21 CFR 520.1200 - Ivermectin, fenbendazole, and praziquantel tablets.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Ivermectin, fenbendazole, and praziquantel tablets... Ivermectin, fenbendazole, and praziquantel tablets. (a) Specifications. Each chewable tablet contains either: (1) 68 micrograms (µg) ivermectin, 1.134 grams fenbendazole, and 57 milligrams (mg) praziquantel; or...

Infecção por clonorchis sinensis em imigrantes asiáticos no Brasil: tratamento com praziquantel Clonorchis sinensis infection in asian immigrants in Brazil: treatment with praziquantel

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O. H. M. Leite

1989-12-01

studied patients were admitted to hospital and treated with praziquantel (60 mg/ kg. Previous to treatment and on the 15th, 30th and 60th days after praziquantel administration, patients were submitted to quantitative stool examinations, according to Kato-Katz's technique and to hematological and biochemical serum analysis. After a 60 day follow-up nine patients (609c were negative for C. sinensis eggs in stools. Those not cured after praziquantel administration (six patients, 40% revealed a sharp decline in faecal elimination of C. sinensis eggs.

Schistosoma haematobium treatment in 1-5 year old children: safety and efficacy of the antihelminthic drug praziquantel.

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Francisca Mutapi

2011-05-01

Full Text Available Morbidity due to schistosomiasis is currently controlled by treatment of schistosome infected people with the antihelminthic drug praziquantel (PZQ. Children aged up to 5 years are currently excluded from schistosome control programmes largely due to the lack of PZQ safety data in this age group. This study investigated the safety and efficacy of PZQ treatment in such children.Zimbabwean children aged 1-5 years (n = 104 were treated with PZQ tablets and side effects were assessed by questionnaire administered to their caregivers within 24 hours of taking PZQ. Treatment efficacy was determined 6 weeks after PZQ administration through schistosome egg counts in urine. The change in infection levels in the children 1-5 years old (n = 100 was compared to that in 6-10 year old children (n = 435.Pre-treatment S. haematobium infection intensity in 1-5 year olds was 14.6 eggs/10 ml urine and prevalence was 21%. Of the 104 children, 3.8% reported side effects within 24 hours of taking PZQ treatment. These were stomach ache, loss of appetite, lethargy and inflammation of the face and body. PZQ treatment significantly reduced schistosome infection levels in 1-5 year olds with an egg reduction rate (ERR of 99% and cure rate (CR of 92%. This was comparable to the efficacy of praziquantel in 6-10 year olds where ERR was 96% and CR was 67%. INTERPRETATION/SIGNIFICANCE: PZQ treatment is as safe and efficacious in children aged 1-5 years as it is in older children aged 6-10 years in whom PZQ is the drug of choice for control of schistosome infections.

Evaluation of the efficacy of emodepside+praziquantel topical solution against cestode (Dipylidium caninum, Taenia taeniaeformis, and Echinococcus multilocularis) infections in cats.

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Charles, S D; Altreuther, G; Reinemeyer, C R; Buch, J; Settje, T; Cruthers, L; Kok, D J; Bowman, D D; Kazacos, K R; Jenkins, D J; Schein, E

2005-10-01

Emodepside+praziquantel topical solution was developed to provide broad-spectrum anthelmintic activity against gastrointestinal parasites in cats. Eight controlled studies were conducted to evaluate the efficacy of a topical solution of emodepside (3 mg/kg) and praziquantel (12 mg/kg) (Profender, BayerAG, Leverkusen, Germany) against feline infections with three species of cestodes. Studies featured naturally acquired infections of Dipylidium caninum or Taenia taeniaeformis, or experimental infections with Echinococcus multilocularis that were placebo-controlled, randomized and blinded. Cats were euthanatized and necropsied between 2 and 11 days after treatment, depending on the target parasite. The efficacy of emodepside+praziquantel topical solution was 100% against D. caninum and T. taeniaeformis, and 98.5- 100% against E. multilocularis. No significant systemic or local adverse reactions to treatment were noted in cats that received the combination. Topical treatment of cats with emodepside+praziquantel topical solution was safe and highly effective against cestode infections.

The impact of urinary schistosomiasis and praziquantel treatment on the nutritional status of Sudanese schoolchildren: a double Blind Placebo controlled study

International Nuclear Information System (INIS)

Raja'a, Yahia Ahmed

1997-08-01

A longitudinal double blind study was designed to investigate the impact of urinary schistosomiasis infection on the nutritional status of school children, in Rahad area of Northern kordofan. The children were allocated at random to either praziquantel treatment or placebo and followed for one year. The effect of the infection and resultant pathology, environmental and demographic factors, the dietary practices and socioeconomic conditions on the nutritional status of 800 children were studied cross- sectionally. Anthropometry and iron status were the indicators of the nutritional status in the study. The effect of praziquantel treatment on the nutritional status was assessed after 6 and 12 months. The data revealed a prevalence rate of 24.4% among 3880 boys and girls screened for urinary schistosomiasis in the town and villages surrounding the lagoon Turda. The study revealed statistically significant differences in intensity of infection when analyzed against sex, ethic group and frequency of visits to Turda. the intensity was greater among boys (t-value=2.45, p=0.015), non-arabs -t-value=2.64,p=0.009) and in those who visited the Turda>4 times a week (t-value=2.35 and p=0.017) than girls, arabs or those who less frequently visited Turda. Alternatively, no significant differences were found with age, rural or urban residence, presents literacy, house-latrine availability or home closeness to the Turda. The assessment of nutritional status revealed that 6 children (0.9%) were severely wasted i.e. very thin. The mildly wasted were 70 cases (10.9%), while severely stunted (very short) children were (1%) and mildly stunted were 69 (8.9%). seb ere undernutrition was indicated in 3 cases (0.4%) and mildly under nourished were 100 cases (12.8). The mean Hb concentration in all of the children was found to be 122.2±11.6 g/l. The mean ferritin concentration in the children who were infected with S.Haematobium and had negative malaria blood film was to be 28.6±2.3 ng

A new soluble and bioactive polymorph of praziquantel.

