, 53.7% and 13.6%, 23.9%, 29.8%, respectively after one, three and five years of follow-up in Kaplan-Meier analysis. First-year hospitalizations were related to diagnostic procedures (37%), surgery or disease activity (27% and 21%). Non-inflammatory disease behavior at diagnosis (HR = 1.32, P = 0.001) and perianal disease (HR = 1.47, P = 0.04) were associated with time to first CD-related hospitalization, while disease behavior change (HR = 2.38, P = 0.002) and need for steroids (HR = 3.14, P = 0.003) were associated with time to first re-hospitalization in multivariate analyses. Early CD-related hospitalization (within the year of diagnosis) was independently associated with need for immunosuppressives (OR = 2.08, P = 0.001) and need for surgeries (OR = 7.25, P < 0.001) during the disease course. Hospitalization and re-hospitalization rates are still high in this cohort, especially during the first-year after the diagnosis. Non-inflammatory disease behavior at diagnosis was identified as the pivotal predictive factor of both hospitalization and re-hospitalization.

  13. Association of IgA multiple myeloma with pre-existing disease

    Energy Technology Data Exchange (ETDEWEB)

    Schafer, A.I.; Miller, J.B.

    1979-01-01

    A retrospective analysis of 153 patients with multiple myeloma was performed for evaluation of the possible significance of pre-existing disease. 37% of the group had no significant antecedent disorder. The most common prior illnesses were peptic ulcer disease and gallbladder disease. Of 12 patients in the group who had prior biliary tract disease and for whom immunoelectrophoretic studies were available, eight (66.7%) had IgA paraproteins. This figure is statistically higher than the 14.1% of prevalence of IgA paraproteins in those myeloma patients without biliary disease. We conclude that prior inflammatory gastrointestinal, pulmonary, and, particularly, biliary disease may be implicated in the pathogenesis of the IgA subset of multiple myeloma.

  14. The Influence of Prior Knowledge on the Retrieval-Directed Function of Note Taking in Prior Knowledge Activation

    Science.gov (United States)

    Wetzels, Sandra A. J.; Kester, Liesbeth; van Merrienboer, Jeroen J. G.; Broers, Nick J.

    2011-01-01

    Background: Prior knowledge activation facilitates learning. Note taking during prior knowledge activation (i.e., note taking directed at retrieving information from memory) might facilitate the activation process by enabling learners to build an external representation of their prior knowledge. However, taking notes might be less effective in…

  15. Varying prior information in Bayesian inversion

    International Nuclear Information System (INIS)

    Walker, Matthew; Curtis, Andrew

    2014-01-01

    Bayes' rule is used to combine likelihood and prior probability distributions. The former represents knowledge derived from new data, the latter represents pre-existing knowledge; the Bayesian combination is the so-called posterior distribution, representing the resultant new state of knowledge. While varying the likelihood due to differing data observations is common, there are also situations where the prior distribution must be changed or replaced repeatedly. For example, in mixture density neural network (MDN) inversion, using current methods the neural network employed for inversion needs to be retrained every time prior information changes. We develop a method of prior replacement to vary the prior without re-training the network. Thus the efficiency of MDN inversions can be increased, typically by orders of magnitude when applied to geophysical problems. We demonstrate this for the inversion of seismic attributes in a synthetic subsurface geological reservoir model. We also present results which suggest that prior replacement can be used to control the statistical properties (such as variance) of the final estimate of the posterior in more general (e.g., Monte Carlo based) inverse problem solutions. (paper)

  16. Prevalence and predictors of hospitalization in Crohn’s disease in a prospective population-based inception cohort from 2000-2012

    Science.gov (United States)

    Golovics, Petra A; Lakatos, Laszlo; Mandel, Michael D; Lovasz, Barbara D; Vegh, Zsuzsanna; Kurti, Zsuzsanna; Szita, Istvan; Kiss, Lajos S; Pandur, Tunde; Lakatos, Peter L

    2015-01-01

    AIM: To analyze the prevalence, length and predictors of hospitalization in the biological era in the population-based inception cohort from Veszprem province. METHODS: Data of 331 incident Crohn’s disease (CD) patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (median age at diagnosis: 28; IQR: 21-40 years). Both in- and outpatient records were collected and comprehensively reviewed. RESULTS: Probabilities of first CD-related hospitalization and re-hospitalization were 32.3%, 45.5%, 53.7% and 13.6%, 23.9%, 29.8%, respectively after one, three and five years of follow-up in Kaplan-Meier analysis. First-year hospitalizations were related to diagnostic procedures (37%), surgery or disease activity (27% and 21%). Non-inflammatory disease behavior at diagnosis (HR = 1.32, P = 0.001) and perianal disease (HR = 1.47, P = 0.04) were associated with time to first CD-related hospitalization, while disease behavior change (HR = 2.38, P = 0.002) and need for steroids (HR = 3.14, P = 0.003) were associated with time to first re-hospitalization in multivariate analyses. Early CD-related hospitalization (within the year of diagnosis) was independently associated with need for immunosuppressives (OR = 2.08, P = 0.001) and need for surgeries (OR = 7.25, P < 0.001) during the disease course. CONCLUSION: Hospitalization and re-hospitalization rates are still high in this cohort, especially during the first-year after the diagnosis. Non-inflammatory disease behavior at diagnosis was identified as the pivotal predictive factor of both hospitalization and re-hospitalization. PMID:26109815

  17. The Prior Internet Resources 2017

    DEFF Research Database (Denmark)

    Engerer, Volkmar Paul; Albretsen, Jørgen

    2017-01-01

    The Prior Internet Resources (PIR) are presented. Prior’s unpublished scientific manuscripts and his wast letter correspondence with fellow researchers at the time, his Nachlass, is now subject to transcription by Prior-researchers worldwide, and form an integral part of PIR. It is demonstrated...

  18. Penalised Complexity Priors for Stationary Autoregressive Processes

    KAUST Repository

    Sø rbye, Sigrunn Holbek; Rue, Haavard

    2017-01-01

    The autoregressive (AR) process of order p(AR(p)) is a central model in time series analysis. A Bayesian approach requires the user to define a prior distribution for the coefficients of the AR(p) model. Although it is easy to write down some prior, it is not at all obvious how to understand and interpret the prior distribution, to ensure that it behaves according to the users' prior knowledge. In this article, we approach this problem using the recently developed ideas of penalised complexity (PC) priors. These prior have important properties like robustness and invariance to reparameterisations, as well as a clear interpretation. A PC prior is computed based on specific principles, where model component complexity is penalised in terms of deviation from simple base model formulations. In the AR(1) case, we discuss two natural base model choices, corresponding to either independence in time or no change in time. The latter case is illustrated in a survival model with possible time-dependent frailty. For higher-order processes, we propose a sequential approach, where the base model for AR(p) is the corresponding AR(p-1) model expressed using the partial autocorrelations. The properties of the new prior distribution are compared with the reference prior in a simulation study.

  19. Penalised Complexity Priors for Stationary Autoregressive Processes

    KAUST Repository

    Sørbye, Sigrunn Holbek

    2017-05-25

    The autoregressive (AR) process of order p(AR(p)) is a central model in time series analysis. A Bayesian approach requires the user to define a prior distribution for the coefficients of the AR(p) model. Although it is easy to write down some prior, it is not at all obvious how to understand and interpret the prior distribution, to ensure that it behaves according to the users\\' prior knowledge. In this article, we approach this problem using the recently developed ideas of penalised complexity (PC) priors. These prior have important properties like robustness and invariance to reparameterisations, as well as a clear interpretation. A PC prior is computed based on specific principles, where model component complexity is penalised in terms of deviation from simple base model formulations. In the AR(1) case, we discuss two natural base model choices, corresponding to either independence in time or no change in time. The latter case is illustrated in a survival model with possible time-dependent frailty. For higher-order processes, we propose a sequential approach, where the base model for AR(p) is the corresponding AR(p-1) model expressed using the partial autocorrelations. The properties of the new prior distribution are compared with the reference prior in a simulation study.

  20. Local application of adipose-derived mesenchymal stem cells supports the healing of fistula: prospective randomised study on rat model of fistulising Crohn's disease

    Czech Academy of Sciences Publication Activity Database

    Ryska, Ondřej; Šerclová, Z.; Měšťák, O.; Matoušková, E.; Veselý, P.; Mrázová, I.

    2017-01-01

    Roč. 52, č. 5 (2017), s. 543-550 ISSN 0036-5521 R&D Projects: GA MZd(CZ) NV16-31806A Institutional support: RVO:67985904 Keywords : mesenchymal stem cell * perianal fistula * bioluminescence Subject RIV: FE - Other Internal Medicine Disciplines OBOR OECD: Gastroenterology and hepatology Impact factor: 2.526, year: 2016

  1. Clinical and Phenotypic Differences in Inflammatory Bowel Disease Among Arab and Jewish Children in Israel.

    Science.gov (United States)

    Rinawi, Firas; Assa, Amit; Bashir, Husam; Peleg, Sarit; Shamir, Raanan

    2017-08-01

    Data on inflammatory bowel disease (IBD) phenotypes among the Arab population in Israel or in the neighboring Arab countries is scarce. We aimed to assess differences in disease phenotype among Arab and Jewish children living in Israel. We performed a retrospective chart review of pediatric IBD cases, which were diagnosed at the Schneider Children's Medical Center and Ha'Emek Medical Center in Israel between 2000 and 2014. Demographic, clinical, and phenotypic variables were compared between Arabs and Jews from Eastern (Sephardic) and Western (Ashkenazi) origin. Seventy-one Arab children with IBD were compared with 165 Ashkenazi and 158 Sephardic Jewish children. Age and gender did not differ between groups. Sephardic and Ashkenazi Jewish Crohn's disease (CD) patients had significantly more stenotic behavior (24 and 26 vs. 5%, p = 0.03) and less fistulzing perianal disease (15 and 11 vs. 31%, p = 0.014) compared with Arab patients. Arab children with ulcerative colitis (UC) had more severe disease at diagnosis compared to Sephardic and Ashkenazi Jews reflected by higher Pediatric UC Activity Index (45 vs. 35 and 35, respectively, p = 0.03). Arab patients had significantly lower proportion of anti-Saccharomyces cerevisiae antibodies positivity (in CD) and perinuclear anti-neutrophil cytoplasmic antibodies positivity (in UC) than both Sephardic and Ashkenazi Jewish children (23 vs. 53 and 65%, p = 0.002 and 35 vs. 60 and 75%, respectively, p = 0.002). Arab and Jewish children with IBD differ in disease characteristics and severity. Whether genetic or environmental factors are the cause for these differences is yet to be determined.

  2. Generalized Bayesian inference with sets of conjugate priors for dealing with prior-data conflict : course at Lund University

    NARCIS (Netherlands)

    Walter, G.

    2015-01-01

    In the Bayesian approach to statistical inference, possibly subjective knowledge on model parameters can be expressed by so-called prior distributions. A prior distribution is updated, via Bayes’ Rule, to the so-called posterior distribution, which combines prior information and information from

  3. The Importance of Prior Knowledge.

    Science.gov (United States)

    Cleary, Linda Miller

    1989-01-01

    Recounts a college English teacher's experience of reading and rereading Noam Chomsky, building up a greater store of prior knowledge. Argues that Frank Smith provides a theory for the importance of prior knowledge and Chomsky's work provided a personal example with which to interpret and integrate that theory. (RS)

  4. Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Miedema, Michael D; Garberich, Ross F; Schnaidt, Lucas J; Peterson, Erin; Strauss, Craig; Sharkey, Scott; Knickelbine, Thomas; Newell, Marc C; Henry, Timothy D

    2017-04-12

    The impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (CVD) events is unclear. We analyzed a prospective cohort of consecutive ST-segment elevation myocardial infarction (STEMI) patients from a regional STEMI system with data on patient demographics, low-density lipoprotein cholesterol levels, CVD risk factors, medication use, and outpatient visits over the 2 years prior to STEMI. We determined pre-STEMI eligibility according to American College of Cardiology/American Heart Association guidelines and the prior Third Report of the Adult Treatment Panel guidelines. Our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male), and 761 (71.7%) did not have known CVD prior to STEMI. Only 62.5% and 19.3% of individuals with and without prior CVD were taking a statin before STEMI, respectively. In individuals not taking a statin, median (interquartile range) low-density lipoprotein cholesterol levels in those with and without known CVD were low (108 [83, 138]  mg/dL and 110 [87, 133] mg/dL). For individuals not taking a statin, only 38.7% were statin eligible by ATP III guidelines. Conversely, 79.0% would have been statin eligible according to American College of Cardiology/American Heart Association guidelines. Less than half of individuals with (49.2%) and without (41.1%) prior CVD had seen a primary care provider during the 2 years prior to STEMI. In a large cohort of STEMI patients, application of American College of Cardiology/American Heart Association guidelines more than doubled pre-STEMI statin eligibility compared with Third Report of the Adult Treatment Panel guidelines. However, access to and utilization of health care, a necessity for guideline implementation, was suboptimal prior to STEMI. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  5. A designated centre for people with disabilities operated by Daughters of Charity Disability Support Services Ltd., Dublin 15

    LENUS (Irish Health Repository)

    de Groof, E Joline

    2015-08-20

    Currently there is no guideline for the treatment of patients with Crohn\\'s disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs.

  6. Savings for visuomotor adaptation require prior history of error, not prior repetition of successful actions.

    Science.gov (United States)

    Leow, Li-Ann; de Rugy, Aymar; Marinovic, Welber; Riek, Stephan; Carroll, Timothy J

    2016-10-01

    When we move, perturbations to our body or the environment can elicit discrepancies between predicted and actual outcomes. We readily adapt movements to compensate for such discrepancies, and the retention of this learning is evident as savings, or faster readaptation to a previously encountered perturbation. The mechanistic processes contributing to savings, or even the necessary conditions for savings, are not fully understood. One theory suggests that savings requires increased sensitivity to previously experienced errors: when perturbations evoke a sequence of correlated errors, we increase our sensitivity to the errors experienced, which subsequently improves error correction (Herzfeld et al. 2014). An alternative theory suggests that a memory of actions is necessary for savings: when an action becomes associated with successful target acquisition through repetition, that action is more rapidly retrieved at subsequent learning (Huang et al. 2011). In the present study, to better understand the necessary conditions for savings, we tested how savings is affected by prior experience of similar errors and prior repetition of the action required to eliminate errors using a factorial design. Prior experience of errors induced by a visuomotor rotation in the savings block was either prevented at initial learning by gradually removing an oppositely signed perturbation or enforced by abruptly removing the perturbation. Prior repetition of the action required to eliminate errors in the savings block was either deprived or enforced by manipulating target location in preceding trials. The data suggest that prior experience of errors is both necessary and sufficient for savings, whereas prior repetition of a successful action is neither necessary nor sufficient for savings. Copyright © 2016 the American Physiological Society.

  7. Nonalcoholic Fatty Liver Disease Is Prevalent in Women With Prior Gestational Diabetes Mellitus and Independently Associated With Insulin Resistance and Waist Circumference

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Andreasen, Camilla; Vedtofte, Louise

    2017-01-01

    , insulin resistance (P = 0.0057) and waist circumference (P = 0.0109) were independently associated with NAFLD. CONCLUSIONS: NAFLD was prevalent in this cohort of relatively young and nonseverely obese women with pGDM who are considered healthy apart from their increased risk for diabetes. Insulin......OBJECTIVE: Type 2 diabetes increases the risk of nonalcoholic fatty liver disease (NAFLD), which is a potentially reversible condition but is also associated with progressive fibrosis and cirrhosis. Women with prior gestational diabetes mellitus (pGDM) have a higher risk for NAFLD. RESEARCH DESIGN...... AND METHODS: One hundred women without diabetes who had pGDM (median [interquartile range]: age 38.6 [6.4] years; BMI 31.0 [6.2] kg/m(2)) and 11 healthy control subjects without NAFLD (age 37.9 [7.8] years; BMI 28.1 [0.8] kg/m(2)) underwent a 75-g oral glucose tolerance test (OGTT), DXA whole-body scan...

  8. [Complications of hemorrhoids].

    Science.gov (United States)

    Slauf, P; Antoš, F; Marx, J

    2014-04-01

    The most common and serious complications of haemorrhoids include perianal thrombosis and incarcerated prolapsed internal haemorrhoids with subsequent thrombosis. They are characterised by severe pain in the perianal region possibly with bleeding. In a short history of the perianal thrombosis, acute surgical incision or excision is indicated, which can result in rapid relief of the painful symptoms. In incarcerated prolapsed internal haemorrhoids, emergency haemorrhoidectomy may also be indicated. Segmental haemorrhoidectomy in the most affected quadrants followed by further elective surgery for haemorrhoids in the next stage is preferred.

  9. PAPILLOMA VIRAL INFECTION AMONG BOYS AND YOUNG MEN PRIMARY PREVENTION

    OpenAIRE

    M.G. Galitskaya; M.I. Ivardava

    2009-01-01

    Young sexually active men may have anogenital HPV related infection, which can cause the genital penis verruca, penis cancer, perianal and anal cancer. Besides, men's HPV infection may cause an infection and subsequent diseases of cervix of the uterus and other organs among women. The available opportunity to inoculate boys and young men against HPV infection provides for 100% guaranteed protection from severe diseases not only for boys and young men but also for girls and women, who men may ...

  10. Divergent Priors and well Behaved Bayes Factors

    NARCIS (Netherlands)

    R.W. Strachan (Rodney); H.K. van Dijk (Herman)

    2011-01-01

    textabstractDivergent priors are improper when defined on unbounded supports. Bartlett's paradox has been taken to imply that using improper priors results in ill-defined Bayes factors, preventing model comparison by posterior probabilities. However many improper priors have attractive properties

  11. Applications of Neuroimaging to Disease-Modification Trials in Alzheimer’s Disease

    Directory of Open Access Journals (Sweden)

    Adam S. Fleisher

    2009-01-01

    Full Text Available Critical to development of new therapies for Alzheimer’s disease (AD is the ability to detect clinical or pathological change over time. Clinical outcome measures typically used in therapeutic trials have unfortunately proven to be relatively variable and somewhat insensitive to change in this slowly progressive disease. For this reason, development of surrogate biomarkers that identify significant disease-associated brain changes are necessary to expedite treatment development in AD. Since AD pathology is present in the brain many years prior to clinical manifestation, ideally we want to develop biomarkers of disease that identify abnormal brain structure or function even prior to cognitive decline. Magnetic resonance imaging, fluorodeoxyglucose positron emission tomography, new amyloid imaging techniques, and spinal fluid markers of AD all have great potential to provide surrogate endpoint measures for AD pathology. The Alzheimer’s disease neuroimaging initiative (ADNI was developed for the distinct purpose of evaluating surrogate biomarkers for drug development in AD. Recent evidence from ADNI demonstrates that imaging may provide more sensitive, and earlier, measures of disease progression than traditional clinical measures for powering clinical drug trials in Alzheimer's disease. This review discusses recently presented data from the ADNI dataset, and the importance of imaging in the future of drug development in AD.

  12. PSYCHOLOGICAL FEATURES IN PATIENTS WITH CORONARY HEART DISEASE (MEN AND WOMEN PRIOR TO CORONARY ARTERY BYPASS GRAFTING DEPENDING ON THEIR INVOLVEMENT IN THE INDIVIDUAL PSYCHO-CORRECTION PROGRAM

    Directory of Open Access Journals (Sweden)

    D. A. Starunskaya

    2017-01-01

    Full Text Available Importance. The study of psychological characteristics of patients is important for the creation and planning of psychological correction and improve the efficiency of the treatment of coronary heart disease.Тhe purpose. This research is devoted to the study of the psychological features in patients with coronary artery disease (CHD in the preoperative period, depending on their involvement in psycho-correction program.Material and methods. We observed 30 patients with coronary heart disease before coronary bypass surgery. Clinical-psychological method (observation, conversation and psychological testing were used.Results  and conclusions. We found that patients who participated in psycho-correction program had lower values of «anxiety», «phobic anxiety» and «obsessive-compulsive» symptoms. In both groups of patients, on average, we identified the prevalence  of the coping-strategies «self-control» and «planning solution». Furthermore, on average, the «self-awareness» and «extraversion» were more manifested features in the structure of the personality traits of the surveyed patients. The revealed features should be taken into account in planning the programs of psycho-correction for patients with CHD prior to CABG surgery.

  13. Mortality in unipolar depression preceding and following chronic somatic diseases

    DEFF Research Database (Denmark)

    Koyanagi, A; Köhler-Forsberg, O; Benros, M E

    2018-01-01

    -varying covariates were constructed to assess the risk for all-cause and non-suicide deaths for individual somatic diseases. RESULTS: For all somatic diseases, prior and/or subsequent depression conferred a significantly higher mortality risk. Prior depression was significantly associated with a higher mortality......OBJECTIVE: It is largely unknown how depression prior to and following somatic diseases affects mortality. Thus, we examined how the temporal order of depression and somatic diseases affects mortality risk. METHOD: Data were from a Danish population-based cohort from 1995 to 2013, which included...... all residents in Denmark during the study period (N = 4 984 912). Nineteen severe chronic somatic disorders from the Charlson Comorbidity Index were assessed. The date of first diagnosis of depression and somatic diseases was identified. Multivariable Cox proportional Hazard models with time...

  14. Prior knowledge in recalling arguments in bioethical dilemmas

    Directory of Open Access Journals (Sweden)

    Hiemke Katharina Schmidt

    2015-09-01

    Full Text Available Prior knowledge is known to facilitate learning new information. Normally in studies confirming this outcome the relationship between prior knowledge and the topic to be learned is obvious: the information to be acquired is part of the domain or topic to which the prior knowledge belongs. This raises the question as to whether prior knowledge of various domains facilitates recalling information. In this study 79 eleventh-grade students completed a questionnaire on their prior knowledge of seven different domains related to the bioethical dilemma of prenatal diagnostics. The students read a text containing arguments for and arguments against prenatal diagnostics. After one week and again 12 weeks later they were asked to write down all the arguments they remembered. Prior knowledge helped them recall the arguments one week (r = .350 and 12 weeks (r = .316 later. Prior knowledge of three of the seven domains significantly helped them recall the arguments one week later (correlations between r = .194 to r = .394. Partial correlations with interest as a control item revealed that interest did not explain the relationship between prior knowledge and recall. Prior knowledge of different domains jointly supports the recall of arguments related to bioethical topics.

  15. Fournier's gangrene: Clinical case and review of the literature

    Directory of Open Access Journals (Sweden)

    Remigio Pernetti

    2016-10-01

    Full Text Available Fournier's gangrene is a life-threatening acute necrotizing fasciitis of perianal,genitourinary and perineal areas. Nowadays, is well known that Fournier gangrene is almost never an idiopathic disease. In this article we report a case of a 70-year-old patient that initially was not treated properly. The gold standard therapy of the Fournier's gangrene remains today a complete, early and extended surgical debridement.

  16. Testability evaluation using prior information of multiple sources

    Institute of Scientific and Technical Information of China (English)

    Wang Chao; Qiu Jing; Liu Guanjun; Zhang Yong

    2014-01-01

    Testability plays an important role in improving the readiness and decreasing the life-cycle cost of equipment. Testability demonstration and evaluation is of significance in measuring such testability indexes as fault detection rate (FDR) and fault isolation rate (FIR), which is useful to the producer in mastering the testability level and improving the testability design, and helpful to the consumer in making purchase decisions. Aiming at the problems with a small sample of testabil-ity demonstration test data (TDTD) such as low evaluation confidence and inaccurate result, a test-ability evaluation method is proposed based on the prior information of multiple sources and Bayes theory. Firstly, the types of prior information are analyzed. The maximum entropy method is applied to the prior information with the mean and interval estimate forms on the testability index to obtain the parameters of prior probability density function (PDF), and the empirical Bayesian method is used to get the parameters for the prior information with a success-fail form. Then, a parametrical data consistency check method is used to check the compatibility between all the sources of prior information and TDTD. For the prior information to pass the check, the prior credibility is calculated. A mixed prior distribution is formed based on the prior PDFs and the corresponding credibility. The Bayesian posterior distribution model is acquired with the mixed prior distribution and TDTD, based on which the point and interval estimates are calculated. Finally, examples of a flying control system are used to verify the proposed method. The results show that the proposed method is feasible and effective.

  17. Can natural selection encode Bayesian priors?

    Science.gov (United States)

    Ramírez, Juan Camilo; Marshall, James A R

    2017-08-07

    The evolutionary success of many organisms depends on their ability to make decisions based on estimates of the state of their environment (e.g., predation risk) from uncertain information. These decision problems have optimal solutions and individuals in nature are expected to evolve the behavioural mechanisms to make decisions as if using the optimal solutions. Bayesian inference is the optimal method to produce estimates from uncertain data, thus natural selection is expected to favour individuals with the behavioural mechanisms to make decisions as if they were computing Bayesian estimates in typically-experienced environments, although this does not necessarily imply that favoured decision-makers do perform Bayesian computations exactly. Each individual should evolve to behave as if updating a prior estimate of the unknown environment variable to a posterior estimate as it collects evidence. The prior estimate represents the decision-maker's default belief regarding the environment variable, i.e., the individual's default 'worldview' of the environment. This default belief has been hypothesised to be shaped by natural selection and represent the environment experienced by the individual's ancestors. We present an evolutionary model to explore how accurately Bayesian prior estimates can be encoded genetically and shaped by natural selection when decision-makers learn from uncertain information. The model simulates the evolution of a population of individuals that are required to estimate the probability of an event. Every individual has a prior estimate of this probability and collects noisy cues from the environment in order to update its prior belief to a Bayesian posterior estimate with the evidence gained. The prior is inherited and passed on to offspring. Fitness increases with the accuracy of the posterior estimates produced. Simulations show that prior estimates become accurate over evolutionary time. In addition to these 'Bayesian' individuals, we also

  18. Example-driven manifold priors for image deconvolution.

    Science.gov (United States)

    Ni, Jie; Turaga, Pavan; Patel, Vishal M; Chellappa, Rama

    2011-11-01

    Image restoration methods that exploit prior information about images to be estimated have been extensively studied, typically using the Bayesian framework. In this paper, we consider the role of prior knowledge of the object class in the form of a patch manifold to address the deconvolution problem. Specifically, we incorporate unlabeled image data of the object class, say natural images, in the form of a patch-manifold prior for the object class. The manifold prior is implicitly estimated from the given unlabeled data. We show how the patch-manifold prior effectively exploits the available sample class data for regularizing the deblurring problem. Furthermore, we derive a generalized cross-validation (GCV) function to automatically determine the regularization parameter at each iteration without explicitly knowing the noise variance. Extensive experiments show that this method performs better than many competitive image deconvolution methods.

  19. Testability evaluation using prior information of multiple sources

    Directory of Open Access Journals (Sweden)

    Wang Chao

    2014-08-01

    Full Text Available Testability plays an important role in improving the readiness and decreasing the life-cycle cost of equipment. Testability demonstration and evaluation is of significance in measuring such testability indexes as fault detection rate (FDR and fault isolation rate (FIR, which is useful to the producer in mastering the testability level and improving the testability design, and helpful to the consumer in making purchase decisions. Aiming at the problems with a small sample of testability demonstration test data (TDTD such as low evaluation confidence and inaccurate result, a testability evaluation method is proposed based on the prior information of multiple sources and Bayes theory. Firstly, the types of prior information are analyzed. The maximum entropy method is applied to the prior information with the mean and interval estimate forms on the testability index to obtain the parameters of prior probability density function (PDF, and the empirical Bayesian method is used to get the parameters for the prior information with a success-fail form. Then, a parametrical data consistency check method is used to check the compatibility between all the sources of prior information and TDTD. For the prior information to pass the check, the prior credibility is calculated. A mixed prior distribution is formed based on the prior PDFs and the corresponding credibility. The Bayesian posterior distribution model is acquired with the mixed prior distribution and TDTD, based on which the point and interval estimates are calculated. Finally, examples of a flying control system are used to verify the proposed method. The results show that the proposed method is feasible and effective.

  20. Attentional and Contextual Priors in Sound Perception.

    Science.gov (United States)

    Wolmetz, Michael; Elhilali, Mounya

    2016-01-01

    Behavioral and neural studies of selective attention have consistently demonstrated that explicit attentional cues to particular perceptual features profoundly alter perception and performance. The statistics of the sensory environment can also provide cues about what perceptual features to expect, but the extent to which these more implicit contextual cues impact perception and performance, as well as their relationship to explicit attentional cues, is not well understood. In this study, the explicit cues, or attentional prior probabilities, and the implicit cues, or contextual prior probabilities, associated with different acoustic frequencies in a detection task were simultaneously manipulated. Both attentional and contextual priors had similarly large but independent impacts on sound detectability, with evidence that listeners tracked and used contextual priors for a variety of sound classes (pure tones, harmonic complexes, and vowels). Further analyses showed that listeners updated their contextual priors rapidly and optimally, given the changing acoustic frequency statistics inherent in the paradigm. A Bayesian Observer model accounted for both attentional and contextual adaptations found with listeners. These results bolster the interpretation of perception as Bayesian inference, and suggest that some effects attributed to selective attention may be a special case of contextual prior integration along a feature axis.

  1. Total Variability Modeling using Source-specific Priors

    DEFF Research Database (Denmark)

    Shepstone, Sven Ewan; Lee, Kong Aik; Li, Haizhou

    2016-01-01

    sequence of an utterance. In both cases the prior for the latent variable is assumed to be non-informative, since for homogeneous datasets there is no gain in generality in using an informative prior. This work shows in the heterogeneous case, that using informative priors for com- puting the posterior......, can lead to favorable results. We focus on modeling the priors using minimum divergence criterion or fac- tor analysis techniques. Tests on the NIST 2008 and 2010 Speaker Recognition Evaluation (SRE) dataset show that our proposed method beats four baselines: For i-vector extraction using an already...... trained matrix, for the short2-short3 task in SRE’08, five out of eight female and four out of eight male common conditions, were improved. For the core-extended task in SRE’10, four out of nine female and six out of nine male common conditions were improved. When incorporating prior information...

  2. Quantitative Evidence Synthesis with Power Priors

    NARCIS (Netherlands)

    Rietbergen, C.|info:eu-repo/dai/nl/322847796

    2016-01-01

    The aim of this thesis is to provide the applied researcher with a practical approach for quantitative evidence synthesis using the conditional power prior that allows for subjective input and thereby provides an alternative tgbgo deal with the difficulties as- sociated with the joint power prior

  3. Recruiting for Prior Service Market

    Science.gov (United States)

    2008-06-01

    perceptions, expectations and issues for re-enlistment • Develop potential marketing and advertising tactics and strategies targeted to the defined...01 JUN 2008 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Recruiting for Prior Service Market 5a. CONTRACT NUMBER 5b. GRANT...Command First Handshake to First Unit of Assignment An Army of One Proud to Be e e to Serve Recruiting for Prior Service Market MAJ Eric Givens / MAJ Brian

  4. Arteriovenous fistula maturation in patients with permanent access created prior to or after hemodialysis initiation.

    Science.gov (United States)

    Duque, Juan C; Martinez, Laisel; Tabbara, Marwan; Dvorquez, Denise; Mehandru, Sushil K; Asif, Arif; Vazquez-Padron, Roberto I; Salman, Loay H

    2017-05-15

    Multiple factors and comorbidities have been implicated in the ability of arteriovenous fistulas (AVF) to mature, including vessel anatomy, advanced age, and the presence of coronary artery disease or peripheral vascular disease. However, little is known about the role of uremia on AVF primary failure. In this study, we attempt to evaluate the effect of uremia on AVF maturation by comparing AVF outcomes between pre-dialysis chronic kidney disease (CKD) stage five patients and those who had their AVF created after hemodialysis (HD) initiation. We included 612 patients who underwent AVF creation between 2003 and 2015 at the University of Miami Hospital and Jackson Memorial Hospital. Effects of uremia on primary failure were evaluated using univariate statistical comparisons and multivariate logistic regression analyses. Primary failure occurred in 28.1% and 26.3% of patients with an AVF created prior to or after HD initiation, respectively (p = 0.73). The time of HD initiation was not associated with AVF maturation in multivariate logistic regression analysis (p = 0.57). In addition, pre-operative blood urea nitrogen (p = 0.78), estimated glomerular filtration rate (p = 0.66), and serum creatinine levels (p = 0.14) were not associated with AVF primary failure in pre-dialysis patients. Our results show that clearance of uremia with regular HD treatments prior to AVF creation does not improve the frequency of vascular access maturation.

  5. PET image reconstruction using multi-parametric anato-functional priors

    Science.gov (United States)

    Mehranian, Abolfazl; Belzunce, Martin A.; Niccolini, Flavia; Politis, Marios; Prieto, Claudia; Turkheimer, Federico; Hammers, Alexander; Reader, Andrew J.

    2017-08-01

    In this study, we investigate the application of multi-parametric anato-functional (MR-PET) priors for the maximum a posteriori (MAP) reconstruction of brain PET data in order to address the limitations of the conventional anatomical priors in the presence of PET-MR mismatches. In addition to partial volume correction benefits, the suitability of these priors for reconstruction of low-count PET data is also introduced and demonstrated, comparing to standard maximum-likelihood (ML) reconstruction of high-count data. The conventional local Tikhonov and total variation (TV) priors and current state-of-the-art anatomical priors including the Kaipio, non-local Tikhonov prior with Bowsher and Gaussian similarity kernels are investigated and presented in a unified framework. The Gaussian kernels are calculated using both voxel- and patch-based feature vectors. To cope with PET and MR mismatches, the Bowsher and Gaussian priors are extended to multi-parametric priors. In addition, we propose a modified joint Burg entropy prior that by definition exploits all parametric information in the MAP reconstruction of PET data. The performance of the priors was extensively evaluated using 3D simulations and two clinical brain datasets of [18F]florbetaben and [18F]FDG radiotracers. For simulations, several anato-functional mismatches were intentionally introduced between the PET and MR images, and furthermore, for the FDG clinical dataset, two PET-unique active tumours were embedded in the PET data. Our simulation results showed that the joint Burg entropy prior far outperformed the conventional anatomical priors in terms of preserving PET unique lesions, while still reconstructing functional boundaries with corresponding MR boundaries. In addition, the multi-parametric extension of the Gaussian and Bowsher priors led to enhanced preservation of edge and PET unique features and also an improved bias-variance performance. In agreement with the simulation results, the clinical results

  6. The influence of prior knowledge on the retrieval-directed function of note taking in prior knowledge activation

    NARCIS (Netherlands)

    Wetzels, Sandra; Kester, Liesbeth; Van Merriënboer, Jeroen; Broers, Nick

    2010-01-01

    Wetzels, S. A. J., Kester, L., Van Merriënboer, J. J. G., & Broers, N. J. (2011). The influence of prior knowledge on the retrieval-directed function of note taking in prior knowledge activation. British Journal of Educational Psychology, 81(2), 274-291. doi: 10.1348/000709910X517425

  7. Intestinal lymphangiectasia in a patient with infantile systemic hyalinosis syndrome: a rare cause of protein-losing enteropathy.

    Science.gov (United States)

    Alreheili, Khalid; AlMehaidib, Ali; Alsaleem, Khalid; Banemi, Mohammad; Aldekhail, Wajeeh; Al-Mayouf, Sulaiman M

    2012-01-01

    Infantile systemic hyalinosis (ISH) is a rare autosomal recessive disease. Typically, ISH patients present with progressive painful joint contractures, intractable diarrhea, hyperpigmented skin lesions, and peri-anal fleshy nodules. We report a case of a 19-month-old male child with atypical ISH presentation. His main clinical finding was protein-losing enteropathy due to intestinal lymphangectasia. This report is intended to enhance awareness about the gastrointestinal tract presentation of ISH.

  8. Prior Sensitivity Analysis in Default Bayesian Structural Equation Modeling.

    Science.gov (United States)

    van Erp, Sara; Mulder, Joris; Oberski, Daniel L

    2017-11-27

    Bayesian structural equation modeling (BSEM) has recently gained popularity because it enables researchers to fit complex models and solve some of the issues often encountered in classical maximum likelihood estimation, such as nonconvergence and inadmissible solutions. An important component of any Bayesian analysis is the prior distribution of the unknown model parameters. Often, researchers rely on default priors, which are constructed in an automatic fashion without requiring substantive prior information. However, the prior can have a serious influence on the estimation of the model parameters, which affects the mean squared error, bias, coverage rates, and quantiles of the estimates. In this article, we investigate the performance of three different default priors: noninformative improper priors, vague proper priors, and empirical Bayes priors-with the latter being novel in the BSEM literature. Based on a simulation study, we find that these three default BSEM methods may perform very differently, especially with small samples. A careful prior sensitivity analysis is therefore needed when performing a default BSEM analysis. For this purpose, we provide a practical step-by-step guide for practitioners to conducting a prior sensitivity analysis in default BSEM. Our recommendations are illustrated using a well-known case study from the structural equation modeling literature, and all code for conducting the prior sensitivity analysis is available in the online supplemental materials. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  9. Cardiopulmonary exercise testing prior to myeloablative allo-SCT: a feasibility study.

    Science.gov (United States)

    Kelsey, C R; Scott, J M; Lane, A; Schwitzer, E; West, M J; Thomas, S; Herndon, J E; Michalski, M G; Horwitz, M E; Hennig, T; Jones, L W

    2014-10-01

    The feasibility of symptom-limited cardiopulmonary exercise testing (CPET) prior to allo-SCT was assessed in addition to the prognostic value of CPET-derived measures. CPET was performed prospectively on 21 patients with hematologic malignancies, with assessments of peak (for example, peak oxygen consumption, VO2peak) and submaximal (for example, ventilatory threshold (VT)) measures of cardiopulmonary function. No serious adverse events were observed during CPET procedures, with 95% of patients achieving criteria for a peak test. Mean VO2peak was 24.7±6.4 mL kg(-1 )min(-1) (range: 10.9-35.5), equivalent to 29%±17% below that of age-matched healthy controls. All patients proceeded with the conditioning regimen followed by allo-SCT. Median follow-up was 25 months. During this period, 11 (52.4%) patients died (n=6, relapsed disease; n=5, non-relapse mortality (NRM)); 9 patients (43%) developed pulmonary toxicity. In univariate analyses, both peak and submaximal markers of cardiopulmonary function were predictors of OS, pulmonary toxicity and NRM. For OS, the HR for VO2peak and VT were 0.89 (95% CI, 0.8-0.99, P=0.04) and 0.84 (95% CI, 0.71-0.98, P=0.03), respectively. In conclusion, CPET is safe and feasible prior to allo-SCT. Patients have marked impairments in cardiopulmonary function prior to allo-SCT. CPET-derived metrics may complement conventional measures to improve risk stratification.

  10. Recolonization of group B Streptococcus (GBS) in women with prior GBS genital colonization in pregnancy.

    Science.gov (United States)

    Tam, Teresa; Bilinski, Ewa; Lombard, Emily

    2012-10-01

    The purpose of the study is to evaluate the incidence of women with prior GBS genital colonization who have recolonization in subsequent pregnancies. This is a retrospective, cohort study of patients with a prior GBS genital colonization in pregnancy and a subsequent pregnancy with a recorded GBS culture result, from January 2000 through June 2007. Documentation of GBS status was through GBS culture performed between 35 to 37 weeks gestation. Exclusion criteria included pregnancies with unknown GBS status, patients with GBS bacteriuria, women with a previous neonate with GBS disease and GBS finding prior to 35 weeks. Data was analyzed using SPSS 15.0. The sample proportion of subjects with GBS genital colonization and its confidence interval were computed to estimate the incidence rate. Logistic regression was performed to assess potential determinants of GBS colonization. Regression coefficients, odds ratios and associated confidence intervals, and p-values were reported, with significant results reported. There were 371 pregnancies that met the test criteria. There were 151 subsequent pregnancies with GBS genital colonization and 220 without GBS recolonization. The incidence of GBS recolonization on patients with prior GBS genital colonization was 40.7% (95% confidence interval 35.7-45.69%). The incidence rate for the sample was significantly larger than 30% (p recolonization in subsequent pregnancies.

  11. Chronic kidney disease: information on southern brazilian patients with kidney disease - 10.4025/actascihealthsci.v34ispec.16048 Chronic kidney disease: information on southern brazilian patients with kidney disease - 10.4025/actascihealthsci.v34ispec.16048

    Directory of Open Access Journals (Sweden)

    Maria Dalva de Barros Carvalho

    2012-12-01

    Full Text Available The profile of patients undergoing haemodialysis in the dialysis unit of Hospital Santa Casa de Maringá, Maringá PR Brazil, is provided. A questionnaire on social and economic data and underlying diseases prior to the Chronic Kidney Disease (CKD identified the patients’ profile. The project was approved by the Ethics Committee of the institution. Eighty-three patients, with 54.21% males, were interviewed. Age bracket ranged between 20 and 59 years in 65.06% of patients. Only 27.71% maintained jobs after the diagnosis and the start of treatment; 63.86% had an average personal income between 1 and 3 minimum wages; 63.85% did not practice any physical activity. Moreover, 53.01% belonged to the European-Brazilian white group; 20.48% to the Afro-Brazilian brown group; 19.28% to the Afro-Brazilian Negro group; 6.02% to other ethnic groups. Further, 85.54% patients reported having an underlying disease prior to the CKD, namely, 61.45% were hypertensive; 31.33% were diabetics and 20.48% had other diseases. Results show the need of a greater attention to these patients’ health care to reduce the negative impacts related to the chronic disease focused.The profile of patients undergoing haemodialysis in the dialysis unit of Hospital Santa Casa de Maringá, Maringá PR Brazil, is provided. A questionnaire on social and economic data and underlying diseases prior to the Chronic Kidney Disease (CKD identified the patients’ profile. The project was approved by the Ethics Committee of the institution. Eighty-three patients, with 54.21% males, were interviewed. Age bracket ranged between 20 and 59 years in 65.06% of patients. Only 27.71% maintained jobs after the diagnosis and the start of treatment; 63.86% had an average personal income between 1 and 3 minimum wages; 63.85% did not practice any physical activity. Moreover, 53.01% belonged to the European-Brazilian white group; 20.48% to the Afro-Brazilian brown group; 19.28% to the Afro-Brazilian Negro

  12. Efficacy, safety, and improved tolerability of travoprost BAK-free ophthalmic solution compared with prior prostaglandin therapy

    Directory of Open Access Journals (Sweden)

    J Charles Henry

    2008-10-01

    Full Text Available J Charles Henry1, James H Peace2, Jeanette A Stewart3,4, William C Stewart3,41Little Rock Eye Clinic, Little Rock, AR, USA; 2Diabetic Eye Medical Clinic, Inglewood, CA, USA; 3PRN Pharmaceutical Research Network, LLC, Dallas,TX, USA; 4Carolina Eye Institute, University of South Carolina, School of Medicine, Columbia, SC, USAPurpose: To evaluate the efficacy, safety and tolerability of changing to travoprost BAK-free from prior prostaglandin therapy in patients with primary open-angle glaucoma or ocular hypertension.Design: Prospective, multi-center, historical control study.Methods: Patients treated with latanoprost or bimatoprost who needed alternative therapy due to tolerability issues were enrolled. Patients were surveyed using the Ocular Surface Disease Index (OSDI to evaluate OSD symptoms prior to changing to travoprost BAK-free dosed once every evening. Patients were re-evaluated 3 months later.Results: In 691 patients, travoprost BAK-free demonstrated improved mean OSDI scores compared to either latanoprost or bimatoprost (p < 0.0001. Patients having any baseline OSD symptoms (n = 235 demonstrated significant improvement after switching to travoprost BAK-free (p < 0.0001. In 70.2% of these patients, symptoms were reduced in severity by at least 1 level. After changing medications to travoprost BAK-free, mean intraocular pressure (IOP was significantly decreased (p < 0.0001. Overall, 72.4% preferred travoprost BAK-free (p < 0.0001, travoprost BAK-free vs prior therapy. Travoprost BAK-free demonstrated less conjunctival hyperemia than either prior therapy (p < 0.0001.Conclusions: Patients previously treated with a BAK-preserved prostaglandin analog who are changed to travoprost BAK-free have clinically and statistically significant improvement in their OSD symptoms, decreased hyperemia, and equal or better IOP control.Keywords: glaucoma, prostaglandin analog, travoprost, latanoprost, bimatoprost, preservative, benzalkonium chloride

  13. Offending prior to first psychiatric contact

    DEFF Research Database (Denmark)

    Stevens, H; Agerbo, E; Dean, K

    2012-01-01

    There is a well-established association between psychotic disorders and subsequent offending but the extent to which those who develop psychosis might have a prior history of offending is less clear. Little is known about whether the association between illness and offending exists in non-psychot......-psychotic disorders. The aim of this study was to determine whether the association between mental disorder and offending is present prior to illness onset in psychotic and non-psychotic disorders.......There is a well-established association between psychotic disorders and subsequent offending but the extent to which those who develop psychosis might have a prior history of offending is less clear. Little is known about whether the association between illness and offending exists in non...

  14. Terminology for pregnancy loss prior to viability

    DEFF Research Database (Denmark)

    Kolte, A M; Bernardi, L A; Christiansen, O B

    2015-01-01

    Pregnancy loss prior to viability is common and research in the field is extensive. Unfortunately, terminology in the literature is inconsistent. The lack of consensus regarding nomenclature and classification of pregnancy loss prior to viability makes it difficult to compare study results from...... different centres. In our opinion, terminology and definitions should be based on clinical findings, and when possible, transvaginal ultrasound. With this Early Pregnancy Consensus Statement, it is our goal to provide clear and consistent terminology for pregnancy loss prior to viability....

  15. Biased and inadequate citation of prior research in reports of cardiovascular trials is a continuing source of waste in research.

    Science.gov (United States)

    Sawin, Veronica I; Robinson, Karen A

    2016-01-01

    We assessed citation of prior research over time and the association of citation with the agreement of results between the trial being reported and the prior trial. Groups of pharmacologic trials in cardiovascular disease were created using meta-analyses, and we assessed citation within these groups. We calculated the proportion of prior trials cited, the proportion of study participants captured in citations, and agreement of results between citing and cited trials. Analysis included 86 meta-analyses with 580 trials published between 1982 and 2011. Reports of trials cited 25% (median; 95% confidence interval [CI], 23-27%) of prior trials, capturing 31% (95% CI, 25-36%) of trial participants. Neither measure differed by publication of the citing trial before vs. after 2005. Prior trials with results that agreed with the reports of trials (supportive trials) were significantly more likely to be cited than nonsupportive trials (relative risk 1.45; 95% CI, 1.30-1.61, P < 0.001). Selective undercitation of prior research continues; three quarters of existing evidence is ignored. This source of waste may result in unnecessary, unethical, and unscientific studies. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Diagnostic and prognostic value of a careful symptom evaluation and high sensitive troponin in patients with suspected stable angina pectoris without prior cardiovascular disease

    DEFF Research Database (Denmark)

    Madsen, Debbie Maria; Diederichsen, Axel C P; Hosbond, Susanne E

    2017-01-01

    -TnI in stable chest pain patients without prior cardiovascular disease. METHODS: During a one-year period, 487 patients with suspected stable AP underwent invasive or CT-coronary angiography (significant stenosis ≥50%). At study inclusion, a careful symptom evaluation was obtained, and patients were classified...... as having typical AP, atypical AP, or non-cardiac chest pain. Hs-TnI was measured in all patients and divided into tertiles for analysis. Follow-up was a median of 4.9 years with cardiovascular death, non-fatal myocardial infarction, unstable AP, ischemic stroke, coronary.......07-5.79; p 12-2.01; p = 0.007) and experiencing future CVE (typical AP, HR: 2.64; 95% CI: 1.74-3.99; p = 0.001, hs-TnI, HR: 1.26; 95% CI: 1.06-1.49; p = 0.008). Patients in the lowest hs-TnI tertile, without typical AP (n = 107) had a 1.9% absolute risk of significant...

  17. Reproducing kernel Hilbert spaces of Gaussian priors

    NARCIS (Netherlands)

    Vaart, van der A.W.; Zanten, van J.H.; Clarke, B.; Ghosal, S.

    2008-01-01

    We review definitions and properties of reproducing kernel Hilbert spaces attached to Gaussian variables and processes, with a view to applications in nonparametric Bayesian statistics using Gaussian priors. The rate of contraction of posterior distributions based on Gaussian priors can be described

  18. Prior Knowledge Assessment Guide

    Science.gov (United States)

    2014-12-01

    assessment in a reasonable amount of time. Hands-on assessments can be extremely diverse in makeup and administration depending on the subject matter...DEVELOPING AND USING PRIOR KNOWLEDGE ASSESSMENTS TO TAILOR TRAINING D-3 ___ Brush and scrub ___ Orchards ___ Rice

  19. Fractional Gaussian noise: Prior specification and model comparison

    KAUST Repository

    Sørbye, Sigrunn Holbek

    2017-07-07

    Fractional Gaussian noise (fGn) is a stationary stochastic process used to model antipersistent or persistent dependency structures in observed time series. Properties of the autocovariance function of fGn are characterised by the Hurst exponent (H), which, in Bayesian contexts, typically has been assigned a uniform prior on the unit interval. This paper argues why a uniform prior is unreasonable and introduces the use of a penalised complexity (PC) prior for H. The PC prior is computed to penalise divergence from the special case of white noise and is invariant to reparameterisations. An immediate advantage is that the exact same prior can be used for the autocorrelation coefficient ϕ(symbol) of a first-order autoregressive process AR(1), as this model also reflects a flexible version of white noise. Within the general setting of latent Gaussian models, this allows us to compare an fGn model component with AR(1) using Bayes factors, avoiding the confounding effects of prior choices for the two hyperparameters H and ϕ(symbol). Among others, this is useful in climate regression models where inference for underlying linear or smooth trends depends heavily on the assumed noise model.

  20. Fractional Gaussian noise: Prior specification and model comparison

    KAUST Repository

    Sø rbye, Sigrunn Holbek; Rue, Haavard

    2017-01-01

    Fractional Gaussian noise (fGn) is a stationary stochastic process used to model antipersistent or persistent dependency structures in observed time series. Properties of the autocovariance function of fGn are characterised by the Hurst exponent (H), which, in Bayesian contexts, typically has been assigned a uniform prior on the unit interval. This paper argues why a uniform prior is unreasonable and introduces the use of a penalised complexity (PC) prior for H. The PC prior is computed to penalise divergence from the special case of white noise and is invariant to reparameterisations. An immediate advantage is that the exact same prior can be used for the autocorrelation coefficient ϕ(symbol) of a first-order autoregressive process AR(1), as this model also reflects a flexible version of white noise. Within the general setting of latent Gaussian models, this allows us to compare an fGn model component with AR(1) using Bayes factors, avoiding the confounding effects of prior choices for the two hyperparameters H and ϕ(symbol). Among others, this is useful in climate regression models where inference for underlying linear or smooth trends depends heavily on the assumed noise model.

  1. Dosimetry prior to I-131-therapy of benign thyroid disease

    International Nuclear Information System (INIS)

    Haenscheid, Heribert; Lassmann, Michael; Reiners, Christoph

    2011-01-01

    The activity to be administered in I-131 therapy of benign thyroid disease is determined by the radiation absorbed dose necessary to cure the disease, the target mass, and the residence time of the I-131 in the target volume. Data from 73 patients with complete sets of uptake measurements 2, 6, 24, 48, and 96 (n = 53) or 120 (n = 20) hours after oral administration of 1 MBq I-131 were used to deduce residence times from subsets of 3, 2, or only 1 measurement for each individual. The values were compared to those obtained with the reference method, i.e. a fit of an uptake function based on a 2-compartment model to all 5 measurements, to quantify the errors introduced by the less demanding assessments. Deviations are less than 10% if the 2- compartment uptake function is fitted to only 3 values measured after 6, 24, and 96-120 h. Use of 2, 24, and 96-120 h data results in errors > 20% in individual patients. The effective half-lives as determined from 2 measurements after 24 and 96-120 h correlate well with those deduced from the reference method with larger deviations in individuals with slow iodine kinetics and late maximal uptake. Residence times determined from the 24 h uptake, assuming linear increase during the first day, and the effective half-life limited to maximum 8 days underestimate the actual values systematically in patients with long and short half-lives. These errors can be eliminated by a modification of the calculation method resulting in deviations less than 14% in all but one individual for this procedure. The accuracy of methods based on only one retention value increases with the time of measurement after the administration of I-131. While systematic errors up to a factor of two occur if the 24 h uptake is used for the estimate, deviations are less than 18% for measurements after 120 h. The results suggest that only one late uptake assessment warrants residence time estimates with an acceptable error. Given the high inherent uncertainties in the

  2. Learning priors for Bayesian computations in the nervous system.

    Directory of Open Access Journals (Sweden)

    Max Berniker

    Full Text Available Our nervous system continuously combines new information from our senses with information it has acquired throughout life. Numerous studies have found that human subjects manage this by integrating their observations with their previous experience (priors in a way that is close to the statistical optimum. However, little is known about the way the nervous system acquires or learns priors. Here we present results from experiments where the underlying distribution of target locations in an estimation task was switched, manipulating the prior subjects should use. Our experimental design allowed us to measure a subject's evolving prior while they learned. We confirm that through extensive practice subjects learn the correct prior for the task. We found that subjects can rapidly learn the mean of a new prior while the variance is learned more slowly and with a variable learning rate. In addition, we found that a Bayesian inference model could predict the time course of the observed learning while offering an intuitive explanation for the findings. The evidence suggests the nervous system continuously updates its priors to enable efficient behavior.

  3. Valid MR imaging predictors of prior knee arthroscopy

    International Nuclear Information System (INIS)

    Discepola, Federico; Le, Huy B.Q.; Park, John S.; Clopton, Paul; Knoll, Andrew N.; Austin, Matthew J.; Resnick, Donald L.

    2012-01-01

    To determine whether fibrosis of the medial patellar reticulum (MPR), lateral patellar reticulum (LPR), deep medial aspect of Hoffa's fat pad (MDH), or deep lateral aspect of Hoffa's fat pad (LDH) is a valid predictor of prior knee arthroscopy. Institutional review board approval and waiver of informed consent were obtained for this HIPPA-compliant study. Initially, fibrosis of the MPR, LPR, MDH, or LDH in MR imaging studies of 50 patients with prior knee arthroscopy and 100 patients without was recorded. Subsequently, two additional radiologists, blinded to clinical data, retrospectively and independently recorded the presence of fibrosis of the MPR in 50 patients with prior knee arthroscopy and 50 without. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for detecting the presence of fibrosis in the MPR were calculated. κ statistics were used to analyze inter-observer agreement. Fibrosis of each of the regions examined during the first portion of the study showed a significant association with prior knee arthroscopy (p < 0.005 for each). A patient with fibrosis of the MPR, LDH, or LPR was 45.5, 9, or 3.7 times more likely, respectively, to have had a prior knee arthroscopy. Logistic regression analysis indicated that fibrosis of the MPR supplanted the diagnostic utility of identifying fibrosis of the LPR, LDH, or MDH, or combinations of these (p ≥ 0.09 for all combinations). In the second portion of the study, fibrosis of the MPR demonstrated a mean sensitivity of 82%, specificity of 72%, PPV of 75%, NPV of 81%, and accuracy of 77% for predicting prior knee arthroscopy. Analysis of MR images can be used to determine if a patient has had prior knee arthroscopy by identifying fibrosis of the MPR, LPR, MDH, or LDH. Fibrosis of the MPR was the strongest predictor of prior knee arthroscopy. (orig.)

  4. Valid MR imaging predictors of prior knee arthroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Discepola, Federico; Le, Huy B.Q. [McGill University Health Center, Jewsih General Hospital, Division of Musculoskeletal Radiology, Montreal, Quebec (Canada); Park, John S. [Annapolis Radiology Associates, Division of Musculoskeletal Radiology, Annapolis, MD (United States); Clopton, Paul; Knoll, Andrew N.; Austin, Matthew J.; Resnick, Donald L. [University of California San Diego (UCSD), Division of Musculoskeletal Radiology, San Diego, CA (United States)

    2012-01-15

    To determine whether fibrosis of the medial patellar reticulum (MPR), lateral patellar reticulum (LPR), deep medial aspect of Hoffa's fat pad (MDH), or deep lateral aspect of Hoffa's fat pad (LDH) is a valid predictor of prior knee arthroscopy. Institutional review board approval and waiver of informed consent were obtained for this HIPPA-compliant study. Initially, fibrosis of the MPR, LPR, MDH, or LDH in MR imaging studies of 50 patients with prior knee arthroscopy and 100 patients without was recorded. Subsequently, two additional radiologists, blinded to clinical data, retrospectively and independently recorded the presence of fibrosis of the MPR in 50 patients with prior knee arthroscopy and 50 without. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for detecting the presence of fibrosis in the MPR were calculated. {kappa} statistics were used to analyze inter-observer agreement. Fibrosis of each of the regions examined during the first portion of the study showed a significant association with prior knee arthroscopy (p < 0.005 for each). A patient with fibrosis of the MPR, LDH, or LPR was 45.5, 9, or 3.7 times more likely, respectively, to have had a prior knee arthroscopy. Logistic regression analysis indicated that fibrosis of the MPR supplanted the diagnostic utility of identifying fibrosis of the LPR, LDH, or MDH, or combinations of these (p {>=} 0.09 for all combinations). In the second portion of the study, fibrosis of the MPR demonstrated a mean sensitivity of 82%, specificity of 72%, PPV of 75%, NPV of 81%, and accuracy of 77% for predicting prior knee arthroscopy. Analysis of MR images can be used to determine if a patient has had prior knee arthroscopy by identifying fibrosis of the MPR, LPR, MDH, or LDH. Fibrosis of the MPR was the strongest predictor of prior knee arthroscopy. (orig.)

  5. Generalized multiple kernel learning with data-dependent priors.

    Science.gov (United States)

    Mao, Qi; Tsang, Ivor W; Gao, Shenghua; Wang, Li

    2015-06-01

    Multiple kernel learning (MKL) and classifier ensemble are two mainstream methods for solving learning problems in which some sets of features/views are more informative than others, or the features/views within a given set are inconsistent. In this paper, we first present a novel probabilistic interpretation of MKL such that maximum entropy discrimination with a noninformative prior over multiple views is equivalent to the formulation of MKL. Instead of using the noninformative prior, we introduce a novel data-dependent prior based on an ensemble of kernel predictors, which enhances the prediction performance of MKL by leveraging the merits of the classifier ensemble. With the proposed probabilistic framework of MKL, we propose a hierarchical Bayesian model to learn the proposed data-dependent prior and classification model simultaneously. The resultant problem is convex and other information (e.g., instances with either missing views or missing labels) can be seamlessly incorporated into the data-dependent priors. Furthermore, a variety of existing MKL models can be recovered under the proposed MKL framework and can be readily extended to incorporate these priors. Extensive experiments demonstrate the benefits of our proposed framework in supervised and semisupervised settings, as well as in tasks with partial correspondence among multiple views.

  6. Web tools for the prioritization of candidate disease genes.

    NARCIS (Netherlands)

    Oti, M.O.; Ballouz, S.; Wouters, M.A.

    2011-01-01

    Despite increasing sequencing capacity, genetic disease investigation still frequently results in the identification of loci containing multiple candidate disease genes that need to be tested for involvement in the disease. This process can be expedited by prioritizing the candidates prior to

  7. Calibrated birth-death phylogenetic time-tree priors for bayesian inference.

    Science.gov (United States)

    Heled, Joseph; Drummond, Alexei J

    2015-05-01

    Here we introduce a general class of multiple calibration birth-death tree priors for use in Bayesian phylogenetic inference. All tree priors in this class separate ancestral node heights into a set of "calibrated nodes" and "uncalibrated nodes" such that the marginal distribution of the calibrated nodes is user-specified whereas the density ratio of the birth-death prior is retained for trees with equal values for the calibrated nodes. We describe two formulations, one in which the calibration information informs the prior on ranked tree topologies, through the (conditional) prior, and the other which factorizes the prior on divergence times and ranked topologies, thus allowing uniform, or any arbitrary prior distribution on ranked topologies. Although the first of these formulations has some attractive properties, the algorithm we present for computing its prior density is computationally intensive. However, the second formulation is always faster and computationally efficient for up to six calibrations. We demonstrate the utility of the new class of multiple-calibration tree priors using both small simulations and a real-world analysis and compare the results to existing schemes. The two new calibrated tree priors described in this article offer greater flexibility and control of prior specification in calibrated time-tree inference and divergence time dating, and will remove the need for indirect approaches to the assessment of the combined effect of calibration densities and tree priors in Bayesian phylogenetic inference. © The Author(s) 2014. Published by Oxford University Press, on behalf of the Society of Systematic Biologists.

  8. Optimizing screening for tuberculosis and hepatitis B prior to starting tumor necrosis factor-α inhibitors in Crohn's disease.

    Science.gov (United States)

    van der Have, Mike; Oldenburg, Bas; Fidder, Herma H; Belderbos, Tim D G; Siersema, Peter D; van Oijen, Martijn G H

    2014-03-01

    Treatment with tumor necrosis factor-α (TNF-α) inhibitors in patients with Crohn's disease (CD) is associated with potentially serious infections, including tuberculosis (TB) and hepatitis B virus (HBV). We assessed the cost-effectiveness of extensive TB screening and HBV screening prior to initiating TNF-α inhibitors in CD. We constructed two Markov models: (1) comparing tuberculin skin test (TST) combined with chest X-ray (conventional TB screening) versus TST and chest X-ray followed by the interferon-gamma release assay (extensive TB screening) in diagnosing TB; and (2) HBV screening versus no HBV screening. Our base-case included an adult CD patient starting with infliximab treatment. Input parameters were extracted from the literature. Direct medical costs were assessed and discounted following a third-party payer perspective. The main outcome was the incremental cost-effectiveness ratio (ICER). Sensitivity and Monte Carlo analyses were performed over wide ranges of probability and cost estimates. At base-case, the ICERs of extensive screening and HBV screening were €64,340 and €75,760 respectively to gain one quality-adjusted life year. Sensitivity analyses concluded that extensive TB screening was a cost-effective strategy if the latent TB prevalence is more than 12 % or if the false positivity rate of TST is more than 20 %. HBV screening became cost-effective if HBV reactivation or HBV-related mortality is higher than 37 and 62 %, respectively. Extensive TB screening and HBV screening are not cost-effective compared with conventional TB screening and no HBV screening, respectively. However, when targeted at high-risk patient groups, these screening strategies are likely to become cost-effective.

  9. Population snapshot of Streptococcus pneumoniae causing invasive disease in South Africa prior to introduction of pneumococcal conjugate vaccines.

    Directory of Open Access Journals (Sweden)

    Kedibone M Ndlangisa

    Full Text Available We determined the sequence types of isolates that caused invasive pneumococcal disease (IPD prior to routine use of pneumococcal conjugate vaccines (PCV in South Africa. PCV-13 serotypes and 6C isolates collected in 2007 (1 461/2 437, 60% from patients of all ages as part of on-going, national, laboratory-based surveillance for IPD, were selected for genetic characterization. In addition, all 134 non-PCV isolates from children <2 years were selected for characterization. Sequence type diversity by serotype and age category (children <5 years vs. individuals ≥5 years was assessed for PCV serotypes using Simpson's index of diversity. Similar genotypes circulated among isolates from children and adults and the majority of serotypes were heterogeneous. While globally disseminated clones were common among some serotypes (e.g., serotype 1 [clonal complex (CC 217, 98% of all serotype 1] and 14 [CC230, 43%], some were represented mainly by clonal complexes rarely reported elsewhere (e.g., serotype 3 [CC458, 60%] and 19A [CC2062, 83%]. In children <2 years, serotype 15B and 8 were the most common serotypes among non-PCV isolates (16% [22/134] and 15% [20/134] isolates, respectively. Sequence type 7052 and 53 were most common among serotypes 15B and 8 isolates and accounted for 58% (7/12 and 64% (9/14 of the isolates, respectively. Serotype 19F, 14, 19A and 15B had the highest proportions of penicillin non-susceptible isolates. Genotypes rarely reported in other parts of the world but common among some of our serotypes highlight the importance of our data as these genotypes may emerge post PCV introduction.

  10. The impact of dyslipidaemia on cardiovascular mortality in individuals without a prior history of diabetes in the DECODE Study

    DEFF Research Database (Denmark)

    Zhang, L.; Qiao, Q.; Tuomilehto, J.

    2009-01-01

    OBJECTIVE: To evaluate the impact of dyslipidaemia on cardiovascular disease (CVD) mortality in relation to fasting (FPG) and 2-h (2hPG) plasma glucose levels in individuals without a prior history of diabetes. METHODS: Data from 14 European population-based prospective studies of 9132 men and 8631...

  11. Incidence, clearance, and disease progression of genital human papillomavirus infection in heterosexual men.

    Science.gov (United States)

    Moreira, Edson Duarte; Giuliano, Anna R; Palefsky, Joel; Flores, Carlos Aranda; Goldstone, Stephen; Ferris, Daron; Hillman, Richard J; Moi, Harald; Stoler, Mark H; Marshall, Brooke; Vuocolo, Scott; Guris, Dalya; Haupt, Richard M

    2014-07-15

    In this analysis, we examine the incidence and clearance of external genital human papillomavirus (HPV) infection among heterosexual males aged 16-24 years. A total of 1732 males aged 16-24 years old in the placebo arm of a quadrivalent HPV vaccine trial were included in this analysis. Participants were enrolled from 18 countries in Africa, the Asia-Pacific region, Europe, Latin America, and North America. Subjects underwent anogenital examinations and sampling of the penis, scrotum, and perineal/perianal regions. The incidence rate of any HPV DNA genotype 6, 11, 16, and/or 18 detection was 9.0 cases per 100 person-years. Rates of HPV DNA detection were highest in men from Africa. Median time to clearance of HPV genotypes 6, 11, 16, and 18 DNA was 6.1, 6.1, 7.7, and 6.2 months, respectively. Median time to clearance of persistently detected HPV 6, 11, 16, and 18 DNA was 6.7, 3.2, 9.2, and 4.7 months, respectively. The study results suggest that the acquisition of HPV 6, 11, 16, and/or 18 in males is common and that many of these so-called infections are subsequently cleared, similar to findings for women. Nevertheless, given the high rate of HPV detection among young men, HPV vaccination of males may reduce infection in men and reduce the overall burden of HPV-associated disease in the community. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  12. Improving Open Access through Prior Learning Assessment

    Science.gov (United States)

    Yin, Shuangxu; Kawachi, Paul

    2013-01-01

    This paper explores and presents new data on how to improve open access in distance education through using prior learning assessments. Broadly there are three types of prior learning assessment (PLAR): Type-1 for prospective students to be allowed to register for a course; Type-2 for current students to avoid duplicating work-load to gain…

  13. The effect of prior transfusion history on blood donor anti-hepatitis C virus antibody.

    Science.gov (United States)

    Mazda, T; Nakata, K; Ota, K; Kaminuma, Y; Katayama, T

    1993-01-01

    In Japan, the major transfusion-associated disease is non-A, non-B hepatitis. We studied the relationship between transfusion history and blood donor antibodies to hepatitis C virus (HCV). The positive rate of antibodies to the HCV nonstructural protein (c100-3) depended on age and the time elapsed since transfusion. The anti-c100-3 ratio for subjects with transfusions made prior to 20 years ago was high. One quarter century ago, a change occurred in national blood policy from paid to non-paid voluntary donations. We also have studied the anti-HCV positive rate among donors with prior transfusion using a second generation HCV test kit which includes anti-HCV core antibody detection. The anti-HCV positive rate for the second generation test was higher than that for the anti-c100-3 test. Introduction of the second generation test is therefore more useful in screening than the anti-c100-3 test for blood programs.

  14. Training shortest-path tractography: Automatic learning of spatial priors

    DEFF Research Database (Denmark)

    Kasenburg, Niklas; Liptrot, Matthew George; Reislev, Nina Linde

    2016-01-01

    Tractography is the standard tool for automatic delineation of white matter tracts from diffusion weighted images. However, the output of tractography often requires post-processing to remove false positives and ensure a robust delineation of the studied tract, and this demands expert prior...... knowledge. Here we demonstrate how such prior knowledge, or indeed any prior spatial information, can be automatically incorporated into a shortest-path tractography approach to produce more robust results. We describe how such a prior can be automatically generated (learned) from a population, and we...

  15. Acquisition of multiple prior distributions in tactile temporal order judgment

    Directory of Open Access Journals (Sweden)

    Yasuhito eNagai

    2012-08-01

    Full Text Available The Bayesian estimation theory proposes that the brain acquires the prior distribution of a task and integrates it with sensory signals to minimize the effect of sensory noise. Psychophysical studies have demonstrated that our brain actually implements Bayesian estimation in a variety of sensory-motor tasks. However, these studies only imposed one prior distribution on participants within a task period. In this study, we investigated the conditions that enable the acquisition of multiple prior distributions in temporal order judgment (TOJ of two tactile stimuli across the hands. In Experiment 1, stimulation intervals were randomly selected from one of two prior distributions (biased to right hand earlier and biased to left hand earlier in association with color cues (green and red, respectively. Although the acquisition of the two priors was not enabled by the color cues alone, it was significant when participants shifted their gaze (above or below in response to the color cues. However, the acquisition of multiple priors was not significant when participants moved their mouths (opened or closed. In Experiment 2, the spatial cues (above and below were used to identify which eye position or retinal cue position was crucial for the eye-movement-dependent acquisition of multiple priors in Experiment 1. The acquisition of the two priors was significant when participants moved their gaze to the cues (i.e., the cue positions on the retina were constant across the priors, as well as when participants did not shift their gazes (i.e., the cue positions on the retina changed according to the priors. Thus, both eye and retinal cue positions were effective in acquiring multiple priors. Based on previous neurophysiological reports, we discuss possible neural correlates that contribute to the acquisition of multiple priors.

  16. Use of antibiotics in patients with Crohn's disease: a systematic review and meta-analysis.

    Science.gov (United States)

    Su, Jie Wen; Ma, Jing Jing; Zhang, Hong Jie

    2015-02-01

    Some studies have suggested that antibiotic treatment might be efficient for patients with active Crohn's disease (CD). However, the results are conflicting. The aim of this study was to summarize the available evidence on the efficacy of antibiotics, especially ciprofloxacin, in treating patients with CD. A literature search was conducted on the PubMed, Medline, Web of Science and Excerpta Medica Database (EMBASE) for manuscripts published until March 2014. Randomized controlled trials that mainly evaluated the efficacy of antibiotic treatment in patients with CD using clinical remission or response as the key outcome of interest were included. Intention-to-treat analyses were used to evaluate the relative risk (RR) and 95% confidence intervals (CI). In all, 15 randomized placebo-controlled clinical trials involving 1407 participants were included in the meta-analysis. A pooled analysis revealed that compared with placebo, antibiotics benefited CD patients to a certain extent (RR 1.33, 95% CI 1.17-1.51, P antibiotics was beneficial for patients with CD. Nevertheless, subgroup analyses indicated that treatment with ciprofloxacin alone was significantly efficient for CD patients with perianal fistulas. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  17. Novel exonic mutation inducing aberrant splicing in the IL10RA gene and resulting in infantile-onset inflammatory bowel disease: a case report.

    Science.gov (United States)

    Yanagi, Tadahiro; Mizuochi, Tatsuki; Takaki, Yugo; Eda, Keisuke; Mitsuyama, Keiichi; Ishimura, Masataka; Takada, Hidetoshi; Shouval, Dror S; Griffith, Alexandra E; Snapper, Scott B; Yamashita, Yushiro; Yamamoto, Ken

    2016-01-28

    Although deleterious mutations in interleukin-10 and its receptor molecules cause severe infantile-onset inflammatory bowel disease, there are no reports of mutations affecting this signaling pathway in Japanese patients. Here we report a novel exonic mutation in the IL10RA gene that caused unique splicing aberrations in a Japanese patient with infantile-onset of inflammatory bowel disease in association with immune thrombocytopenic purpura and a transient clinical syndrome mimicking juvenile myelomonocytic leukemia. A Japanese boy, who was the first child of non-consanguineous healthy parents, developed bloody diarrhea, perianal fistula, and folliculitis in early infancy and was diagnosed with inflammatory bowel disease. He also developed immune thrombocytopenic purpura and transient features mimicking juvenile myelomonocytic leukemia. The patient failed to respond to various treatments, including elemental diet, salazosulfapyridine, metronidazole, corticosteroid, infliximab, and adalimumab. We identified a novel mutation (c.537G > A, p.T179T) in exon 4 of the IL10RA gene causing unique splicing aberrations and resulting in lack of signaling through the interleukin-10 receptor. At 21 months of age, the patient underwent allogeneic hematopoietic stem cell transplantation and achieved clinical remission. We describe a novel exonic mutation in the IL10RA gene resulting in infantile-onset inflammatory bowel disease. This mutation might also be involved in his early-onset hematologic disorders. Physicians should be familiar with the clinical phenotype of IL-10 signaling defects in order to enable prompt diagnosis at an early age and referral for allogeneic hematopoietic stem cell transplantation.

  18. vanishing bone disease in a tertiary teaching hospital in uganda

    African Journals Online (AJOL)

    prior to the above presentation and review of systems were unremarkable. General examination revealed a ... syndrome or disease, massive osteolysis, disappearing bone disease, vanishing bone disease, idiopathic ... patient symptoms and anatomic location. Medical treatment involves, radiation therapy, anti-osteoclastic.

  19. Prior-based artifact correction (PBAC) in computed tomography

    International Nuclear Information System (INIS)

    Heußer, Thorsten; Brehm, Marcus; Ritschl, Ludwig; Sawall, Stefan; Kachelrieß, Marc

    2014-01-01

    Purpose: Image quality in computed tomography (CT) often suffers from artifacts which may reduce the diagnostic value of the image. In many cases, these artifacts result from missing or corrupt regions in the projection data, e.g., in the case of metal, truncation, and limited angle artifacts. The authors propose a generalized correction method for different kinds of artifacts resulting from missing or corrupt data by making use of available prior knowledge to perform data completion. Methods: The proposed prior-based artifact correction (PBAC) method requires prior knowledge in form of a planning CT of the same patient or in form of a CT scan of a different patient showing the same body region. In both cases, the prior image is registered to the patient image using a deformable transformation. The registered prior is forward projected and data completion of the patient projections is performed using smooth sinogram inpainting. The obtained projection data are used to reconstruct the corrected image. Results: The authors investigate metal and truncation artifacts in patient data sets acquired with a clinical CT and limited angle artifacts in an anthropomorphic head phantom data set acquired with a gantry-based flat detector CT device. In all cases, the corrected images obtained by PBAC are nearly artifact-free. Compared to conventional correction methods, PBAC achieves better artifact suppression while preserving the patient-specific anatomy at the same time. Further, the authors show that prominent anatomical details in the prior image seem to have only minor impact on the correction result. Conclusions: The results show that PBAC has the potential to effectively correct for metal, truncation, and limited angle artifacts if adequate prior data are available. Since the proposed method makes use of a generalized algorithm, PBAC may also be applicable to other artifacts resulting from missing or corrupt data

  20. Infection or allergy? The multifaceted nature of vulvar dermatoses

    Directory of Open Access Journals (Sweden)

    Alok Vij, MD

    2015-12-01

    Full Text Available Chronic dermatitis or pruritus affecting the female genital and perianal skin can be challenging to properly diagnose and manage. The differential diagnosis generally includes allergic, inflammatory, infectious, and neoplastic conditions. We report the case of a 52-year-old woman with a 6-month history of a progressive, debilitating vulvar and perianal rash that highlights the multifaceted nature of female genital dermatoses.

  1. Estimating Functions with Prior Knowledge, (EFPK) for diffusions

    DEFF Research Database (Denmark)

    Nolsøe, Kim; Kessler, Mathieu; Madsen, Henrik

    2003-01-01

    In this paper a method is formulated in an estimating function setting for parameter estimation, which allows the use of prior information. The main idea is to use prior knowledge of the parameters, either specified as moments restrictions or as a distribution, and use it in the construction of a...... of an estimating function. It may be useful when the full Bayesian analysis is difficult to carry out for computational reasons. This is almost always the case for diffusions, which is the focus of this paper, though the method applies in other settings.......In this paper a method is formulated in an estimating function setting for parameter estimation, which allows the use of prior information. The main idea is to use prior knowledge of the parameters, either specified as moments restrictions or as a distribution, and use it in the construction...

  2. Arthur Prior and 'Now'

    DEFF Research Database (Denmark)

    Blackburn, Patrick Rowan; Jørgensen, Klaus Frovin

    2016-01-01

    ’s search led him through the work of Castañeda, and back to his own work on hybrid logic: the first made temporal reference philosophically respectable, the second made it technically feasible in a modal framework. With the aid of hybrid logic, Prior built a bridge from a two-dimensional UT calculus...

  3. Self-prior strategy for organ reconstruction in fluorescence molecular tomography.

    Science.gov (United States)

    Zhou, Yuan; Chen, Maomao; Su, Han; Luo, Jianwen

    2017-10-01

    The purpose of this study is to propose a strategy for organ reconstruction in fluorescence molecular tomography (FMT) without prior information from other imaging modalities, and to overcome the high cost and ionizing radiation caused by the traditional structural prior strategy. The proposed strategy is designed as an iterative architecture to solve the inverse problem of FMT. In each iteration, a short time Fourier transform (STFT) based algorithm is used to extract the self-prior information in the space-frequency energy spectrum with the assumption that the regions with higher fluorescence concentration have larger energy intensity, then the cost function of the inverse problem is modified by the self-prior information, and lastly an iterative Laplacian regularization algorithm is conducted to solve the updated inverse problem and obtains the reconstruction results. Simulations and in vivo experiments on liver reconstruction are carried out to test the performance of the self-prior strategy on organ reconstruction. The organ reconstruction results obtained by the proposed self-prior strategy are closer to the ground truth than those obtained by the iterative Tikhonov regularization (ITKR) method (traditional non-prior strategy). Significant improvements are shown in the evaluation indexes of relative locational error (RLE), relative error (RE) and contrast-to-noise ratio (CNR). The self-prior strategy improves the organ reconstruction results compared with the non-prior strategy and also overcomes the shortcomings of the traditional structural prior strategy. Various applications such as metabolic imaging and pharmacokinetic study can be aided by this strategy.

  4. Heuristics as Bayesian inference under extreme priors.

    Science.gov (United States)

    Parpart, Paula; Jones, Matt; Love, Bradley C

    2018-05-01

    Simple heuristics are often regarded as tractable decision strategies because they ignore a great deal of information in the input data. One puzzle is why heuristics can outperform full-information models, such as linear regression, which make full use of the available information. These "less-is-more" effects, in which a relatively simpler model outperforms a more complex model, are prevalent throughout cognitive science, and are frequently argued to demonstrate an inherent advantage of simplifying computation or ignoring information. In contrast, we show at the computational level (where algorithmic restrictions are set aside) that it is never optimal to discard information. Through a formal Bayesian analysis, we prove that popular heuristics, such as tallying and take-the-best, are formally equivalent to Bayesian inference under the limit of infinitely strong priors. Varying the strength of the prior yields a continuum of Bayesian models with the heuristics at one end and ordinary regression at the other. Critically, intermediate models perform better across all our simulations, suggesting that down-weighting information with the appropriate prior is preferable to entirely ignoring it. Rather than because of their simplicity, our analyses suggest heuristics perform well because they implement strong priors that approximate the actual structure of the environment. We end by considering how new heuristics could be derived by infinitely strengthening the priors of other Bayesian models. These formal results have implications for work in psychology, machine learning and economics. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  5. Secukinumab treatment of moderate to severe plaque psoriasis in routine clinical care: real-life data of prior and concomitant use of psoriasis treatments from the PROSPECT study.

    Science.gov (United States)

    Körber, A; Thaçi, D; von Kiedrowski, R; Bachhuber, T; Melzer, N; Kasparek, T; Kraehn-Senftleben, G; Amon, U; Augustin, M

    2018-03-01

    Secukinumab, a fully human anti-interleukin-17A monoclonal antibody, has demonstrated efficacy and safety in patients with moderate to severe psoriasis. However, as per study protocols, transition periods from prior psoriasis treatments of a defined minimal length were required and use of concomitant psoriasis medication was prohibited. There is therefore a lack of data on the effect of shorter transition periods and concomitant psoriasis treatment with other pharmacologically active substances on the effectiveness and safety of secukinumab in routine clinical practice. The PROSPECT study was designed to assess prior and concomitant use of psoriasis treatments in subjects receiving secukinumab and the duration of transition periods from prior treatments to secukinumab. Here, we report the baseline characteristics and the duration of transition period in an interim analysis of the first 805 subjects. PROSPECT is an ongoing 24-week, single-cohort, non-interventional study. Subjects with moderate to severe psoriasis with a decision to receive secukinumab were included. The majority of subjects were male (491/796, 61.7%), with a mean age of 47.7 years (SD 13.7). The baseline Psoriasis Area and Severity Index (PASI) was available for 92.4% (744/805) of subjects, and mean baseline PASI was 17.5 (SD 13.1); 93.4% (752/805) of subjects had signs of high disease severity. Use of concomitant treatment increased with the number of signs. Within the last 12 months prior to inclusion, 10%, 40%, and 28% of subjects had received topical, conventional systemic, or biologic treatments as their last prior psoriasis therapy, respectively, and 22% of subjects had not received any psoriasis therapy. Discontinuation of prior treatment due to adverse events was high in subjects with conventional systemic treatment (93/413, 22.5%) compared to biologic treatment (5/210, 2.4%). The median duration of the transition period was 14.0, 30.5, and 38.0 days for prior topical, conventional systemic

  6. Prospective regularization design in prior-image-based reconstruction

    International Nuclear Information System (INIS)

    Dang, Hao; Siewerdsen, Jeffrey H; Stayman, J Webster

    2015-01-01

    Prior-image-based reconstruction (PIBR) methods leveraging patient-specific anatomical information from previous imaging studies and/or sequences have demonstrated dramatic improvements in dose utilization and image quality for low-fidelity data. However, a proper balance of information from the prior images and information from the measurements is required (e.g. through careful tuning of regularization parameters). Inappropriate selection of reconstruction parameters can lead to detrimental effects including false structures and failure to improve image quality. Traditional methods based on heuristics are subject to error and sub-optimal solutions, while exhaustive searches require a large number of computationally intensive image reconstructions. In this work, we propose a novel method that prospectively estimates the optimal amount of prior image information for accurate admission of specific anatomical changes in PIBR without performing full image reconstructions. This method leverages an analytical approximation to the implicitly defined PIBR estimator, and introduces a predictive performance metric leveraging this analytical form and knowledge of a particular presumed anatomical change whose accurate reconstruction is sought. Additionally, since model-based PIBR approaches tend to be space-variant, a spatially varying prior image strength map is proposed to optimally admit changes everywhere in the image (eliminating the need to know change locations a priori). Studies were conducted in both an ellipse phantom and a realistic thorax phantom emulating a lung nodule surveillance scenario. The proposed method demonstrated accurate estimation of the optimal prior image strength while achieving a substantial computational speedup (about a factor of 20) compared to traditional exhaustive search. Moreover, the use of the proposed prior strength map in PIBR demonstrated accurate reconstruction of anatomical changes without foreknowledge of change locations in

  7. GENERAL ASPECTS REGARDING THE PRIOR DISCIPLINARY RESEARCH

    Directory of Open Access Journals (Sweden)

    ANDRA PURAN (DASCĂLU

    2012-05-01

    Full Text Available Disciplinary research is the first phase of the disciplinary action. According to art. 251 paragraph 1 of the Labour Code no disciplinary sanction may be ordered before performing the prior disciplinary research.These regulations provide an exception: the sanction of written warning. The current regulations in question, kept from the old regulation, provides a protection for employees against abuses made by employers, since sanctions are affecting the salary or the position held, or even the development of individual employment contract. Thus, prior research of the fact that is a misconduct, before a disciplinary sanction is applied, is an essential condition for the validity of the measure ordered. Through this study we try to highlight some general issues concerning the characteristics, processes and effects of prior disciplinary research.