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Zanolla, Debora; Perissutti, Beatrice; Passerini, Nadia; Chierotti, Michele R; Hasa, Dritan; Voinovich, Dario; Gigli, Lara; Demitri, Nicola; Geremia, Silvano; Keiser, Jennifer; Cerreia Vioglio, Paolo; Albertini, Beatrice

2018-01-30

Praziquantel is the only available drug to treat Schistosomiasis. However, its utilization is limited by many drawbacks, including the high therapeutic dose needed, resulting in large tablets and capsules difficult to be swallowed, especially from pediatric patients. In this study, an alternative option to overcome these disadvantages is proposed: to switch to a novel crystalline polymorph of racemic compound praziquantel. The preparation of the crystalline polymorph was realized via a neat grinding process in a vibrational mill. The new phase (Form B) was chemically identical to the starting material (as proved by HPLC, 1 H-NMR, and polarimetry), but showed different physical properties (as evaluated by SEM, differential scanning calorimetry, thermogravimetry, ATR-FTIR spectroscopy, X-ray powder diffraction, and solid-state NMR). Furthermore, the crystal structure of the new phase was solved from the powder synchrotron X-ray diffraction pattern, resulting in a monoclinic C2/c cell and validated by DFT-D calculation. Moreover the simulated solid-state NMR 13 C chemical shifts were in excellent agreement with the experimental data. The conversion of original praziquantel into Form B showed to affect positively the water solubility and the intrinsic dissolution rate of praziquantel. Both the in vitro and in vivo activity against Schistosoma mansoni were maintained. Our findings suggest that the new phase, that proved to be physically stable for at least one year, is a promising product for designing a new praziquantel formulation. Copyright © 2018. Published by Elsevier B.V.

Mini-review: the ultrasonographical and serological chanbges and their improvement after praziquantel treatment Schistosoma japonicum infected patients in Leyete, Philippines

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Manami Tanaka

1992-01-01

Full Text Available We have identified the specific ultrasonographical (US changes in Schistosoma japonicum infected patients with the serological changes in general liver function markers. The US examination with the following haematological and biochemical serum analysis was performed on 102 patients in Shistosomiasis Hospital, Leyte, Philippines. The US liver images were classified into 4 patterns according to the development of periportal fibrosis and the patterns of echogenic bands. Among various haematological and biochemical serum parameters of liver damage. The serum levels of total bile acid (TBA and procollagen-III-peptide (P-III-P correlated well with the development of hepatic fibrosis and the portal hypertension. These patients were subsequently treated with praziquantel (3 x 20 mg/kg, and improvement of the thickening of the portal vein wall and the dintensity of the echogenic band formation was detected 6 months after treatment. The significant US changes could not be detected in the patients with severe hepatic fibrosis caused in the long term infection. The results revealed that the US examination with the serum TBa level would provider a sensitive tool monitor the severity of the infection and also the improvement occured shortly after praziquantel treatment.

The adverse effects of albendazole and praziquantel in mass drug ...

African Journals Online (AJOL)

In 2005 children in Mwea schools were treated with albendazole 400mg and praziquantel. 40mg/kg body ... treatment to three hundred children in one day, which makes the approach cost effective and should be ... sex, and whether they had had headache, fever, cough, .... incase of severe side effects their efficacy may not.

Comparative efficacy of one versus two doses of praziquantel on cure rate of Schistosoma mansoni infection and re-infection in Mayuge District, Uganda

DEFF Research Database (Denmark)

Tukahebwa, Edridah M.; Vennervald, Birgitte J; Nuwaha, Fred

2013-01-01

BACKGROUND: The current recommended control strategy for schistosomiasis is annual treatment using 40 mg/kg of praziquantel. However, praziquantel is only effective on adult worms and giving a second dose may increase its efficacy. We assessed the effect of one versus two doses of praziquantel...... on cure rate and re-infection with Schistosoma mansoni in a high endemic community along Lake Victoria, Uganda. METHODOLOGY: To investigate the effect of the two regimens, 395 infected people were randomised into two groups; one received a single standard dose of praziquantel (Distocide® 600 mg, Shin...... Poong Pharmaceuticals, Seoul, Republic of Korea), 40mg/kg body weight, while the other group received a second dose 2 weeks later. Cure rate and infection intensity were assessed 9 weeks after the first treatment using standard parasitological procedures. Re-infection levels were monitored 8 and 24...

In vitro uptake of 14C-praziquantel by cestodes, trematodes, and a nematode

International Nuclear Information System (INIS)

Andrews, P.; Thomas, H.; Weber, H.

1980-01-01

14 C-praziquantel was rapidly taken up by Schistosoma mansoni, Fasciola hepatica, Hymenolepis nana, and isolated strobilocerci of Taenia taeniaeformis. Schistosoma mansoni lost praziquantel rapidly to drug-free medium. Chromatography of extracts prepared after incubation of S. mansoni and H. nana yielded no indication that praziquantel was metabolized. Autoradiography revealed a uniform distribution of praziquantel throughout the tissues of S. mansoni and H. nana. Uptake was considerably slower in the nematode Heterakis spumosa and apparently via the oral route

Efficacy and safety of praziquantel in preschool-aged children in an area co-endemic for Schistosoma mansoni and S. haematobium.

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Jean T Coulibaly

Full Text Available In sub-Saharan Africa the recommended strategy to control schistosomiasis is preventive chemotherapy. Emphasis is placed on school-aged children, but in high endemicity areas, preschool-aged children are also at risk, and hence might need treatment with praziquantel. Since a pediatric formulation (e.g., syrup is not available outside of Egypt, crushed praziquantel tablets are used, but the efficacy and safety of this treatment regimen is insufficiently studied.We assessed the efficacy and safety of crushed praziquantel tablets among preschool-aged children (<6 years in the Azaguié district, south Côte d'Ivoire, where Schistosoma mansoni and S. haematobium coexist. Using a cross-sectional design, children provided two stool and two urine samples before and 3 weeks after treatment. Crushed praziquantel tablets, mixed with water, were administered at a dose of 40 mg/kg. Adverse events were assessed and graded 4 and 24 hours posttreatment by interviewing mothers/guardians.Overall, 160 preschool-aged children had at least one stool and one urine sample examined with duplicate Kato-Katz thick smears and a point-of-care circulating cathodic antigen (POC-CCA cassette for S. mansoni, and urine filtration for S. haematobium diagnosis before and 3 weeks after praziquantel administration. According to the Kato-Katz and urine filtration results, we found high efficacy against S. mansoni (cure rate (CR, 88.6%; egg reduction rate (ERR, 96.7% and S. haematobium (CR, 88.9%; ERR, 98.0%. POC-CCA revealed considerably lower efficacy against S. mansoni (CR, 53.8%. Treatment was generally well tolerated, but moderately severe adverse events (i.e., body and face inflammation, were observed in four Schistosoma egg-negative children.Crushed praziquantel administered to preschool-aged children at a dose of 40 mg/kg is efficacious against S. mansoni and S. haematobium in a co-endemic setting of Côte d'Ivoire. Further research is required with highly sensitive