  8. Bayesian Prior Probability Distributions for Internal Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Miller, G.; Inkret, W.C.; Little, T.T.; Martz, H.F.; Schillaci, M.E

    2001-07-01

    The problem of choosing a prior distribution for the Bayesian interpretation of measurements (specifically internal dosimetry measurements) is considered using a theoretical analysis and by examining historical tritium and plutonium urine bioassay data from Los Alamos. Two models for the prior probability distribution are proposed: (1) the log-normal distribution, when there is some additional information to determine the scale of the true result, and (2) the 'alpha' distribution (a simplified variant of the gamma distribution) when there is not. These models have been incorporated into version 3 of the Bayesian internal dosimetric code in use at Los Alamos (downloadable from our web site). Plutonium internal dosimetry at Los Alamos is now being done using prior probability distribution parameters determined self-consistently from population averages of Los Alamos data. (author)

  9. The Use of Thrombopoietin Receptor Agonists for Correction of Thrombocytopenia prior to Elective Procedures in Chronic Liver Diseases: Review of Current Evidence

    Directory of Open Access Journals (Sweden)

    Kamran Qureshi

    2016-01-01

    Full Text Available Patients with chronic liver diseases (CLD undergo a range of invasive procedures during their clinical lifetime. Various hemostatic abnormalities are frequently identified during the periprocedural work-up; including thrombocytopenia. Thrombocytopenia of cirrhosis is multifactorial in origin, and decreased activity of thrombopoietin has been identified to be a major cause. Liver is an important site of thrombopoietin production and its levels are decreased in patients with cirrhosis. Severe thrombocytopenia (platelet counts < 60–75,000/µL is associated with increased risk of bleeding with invasive procedures. In recent years, compounds with thrombopoietin receptor agonist activity have been studied as therapeutic options to raise platelet counts in CLD. We reviewed the use of Eltrombopag, Romiplostim, and Avatrombopag prior to various invasive procedures in patients with CLD. These agents seem promising in raising platelet counts before elective procedures resulting in reduction in platelet transfusions, and they also enabled more patients to undergo the procedures. However, these studies were not primarily aimed at comparing bleeding episodes among groups. Use of these agents had some adverse consequences, importantly being the occurrence of portal vein thrombosis. This review highlights the need of further studies to identify reliable methods of safely reducing the provoked bleeding risk linked to thrombocytopenia in CLD.

  10. Spectrally Consistent Satellite Image Fusion with Improved Image Priors

    DEFF Research Database (Denmark)

    Nielsen, Allan Aasbjerg; Aanæs, Henrik; Jensen, Thomas B.S.

    2006-01-01

    Here an improvement to our previous framework for satellite image fusion is presented. A framework purely based on the sensor physics and on prior assumptions on the fused image. The contributions of this paper are two fold. Firstly, a method for ensuring 100% spectrally consistency is proposed......, even when more sophisticated image priors are applied. Secondly, a better image prior is introduced, via data-dependent image smoothing....

  11. Bayesian Inference for Structured Spike and Slab Priors

    DEFF Research Database (Denmark)

    Andersen, Michael Riis; Winther, Ole; Hansen, Lars Kai

    2014-01-01

    Sparse signal recovery addresses the problem of solving underdetermined linear inverse problems subject to a sparsity constraint. We propose a novel prior formulation, the structured spike and slab prior, which allows to incorporate a priori knowledge of the sparsity pattern by imposing a spatial...

  12. PET reconstruction via nonlocal means induced prior.

    Science.gov (United States)

    Hou, Qingfeng; Huang, Jing; Bian, Zhaoying; Chen, Wufan; Ma, Jianhua

    2015-01-01

    The traditional Bayesian priors for maximum a posteriori (MAP) reconstruction methods usually incorporate local neighborhood interactions that penalize large deviations in parameter estimates for adjacent pixels; therefore, only local pixel differences are utilized. This limits their abilities of penalizing the image roughness. To achieve high-quality PET image reconstruction, this study investigates a MAP reconstruction strategy by incorporating a nonlocal means induced (NLMi) prior (NLMi-MAP) which enables utilizing global similarity information of image. The present NLMi prior approximates the derivative of Gibbs energy function by an NLM filtering process. Specially, the NLMi prior is obtained by subtracting the current image estimation from its NLM filtered version and feeding the residual error back to the reconstruction filter to yield the new image estimation. We tested the present NLMi-MAP method with simulated and real PET datasets. Comparison studies with conventional filtered backprojection (FBP) and a few iterative reconstruction methods clearly demonstrate that the present NLMi-MAP method performs better in lowering noise, preserving image edge and in higher signal to noise ratio (SNR). Extensive experimental results show that the NLMi-MAP method outperforms the existing methods in terms of cross profile, noise reduction, SNR, root mean square error (RMSE) and correlation coefficient (CORR).

  13. Giant Condyloma Acuminatum: A Surgical Riddle

    Directory of Open Access Journals (Sweden)

    Shukla

    2016-08-01

    Full Text Available Giant condyloma acuminatum (GCA commonly known as Buschke-Lowenstein tumor (BLT is a rare sexually transmitted disease, which is always preceded by condyloma accuminata and linked to human papillomavirus (HPV. Most commonly affected sites are male and female genitalia, anal and perianal regions. Giant condyloma acuminatum is well-known as slow growing but locally destructive with a high rate of recurrence and increased frequency of malignant transformation. Surgical management is considered to be the best among all the options.

  14. Bayesian Image Restoration Using a Large-Scale Total Patch Variation Prior

    Directory of Open Access Journals (Sweden)

    Yang Chen

    2011-01-01

    Full Text Available Edge-preserving Bayesian restorations using nonquadratic priors are often inefficient in restoring continuous variations and tend to produce block artifacts around edges in ill-posed inverse image restorations. To overcome this, we have proposed a spatial adaptive (SA prior with improved performance. However, this SA prior restoration suffers from high computational cost and the unguaranteed convergence problem. Concerning these issues, this paper proposes a Large-scale Total Patch Variation (LS-TPV Prior model for Bayesian image restoration. In this model, the prior for each pixel is defined as a singleton conditional probability, which is in a mixture prior form of one patch similarity prior and one weight entropy prior. A joint MAP estimation is thus built to ensure the iteration monotonicity. The intensive calculation of patch distances is greatly alleviated by the parallelization of Compute Unified Device Architecture(CUDA. Experiments with both simulated and real data validate the good performance of the proposed restoration.

  15. Neutrino mass priors for cosmology from random matrices

    Science.gov (United States)

    Long, Andrew J.; Raveri, Marco; Hu, Wayne; Dodelson, Scott

    2018-02-01

    Cosmological measurements of structure are placing increasingly strong constraints on the sum of the neutrino masses, Σ mν, through Bayesian inference. Because these constraints depend on the choice for the prior probability π (Σ mν), we argue that this prior should be motivated by fundamental physical principles rather than the ad hoc choices that are common in the literature. The first step in this direction is to specify the prior directly at the level of the neutrino mass matrix Mν, since this is the parameter appearing in the Lagrangian of the particle physics theory. Thus by specifying a probability distribution over Mν, and by including the known squared mass splittings, we predict a theoretical probability distribution over Σ mν that we interpret as a Bayesian prior probability π (Σ mν). Assuming a basis-invariant probability distribution on Mν, also known as the anarchy hypothesis, we find that π (Σ mν) peaks close to the smallest Σ mν allowed by the measured mass splittings, roughly 0.06 eV (0.1 eV) for normal (inverted) ordering, due to the phenomenon of eigenvalue repulsion in random matrices. We consider three models for neutrino mass generation: Dirac, Majorana, and Majorana via the seesaw mechanism; differences in the predicted priors π (Σ mν) allow for the possibility of having indications about the physical origin of neutrino masses once sufficient experimental sensitivity is achieved. We present fitting functions for π (Σ mν), which provide a simple means for applying these priors to cosmological constraints on the neutrino masses or marginalizing over their impact on other cosmological parameters.

  16. Estimating security betas using prior information based on firm fundamentals

    NARCIS (Netherlands)

    Cosemans, M.; Frehen, R.; Schotman, P.C.; Bauer, R.

    2010-01-01

    This paper proposes a novel approach for estimating time-varying betas of individual stocks that incorporates prior information based on fundamentals. We shrink the rolling window estimate of beta towards a firm-specific prior that is motivated by asset pricing theory. The prior captures structural

  17. Borrelia infection and risk of celiac disease.

    Science.gov (United States)

    Alaedini, Armin; Lebwohl, Benjamin; Wormser, Gary P; Green, Peter H; Ludvigsson, Jonas F

    2017-09-15

    Environmental factors, including infectious agents, are speculated to play a role in the rising prevalence and the geographic distribution of celiac disease, an autoimmune disorder. In the USA and Sweden where the regional variation in the frequency of celiac disease has been studied, a similarity with the geographic distribution of Lyme disease, an emerging multisystemic infection caused by Borrelia burgdorferi spirochetes, has been found, thus raising the possibility of a link. We aimed to determine if infection with Borrelia contributes to an increased risk of celiac disease. Biopsy reports from all of Sweden's pathology departments were used to identify 15,769 individuals with celiac disease. Through linkage to the nationwide Patient Register, we compared the rate of earlier occurrence of Lyme disease in the patients with celiac disease to that in 78,331 matched controls. To further assess the temporal relationship between Borrelia infection and celiac disease, we also examined the risk of subsequent Lyme disease in patients with a diagnosis of celiac disease. Twenty-five individuals (0.16%) with celiac disease had a prior diagnosis of Lyme disease, whereas 79 (0.5%) had a subsequent diagnosis of Lyme disease. A modest association between Lyme disease and celiac disease was seen both before (odds ratio, 1.61; 95% confidence interval (CI), 1.06-2.47) and after the diagnosis of celiac disease (hazard ratio, 1.82; 95% CI, 1.40-2.35), with the risk of disease being highest in the first year of follow-up. Only a minor fraction of the celiac disease patient population had a prior diagnosis of Lyme disease. The similar association between Lyme disease and celiac disease both before and after the diagnosis of celiac disease is strongly suggestive of surveillance bias as a likely contributor. Taken together, the data indicate that Borrelia infection is not a substantive risk factor in the development of celiac disease.

  18. 34 CFR 303.403 - Prior notice; native language.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Prior notice; native language. 303.403 Section 303.403... TODDLERS WITH DISABILITIES Procedural Safeguards General § 303.403 Prior notice; native language. (a... file a complaint and the timelines under those procedures. (c) Native language. (1) The notice must be...

  19. Differential diagnosis of Jakob-Creutzfeldt disease

    OpenAIRE

    Paterson, RW; Torres-Chae, CC; Kuo, AL; Ando, T; Nguyen, EA; Wong, K; DeArmond, SJ; Haman, A; Garcia, P; Johnson, DY; Miller, BL; Geschwind, MD

    2012-01-01

    Objectives: To identify the misdiagnoses of patients with sporadic Jakob-Creutzfeldt disease (sCJD) during the course of their disease and determine which medical specialties saw patients with sCJD prior to the correct diagnosis being made and at what point in the disease course a correct diagnosis was made. Design: Retrospective medical record review. Setting: A specialty referral center of a tertiary academic medical center. Participants: One hundred sixty-three serial patients over a 5.5-y...

  20. Disease: H01812 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available hology of this disease is attributed mainly to activated cytotoxic T cells. It has ...eks prior to onset is observed in 38% of the patients. There is evidence of autoimmune involvement in the pathogenesis. The immunopat

  1. [Clinical and evolutive profile of Crohn's disease in Hospital Rebagliati (Lima-Peru)].

    Science.gov (United States)

    Bendaño, Teófilo; Frisancho, Oscar

    2010-01-01

    Crohn's Disease (CD) is uncommon in Peru, in that respect, we don't know its clinical and developmental profile. This is a descriptive, retrospective, transversal and observational patients diagnosed with CD in the last 20 years in the Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins'. For the small size of the population, we used a census record. The diagnosis was made using the criteria of Lennard-Jones. We present seventeen cases, most female (11 / 6). The average age was 39.9 years (60% over 40 years). Only one patient had family history (second degree of consanguinity). Sixteen were latins and one white. Clinical manifestations were abdominal pain (88.2%), diarrhea (76.5%), weight loss (76, 5%), bleeding (58.8%) and fever (58.8%). Laboratory findings showed: anemia (76.5%), thrombocytosis (58.8%), hypoalbuminemia (52.9%), leukocytosis (23.5%), nitrogen retention (11.7%), leukopenia (5.9%), and elevated acute phase reactants ( c-reactive protein or erythrocyte sedimentation rate) 76.5%. Extraintestinal manifestations were cutaneous (29.4%), articular diseases (17.6%) and hepatobiliary (11.7%). Five patients (29.4%) received treatment of tuberculosis without success (before diagnosis). Nine patients (52.9%) had acute complications requiring emergency care. The phenotypic pattern type (Montreal's classification) was: non-stricturing non-penetrating 35.3%, stricturing 35.3% and penetrating 29.4%. Inflammation of the ileon was found in 70.5% (47% ileocolonic and ileal 23.5%), nine (53%) had perianal lesions. The activity at diagnosis was mild moderate disease in 8 (47.0%), moderate severe disease in 7 (41.2%) and severe ulminant 2 (11.8%). The macroscopic lesions were predominant stenosis 13 (76.5%), followed by ulcers in 12 (70.6%), erosive erythematous inflammation 11 (64.7%) and thickening of folds in 10 (58.8 %), seven (41%) had fistulas. As initial treatment were used aminosalicylates (13 patients) and systemic corticosteroids in 6

  2. Parkinson's disease: diagnostic utility of volumetric imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Wei-Che; Chen, Meng-Hsiang [Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Department of Diagnostic Radiology, Kaohsiung (China); Chou, Kun-Hsien [National Yang-Ming University, Brain Research Center, Taipei (China); Lee, Pei-Lin [National Yang-Ming University, Department of Biomedical Imaging and Radiological Sciences, Taipei (China); Tsai, Nai-Wen; Lu, Cheng-Hsien [Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Department of Neurology, Kaohsiung (China); Chen, Hsiu-Ling [Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Department of Diagnostic Radiology, Kaohsiung (China); National Yang-Ming University, Department of Biomedical Imaging and Radiological Sciences, Taipei (China); Hsu, Ai-Ling [National Taiwan University, Institute of Biomedical Electronics and Bioinformatics, Taipei (China); Huang, Yung-Cheng [Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Department of Nuclear Medicine, Kaohsiung (China); Lin, Ching-Po [National Yang-Ming University, Brain Research Center, Taipei (China); National Yang-Ming University, Department of Biomedical Imaging and Radiological Sciences, Taipei (China)

    2017-04-15

    This paper aims to examine the effectiveness of structural imaging as an aid in the diagnosis of Parkinson's disease (PD). High-resolution T{sub 1}-weighted magnetic resonance imaging was performed in 72 patients with idiopathic PD (mean age, 61.08 years) and 73 healthy subjects (mean age, 58.96 years). The whole brain was parcellated into 95 regions of interest using composite anatomical atlases, and region volumes were calculated. Three diagnostic classifiers were constructed using binary multiple logistic regression modeling: the (i) basal ganglion prior classifier, (ii) data-driven classifier, and (iii) basal ganglion prior/data-driven hybrid classifier. Leave-one-out cross validation was used to unbiasedly evaluate the predictive accuracy of imaging features. Pearson's correlation analysis was further performed to correlate outcome measurement using the best PD classifier with disease severity. Smaller volume in susceptible regions is diagnostic for Parkinson's disease. Compared with the other two classifiers, the basal ganglion prior/data-driven hybrid classifier had the highest diagnostic reliability with a sensitivity of 74%, specificity of 75%, and accuracy of 74%. Furthermore, outcome measurement using this classifier was associated with disease severity. Brain structural volumetric analysis with multiple logistic regression modeling can be a complementary tool for diagnosing PD. (orig.)

  3. The demography of Atelopus decline: Harlequin frog survival and abundance in central Panama prior to and during a disease outbreak

    Directory of Open Access Journals (Sweden)

    Rebecca McCaffery

    2015-07-01

    Full Text Available Harlequin frogs (Bufonidae: Atelopus are a species-rich genus of Neotropical toads that have experienced disproportionately severe population declines and extinctions caused by the amphibian chytrid fungus Batrachochytrium dendrobatidis (Bd. The genus Atelopus is of high conservation concern, but relatively little is known about the population dynamics and life history of the majority of species. We examined the demography of one population of Atelopus zeteki and two populations of A. varius in central Panama using three to six years of mark-recapture data collected prior to and during an outbreak of Bd. We estimated male survival probabilities prior to the arrival of Bd and sex-specific population sizes for these three populations using state-space Bayesian population models. Prior to the arrival of Bd, monthly apparent survival probabilities were higher for A. varius males than for A. zeteki males, and recaptures among years were low in both species. Abundance of both species varied over time and declined rapidly after the arrival of Bd. Male densities were generally greater than female densities, though female densities were higher or equivalent to males after the arrival of Bd. Estimates of survival and abundance over time may be explained by differences in the use of stream habitat by the two sexes and three populations, both during and between breeding seasons. These estimates provide key baseline population information that can be used to inform reintroductions from captive assurance colonies and studies of extant Atelopus populations as part of conservation and management programs.

  4. 30 CFR 872.29 - What are prior balance replacement funds?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 3 2010-07-01 2010-07-01 false What are prior balance replacement funds? 872... § 872.29 What are prior balance replacement funds? “Prior balance replacement funds” are moneys we must... general funds of the United States Treasury that are otherwise unappropriated. Under section 411(h)(1) of...

  5. Diseases of wild rice

    Science.gov (United States)

    Diseases are much more pronounced in cultivated wild rice than in natural stands, most likely due to the narrower genetic base of the populations, plant stress due to high planting density and floodwater removal prior to harvest, and high relative humidity in the plant canopy. Yield losses occur as ...

  6. Prior opportunities to identify abuse in children with abusive head trauma.

    Science.gov (United States)

    Letson, Megan M; Cooper, Jennifer N; Deans, Katherine J; Scribano, Philip V; Makoroff, Kathi L; Feldman, Kenneth W; Berger, Rachel P

    2016-10-01

    Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities. All AHT cases from 7/1/2009 to 12/31/2011 at four tertiary care children's hospitals were included. A prior opportunity was defined as prior evaluation by either a medical or child protective services (CPS) professional when the symptoms and/or referral could be consistent with abuse but the diagnosis was not made and/or an alternate explanation was given and accepted. Two-hundred-thirty-two children with AHT were identified; median age (IQR) was 5.40 (3.30, 14.60) months. Ten percent (22/232) died. Of the 232 patients diagnosed with AHT, 31% (n=73) had a total of 120 prior opportunities. Fifty-nine children (25%) had at least one prior opportunity to identify abuse in a medical setting, representing 98 prior opportunities. An additional 14 (6%) children had 22 prior opportunities through previous CPS involvement. There were no differences between those with and without a prior opportunity based on age, gender, race, insurance, mortality, or institution. Children with prior opportunities in a medical setting were more likely to have chronic subdural hemorrhage (48 vs. 17%, p<0.01) and healing fractures (31 vs. 19%, p=0.05). The most common prior opportunities included vomiting 31.6% (38/120), prior CPS contact 20% (24/120), and bruising 11.7% (14/120). Improvements in earlier recognition of AHT and subsequent intervention might prevent additional injuries and reduce mortality. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Variational segmentation problems using prior knowledge in imaging and vision

    DEFF Research Database (Denmark)

    Fundana, Ketut

    This dissertation addresses variational formulation of segmentation problems using prior knowledge. Variational models are among the most successful approaches for solving many Computer Vision and Image Processing problems. The models aim at finding the solution to a given energy functional defined......, prior knowledge is needed to obtain the desired solution. The introduction of shape priors in particular, has proven to be an effective way to segment objects of interests. Firstly, we propose a prior-based variational segmentation model to segment objects of interest in image sequences, that can deal....... Many objects have high variability in shape and orientation. This often leads to unsatisfactory results, when using a segmentation model with single shape template. One way to solve this is by using more sophisticated shape models. We propose to incorporate shape priors from a shape sub...

  8. The use of infrared thermography to detect the stages of estrus cycle and ovulation time in anatolian shepherd dogs

    OpenAIRE

    Kemal Tuna Olğaç; Ergun Akçay; Beste Çil; Burak Mehmet Uçar; Ali Daşkın

    2017-01-01

    Abstract Background The aim of the study is to evaluate the effectiveness of thermographic monitoring, using the temperature changes of perianal and perivulvar areas for the determination of estrus in Anatolian Shepherd bitches. Fifteen bitches were used in the study. Blood and vaginal smear samples were collected and thermographic monitoring of perianal and perivulvar areas were carried out starting from proestrus to early diestrus. Also, external signs of estrus were investigated. Smear sam...

  9. Pregnancy and rheumatic diseases.

    Science.gov (United States)

    Gayed, M; Gordon, C

    2007-11-01

    Pregnancy is an issue that should be discussed with all patients with rheumatic diseases who are in the reproductive age group. Infertility is rarely due to the disease but can be associated with cyclophosphamide therapy. Most rheumatic diseases that are well controlled prior to pregnancy do not deteriorate in pregnancy, providing that the patient continues with appropriate disease-modifying therapy. Some patients with inflammatory arthritis go in to remission during pregnancy. Patients with renal involvement may be at increased risk of disease flare. This needs to be distinguished from pre-eclampsia. Intrauterine growth restriction is more likely in patients with active systemic disease, hypertension, a history of thrombosis and renal involvement. Premature delivery may need to be planned to reduce the risks of stillbirth and can be associated with a variety of neonatal complications. Post-partum flare is common in all the rheumatic diseases.

  10. SMELL-S and SMELL-R: olfactory tests not influenced by odor-specific insensitivity or prior olfactory experience

    OpenAIRE

    Keller, Andreas; Wong, Michele; Jiang, Rong-San; Vosshall, Leslie; Hsieh, Julien

    2017-01-01

    Smell dysfunction is a common and underdiagnosed medical condition that can have serious consequences. It is also an early biomarker of Alzheimer's disease that precedes detectable memory loss. Clinical tests that evaluate the sense of smell face two major challenges. First, human sensitivity to individual odorants varies significantly, leading to potential misdiagnosis of people with an otherwise normal sense of smell but insensitivity to the test odorant. Second, prior familiarity with odor...

  11. 9 CFR 113.330 - Marek's Disease Vaccines.

    Science.gov (United States)

    2010-01-01

    ..., negative for Marek's disease virus antibodies, and from the same source, shall be isolated into the...) Specific pathogen free chickens or embryos, negative for Marek's disease antibodies, and from the same... diluent according to the label recommendations, and held in an ice bath at 0°C to 4°C for 2 hours prior to...

  12. Prior and present evidence: how prior experience interacts with present information in a perceptual decision making task.

    Directory of Open Access Journals (Sweden)

    Muhsin Karim

    Full Text Available Vibrotactile discrimination tasks have been used to examine decision making processes in the presence of perceptual uncertainty, induced by barely discernible frequency differences between paired stimuli or by the presence of embedded noise. One lesser known property of such tasks is that decisions made on a single trial may be biased by information from prior trials. An example is the time-order effect whereby the presentation order of paired stimuli may introduce differences in accuracy. Subjects perform better when the first stimulus lies between the second stimulus and the global mean of all stimuli on the judged dimension ("preferred" time-orders compared to the alternative presentation order ("nonpreferred" time-orders. This has been conceptualised as a "drift" of the first stimulus representation towards the global mean of the stimulus-set (an internal standard. We describe the influence of prior information in relation to the more traditionally studied factors of interest in a classic discrimination task.Sixty subjects performed a vibrotactile discrimination task with different levels of uncertainty parametrically induced by increasing task difficulty, aperiodic stimulus noise, and changing the task instructions whilst maintaining identical stimulus properties (the "context".The time-order effect had a greater influence on task performance than two of the explicit factors-task difficulty and noise-but not context. The influence of prior information increased with the distance of the first stimulus from the global mean, suggesting that the "drift" velocity of the first stimulus towards the global mean representation was greater for these trials.Awareness of the time-order effect and prior information in general is essential when studying perceptual decision making tasks. Implicit mechanisms may have a greater influence than the explicit factors under study. It also affords valuable insights into basic mechanisms of information

  13. The Prior Can Often Only Be Understood in the Context of the Likelihood

    Directory of Open Access Journals (Sweden)

    Andrew Gelman

    2017-10-01

    Full Text Available A key sticking point of Bayesian analysis is the choice of prior distribution, and there is a vast literature on potential defaults including uniform priors, Jeffreys’ priors, reference priors, maximum entropy priors, and weakly informative priors. These methods, however, often manifest a key conceptual tension in prior modeling: a model encoding true prior information should be chosen without reference to the model of the measurement process, but almost all common prior modeling techniques are implicitly motivated by a reference likelihood. In this paper we resolve this apparent paradox by placing the choice of prior into the context of the entire Bayesian analysis, from inference to prediction to model evaluation.

  14. Quantum steganography using prior entanglement

    International Nuclear Information System (INIS)

    Mihara, Takashi

    2015-01-01

    Steganography is the hiding of secret information within innocent-looking information (e.g., text, audio, image, video, etc.). A quantum version of steganography is a method based on quantum physics. In this paper, we propose quantum steganography by combining quantum error-correcting codes with prior entanglement. In many steganographic techniques, embedding secret messages in error-correcting codes may cause damage to them if the embedded part is corrupted. However, our proposed steganography can separately create secret messages and the content of cover messages. The intrinsic form of the cover message does not have to be modified for embedding secret messages. - Highlights: • Our steganography combines quantum error-correcting codes with prior entanglement. • Our steganography can separately create secret messages and the content of cover messages. • Errors in cover messages do not have affect the recovery of secret messages. • We embed a secret message in the Steane code as an example of our steganography

  15. Quantum steganography using prior entanglement

    Energy Technology Data Exchange (ETDEWEB)

    Mihara, Takashi, E-mail: mihara@toyo.jp

    2015-06-05

    Steganography is the hiding of secret information within innocent-looking information (e.g., text, audio, image, video, etc.). A quantum version of steganography is a method based on quantum physics. In this paper, we propose quantum steganography by combining quantum error-correcting codes with prior entanglement. In many steganographic techniques, embedding secret messages in error-correcting codes may cause damage to them if the embedded part is corrupted. However, our proposed steganography can separately create secret messages and the content of cover messages. The intrinsic form of the cover message does not have to be modified for embedding secret messages. - Highlights: • Our steganography combines quantum error-correcting codes with prior entanglement. • Our steganography can separately create secret messages and the content of cover messages. • Errors in cover messages do not have affect the recovery of secret messages. • We embed a secret message in the Steane code as an example of our steganography.

  16. Crowdsourcing prior information to improve study design and data analysis.

    Directory of Open Access Journals (Sweden)

    Jeffrey S Chrabaszcz

    Full Text Available Though Bayesian methods are being used more frequently, many still struggle with the best method for setting priors with novel measures or task environments. We propose a method for setting priors by eliciting continuous probability distributions from naive participants. This allows us to include any relevant information participants have for a given effect. Even when prior means are near-zero, this method provides a principle way to estimate dispersion and produce shrinkage, reducing the occurrence of overestimated effect sizes. We demonstrate this method with a number of published studies and compare the effect of different prior estimation and aggregation methods.

  17. Mercury exposure and risk of cardiovascular disease in two U.S. cohorts

    DEFF Research Database (Denmark)

    Mozaffarian, Dariush; Shi, Peilin; Morris, J Steven

    2011-01-01

    Exposure to methylmercury from fish consumption has been linked to a potentially increased risk of cardiovascular disease, but evidence from prior studies is equivocal. Beneficial effects of the ingestion of fish and selenium may also modify such effects.......Exposure to methylmercury from fish consumption has been linked to a potentially increased risk of cardiovascular disease, but evidence from prior studies is equivocal. Beneficial effects of the ingestion of fish and selenium may also modify such effects....

  18. Formulating informative, data-based priors for failure probability estimation in reliability analysis

    International Nuclear Information System (INIS)

    Guikema, Seth D.

    2007-01-01

    Priors play an important role in the use of Bayesian methods in risk analysis, and using all available information to formulate an informative prior can lead to more accurate posterior inferences. This paper examines the practical implications of using five different methods for formulating an informative prior for a failure probability based on past data. These methods are the method of moments, maximum likelihood (ML) estimation, maximum entropy estimation, starting from a non-informative 'pre-prior', and fitting a prior based on confidence/credible interval matching. The priors resulting from the use of these different methods are compared qualitatively, and the posteriors are compared quantitatively based on a number of different scenarios of observed data used to update the priors. The results show that the amount of information assumed in the prior makes a critical difference in the accuracy of the posterior inferences. For situations in which the data used to formulate the informative prior is an accurate reflection of the data that is later observed, the ML approach yields the minimum variance posterior. However, the maximum entropy approach is more robust to differences between the data used to formulate the prior and the observed data because it maximizes the uncertainty in the prior subject to the constraints imposed by the past data

  19. Finding A Minimally Informative Dirichlet Prior Using Least Squares

    International Nuclear Information System (INIS)

    Kelly, Dana

    2011-01-01

    In a Bayesian framework, the Dirichlet distribution is the conjugate distribution to the multinomial likelihood function, and so the analyst is required to develop a Dirichlet prior that incorporates available information. However, as it is a multiparameter distribution, choosing the Dirichlet parameters is less straightforward than choosing a prior distribution for a single parameter, such as p in the binomial distribution. In particular, one may wish to incorporate limited information into the prior, resulting in a minimally informative prior distribution that is responsive to updates with sparse data. In the case of binomial p or Poisson λ, the principle of maximum entropy can be employed to obtain a so-called constrained noninformative prior. However, even in the case of p, such a distribution cannot be written down in the form of a standard distribution (e.g., beta, gamma), and so a beta distribution is used as an approximation in the case of p. In the case of the multinomial model with parametric constraints, the approach of maximum entropy does not appear tractable. This paper presents an alternative approach, based on constrained minimization of a least-squares objective function, which leads to a minimally informative Dirichlet prior distribution. The alpha-factor model for common-cause failure, which is widely used in the United States, is the motivation for this approach, and is used to illustrate the method. In this approach to modeling common-cause failure, the alpha-factors, which are the parameters in the underlying multinomial model for common-cause failure, must be estimated from data that are often quite sparse, because common-cause failures tend to be rare, especially failures of more than two or three components, and so a prior distribution that is responsive to updates with sparse data is needed.

  20. A Noninformative Prior on a Space of Distribution Functions

    Directory of Open Access Journals (Sweden)

    Alexander Terenin

    2017-07-01

    Full Text Available In a given problem, the Bayesian statistical paradigm requires the specification of a prior distribution that quantifies relevant information about the unknowns of main interest external to the data. In cases where little such information is available, the problem under study may possess an invariance under a transformation group that encodes a lack of information, leading to a unique prior—this idea was explored at length by E.T. Jaynes. Previous successful examples have included location-scale invariance under linear transformation, multiplicative invariance of the rate at which events in a counting process are observed, and the derivation of the Haldane prior for a Bernoulli success probability. In this paper we show that this method can be extended, by generalizing Jaynes, in two ways: (1 to yield families of approximately invariant priors; and (2 to the infinite-dimensional setting, yielding families of priors on spaces of distribution functions. Our results can be used to describe conditions under which a particular Dirichlet Process posterior arises from an optimal Bayesian analysis, in the sense that invariances in the prior and likelihood lead to one and only one posterior distribution.

  1. Implicit Priors in Galaxy Cluster Mass and Scaling Relation Determinations

    Science.gov (United States)

    Mantz, A.; Allen, S. W.

    2011-01-01

    Deriving the total masses of galaxy clusters from observations of the intracluster medium (ICM) generally requires some prior information, in addition to the assumptions of hydrostatic equilibrium and spherical symmetry. Often, this information takes the form of particular parametrized functions used to describe the cluster gas density and temperature profiles. In this paper, we investigate the implicit priors on hydrostatic masses that result from this fully parametric approach, and the implications of such priors for scaling relations formed from those masses. We show that the application of such fully parametric models of the ICM naturally imposes a prior on the slopes of the derived scaling relations, favoring the self-similar model, and argue that this prior may be influential in practice. In contrast, this bias does not exist for techniques which adopt an explicit prior on the form of the mass profile but describe the ICM non-parametrically. Constraints on the slope of the cluster mass-temperature relation in the literature show a separation based the approach employed, with the results from fully parametric ICM modeling clustering nearer the self-similar value. Given that a primary goal of scaling relation analyses is to test the self-similar model, the application of methods subject to strong, implicit priors should be avoided. Alternative methods and best practices are discussed.

  2. Superposing pure quantum states with partial prior information

    Science.gov (United States)

    Dogra, Shruti; Thomas, George; Ghosh, Sibasish; Suter, Dieter

    2018-05-01

    The principle of superposition is an intriguing feature of quantum mechanics, which is regularly exploited in many different circumstances. A recent work [M. Oszmaniec et al., Phys. Rev. Lett. 116, 110403 (2016), 10.1103/PhysRevLett.116.110403] shows that the fundamentals of quantum mechanics restrict the process of superimposing two unknown pure states, even though it is possible to superimpose two quantum states with partial prior knowledge. The prior knowledge imposes geometrical constraints on the choice of input states. We discuss an experimentally feasible protocol to superimpose multiple pure states of a d -dimensional quantum system and carry out an explicit experimental realization for two single-qubit pure states with partial prior information on a two-qubit NMR quantum information processor.

  3. On the prior probabilities for two-stage Bayesian estimates

    International Nuclear Information System (INIS)

    Kohut, P.

    1992-01-01

    The method of Bayesian inference is reexamined for its applicability and for the required underlying assumptions in obtaining and using prior probability estimates. Two different approaches are suggested to determine the first-stage priors in the two-stage Bayesian analysis which avoid certain assumptions required for other techniques. In the first scheme, the prior is obtained through a true frequency based distribution generated at selected intervals utilizing actual sampling of the failure rate distributions. The population variability distribution is generated as the weighed average of the frequency distributions. The second method is based on a non-parametric Bayesian approach using the Maximum Entropy Principle. Specific features such as integral properties or selected parameters of prior distributions may be obtained with minimal assumptions. It is indicated how various quantiles may also be generated with a least square technique

  4. Form of prior for constrained thermodynamic processes with uncertainty

    Science.gov (United States)

    Aneja, Preety; Johal, Ramandeep S.

    2015-05-01

    We consider the quasi-static thermodynamic processes with constraints, but with additional uncertainty about the control parameters. Motivated by inductive reasoning, we assign prior distribution that provides a rational guess about likely values of the uncertain parameters. The priors are derived explicitly for both the entropy-conserving and the energy-conserving processes. The proposed form is useful when the constraint equation cannot be treated analytically. The inference is performed using spin-1/2 systems as models for heat reservoirs. Analytical results are derived in the high-temperatures limit. An agreement beyond linear response is found between the estimates of thermal quantities and their optimal values obtained from extremum principles. We also seek an intuitive interpretation for the prior and the estimated value of temperature obtained therefrom. We find that the prior over temperature becomes uniform over the quantity kept conserved in the process.

  5. Inverse problems with non-trivial priors: efficient solution through sequential Gibbs sampling

    DEFF Research Database (Denmark)

    Hansen, Thomas Mejer; Cordua, Knud Skou; Mosegaard, Klaus

    2012-01-01

    Markov chain Monte Carlo methods such as the Gibbs sampler and the Metropolis algorithm can be used to sample solutions to non-linear inverse problems. In principle, these methods allow incorporation of prior information of arbitrary complexity. If an analytical closed form description of the prior...... is available, which is the case when the prior can be described by a multidimensional Gaussian distribution, such prior information can easily be considered. In reality, prior information is often more complex than can be described by the Gaussian model, and no closed form expression of the prior can be given....... We propose an algorithm, called sequential Gibbs sampling, allowing the Metropolis algorithm to efficiently incorporate complex priors into the solution of an inverse problem, also for the case where no closed form description of the prior exists. First, we lay out the theoretical background...

  6. Invasive angiography and revascularization in patients with stable angina following prior coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Joshi, Francis R; Biasco, Luigi; Pedersen, Frants

    2017-01-01

    . Follow-up data were available for all patients, by means of records linked to each Danish social security number. RESULTS: In patients with prior CABG and stable angina (n = 2,309), diagnostic angiography led to revascularization in 574 (24.9%) cases. Chronic kidney disease (HR 1.93 [1.08-3.44], P = 0......BACKGROUND: There are limited data to guide the optimum approach to patients presenting with angina after coronary artery bypass grafting (CABG). Although often referred for invasive angiography, the effectiveness of this is unknown; angina may also result from diffuse distal or micro......-vascular coronary disease and it is not known how often targets for intervention are identified. METHODS: Retrospective review of 50,460 patients undergoing angiography in East Denmark between January 2010 and December 2014. Clinical and procedural data were prospectively stored in a regional electronic database...

  7. Infectious Diseases and Immunizations in International Adoption.

    Science.gov (United States)

    Obringer, Emily; Walsh, Linda

    2017-02-01

    Children who are adopted internationally have an increased risk of infectious diseases due to endemic conditions and variable access to preventive health care, such as vaccines, in their country of origin. Pediatricians and other providers who care for children should be familiar with the recommended screening for newly arrived international adoptees. Testing for gastrointestinal pathogens, tuberculosis, hepatitis, syphilis, and HIV should be routinely performed. Other endemic diseases and common skin infections may need to be assessed. Evaluation of the child's immunization record is also important, as nearly all international adoptees will require catch-up vaccines. The provider may also be asked to review medical records prior to adoption, provide travel advice, and ensure that parents and other close contacts are up-to-date on immunizations prior to the arrival of the newest family member. The pediatrician serves a unique role in facilitating the evaluation, treatment, and prevention of infectious diseases in international adoptees. [Pediatr Ann. 2017;46(2):e56-e60.]. Copyright 2017, SLACK Incorporated.

  8. Management of breast cancer following Hodgkin's disease

    International Nuclear Information System (INIS)

    Wolden, Suzanne L.; Carlson, Robert W.; Jeffrey, Stefanie S.; Hancock, Steven L.

    1997-01-01

    Purpose: To evaluate the incidence, histology, risk factors, treatment, and prognosis of breast cancer occurring after Hodgkin's disease. Materials and Methods: Sixty-five cases of breast cancer in 61 survivors of Hodgkin's lymphoma were analyzed. The median age at treatment for Hodgkin's disease was 24.1 [range (R): 13.3 - 71.8] years. Fifty-one percent had received radiotherapy alone, 47% radiation and chemotherapy, and 2% chemotherapy only. Relative and absolute risks were calculated based on 47 invasive breast cancers in 1049 women treated for Hodgkin's disease at Stanford. Results: The median age at diagnosis of breast cancer was 41.9 (R: 23.0 - 79.1) years; 76% of women were premenopausal. The median interval between Hodgkin's disease and breast cancer was 17.6 (R: 1.5 - 32.7) years with an increasing incidence beginning eight years after radiotherapy. The current relative risk of invasive breast cancer following Hodgkin's disease is 4.7 [95% confidence interval (CI): 3.4 - 6.1] with an absolute risk of 29.5 (CI: 18.8 - 40.2) excess cases per 10,000 person-years. Eighty-seven percent of breast cancers occurred in or at the margin of a prior radiotherapy field where a mean dose of 43.5 (R: 24.0 - 51.0) Gy was delivered. There was a family history of breast cancer in 31% of women. Cancers were detected by self examination (66%), screening mammography (27%), and physician examination (7%). Many tumors (60%) were located in the upper outer quadrants, corresponding to the axillary portion of a mantle field. There were seven cases of carcinoma in situ: six DCIS and one LCIS. The histologic distribution of invasive tumors paralleled that reported in the general population: 4% pure lobular, 35% high grade ductal, 45% intermediate grade ductal, 7% low-grade ductal, 4% tubular, 2% medullary, and 2% mucinous. Estrogen receptors were positive in 59% of evaluable cases. While 90% of invasive tumors were smaller than four centimeters, 96% were managed with mastectomy

  9. An association between newly diagnosed cutaneous T cell lymphoma and prior impetigo: a nested case-control study.

    Science.gov (United States)

    Boursi, Ben; Haynes, Kevin; Mamtani, Ronac; Yang, Yu-Xiao

    2016-11-01

    Colonization with staphylococcus aureus (SA) is associated with disease activity and progression in patients with cutaneous T-cell lymphoma (CTCL) secondary to T-cell activation by bacterial superantigens. The aim of the current study was to evaluate the possible role of SA as an etiologic factor affecting CTCL initiation. We conducted a nested case-control study in a large population-representative database from the UK. Cases were defined as all patients with an incident diagnosis of mycosis fungoides (MF) or Sezary syndrome (SS) between 1995 and 2013. For every case, four eligible controls matched on age, sex, practice-site, and duration of follow-up were selected. Exposure of interest was clinical diagnosis of impetigo prior to CTCL diagnosis. Conditional logistic regression was used to calculate odds-ratio (ORs) and 95 % confidence-interval (CI) for CTCL risk. The results were further stratified according to age, sex and time interval between impetigo and CTCL diagnosis. The study population included 310 cases with MF or SS and 1223 matched controls. Among cases with CTCL 4.8 % (n = 15) had impetigo prior to cancer diagnosis compared to 2 % (n = 24) of controls. The adjusted OR for CTCL diagnosis among patients with prior impetigo was 2.33 (95 % CI 1.12-4.83). The risk was elevated among individuals with impetigo 1-5 years before cancer diagnosis (OR 3.33, 95 % CI 1.00-11.10). There was no change in risk among patients with impetigo more than 5 years before cancer diagnosis (OR 1.09, 95 % CI 0.35-3.37). Our results suggest a possible association between SA colonization and CTCL initiation that might serve as an important etiological factor for the disease.