Pharmacokinetics of combined treatment with praziquantel and albendazole in neurocysticercosis

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Garcia, Hector H; Lescano, Andres G; Lanchote, Vera L; Pretell, E Javier; Gonzales, Isidro; Bustos, Javier A; Takayanagui, Osvaldo M; Bonato, Pierina S; Horton, John; Saavedra, Herbert; Gonzalez, Armando E; Gilman, Robert H

2011-01-01

AIMS Neurocysticercosis is the most common cause of acquired epilepsy in the world. Antiparasitic treatment of viable brain cysts is of clinical benefit, but current antiparasitic regimes provide incomplete parasiticidal efficacy. Combined use of two antiparasitic drugs may improve clearance of brain parasites. Albendazole (ABZ) has been used together with praziquantel (PZQ) before for geohelminths, echinococcosis and cysticercosis, but their combined use is not yet formally recommended and only scarce, discrepant data exist on their pharmacokinetics when given together. We assessed the pharmacokinetics of their combined use for the treatment of neurocysticercosis. METHODS A randomized, double-blind, placebo-controlled phase II evaluation of the pharmacokinetics of ABZ and PZQ in 32 patients with neurocysticercosis was carried out. Patients received their usual concomitant medications including an antiepileptic drug, dexamethasone, and ranitidine. Randomization was stratified by antiepileptic drug (phenytoin or carbamazepine). Subjects had sequential blood samples taken after the first dose of antiparasitic drugs and again after 9 days of treatment, and were followed for 3 months after dosing. RESULTS Twenty-one men and 11 women, aged 16 to 55 (mean age 28) years were included. Albendazole sulfoxide concentrations were increased in the combination group compared with the ABZ alone group, both in patients taking phenytoin and patients taking carbamazepine. PZQ concentrations were also increased by the end of therapy. There were no significant side effects in this study group. CONCLUSIONS Combined ABZ + PZQ is associated with increased albendazole sulfoxide plasma concentrations. These increased concentrations could independently contribute to increased cysticidal efficacy by themselves or in addition to a possible synergistic effect. PMID:21332573

Decrease in Seminal HIV-1 RNA Load After Praziquantel Treatment of Urogenital Schistosomiasis Coinfection in HIV-Positive Men—An Observational Study

DEFF Research Database (Denmark)

Midzi, Nicholas; Mduluza, Takafira; Mudenge, Boniface

2017-01-01

BACKGROUND: Urogenital schistosomiasis due to Schistosoma hematobium infection is hypothesized to cause increased HIV-1 RNA shedding in semen in HIV co-infected men as result of chronic egg-induced inflammation in the prostate and the seminal vesicles. The effect of treatment with the antihelmint...... targeting praziquantel as a supplementary preventive measure of sexual transmission of HIV-1 in S. haematobium endemic areas in sub-Saharan Africa....

The study of base and surface-active substances influence on biopharmaceutical characteristics of suppository with praziquantel

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D. M. Romanina

2016-12-01

Full Text Available Acne dermatoses (rosacea, perioral dermatitis, seborrheic dermatitis etc. are one of the most actual problems in dermatology. Praziquantel is an antiparasitic medication effective towards trematodes, cestodes. Investigations developed by domestic scientists revealed antidemodicosis activity of praziquantel. Use of semisolid dosage forms for rectal administration will allow to increase its efficacy and minimize the risks of adverse reactions. The aim of this work is the study of influence of excipients (bases and surfactants use in suppository manufacturing on the biopharmaceutical characteristics of praziquantel rectal dosage form. Methods and results. As excipients for praziquantel rectal dosage form we have investigated suppository bases and surfactants, which are widely used in manufacturing and compounding of semisolid dosage forms and are described in literature. Suppositories were made by the fusion method. Concentration of surfactants in all compositions was 2%, praziquantel – 0,6 g on one suppository. Investigation was carried out by the 2-factors dispersive analysis with repeated observations. Suppository compounding was carried out by the suspension type. After thorough pulverization of praziquantel, it was mixed with some part of the base and then obtained mixture was added to the all melted base. As optimization parameter the praziquantel releasing was chosen as the first step of bioavailability investigation. Praziquantel releasing from suppository was studied by the equilibrium dialysis by Kruvchinsky. Ethyl alcohol was chosen as a dialysis medium considering the solubility of praziquantel. Concentration of released praziquantel after 30 minutes of the dialysis was determined by spectrophotometric analysis. Conclusion. It has been established that the sort of the base and surfactant have significant influence on praziquantel releasing from rectal suppository. It has been revealed that sort of base has the greatest influence on

Serologic and ultrasonographic parameters of praziquantel treatment of hepatic fibrosis in Schistosoma japonicum infection.

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Ohmae, H; Tanaka, M; Nara, T; Utsunomiya, H; Taguchi, H; Irie, Y; Yasuraoka, K

1991-09-01

We describe the parameters useful in evaluating the development of hepatic fibrosis in Schistosoma japonicum infection, as well as its improvement after treatment with praziquantel (PZQ). Various serologic parameters and ultrasonographic images were examined, and their changes were monitored using rabbits infected with 200 or 300 cercariae of S. japonicum. Infected rabbits were administered one oral treatment of PZQ at a dosage of 100 mg/kg at 6, 12, or 24 weeks after infection. Histopathologic examinations revealed that PZQ had a strong and rapid effect, even on damage that developed long after the infection. The improvement of moderate hepatic fibrosis that developed over 24 weeks after infection was also detected by histopathologic examinations. The serum level of total bile acid was the most sensitive parameter in evaluating the severity of hepatic fibrosis and its improvement after treatment with PZQ. The level of serum procollagen-III-peptide was also useful in evaluating the development of hepatic fibrosis, but not in its improvement. Ultrasonography revealed specific echogenic bands and nodules according to the progress of granuloma formation and fibrosis, and the reversal of these changes could also be observed after treatment with PZQ.

In vitro uptake of /sup 14/C-praziquantel by cestodes, trematodes, and a nematode

Energy Technology Data Exchange (ETDEWEB)

Andrews, P.; Thomas, H.; Weber, H.

1980-12-01

/sup 14/C-praziquantel was rapidly taken up by Schistosoma mansoni, Fasciola hepatica, Hymenolepis nana, and isolated strobilocerci of Taenia taeniaeformis. Schistosoma mansoni lost praziquantel rapidly to drug-free medium. Chromatography of extracts prepared after incubation of S. mansoni and H. nana yielded no indication that praziquantel was metabolized. Autoradiography revealed a uniform distribution of praziquantel throughout the tissues of S. mansoni and H. nana. Uptake was considerably slower in the nematode Heterakis spumosa and apparently via the oral route.

The impact of repeated treatment with praziquantel of schistosomiasis in children under six years of age living in an endemic area for Schistosoma haematobium infection

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Mduluza T

2001-01-01

Full Text Available Praziquantel was given every eight weeks for two years to children aged under six years of age, living in a Schistosoma haematobium endemic area. Infection with S. haematobium and haematuria were examined in urine and antibody profiles (IgA, IgE, IgM, IgG1, IgG2, IgG3, and IgG4 against S. haematobium adult worm and egg antigens were determined from sera collected before each treatment. Chemotherapy reduced infection prevalence and mean intensity from 51.8% and 110 eggs per 10 ml urine, respectively, before starting re-treatment programme to very low levels thereafter. Praziquantel is not accumulated after periodic administration in children. Immunoglobulin levels change during the course of treatment with a shift towards 'protective' mechanisms. The significant changes noted in some individuals were the drop in 'blocking' IgG2 and IgG4 whereas the 'protecting' IgA and IgG1 levels increased. The antibody profiles in the rest of the children remained generally unchanged throughout the study and no haematuria was observed after the second treatment. The removal of worms before production of large number of eggs, prevented the children from developing morbidity.

Praziquantel treatment decreases Schistosoma mansoni genetic diversity in experimental infections.

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Regina Coeli

Full Text Available BACKGROUND: Schistosomiasis has a considerable impact on public health in many tropical and subtropical areas. In the new world, schistosomiasis is caused by the digenetic trematode Schistosoma mansoni. Chemotherapy is the main measure for controlling schistosomiasis, and the current drug of choice for treatment is praziquantel (PZQ. Although PZQ is efficient and safe, its repetitive large-scale use in endemic areas may lead to the selection of resistant strains. Isolates less susceptible to PZQ have been found in the field and selected for in the laboratory. The impact of selecting strains with a decreased susceptibility phenotype on disease dynamics and parasite population genetics is not fully understood. This study addresses the impact of PZQ pressure on the genetics of a laboratory population by analyzing frequency variations of polymorphic genetic markers. METHODOLOGY: Infected mice were treated with increasing PZQ doses until the highest dose of 3 × 300 mg/Kg was reached. The effect of PZQ treatment on the parasite population was assessed using five polymorphic microsatellite markers. Parasitological and genetic data were compared with those of the untreated control. After six parasite generations submitted to treatment, it was possible to obtain a S. mansoni population with decreased susceptibility to PZQ. In our experiments we also observed that female worms were more susceptible to PZQ than male worms. CONCLUSIONS: The selective pressure exerted by PZQ led to decreased genetic variability in S. mansoni and increased endogamy. The understanding of how S. mansoni populations respond to successive drug pressure has important implications on the appearance and maintenance of a PZQ resistance phenotype in endemic regions.

Clinical efficacy and tolerability of praziquantel for intestinal and urinary schistosomiasis-a meta-analysis of comparative and non-comparative clinical trials.

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Julien Zwang

Full Text Available Extensive use of praziquantel for treatment and control of schistosomiasis requires a comprehensive understanding of efficacy and safety of various doses for different Schistosoma species.A systematic review and meta-analysis of comparative and non-comparative trials of praziquantel at any dose for any Schistosoma species assessed within two months post-treatment. Of 273 studies identified, 55 were eligible (19,499 subjects treated with praziquantel, control treatment or placebo. Most studied were in school-aged children (64%, S. mansoni (58%, and the 40 mg/kg dose (56%; 68% of subjects were in Africa. Efficacy was assessed as cure rate (CR, n=17,017 and egg reduction rate (ERR, n=13,007; safety as adverse events (AE incidence. The WHO-recommended dose of praziquantel 40 mg/kg achieved CRs of 94.7% (95%CI 92.2-98.0 for S. japonicum, 77.1% (68.4-85.1 for S. haematobium, 76.7% (95%CI 71.9-81.2 for S. mansoni, and 63.5% (95%CI 48.2-77.0 for mixed S. haematobium/S. mansoni infections. Using a random-effect meta-analysis regression model, a dose-effect for CR was found up to 40 mg/kg for S. mansoni and 30 mg/kg for S. haematobium. The mean ERR was 95% for S. japonicum, 94.1% for S. haematobium, and 86.3% for S. mansoni. No significant relationship between dose and ERR was detected. Tolerability was assessed in 40 studies (12,435 subjects. On average, 56.9% (95%CI 47.4-67.9 of the subjects receiving praziquantel 40 mg/kg experienced an AE. The incidence of AEs ranged from 2.3% for urticaria to 31.1% for abdominal pain.The large number of subjects allows generalizable conclusions despite the inherent limitations of aggregated-data meta-analyses. The choice of praziquantel dose of 40 mg/kg is justified as a reasonable compromise for all species and ages, although in a proportion of sites efficacy may be lower than expected and age effects could not be fully explored.

Little effect of praziquantel or artemisinin on clonorchiasis in Northern Vietnam. A pilot study

NARCIS (Netherlands)

Tinga, N.; de, N.; Vien, H. V.; Chau, L.; Toan, N. D.; Kager, P. A.; Vries, P. J.