  10. SUSPENSION OF THE PRIOR DISCIPLINARY INVESTIGATION ACCORDING TO LABOR LAW

    Directory of Open Access Journals (Sweden)

    Nicolae, GRADINARU

    2014-11-01

    Full Text Available In order to conduct the prior disciplinary investigation, the employee shall be convoked in writing by the person authorized by the employer to carry out the research, specifying the subject, date, time and place of the meeting. For this purpose the employer shall appoint a committee charged with conducting the prior disciplinary investigation. Prior disciplinary research cannot be done without the possibility of the accused person to defend himself. It would be an abuse of the employer to violate these provisions. Since the employee is entitled to formulate and sustain defence in proving innocence or lesser degree of guilt than imputed, it needs between the moment were disclosed to the employee and the one of performing the prior disciplinary investigation to be a reasonable term for the employee to be able to prepare a defence in this regard. The employee's failure to present at the convocation, without an objective reason entitles the employer to dispose the sanctioning without making the prior disciplinary investigation. The objective reason which makes the employee, that is subject to prior disciplinary investigation, unable to present to the preliminary disciplinary investigation, should be at the time of the investigation in question.

  11. Adaptive estimation of multivariate functions using conditionally Gaussian tensor-product spline priors

    NARCIS (Netherlands)

    Jonge, de R.; Zanten, van J.H.

    2012-01-01

    We investigate posterior contraction rates for priors on multivariate functions that are constructed using tensor-product B-spline expansions. We prove that using a hierarchical prior with an appropriate prior distribution on the partition size and Gaussian prior weights on the B-spline

  12. Adaptive nonparametric Bayesian inference using location-scale mixture priors

    NARCIS (Netherlands)

    Jonge, de R.; Zanten, van J.H.

    2010-01-01

    We study location-scale mixture priors for nonparametric statistical problems, including multivariate regression, density estimation and classification. We show that a rate-adaptive procedure can be obtained if the prior is properly constructed. In particular, we show that adaptation is achieved if

  13. Assessment of prior learning in vocational education and training

    DEFF Research Database (Denmark)

    Wahlgren, Bjarne; Aarkrog, Vibe

    ’ knowledge, skills and competences during the students’ performances and the methods that the teachers apply in order to assess the students’ prior learning in relation to the regulations of the current VET-program. In particular the study focuses on how to assess not only the students’ explicated knowledge......The article deals about the results of a study of the assessment of prior learning among adult workers who want to obtain formal qualifications as skilled workers. The study contributes to developing methods for assessing prior learning including both the teachers’ ways of eliciting the students...... and skills but also their competences, i.e. the way the students use their skills and knowledge to perform in practice. Based on a description of the assessment procedures the article discusses central issues in relation to the assessment of prior learning. The empirical data have been obtained in the VET...

  14. Análise de custos entre a raquianestesia e a anestesia venosa com propofol associada ao bloqueio perianal local em operações anorretais Cost analysis between spinal and venous anesthesia with propofol associated with local perianal block in anorectal procedures

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Kotze

    2009-09-01

    Full Text Available RACIONAL: Atualmente cerca de 90% das operações anorretais podem ser realizadas em regime ambulatorial. A técnica anestésica é fator fundamental na busca de menor tempo de internamento e redução de custos nestes procedimentos. Não há consenso na literatura sobre qual o melhor tipo de anestesia para essas operações. OBJETIVO: Comparar os custos da técnica de raquianestesia com bupivacaína 0,5% isobárica com a técnica de anestesia venosa com propofol associada ao bloqueio perianal local com lidocaína a 2% e bupivacaína 0,5% (anestesia combinada em pacientes submetidos a operações anorretais. MÉTODOS: Foram analisados dados de 99 pacientes submetidos à operações anorretais, divididos em dois grupos: grupo I (raquianestesia, composto por 50 pacientes e grupo II (anestesia combinada, composto por 49 pacientes. Foram estudados os procedimentos cirúrgicos, tempo de procedimento anestésico-cirúrgico, tempo de internamento e custos globais de cada paciente. RESULTADOS: Não houve diferença estatística significativa entre os grupos estudados em relação ao tipo de procedimento cirúrgico, sexo, idade e complicações. O tempo médio do procedimento anestésico-cirúrgico, no grupo I foi de 53,1 minutos e de 44,08 minutos no grupo II (P=0,034. O tempo médio de internamento foi de 19,68 horas no grupo I e de 7,08 horas no grupo II (PBACKGROUND: Approximately ninety percent of anorectal surgical procedures are performed in ambulatory basis. The choice of a proper anesthetic technique is important to achieve shorter hospital stay and low costs. There's no evidence in the literature that an ideal type of anesthesia for these procedures exists. AIM: To compare the costs of patients operated with spinal anesthesia (0,5% bupivacaine with combined anesthesia (propofol and local perineal block with 2% lidocaine and 0,5% bupivacaine in anorectal surgical procedures. METHODS: Data from 99 patients submitted to anorectal operations were

  15. Magnetic resonance imaging biomarkers of chronic obstructive pulmonary disease prior to radiation therapy for non-small cell lung cancer

    International Nuclear Information System (INIS)

    Sheikh, Khadija; Capaldi, Dante P.I.; Hoover, Douglas A.; Palma, David A.; Yaremko, Brian P.; Parraga, Grace

    2015-01-01

    •Three imaging phenotypes of COPD and ventilation heterogeneity.•We examine relationships for non-tumour lobe ventilation voids and clinical tests.•Smoking history and airflow obstruction were diagnostics for imaging phenotypes. Three imaging phenotypes of COPD and ventilation heterogeneity. We examine relationships for non-tumour lobe ventilation voids and clinical tests. Smoking history and airflow obstruction were diagnostics for imaging phenotypes. In this prospectively planned interim-analysis, the prevalence of chronic obstructive lung disease (COPD) phenotypes was determined using magnetic resonance imaging (MRI) and X-ray computed tomography (CT) in non-small-cell-lung-cancer (NSCLC) patients. Stage-III-NSCLC patients provided written informed consent for pulmonary function tests, imaging and the 6-min-walk-test. Ventilation defect percent (VDP) and CT lung density (relative-of-CT-density-histogram <−950, RA 950 ) were measured. Patients were classified into three subgroups based on qualitative and quantitative COPD and tumour-specific imaging phenotypes: (1) tumour-specific ventilation defects (TSD), (2) tumour-specific and other ventilation defects without emphysema (TSD V ), and, (3) tumour-specific and other ventilation defects with emphysema (TSD VE ). Seventeen stage-III NSCLC patients were evaluated (68 ± 7 years, 7 M/10 F, mean FEV 1 = 77% pred ) including seven current and 10 ex-smokers and eight patients with a prior lung disease diagnosis. There was a significant difference for smoking history (p = .02) and FEV 1 /FVC (p = .04) for subgroups classified using quantitative imaging. Patient subgroups classified using qualitative imaging findings were significantly different for emphysema (RA 950 , p < .001). There were significant relationships for whole-lung VDP (p < .05), but not RECIST or tumour-lobe VDP measurements with pulmonary function and exercise measurements. Preliminary analysis for non-tumour burden ventilation abnormalities

  16. Lyme disease: case report of persistent Lyme disease from Pulaski County, Virginia

    Directory of Open Access Journals (Sweden)

    Palmieri JR

    2013-12-01

    Full Text Available James R Palmieri,1 Scott King,1 Matthew Case,1 Arben Santo21Department of Microbiology, Infectious and Emerging Diseases, 2Department of Pathology, Edward Via College of Osteopathic Medicine, Blacksburg, VA, USAAbstract: A 50-year-old woman from Pulaski, Virginia, presented to a local clinic with headaches, fever, generalized joint pain, excessive thirst and fluid intake, and a progressing rash on her back. On physical examination, she had a large circular red rash on her back with a bull's-eye appearance, 16 × 18 cm in diameter. Serologic tests confirmed a diagnosis of Lyme disease. The patient could recall a walk through the woods 3 weeks prior, although she never noticed a tick on her body. Following a prolonged course of antibiotics, this case report presents a patient with ongoing symptoms consistent with post-treatment Lyme disease.Keywords: arthritis, chronic Lyme disease (CLD, ELISA, erythema migrans, ixodid ticks, Lyme disease, post-treatment Lyme disease syndrome (PTLDS, Western blotting

  17. Random template placement and prior information

    International Nuclear Information System (INIS)

    Roever, Christian

    2010-01-01

    In signal detection problems, one is usually faced with the task of searching a parameter space for peaks in the likelihood function which indicate the presence of a signal. Random searches have proven to be very efficient as well as easy to implement, compared e.g. to searches along regular grids in parameter space. Knowledge of the parameterised shape of the signal searched for adds structure to the parameter space, i.e., there are usually regions requiring to be densely searched while in other regions a coarser search is sufficient. On the other hand, prior information identifies the regions in which a search will actually be promising or may likely be in vain. Defining specific figures of merit allows one to combine both template metric and prior distribution and devise optimal sampling schemes over the parameter space. We show an example related to the gravitational wave signal from a binary inspiral event. Here the template metric and prior information are particularly contradictory, since signals from low-mass systems tolerate the least mismatch in parameter space while high-mass systems are far more likely, as they imply a greater signal-to-noise ratio (SNR) and hence are detectable to greater distances. The derived sampling strategy is implemented in a Markov chain Monte Carlo (MCMC) algorithm where it improves convergence.

  18. Personality, depressive symptoms and prior trauma exposure of new ...

    African Journals Online (AJOL)

    Background. Police officers are predisposed to trauma exposure. The development of depression and post-traumatic stress disorder (PTSD) may be influenced by personality style, prior exposure to traumatic events and prior depression. Objectives. To describe the personality profiles of new Metropolitan Police Service ...

  19. Uncertainty plus prior equals rational bias: an intuitive Bayesian probability weighting function.

    Science.gov (United States)

    Fennell, John; Baddeley, Roland

    2012-10-01

    Empirical research has shown that when making choices based on probabilistic options, people behave as if they overestimate small probabilities, underestimate large probabilities, and treat positive and negative outcomes differently. These distortions have been modeled using a nonlinear probability weighting function, which is found in several nonexpected utility theories, including rank-dependent models and prospect theory; here, we propose a Bayesian approach to the probability weighting function and, with it, a psychological rationale. In the real world, uncertainty is ubiquitous and, accordingly, the optimal strategy is to combine probability statements with prior information using Bayes' rule. First, we show that any reasonable prior on probabilities leads to 2 of the observed effects; overweighting of low probabilities and underweighting of high probabilities. We then investigate 2 plausible kinds of priors: informative priors based on previous experience and uninformative priors of ignorance. Individually, these priors potentially lead to large problems of bias and inefficiency, respectively; however, when combined using Bayesian model comparison methods, both forms of prior can be applied adaptively, gaining the efficiency of empirical priors and the robustness of ignorance priors. We illustrate this for the simple case of generic good and bad options, using Internet blogs to estimate the relevant priors of inference. Given this combined ignorant/informative prior, the Bayesian probability weighting function is not only robust and efficient but also matches all of the major characteristics of the distortions found in empirical research. PsycINFO Database Record (c) 2012 APA, all rights reserved.

  20. Logarithmic Laplacian Prior Based Bayesian Inverse Synthetic Aperture Radar Imaging.

    Science.gov (United States)

    Zhang, Shuanghui; Liu, Yongxiang; Li, Xiang; Bi, Guoan

    2016-04-28

    This paper presents a novel Inverse Synthetic Aperture Radar Imaging (ISAR) algorithm based on a new sparse prior, known as the logarithmic Laplacian prior. The newly proposed logarithmic Laplacian prior has a narrower main lobe with higher tail values than the Laplacian prior, which helps to achieve performance improvement on sparse representation. The logarithmic Laplacian prior is used for ISAR imaging within the Bayesian framework to achieve better focused radar image. In the proposed method of ISAR imaging, the phase errors are jointly estimated based on the minimum entropy criterion to accomplish autofocusing. The maximum a posterior (MAP) estimation and the maximum likelihood estimation (MLE) are utilized to estimate the model parameters to avoid manually tuning process. Additionally, the fast Fourier Transform (FFT) and Hadamard product are used to minimize the required computational efficiency. Experimental results based on both simulated and measured data validate that the proposed algorithm outperforms the traditional sparse ISAR imaging algorithms in terms of resolution improvement and noise suppression.

  1. Logarithmic Laplacian Prior Based Bayesian Inverse Synthetic Aperture Radar Imaging

    Directory of Open Access Journals (Sweden)

    Shuanghui Zhang

    2016-04-01

    Full Text Available This paper presents a novel Inverse Synthetic Aperture Radar Imaging (ISAR algorithm based on a new sparse prior, known as the logarithmic Laplacian prior. The newly proposed logarithmic Laplacian prior has a narrower main lobe with higher tail values than the Laplacian prior, which helps to achieve performance improvement on sparse representation. The logarithmic Laplacian prior is used for ISAR imaging within the Bayesian framework to achieve better focused radar image. In the proposed method of ISAR imaging, the phase errors are jointly estimated based on the minimum entropy criterion to accomplish autofocusing. The maximum a posterior (MAP estimation and the maximum likelihood estimation (MLE are utilized to estimate the model parameters to avoid manually tuning process. Additionally, the fast Fourier Transform (FFT and Hadamard product are used to minimize the required computational efficiency. Experimental results based on both simulated and measured data validate that the proposed algorithm outperforms the traditional sparse ISAR imaging algorithms in terms of resolution improvement and noise suppression.

  2. The Role of Prior Knowledge in International Franchise Partner Recruitment

    OpenAIRE

    Wang, Catherine; Altinay, Levent

    2006-01-01

    Purpose To investigate the role of prior knowledge in the international franchise partner recruitment process and to evaluate how cultural distance influences the role of prior knowledge in this process. Design/Methodology/Approach A single embedded case study of an international hotel firm was the focus of the enquiry. Interviews, observations and document analysis were used as the data collection techniques. Findings Findings reveal that prior knowledge of the franchisor enab...

  3. Antibiotic Prophylaxis for Gynecologic Procedures prior to and during the Utilization of Assisted Reproductive Technologies: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Nigel Pereira

    2016-01-01

    Full Text Available The use of assisted reproductive technologies (ART has increased steadily. There has been a corresponding increase in the number of ART-related procedures such as hysterosalpingography (HSG, saline infusion sonography (SIS, hysteroscopy, laparoscopy, oocyte retrieval, and embryo transfer (ET. While performing these procedures, the abdomen, upper vagina, and endocervix are breached, leading to the possibility of seeding pelvic structures with microorganisms. Antibiotic prophylaxis is therefore important to prevent or treat any procedure-related infections. After careful review of the published literature, it is evident that routine antibiotic prophylaxis is generally not recommended for the majority of ART-related procedures. For transcervical procedures such as HSG, SIS, hysteroscopy, ET, and chromotubation, patients at risk for pelvic infections should be screened and treated prior to the procedure. Patients with a history of pelvic inflammatory disease (PID or dilated fallopian tubes are at high risk for postprocedural infections and should be given antibiotic prophylaxis during procedures such as HSG, SIS, or chromotubation. Antibiotic prophylaxis is recommended prior to oocyte retrieval in patients with a history of endometriosis, PID, ruptured appendicitis, or multiple prior pelvic surgeries.

  4. Lyme disease of the brainstem

    Energy Technology Data Exchange (ETDEWEB)

    Kalina, Peter [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Decker, Andrew [Northern Westchester Hospital Center, Department of Neurology, Mt. Kisco, NY (United States); Kornel, Ezriel [Northern Westchester Hospital Center, Division of Neurosurgery, Mt. Kisco, NY (United States); Halperin, John J. [North Shore University Hospital, Department of Neurology, Manhasset, NY (United States)

    2005-12-01

    Lyme disease is a multisystem infectious disease caused by the tick-borne spirochete, Borrelia burgdorferi. Central nervous system (CNS) involvement typically causes local inflammation, most commonly meningitis, but rarely parenchymal brain involvement. We describe a patient who presented with clinical findings suggesting a brainstem process. Magnetic resonance imaging (MRI) and positron emission tomography (PET) suggested a brainstem neoplasm. Prior to biopsy, laboratory evaluation led to the diagnosis of Lyme disease. Clinical and imaging abnormalities improved markedly following antimicrobial therapy. We describe Lyme disease involvement of the cerebellar peduncles with hypermetabolism on PET. Although MRI is the primary imaging modality for most suspected CNS pathology, the practical applications of PET continue to expand. (orig.)

  5. Lyme disease of the brainstem

    International Nuclear Information System (INIS)

    Kalina, Peter; Decker, Andrew; Kornel, Ezriel; Halperin, John J.

    2005-01-01

    Lyme disease is a multisystem infectious disease caused by the tick-borne spirochete, Borrelia burgdorferi. Central nervous system (CNS) involvement typically causes local inflammation, most commonly meningitis, but rarely parenchymal brain involvement. We describe a patient who presented with clinical findings suggesting a brainstem process. Magnetic resonance imaging (MRI) and positron emission tomography (PET) suggested a brainstem neoplasm. Prior to biopsy, laboratory evaluation led to the diagnosis of Lyme disease. Clinical and imaging abnormalities improved markedly following antimicrobial therapy. We describe Lyme disease involvement of the cerebellar peduncles with hypermetabolism on PET. Although MRI is the primary imaging modality for most suspected CNS pathology, the practical applications of PET continue to expand. (orig.)

  6. Locally advanced cervix cancer: chemotherapy prior to definitive surgery or radiotherapy. A single institutional experience

    International Nuclear Information System (INIS)

    MacLeod, C.; O'Donnell, A.; Tattersall, M.H.N.; Dalrymple, C.; Firth, I.

    2001-01-01

    Primary or neoadjuvant chemotherapy prior to definitive local therapy has potential advantages for locally advanced cervix cancer. It can down stage a cancer and allow definitive local therapy to be technically possible (surgery), or potentially more effective (radiotherapy). It can also eradicate subclinical systemic metastases. This report reviews a single institution's experience of neoadjuvant chemotherapy prior to definitive local therapy for cervix cancer over a 13-year period. One hundred and six patients were treated with this intent. The patients were analysed for their response to chemotherapy, treatment received, survival, relapse and toxicity. The chemotherapy was feasible and the majority of patients had a complete or partial response (58.5%). Eight patients did not proceed to local treatment. Forty-six patients had definitive surgery and 52 had definitive radiotherapy. The 5-year overall survival was 27% and the majority of patients died with disease. The first site of relapse was usually in the pelvis (46.2%). Late complications that required ongoing medical therapy (n = 6) or surgical intervention (n = 2) were recorded in eight patients (7.5%). On univariate analysis stage (P= 0.04), tumour size (P = 0.01), lymph node status (P=0.003), response to chemotherapy (P = 0.045) and treatment (P = 0.003) were all significant predictors of survival. On multivariate analysis, tumour size (P < 0.0001) and nodal status (P = 0.02) were significant predictors of survival. Despite the impressive responses to chemotherapy of advanced cervix cancer, there is evidence from randomized trials that it does not improve or compromise survival prior to radiotherapy. As its role prior to surgery remains unclear, it should not be used in this setting outside a prospective randomized trial. Copyright (2001) Blackwell Science Pty Ltd

  7. A case-control study on the association between bladder cancer and prior bladder calculus.

    Science.gov (United States)

    Chung, Shiu-Dong; Tsai, Ming-Chieh; Lin, Ching-Chun; Lin, Herng-Ching

    2013-03-15

    Bladder calculus is associated with chronic irritation and inflammation. As there is substantial documentation that inflammation can play a direct role in carcinogenesis, to date the relationship between stone formation and bladder cancer (BC) remains unclear. This study aimed to examine the association between BC and prior bladder calculus using a population-based dataset. This case-control study included 2,086 cases who had received their first-time diagnosis of BC between 2001 and 2009 and 10,430 randomly selected controls without BC. Conditional logistic regressions were employed to explore the association between BC and having been previously diagnosed with bladder calculus. Of the sampled subjects, bladder calculus was found in 71 (3.4%) cases and 105 (1.1%) controls. Conditional logistic regression analysis revealed that the odds ratio (OR) of having been diagnosed with bladder calculus before the index date for cases was 3.42 (95% CI = 2.48-4.72) when compared with controls after adjusting for monthly income, geographic region, hypertension, diabetes, coronary heart disease, and renal disease, tobacco use disorder, obesity, alcohol abuse, and schistosomiasis, bladder outlet obstruction, and urinary tract infection. We further analyzed according to sex and found that among males, the OR of having been previously diagnosed with bladder calculus for cases was 3.45 (95% CI = 2.39-4.99) that of controls. Among females, the OR was 3.05 (95% CI = 1.53-6.08) that of controls. These results add to the evidence surrounding the conflicting reports regarding the association between BC and prior bladder calculus and highlight a potential target population for bladder cancer screening.

  8. Advanced prior modeling for 3D bright field electron tomography

    Science.gov (United States)

    Sreehari, Suhas; Venkatakrishnan, S. V.; Drummy, Lawrence F.; Simmons, Jeffrey P.; Bouman, Charles A.

    2015-03-01

    Many important imaging problems in material science involve reconstruction of images containing repetitive non-local structures. Model-based iterative reconstruction (MBIR) could in principle exploit such redundancies through the selection of a log prior probability term. However, in practice, determining such a log prior term that accounts for the similarity between distant structures in the image is quite challenging. Much progress has been made in the development of denoising algorithms like non-local means and BM3D, and these are known to successfully capture non-local redundancies in images. But the fact that these denoising operations are not explicitly formulated as cost functions makes it unclear as to how to incorporate them in the MBIR framework. In this paper, we formulate a solution to bright field electron tomography by augmenting the existing bright field MBIR method to incorporate any non-local denoising operator as a prior model. We accomplish this using a framework we call plug-and-play priors that decouples the log likelihood and the log prior probability terms in the MBIR cost function. We specifically use 3D non-local means (NLM) as the prior model in the plug-and-play framework, and showcase high quality tomographic reconstructions of a simulated aluminum spheres dataset, and two real datasets of aluminum spheres and ferritin structures. We observe that streak and smear artifacts are visibly suppressed, and that edges are preserved. Also, we report lower RMSE values compared to the conventional MBIR reconstruction using qGGMRF as the prior model.

  9. Understanding sleep disturbance in athletes prior to important competitions.

    Science.gov (United States)

    Juliff, Laura E; Halson, Shona L; Peiffer, Jeremiah J

    2015-01-01

    Anecdotally many athletes report worse sleep in the nights prior to important competitions. Despite sleep being acknowledged as an important factor for optimal athletic performance and overall health, little is understood about athlete sleep around competition. The aims of this study were to identify sleep complaints of athletes prior to competitions and determine whether complaints were confined to competition periods. Cross-sectional study. A sample of 283 elite Australian athletes (129 male, 157 female, age 24±5 y) completed two questionnaires; Competitive Sport and Sleep questionnaire and the Pittsburgh Sleep Quality Index. 64.0% of athletes indicated worse sleep on at least one occasion in the nights prior to an important competition over the past 12 months. The main sleep problem specified by athletes was problems falling asleep (82.1%) with the main reasons responsible for poor sleep indicated as thoughts about the competition (83.5%) and nervousness (43.8%). Overall 59.1% of team sport athletes reported having no strategy to overcome poor sleep compared with individual athletes (32.7%, p=0.002) who utilised relaxation and reading as strategies. Individual sport athletes had increased likelihood of poor sleep as they aged. The poor sleep reported by athletes prior to competition was situational rather than a global sleep problem. Poor sleep is common prior to major competitions in Australian athletes, yet most athletes are unaware of strategies to overcome the poor sleep experienced. It is essential coaches and scientists monitor and educate both individual and team sport athletes to facilitate sleep prior to important competitions. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  10. Impact of preoperative patient characteristics on posturethroplasty recurrence: The significance of stricture length and prior treatments

    Directory of Open Access Journals (Sweden)

    Jibril Oyekunle Bello

    2016-01-01

    Full Text Available Introduction: Urethral strictures are common in urologic practice of Sub-Saharan Africa including Nigeria. We determine the rate of stricture recurrence following urethroplasty for anterior urethral strictures and evaluate preoperative variables that predict of stricture recurrence in our practice. Subjects and Methods: Thirty-six men who had urethroplasty for proven anterior urethral stricture disease between February 2012 and January 2015 were retrospectively analyzed. Preoperative factors including age, socioeconomic factors, comorbidities, etiology of strictures, stricture location, stricture length, periurethral spongiofibrosis, and prior stricture treatments were assessed for independent predictors of stricture recurrence. Results: The median age was 49.5 years (range 21-90, median stricture length was 4 cm (range 1-18 cm and the overall recurrence rate was 27.8%. Postinfectious strictures, pan urethral strictures or multiple strictures involving the penile and bulbar urethra were more common. Most patients had penile circular fasciocutaneous flap urethroplasty. Following univariate analysis of potential preoperative predictors of stricture recurrence, stricture length, and prior treatments with dilations or urethrotomies were found to be significantly associated with stricture recurrence. On multivariate analysis, they both remained statistically significant. Patients who had prior treatments had greater odds of having a recurrent stricture (odds ratio 18, 95% confidence interval [CI] 1.4-224.3. Stricture length was dichotomized based on receiver operating characteristic (ROC analysis, and strictures of length ≥5 cm had significantly greater recurrence (area under ROC curve of 0.825, 95% CI 0.690-0.960, P = 0.032. Conclusion: Patients who had prior dilatations or urethrotomies and those with long strictures particularly strictures ≥5 cm have significantly greater odds of developing a recurrence following urethroplasty in Nigerian

  11. Deficits in synaptic function occur at medial perforant path-dentate granule cell synapses prior to Schaffer collateral-CA1 pyramidal cell synapses in the novel TgF344-Alzheimer's Disease Rat Model.

    Science.gov (United States)

    Smith, Lindsey A; McMahon, Lori L

    2018-02-01

    Alzheimer's disease (AD) pathology begins decades prior to onset of clinical symptoms, and the entorhinal cortex and hippocampus are among the first and most extensively impacted brain regions. The TgF344-AD rat model, which more fully recapitulates human AD pathology in an age-dependent manner, is a next generation preclinical rodent model for understanding pathophysiological processes underlying the earliest stages of AD (Cohen et al., 2013). Whether synaptic alterations occur in hippocampus prior to reported learning and memory deficit is not known. Furthermore, it is not known if specific hippocampal synapses are differentially affected by progressing AD pathology, or if synaptic deficits begin to appear at the same age in males and females in this preclinical model. Here, we investigated the time-course of synaptic changes in basal transmission, paired-pulse ratio, as an indirect measure of presynaptic release probability, long-term potentiation (LTP), and dendritic spine density at two hippocampal synapses in male and ovariectomized female TgF344-AD rats and wildtype littermates, prior to reported behavioral deficits. Decreased basal synaptic transmission begins at medial perforant path-dentate granule cell (MPP-DGC) synapses prior to Schaffer-collateral-CA1 (CA3-CA1) synapses, in the absence of a change in paired-pulse ratio (PPR) or dendritic spine density. N-methyl-d-aspartate receptor (NMDAR)-dependent LTP magnitude is unaffected at CA3-CA1 synapses at 6, 9, and 12months of age, but is significantly increased at MPP-DGC synapses in TgF344-AD rats at 6months only. Sex differences were only observed at CA3-CA1 synapses where the decrease in basal transmission occurs at a younger age in males versus females. These are the first studies to define presymptomatic alterations in hippocampal synaptic transmission in the TgF344-AD rat model. The time course of altered synaptic transmission mimics the spread of pathology through hippocampus in human AD and provides

  12. Nudging toward Inquiry: Awakening and Building upon Prior Knowledge

    Science.gov (United States)

    Fontichiaro, Kristin, Comp.

    2010-01-01

    "Prior knowledge" (sometimes called schema or background knowledge) is information one already knows that helps him/her make sense of new information. New learning builds on existing prior knowledge. In traditional reporting-style research projects, students bypass this crucial step and plow right into answer-finding. It's no wonder that many…

  13. 5 CFR 6201.103 - Prior approval for outside employment.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Prior approval for outside employment. 6201.103 Section 6201.103 Administrative Personnel EXPORT-IMPORT BANK OF THE UNITED STATES SUPPLEMENTAL STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXPORT-IMPORT BANK OF THE UNITED STATES § 6201.103 Prior...

  14. Source Localization by Entropic Inference and Backward Renormalization Group Priors

    Directory of Open Access Journals (Sweden)

    Nestor Caticha

    2015-04-01

    Full Text Available A systematic method of transferring information from coarser to finer resolution based on renormalization group (RG transformations is introduced. It permits building informative priors in finer scales from posteriors in coarser scales since, under some conditions, RG transformations in the space of hyperparameters can be inverted. These priors are updated using renormalized data into posteriors by Maximum Entropy. The resulting inference method, backward RG (BRG priors, is tested by doing simulations of a functional magnetic resonance imaging (fMRI experiment. Its results are compared with a Bayesian approach working in the finest available resolution. Using BRG priors sources can be partially identified even when signal to noise ratio levels are up to ~ -25dB improving vastly on the single step Bayesian approach. For low levels of noise the BRG prior is not an improvement over the single scale Bayesian method. Analysis of the histograms of hyperparameters can show how to distinguish if the method is failing, due to very high levels of noise, or if the identification of the sources is, at least partially possible.

  15. Cyclosporine in veterinary dermatology.

    Science.gov (United States)

    Palmeiro, Brian S

    2013-01-01

    Cyclosporine is an immunomodulatory medication that is efficacious and approved for atopic dermatitis in dogs and allergic dermatitis in cats; it has also been used to successfully manage a variety of immune-mediated dermatoses in dogs and cats. This article reviews the use of cyclosporine in veterinary dermatology including its mechanism of action, pharmacokinetics, drug interactions, side effects, and relevant clinical updates. Dermatologic indications including atopic/allergic dermatitis, perianal fistulas, sebaceous adenitis, and other immune-mediated skin diseases are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Primary invasive carcinoma of the vagina after Le Fort partial colpocleisis for stage IV pelvic organ prolapse: a case report.

    Science.gov (United States)

    Cho, Moon Kyoung; Kim, Chul Hong; Kim, Yoon Ha

    2011-11-01

    We present here the case report of a postmenopausal woman who complained of recurrent pus-like vaginal discharge and perianal pain 1 year after Le Fort colpocleisis, which was subsequently identified as a primary invasive carcinoma of the vagina. Biopsy confirmed a squamous cell carcinoma in the vagina, and the disease was classified as stage III according to FIGO staging. The patient received pelvic radiotherapy. This case emphasizes that differential diagnosis of recurrent vaginal discharge that presents remote from obliterative procedure for pelvic organ prolapse should consider not only pyometra, but also other causes.

  17. Identification of subsurface structures using electromagnetic data and shape priors

    Energy Technology Data Exchange (ETDEWEB)

    Tveit, Svenn, E-mail: svenn.tveit@uni.no [Uni CIPR, Uni Research, Bergen 5020 (Norway); Department of Mathematics, University of Bergen, Bergen 5020 (Norway); Bakr, Shaaban A., E-mail: shaaban.bakr1@gmail.com [Department of Mathematics, Faculty of Science, Assiut University, Assiut 71516 (Egypt); Uni CIPR, Uni Research, Bergen 5020 (Norway); Lien, Martha, E-mail: martha.lien@octio.com [Uni CIPR, Uni Research, Bergen 5020 (Norway); Octio AS, Bøhmergaten 44, Bergen 5057 (Norway); Mannseth, Trond, E-mail: trond.mannseth@uni.no [Uni CIPR, Uni Research, Bergen 5020 (Norway); Department of Mathematics, University of Bergen, Bergen 5020 (Norway)

    2015-03-01

    We consider the inverse problem of identifying large-scale subsurface structures using the controlled source electromagnetic method. To identify structures in the subsurface where the contrast in electric conductivity can be small, regularization is needed to bias the solution towards preserving structural information. We propose to combine two approaches for regularization of the inverse problem. In the first approach we utilize a model-based, reduced, composite representation of the electric conductivity that is highly flexible, even for a moderate number of degrees of freedom. With a low number of parameters, the inverse problem is efficiently solved using a standard, second-order gradient-based optimization algorithm. Further regularization is obtained using structural prior information, available, e.g., from interpreted seismic data. The reduced conductivity representation is suitable for incorporation of structural prior information. Such prior information cannot, however, be accurately modeled with a gaussian distribution. To alleviate this, we incorporate the structural information using shape priors. The shape prior technique requires the choice of kernel function, which is application dependent. We argue for using the conditionally positive definite kernel which is shown to have computational advantages over the commonly applied gaussian kernel for our problem. Numerical experiments on various test cases show that the methodology is able to identify fairly complex subsurface electric conductivity distributions while preserving structural prior information during the inversion.

  18. PIRPLE: a penalized-likelihood framework for incorporation of prior images in CT reconstruction

    International Nuclear Information System (INIS)

    Stayman, J Webster; Dang, Hao; Ding, Yifu; Siewerdsen, Jeffrey H

    2013-01-01

    Over the course of diagnosis and treatment, it is common for a number of imaging studies to be acquired. Such imaging sequences can provide substantial patient-specific prior knowledge about the anatomy that can be incorporated into a prior-image-based tomographic reconstruction for improved image quality and better dose utilization. We present a general methodology using a model-based reconstruction approach including formulations of the measurement noise that also integrates prior images. This penalized-likelihood technique adopts a sparsity enforcing penalty that incorporates prior information yet allows for change between the current reconstruction and the prior image. Moreover, since prior images are generally not registered with the current image volume, we present a modified model-based approach that seeks a joint registration of the prior image in addition to the reconstruction of projection data. We demonstrate that the combined prior-image- and model-based technique outperforms methods that ignore the prior data or lack a noise model. Moreover, we demonstrate the importance of registration for prior-image-based reconstruction methods and show that the prior-image-registered penalized-likelihood estimation (PIRPLE) approach can maintain a high level of image quality in the presence of noisy and undersampled projection data. (paper)

  19. Incorporating priors for EEG source imaging and connectivity analysis

    Directory of Open Access Journals (Sweden)

    Xu eLei

    2015-08-01

    Full Text Available Electroencephalography source imaging (ESI is a useful technique to localize the generators from a given scalp electric measurement and to investigate the temporal dynamics of the large-scale neural circuits. By introducing reasonable priors from other modalities, ESI reveals the most probable sources and communication structures at every moment in time. Here, we review the available priors from such techniques as magnetic resonance imaging (MRI, functional MRI (fMRI, and positron emission tomography (PET. The modality's specific contribution is analyzed from the perspective of source reconstruction. For spatial priors, such as EEG-correlated fMRI, temporally coherent networks and resting-state fMRI are systematically introduced in the ESI. Moreover, the fiber tracking (diffusion tensor imaging, DTI and neuro-stimulation techniques (transcranial magnetic stimulation, TMS are also introduced as the potential priors, which can help to draw inferences about the neuroelectric connectivity in the source space. We conclude that combining EEG source imaging with other complementary modalities is a promising approach towards the study of brain networks in cognitive and clinical neurosciences.

  20. Head trauma and Alzheimer's disease

    NARCIS (Netherlands)

    Nandoe, Rishi D. S.; Scheltens, Philip; Eikelenboom, Piet

    2002-01-01

    The authors describe a case of a 55 year old woman who was diagnosed with Alzheimer's disease 1.5 years after a car accident in which she experienced a mild concussion. Extensive history taking disclosed no cognitive changes prior to the car accident. The case is discussed in view of the

  1. Rubber band ligation and infrared photocoagulation for the outpatient treatment of hemorrhoidal disease.

    Science.gov (United States)

    Ricci, Maurício Pichler; Matos, Délcio; Saad, Sarhan Sydney

    2008-01-01

    To compare the results of rubber band ligation and infrared photocoagulation for the treatment of hemorrhoidal disease through the analysis of the incidence of complications after each treatment and respective success rate. Forty-eight patients with first, second or third degree hemorrhoidal disease were randomized to receive treatment with either rubber band ligation (n=23) or infrared photocoagulation (n=25). Each patient was assessed at 1 week and 4 week intervals after treatment. We compared the incidence of complications and efficiency of each treatment modality and Qui-square, Fisher's Exact Test and Student's t Test were used to statistical analysis. Bleeding occured in eight (34,7%) patients treated with rubber band ligation and in four (16,0%) after infrared photocoagulation (p=0,243). Thirteen (52,0%) patients felt pain during infrared photocoagulation and 9 (39,1%) after rubber band ligation (p=0,546). After rubber band ligation, 14 (60,8%) required medication for pain relief. One patient (4,0%) required medication after infrared photocoagulation (prubber band ligator and 1 (4,0%) treated with infrared photocoagulation had symptomatic mucosal ulcers. Perianal dermatitis occured in two (8,0%) patients treated with infrared photocoagulation and one patient (4,3%) was observed to have prolapsed thrombosed piles after rubber band ligation. One month after treatment, 17 of 23 patients treated with rubber band ligation (73,9%) and 18 of 25 patients treated with infrared photocoagulation were asymptomatic. Rubber band ligation treated bleeding and prolapse in 90,0% and 82,4% respectively. Infrared photocoagulation treats bleeding and prolapse in 93,7% and 87,5% respectively. Those differences are not significant. Rubber band ligation causes significantly more pain than infrared photocoagulation during the first week after the procedures and their success rate are not different after four weeks of treatment.

  2. Inflammatory Bowel Disease During Pregnancy.

    Science.gov (United States)

    Rajapakse, Ramona; Korelitz, Burton I.

    2001-06-01

    The management of both male and female patients with inflammatory bowel disease (IBD) who wish to have a baby is challenging. For women, the most important factor to bear in mind is that the outcome of pregnancy is largely influenced by disease activity at the time of conception. Women with quiescent disease are likely to have an uncomplicated pregnancy with the delivery of a healthy baby, whereas women with active disease are more likely to have complications such as spontaneous abortions, miscarriages, stillbirths, and exacerbation of the disease. This is more true of patients with Crohn's disease than of patients with ulcerative colitis. Although the safety of medications used during pregnancy is an important issue, the impact of the medications used to treat IBD is less important in comparison to disease activity itself. 5-Aminosalicylic acid (5-ASA) products appear to be safe during pregnancy; corticosteroids are probably safe; 6-mercaptopurine and azathioprine should be used with caution; and methotrexate is contraindicated. There are inadequate data on the use of infliximab during pregnancy. In regard to men with IBD, the disease itself does not seem to have any negative impact on fertility. However, there is controversy about the effects of using 6-mercaptopurine and azathioprine prior to and during fertilization. In view of possible adverse pregnancy outcomes, it would be prudent to withhold 6-mercaptopurine and azathioprine therapy in men with IBD for 3 months prior to conception, when feasible. Most IBD medications should be continued before, during, and after pregnancy, with careful attention to the known cautions and exceptions. If IBD in a pregnant patient is in remission, the prognosis for pregnancy is the same as if she did not have IBD. Active disease should therefore be treated aggressively and remission accomplished before pregnancy is attempted. Similarly, a woman who unexpectedly becomes pregnant while her IBD is active should be treated

  3. Penalising Model Component Complexity: A Principled, Practical Approach to Constructing Priors

    KAUST Repository

    Simpson, Daniel

    2017-04-06

    In this paper, we introduce a new concept for constructing prior distributions. We exploit the natural nested structure inherent to many model components, which defines the model component to be a flexible extension of a base model. Proper priors are defined to penalise the complexity induced by deviating from the simpler base model and are formulated after the input of a user-defined scaling parameter for that model component, both in the univariate and the multivariate case. These priors are invariant to repa-rameterisations, have a natural connection to Jeffreys\\' priors, are designed to support Occam\\'s razor and seem to have excellent robustness properties, all which are highly desirable and allow us to use this approach to define default prior distributions. Through examples and theoretical results, we demonstrate the appropriateness of this approach and how it can be applied in various situations.

  4. Penalising Model Component Complexity: A Principled, Practical Approach to Constructing Priors

    KAUST Repository

    Simpson, Daniel; Rue, Haavard; Riebler, Andrea; Martins, Thiago G.; Sø rbye, Sigrunn H.

    2017-01-01

    In this paper, we introduce a new concept for constructing prior distributions. We exploit the natural nested structure inherent to many model components, which defines the model component to be a flexible extension of a base model. Proper priors are defined to penalise the complexity induced by deviating from the simpler base model and are formulated after the input of a user-defined scaling parameter for that model component, both in the univariate and the multivariate case. These priors are invariant to repa-rameterisations, have a natural connection to Jeffreys' priors, are designed to support Occam's razor and seem to have excellent robustness properties, all which are highly desirable and allow us to use this approach to define default prior distributions. Through examples and theoretical results, we demonstrate the appropriateness of this approach and how it can be applied in various situations.

  5. On Bayesian reliability analysis with informative priors and censoring

    International Nuclear Information System (INIS)

    Coolen, F.P.A.