1999-01-01

The first choice for treatment of Clonorchis sinensis infections is praziquantel. Experimental data suggest that artemisinin derivatives are active against C. sinensis. The efficacy of both drugs against clonorchiasis was evaluated in a pilot study in clonorchiasis patients in an endemic area in the

The Accuracy of Praziquantel Dose Poles for Mass Treatment of Schistosomiasis in School Girls in KwaZulu-Natal, South Africa

DEFF Research Database (Denmark)

Baan, Marije; Galappaththi-Arachchige, Hashini Nilushika; Gagai, Silindile

2016-01-01

and the recently developed Modified Dose Pole for adults with two additional intervals and correction for body mass index (BMI). Methodology In randomly selected primary and secondary schools of schistosomiasis-endemic areas, height and weight of female pupils were measured. The WHO Tablet Pole and Modified Dose....... Conclusions This study shows that the WHO Tablet Pole will be inaccurate in estimating the dose of praziquantel in South African girls due to high prevalence of overweight/obesity. Under-dosing of individuals who appear overweight/obese could be largely prevented by adding an extra praziquantel tablet...

Suspected adverse reactions to oral administration of a praziquantel-pyrantel combination in captive cheetahs (Acinonyx jubatus).

Science.gov (United States)

Whitehouse-Tedd, Katherine M; Smith, Liesl; Budd, Jane A; Lloyd, Christopher G

2017-11-15

OBJECTIVE To characterize adverse reactions to oral administration of a combination of praziquantel and pyrantel embonate or pyrantel pamoate, with or without oxantel embonate, in captive cheetahs (Acinonyx jubatus). DESIGN Retrospective case series and case-control study. ANIMALS 16 captive cheetahs with signs of adverse reaction to oral administration of praziquantel and pyrantel, with or without oxantel embonate (affected group), and 27 cheetahs without such reactions (unaffected group), all from 3 independent facilities. PROCEDURES Medical records and postmortem findings for affected cheetahs were reviewed and compared with those of unaffected animals. Anthelmintic doses administered, age, and sex of cheetahs were compared between groups. RESULTS 3 reactions in affected cheetahs were fatal, whereas the remainder ranged from mild to severe. Postmortem examination failed to reveal any disease processes or conditions to explain the deaths. No differences in anthelmintic dose were identified between affected and unaffected cheetahs for all facilities combined, and no correlation existed between dose and reaction severity. No association with sex was detected, but affected cheetahs were significantly younger than unaffected cheetahs. This difference was not significant after controlling for facility. CONCLUSIONS AND CLINICAL RELEVANCE Cheetahs were concluded to have had an adverse reaction to the praziquantel-pyrantel combination because of temporal proximity of onset of clinical signs to dose administration, similarity of signs to those reported for toxicosis in other species for these drugs, and a lack of other disease process or environmental explanatory factors. A highly cautious approach to the use of this drug combination is recommended for cheetahs.

The Efficacy of Single-Dose versus Double-Dose Praziquantel Treatments on Schistosoma mansoni Infections: Its Implication on Undernutrition and Anaemia among Primary Schoolchildren in Two On-Shore Communities, Northwestern Tanzania

Science.gov (United States)

Buza, Joram; Mpolya, Emmanuel A.; Angelo, Teckla; Kinung'hi, Safari M.

2017-01-01

Administering more than one treatment may increase Praziquantel cure and egg reduction rates, thereby hastening achievement of schistosomiasis transmission control. A total of 431 S. mansoni-infected schoolchildren were randomized to receive either a single or repeated 40 mg/kg Praziquantel dose. Heights, weights, and haemoglobin levels were determined using a stadiometer, weighing scale, and HemoCue, respectively. At 8 weeks, cure rate was higher on repeated dose (93.10%) compared to single dose (68.68%) (p 0.05) and 8 (p > 0.05) months with no difference in reinfection rate. No difference in the prevalence of stunting was observed between the two treatment regimens (p > 0.05) at 8 months, but there was an increase in the prevalence of wasting among those on repeated dose (p 0.05). To achieve reduction of transmission intensity and disease control in highly endemic areas, repeated treatments alone may not be sufficient. This trial was registered with PACTR201601001416338. PMID:29094048

[Coverage rate and satisfaction of populations after mass treatment with praziquantel and albendazole in Mali].

Science.gov (United States)

Sangho, H; Dabo, A; Sidibé, A; Dembélé, R; Diawara, A; Diallo, A; Konaté, S

2009-01-01

In Mali, schistosomiasis always remains a major public health problem. In 2005, mass treatment campaigns with praziquantel and albendazole have been organized in all endemic regions. The present study aimed to assess the impact of these mass treatment campaigns and the recipient's satisfaction in two endemic areas (Mopti and Ségou). It was a cross-sectional study with one passage from February to March 2006. The study carried out on political authorities (n=142), teachers and school administers (n=70), health workers (n=46), community distributors (n=33), community members (n=2170) and pupils (n=2480). We used Lot Quality Assurance Sample (LQAS) to determine treatment coverage and recipient's satisfaction. Two types of lots were considered, villages and schools. Questionnaires were used for investigation. In Ségou, the treatment rates varied from 100% at school level and in community in Bla district to 97.2% in the community of Ségou town. In Mopti, a treatment rate of 100% was observed in Bankass and Douentza both at school and in the community. The proportion of happiest individuals (to feel well) after the mass treatment campaign was 72.3% among pupils and 76.6% in the community. The results of this study suggest that the high treatment coverage rates observed during these campaigns should be sustained by a yearly chemotherapy strategy preceded by a community's health education programmes.

microRNA analysis of Taenia crassiceps cysticerci under praziquantel treatment and genome-wide identification of Taenia solium miRNAs.

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Pérez, Matías Gastón; Macchiaroli, Natalia; Lichtenstein, Gabriel; Conti, Gabriela; Asurmendi, Sebastián; Milone, Diego Humberto; Stegmayer, Georgina; Kamenetzky, Laura; Cucher, Marcela; Rosenzvit, Mara Cecilia

2017-09-01

MicroRNAs (miRNAs) are small non-coding RNAs that have emerged as important regulators of gene expression and perform critical functions in development and disease. In spite of the increased interest in miRNAs from helminth parasites, no information is available on miRNAs from Taenia solium, the causative agent of cysticercosis, a neglected disease affecting millions of people worldwide. Here we performed a comprehensive analysis of miRNAs from Taenia crassiceps, a laboratory model for T. solium studies, and identified miRNAs in the T. solium genome. Moreover, we analysed the effect of praziquantel, one of the two main drugs used for cysticercosis treatment, on the miRNA expression profile of T. crassiceps cysticerci. Using small RNA-seq and two independent algorithms for miRNA prediction, as well as northern blot validation, we found transcriptional evidence of 39 miRNA loci in T. crassiceps. Since miRNAs were mapped to the T. solium genome, these miRNAs are considered common to both parasites. The miRNA expression profile of T. crassiceps was biased to the same set of highly expressed miRNAs reported in other cestodes. We found a significant altered expression of miR-7b under praziquantel treatment. In addition, we searched for miRNAs predicted to target genes related to drug response. We performed a detailed target prediction for miR-7b and found genes related to drug action. We report an initial approach to study the effect of sub-lethal drug treatment on miRNA expression in a cestode parasite, which provides a platform for further studies of miRNA involvement in drug effects. The results of our work could be applied to drug development and provide basic knowledge of cysticercosis and other neglected helminth infections. Copyright © 2017 Australian Society for Parasitology. Published by Elsevier Ltd. All rights reserved.

Degradation rate of praziquantel and fenbendazole in rainbow trout following oral administration.

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Soukupova-Markova, Zdenka; Doubkova, Veronika; Marsalek, Petr; Svobodova, Zdenka; Papezikova, Ivana; Lang, Stepan; Navratil, Stanislav; Palikova, Miroslava

2015-01-01

The aim of this study was to evaluate and compare the rate of degradation and elimination of praziquantel and fenbendazole antiparasitics following oral administration to salmonids. In addition, we determine whether the length of the legal withdrawal period is sufficient for complete elimination of antiparasitic residue from the body. The use of these drugs in fish is currently considered off-label and data on degradation are not available for rainbow trout. The model species for this experiment was the rainbow trout (Oncorhynchus mykiss) and praziquantel and fenbendazole were chosen for experimental therapy. Both drugs were administered into the gastrointestinal tract using a stomach tube. Concentrations of fenbendazole and praziquantel were established through high performance liquid chromatography-tandem mass spectrometry. Our results show that concentrations of praziquantel and fenbendazole reach their maximum in the body within 24 hours of administration, with concentrations dropping sharply over the following 24 hours. With one exception, when trace amounts of both substances were found in blood plasma, the drugs were completely degraded and eliminated from the body by the end of the experiment (corresponding to 497.6 degree days). Praziquantel and fenbendazole both show a high rate of degradation and elimination from fish. As both substances were eliminated from the body within the required withdrawal period (i.e. within 500 degree days) they can be safely used based on current knowledge of their therapeutic effect for treating helminth infections.

Efficacy of combined antiparasitic therapy with praziquantel and albendazole for neurocysticercosis: a double-blind, randomised controlled trial.

Science.gov (United States)

Garcia, Hector H; Gonzales, Isidro; Lescano, Andres G; Bustos, Javier A; Zimic, Mirko; Escalante, Diego; Saavedra, Herbert; Gavidia, Martin; Rodriguez, Lourdes; Najar, Enrique; Umeres, Hugo; Pretell, E Javier

2014-08-01

Neurocysticercosis causes a substantial burden of seizure disorders worldwide. Treatment with either praziquantel or albendazole has suboptimum efficacy. We aimed to establish whether combination of these drugs would increase cysticidal efficacy and whether complete cyst resolution results in fewer seizures. We added an increased dose albendazole group to establish a potential effect of increased albendazole concentrations. In this double-blind, placebo-controlled, phase 3 trial, patients with viable intraparenchymal neurocysticercosis were randomly assigned to receive 10 days of combined albendazole (15 mg/kg per day) plus praziquantel (50 mg/kg per day), standard albendazole (15 mg/kg per day), or increased dose albendazole (22·5 mg/kg per day). Randomisation was done with a computer generated schedule balanced within four strata based on number of cysts and concomitant antiepileptic drug. Patients and investigators were masked to group assignment. The primary outcome was complete cyst resolution on 6-month MRI. Enrolment was stopped after interim analysis because of parasiticidal superiority of one treatment group. Analysis excluded patients lost to follow-up before the 6-month MRI. This trial is registered with ClinicalTrials.gov, number NCT00441285. Between March 3, 2010 and Nov 14, 2011, 124 patients were randomly assigned to study groups (41 to receive combined albendazole plus praziquantel [39 analysed], 43 standard albendazole [41 analysed], and 40 increased albendazole [38 analysed]). 25 (64%) of 39 patients in the combined treatment group had complete resolution of brain cysts compared with 15 (37%) of 41 patients in the standard albendazole group (rate ratio [RR] 1·75, 95% CI 1·10-2·79, p=0·014). 20 (53%) of 38 patients in the increased albendazole group had complete cyst resolution at 6-month MRI compared with 15 (37%) of 41 patients in the standard albendazole group (RR 1·44, 95% CI 0·87-2·38, p=0·151). No significant differences in adverse

Efficacy of praziquantel against Clonorchis sinensis infection in dogs and cats.

OpenAIRE

斎藤, 哲郎; 森重, 和久; 川崎, 伸二; 頓宮, 廉正

1993-01-01

The efficacy of praziquantel was tested using 11 dogs and 3 cats infected with Clonorchis sinensis. Each experimental animal was infected with 50 metacercariae of Clonorchis sinensis respectively. The efficacy of the drug was evaluated by considerable reductions of EPG. The worms were eliminated from 91% of dogs and 100% of cats with hypodermic injection of total 75mg/kg praziquantel. This drug was effective against Clonorchis sinensis infection in dogs and cats as in the case of other tremat...

Efficacy of a novel topical fipronil, (S)-methoprene, eprinomectin and praziquantel combination against naturally acquired intestinal nematode and cestode infections in cats.