    1996-01-01

    In the statistical literature many methods have been presented to deal with censored observations, both within the Bayesian and non-Bayesian frameworks, and such methods have been successfully applied to, e.g., reliability problems. Also, in reliability theory it is often emphasized that, through shortage of statistical data and possibilities for experiments, one often needs to rely heavily on judgements of engineers, or other experts, for which means Bayesian methods are attractive. It is therefore important that such judgements can be elicited easily to provide informative prior distributions that reflect the knowledge of the engineers well. In this paper we focus on this aspect, especially on the situation that the judgements of the consulted engineers are based on experiences in environments where censoring has also been present previously. We suggest the use of the attractive interpretation of hyperparameters of conjugate prior distributions when these are available for assumed parametric models for lifetimes, and we show how one may go beyond the standard conjugate priors, using similar interpretations of hyper-parameters, to enable easier elicitation when censoring has been present in the past. This may even lead to more flexibility for modelling prior knowledge than when using standard conjugate priors, whereas the disadvantage of more complicated calculations that may be needed to determine posterior distributions play a minor role due to the advanced mathematical and statistical software that is widely available these days

  6. Action priors for learning domain invariances

    CSIR Research Space (South Africa)

    Rosman, Benjamin S

    2015-04-01

    Full Text Available behavioural invariances in the domain, by identifying actions to be prioritised in local contexts, invariant to task details. This information has the effect of greatly increasing the speed of solving new problems. We formalise this notion as action priors...

  7. Free Recall Episodic Memory Performance Predicts Dementia Ten Years prior to Clinical Diagnosis: Findings from the Betula Longitudinal Study

    Directory of Open Access Journals (Sweden)

    Carl-Johan Boraxbekk

    2015-05-01

    Full Text Available Background/Aims: Early dementia diagnosis is a considerable challenge. The present study examined the predictive value of cognitive performance for a future clinical diagnosis of late-onset Alzheimer's disease or vascular dementia in a random population sample. Methods: Cognitive performance was retrospectively compared between three groups of participants from the Betula longitudinal cohort. Group 1 developed dementia 11-22 years after baseline testing (n = 111 and group 2 after 1-10 years (n = 280; group 3 showed no deterioration towards dementia during the study period (n = 2,855. Multinomial logistic regression analysis was used to investigate the predictive value of tests reflecting episodic memory performance, semantic memory performance, visuospatial ability, and prospective memory performance. Results: Age- and education-corrected performance on two free recall episodic memory tests significantly predicted dementia 10 years prior to clinical diagnosis. Free recall performance also predicted dementia 11-22 years prior to diagnosis when controlling for education, but not when age was added to the model. Conclusion: The present results support the suggestion that two free recall-based tests of episodic memory function may be useful for detecting individuals at risk of developing dementia 10 years prior to clinical diagnosis.

  8. Patients with colorectal lung oligometastases (L-OMD) treated by dose adapted SABR at diagnosis of oligometastatic disease have better outcomes than patients previously treated for their metastatic disease.

    LENUS (Irish Health Repository)

    Mihai, Alina

    2017-01-01

    To evaluate the clinical outcomes of patients with OMD from a CRC primary, who underwent SABR either as first treatment at diagnosis of metachronous oligometastatic disease to lung or at progression in lung after prior treatments for metastatic disease.

  9. Finding a minimally informative Dirichlet prior distribution using least squares

    International Nuclear Information System (INIS)

    Kelly, Dana; Atwood, Corwin

    2011-01-01

    In a Bayesian framework, the Dirichlet distribution is the conjugate distribution to the multinomial likelihood function, and so the analyst is required to develop a Dirichlet prior that incorporates available information. However, as it is a multiparameter distribution, choosing the Dirichlet parameters is less straightforward than choosing a prior distribution for a single parameter, such as p in the binomial distribution. In particular, one may wish to incorporate limited information into the prior, resulting in a minimally informative prior distribution that is responsive to updates with sparse data. In the case of binomial p or Poisson λ, the principle of maximum entropy can be employed to obtain a so-called constrained noninformative prior. However, even in the case of p, such a distribution cannot be written down in the form of a standard distribution (e.g., beta, gamma), and so a beta distribution is used as an approximation in the case of p. In the case of the multinomial model with parametric constraints, the approach of maximum entropy does not appear tractable. This paper presents an alternative approach, based on constrained minimization of a least-squares objective function, which leads to a minimally informative Dirichlet prior distribution. The alpha-factor model for common-cause failure, which is widely used in the United States, is the motivation for this approach, and is used to illustrate the method. In this approach to modeling common-cause failure, the alpha-factors, which are the parameters in the underlying multinomial model for common-cause failure, must be estimated from data that are often quite sparse, because common-cause failures tend to be rare, especially failures of more than two or three components, and so a prior distribution that is responsive to updates with sparse data is needed.

  10. Finding a Minimally Informative Dirichlet Prior Distribution Using Least Squares

    International Nuclear Information System (INIS)

    Kelly, Dana; Atwood, Corwin

    2011-01-01

    In a Bayesian framework, the Dirichlet distribution is the conjugate distribution to the multinomial likelihood function, and so the analyst is required to develop a Dirichlet prior that incorporates available information. However, as it is a multiparameter distribution, choosing the Dirichlet parameters is less straight-forward than choosing a prior distribution for a single parameter, such as p in the binomial distribution. In particular, one may wish to incorporate limited information into the prior, resulting in a minimally informative prior distribution that is responsive to updates with sparse data. In the case of binomial p or Poisson, the principle of maximum entropy can be employed to obtain a so-called constrained noninformative prior. However, even in the case of p, such a distribution cannot be written down in closed form, and so an approximate beta distribution is used in the case of p. In the case of the multinomial model with parametric constraints, the approach of maximum entropy does not appear tractable. This paper presents an alternative approach, based on constrained minimization of a least-squares objective function, which leads to a minimally informative Dirichlet prior distribution. The alpha-factor model for common-cause failure, which is widely used in the United States, is the motivation for this approach, and is used to illustrate the method. In this approach to modeling common-cause failure, the alpha-factors, which are the parameters in the underlying multinomial aleatory model for common-cause failure, must be estimated from data that is often quite sparse, because common-cause failures tend to be rare, especially failures of more than two or three components, and so a prior distribution that is responsive to updates with sparse data is needed.

  11. Safety and utility of kyphoplasty prior to spine stereotactic radiosurgery for metastatic tumors: a clinical and dosimetric analysis.

    Science.gov (United States)

    Barzilai, Ori; DiStefano, Natalie; Lis, Eric; Yamada, Yoshiya; Lovelock, D Michael; Fontanella, Andrew N; Bilsky, Mark H; Laufer, Ilya

    2018-01-01

    OBJECTIVE The aim of this study was to evaluate the safety and efficacy of kyphoplasty treatment prior to spine stereotactic radiosurgery (SRS) in patients with spine metastases. METHODS A retrospective review of charts, radiology reports, and images was performed for all patients who received SRS (single fraction; either standalone or post-kyphoplasty) at a large tertiary cancer center between January 2012 and July 2015. Patient and tumor variables were documented, as well as treatment planning data and dosimetry. To measure the photon scatter due to polymethyl methacrylate, megavolt photon beam attenuation was determined experimentally as it passed through a kyphoplasty cement phantom. Corrected electron density values were recalculated and compared with uncorrected values. RESULTS Of 192 treatment levels in 164 unique patients who underwent single-fraction SRS, 17 (8.8%) were treated with kyphoplasty prior to radiation delivery to the index level. The median time from kyphoplasty to SRS was 22 days. Four of 192 treatments (2%) demonstrated local tumor recurrence or progression at the time of analysis. Of the 4 local failures, 1 patient had kyphoplasty prior to SRS. This recurrence occurred 18 months after SRS in the setting of widespread systemic disease and spinal tumor progression. Dosimetric review demonstrated a lower than average treatment dose for this case compared with the rest of the cohort. There were no significant differences in dosimetry analysis between the group of patients who underwent kyphoplasty prior to SRS and the remaining patients in the cohort. A preliminary analysis of polymethyl methacrylate showed that dosimetric errors due to uncorrected electron density values were insignificant. CONCLUSIONS In cases without epidural spinal cord compression, stabilization with cement augmentation prior to SRS is safe and does not alter the efficacy of the radiation or preclude physicians from adhering to SRS planning and contouring guidelines.

  12. Active Prior Tactile Knowledge Transfer for Learning Tactual Properties of New Objects

    Directory of Open Access Journals (Sweden)

    Di Feng

    2018-02-01

    Full Text Available Reusing the tactile knowledge of some previously-explored objects (prior objects helps us to easily recognize the tactual properties of new objects. In this paper, we enable a robotic arm equipped with multi-modal artificial skin, like humans, to actively transfer the prior tactile exploratory action experiences when it learns the detailed physical properties of new objects. These experiences, or prior tactile knowledge, are built by the feature observations that the robot perceives from multiple sensory modalities, when it applies the pressing, sliding, and static contact movements on objects with different action parameters. We call our method Active Prior Tactile Knowledge Transfer (APTKT, and systematically evaluated its performance by several experiments. Results show that the robot improved the discrimination accuracy by around 10 % when it used only one training sample with the feature observations of prior objects. By further incorporating the predictions from the observation models of prior objects as auxiliary features, our method improved the discrimination accuracy by over 20 % . The results also show that the proposed method is robust against transferring irrelevant prior tactile knowledge (negative knowledge transfer.

  13. [Acute anal pain].

    Science.gov (United States)

    Pittet, Olivier; Demartines, Nicolas; Hahnloser, Dieter

    2013-07-01

    Acute anal pain is a common proctological problem. A detailed history together with the clinical examination are crucial for the diagnosis. An acute perianal vein thrombosis can be successfully excised within the first 72 hours. Acute anal fissures are best treated conservatively using stool regulation and topical medications reducing the sphincter spasm. A chronic anal fissure needs surgery. Perianal abscesses can very often be incised and drained in local anesthesia. Proctalgia fugax and the levator ani syndrome are exclusion diagnoses and are treated symptomatically.

  14. Figure-ground segmentation based on class-independent shape priors

    Science.gov (United States)

    Li, Yang; Liu, Yang; Liu, Guojun; Guo, Maozu

    2018-01-01

    We propose a method to generate figure-ground segmentation by incorporating shape priors into the graph-cuts algorithm. Given an image, we first obtain a linear representation of an image and then apply directional chamfer matching to generate class-independent, nonparametric shape priors, which provide shape clues for the graph-cuts algorithm. We then enforce shape priors in a graph-cuts energy function to produce object segmentation. In contrast to previous segmentation methods, the proposed method shares shape knowledge for different semantic classes and does not require class-specific model training. Therefore, the approach obtains high-quality segmentation for objects. We experimentally validate that the proposed method outperforms previous approaches using the challenging PASCAL VOC 2010/2012 and Berkeley (BSD300) segmentation datasets.

  15. Prior Exposure and Educational Environment towards Entrepreneurial Intention

    Directory of Open Access Journals (Sweden)

    Karla Soria-Barreto

    2017-07-01

    Full Text Available This research is based on the responses to a questionnaire applied to 351 students of business management in Chile and Colombia. Through the analysis of structural equations on Ajzen’s model, we found that entrepreneurial education, the University environment, and the prior entrepreneurial exposure are mediated by the factors of the Ajzen`s model to generate entrepreneurial intention in higher education students. The results show that entrepreneurial education strengthens the perceived control of behavior and, with it, albeit in a differentiated way, the entrepreneurial intention of men and women. University environment affects entrepreneurial intention through attitude towards entrepreneurship; and finally, the work experience, used as one of the variables that measure prior entrepreneurial exposure, explains the entrepreneurial intention inversely through the subjective norms. We found that gender has a moderate effect on perceived control of behavior and entrepreneurial education. The scarce studies on the impact of the University environment and the mixed results of the entrepreneurial education and prior entrepreneurial exposure toward entrepreneurial intention show the necessity for further research. A second contribution is the opportunity to present new evidence about the relationship between University environment, entrepreneurial education and prior exposure to developing countries of South America, including the gender effect (moderator for entrepreneurial intention. It is important to note that most of the research in this area applies to developed countries, and some scholars suggest that extrapolating the results is not convenient.

  16. Emerging infectious diseases of wildlife: a critical perspective.

    Science.gov (United States)

    Tompkins, Daniel M; Carver, Scott; Jones, Menna E; Krkošek, Martin; Skerratt, Lee F

    2015-04-01

    We review the literature to distinguish reports of vertebrate wildlife disease emergence with sufficient evidence, enabling a robust assessment of emergence drivers. For potentially emerging agents that cannot be confirmed, sufficient data on prior absence (or a prior difference in disease dynamics) are frequently lacking. Improved surveillance, particularly for neglected host taxa, geographical regions and infectious agents, would enable more effective management should emergence occur. Exposure to domestic sources of infection and human-assisted exposure to wild sources were identified as the two main drivers of emergence across host taxa; the domestic source was primary for fish while the wild source was primary for other taxa. There was generally insufficient evidence for major roles of other hypothesized drivers of emergence. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Prior elicitation: Interactive spreadsheet graphics with sliders can be fun, and informative

    OpenAIRE

    Jones, G; Johnson, WO

    2014-01-01

    There are several approaches to setting priors in Bayesian data analysis. Some attempt to minimize the impact of the prior on the posterior, allowing the data to "speak for themselves," or to provide Bayesian inferences that have good frequentist properties. In contrast, this note focuses on priors where scientific knowledge is used, possibly partially informative. There are many articles on the use of such subjective information. We focus on using standard software for eliciting priors from ...

  18. In a randomized trial, the live attenuated tetravalent dengue vaccine TV003 is well-tolerated and highly immunogenic in subjects with flavivirus exposure prior to vaccination.

    Directory of Open Access Journals (Sweden)

    Stephen S Whitehead

    2017-05-01

    Full Text Available Infection caused by the four serotypes of dengue virus (DENV-1-4 is a leading cause of mosquito-borne disease. Clinically-severe dengue disease is more common when secondary dengue infection occurs following prior infection with a heterologous dengue serotype. Other flaviviruses such as yellow fever virus, Japanese encephalitis virus, and Zika virus, can also elicit antibodies which are cross-reactive to DENV. As candidate dengue vaccines become available in endemic settings and for individuals who have received other flavivirus vaccines, it is important to examine vaccine safety and immunogenicity in these flavivirus-experienced populations. We performed a randomized, controlled trial of the National Institutes of Health live attenuated tetravalent dengue vaccine candidate (TV003 in fifty-eight individuals with prior exposure to flavivirus infection or vaccine. As in prior studies of this vaccine in flavivirus-naive volunteers, flavivirus-experienced subjects received two doses of vaccine six months apart and were followed closely for clinical events, laboratory changes, viremia, and neutralizing antibody titers. TV003 was well tolerated with few adverse events other than rash, which was predominately mild. Following one dose, 87% of vaccinees had an antibody response to all four serotypes (tetravalent response, suggesting a robust immune response. In addition, 76% of vaccinees were viremic; mean peak titers ranged from 0.68–1.1 log10 PFU/mL and did not differ by serotype. The second dose of TV003 was not associated with viremia, rash, or a sustained boost in antibody titers indicating that a single dose of the vaccine is likely sufficient to prevent viral replication and thus protect against disease. In comparison to the viremia and neutralizing antibody response elicited by TV003 in flavivirus-naïve subjects from prior studies, we found that subjects who were flavivirus-exposed prior to vaccination exhibited slightly higher DENV-3 viremia

  19. Aspirin Allergy Desensitization in Cerebrovascular Disease

    Science.gov (United States)

    Zuckerman, Scott L; Seder, David B; Tsujiura, Crystiana; Cushing, Deborah; Gallup, Holly; Mocco, J; Hanel, Richard A; Ecker, Robert D

    2014-01-01

    Summary Aspirin (ASA) is the mainstay of treatment in cerebrovascular and systemic vascular disease. ASA hypersensitivity can pose a challenge to achieving optimum medical management prior to and after neurointerventional treatment. Desensitization to ASA is well described in the allergy and cardiovascular literature, but there are no similar discussions specific to neurointervention. The purpose of our study was to describe our experience with ASA hypersensitivity management and review the relevant literature. Two cases of patients with symptomatic cerebrovascular disease requiring neurointervention who were successfully desensitized to their ASA hypersensitivity prior to treatment are described. The subsequent literature is reviewed. Several ASA desensitization protocols exist and have been proven to successfully treat ASA hypersensitivity and allow for ASA therapy to be safely initiated. We describe several previously published protocols. ASA desensitization is a safe and simple way to manage ASA hypersensitivity. We provide comprehensive management guidelines for the neurointerventionalist engaging in ASA desensitization. PMID:24556294

  20. Bayesian image reconstruction in SPECT using higher order mechanical models as priors

    International Nuclear Information System (INIS)

    Lee, S.J.; Gindi, G.; Rangarajan, A.

    1995-01-01

    While the ML-EM (maximum-likelihood-expectation maximization) algorithm for reconstruction for emission tomography is unstable due to the ill-posed nature of the problem, Bayesian reconstruction methods overcome this instability by introducing prior information, often in the form of a spatial smoothness regularizer. More elaborate forms of smoothness constraints may be used to extend the role of the prior beyond that of a stabilizer in order to capture actual spatial information about the object. Previously proposed forms of such prior distributions were based on the assumption of a piecewise constant source distribution. Here, the authors propose an extension to a piecewise linear model--the weak plate--which is more expressive than the piecewise constant model. The weak plate prior not only preserves edges but also allows for piecewise ramplike regions in the reconstruction. Indeed, for the application in SPECT, such ramplike regions are observed in ground-truth source distributions in the form of primate autoradiographs of rCBF radionuclides. To incorporate the weak plate prior in a MAP approach, the authors model the prior as a Gibbs distribution and use a GEM formulation for the optimization. They compare quantitative performance of the ML-EM algorithm, a GEM algorithm with a prior favoring piecewise constant regions, and a GEM algorithm with the weak plate prior. Pointwise and regional bias and variance of ensemble image reconstructions are used as indications of image quality. The results show that the weak plate and membrane priors exhibit improved bias and variance relative to ML-EM techniques

  1. Early-onset Hirayama disease in a female

    Directory of Open Access Journals (Sweden)

    Matthias Baumann

    2017-01-01

    Full Text Available Objectives: Hirayama disease is a rare myelopathy, occurring predominantly in males with onset in the teens. Methods and results: Here, we report a young female patient who developed the first signs of Hirayama disease at 10.5 years of age. Prior to onset, she had experienced a growth spurt and grew about 8 cm. The disease progressed over 3 years and the typical clinical, electrophysiological, and neuroimaging signs of Hirayama disease were found. After this period and achievement of her final height, no further progression was noticed. Conclusions: This case highlights that pediatric neurologists should be aware of Hirayama disease, which can also occur in girls in early adolescence.

  2. Physical examination prior to initiating hormonal contraception: a systematic review.

    Science.gov (United States)

    Tepper, Naomi K; Curtis, Kathryn M; Steenland, Maria W; Marchbanks, Polly A

    2013-05-01

    Provision of contraception is often linked with physical examination, including clinical breast examination (CBE) and pelvic examination. This review was conducted to evaluate the evidence regarding outcomes among women with and without physical examination prior to initiating hormonal contraceptives. The PubMed database was searched from database inception through March 2012 for all peer-reviewed articles in any language concerning CBE and pelvic examination prior to initiating hormonal contraceptives. The quality of each study was assessed using the United States Preventive Services Task Force grading system. The search did not identify any evidence regarding outcomes among women screened versus not screened with CBE prior to initiation of hormonal contraceptives. The search identified two case-control studies of fair quality which compared women who did or did not undergo pelvic examination prior to initiating oral contraceptives (OCs) or depot medroxyprogesterone acetate (DMPA). No differences in risk factors for cervical neoplasia, incidence of sexually transmitted infections, incidence of abnormal Pap smears or incidence of abnormal wet mount findings were observed. Although women with breast cancer should not use hormonal contraceptives, there is little utility in screening prior to initiation, due to the low incidence of breast cancer and uncertain value of CBE among women of reproductive age. Two fair quality studies demonstrated no differences between women who did or did not undergo pelvic examination prior to initiating OCs or DMPA with respect to risk factors or clinical outcomes. In addition, pelvic examination is not likely to detect any conditions for which hormonal contraceptives would be unsafe. Published by Elsevier Inc.

  3. 46 CFR 221.111 - Status of prior transactions-controlling dates.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Status of prior transactions-controlling dates. 221.111 Section 221.111 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REGULATIONS AFFECTING... MARITIME INTERESTS Savings Provisions § 221.111 Status of prior transactions—controlling dates. (a) The...

  4. On the use of a pruning prior for neural networks

    DEFF Research Database (Denmark)

    Goutte, Cyril

    1996-01-01

    We address the problem of using a regularization prior that prunes unnecessary weights in a neural network architecture. This prior provides a convenient alternative to traditional weight-decay. Two examples are studied to support this method and illustrate its use. First we use the sunspots...

  5. New Riemannian Priors on the Univariate Normal Model

    Directory of Open Access Journals (Sweden)

    Salem Said

    2014-07-01

    Full Text Available The current paper introduces new prior distributions on the univariate normal model, with the aim of applying them to the classification of univariate normal populations. These new prior distributions are entirely based on the Riemannian geometry of the univariate normal model, so that they can be thought of as “Riemannian priors”. Precisely, if {pθ ; θ ∈ Θ} is any parametrization of the univariate normal model, the paper considers prior distributions G( θ - , γ with hyperparameters θ - ∈ Θ and γ > 0, whose density with respect to Riemannian volume is proportional to exp(−d2(θ, θ - /2γ2, where d2(θ, θ - is the square of Rao’s Riemannian distance. The distributions G( θ - , γ are termed Gaussian distributions on the univariate normal model. The motivation for considering a distribution G( θ - , γ is that this distribution gives a geometric representation of a class or cluster of univariate normal populations. Indeed, G( θ - , γ has a unique mode θ - (precisely, θ - is the unique Riemannian center of mass of G( θ - , γ, as shown in the paper, and its dispersion away from θ - is given by γ.  Therefore, one thinks of members of the class represented by G( θ - , γ as being centered around θ - and  lying within a typical  distance determined by γ. The paper defines rigorously the Gaussian distributions G( θ - , γ and describes an algorithm for computing maximum likelihood estimates of their hyperparameters. Based on this algorithm and on the Laplace approximation, it describes how the distributions G( θ - , γ can be used as prior distributions for Bayesian classification of large univariate normal populations. In a concrete application to texture image classification, it is shown that  this  leads  to  an  improvement  in  performance  over  the  use  of  conjugate  priors.

  6. Prior indigenous technological species

    Science.gov (United States)

    Wright, Jason T.

    2018-01-01

    One of the primary open questions of astrobiology is whether there is extant or extinct life elsewhere the solar system. Implicit in much of this work is that we are looking for microbial or, at best, unintelligent life, even though technological artefacts might be much easier to find. Search for Extraterrestrial Intelligence (SETI) work on searches for alien artefacts in the solar system typically presumes that such artefacts would be of extrasolar origin, even though life is known to have existed in the solar system, on Earth, for eons. But if a prior technological, perhaps spacefaring, species ever arose in the solar system, it might have produced artefacts or other technosignatures that have survived to present day, meaning solar system artefact SETI provides a potential path to resolving astrobiology's question. Here, I discuss the origins and possible locations for technosignatures of such a prior indigenous technological species, which might have arisen on ancient Earth or another body, such as a pre-greenhouse Venus or a wet Mars. In the case of Venus, the arrival of its global greenhouse and potential resurfacing might have erased all evidence of its existence on the Venusian surface. In the case of Earth, erosion and, ultimately, plate tectonics may have erased most such evidence if the species lived Gyr ago. Remaining indigenous technosignatures might be expected to be extremely old, limiting the places they might still be found to beneath the surfaces of Mars and the Moon, or in the outer solar system.

  7. Prior information in structure estimation

    Czech Academy of Sciences Publication Activity Database

    Kárný, Miroslav; Nedoma, Petr; Khailova, Natalia; Pavelková, Lenka

    2003-01-01

    Roč. 150, č. 6 (2003), s. 643-653 ISSN 1350-2379 R&D Projects: GA AV ČR IBS1075102; GA AV ČR IBS1075351; GA ČR GA102/03/0049 Institutional research plan: CEZ:AV0Z1075907 Keywords : prior knowledge * structure estimation * autoregressive models Subject RIV: BC - Control Systems Theory Impact factor: 0.745, year: 2003 http://library.utia.cas.cz/separaty/historie/karny-0411258.pdf

  8. Assessment of Prior Learning in Adult Vocational Education and Training

    Directory of Open Access Journals (Sweden)

    Vibe Aarkrog

    2015-04-01

    Full Text Available The article deals about the results of a study of school-based Assessment of Prior Learning of adults who have enrolled as students in a VET college in order to qualify for occupations as skilled workers. Based on examples of VET teachers’ methods for assessing the students’ prior learning in the programs for gastronomes, respectively child care assistants the article discusses two issues in relation to Assessment of Prior Learing: the encounter of practical experience and school-based knowledge and the validity and reliability of the assessment procedures. Through focusing on the students’ knowing that and knowing why the assessment is based on a scholastic perception of the students’ needs for training, reflecting one of the most important challenges in Assessment of Prior Learning: how can practical experience be transformed into credits for the knowledge parts of the programs? The study shows that by combining several Assessment of Prior Learning methods and comparing the teachers’ assessments the teachers respond to the issues of validity and reliability. However, validity and reliability might be even further strengthened, if the competencies are well defined, if the education system is aware of securing a reasonable balance between knowing how, knowing that, and knowing why, and if the teachers are adequately trained for the assessment procedures.

  9. Validity in assessment of prior learning

    DEFF Research Database (Denmark)

    Wahlgren, Bjarne; Aarkrog, Vibe

    2015-01-01

    , the article discusses the need for specific criteria for assessment. The reliability and validity of the assessment procedures depend on whether the competences are well-defined, and whether the teachers are adequately trained for the assessment procedures. Keywords: assessment, prior learning, adult...... education, vocational training, lifelong learning, validity...

  10. Prior authorisation schemes: trade barriers in need of scientific justification

    NARCIS (Netherlands)

    Meulen, van der B.M.J.

    2010-01-01

    Case C-333/08 Commission v. French Republic ‘processing aids’ [2010] ECR-0000 French prior authorisation scheme for processing aids in food production infringes upon Article 34 TFEU** 1. A prior authorisation scheme not complying with the principle of proportionality, infringes upon Article 34 TFEU.

  11. [Lymphogranuloma venereum: the first Hungarian cases].

    Science.gov (United States)

    Bánvölgyi, András; Balla, Eszter; Bognár, Péter; Tóth, Béla; Ostorházi, Eszter; Bánhegyi, Dénes; Kárpáti, Sarolta; Marschalkó, Márta

    2015-01-04

    Lymphogranuloma venereum is a sexually transmitted infection caused by the Chlamydia trachomatis serovars L1-3. It has been found to be endemic in tropical countries. In the last decades several cases have been reported in Western Europe, particularly in men who have sex with men population infected with human immunodeficiency virus. The authors present three cases of lymphogranuloma venereum infections, observed at their department in 2013 and 2014. The three human immunodeficiency virus infected patients who belonged to men who have sex with men population had casual sexual contacts in Western Europe. The symptoms included urethral discharge, discomfort and inguinal lymphadenomegaly in two patients, and rectal pain, discharge and perianal ulceration in one patient. The diagnosis was confirmed by nucleic acid amplification test performed in samples obtained from urethral discharge and exudate of perianal ulcer; lymphogranuloma venereum 2b serovars were demonstrated in two patients and serovar 2 in one patient. Doxycyclin (daily dose of two times 100 mg for 21 days) resolved the symptoms in all cases. The authors conclude that lymphogranuloma venereum is a diagnostic challenge in Hungary, too. It is important to be aware of the altered clinical features of this disease to prevent complications and spreading.

  12. Generalized species sampling priors with latent Beta reinforcements

    Science.gov (United States)

    Airoldi, Edoardo M.; Costa, Thiago; Bassetti, Federico; Leisen, Fabrizio; Guindani, Michele

    2014-01-01

    Many popular Bayesian nonparametric priors can be characterized in terms of exchangeable species sampling sequences. However, in some applications, exchangeability may not be appropriate. We introduce a novel and probabilistically coherent family of non-exchangeable species sampling sequences characterized by a tractable predictive probability function with weights driven by a sequence of independent Beta random variables. We compare their theoretical clustering properties with those of the Dirichlet Process and the two parameters Poisson-Dirichlet process. The proposed construction provides a complete characterization of the joint process, differently from existing work. We then propose the use of such process as prior distribution in a hierarchical Bayes modeling framework, and we describe a Markov Chain Monte Carlo sampler for posterior inference. We evaluate the performance of the prior and the robustness of the resulting inference in a simulation study, providing a comparison with popular Dirichlet Processes mixtures and Hidden Markov Models. Finally, we develop an application to the detection of chromosomal aberrations in breast cancer by leveraging array CGH data. PMID:25870462

  13. Natural priors, CMSSM fits and LHC weather forecasts

    International Nuclear Information System (INIS)

    Allanach, Benjamin C.; Cranmer, Kyle; Lester, Christopher G.; Weber, Arne M.

    2007-01-01

    Previous LHC forecasts for the constrained minimal supersymmetric standard model (CMSSM), based on current astrophysical and laboratory measurements, have used priors that are flat in the parameter tan β, while being constrained to postdict the central experimental value of M Z . We construct a different, new and more natural prior with a measure in μ and B (the more fundamental MSSM parameters from which tan β and M Z are actually derived). We find that as a consequence this choice leads to a well defined fine-tuning measure in the parameter space. We investigate the effect of such on global CMSSM fits to indirect constraints, providing posterior probability distributions for Large Hadron Collider (LHC) sparticle production cross sections. The change in priors has a significant effect, strongly suppressing the pseudoscalar Higgs boson dark matter annihilation region, and diminishing the probable values of sparticle masses. We also show how to interpret fit information from a Markov Chain Monte Carlo in a frequentist fashion; namely by using the profile likelihood. Bayesian and frequentist interpretations of CMSSM fits are compared and contrasted

  14. Glucose intolerance develops prior to increased adiposity and accelerated cessation of estrous cyclicity in female growth-restricted rats

    Science.gov (United States)

    Intapad, Suttira; Dasinger, John Henry; Brown, Andrew D.; Fahling, Joel M.; Esters, Joyee; Alexander, Barbara T.

    2015-01-01

    Background The incidence of metabolic disease increases in early menopause. Low birth weight influences the age at menopause. Thus, this study tested the hypothesis that intrauterine growth restriction programs early reproductive aging and impaired glucose homeostasis in female rats. Methods Estrous cyclicity, body composition, and glucose homeostasis were determined in female control and growth-restricted rats at 6 and 12 months of age; sex steroids at 12 months. Results Glucose intolerance was present at 6 months of age prior to cessation of estrous cyclicity and increased adiposity in female growth-restricted rats. However, female growth-restricted rats exhibited persistent estrus and a significant increase in adiposity, fasting glucose and testosterone at 12 months of age (Pgrowth-restricted rats (Pgrowth programmed glucose intolerance that developed prior to early estrous acyclicity; yet, fasting glucose levels were elevated in conjunction with increased adiposity, accelerated cessation of estrous cyclicity and a shift towards testosterone excess at 12 months of age in female growth-restricted rats. PMID:26854801

  15. Neutrino masses and their ordering: global data, priors and models

    Science.gov (United States)

    Gariazzo, S.; Archidiacono, M.; de Salas, P. F.; Mena, O.; Ternes, C. A.; Tórtola, M.

    2018-03-01

    We present a full Bayesian analysis of the combination of current neutrino oscillation, neutrinoless double beta decay and Cosmic Microwave Background observations. Our major goal is to carefully investigate the possibility to single out one neutrino mass ordering, namely Normal Ordering or Inverted Ordering, with current data. Two possible parametrizations (three neutrino masses versus the lightest neutrino mass plus the two oscillation mass splittings) and priors (linear versus logarithmic) are exhaustively examined. We find that the preference for NO is only driven by neutrino oscillation data. Moreover, the values of the Bayes factor indicate that the evidence for NO is strong only when the scan is performed over the three neutrino masses with logarithmic priors; for every other combination of parameterization and prior, the preference for NO is only weak. As a by-product of our Bayesian analyses, we are able to (a) compare the Bayesian bounds on the neutrino mixing parameters to those obtained by means of frequentist approaches, finding a very good agreement; (b) determine that the lightest neutrino mass plus the two mass splittings parametrization, motivated by the physical observables, is strongly preferred over the three neutrino mass eigenstates scan and (c) find that logarithmic priors guarantee a weakly-to-moderately more efficient sampling of the parameter space. These results establish the optimal strategy to successfully explore the neutrino parameter space, based on the use of the oscillation mass splittings and a logarithmic prior on the lightest neutrino mass, when combining neutrino oscillation data with cosmology and neutrinoless double beta decay. We also show that the limits on the total neutrino mass ∑ mν can change dramatically when moving from one prior to the other. These results have profound implications for future studies on the neutrino mass ordering, as they crucially state the need for self-consistent analyses which explore the

  16. Prior Authorization of PMDs Demonstration - Status Update

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS implemented a Prior Authorization process for scooters and power wheelchairs for people with Fee-For-Service Medicare who reside in seven states with high...

  17. Short Report Biochemical derangements prior to emergency ...

    African Journals Online (AJOL)

    MMJ VOL 29 (1): March 2017. Biochemical derangements prior to emergency laparotomy at QECH 55. Malawi Medical Journal 29 (1): March 2017 ... Venepuncture was performed preoperatively for urgent cases, defined as those requiring.

  18. 29 CFR 553.23 - Agreement or understanding prior to performance of work.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Agreement or understanding prior to performance of work... understanding prior to performance of work. (a) General. (1) As a condition for use of compensatory time in lieu... reached prior to the performance of work. This can be accomplished pursuant to a collective bargaining...

  19. 7 CFR 4290.480 - Prior approval of changes to RBIC's business plan.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Prior approval of changes to RBIC's business plan... § 4290.480 Prior approval of changes to RBIC's business plan. Without the Secretary's prior written approval, no change in your business plan, upon which you were selected and licensed as a RBIC, may take...

  20. Feasibility of 3-T MRI for the evaluation of Crohn disease in children

    International Nuclear Information System (INIS)

    Dagia, Charuta; Ditchfield, Michael; Kean, Michael; Catto-Smith, Anthony

    2010-01-01

    Crohn disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract from the oral cavity to the anal canal. It occurs in all ages and is a significant cause for morbidity in children. Interest in MRI evaluation of CD has increased because of the concern regarding cumulative radiation dose from contrast fluoroscopic studies and CT. Several reports have demonstrated MRI to be a useful technique for CD. Most of these studies were performed at 1.5-T field strength. Imaging at a higher field strength, with a greater signal-to-noise ratio, has the potential of reducing scan times and increasing the resolution. However, there is a concurrent increase in artefacts, and these can be pronounced with abdominal imaging at 3 T. To determine the feasibility of 3-T MRI for CD in children and to assess the value of different sequences and the effect of artefacts that could potentially limit the role of bowel MR imaging at higher field strengths. A retrospective study of 46 children with biopsy-proven CD (ages 8-19 years, 53% boys) was performed. Sixty-eight consecutive MRI studies were performed on a 3-T scanner between 2005 and 2007; 42 of the abdomen (62%) and 26 of the pelvis/perineum (38%). Sorbitol was administered for the abdominal studies; orally for 36/42 (86%) studies and via a naso-jejunal (NJ) tube for 6/42 (14%) studies. For the abdomen, T2-W half-fourier acquisition single-shot turbo spin-echo (T2-W HASTE), true steady-state free precession (true FISP), pre-contrast and contrast-enhanced (CE) T1-volume interpolated gradient-echo (T1-W VIBE) and CE T1-W fast low-angle shot (T1-W FLASH) sequences were performed. For the perianal and pelvic assessment, fat-saturated T2-W turbo spin-echo (TSE), pre-contrast and CE T1-W FLASH or VIBE sequences were performed. The sequences were scored for diagnostic quality by two paediatric radiologists for visualisation of the bowel wall, whether normal or pathological and the visualization

  1. Drunkorexia: Calorie Restriction Prior to Alcohol Consumption among College Freshman

    Science.gov (United States)

    Burke, Sloane C.; Cremeens, Jennifer; Vail-Smith, Karen; Woolsey, Conrad

    2010-01-01

    Using a sample of 692 freshmen at a southeastern university, this study examined caloric restriction among students prior to planned alcohol consumption. Participants were surveyed for self-reported alcohol consumption, binge drinking, and caloric intake habits prior to drinking episodes. Results indicated that 99 of 695 (14%) of first year…

  2. Prior knowledge processing for initial state of Kalman filter

    Czech Academy of Sciences Publication Activity Database

    Suzdaleva, Evgenia

    2010-01-01

    Roč. 24, č. 3 (2010), s. 188-202 ISSN 0890-6327 R&D Projects: GA ČR(CZ) GP201/06/P434 Institutional research plan: CEZ:AV0Z10750506 Keywords : Kalman filtering * prior knowledge * state-space model * initial state distribution Subject RIV: BC - Control Systems Theory Impact factor: 0.729, year: 2010 http://library.utia.cas.cz/separaty/2009/AS/suzdaleva-prior knowledge processing for initial state of kalman filter.pdf

  3. Antecedent cardiovascular disease and autoimmunity in Philadelphia-negative chronic myeloproliferative neoplasms

    DEFF Research Database (Denmark)

    Sørensen, Anders Lindholm; Hasselbalch, Hans K

    2016-01-01

    leukemia (CLL) patients. Odds ratios (ORs) and p-values using Fischer's exact tests were calculated. The data was adjusted for confounding effects by logistic regression. Results: A significantly increased risk of MPNs compared to CLL was observed in subjects with a prior history of any autoimmune disease...... (OR = 1.86, 95%CI 1.16-2.98). A positive association between JAK2-V617F positive MPN and any autoimmune disease was observed at follow-up (OR = 2.62, 95% CI 1.21-5.67). A significantly increased risk of MPN compared to CLL was also observed in subjects with prior thromboembolic events (TE-events) (OR...... in the hematopoietic stem cell resulting in MPNs, or whether this association actually reflects a long-lasting pre-MPN-diagnosis phase, in which the MPN-disease per se contributes to a chronic inflammatory state and immune deregulation....

  4. Avoiding the known prior acts exclusion when insuring newly acquired entities.

    Science.gov (United States)

    Gasior, J P; Passannante, W G

    1998-09-01

    Adding a new entity to an organization's existing insurance program can be problematic if the existing policy contains a known prior acts exclusion clause. By purportedly excluding claims that a policyholder "could have reasonably foreseen or discovered," the known prior acts exclusion allows the insurer to reject those claims after a lawsuit has been filed policyholders should have known prior acts exclusion clauses removed from their policies or work with their insurers on language that will clarify the policy regarding this exclusion.

  5. Apples and oranges: avoiding different priors in Bayesian DNA sequence analysis

    Directory of Open Access Journals (Sweden)

    Posch Stefan

    2010-03-01

    Full Text Available Abstract Background One of the challenges of bioinformatics remains the recognition of short signal sequences in genomic DNA such as donor or acceptor splice sites, splicing enhancers or silencers, translation initiation sites, transcription start sites, transcription factor binding sites, nucleosome binding sites, miRNA binding sites, or insulator binding sites. During the last decade, a wealth of algorithms for the recognition of such DNA sequences has been developed and compared with the goal of improving their performance and to deepen our understanding of the underlying cellular processes. Most of these algorithms are based on statistical models belonging to the family of Markov random fields such as position weight matrix models, weight array matrix models, Markov models of higher order, or moral Bayesian networks. While in many comparative studies different learning principles or different statistical models have been compared, the influence of choosing different prior distributions for the model parameters when using different learning principles has been overlooked, and possibly lead to questionable conclusions. Results With the goal of allowing direct comparisons of different learning principles for models from the family of Markov random fields based on the same a-priori information, we derive a generalization of the commonly-used product-Dirichlet prior. We find that the derived prior behaves like a Gaussian prior close to the maximum and like a Laplace prior in the far tails. In two case studies, we illustrate the utility of the derived prior for a direct comparison of different learning principles with different models for the recognition of binding sites of the transcription factor Sp1 and human donor splice sites. Conclusions We find that comparisons of different learning principles using the same a-priori information can lead to conclusions different from those of previous studies in which the effect resulting from different

  6. Requirements of exercise myocardial scintigraphy (EMS) using Tl-201 prior and subsequent to coronary revascularisation, based on the example of transluminal angioplasty

    International Nuclear Information System (INIS)

    Maul, F.D.; Hoer, G.; Standke, R.; Kober, G.; Klepzig, H. Jr.; Doerr, G.; Baum, R.P.; Happ, J.; Kaltenbach, M.; Frankfurt Univ.