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Knaus, Martin; Abu-Madi, Marawan A; Ibarra-Velarde, Froylán; Kok, Dawie J; Kusi, Ilir; Postoli, Rezart; Chester, S Theodore; Rosentel, Joseph; Alva, Roberto; Irwin, Jennifer; Visser, Martin; Winter, Renate; Rehbein, Steffen

2014-04-28

The efficacy of a novel topical combination formulation of fipronil, (S)-methoprene, eprinomectin and praziquantel against naturally acquired intestinal nematode and cestode infections in cats was evaluated in seven negative control, blinded studies. Cats were selected based on a pre-treatment faecal examination indicating a patent infection with at least hookworms (two studies), Toxocara ascarids (one study), taeniid cestodes (two studies) or Dipylidium cestodes (two studies). In each study, cats were assigned randomly to blocks of two animals each, based on decreasing pre-treatment body weight and were randomly allocated to one of two groups of six to 12 cats: untreated (control) or treated with topical fipronil (8.3%, w/v), (S)-methoprene (10%, w/v), eprinomectin (0.4%, w/v) and praziquantel (8.3%, w/v) (BROADLINE(®), Merial) at 0.12 mL/kg body weight (providing a minimum of 10mg fipronil+12 mg S-methoprene+0.5mg eprinomectin+10mg praziquantel per kg body weight). The topical treatment was administered directly on the skin in the midline of the neck in a single spot once on Day 0. For parasite recovery and count, cats were euthanized humanely and necropsied seven or ten days after treatment. A single treatment with the novel topical combination product provided 91% efficacy against Ancylostoma braziliense, ≥ 99% efficacy against Ancylostoma tubaeforme, and >97% efficacy against Toxocara cati. Similarly, excellent efficacy was established against Taenia taeniaeformis, Dipylidium caninum and Diplopylidium spp. as demonstrated by >97% and up to 100% reductions of cestode counts in the treated cats when compared to the untreated controls (P<0.01). All cats accepted the treatment well based on health observations post-treatment and daily health observations. No adverse experiences or other health problems were observed throughout the studies. The results of this series of controlled studies demonstrated high efficacy and excellent acceptability of the novel

1 Impact of praziquantel mass drug administration campaign on ...

African Journals Online (AJOL)

used to collect information on MDA uptake, knowledge of schistosomiasis, sources .... transmission and in which Praziquantel mass drug administration has been ..... MoHSW (2012) Tanzania Mainland Strategic Master Plan for the Neglected ...

Praziquantel, levamisol e diflubenzuron no controle de Dolops carvalhoi (Crustacea: Branchiura e Anacanthorus penilabiatus (Monogenea: Dactylogyridae em Piaractus mesopotamicus Holmberg, 1887 (Osteichthyes: Characidae Praziquantel, levamisole and diflubenzuron in the control of Dolops carvalhoi (Crustacea: Branchiura and Anacanthorus penilabiatus (Monogenea: Dactylogyridae in Piaractus mesopotamicus Holmberg, 1887 (Osteichthyes: Characidae

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Sergio Henrique Canello Schalch

2009-03-01

Full Text Available Neste trabalho, avaliou-se a eficácia antiparasitária do praziquantel, levamisol e diflubenzuron administrados via oral, adicionados à ração, para pacus (Piaractus mesopotamicus infectados por Anacanthorus penilabiatus e Dolops carvalhoi. Foram utilizadas 19 caixas d'água de 300 L de capacidade, comportando 28 peixes cada. Os tratamentos foram feitos misturando os princípios ativos nas dietas. A intensidade parasitária e eficácia foram avaliadas 1 dia antes e 3, 7 e 15 dias após o início da alimentação com ração contendo diflubenzuron, levamisol e praziquantel isolados ou associados em diferentes concentrações por 7 dias. Os resultados da eficácia terapêutica sugerem que, isoladamente ou associado com levamisol e praziquantel, o diflubenzuron é eficiente contra o crustáceo D. carvalhoi, demonstrando que a eficácia dos tratamentos nos dias 3, 7 e 15 variou de 96,2 a 100%. Contra os monogenóides, as drogas não apresentaram eficácia satisfatória. Os resultados sugerem o uso do diflubenzuron para o controle de D. cavalhoi em peixes de cativeiro e em condições de quarentenário.This assay evaluated the control efficacy of diflubenzuron, praziquantel and levamisole added to the diet of pacu (Piaractus mesoptamicus infected with Anacanthorus penilabiatus and Dolops carvalhoi. 19 water tanks of 300 L capacity were utilized with 28 fish in each one. The treatments were made by mixing the active principles in the diet. The experiment was evaluated in four harvests done 1 day before and 3, 7 and 15 days after the treatment. The medicated feeding was applied for 7 days. The results of efficacy suggest that the diflubenzuron alone or associated with levamisole and praziquantel was efficient against the crustacean D. carvalhoi and the efficacy in the 3, 7 and 15 days evaluations ranged from 96,2 to 100%. Against the monogenean the drugs did not present efficacy. The results suggest the use of diflubenzuron for the control of D

Tentativa de controle de Hymenolepis nana através de tratamentos clínicos repetidos, com praziquantel, em uma comunidade fechada The use of repeated praziquantel treatments in an attempt to control Hymenolepis nana in an orphanage

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R. S. Rocha

1981-08-01

controle da himenolepíase.Praziquantel was used repeatedly in an orphanage to determine its effectiveness in controlling hymenolepis. At the same time, the possible mechanisms of the transmission of this parasitosis were studied. The first group examined consisted of 161 people of which 109 were the orphanage children, who varied in age from days or months to eight years, and 52 adults, employees of the institution. Stool tests of all were made about every two months, using the Hoffman, Pons and Janer method; cure control was carried out by the same method seven to fourteen days after treatment. Every two weeks, H. nana eggs were searched for under the finger nails of the children, in insects, in domestic wastes, on door knobs and refrigerator handles, and on toilet flush knobs and strings. Water collected from rinsed urinals and shower floors was also tested. Eggs and larva of helminths and protozoa cysts were found in domestic waste and cockroaches and on door knobs. H. nana eggs were found in puddles of water left on shower floors and the rinse water of urinals. Every patient whose feces had H. nana eggs was treated with a single oral 25mg/kg dose of praziquantel, taken after lunch. In the four groups treated (66 patients in all, no important side effects were observed, and follow-up indicated 100% cure. For the 5th and last treatment, a group of both positive and negative (for H. nana people was divided into sub-groups and treated with one (25mg/kg or two doses of the medicine for a period of four days (total: 50mg/kg. Follow-up examination two months after treatment showed that only six patients were still eliminating eggs of the parasite; all belonged to the sub-group treated with a single dose of the drug. In spite of the treatments given an of the high percentage of cure, control of hymenolepiasis was not achieved.