    1985-01-01

    Quantitative exercise myocardial scintigraphy (EMS) using Thallium-201 in planar technique was applied in 128 patients prior and subsequent to transluminal coronary angioplasty. The overall sensitivity was 92%, and 88% for multivessel disease. In contrast to previous reports, the sensitivity for lesions of the posterior wall proved not inferior to that for lesions of the anterior wall: RCA-stenoses 92%; LCX-stenoses 100% and RIA-stenoses 93%. The specificity was found to be 88%, and the accuracy 92%. Myocardial ischaemia, as detected by EMS and ex. ECG, amounted to 84% and 72%, respectively in single vessel disease. The degree of ischaemia, which was measured semiquantitatively in terms of score, paralleled that of stenosis. The accuracy for localisation of anterior or posterior wall lesions was 92%. In unsuccessfully treated patients the results were completely reproducible (100%) both in terms of the decision 'CAD yes or no', and regarding the localisation of a myocardial lesion. The reproducibility for detection of myocardial ischaemia was 82%. Conclusion: In comparison with SPECT the quantitative planar EMS procedure using Tl-201 is the method of choice for the detection and assessment of ischaemia prior and subsequent to revascularisation therapy. (orig.) [de

  7. Living with advanced Parkinson's disease: a constant struggle with unpredictability.

    Science.gov (United States)

    Haahr, Anita; Kirkevold, Marit; Hall, Elisabeth O C; Ostergaard, Karen

    2011-02-01

    This paper is a report of an exploration of patients' lifeworld and way of managing life with advanced Parkinson's disease prior to Deep Brain Stimulation and what they expect from life following this treatment. Parkinson's disease is a progressive neurodegenerative disease, which is initially well-treated with L-dopa. Living with Parkinson's disease means living with the experience of continuous loss of independence and self-esteem and unpredictable ON/OFF phenomena. Thus, in the advanced stage of the disease, treatment with Deep Brain Stimulation may become relevant. Eleven patients eligible for Deep Brain Stimulation were interviewed prior to treatment. Data were collected in 2007 and analysed according to the hermeneutic phenomenological methodology of van Manen, using the four existentials as analytic tools. Living with advanced Parkinson's disease can be described as the experience of living with and managing unpredictability. The disease gradually took over, and participants had to struggle with unpredictability on a daily basis. Themes in relation to this were: The body - setting the agenda, Always a struggle to be on time, Living in dependence and compromise - being a burden, and Living with restrained space and changes in social life. Parkinson's disease leads to profound bodily restrictions. Living with an unpredictable body affects all aspects of life, and nurses need to be aware of the impact the disease has on the entire lifeworld, and how this may affect the way treatment is perceived. © 2010 Blackwell Publishing Ltd.

  8. Evil radioactivity. Subjective perception of radioactivity in patients with thyroid disease prior to treatment with radioiodine

    International Nuclear Information System (INIS)

    Freudenberg, L.S.; Beyer, T.; Mueller, S.P.; Goerges, R.; Bockisch, A.

    2006-01-01

    Aim: We assess the perspective of patients with thyroid disease towards radiation and radioactivity by means of a cultural-anthropological approach based on qualitative measures and quantitative scores. From the interviews with the patients we evaluate as to how much radioactivity is accepted as an abstract term or as a benefit within the medical context. Patients, methods: 68 patients with autonomously functioning thyroid lesions (35 women, 33 men, 32-81 years) were included in this study. All patients were interviewed in an open dialogue with the principal investigator. Patients were asked to describe their attitude towards radioactivity in general and towards radioiodine therapy in particular. Patients were asked to use a scoring system (1=positive, 5=negative) to quantify their attitudes. Results: The responses of all patients towards radioactivity in general were heterogeneous with most responses reflecting a negative perception. Many patients expressed their associated fears about atomic energy, malignant diseases and radioactive contamination. The scoring system reflected a mostly negative opinion base. However, patients became more positive once they assumed an immediate benefit of radioactivity for the treatment of their own disease (p=0.01). Conclusions: Knowing about significant differences in patient's perception about radioactivity in general or in the clinical context may help to optimise and tailor the initial, pre-therapeutical interview towards the patient. (orig.)

  9. Evil radioactivity. Subjective perception of radioactivity in patients with thyroid disease prior to treatment with radioiodine

    Energy Technology Data Exchange (ETDEWEB)

    Freudenberg, L.S. [Universitaetsklinikum Essen (Germany). Klinik fuer Nuklearmedizin; Radiologisch-Nuklearmedizinische Gemeinschaftspraxis, Grevenbroich (Germany); Beyer, T.; Mueller, S.P.; Goerges, R.; Bockisch, A. [Universitaetsklinikum Essen (Germany). Klinik fuer Nuklearmedizin; Hopfenbach, A. [Radiologisch-Nuklearmedizinische Gemeinschaftspraxis, Grevenbroich (Germany)

    2006-07-01

    Aim: We assess the perspective of patients with thyroid disease towards radiation and radioactivity by means of a cultural-anthropological approach based on qualitative measures and quantitative scores. From the interviews with the patients we evaluate as to how much radioactivity is accepted as an abstract term or as a benefit within the medical context. Patients, methods: 68 patients with autonomously functioning thyroid lesions (35 women, 33 men, 32-81 years) were included in this study. All patients were interviewed in an open dialogue with the principal investigator. Patients were asked to describe their attitude towards radioactivity in general and towards radioiodine therapy in particular. Patients were asked to use a scoring system (1=positive, 5=negative) to quantify their attitudes. Results: The responses of all patients towards radioactivity in general were heterogeneous with most responses reflecting a negative perception. Many patients expressed their associated fears about atomic energy, malignant diseases and radioactive contamination. The scoring system reflected a mostly negative opinion base. However, patients became more positive once they assumed an immediate benefit of radioactivity for the treatment of their own disease (p=0.01). Conclusions: Knowing about significant differences in patient's perception about radioactivity in general or in the clinical context may help to optimise and tailor the initial, pre-therapeutical interview towards the patient. (orig.)

  10. Disease introduction is associated with a phase transition in bighorn sheep demographics

    Science.gov (United States)

    Manlove, Kezia; Cassirer, E. Frances; Cross, Paul C.; Plowright, Raina K.; Hudson, Peter J.

    2016-01-01

    Ecological theory suggests that pathogens are capable of regulating or limiting host population dynamics, and this relationship has been empirically established in several settings. However, although studies of childhood diseases were integral to the development of disease ecology, few studies show population limitation by a disease affecting juveniles. Here, we present empirical evidence that disease in lambs constrains population growth in bighorn sheep (Ovis canadensis) based on 45 years of population-level and 18 years of individual-level monitoring across 12 populations. While populations generally increased (λ = 1.11) prior to disease introduction, most of these same populations experienced an abrupt change in trajectory at the time of disease invasion, usually followed by stagnant-to-declining growth rates (λ = 0.98) over the next 20 years. Disease-induced juvenile mortality imposed strong constraints on population growth that were not observed prior to disease introduction, even as adult survival returned to pre-invasion levels. Simulations suggested that models including persistent disease-induced mortality in juveniles qualitatively matched observed population trajectories, whereas models that only incorporated all-age disease events did not. We use these results to argue that pathogen persistence may pose a lasting, but under-recognized, threat to host populations, particularly in cases where clinical disease manifests primarily in juveniles.

  11. Satellite Infrared Radiation Measurements Prior to the Major Earthquakes

    Science.gov (United States)

    Ouzounov, Dimitar; Pulintes, S.; Bryant, N.; Taylor, Patrick; Freund, F.

    2005-01-01

    This work describes our search for a relationship between tectonic stresses and increases in mid-infrared (IR) flux as part of a possible ensemble of electromagnetic (EM) phenomena that may be related to earthquake activity. We present and &scuss observed variations in thermal transients and radiation fields prior to the earthquakes of Jan 22, 2003 Colima (M6.7) Mexico, Sept. 28 .2004 near Parkfield (M6.0) in California and Northern Sumatra (M8.5) Dec. 26,2004. Previous analysis of earthquake events has indicated the presence of an IR anomaly, where temperatures increased or did not return to its usual nighttime value. Our procedures analyze nighttime satellite data that records the general condtion of the ground after sunset. We have found from the MODIS instrument data that five days before the Colima earthquake the IR land surface nighttime temperature rose up to +4 degrees C in a 100 km radius around the epicenter. The IR transient field recorded by MODIS in the vicinity of Parkfield, also with a cloud free environment, was around +1 degree C and is significantly smaller than the IR anomaly around the Colima epicenter. Ground surface temperatures near the Parkfield epicenter four days prior to the earthquake show steady increase. However, on the night preceding the quake, a significant drop in relative humidity was indicated, process similar to those register prior to the Colima event. Recent analyses of continuous ongoing long- wavelength Earth radiation (OLR) indicate significant and anomalous variability prior to some earthquakes. The cause of these anomalies is not well understood but could be the result of a triggering by an interaction between the lithosphere-hydrosphere and atmospheric related to changes in the near surface electrical field and/or gas composition prior to the earthquake. The OLR anomaly usually covers large areas surrounding the main epicenter. We have found strong anomalies signal (two sigma) along the epicentral area signals on Dec 21

  12. Preparing learners with partly incorrect intuitive prior knowledge for learning

    Directory of Open Access Journals (Sweden)

    Andrea eOhst

    2014-07-01

    Full Text Available Learners sometimes have incoherent and fragmented intuitive prior knowledge that is (partly ‘incompatible’ with the to-be-learned contents. Such knowledge in pieces can cause conceptual disorientation and cognitive overload while learning. We hypothesized that a pre-training intervention providing a generalized schema as a structuring framework for such knowledge in pieces would support (reorganizing-processes of prior knowledge and thus reduce unnecessary cognitive load during subsequent learning. Fifty-six student teachers participated in the experiment. A framework group underwent a pre-training intervention providing a generalized, categorical schema for categorizing primary learning strategies and related but different strategies as a cognitive framework for (re-organizing their prior knowledge. Our control group received comparable factual information but no framework. Afterwards, all participants learned about primary learning strategies. The framework group claimed to possess higher levels of interest and self-efficacy, achieved higher learning outcomes, and learned more efficiently. Hence, providing a categorical framework can help overcome the barrier of incorrect prior knowledge in pieces.

  13. Preparing learners with partly incorrect intuitive prior knowledge for learning

    Science.gov (United States)

    Ohst, Andrea; Fondu, Béatrice M. E.; Glogger, Inga; Nückles, Matthias; Renkl, Alexander

    2014-01-01

    Learners sometimes have incoherent and fragmented intuitive prior knowledge that is (partly) “incompatible” with the to-be-learned contents. Such knowledge in pieces can cause conceptual disorientation and cognitive overload while learning. We hypothesized that a pre-training intervention providing a generalized schema as a structuring framework for such knowledge in pieces would support (re)organizing-processes of prior knowledge and thus reduce unnecessary cognitive load during subsequent learning. Fifty-six student teachers participated in the experiment. A framework group underwent a pre-training intervention providing a generalized, categorical schema for categorizing primary learning strategies and related but different strategies as a cognitive framework for (re-)organizing their prior knowledge. Our control group received comparable factual information but no framework. Afterwards, all participants learned about primary learning strategies. The framework group claimed to possess higher levels of interest and self-efficacy, achieved higher learning outcomes, and learned more efficiently. Hence, providing a categorical framework can help overcome the barrier of incorrect prior knowledge in pieces. PMID:25071638

  14. Prior contralateral amputation predicts worse outcomes for lower extremity bypasses performed in the intact limb.

    Science.gov (United States)

    Baril, Donald T; Goodney, Philip P; Robinson, William P; Nolan, Brian W; Stone, David H; Li, YouFu; Cronenwett, Jack L; Schanzer, Andres

    2012-08-01

    graft occlusion (38% vs 17%; P < .0001) and major amputation (16% vs 7%; P < .0001) at 1 year, there was not a significant difference in mortality (16% vs 10%; P = .160). On multivariable analysis, prior contralateral amputation was an independent predictor of both major amputation (odds ratio, 1.73; confidence interval, 1.06-2.83; P = .027) and graft occlusion (odds ratio, 1.93; confidence interval, 1.39-2.68; P < .0001) at 1 year. Patients with prior contralateral amputations who present with CLI in the intact limb represent a high-risk population, even among patients with advanced peripheral arterial disease. When considering LEB in this setting, both physicians and patients should expect increased rates of perioperative adverse events, increased rates of 1-year graft occlusion, and decreased rates of limb salvage, when compared with patients who have not undergone a contralateral amputation. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  15. 29 CFR 452.40 - Prior office holding.

    Science.gov (United States)

    2010-07-01

    ... DISCLOSURE ACT OF 1959 Candidacy for Office; Reasonable Qualifications § 452.40 Prior office holding. A.... 26 26 Wirtz v. Hotel, Motel and Club Employees Union, Local 6, 391 U.S. 492 at 504. The Court stated...

  16. An Adaptively Accelerated Bayesian Deblurring Method with Entropy Prior

    Directory of Open Access Journals (Sweden)

    Yong-Hoon Kim

    2008-05-01

    Full Text Available The development of an efficient adaptively accelerated iterative deblurring algorithm based on Bayesian statistical concept has been reported. Entropy of an image has been used as a “prior” distribution and instead of additive form, used in conventional acceleration methods an exponent form of relaxation constant has been used for acceleration. Thus the proposed method is called hereafter as adaptively accelerated maximum a posteriori with entropy prior (AAMAPE. Based on empirical observations in different experiments, the exponent is computed adaptively using first-order derivatives of the deblurred image from previous two iterations. This exponent improves speed of the AAMAPE method in early stages and ensures stability at later stages of iteration. In AAMAPE method, we also consider the constraint of the nonnegativity and flux conservation. The paper discusses the fundamental idea of the Bayesian image deblurring with the use of entropy as prior, and the analytical analysis of superresolution and the noise amplification characteristics of the proposed method. The experimental results show that the proposed AAMAPE method gives lower RMSE and higher SNR in 44% lesser iterations as compared to nonaccelerated maximum a posteriori with entropy prior (MAPE method. Moreover, AAMAPE followed by wavelet wiener filtering gives better result than the state-of-the-art methods.

  17. ASPECTOS RELEVANTES DE LA ENTEROBIOSIS HUMANA. REVISIÓN CRÍTICA I RELEVANT ASPECTS OF HUMAN ENTEROBIOSIS. A CRITICAL REVIEW

    Directory of Open Access Journals (Sweden)

    Dalmiro Cazorla-Perfetti

    2018-04-01

    Full Text Available Enterobiosis is a human intestinal parasitic disease caused by the nematode worm Enterobius vermicularis . At night, gravid female pinworms migrate from large intestine to perianal/perineal areas where they lay eggs. Pinworm infection has a cosmopolitan distribution and is more prevalent among children, potentially causing adverse effects on their behavior, school success and nutritional condition. We consider that enterobiosis is one of the most underestimated entero-parasitic infection in humans. The present study makes a critical review of several important aspects about enterobiosis, including biology and taxonmy of E. vermicularis , diagnostic tools, pathologic effects, epidemiology and tretament.

  18. Modeling and validating Bayesian accrual models on clinical data and simulations using adaptive priors.

    Science.gov (United States)

    Jiang, Yu; Simon, Steve; Mayo, Matthew S; Gajewski, Byron J

    2015-02-20

    Slow recruitment in clinical trials leads to increased costs and resource utilization, which includes both the clinic staff and patient volunteers. Careful planning and monitoring of the accrual process can prevent the unnecessary loss of these resources. We propose two hierarchical extensions to the existing Bayesian constant accrual model: the accelerated prior and the hedging prior. The new proposed priors are able to adaptively utilize the researcher's previous experience and current accrual data to produce the estimation of trial completion time. The performance of these models, including prediction precision, coverage probability, and correct decision-making ability, is evaluated using actual studies from our cancer center and simulation. The results showed that a constant accrual model with strongly informative priors is very accurate when accrual is on target or slightly off, producing smaller mean squared error, high percentage of coverage, and a high number of correct decisions as to whether or not continue the trial, but it is strongly biased when off target. Flat or weakly informative priors provide protection against an off target prior but are less efficient when the accrual is on target. The accelerated prior performs similar to a strong prior. The hedging prior performs much like the weak priors when the accrual is extremely off target but closer to the strong priors when the accrual is on target or only slightly off target. We suggest improvements in these models and propose new models for future research. Copyright © 2014 John Wiley & Sons, Ltd.

  19. Bridging the Gap between Research and Clinical Practice in Asymptomatic Alzheimer's Disease.

    Science.gov (United States)

    Downing, A M; Yaari, R; Ball, D E; Selzler, K J; Devous, M D

    2016-01-01

    Due to the growing global health impact of Alzheimer's disease (AD), there is a greater need for interventions that prevent or delay the onset of clinical symptoms of this debilitating disease. Clinical trials for disease-modifying compounds in AD have shifted towards earlier stages in the spectrum of illness, including the stage prior to cognitive symptoms. A population of specific interest for clinical research includes individuals with evidence of Alzheimer's disease pathology who are asymptomatic (ADPa). The challenges and barriers regarding medical treatment of ADPa must be identified and addressed prior to the completion of a positive clinical trial in order to accelerate the translation of research findings to clinical practice. This report applies an existing public health impact model from Spencer and colleagues (2013) to evaluate the readiness of the clinical practice environment to treat ADPa individuals if a disease-modifying agent achieves approval. We contrast the current clinical practice environment with a potential future state through investigating the effectiveness, reach, feasibility, sustainability, and transferability of the practice of treating ADPa individuals.

  20. Associations between DSM-IV mental disorders and subsequent heart disease onset : Beyond depression

    NARCIS (Netherlands)

    Scott, Kate M.; de Jonge, Peter; Alonso, Jordi; Viana, Maria Carmen; Liu, Zhaorui; O'Neill, Siobhan; Aguilar-Gaxiola, Sergio; Bruffaerts, Ronny; Caldas-de-Almeida, Jose Miguel; Stein, Dan J.; de Girolamo, Giovanni; Florescu, Silvia E.; Hu, Chiyi; Taib, Nezar Ismet; Lepine, Jean-Pierre; Levinson, Daphna; Matschinger, Herbert; Elena Medina-Mora, Maria; Piazza, Marina; Posada-Villa, Jose A.; Uda, Hidenori; Wojtyniak, Bogdan J.; Lim, Carmen C. W.; Kessler, Ronald C.

    2013-01-01

    Background: Prior studies on the depression-heart disease association have not usually used diagnosticmeasures of depression, or taken other mental disorders into consideration. As a result, it is not clear whether the association between depression and heart disease onset reflects a specific

  1. Effects of prior information on decoding degraded speech: an fMRI study.

    Science.gov (United States)

    Clos, Mareike; Langner, Robert; Meyer, Martin; Oechslin, Mathias S; Zilles, Karl; Eickhoff, Simon B

    2014-01-01

    Expectations and prior knowledge are thought to support the perceptual analysis of incoming sensory stimuli, as proposed by the predictive-coding framework. The current fMRI study investigated the effect of prior information on brain activity during the decoding of degraded speech stimuli. When prior information enabled the comprehension of the degraded sentences, the left middle temporal gyrus and the left angular gyrus were activated, highlighting a role of these areas in meaning extraction. In contrast, the activation of the left inferior frontal gyrus (area 44/45) appeared to reflect the search for meaningful information in degraded speech material that could not be decoded because of mismatches with the prior information. Our results show that degraded sentences evoke instantaneously different percepts and activation patterns depending on the type of prior information, in line with prediction-based accounts of perception. Copyright © 2012 Wiley Periodicals, Inc.

  2. Bacillus Calmette-Guérin (BCG) Treatment Failures with Non-Muscle Invasive Bladder Cancer: A Data-Driven Definition for BCG Unresponsive Disease.

    Science.gov (United States)

    Steinberg, Ryan L; Thomas, Lewis J; Mott, Sarah L; O'Donnell, Michael A

    2016-04-27

    Objective: To create the first data-driven definition for those unlikely to benefit from further BCG treatment. Materials and Methods: The database created for the Phase 2 BCG-Interferon- α 2B (IFN) study was queried and BCG failure patients were identified ( n  = 334). Full study protocols have previously been published. Separate models were constructed for analysis of patients with any CIS (pure or concomitant) and pure papillary disease. Variables considered included age, gender, stage, grade, tumor size and focality (for papillary only), number of prior BCG courses, and prior BCG failure interval. Results: Patients with recurrent CIS within 6 months of their most recent prior BCG course (HR 2.56, p  disease within 6 months (HR 1.82, p  = 0.02), ≥2 BCG failures (HR 1.54, p  = 0.03), and multifocal disease (HR 2.05, p  disease remained disease free in 38% of cases (24-51% 95% CI) at 2 years with low rates of progression. Conclusions: Patients who fail two courses of BCG with either persistent or recurrent multifocal papillary disease within 6 months or CIS within 12 months of their prior BCG should be considered BCG unresponsive. Recurrent T1 disease respond reasonably well to another course with low progression rates but further investigation is warranted.

  3. Prior entanglement between senders enables perfect quantum network coding with modification

    International Nuclear Information System (INIS)

    Hayashi, Masahito

    2007-01-01

    We find a protocol transmitting two quantum states crossly in the butterfly network only with prior entanglement between two senders. This protocol requires only one qubit transmission or two classical bits (cbits) transmission in each channel in the butterfly network. It is also proved that it is impossible without prior entanglement. More precisely, an upper bound of average fidelity is given in the butterfly network when prior entanglement is not allowed. The presented result concerns only the butterfly network, but our techniques can be applied to a more general graph

  4. Forecasting economy with Bayesian autoregressive distributed lag model: choosing optimal prior in economic downturn

    OpenAIRE

    Bušs, Ginters

    2009-01-01

    Bayesian inference requires an analyst to set priors. Setting the right prior is crucial for precise forecasts. This paper analyzes how optimal prior changes when an economy is hit by a recession. For this task, an autoregressive distributed lag (ADL) model is chosen. The results show that a sharp economic slowdown changes the optimal prior in two directions. First, it changes the structure of the optimal weight prior, setting smaller weight on the lagged dependent variable compared to varia...

  5. A Bayesian hierarchical model with novel prior specifications for estimating HIV testing rates.

    Science.gov (United States)

    An, Qian; Kang, Jian; Song, Ruiguang; Hall, H Irene

    2016-04-30

    Human immunodeficiency virus (HIV) infection is a severe infectious disease actively spreading globally, and acquired immunodeficiency syndrome (AIDS) is an advanced stage of HIV infection. The HIV testing rate, that is, the probability that an AIDS-free HIV infected person seeks a test for HIV during a particular time interval, given no previous positive test has been obtained prior to the start of the time, is an important parameter for public health. In this paper, we propose a Bayesian hierarchical model with two levels of hierarchy to estimate the HIV testing rate using annual AIDS and AIDS-free HIV diagnoses data. At level one, we model the latent number of HIV infections for each year using a Poisson distribution with the intensity parameter representing the HIV incidence rate. At level two, the annual numbers of AIDS and AIDS-free HIV diagnosed cases and all undiagnosed cases stratified by the HIV infections at different years are modeled using a multinomial distribution with parameters including the HIV testing rate. We propose a new class of priors for the HIV incidence rate and HIV testing rate taking into account the temporal dependence of these parameters to improve the estimation accuracy. We develop an efficient posterior computation algorithm based on the adaptive rejection metropolis sampling technique. We demonstrate our model using simulation studies and the analysis of the national HIV surveillance data in the USA. Copyright © 2015 John Wiley & Sons, Ltd.

  6. Prior exercise and antioxidant supplementation: effect on oxidative stress and muscle injury

    Directory of Open Access Journals (Sweden)

    Schilling Brian K

    2007-10-01

    Full Text Available Abstract Background Both acute bouts of prior exercise (preconditioning and antioxidant nutrients have been used in an attempt to attenuate muscle injury or oxidative stress in response to resistance exercise. However, most studies have focused on untrained participants rather than on athletes. The purpose of this work was to determine the independent and combined effects of antioxidant supplementation (vitamin C + mixed tocopherols/tocotrienols and prior eccentric exercise in attenuating markers of skeletal muscle injury and oxidative stress in resistance trained men. Methods Thirty-six men were randomly assigned to: no prior exercise + placebo; no prior exercise + antioxidant; prior exercise + placebo; prior exercise + antioxidant. Markers of muscle/cell injury (muscle performance, muscle soreness, C-reactive protein, and creatine kinase activity, as well as oxidative stress (blood protein carbonyls and peroxides, were measured before and through 48 hours of exercise recovery. Results No group by time interactions were noted for any variable (P > 0.05. Time main effects were noted for creatine kinase activity, muscle soreness, maximal isometric force and peak velocity (P Conclusion There appears to be no independent or combined effect of a prior bout of eccentric exercise or antioxidant supplementation as used here on markers of muscle injury in resistance trained men. Moreover, eccentric exercise as used in the present study results in minimal blood oxidative stress in resistance trained men. Hence, antioxidant supplementation for the purpose of minimizing blood oxidative stress in relation to eccentric exercise appears unnecessary in this population.

  7. Statistical Learning Is Not Affected by a Prior Bout of Physical Exercise.

    Science.gov (United States)

    Stevens, David J; Arciuli, Joanne; Anderson, David I

    2016-05-01

    This study examined the effect of a prior bout of exercise on implicit cognition. Specifically, we examined whether a prior bout of moderate intensity exercise affected performance on a statistical learning task in healthy adults. A total of 42 participants were allocated to one of three conditions-a control group, a group that exercised for 15 min prior to the statistical learning task, and a group that exercised for 30 min prior to the statistical learning task. The participants in the exercise groups cycled at 60% of their respective V˙O2 max. Each group demonstrated significant statistical learning, with similar levels of learning among the three groups. Contrary to previous research that has shown that a prior bout of exercise can affect performance on explicit cognitive tasks, the results of the current study suggest that the physiological stress induced by moderate-intensity exercise does not affect implicit cognition as measured by statistical learning. Copyright © 2015 Cognitive Science Society, Inc.

  8. The role of the amygdala during emotional processing in Huntington's disease: from pre-manifest to late stage disease.

    Science.gov (United States)

    Mason, Sarah L; Zhang, Jiaxiang; Begeti, Faye; Guzman, Natalie Valle; Lazar, Alpar S; Rowe, James B; Barker, Roger A; Hampshire, Adam

    2015-04-01

    Deficits in emotional processing can be detected in the pre-manifest stage of Huntington's disease and negative emotion recognition has been identified as a predictor of clinical diagnosis. The underlying neuropathological correlates of such deficits are typically established using correlative structural MRI studies. This approach does not take into consideration the impact of disruption to the complex interactions between multiple brain circuits on emotional processing. Therefore, exploration of the neural substrates of emotional processing in pre-manifest HD using fMRI connectivity analysis may be a useful way of evaluating the way brain regions interrelate in the period prior to diagnosis. We investigated the impact of predicted time to disease onset on brain activation when participants were exposed to pictures of faces with angry and neutral expressions, in 20 pre-manifest HD gene carriers and 23 healthy controls. On the basis of the results of this initial study went on to look at amygdala dependent cognitive performance in 79 Huntington's disease patients from a cross-section of disease stages (pre-manifest to late disease) and 26 healthy controls, using a validated theory of mind task: "the Reading the Mind in the Eyes Test" which has been previously been shown to be amygdala dependent. Psychophysiological interaction analysis identified reduced connectivity between the left amygdala and right fusiform facial area in pre-manifest HD gene carriers compared to controls when viewing angry compared to neutral faces. Change in PPI connectivity scores correlated with predicted time to disease onset (r=0.45, pneural networks underlying social cognition and emotional processing can be detected prior to clinical diagnosis in Huntington's disease. Connectivity between the amygdala and other brain regions is impacted by the disease process in pre-manifest HD and may therefore be a useful way of identifying participants who are approaching a clinical diagnosis

  9. Incorporating prior knowledge induced from stochastic differential equations in the classification of stochastic observations.

    Science.gov (United States)

    Zollanvari, Amin; Dougherty, Edward R

    2016-12-01

    In classification, prior knowledge is incorporated in a Bayesian framework by assuming that the feature-label distribution belongs to an uncertainty class of feature-label distributions governed by a prior distribution. A posterior distribution is then derived from the prior and the sample data. An optimal Bayesian classifier (OBC) minimizes the expected misclassification error relative to the posterior distribution. From an application perspective, prior construction is critical. The prior distribution is formed by mapping a set of mathematical relations among the features and labels, the prior knowledge, into a distribution governing the probability mass across the uncertainty class. In this paper, we consider prior knowledge in the form of stochastic differential equations (SDEs). We consider a vector SDE in integral form involving a drift vector and dispersion matrix. Having constructed the prior, we develop the optimal Bayesian classifier between two models and examine, via synthetic experiments, the effects of uncertainty in the drift vector and dispersion matrix. We apply the theory to a set of SDEs for the purpose of differentiating the evolutionary history between two species.

  10. 30 CFR 77.1712 - Reopening mines; notification; inspection prior to mining.

    Science.gov (United States)

    2010-07-01

    ... to mining. 77.1712 Section 77.1712 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... prior to mining. Prior to reopening any surface coal mine after it has been abandoned or declared... an authorized representative of the Secretary before any mining operations in such mine are...

  11. Prior Visual Experience Modulates Learning of Sound Localization Among Blind Individuals.

    Science.gov (United States)

    Tao, Qian; Chan, Chetwyn C H; Luo, Yue-Jia; Li, Jian-Jun; Ting, Kin-Hung; Lu, Zhong-Lin; Whitfield-Gabrieli, Susan; Wang, Jun; Lee, Tatia M C

    2017-05-01

    Cross-modal learning requires the use of information from different sensory modalities. This study investigated how the prior visual experience of late blind individuals could modulate neural processes associated with learning of sound localization. Learning was realized by standardized training on sound localization processing, and experience was investigated by comparing brain activations elicited from a sound localization task in individuals with (late blind, LB) and without (early blind, EB) prior visual experience. After the training, EB showed decreased activation in the precuneus, which was functionally connected to a limbic-multisensory network. In contrast, LB showed the increased activation of the precuneus. A subgroup of LB participants who demonstrated higher visuospatial working memory capabilities (LB-HVM) exhibited an enhanced precuneus-lingual gyrus network. This differential connectivity suggests that visuospatial working memory due to the prior visual experience gained via LB-HVM enhanced learning of sound localization. Active visuospatial navigation processes could have occurred in LB-HVM compared to the retrieval of previously bound information from long-term memory for EB. The precuneus appears to play a crucial role in learning of sound localization, disregarding prior visual experience. Prior visual experience, however, could enhance cross-modal learning by extending binding to the integration of unprocessed information, mediated by the cognitive functions that these experiences develop.

  12. Prior image constrained image reconstruction in emerging computed tomography applications

    Science.gov (United States)

    Brunner, Stephen T.

    Advances have been made in computed tomography (CT), especially in the past five years, by incorporating prior images into the image reconstruction process. In this dissertation, we investigate prior image constrained image reconstruction in three emerging CT applications: dual-energy CT, multi-energy photon-counting CT, and cone-beam CT in image-guided radiation therapy. First, we investigate the application of Prior Image Constrained Compressed Sensing (PICCS) in dual-energy CT, which has been called "one of the hottest research areas in CT." Phantom and animal studies are conducted using a state-of-the-art 64-slice GE Discovery 750 HD CT scanner to investigate the extent to which PICCS can enable radiation dose reduction in material density and virtual monochromatic imaging. Second, we extend the application of PICCS from dual-energy CT to multi-energy photon-counting CT, which has been called "one of the 12 topics in CT to be critical in the next decade." Numerical simulations are conducted to generate multiple energy bin images for a photon-counting CT acquisition and to investigate the extent to which PICCS can enable radiation dose efficiency improvement. Third, we investigate the performance of a newly proposed prior image constrained scatter correction technique to correct scatter-induced shading artifacts in cone-beam CT, which, when used in image-guided radiation therapy procedures, can assist in patient localization, and potentially, dose verification and adaptive radiation therapy. Phantom studies are conducted using a Varian 2100 EX system with an on-board imager to investigate the extent to which the prior image constrained scatter correction technique can mitigate scatter-induced shading artifacts in cone-beam CT. Results show that these prior image constrained image reconstruction techniques can reduce radiation dose in dual-energy CT by 50% in phantom and animal studies in material density and virtual monochromatic imaging, can lead to radiation

  13. [Psychiatric disorders in patients with Cushing's disease before and after neurosurgery].

    Science.gov (United States)

    Gnjidiae, Zivko; Karloviae, Dalibor; Buljan, Danijel; Malencia, Masa; Kovak-Mufiae, Ana; Kostanjsak, Lidija

    2011-01-01

    Cushing's disease which is a consequence of ACTH-secreting pituitary adenoma leads to hypercortisolism. Cushing's disease is associated with several psychiatric disturbances. The aim of the present study was to identify which psychiatric disorders were present in patients with Cushing's disease over a 2-year period and to monitor their general psychiatric condition. Additionally, the study aimed to examine the relationship between the duration of Cushing's disease, and the severity of psychiatric conditions based on psychiatric rating scales. The study included 39 patients with Cushing's disease that underwent neurosurgery for ACTH-secreting pituitary adenomas. The transsphenoidal approach (the standard microsurgery technique) was performed in all patients. ACTH-secreting pituitary adenomas were confirmed based on immunohistochemistry in all patients. Psychiatric conditions in the patients were identified using the Clinical Global Impression Scale (CGI) and ICD 10 diagnostic criteria at 3 time points: prior to surgery, and 6 and 48 months post surgery. The Cushing's disease patients exhibited statistically significant improvement in their psychiatric condition, according to the CGI, 6 and 48 months post surgery. There wasn't any significant correlation between the duration of Cushing's disease and psychiatric status, as measured by the CGI prior to surgery, 6 months post surgery, or 48 months post surgery. Patients with Cushing's disease had a significant level psychiatric disturbance that remitted after surgery. There wasn't a significant correlation between the duration of Cushing's disease and psychiatric status.

  14. Maternal periodontal disease and risk of preeclampsia: a meta-analysis.

    Science.gov (United States)

    Huang, Xi; Wang, Juan; Liu, Jian; Hua, Li; Zhang, Dan; Hu, Ting; Ge, Zi-Li

    2014-10-01

    Research on the association between maternal periodontal disease and the risk of preeclampsia has generated inconsistent results. This meta-analysis was conducted to evaluate the association between maternal periodontal disease and the risk of preeclampsia. A literature search of PubMed and Embase was performed to identify relevant papers published before March 2013. Only observational studies that assessed maternal periodontal disease and the risk of preeclampsia were selected. Patients' periodontal status was examined at different time points during pregnancy or after delivery (at 14-32 weeks of gestation, within 48 h prior to or within 5 days after delivery). Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated for cases and controls. Cases were defined as women with concurrent hypertension and proteinuria after 20 weeks of gestation. Eleven studies involving 1118 women with preeclampsia and 2798 women without preeclampsia were identified and analyzed. Women with periodontal disease before 32 weeks of gestation had a 3.69-fold higher risk of developing preeclampsia than their counterparts without periodontal disease (OR=3.69; 95% CI=2.58-5.27). Periodontal disease within 48 h prior to delivery was associated with a 2.68-fold higher risk of preeclampsia (OR=2.68; 95% CI=1.39-5.18). Pregnant women with periodontal disease within 5 days after delivery had a 2.22-fold higher risk of preeclampsia than women without periodontal disease (OR=2.22; 95% CI=1.16-4.27). In conclusion, this meta-analysis suggests that maternal periodontal disease is an independent predictor of preeclampsia.

  15. Prior Knowledge Facilitates Mutual Gaze Convergence and Head Nodding Synchrony in Face-to-face Communication.

    Science.gov (United States)

    Thepsoonthorn, C; Yokozuka, T; Miura, S; Ogawa, K; Miyake, Y

    2016-12-02

    As prior knowledge is claimed to be an essential key to achieve effective education, we are interested in exploring whether prior knowledge enhances communication effectiveness. To demonstrate the effects of prior knowledge, mutual gaze convergence and head nodding synchrony are observed as indicators of communication effectiveness. We conducted an experiment on lecture task between lecturer and student under 2 conditions: prior knowledge and non-prior knowledge. The students in prior knowledge condition were provided the basic information about the lecture content and were assessed their understanding by the experimenter before starting the lecture while the students in non-prior knowledge had none. The result shows that the interaction in prior knowledge condition establishes significantly higher mutual gaze convergence (t(15.03) = 6.72, p < 0.0001; α = 0.05, n = 20) and head nodding synchrony (t(16.67) = 1.83, p = 0.04; α = 0.05, n = 19) compared to non-prior knowledge condition. This study reveals that prior knowledge facilitates mutual gaze convergence and head nodding synchrony. Furthermore, the interaction with and without prior knowledge can be evaluated by measuring or observing mutual gaze convergence and head nodding synchrony.

  16. Mind wandering during film comprehension: The role of prior knowledge and situational interest.

    Science.gov (United States)

    Kopp, Kristopher; Mills, Caitlin; D'Mello, Sidney

    2016-06-01

    This study assessed the occurrence and factors that influence mind wandering (MW) in the domain of film comprehension. The cascading model of inattention assumes that a stronger mental representation (i.e., a situation model) during comprehension results in less MW. Accordingly, a suppression hypothesis suggests that MW would decrease as a function of having the knowledge of the plot of a film prior to viewing, because the prior-knowledge would help to strengthen the situation model during comprehension. Furthermore, an interest-moderation hypothesis would predict that the suppression effect of prior-knowledge would only emerge when there was interest in viewing the film. In the current experiment, 108 participants either read a short story that depicted the plot (i.e., prior-knowledge condition) or read an unrelated story of equal length (control condition) prior to viewing the short film (32.5 minutes) entitled The Red Balloon. Participants self-reported their interest in viewing the film immediately before the film was presented. MW was tracked using a self-report method targeting instances of MW with metacognitive awareness. Participants in the prior-knowledge condition reported less MW compared with the control condition, thereby supporting the suppression hypothesis. MW also decreased over the duration of the film, but only for those with prior-knowledge of the film. Finally, prior-knowledge effects on MW were only observed when interest was average or high, but not when interest was low.

  17. Evaluation of surgical staging prior to combined modality therapy for esophageal cancer

    International Nuclear Information System (INIS)

    Suntharalingam, M.; Vines, E.; Echo, D. van; Greenwald, B.; Krasna, M.

    1996-01-01

    OBJECTIVE: Historically, patients with esophageal cancer have had a poor outcome despite aggressive treatment approaches. Recently chemo/RT followed by surgical resection has shown a significant improvement in survival in this patient population. The success of this aggressive approach has been predicated on accurate definition of disease extent and appropriate patient selection. We have performed pre-treatment surgical staging (thoracoscopy and laparoscopy) on 38 pts. referred for management of their localized esophageal cancer. The purpose of this report is to compare the results of clinical (CT, MRI, EGD, EUS) vs. surgical staging. The data gathered prospectively will also be used to identify potential predictors for disease-free survival. METHODS: Thirty-eight pts. were treated with combined modality therapy prior to a planned surgical resection. Patients received 50.4 Gy in 1.8 Gy fractions in conjunction with 5 FU (1 Gm/m2) and Cisplatin (100 mg/m2) on days 1 and 28. Patients were evaluated 4 to 6 wks. after completion of therapy for consideration of Ivor-Lewis esophagectomy. Of the original 38 pts., 4 are awaiting surgery, 3 died prior to resection, 2 pts. progressed through chemo/RT, and 1 refused. To date, 28 pts. are available for analysis with a median follow up of 21.5 months. This group included 16 pts. with squamous cell and 12 with adenocarcinoma. RESULTS: Twenty-five of the 28 pts. taken to surgery have undergone pre treatment surgical staging (2 refused, 1 medically unfit). Evaluation of tumor status revealed noninvasive staging to be accurate 56% of the time. Five pts. were converted from T 2 to T 3 , 1 from T 3 to T 4 and 3 T 4 tumors were found to be T 3 . Using the surgical findings at time of staging, 6 pts. were found to have T 2 tumors, 16 had T 3 tumors, and 3 had T 4 tumors. Clinical lymph node status was confirmed in 15 patients (60%). Six went from N+ to N 0 and 4 pts. thought to be N 0 were N+. Eight patients had evidence of positive

  18. l0 Sparsity for Image Denoising with Local and Global Priors

    Directory of Open Access Journals (Sweden)

    Xiaoni Gao

    2015-01-01

    Full Text Available We propose a l0 sparsity based approach to remove additive white Gaussian noise from a given image. To achieve this goal, we combine the local prior and global prior together to recover the noise-free values of pixels. The local prior depends on the neighborhood relationships of a search window to help maintain edges and smoothness. The global prior is generated from a hierarchical l0 sparse representation to help eliminate the redundant information and preserve the global consistency. In addition, to make the correlations between pixels more meaningful, we adopt Principle Component Analysis to measure the similarities, which can be both propitious to reduce the computational complexity and improve the accuracies. Experiments on the benchmark image set show that the proposed approach can achieve superior performance to the state-of-the-art approaches both in accuracy and perception in removing the zero-mean additive white Gaussian noise.

  19. The expanding universe of inflammatory bowel disease genetics.

    Science.gov (United States)

    Achkar, Jean-Paul; Duerr, Richard

    2008-07-01

    Genetic factors play an important role in the pathogenesis of inflammatory bowel disease. In this review, we will provide an update on the rapid advances in the discovery of inflammatory bowel disease, primarily Crohn's disease, associated genes. Seven recently published Crohn's disease genome-wide association studies have confirmed prior findings related to the nucleotide-binding oligomerization domain 2 (NOD2) gene and the IBD5 locus. In addition, 10 novel loci have been identified and well replicated. Several promising associations between Crohn's disease and gene variants have been identified and replicated, the two most widely replicated being variants in the IL23R and ATG16L1 genes. These findings highlight and further support the importance of the immune system and its interactions with the intestinal microflora in the pathogenesis of inflammatory bowel disease.

  20. Evolution of Industry Knowledge in the Public Domain: Prior Art Searching for Software Patents

    Directory of Open Access Journals (Sweden)

    Jinseok Park

    2005-03-01

    Full Text Available Searching prior art is a key part of the patent application and examination processes. A comprehensive prior art search gives the inventor ideas as to how he can improve or circumvent existing technology by providing up to date knowledge on the state of the art. It also enables the patent applicant to minimise the likelihood of an objection from the patent office. This article explores the characteristics of prior art associated with software patents, dealing with difficulties in searching prior art due to the lack of resources, and considers public contribution to the formation of prior art databases. It addresses the evolution of electronic prior art in line with technological development, and discusses laws and practices in the EPO, USPTO, and the JPO in relation to the validity of prior art resources on the Internet. This article also investigates the main features of searching sources and tools in the three patent offices as well as non-patent literature databases. Based on the analysis of various searching databases, it provides some strategies of efficient prior art searching that should be considered for software-related inventions.

  1. Prevention of congenital Chagas disease by Benznidazole treatment in reproductive-age women. An observational study.

    Science.gov (United States)

    Álvarez, María G; Vigliano, Carlos; Lococo, Bruno; Bertocchi, Graciela; Viotti, Rodolfo

    2017-10-01

    Since the decline in new cases of infection by insect/vector, congenital Chagas disease has become more relevant in the transmission of Chagas disease. Treatment with benznidazole significantly reduces the parasitemia, which constitutes an important factor linked to vertical transmission. The objective of this study was to evaluate whether treatment with benznidazole previously administered to women of childbearing age can prevent or reduce the incidence of new cases of congenital Chagas disease. An historical cohort study that included all women in reproductive age (15-45 years) assisted in our center was designed. We included 67 mothers with chronic Chagas disease; 35 women had not been treated prior to pregnancy, 15 had been treated prior to pregnancy and 17 gave birth prior and after treatment with benznidazole. Eight mothers gave birth to 16 children with congenital Chagas disease (8/67, 12%). The prevalence of congenital Chagas was 16/114 (14%) children born to untreated mothers and 0/42 (0%) children born to benznidazole- treated mothers, p=0.01. No significant differences were observed in clinical, serologic, epidemiological or socioeconomic baseline variables between mothers with and without children born with congenital Chagas. A 32% conversion rate to negative serology was observed in benznidazole-treated women after long-term follow up. Antiparasitic treatment administered to women in reproductive age can prevent the occurrence of congenital Chagas disease. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. The tobacco paradox in acute coronary syndrome. The prior cessation of smoking as a marker of a better short-term prognosis.

    Science.gov (United States)

    Bastos-Amador, P; Almendro-Delia, M; Muñoz-Calero, B; Blanco-Ponce, E; Recio-Mayoral, A; Reina-Toral, A; Cruz-Fernandez, J M; García-Alcántara, A; Hidalgo-Urbano, R; García-Rubira, J C

    2016-01-01

    The tobacco paradox is a phenomenon insufficiently explained by previous studies. This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome. We obtained data from the ARIAM registry, between 2001 and 2012. The study included 42,827 patients with acute coronary syndrome (mean age, 65±13 years; 26.4% women). The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis. The smokers were younger, were more often men, had less diabetes, hypertension and prior history of heart failure, stroke, arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking. The ex-smokers had more dyslipidaemia and history of angina, myocardial infarction, ischemic heart disease, peripheral vasculopathy and chronic bronchial disease. Smokers and ex-smokers less frequently developed cardiogenic shock (smokers 4.2%, ex-smokers 4.7% and nonsmokers 6.9%, P<.001). Hospital mortality was 7.8% for the nonsmokers, 4.9% for the ex-smokers and 3.1% for the smokers (P<.001). In the multivariate analysis, the smoker factor lost its influence in the prognosis (-0.26%, p=.52 using an inverse probability calculation; and+0.26%, P=.691 using a propensity analysis). However, the exsmoker factor showed a significant reduction in mortality in both tests (-2.4% in the inverse probability analysis, P<.001; and -1.5% in the propensity analysis, P=.005). The tobacco paradox is a finding that could be explained by other prognostic factors. Smoking cessation prior to hospitalization for acute coronary syndrome is associated with a better prognosis. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  3. Necrotizing soft tissue infection in pregnancy

    Directory of Open Access Journals (Sweden)

    Nestorović Milica

    2017-01-01

    Full Text Available Introduction. Necrotizing soft tissue infection (NSTI is a life-threatening condition, characterized by widely spread necrosis of skin, subcutaneous fat, fascia and muscles. Treatment involves surgical debridement and broad-spectrum antimicrobial therapy. Mortality is still high due to diagnostic delays. NSTI is rare in general population, there are even less literature data of this condition in pregnancy. Timely diagnosis and therapy is crucial for outcome of these patients. Clinicians should have in mind NSTI in patients with perianal infections, especially in cases where immunosuppressive role of pregnancy is present. Case outline. We present a case of a 21-year-old pregnant woman with NSTI spreading from perianal region. The patient was admitted to hospital in the 31st week of otherwise healthy twin pregnancy one day after incision of perianal abscess. At admission she was examined by a gynecologist; vital signs were stable, laboratory results showed the presence of infection. She was referred for another surgical procedure and broad-spectrum antibiotics were prescribed. The next morning the patient complained of intense abdominal pain. Clinical exam revealed only discrete redness of the skin tender on palpation, crepitating. She was immediately referred to surgery. Intraoperative findings revealed massive soft tissue infection spreading up to the chest wall. Wide skin incisions and debridement were performed. The patient developed septic shock and after initial resuscitation gynecologist confirmed intrauterine death of twins and indicated labor induction. Over the next few days the patient’s general condition improved. On several occasions the wounds were aggressively debrided under general anesthesia, which left the patient with large abdominal wall defect. Twenty-three days after the initial operation, the defect was reconstructed with partial-thickness skin grafts, providing satisfactory results. Conclusion. Diagnosis and outcome of

  4. 25 CFR 11.303 - Notification of rights prior to custodial interrogation.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Notification of rights prior to custodial interrogation. 11.303 Section 11.303 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER... to custodial interrogation. Prior to custodial interrogation, the suspect shall be advised of the...

  5. Impact of Bayesian Priors on the Characterization of Binary Black Hole Coalescences.

    Science.gov (United States)

    Vitale, Salvatore; Gerosa, Davide; Haster, Carl-Johan; Chatziioannou, Katerina; Zimmerman, Aaron

    2017-12-22

    In a regime where data are only mildly informative, prior choices can play a significant role in Bayesian statistical inference, potentially affecting the inferred physics. We show this is indeed the case for some of the parameters inferred from current gravitational-wave measurements of binary black hole coalescences. We reanalyze the first detections performed by the twin LIGO interferometers using alternative (and astrophysically motivated) prior assumptions. We find different prior distributions can introduce deviations in the resulting posteriors that impact the physical interpretation of these systems. For instance, (i) limits on the 90% credible interval on the effective black hole spin χ_{eff} are subject to variations of ∼10% if a prior with black hole spins mostly aligned to the binary's angular momentum is considered instead of the standard choice of isotropic spin directions, and (ii) under priors motivated by the initial stellar mass function, we infer tighter constraints on the black hole masses, and in particular, we find no support for any of the inferred masses within the putative mass gap M≲5  M_{⊙}.

  6. The search for Infrared radiation prior to major earthquakes

    Science.gov (United States)

    Ouzounov, D.; Taylor, P.; Pulinets, S.

    2004-12-01

    This work describes our search for a relationship between tectonic stresses and electro-chemical and thermodynamic processes in the Earth and increases in mid-IR flux as part of a possible ensemble of electromagnetic (EM) phenomena that may be related to earthquake activity. Recent analysis of continuous ongoing long- wavelength Earth radiation (OLR) indicates significant and anomalous variability prior to some earthquakes. The cause of these anomalies is not well understood but could be the result of a triggering by an interaction between the lithosphere-hydrosphere and atmospheric related to changes in the near surface electrical field and gas composition prior to the earthquake. The OLR anomaly covers large areas surrounding the main epicenter. We have use the NOAA IR data to differentiate between the global and seasonal variability and these transient local anomalies. Indeed, on the basis of a temporal and spatial distribution analysis, an anomaly pattern is found to occur several days prior some major earthquakes. The significance of these observations was explored using data sets of some recent worldwide events.

  7. Effects of prior knowledge on decisions made under perceptual vs. categorical uncertainty

    Directory of Open Access Journals (Sweden)

    Kathleen eHansen

    2012-11-01

    Full Text Available Humans use prior knowledge to bias decisions made under uncertainty. In this fMRI study we predicted that different brain dynamics play a role when prior knowledge is added to decisions made under perceptual vs. categorical uncertainty. Subjects decided whether shapes belonged to Category S – smoother – or Category B – bumpier – under both uncertainty conditions, with or without prior knowledge cues. When present, the prior knowledge cue, 80/20 or 50/50, indicated that 80% and 20% (or 50% and 50% were the chances that responding "S" and "B" (or vice versa would be correct. During perceptual uncertainty, shapes were degraded with noise. During categorical uncertainty, shapes were ambiguous. Adding the 80/20 cue increased activation during perceptual uncertainty in bilateral lateral occipital cortex and left middle frontal gyrus (MidFG, and decreased activity in bilateral lateral occipital cortex during categorical uncertainty. Right MidFG and other frontoparietal regions were active in all conditions. The results demonstrate that left MidFG shows activation changes, suggestive of an influence on visual cortex, that depend on the factor that makes the decisions difficult. When sensory evidence is difficult to perceive, prior knowledge increases visual cortical activity. When the sensory evidence is easy to perceive but difficult to interpret, prior knowledge decreases visual cortical activity.

  8. Contribution of Prior Semantic Knowledge to New Episodic Learning in Amnesia

    Science.gov (United States)

    Kan, Irene P.; Alexander, Michael P.; Verfaellie, Mieke

    2009-01-01

    We evaluated whether prior semantic knowledge would enhance episodic learning in amnesia. Subjects studied prices that are either congruent or incongruent with prior price knowledge for grocery and household items and then performed a forced-choice recognition test for the studied prices. Consistent with a previous report, healthy controls'…

  9. Cortical plasticity as a mechanism for storing Bayesian priors in sensory perception.

    Science.gov (United States)

    Köver, Hania; Bao, Shaowen

    2010-05-05

    Human perception of ambiguous sensory signals is biased by prior experiences. It is not known how such prior information is encoded, retrieved and combined with sensory information by neurons. Previous authors have suggested dynamic encoding mechanisms for prior information, whereby top-down modulation of firing patterns on a trial-by-trial basis creates short-term representations of priors. Although such a mechanism may well account for perceptual bias arising in the short-term, it does not account for the often irreversible and robust changes in perception that result from long-term, developmental experience. Based on the finding that more frequently experienced stimuli gain greater representations in sensory cortices during development, we reasoned that prior information could be stored in the size of cortical sensory representations. For the case of auditory perception, we use a computational model to show that prior information about sound frequency distributions may be stored in the size of primary auditory cortex frequency representations, read-out by elevated baseline activity in all neurons and combined with sensory-evoked activity to generate a perception that conforms to Bayesian integration theory. Our results suggest an alternative neural mechanism for experience-induced long-term perceptual bias in the context of auditory perception. They make the testable prediction that the extent of such perceptual prior bias is modulated by both the degree of cortical reorganization and the magnitude of spontaneous activity in primary auditory cortex. Given that cortical over-representation of frequently experienced stimuli, as well as perceptual bias towards such stimuli is a common phenomenon across sensory modalities, our model may generalize to sensory perception, rather than being specific to auditory perception.

  10. The associations among prior drinking consequences, subjective evaluations, and subsequent alcohol outcomes.

    Science.gov (United States)

    Zaso, Michelle J; Park, Aesoon; Kim, Jueun; Gellis, Les A; Kwon, Hoin; Maisto, Stephen A

    2016-05-01

    Although the many positive and negative psychosocial consequences of alcohol use are well documented, evidence of the association between prior drinking consequences and subsequent alcohol-related outcomes is mixed. Social learning theory highlights that cognitive appraisals of prior drinking consequences play a crucial intermediate role in the relation of prior drinking consequences with subsequent alcohol-related outcomes. This prospective study was designed to test the mediating effects of subjective evaluations (i.e., perceived valence and controllability) in the association of prior drinking consequences with change in binge drinking and drinking consequences over time. Participants were 171 college students (69% female, 74% White, M age = 18.95 years, SD = 1.35) who completed 2 online surveys, with an average interval of 68 days (SD = 10.22) between assessments. Path analyses of the data did not support mediational effects of perceived valence or controllability of prior drinking consequences on subsequent alcohol-related outcomes. Specifically, greater frequency of negative consequences was associated with lower perceived valence and controllability, and greater frequency of positive consequences was associated with lower perceived controllability of the experienced consequences. However, perceptions of valence and controllability were not in turn associated with subsequent binge drinking and drinking consequences. Instead, greater frequency of positive consequences was directly associated with greater subsequent frequency of binge drinking. Findings highlight the importance of prior positive consequences in the escalation of binge drinking over a short period of time, although this relation may not be accounted for by perceptions of valence and controllability of the prior drinking consequences. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  11. Susceptibility to exacerbation in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Hurst, John R; Vestbo, Jørgen; Anzueto, Antonio

    2010-01-01

    be predicted on the basis of the patient's recall of previous treated events. In addition to its association with more severe disease and prior exacerbations, the phenotype was independently associated with a history of gastroesophageal reflux or heartburn, poorer quality of life, and elevated white-cell count...

  12. Rapid sampling of molecular motions with prior information constraints.

    Science.gov (United States)

    Raveh, Barak; Enosh, Angela; Schueler-Furman, Ora; Halperin, Dan

    2009-02-01

    Proteins are active, flexible machines that perform a range of different functions. Innovative experimental approaches may now provide limited partial information about conformational changes along motion pathways of proteins. There is therefore a need for computational approaches that can efficiently incorporate prior information into motion prediction schemes. In this paper, we present PathRover, a general setup designed for the integration of prior information into the motion planning algorithm of rapidly exploring random trees (RRT). Each suggested motion pathway comprises a sequence of low-energy clash-free conformations that satisfy an arbitrary number of prior information constraints. These constraints can be derived from experimental data or from expert intuition about the motion. The incorporation of prior information is very straightforward and significantly narrows down the vast search in the typically high-dimensional conformational space, leading to dramatic reduction in running time. To allow the use of state-of-the-art energy functions and conformational sampling, we have integrated this framework into Rosetta, an accurate protocol for diverse types of structural modeling. The suggested framework can serve as an effective complementary tool for molecular dynamics, Normal Mode Analysis, and other prevalent techniques for predicting motion in proteins. We applied our framework to three different model systems. We show that a limited set of experimentally motivated constraints may effectively bias the simulations toward diverse predicates in an outright fashion, from distance constraints to enforcement of loop closure. In particular, our analysis sheds light on mechanisms of protein domain swapping and on the role of different residues in the motion.

  13. Rapid sampling of molecular motions with prior information constraints.

    Directory of Open Access Journals (Sweden)

    Barak Raveh

    2009-02-01

    Full Text Available Proteins are active, flexible machines that perform a range of different functions. Innovative experimental approaches may now provide limited partial information about conformational changes along motion pathways of proteins. There is therefore a need for computational approaches that can efficiently incorporate prior information into motion prediction schemes. In this paper, we present PathRover, a general setup designed for the integration of prior information into the motion planning algorithm of rapidly exploring random trees (RRT. Each suggested motion pathway comprises a sequence of low-energy clash-free conformations that satisfy an arbitrary number of prior information constraints. These constraints can be derived from experimental data or from expert intuition about the motion. The incorporation of prior information is very straightforward and significantly narrows down the vast search in the typically high-dimensional conformational space, leading to dramatic reduction in running time. To allow the use of state-of-the-art energy functions and conformational sampling, we have integrated this framework into Rosetta, an accurate protocol for diverse types of structural modeling. The suggested framework can serve as an effective complementary tool for molecular dynamics, Normal Mode Analysis, and other prevalent techniques for predicting motion in proteins. We applied our framework to three different model systems. We show that a limited set of experimentally motivated constraints may effectively bias the simulations toward diverse predicates in an outright fashion, from distance constraints to enforcement of loop closure. In particular, our analysis sheds light on mechanisms of protein domain swapping and on the role of different residues in the motion.

  14. Sequential treatment for proctalgia fugax. Mid-term follow-up.

    Science.gov (United States)

    Gracia Solanas, J A; Ramírez Rodríguez, J M; Elía Guedea, M; Aguilella Diago, V; Martínez Díez, M

    2005-07-01

    Proctalgia fugax (PF) is a benign, self-limiting disease characterized by episodes of intense anorectal pain at frequent intervals in the absence of organic proctological disease. Even though PF was described more than a century ago, its etiology remains unclear. Currently there is no information available. Few papers quoting many ways of management have been published. The aim of this study was to investigate patients complaining of this condition and to treat them with sequential therapy. We devised a descriptive, prospective study of patients complaining of acute perianal pain--duration less than 30 minutes--without organic disease or previous perianal surgery since 1996 to 2002 in our Department. We treated these patients using a three-step treatment (1: information, hip bath, benzodiazepines; 2: sublingual nifedipine 10 mg, or topic 0.1% nitroglycerin on demand; 3: internal anal sphincterotomy if hypertrophy of the internal anal sphincter was demonstrated by anal ultrasonography and no improvement was confirmed with the previous steps of treatment). We defined remarkable improvement as a decrease in the number of episodes by half or in pain intensity by 50%. Fifteen patients with an average follow-up of 4 years. Anal endosonography confirmed a grossly thickened internal anal sphincter (IAS) in 5 cases. After the first step of treatment 7 patients improved and 1 patient was cured; after the second step of treatment 3 patients improved and 1 was cured; the third step was applied to 3 patients with a thickened IAS; 1 patient improved and 1 patient was cured. A total resolution of PF is not always possible, but we may improve symptoms and their frequency. Almost 50% of patients in our series improved with the first step of treatment; 30% of our patients had IAS hypertrophy. Anal endosonography can help in the diagnosis of organic diseases or IAS hypertrophy, for which we can perform an internal anal sphincter myectomy.

  15. 38 CFR 3.950 - Helpless children; Spanish-American and prior wars.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Helpless children; Spanish-American and prior wars. 3.950 Section 3.950 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF... § 3.950 Helpless children; Spanish-American and prior wars. Marriage is not a bar to the payment of...

  16. Using Priors to Compensate Geometrical Problems in Head-Mounted Eye Trackers

    DEFF Research Database (Denmark)

    Batista Narcizo, Fabricio; Ahmed, Zaheer; Hansen, Dan Witzner

    The use of additional information (a.k.a. priors) to help the eye tracking process is presented as an alternative to compensate classical geometrical problems in head-mounted eye trackers. Priors can be obtained from several distinct sources, such as: sensors to collect information related...... estimation specially for uncalibrated head-mounted setups....

  17. 46 CFR 176.710 - Inspection and testing prior to hot work.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Inspection and testing prior to hot work. 176.710... testing prior to hot work. (a) An inspection for flammable or combustible gases must be conducted by a... operations involving riveting, welding, burning, or other fire producing actions may be made aboard a vessel...

  18. 46 CFR 115.710 - Inspection and testing prior to hot work.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Inspection and testing prior to hot work. 115.710... AND CERTIFICATION Repairs and Alterations § 115.710 Inspection and testing prior to hot work. (a) An... involving riveting, welding, burning, or other fire producing actions may be made aboard a vessel: (1...

  19. 13 CFR 115.62 - Prohibition on participation in Prior Approval program.

    Science.gov (United States)

    2010-01-01

    ... Prior Approval program. 115.62 Section 115.62 Business Credit and Assistance SMALL BUSINESS... in Prior Approval program. A PSB Surety is not eligible to submit applications under subpart B of this part. This prohibition does not extend to an Affiliate, as defined in 13 CFR § 121.103, of a PSB...

  20. Neoadjuvant chemotherapy with methotrexate and cisplatin prior to radiotherapy for invasive transitional cell carcinoma of the bladder. Assessment of feasibility and toxicity

    International Nuclear Information System (INIS)

    Howard, G.C.W.; Cornbleet, M.A.; Whillis, D.; Hargreave, T.B.; Chisholm, G.D.

    1991-01-01

    A prospective study has been performed to assess the feasibility and toxicity of administering neoadjuvant chemotherapy with methotrexate and cisplatin prior to radical radiotherapy. Twenty patients with advanced transitional cell carcinoma of the bladder were assessed after each of 3 courses of chemotherapy, after radiotherapy and 6 months following treatment. Of particular concern was whether neoadjuvant chemotherapy compromised the ability to give potentially curative radical radiotherapy, delayed effective palliation of distressing urinary symptoms, or allowed local tumour progression prior to definitive treatment. It was concluded that this chemotherapy regimen was well tolerated, did not compromise the ability to give radical radiotherapy and resulted in the prompt palliation of urinary symptoms. This treatment, however, did not stop the development or progression of metastatic disease in some patients. In only 1 patient was there local progression during chemotherapy. (author)

  1. Role of strategies and prior exposure in mental rotation.

    Science.gov (United States)

    Cherney, Isabelle D; Neff, Nicole L

    2004-06-01

    The purpose of these two studies was to examine sex differences in strategy use and the effect of prior exposure on the performance on Vandenberg and Kuse's 1978 Mental Rotation Test. A total of 152 participants completed the spatial task and self-reported their strategy use. Consistent with previous studies, men outperformed women. Strategy usage did not account for these differences, although guessing did. Previous exposure to the Mental Rotation Test, American College Test scores and frequent computer or video game play predicted performance on the test. These results suggest that prior exposure to spatial tasks may provide cues to improve participants' performance.

  2. C. A. Meredith, A. N. Prior, and Possible Worlds

    DEFF Research Database (Denmark)

    Hasle, Per Frederik Vilhelm; Rybaříková, Zuzana

    of Meredith’s and Prior’s work. On the one hand, it might cause corruption of Meredith’s system of logic and lead to paradoxes, as Prior pointed out in ‘Modal Logic with Functorial Variables and a Contingent Constant’. On the other hand, considering Prior as a mere follower of Meredith could cause......, their understanding of the relevant formal representations and indeed their general approach to modal logic considerably differed. These differences should be pointed out in order to more precisely appreciate the contribution of each of these authors. To neglect the differences could cause the misinterpretation...

  3. Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study.

    Science.gov (United States)

    Morar, Pritesh S; Hollingshead, James; Bemelman, Willem; Sevdalis, Nick; Pinkney, Thomas; Wilson, Graeme; Dunlop, Malcolm; Davies, R Justin; Guy, Richard; Fearnhead, Nicola; Brown, Steven; Warusavitarne, Janindra; Edwards, Cathryn; Faiz, Omar

    2017-10-27

    Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

  4. Early vitrectomy effective for Norrie disease.

    Science.gov (United States)

    Walsh, Mark K; Drenser, Kimberly A; Capone, Antonio; Trese, Michael T

    2010-04-01

    To review our experience with Norrie disease to determine if early vitrectomy abrogates the natural history of this rare disease; namely, bilateral no light perception visual acuity and phthisis bulbi. We retrospectively reviewed the medical records of all patients seen in our tertiary care pediatric retinal clinical practice from 1988 through 2008 with a potential diagnosis of Norrie disease. Inclusion required not only clinical findings consistent with Norrie disease but also genetics and/or a family history consistent with Norrie disease. Medical record review revealed 14 boys with clinically diagnosed Norrie disease and either Norrie disease gene (NDP) mutations noted on genetic testing (13 patients) and/or a clear family history consistent with Norrie disease (4 patients). All 14 boys with definite Norrie disease had vitrectomy with or without lensectomy in at least 1 eye prior to 12 months of age. Of the 14 boys with definite Norrie disease, 7 maintained at least light perception visual acuity in 1 eye and 3 had no light perception visual acuity bilaterally; visual acuity data were not available for 4 patients. Only 2 of 24 (8%) eyes became phthisical. Historically, no treatment has been offered to mitigate the dismal natural history of Norrie disease. We recommend consideration of early vitrectomy in Norrie disease.

  5. Use of prior mammograms in the transition to digital mammography: A performance and cost analysis

    International Nuclear Information System (INIS)

    Taylor-Phillips, S.; Wallis, M.G.; Duncan, A.; Gale, A.G.

    2012-01-01

    Breast screening in Europe is gradually changing from film to digital imaging and reporting of cases. In the transition period prior mammograms (from the preceding screening round) are films thereby potentially causing difficulties in comparison to current digital mammograms. To examine this breast screening performance was measured at a digital mammography workstation with prior mammograms displayed in different formats, and the associated costs calculated. 160 selected difficult cases (41% malignant) were read by eight UK qualified mammography readers in three conditions: with film prior mammograms; with digitised prior mammograms; or without prior mammograms. Lesion location and probability of malignancy were recorded, alongside a decision of whether to recall each case for further tests. JAFROC analysis showed a difference between conditions (p = .006); performance with prior mammograms in either film or digitised formats was superior to that without prior mammograms (p < .05). There was no difference in the performance when the prior mammograms were presented in film or digitised form. The number of benign or normal cases recalled was 26% higher without prior mammograms than with digitised or film prior mammograms (p < .05). This would correspond to an increase in recall rate at the study hospital from 4.3% to 5.5% with no associated increase in cancer detection rate. The cost of this increase was estimated to be £11,581 (€13,666) per 10,000 women screened, which is higher than the cost of digitised (£11,114/€13,115), or film display (£6451/€7612) of the prior mammograms. It is recommended that, where available, prior mammograms are used in the transition to digital breast screening.

  6. Stress and Disease Onset in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

    Directory of Open Access Journals (Sweden)

    Christina V. Golemati

    2017-12-01

    Full Text Available ObjectiveTo explore the potential contribution of stress as a trigger for disease onset in patients with antineutrophil cytoplasmic antibody (ANCA associated vasculitis (AAV.Methods53 AAV and 85 rheumatoid arthritis (RA patients as well as 53 healthy controls (HC were thoroughly asked for the number and impact of stressful life events, coping strategies, and available social support 12 months prior to disease onset. Anxiety, depression, personality dimensions, insomnia, and fatigue were also determined.ResultsAAV patients reported higher scoring of the impact of stressful life events compared to the RA and HC group prior to disease onset (2.8 ± 3.1 vs 1.8 ± 2.1 vs 1.7 ± 2.3, p-values: 0.047 and 0.053, respectively. While the number of reported stressful events was found to be significantly higher in AAV vs RA patients but not HC, certain coping strategies and social support features were more commonly implemented by AAV patients compared to HC, but not RA patients. As far as personality and other psychosocial characteristics, AAV patients displayed significantly higher psychoticism traits compared to RA, with no other differences being detected between AAV patients and both RA and HC. After adjusting for potential cofounders, scoring of the impact of stressful life events >3 was independently associated with AAV development compared to both RA and HC [ORs (95% CI: 4.6 (1.6–13.4 and 4.4 (1.0–19.0, respectively].ConclusionThe perceived impact of stressful life events prior to disease onset emerged as a contributing factor for AAV development.

  7. Effects of prior aversive experience upon retrograde amnesia induced by hypothermia.

    Science.gov (United States)

    Jensen, R A; Riccio, D C; Gehres, L

    1975-08-01

    Two experiments examined the extent to which retrograde amnesia (RA) is attenuated by prior learning experiences. In Experiment 1, rats initially received either passive avoidance training in a step-through apparatus, exposure to the apparatus, or noncontingent footshock. When training on a second but different passive avoidance task was followed by hypothermia treatment, RA was obtained only in the latter two groups. In Experiment 2, one-way active avoidance training, yoked noncontingent shocks, or apparatus exposure constituted the initial experience. Subsequent step-down passive avoidance training and amnestic treatment resulted in memory loss for the prior apparatus exposure group, but not for either of the preshocked conditions. These experiments demonstrate that certain types of prior aversive experience can substantially modify the magnitude of RA, and, in conjunction with other familiarization studies, emphasize a paradox for interpretations of RA based solely upon CNS disruption. The possibility that hypothermia treatment serves as an important contextual or encoding cue necessary for memory retrieval was considered. It was suggested that prior experience may block RA by enabling rats to differentiate training and treatment conditions.

  8. Improved compressed sensing-based cone-beam CT reconstruction using adaptive prior image constraints

    Science.gov (United States)

    Lee, Ho; Xing, Lei; Davidi, Ran; Li, Ruijiang; Qian, Jianguo; Lee, Rena

    2012-04-01

    Volumetric cone-beam CT (CBCT) images are acquired repeatedly during a course of radiation therapy and a natural question to ask is whether CBCT images obtained earlier in the process can be utilized as prior knowledge to reduce patient imaging dose in subsequent scans. The purpose of this work is to develop an adaptive prior image constrained compressed sensing (APICCS) method to solve this problem. Reconstructed images using full projections are taken on the first day of radiation therapy treatment and are used as prior images. The subsequent scans are acquired using a protocol of sparse projections. In the proposed APICCS algorithm, the prior images are utilized as an initial guess and are incorporated into the objective function in the compressed sensing (CS)-based iterative reconstruction process. Furthermore, the prior information is employed to detect any possible mismatched regions between the prior and current images for improved reconstruction. For this purpose, the prior images and the reconstructed images are classified into three anatomical regions: air, soft tissue and bone. Mismatched regions are identified by local differences of the corresponding groups in the two classified sets of images. A distance transformation is then introduced to convert the information into an adaptive voxel-dependent relaxation map. In constructing the relaxation map, the matched regions (unchanged anatomy) between the prior and current images are assigned with smaller weight values, which are translated into less influence on the CS iterative reconstruction process. On the other hand, the mismatched regions (changed anatomy) are associated with larger values and the regions are updated more by the new projection data, thus avoiding any possible adverse effects of prior images. The APICCS approach was systematically assessed by using patient data acquired under standard and low-dose protocols for qualitative and quantitative comparisons. The APICCS method provides an

  9. Brain Magnetic Resonance Immediately Prior To Surgery In Single Ventricles and Surgical Postponement

    Science.gov (United States)

    Fogel, Mark A.; Pawlowski, Tom; Schwab, Peter J.; Nicolson, Susan C.; Montenegro, Lisa M.; Berenstein, Laura Diaz; Spray, Thomas L.; Gaynor, J William; Fuller, Stephanie; Keller, Marc S.; Harris, Matthew A.; Whitehead, Kevin K.; Vossough, Arastoo; Licht, Daniel J.

    2014-01-01

    Background Single ventricle patients undergoing surgical reconstruction experience a high rate of brain injury; incidental findings on pre-operative brain scans may result in safety considerations involving hemorrhage extension during cardiopulmonary bypass that result in surgical postponement. Methods Single ventricle patients were studied with brain scans immediately preoperatively as part of a National Institute of Health study and were reviewed by neuroradiology immediately prior to cardiopulmonary bypass. Results One hundred and thirty four consecutive subjects recruited into the project were studied: 33 prior to stage I (3.7±1.8 days), 34 prior to bidirectional Glenn (5.8±3.5 months) and 67 prior to Fontan (3.3±1.1 years). Six (4.5%) surgeries were postponed because of concerning imaging findings on brain MRI; 2 prior to stage I, 3 prior to bidirectional Glenn and 1 prior to Fontan. Five were due to unexpected incidental findings of acute intracranial hemorrhage and one due to diffuse cerebellar cytotoxic edema; none who proceeded to surgery had these lesions. Prematurity as well as genetic syndromes were not present in any with postponed surgery. Four of 4 prior to bidirectional Glenn/Fontan with surgical delays had hypoplastic left heart syndrome compared with 44/97 who did not (P=0.048). After observation and follow up, all eventually had successful surgeries with bypass. Conclusion Preoperative brain MRI performed in children with single ventricles disclosed injuries in 4.5% leading to surgical delay; hemorrhagic lesions were most common and raised concerns for extension during surgery. The true risk of progression and need for delay of surgery due to heparinization associated with these lesions remains uncertain. PMID:25149046

  10. Priming in implicit memory tasks: prior study causes enhanced discriminability, not only bias.

    Science.gov (United States)

    Zeelenberg, René; Wagenmakers, Eric-Jan M; Raaijmakers, Jeroen G W

    2002-03-01

    R. Ratcliff and G. McKoon (1995, 1996, 1997; R. Ratcliff, D. Allbritton, & G. McKoon, 1997) have argued that repetition priming effects are solely due to bias. They showed that prior study of the target resulted in a benefit in a later implicit memory task. However, prior study of a stimulus similar to the target resulted in a cost. The present study, using a 2-alternative forced-choice procedure, investigated the effect of prior study in an unbiased condition: Both alternatives were studied prior to their presentation in an implicit memory task. Contrary to a pure bias interpretation of priming, consistent evidence was obtained in 3 implicit memory tasks (word fragment completion, auditory word identification, and picture identification) that performance was better when both alternatives were studied than when neither alternative was studied. These results show that prior study results in enhanced discriminability, not only bias.

  11. Important predictors of response determined by surgical staging prior to triple modality therapy for esophageal cancer

    International Nuclear Information System (INIS)

    Suntharalingam, M.; Vines, E.; Slawson, R.; Doyle, A.; Schuetz, J.; Greenwald, B.; Sonnet, J.; Krasna, M.

    1997-01-01

    Purpose/Objective: Since 1992, the University of Maryland has routinely performed preoperative surgical staging including thoracoscopy and laparoscopy on patients undergoing concurrent chemoradiation followed by surgical resection for esophageal carcinoma. We have performed an analysis of the pathologic pretreatment data in an attempt to identify possible predictors of response and outcome. Materials: Patients underwent thoracoscopy and laparoscopy in order to determine resectability of the primary lesion and pathologic nodal status prior to therapy. To date, 32 patients have completed triple modality therapy (28 men, 4 women, median age 59). Patients received 50.4 Gy in 1.8 Gy fractions in conjunction with two cycles of 5-FU (1 gm/m2) and Cisplatin (100 mg/m2) on days 1 and 28. Radiotherapy fields were determined by the extent of disease discovered at time of surgical staging. Ivor Lewis esophagectomy was performed 4 to 6 weeks after completion of chemo/RT. The median follow up is 24.8 months (range 4-49 mo.) Sixteen patients had squamous cell ca and 16 had adenocarcinoma. Univariate and multivariate analysis was performed in order to determine the influence of age, KPS, T stage, Lymph Nodes status and histology, on the likelihood of achieving a pathologic complete response and disease free survival. Results: Twenty-eight have undergone preoperative staging (2 refused, 2 medical contraindications.) All 32 patients are valuable for response to therapy and are included in the analysis. The three year cause specific and disease free survival is 46% and 41% respectively with a median CSS of 23 months and DFS of 19 months. The overall complete response rate assessed by histologic and immunohistologic evaluation at the time of esophagectomy is 31%. The DFS at 32 months is 72% (median not reached) for these patients versus 24% for those with residual disease at the time of surgery. The most significant predictor for the likelihood of achieving a pathologic CR was the

  12. Effect of Prior Health-Related Employment on the Registered Nurse Workforce Supply.

    Science.gov (United States)

    Yoo, Byung-kwan; Lin, Tzu-chun; Kim, Minchul; Sasaki, Tomoko; Spetz, Joanne

    2016-01-01

    Registered nurses (RN) who held prior health-related employment in occupations other than licensed practical or vocational nursing (LPN/LVN) are reported to have increased rapidly in the past decades. Researchers examined whether prior health-related employment affects RN workforce supply. A cross-sectional bivariate probit model using the 2008 National Sample Survey of Registered Nurses was esti- mated. Prior health-related employment in relatively lower-wage occupations, such as allied health, clerk, or nursing aide, was positively associated with working s an RN. ~>Prior health-related employ- ment in relatively higher-wage categories, such as a health care manager or LPN/LVN, was positively associated with working full-time as an RN. Policy implications are to promote an expanded career ladder program and a nursing school admission policy that targets non-RN health care workers with an interest in becoming RNs.

  13. Prior adversities predict posttraumatic stress reactions in adolescents following the Oslo Terror events 2011

    Science.gov (United States)

    Nordanger, Dag Ø.; Breivik, Kyrre; Haugland, Bente Storm; Lehmann, Stine; Mæhle, Magne; Braarud, Hanne Cecilie; Hysing, Mari

    2014-01-01

    Background Former studies suggest that prior exposure to adverse experiences such as violence or sexual abuse increases vulnerability to posttraumatic stress reactions in victims of subsequent trauma. However, little is known about how such a history affects responses to terror in the general adolescent population. Objective To explore the role of prior exposure to adverse experiences as risk factors for posttraumatic stress reactions to the Oslo Terror events. Method We used data from 10,220 high school students in a large cross-sectional survey of adolescents in Norway that took place seven months after the Oslo Terror events. Prior exposure assessed was: direct exposure to violence, witnessing of violence, and unwanted sexual acts. We explored how these prior adversities interact with well-established risk factors such as proximity to the events, perceived life threat during the terror events, and gender. Results All types of prior exposure as well as the other risk factors were associated with terror-related posttraumatic stress reactions. The effects of prior adversities were, although small, independent of adolescents’ proximity to the terror events. Among prior adversities, only the effect of direct exposure to violence was moderated by perceived life threat. Exposure to prior adversities increased the risk of posttraumatic stress reactions equally for both genders, but proximity to the terror events and perceived life threat increased the risk more in females. Conclusions Terror events can have a more destabilizing impact on victims of prior adversities, independent of their level of exposure. The findings may be relevant to mental health workers and others providing post-trauma health care. PMID:24872862

  14. Prior adversities predict posttraumatic stress reactions in adolescents following the Oslo Terror events 2011.

    Science.gov (United States)

    Nordanger, Dag Ø; Breivik, Kyrre; Haugland, Bente Storm; Lehmann, Stine; Mæhle, Magne; Braarud, Hanne Cecilie; Hysing, Mari

    2014-01-01

    Former studies suggest that prior exposure to adverse experiences such as violence or sexual abuse increases vulnerability to posttraumatic stress reactions in victims of subsequent trauma. However, little is known about how such a history affects responses to terror in the general adolescent population. To explore the role of prior exposure to adverse experiences as risk factors for posttraumatic stress reactions to the Oslo Terror events. We used data from 10,220 high school students in a large cross-sectional survey of adolescents in Norway that took place seven months after the Oslo Terror events. Prior exposure assessed was: direct exposure to violence, witnessing of violence, and unwanted sexual acts. We explored how these prior adversities interact with well-established risk factors such as proximity to the events, perceived life threat during the terror events, and gender. All types of prior exposure as well as the other risk factors were associated with terror-related posttraumatic stress reactions. The effects of prior adversities were, although small, independent of adolescents' proximity to the terror events. Among prior adversities, only the effect of direct exposure to violence was moderated by perceived life threat. Exposure to prior adversities increased the risk of posttraumatic stress reactions equally for both genders, but proximity to the terror events and perceived life threat increased the risk more in females. Terror events can have a more destabilizing impact on victims of prior adversities, independent of their level of exposure. The findings may be relevant to mental health workers and others providing post-trauma health care.

  15. Order-Constrained Reference Priors with Implications for Bayesian Isotonic Regression, Analysis of Covariance and Spatial Models

    Science.gov (United States)

    Gong, Maozhen

    Selecting an appropriate prior distribution is a fundamental issue in Bayesian Statistics. In this dissertation, under the framework provided by Berger and Bernardo, I derive the reference priors for several models which include: Analysis of Variance (ANOVA)/Analysis of Covariance (ANCOVA) models with a categorical variable under common ordering constraints, the conditionally autoregressive (CAR) models and the simultaneous autoregressive (SAR) models with a spatial autoregression parameter rho considered. The performances of reference priors for ANOVA/ANCOVA models are evaluated by simulation studies with comparisons to Jeffreys' prior and Least Squares Estimation (LSE). The priors are then illustrated in a Bayesian model of the "Risk of Type 2 Diabetes in New Mexico" data, where the relationship between the type 2 diabetes risk (through Hemoglobin A1c) and different smoking levels is investigated. In both simulation studies and real data set modeling, the reference priors that incorporate internal order information show good performances and can be used as default priors. The reference priors for the CAR and SAR models are also illustrated in the "1999 SAT State Average Verbal Scores" data with a comparison to a Uniform prior distribution. Due to the complexity of the reference priors for both CAR and SAR models, only a portion (12 states in the Midwest) of the original data set is considered. The reference priors can give a different marginal posterior distribution compared to a Uniform prior, which provides an alternative for prior specifications for areal data in Spatial statistics.

  16. Prognostic Value of Negative Coronary CT Angiography in Severely Obese Patients Prior to Bariatric Surgery: a Follow-Up After 6 Years.

    Science.gov (United States)

    Messerli, Michael; Maywald, Céline; Wälti, Stephan; Warschkow, René; Wildermuth, Simon; Alkadhi, Hatem; Leschka, Sebastian; Schiesser, Marc

    2017-08-01

    This study aims to determine the long-term prognostic value of coronary CT angiography (CCTA) prior to bariatric surgery in severely obese patients with a body mass index (BMI) ≥35 kg/m 2 . Seventy consecutive patients undergoing cardiac CT for coronary assessment prior to bariatric surgery were prospectively included. Images were analysed for the presence of coronary calcification and for non-obstructive (50% stenosis) coronary artery disease (CAD). A median clinical follow-up of 6.1 years in 54 patients was obtained for major adverse cardiovascular events (MACEs), defined as death, non-fatal myocardial infarction or coronary revascularisation. Weight loss and BMI decrease following bariatric surgery were recorded. The median BMI prior to surgery was 46.9 kg/m 2 . The median percentage of excess BMI loss after surgery was 75%. CT showed coronary calcification in 26 (48%) patients, whereas 28 (52%) patients had no calcification. CCTA revealed normal coronaries in 47 (87%) and non-obstructive CAD in 7 (13%) patients. No obstructive CAD was found. All patients successfully underwent bariatric surgery, and no MACE occurred neither perioperatively nor in the follow-up period. The negative predictive value of CCTA was 100% (95% confidence interval of 90.1-100.0%). In severely obese patients, the absence of obstructive CAD in cardiac CT prior to bariatric surgery with subsequently marked weight reduction has strong long-term prognostic implications for ruling out major adverse cardiac events in the postoperative period.

  17. Prior learning assessment and quality assurance practice ...

    African Journals Online (AJOL)

    The use of RPL (Recognition of Prior Learning) in higher education to assess RPL candidates for admission into programmes of study met with a lot of criticism from faculty academics. Lecturers viewed the possibility of admitting large numbers of under-qualified adult learners, as a threat to the institution's reputation, or an ...

  18. The use of infrared thermography to detect the stages of estrus cycle and ovulation time in anatolian shepherd dogs.

    Science.gov (United States)

    Olğaç, Kemal Tuna; Akçay, Ergun; Çil, Beste; Uçar, Burak Mehmet; Daşkın, Ali

    2017-01-01

    The aim of the study is to evaluate the effectiveness of thermographic monitoring, using the temperature changes of perianal and perivulvar areas for the determination of estrus in Anatolian Shepherd bitches. Fifteen bitches were used in the study. Blood and vaginal smear samples were collected and thermographic monitoring of perianal and perivulvar areas were carried out starting from proestrus to early diestrus. Also, external signs of estrus were investigated. Smear samples were evaluated by light microscopy after Diff-Quik staining method and superficial and keratinized superficial cells were determined as percentage (S + KS%). Progesterone and luteinizing hormone measurements were done by radioimmunoassay. The difference in temperature between perianal and perivulvar areas was evaluated through thermographic images by FLIR ResearchIR Software. According to the results obtained from the study, differences between progesterone and S + KS% were statistically significant ( P   0,05). Serum luteinizing hormone levels did not sign any difference ( P  > 0,05). As a result, thermographic monitoring alone is not enough for estrus detection in Anatolian Shepherd bitches. However, it can be used to assist the actual estrus detection technique in terms of providing some foreknowledge by evaluating the differences in temperature.

  19. The Effects of Prior Outcomes on Risky Choice: Evidence from the Stock Market

    Directory of Open Access Journals (Sweden)

    Fenghua Wen

    2014-01-01

    Full Text Available How do prior outcomes affect the risk choice? Research on this can help people to understand investors’ dynamic decisions in financial market. This paper puts forward a new value function. By analyzing the new value function, we find that the prior gains and losses have an impact on the form of value function and the current investors’ risk attitude. Then the paper takes the behavior of the whole stock market as the research object, adopts aggregative index number of 14 representative stocks around the world as samples, and establishes a TVRA-GARCH-M model to investigate the influences of prior gains and losses on the current risk attitude. The empirical study indicates that, at the whole market level, prior gains increase people’s current willingness to take risk assert; that is to say, the house money effect exists in the market, while people are more risk aversion following prior losses.

  20. Phase transitions in restricted Boltzmann machines with generic priors

    Science.gov (United States)

    Barra, Adriano; Genovese, Giuseppe; Sollich, Peter; Tantari, Daniele

    2017-10-01

    We study generalized restricted Boltzmann machines with generic priors for units and weights, interpolating between Boolean and Gaussian variables. We present a complete analysis of the replica symmetric phase diagram of these systems, which can be regarded as generalized Hopfield models. We underline the role of the retrieval phase for both inference and learning processes and we show that retrieval is robust for a large class of weight and unit priors, beyond the standard Hopfield scenario. Furthermore, we show how the paramagnetic phase boundary is directly related to the optimal size of the training set necessary for good generalization in a teacher-student scenario of unsupervised learning.

  1. CT colonography combined with fistulography - a case of periannal fistula of a 6 months old child

    International Nuclear Information System (INIS)

    Sirakov, N.; Velkova, K.; Sirakov, V.; Tashev, P.

    2007-01-01

    We present a 6 months old child with perianal fistula with repeated secretion from it. The child was examined by double contrast barium enema and transrectal ultrasonography that gave suggestions of perianal fistula with no communication to the rectum and suspicion of a anal duplication of the rectum. The child was examined by CT colonography combined with fistulography. The exam was carried out on a axial CT Somatom Emotion by Siemens. The purpose of our report is to present the results of the combination of CT colonography and fistulography, applied to a 6-month-old child, as well as to present the specific protocol that we used for this examination. (authors)

  2. Thallium 201 Exercise Scintigraphy for Detection of Multivessel Coronary Artery Disease After Transmural Myocardial Infarction

    Science.gov (United States)

    Ahmadpour, Hedayatolah; Siegel, Michael E.; Colletti, Patrick; Haywood, L. Julian

    1984-01-01

    Fifty patients with prior transmural myocardial infarction were studied with cardiac catheterization, coronary angiography, and thallium 201 exercise perfusion scintigraphy. Obstructive coronary disease involved two or three vessels in 37 patients. The sensitivity of a positive electrocardiographic test during exercise for detecting multivessel coronary disease was only 40 percent (15/37), and the sensitivity of a reversible defect on 201Tl perfusion scintigraphy was 48 percent (18/37). The combination of exercise testing and 201Tl scintigraphy detected multivessel coronary disease in 75 percent (28/37) (P < .05). New perfusion defects occurred in 61 percent (13/21) of patients with inferior myocardial infarction and multivessel coronary disease whereas it occurred in only 35 percent (5/14) of patients with prior anterior infarction and multivessel coronary disease (P < .05). 201Tl exercise perfusion scintigraphy appears to be more sensitive for detecting significant multivessel coronary disease in the presence of previous inferior infarction compared with previous anterior infarction. Combined graded exercise testing and 201Tl perfusion scintigraphy can reliably detect the presence of significant multivessel coronary disease after transmural myocardial infarction. ImagesFigure 3 PMID:6512876

  3. Recognition of Prior Learning: The Participants' Perspective

    Science.gov (United States)

    Miguel, Marta C.; Ornelas, José H.; Maroco, João P.

    2016-01-01

    The current narrative on lifelong learning goes beyond formal education and training, including learning at work, in the family and in the community. Recognition of prior learning is a process of evaluation of those skills and knowledge acquired through life experience, allowing them to be formally recognized by the qualification systems. It is a…

  4. Prior-to-Exam: What Activities Enhance Performance?

    Science.gov (United States)

    Rhoads, C. J.; Healy, Therese

    2013-01-01

    Can instructors impact their student performance by recommending an activity just prior to taking an exam? In this study, college students were randomly assigned to one of three treatment groups (study, exercise, or meditation) or a control group. Each group was given two different types of tests; a traditional concept exam, and a non-traditional…

  5. Bayesian linear regression : different conjugate models and their (in)sensitivity to prior-data conflict

    NARCIS (Netherlands)

    Walter, G.M.; Augustin, Th.; Kneib, Thomas; Tutz, Gerhard

    2010-01-01

    The paper is concerned with Bayesian analysis under prior-data conflict, i.e. the situation when observed data are rather unexpected under the prior (and the sample size is not large enough to eliminate the influence of the prior). Two approaches for Bayesian linear regression modeling based on

  6. Seroprevalence of chronic hepatitis B virus infection and prior immunity in immigrants and refugees: a systematic review and meta-analysis.

    Science.gov (United States)

    Rossi, Carmine; Shrier, Ian; Marshall, Lee; Cnossen, Sonya; Schwartzman, Kevin; Klein, Marina B; Schwarzer, Guido; Greenaway, Chris

    2012-01-01

    International migrants experience increased mortality from hepatocellular carcinoma compared to host populations, largely due to undetected chronic hepatitis B infection (HBV). We conducted a systematic review of the seroprevalence of chronic HBV and prior immunity in migrants arriving in low HBV prevalence countries to identify those at highest risk in order to guide disease prevention and control strategies. Medline, Medline In-Process, EMBASE and the Cochrane Database of Systematic Reviews were searched. Studies that reported HBV surface antigen or surface antibodies in migrants were included. The seroprevalence of chronic HBV and prior immunity were pooled by region of origin and immigrant class, using a random-effects model. A random-effects logistic regression was performed to explore heterogeneity. The number of chronically infected migrants in each immigrant-receiving country was estimated using the pooled HBV seroprevalences and country-specific census data. A total of 110 studies, representing 209,822 immigrants and refugees were included. The overall pooled seroprevalence of infection was 7.2% (95% CI: 6.3%-8.2%) and the seroprevalence of prior immunity was 39.7% (95% CI: 35.7%-43.9%). HBV seroprevalence differed significantly by region of origin. Migrants from East Asia and Sub-Saharan Africa were at highest risk and migrants from Eastern Europe were at an intermediate risk of infection. Region of origin, refugee status and decade of study were independently associated with infection in the adjusted random-effects logistic model. Almost 3.5 million migrants (95% CI: 2.8-4.5 million) are estimated to be chronically infected with HBV. The seroprevalence of chronic HBV infection is high in migrants from most world regions, particularly among those from East Asia, Sub-Saharan Africa and Eastern Europe, and more than 50% were found to be susceptible to HBV. Targeted screening and vaccination of international migrants can become an important component of HBV

  7. Seroprevalence of chronic hepatitis B virus infection and prior immunity in immigrants and refugees: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Carmine Rossi

    Full Text Available BACKGROUND: International migrants experience increased mortality from hepatocellular carcinoma compared to host populations, largely due to undetected chronic hepatitis B infection (HBV. We conducted a systematic review of the seroprevalence of chronic HBV and prior immunity in migrants arriving in low HBV prevalence countries to identify those at highest risk in order to guide disease prevention and control strategies. METHODS AND FINDINGS: Medline, Medline In-Process, EMBASE and the Cochrane Database of Systematic Reviews were searched. Studies that reported HBV surface antigen or surface antibodies in migrants were included. The seroprevalence of chronic HBV and prior immunity were pooled by region of origin and immigrant class, using a random-effects model. A random-effects logistic regression was performed to explore heterogeneity. The number of chronically infected migrants in each immigrant-receiving country was estimated using the pooled HBV seroprevalences and country-specific census data. A total of 110 studies, representing 209,822 immigrants and refugees were included. The overall pooled seroprevalence of infection was 7.2% (95% CI: 6.3%-8.2% and the seroprevalence of prior immunity was 39.7% (95% CI: 35.7%-43.9%. HBV seroprevalence differed significantly by region of origin. Migrants from East Asia and Sub-Saharan Africa were at highest risk and migrants from Eastern Europe were at an intermediate risk of infection. Region of origin, refugee status and decade of study were independently associated with infection in the adjusted random-effects logistic model. Almost 3.5 million migrants (95% CI: 2.8-4.5 million are estimated to be chronically infected with HBV. CONCLUSIONS: The seroprevalence of chronic HBV infection is high in migrants from most world regions, particularly among those from East Asia, Sub-Saharan Africa and Eastern Europe, and more than 50% were found to be susceptible to HBV. Targeted screening and vaccination of

  8. Prior adversities predict posttraumatic stress reactions in adolescents following the Oslo Terror events 2011

    Directory of Open Access Journals (Sweden)

    Dag Ø. Nordanger

    2014-05-01

    Full Text Available Background: Former studies suggest that prior exposure to adverse experiences such as violence or sexual abuse increases vulnerability to posttraumatic stress reactions in victims of subsequent trauma. However, little is known about how such a history affects responses to terror in the general adolescent population. Objective: To explore the role of prior exposure to adverse experiences as risk factors for posttraumatic stress reactions to the Oslo Terror events. Method: We used data from 10,220 high school students in a large cross-sectional survey of adolescents in Norway that took place seven months after the Oslo Terror events. Prior exposure assessed was: direct exposure to violence, witnessing of violence, and unwanted sexual acts. We explored how these prior adversities interact with well-established risk factors such as proximity to the events, perceived life threat during the terror events, and gender. Results: All types of prior exposure as well as the other risk factors were associated with terror-related posttraumatic stress reactions. The effects of prior adversities were, although small, independent of adolescents’ proximity to the terror events. Among prior adversities, only the effect of direct exposure to violence was moderated by perceived life threat. Exposure to prior adversities increased the risk of posttraumatic stress reactions equally for both genders, but proximity to the terror events and perceived life threat increased the risk more in females. Conclusions: Terror events can have a more destabilizing impact on victims of prior adversities, independent of their level of exposure. The findings may be relevant to mental health workers and others providing post-trauma health care.

  9. A comprehensive review and update on Crohn's disease.

    Science.gov (United States)

    Gajendran, Mahesh; Loganathan, Priyadarshini; Catinella, Anthony P; Hashash, Jana G

    2018-02-01

    The term inflammatory bowel disease (IBD) refers principally to two major categories of chronic relapsing inflammatory intestinal disorders: Crohn's disease (CD) and ulcerative colitis (UC). In the United States, it is currently estimated that about 1.5 million people suffer from IBD, causing considerable suffering, mortality and economic loss every year. Yet the cause of IBD is unknown, and until we understand more, prevention or cure will not be possible. There is a lot of variation in the incidence and prevalence of CD based on geographic region, environment, immigrant population, and ethnic groups. The annual incidence of CD in North America is reported to be 3.1-20.2 per 100,000 with a prevalence of 201 per 100,000 population. Based on the epidemiological, genetic and immunological data, CD is considered to be a heterogeneous disorder with multifactorial etiology in which genetics and environment interact to manifest the disease. Several genes have been studied so for with respect to CD, but thus far the strong and replicated associations have been identified with NOD2, IL23R and ATG16L1 genes. The risk factors implicated with CD include smoking, low fiber- high carbohydrate diet, altered microbiome and medications such as non-steroidal anti-inflammatory drugs. CD is typically characterized by transmural inflammation of the intestine and could affect any part of the gastrointestinal tract from mouth to perianal area. In terms of distribution of the disease 25% of the patients have colitis only, 25% is ileitis only and 50% have ileocolitis. The Montreal classification is based on the age at diagnosis ( 40), disease location (Ileal, colonic, Ileocolonic) and the disease behavior (nonstricturing/nonpenetrating, stricturing, penetrating). The key features for diagnosing CD comprises a combination of radiographic, endoscopic and pathological findings demonstrating focal, asymmetric, transmural or granulomatous features. Abdominal Computed tomography (CT

  10. Prior Knowledge Improves Decoding of Finger Flexion from Electrocorticographic (ECoG Signals

    Directory of Open Access Journals (Sweden)

    Zuoguan eWang

    2011-11-01

    Full Text Available Brain-computer interfaces (BCIs use brain signals to convey a user's intent. Some BCI approaches begin by decoding kinematic parameters of movements from brain signals, and then proceed to using these signals, in absence of movements, to allow a user to control an output. Recent results have shown that electrocorticographic (ECoG recordings from the surface of the brain in humans can give information about kinematic parameters (eg{} hand velocity or finger flexion. The decoding approaches in these studies usually employed classical classification/regression algorithms that derive a linear mapping between brain signals and outputs. However, they typically only incorporate little prior information about the target movement parameter. In this paper, we incorporate prior knowledge using a Bayesian decoding method, and use it to decode finger flexion from ECoG signals. Specifically, we exploit the anatomic constraints and dynamic constraints that govern finger flexion and incorporate these constraints in the construction, structure, and the probabilistic functions of the prior model of a switched non-parametric dynamic system (SNDS. Given a measurement model resulting from a traditional linear regression method, we decoded finger flexion using posterior estimation that combined the prior and measurement models. Our results show that the application of the Bayesian decoding model, which incorporates prior knowledge, improves decoding performance compared to the application of a linear regression model, which does not incorporate prior knowledge. Thus, the results presented in this paper may ultimately lead to neurally controlled hand prostheses with full fine-grained finger articulation.

  11. Interactive lesion segmentation with shape priors from offline and online learning.

    Science.gov (United States)

    Shepherd, Tony; Prince, Simon J D; Alexander, Daniel C

    2012-09-01

    In medical image segmentation, tumors and other lesions demand the highest levels of accuracy but still call for the highest levels of manual delineation. One factor holding back automatic segmentation is the exemption of pathological regions from shape modelling techniques that rely on high-level shape information not offered by lesions. This paper introduces two new statistical shape models (SSMs) that combine radial shape parameterization with machine learning techniques from the field of nonlinear time series analysis. We then develop two dynamic contour models (DCMs) using the new SSMs as shape priors for tumor and lesion segmentation. From training data, the SSMs learn the lower level shape information of boundary fluctuations, which we prove to be nevertheless highly discriminant. One of the new DCMs also uses online learning to refine the shape prior for the lesion of interest based on user interactions. Classification experiments reveal superior sensitivity and specificity of the new shape priors over those previously used to constrain DCMs. User trials with the new interactive algorithms show that the shape priors are directly responsible for improvements in accuracy and reductions in user demand.

  12. Association between prior vaginal birth after cesarean and subsequent labor outcome.

    Science.gov (United States)

    Krispin, Eyal; Hiersch, Liran; Wilk Goldsher, Yulia; Wiznitzer, Arnon; Yogev, Yariv; Ashwal, Eran

    2018-04-01

    To estimate the effect of prior successful vaginal birth after cesarean (VBAC) on the rate of uterine rupture and delivery outcome in women undergoing labor after cesarean. A retrospective cohort study of all women attempting labor after cesarean delivery in a university-affiliated tertiary-hospital (2007-2014) was conducted. Study group included women attempting vaginal delivery with a history of cesarean delivery and at least one prior VBAC. Control group included women attempting first vaginal delivery following cesarean delivery. Primary outcome was defined as the rate of uterine rupture. Secondary outcomes were delivery and maternal outcomes. Of 62,463 deliveries during the study period, 3256 met inclusion criteria. One thousand two hundred and eleven women had VBAC prior to the index labor and 2045 underwent their first labor after cesarean. Women in the study group had a significantly lower rate of uterine rupture 9 (0.7%) in respect to control 33 (1.6%), p = .036, and had a higher rate of successful vaginal birth (96 vs. 84.9%, p cesarean, prior VBAC appears to be associated with lower rate of uterine rupture and higher rate of successful vaginal birth.

  13. Performance of informative priors skeptical of large treatment effects in clinical trials: A simulation study.

    Science.gov (United States)

    Pedroza, Claudia; Han, Weilu; Thanh Truong, Van Thi; Green, Charles; Tyson, Jon E

    2018-01-01

    One of the main advantages of Bayesian analyses of clinical trials is their ability to formally incorporate skepticism about large treatment effects through the use of informative priors. We conducted a simulation study to assess the performance of informative normal, Student- t, and beta distributions in estimating relative risk (RR) or odds ratio (OR) for binary outcomes. Simulation scenarios varied the prior standard deviation (SD; level of skepticism of large treatment effects), outcome rate in the control group, true treatment effect, and sample size. We compared the priors with regards to bias, mean squared error (MSE), and coverage of 95% credible intervals. Simulation results show that the prior SD influenced the posterior to a greater degree than the particular distributional form of the prior. For RR, priors with a 95% interval of 0.50-2.0 performed well in terms of bias, MSE, and coverage under most scenarios. For OR, priors with a wider 95% interval of 0.23-4.35 had good performance. We recommend the use of informative priors that exclude implausibly large treatment effects in analyses of clinical trials, particularly for major outcomes such as mortality.

  14. Compressive Online Robust Principal Component Analysis with Multiple Prior Information

    DEFF Research Database (Denmark)

    Van Luong, Huynh; Deligiannis, Nikos; Seiler, Jürgen

    -rank components. Unlike conventional batch RPCA, which processes all the data directly, our method considers a small set of measurements taken per data vector (frame). Moreover, our method incorporates multiple prior information signals, namely previous reconstructed frames, to improve these paration...... and thereafter, update the prior information for the next frame. Using experiments on synthetic data, we evaluate the separation performance of the proposed algorithm. In addition, we apply the proposed algorithm to online video foreground and background separation from compressive measurements. The results show...

  15. Pseudocarcinomatous epithelial hyperplasia in the bladder unassociated with prior irradiation or chemotherapy.

    Science.gov (United States)

    Lane, Zhaoli; Epstein, Jonathan I

    2008-01-01

    Pseudocarcinomatous epithelial hyperplasia in the bladder is a little known phenomenon, recognized to be associated with prior irradiation and/or chemotherapy. Whether this process can occur outside of this setting has not been studied. We identified 8 of these cases mimicking invasive urothelial carcinoma from our consultation files from 07/04 to 07/06 with no prior history of radiation or chemotherapy. The mean age at diagnosis was 65 years (range, 42 to 81 y), with 5 of the 8 males. Seven patients had a potential etiology for these changes that could either have resulted in localized ischemia or injury to the urothelium. These included case 1: atrial fibrillation, hypertension, congestive heart failure, gastrointestinal bleeding, and coronary artery vascular disease; case 2: coronary angioplasty, atrial fibrillation, hyperlipidemia, and amputation of arm for ischemia; case 3: hypertension, uncontrolled diabetes, hyperlipidemia, and atrial fibrillation; case 4: underlying arteriovenous malformation of the bladder; cases 5 to 6: history of indwelling Foley catheter; and case 7: history of radical prostatectomy for prostate cancer but no radiation. One patient had no potential contributing factors. All 8 patients presented with gross hematuria. At cystoscopy, 7 patients had polypoid lesions with 1 appearing nonpolypoid. Histologically, all cases showed epithelial proliferation of urothelium with cells having prominent eosinophilic cytoplasm. This process that mimicked invasive cancer within the lamina propria was marked in 3 cases (38%). Moderate nuclear pleomorphism was seen in 6 cases (75%). Only 1 case revealed mitotic figures. Ulceration was seen in 1 case. All cases showed some degree of hemorrhage with hemosiderin deposition identified in 3 cases (38%). Fibrin deposition was present in 1 case within the stroma, 3 cases in the vessels, and 4 cases in both. Five cases show stromal fibrosis. Edema and vascular congestion were common features (90% and 100

  16. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study.

    Science.gov (United States)

    Ng, Siew C; Tang, Whitney; Ching, Jessica Y; Wong, May; Chow, Chung Mo; Hui, A J; Wong, T C; Leung, Vincent K; Tsang, Steve W; Yu, Hon Ho; Li, Mo Fong; Ng, Ka Kei; Kamm, Michael A; Studd, Corrie; Bell, Sally; Leong, Rupert; de Silva, H Janaka; Kasturiratne, Anuradhani; Mufeena, M N F; Ling, Khoon Lin; Ooi, Choon Jin; Tan, Poh Seng; Ong, David; Goh, Khean L; Hilmi, Ida; Pisespongsa, Pises; Manatsathit, Sathaporn; Rerknimitr, Rungsun; Aniwan, Satimai; Wang, Yu Fang; Ouyang, Qin; Zeng, Zhirong; Zhu, Zhenhua; Chen, Min Hu; Hu, Pin Jin; Wu, Kaichun; Wang, Xin; Simadibrata, Marcellus; Abdullah, Murdani; Wu, Justin Cy; Sung, Joseph J Y; Chan, Francis K L

    2013-07-01

    Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

  17. [Pregnancy in systemic autoimmune diseases: Myths, certainties and doubts].

    Science.gov (United States)

    Danza, Álvaro; Ruiz-Irastorza, Guillermo; Khamashta, Munther

    2016-10-07

    Systemic autoimmune diseases especially affect young women during childbearing age. The aim of this review is to update systemic lupus erythematosus, antiphospholipid syndrome and systemic sclerosis management during pregnancy. These diseases present variable maternal and fetal risks. Studies show that an appropriate disease control and a reasonable remission period prior to pregnancy are associated with satisfactory obstetric outcomes. Antiphospholipid autoantibodies profile, anti-Ro/anti-La antibodies, pulmonary pressure and activity evaluation are crucial to assess the pregnancy risk. Monitoring requires a multidisciplinary team, serial analytic controls and Doppler ultrasound of maternal and fetal circulation. Evaluation of the activity of the disease is essential. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  18. ROLE OF ECOLOGICAL DISTURBANCES IN EMERGENCE OF SYLVATIC ZOONOSES AND NIDAL DISEASES

    Directory of Open Access Journals (Sweden)

    Shivaji Bhattacharya

    2012-01-01

    Full Text Available Influence of human civilization and disturbance of ecology has an important role on the evolution and emergence of new sylvatic zoonoses as well as nidal diseases.Proper study of different causes and mechanisms of escape of disease agents from their natural boundaries of niche and taking of suitable biosecurity measures for those diseases should be ensured prior to any developmental and welfare activities of human which are responsible for any kind of ecological disturbance.

  19. Coronary heart disease is not significantly linked to acute kidney injury identified using Acute Kidney Injury Group criteria.

    Science.gov (United States)

    Yayan, Josef

    2012-01-01

    Patients with unstable angina or myocardial infarction are at risk of acute kidney injury, which may be aggravated by the iodine-containing contrast agent used during coronary angiography; however, the relationship between these two conditions remains unclear. The current study investigated the relationship between acute kidney injury and coronary heart disease prior to coronary angiography. All patients were evaluated after undergoing coronary angiography in the cardiac catheterization laboratory of the Vinzentius Hospital in Landau, Germany, in 2011. The study group included patients with both acute coronary heart disease and acute kidney injury (as defined according to the classification of the Acute Kidney Injury Group); the control group included patients without acute coronary heart disease. Serum creatinine profiles were evaluated in all patients, as were a variety of demographic and health characteristics. Of the 303 patients examined, 201 (66.34%) had coronary artery disease. Of these, 38 (18.91%) also had both acute kidney injury and acute coronary heart disease prior to and after coronary angiography, and of which in turn 34 (16.91%) had both acute kidney injury and acute coronary heart disease only prior to the coronary angiography. However, the occurrence of acute kidney injury was not significantly related to the presence of coronary heart disease (P = 0.95, Chi-square test). The results of this study indicate that acute kidney injury is not linked to acute coronary heart disease. However, physicians should be aware that many coronary heart patients may develop kidney injury while hospitalized for angiography.

  20. Prior Expectations Bias Sensory Representations in Visual Cortex

    NARCIS (Netherlands)

    Kok, P.; Brouwer, G.J.; Gerven, M.A.J. van; Lange, F.P. de

    2013-01-01

    Perception is strongly influenced by expectations. Accordingly, perception has sometimes been cast as a process of inference, whereby sensory inputs are combined with prior knowledge. However, despite a wealth of behavioral literature supporting an account of perception as probabilistic inference,

  1. Do Managers Manipulate Earnings Prior to Management Buyouts?

    NARCIS (Netherlands)

    Mao, Y.; Renneboog, L.D.R.

    2013-01-01

    Abstract: To address the question as to whether managers manipulate accounting numbers downwards prior to management buyouts (MBOs), we implement an industry-adjusted buyout-specific approach and receive an affirmative answer. In UK buyout companies, negative earnings manipulation (understating the

  2. Bayesian nonparametric system reliability using sets of priors

    NARCIS (Netherlands)

    Walter, G.M.; Aslett, L.J.M.; Coolen, F.P.A.

    2016-01-01

    An imprecise Bayesian nonparametric approach to system reliability with multiple types of components is developed. This allows modelling partial or imperfect prior knowledge on component failure distributions in a flexible way through bounds on the functioning probability. Given component level test

  3. A scale-free structure prior for graphical models with applications in functional genomics.

    Directory of Open Access Journals (Sweden)

    Paul Sheridan

    Full Text Available The problem of reconstructing large-scale, gene regulatory networks from gene expression data has garnered considerable attention in bioinformatics over the past decade with the graphical modeling paradigm having emerged as a popular framework for inference. Analysis in a full Bayesian setting is contingent upon the assignment of a so-called structure prior-a probability distribution on networks, encoding a priori biological knowledge either in the form of supplemental data or high-level topological features. A key topological consideration is that a wide range of cellular networks are approximately scale-free, meaning that the fraction, , of nodes in a network with degree is roughly described by a power-law with exponent between and . The standard practice, however, is to utilize a random structure prior, which favors networks with binomially distributed degree distributions. In this paper, we introduce a scale-free structure prior for graphical models based on the formula for the probability of a network under a simple scale-free network model. Unlike the random structure prior, its scale-free counterpart requires a node labeling as a parameter. In order to use this prior for large-scale network inference, we design a novel Metropolis-Hastings sampler for graphical models that includes a node labeling as a state space variable. In a simulation study, we demonstrate that the scale-free structure prior outperforms the random structure prior at recovering scale-free networks while at the same time retains the ability to recover random networks. We then estimate a gene association network from gene expression data taken from a breast cancer tumor study, showing that scale-free structure prior recovers hubs, including the previously unknown hub SLC39A6, which is a zinc transporter that has been implicated with the spread of breast cancer to the lymph nodes. Our analysis of the breast cancer expression data underscores the value of the scale

  4. Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy (GATT) in Eyes With Prior Incisional Glaucoma Surgery.

    Science.gov (United States)

    Grover, Davinder S; Godfrey, David G; Smith, Oluwatosin; Shi, Wei; Feuer, William J; Fellman, Ronald L

    2017-01-01

    To report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior incisional glaucoma surgery. A retrospective review was performed for all patients who underwent a GATT procedure with a history of prior incisional glaucoma surgery. Thirty-five eyes of 35 patients were treated. The mean age was 67.7 years. Nineteen eyes had a prior trabeculectomy, 13 eyes had a prior glaucoma drainage device, 4 eyes had a prior trabectome, and 5 eyes had prior endocyclophotocoagulation. Mean follow-up time was 22.7 months. For all eyes, the mean preoperative intraocular pressure (IOP) (SD) was 25.7 (6.5) mm Hg on 3.2 (1.0) glaucoma medications and at 24 months, the mean IOP (SD) was 15.4 (4.9) mm Hg on 2.0 (1.4) glaucoma medications (P<0.001). The prior trabeculectomy group had a preoperative IOP (SD) of 24.6 (6.4) mm Hg on 3.2 (1.0) medications and at month 24, the mean IOP (SD) was 16.7 (5.6) mm Hg on 2.1 (1.4) glaucoma medications. In the prior glaucoma drainage device group, the mean preoperative IOP (SD) was 27.0 (7.1) mm Hg on 3.4 (1.1) glaucoma medications and at 24 months, the mean IOP (SD) was 12.9 (2.6) mm Hg on 2.1 (1.2) glaucoma medications. At 24 months, the cumulative proportion of failure was 0.4 and the cumulative proportion of reoperation was 0.29. GATT appears to be safe and successful in treating 60% to 70% of open-angle patients with prior incisional glaucoma surgery. When considering all eyes, there was a significant decrease in IOP and required glaucoma medications at 24 months. This surgery should be considered in certain patients with open angles who have failed a primary traditional glaucoma surgery.

  5. Compositional-prior-guided image reconstruction algorithm for multi-modality imaging

    Science.gov (United States)

    Fang, Qianqian; Moore, Richard H.; Kopans, Daniel B.; Boas, David A.

    2010-01-01

    The development of effective multi-modality imaging methods typically requires an efficient information fusion model, particularly when combining structural images with a complementary imaging modality that provides functional information. We propose a composition-based image segmentation method for X-ray digital breast tomosynthesis (DBT) and a structural-prior-guided image reconstruction for a combined DBT and diffuse optical tomography (DOT) breast imaging system. Using the 3D DBT images from 31 clinically measured healthy breasts, we create an empirical relationship between the X-ray intensities for adipose and fibroglandular tissue. We use this relationship to then segment another 58 healthy breast DBT images from 29 subjects into compositional maps of different tissue types. For each breast, we build a weighted-graph in the compositional space and construct a regularization matrix to incorporate the structural priors into a finite-element-based DOT image reconstruction. Use of the compositional priors enables us to fuse tissue anatomy into optical images with less restriction than when using a binary segmentation. This allows us to recover the image contrast captured by DOT but not by DBT. We show that it is possible to fine-tune the strength of the structural priors by changing a single regularization parameter. By estimating the optical properties for adipose and fibroglandular tissue using the proposed algorithm, we found the results are comparable or superior to those estimated with expert-segmentations, but does not involve the time-consuming manual selection of regions-of-interest. PMID:21258460

  6. Topical video object discovery from key frames by modeling word co-occurrence prior.

    Science.gov (United States)

    Zhao, Gangqiang; Yuan, Junsong; Hua, Gang; Yang, Jiong

    2015-12-01

    A topical video object refers to an object, that is, frequently highlighted in a video. It could be, e.g., the product logo and the leading actor/actress in a TV commercial. We propose a topic model that incorporates a word co-occurrence prior for efficient discovery of topical video objects from a set of key frames. Previous work using topic models, such as latent Dirichelet allocation (LDA), for video object discovery often takes a bag-of-visual-words representation, which ignored important co-occurrence information among the local features. We show that such data driven co-occurrence information from bottom-up can conveniently be incorporated in LDA with a Gaussian Markov prior, which combines top-down probabilistic topic modeling with bottom-up priors in a unified model. Our experiments on challenging videos demonstrate that the proposed approach can discover different types of topical objects despite variations in scale, view-point, color and lighting changes, or even partial occlusions. The efficacy of the co-occurrence prior is clearly demonstrated when compared with topic models without such priors.

  7. Efficacy in the use of local anesthesia in patients with surgical intervention for the resolution of anorectal pathologies

    Directory of Open Access Journals (Sweden)

    Victoria Dowling

    2018-01-01

    Full Text Available A prospective, comparative, longitudinal study was conducted in the period from April 2016 to January 2017 in order to determine the efficacy of local anesthesia for the surgical resolution of anorectal pathologies in surgically operated patients who attended the General University Hospital “Luis Gomez Lopez. Thus, the population was composed of patients with anorectal pathologies of low complexity, with no previous anorectal surgical history (Hemorrhoids, anal fissure, perianal fistula, hypertrophic anal papilla, perianal condyloma acuminata, which were agreed to be included in this study, without contraindications for use of local anesthesia. A non-probabilistic, intentional sample was made up of 30 patients and the anesthetic protocol was administered following an anesthetic protocol of perianal local anesthesia using anesthetic mixture (70% of 2% lidocaine + 30% of 0.5% bupivacaine quantifying pain tolerance during the intraoperative period on the first and fifth postoperative days, as well as any adverse effects. The results were expressed in absolute numbers and percentages; a good tolerance to pain was observed with some differences related to the sex of the individuals studied; no complications were observed. Resumo: Esse estudo prospectivo, comparativo e longitudinal foi realizado no período de abril de 2016 a janeiro de 2017, com o objetivo de determinar a eficácia da anestesia local para resolução cirúrgica de patologias anorretais em pacientes cirurgicamente operados que compareceram no Hospital Geral Universitário Luis Gomez Lopes. Essa população se compunha de pacientes com patologias anorretais de baixa complexidade, sem história prévia de cirurgia anorretal (hemorroidas, fissura anal, fístula perianal, papila anal hipertrófica, condiloma acuminado perianal, com prévia concordância em participar no presente estudo e sem contraindicações para o uso de anestesia local. Foi obtida uma amostra intencional e n

  8. Carotid and coronary disease management prior to open and endovascular aortic surgery. What are the current guidelines?

    Science.gov (United States)

    Thompson, J P

    2014-04-01

    Several bodies produce broadly concurring and updated guidelines for the evaluation and treatment of cardiovascular disease in both surgical and non-surgical patients. Recent developments include revised recommendations on preoperative stress testing, referral for possible coronary revascularization and medical management. It is recognized that non-invasive cardiac tests are relatively poor at predicting perioperative risk, and "prophylactic" coronary revascularization has a limited role. The planned aortic intervention (open or endovascular repair) also influences preoperative management. Patients presenting for elective abdominal aortic aneurysm (AAA) repair should only be referred for cardiological testing if they have active symptoms of coronary artery disease (CAD), known CAD and poor functional exercise capacity, or multiple risk factors for CAD. Coronary revascularization before AAA surgery should be limited to patients with established indications, so cardiac stress testing should only be performed if it would change management i.e. the patient is a candidate for and would benefit from coronary revascularization. When endovascular aortic repair is planned, it is reasonable to proceed to surgery without further cardiac stress testing or evaluation unless otherwise indicated. All non-emergency patients require medical optimization, but perioperative beta blockade benefits only certain patients. Some of the data informing recent guidelines have been questioned and some guidelines are being revised. Current guidelines do not specifically address the management of patients with known or suspected carotid artery disease who may require aortic surgery. For these patients, an individualized approach is required. This review considers recent guidelines. Algorithms for investigation and management based on their recommendations are included.

  9. Diseases associated with hidranitis suppurativa: part 2 of a series on hidradenitis.

    Science.gov (United States)

    Scheinfeld, Noah

    2013-06-15

    diseases is likely underreported. Pyoderma vegetans has been noted in 2 cases of HS and 4 cases of Inflammatory Bowel Disease (IBD) and is likely a clue to the linkage of the pathology of IBD and HS. Pityriasis rubra pilaris, in particular Type VI related to HIV, has a relationship more commonly with acne conglobata, but with HS also. Single case reports of diseases associated with HS include systemic lupus erythematosus, acromegaly, Down syndrome, Bazex-Dupre´-Christol, and prurtis ani, but these might be coincidences. Pyogenic Arthritis, Pyoderma gangrenosum, and Acne (PAPA Syndrome) and Pyoderma gangrenosum, Acne, and Suppurative Hidradenitis (PASH Syndrome) are pyodermic-arthritic syndromes that are associated with HS. Erythema nodosum and granulomatous lobular mastitis have been reported with HS but the significance of these reports is uncertain. Because of scarring, HS can result in lymphedema including scrotal elephantiasis and verrucous lymphedema. HS is sometimes accompanied by obesity, hypertension, and anemia and can be considered a disease in the spectrum of metabolic syndrome, a skin disease with systemic consequences. HS, like other types of chronic inflammation when long standing in the perianal and perineal areas, can result in squamous cell cancer. A variety of drugs can induce HS. These include lithium, sirolimus, cyclosporine, vemurafenib, and oral contraceptives. Inverse psoriasis or psoriasis vulgaris as a side effect of infliximab therapy may be associated with HS. These associations aside, most cases of HS occur in isolation without coincident morbidity.

  10. 20 CFR 404.1247 - When to report wages-for wages paid prior to 1987.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When to report wages-for wages paid prior to... Report Wages and Contributions-for Wages Paid Prior to 1987 § 404.1247 When to report wages—for wages paid prior to 1987. A State shall report wages for the calendar year in which they were actually paid...

  11. Preoperative Tracheostomy Is Associated with Poor Disease-Free Survival in Recurrent Laryngeal Cancer.

    Science.gov (United States)

    Birkeland, Andrew C; Rosko, Andrew J; Beesley, Lauren; Bellile, Emily; Chinn, Steven B; Shuman, Andrew G; Prince, Mark E; Wolf, Gregory T; Bradford, Carol R; Brenner, J Chad; Spector, Matthew E

    2017-09-01

    Objectives It is unknown if preoperative tracheostomy for persistent/recurrent laryngeal squamous cell carcinoma (LSCC) plays a role in unrecognized local disease spread and disease recurrence after salvage laryngectomy. The goals of this study were to determine the effect of preoperative tracheostomy on disease-free survival (DFS) in patients with recurrent/persistent LSCC undergoing salvage laryngectomy. Study Design Retrospective case series derived from prospectively maintained database. Setting Tertiary care academic center. Subjects Patients with recurrent/persistent LSCC after radiation/chemoradiation (RT/CRT) who underwent salvage laryngectomy at the University of Michigan from 1997 to 2015. Methods Demographic, clinical, pathologic, and survival data were collected. Kaplan-Meier survival estimates were performed. Results DFS was worse for patients with tracheostomy prior to laryngectomy than patients without a tracheostomy (5 year: 39% vs 67%; P tracheostomy prior to RT/CRT compared to patients with tracheostomy after RT/CRT or patients without a tracheostomy had worse DFS (5-year: 25%, 49%, and 67%, respectively; P tracheostomy was associated with worse DFS. In multivariable analysis, presence of a preoperative tracheostomy had a worse DFS (hazard ratio, 1.63; 95% confidence interval, 1.00-2.67; P = .048). Conclusion Preoperative tracheostomy is associated with disease recurrence in patients with persistent/recurrent LSCC undergoing salvage laryngectomy, particularly in patients who had tracheostomy prior to completion of initial RT/CRT. Notably, preoperative tracheostomy as a causal factor vs marker for disease recurrence is difficult to ascertain. Nevertheless, clinicians should be aware of the increased risk of locoregional recurrence in patients with preoperative tracheostomy when counseling on surgical salvage and when considering the role of additional therapy.

  12. A gluten-free diet effectively reduces symptoms and health care consumption in a Swedish celiac disease population.

    Science.gov (United States)

    Norström, Fredrik; Sandström, Olof; Lindholm, Lars; Ivarsson, Anneli

    2012-09-17

    A gluten-free diet is the only available treatment for celiac disease. Our aim was to investigate the effect of a gluten-free diet on celiac disease related symptoms, health care consumption, and the risk of developing associated immune-mediated diseases. A questionnaire was sent to 1,560 randomly selected members of the Swedish Society for Coeliacs, divided into equal-sized age- and sex strata; 1,031 (66%) responded. Self-reported symptoms, health care consumption (measured by health care visits and hospitalization days), and missed working days were reported both for the year prior to diagnosis (normal diet) and the year prior to receiving the questionnaire while undergoing treatment with a gluten-free diet. Associated immune-mediated diseases (diabetes mellitus type 1, rheumatic disease, thyroid disease, vitiligo, alopecia areata and inflammatory bowel disease) were self-reported including the year of diagnosis. All investigated symptoms except joint pain improved after diagnosis and initiated gluten-free diet. Both health care consumption and missed working days decreased. Associated immune-mediated diseases were diagnosed equally often before and after celiac disease diagnosis. Initiated treatment with a gluten-free diet improves the situation for celiac disease patients in terms of reduced symptoms and health care consumption. An earlier celiac disease diagnosis is therefore of great importance.

  13. Diagnostic challenges of early Lyme disease: Lessons from a community case series

    Directory of Open Access Journals (Sweden)

    Schwarzwalder Alison

    2009-06-01

    Full Text Available Abstract Background Lyme disease, the most common vector-borne infection in North America, is increasingly reported. When the characteristic rash, erythema migrans, is not recognized and treated, delayed manifestations of disseminated infection may occur. The accuracy of diagnosis and treatment of early Lyme disease in the community is unknown. Methods A retrospective, consecutive case series of 165 patients presenting for possible e