Effect of Cyclodextrin Complexation on the Aqueous Solubility and Solubility/Dose Ratio of Praziquantel

OpenAIRE

Maragos, Stratos; Archontaki, Helen; Macheras, Panos; Valsami, Georgia

2009-01-01

Praziquantel (PZQ), the primary drug of choice in the treatment of schistosomiasis, is a highly lipophilic drug that possesses high permeability and low aqueous solubility and is, therefore, classified as a Class II drug according to the Biopharmaceutics Classification System (BCS). In this work, β-cyclodextrin (β-CD) and hydroxypropyl-β-cyclodextrin (HP-β-CD) were used in order to determine whether increasing the aqueous solubility of a drug by complexation with CDs, a BCS-Class II compound ...

Schistosomiasis and HIV in rural Zimbabwe: efficacy of treatment of schistosomiasis in individuals with HIV coinfection

DEFF Research Database (Denmark)

Kallestrup, Per; Zinyama, Rutendo; Gomo, Exnevia

2006-01-01

There is evidence from experimental models that the praziquantel-induced clearance of schistosomiasis is dependent on the host's immune response. Consequently, human immunodeficiency virus (HIV)-related immunodeficiency may impair the effect of praziquantel treatment.......There is evidence from experimental models that the praziquantel-induced clearance of schistosomiasis is dependent on the host's immune response. Consequently, human immunodeficiency virus (HIV)-related immunodeficiency may impair the effect of praziquantel treatment....

Effect of diazinon and/or praziquantel on selected protein aspects in healthy and Schistosoma mansoni infected mice.

Science.gov (United States)

Hanna, Laila S; Medhat, Amina M; Abdel-Menem, Hanan A

2003-04-01

In Egypt, schistosomiasis is still a major public health problem and praziquantel is the drug of choice for its treatment, whereas diazinon is globally used as an insecticide for controlling pests. They adversely affect the environment. Therefore, the authors studied the effect of 1/20 LD50 diazinon given orally to healthy and Schistosoma mansoni infected mice for 5 successive days up to 9 and 17 weeks coupled with a therapeutic dose (2 x 500 mg/kg Bwt) of praziquantel, 2 weeks before sacrificing. The results showed that non significant differences were obtained from total proteins, albumin, globulins, and albumin/globulin ratio. However, significant differences were revealed from alpha1-, alpha2-, beta1-, beta2-, and gamma-globubins in addition to plasma ceruloplasmin. Diazinon changed the levels of alpha2-, beta1-, and gamma-globubins, while diazinon coupled with schistosomiasis affected the levels of most studied parameters. Consequently, exposure to insecticides should be avoided specially in the rural areas where schistosomiasis is still endemic.

Cysticidal Efficacy of Combined Treatment With Praziquantel and Albendazole for Parenchymal Brain Cysticercosis.

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Garcia, Hector H; Lescano, Andres G; Gonzales, Isidro; Bustos, Javier A; Pretell, E Javier; Horton, John; Saavedra, Herbert; Gonzalez, Armando E; Gilman, Robert H

2016-06-01

The efficacy of current antiparasitic treatment for cerebral Taenia solium cysticercosis with either albendazole (ABZ) or praziquantel (PZQ) is suboptimal. A recent study demonstrated that combining these 2 antiparasitic drugs improves antiparasitic efficacy. We present here the parasiticidal efficacy data obtained during a previous phase II pharmacokinetic study that compared combined ABZ plus PZQ with ABZ alone. The study was a randomized, double-blinded, placebo-controlled phase II evaluation of the pharmacokinetics of ABZ (15 mg/k/d, for 10 days) and PZQ (50 mg/k/d, for 10 days) in intraparenchymal brain cysticercosis. Patients received the usual concomitant medications, including an antiepileptic drug (phenytoin or carbamazepine), dexamethasone, and ranitidine. Randomization was stratified by antiepileptic drug. Patients underwent safety laboratory evaluations at days 4, 7, and 11, as well as magnetic resonance (MR) imaging at 6 months to assess parasiticidal efficacy. Thirty-two patients were included, 16 in each arm. All of them completed antiparasitic treatment and underwent follow-up brain MR imaging. Cysticidal efficacy was strikingly higher in the combined ABZ-plus-PZQ group than in the ABZ-alone group (proportion of cysts resolved, 78 of 82 [95%] vs 23 of 77 [30%] [relative risk {RR}, 3.18; 95% confidence interval {CI}, 2.08-4.88; P < .001]; patients with complete cyst clearance, 12 of 16 [75%] vs 4 of 16 [25%] [RR, 3.00; 95% CI, 1.23-7.34; P = .005]). The combination of ABZ plus PZQ is more effective in destroying viable brain cysticercosis cysts than ABZ alone. NCT00441285. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Taste, a new incentive to switch to (R-praziquantel in schistosomiasis treatment.

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Thorsten Meyer

Full Text Available BACKGROUND: Praziquantel (PZQ is the drug compound of choice in the control and treatment of schistosomiasis. PZQ is administered as a racemate, i. e. 1ratio1 mixture of enantiomers. The schistosomicidal activity arises from one PZQ-enantiomer, whereas the other enantiomer does not contribute to the activity. The WHO's Special Programme for Research and Training in Tropical Diseases (TDR has assigned the low-cost preparation of pure schistosomicidal (--PZQ a key priority for future R&D on PZQ, but so far this transition has not happened. PZQ has two major administration drawbacks, the first being the high dose needed, and its well documented bitter and disgusting taste. Attempts of taste-masking by low-cost means have not been successful. We hypothesized that the non-schistosomicidal component in PZQ would be the main contributor to the unpleasant taste of the drug. If the hypothesis was confirmed, the two major administration drawbacks of PZQ, the high dose needed and its bitter taste, could be addressed in one go by removing the component contributing to the bitter taste. METHODS AND FINDINGS: PZQ was separated into its schistosomicidal and the non-schistosomicidal component, the absolute stereochemical configuration of (--PZQ was determined to be (R-PZQ by X-ray crystallography, and the extent of bitterness was determined for regular racemic PZQ and the schistosomicidal component in a taste study in humans. FINDING: The schistosomicidal component alone is significantly less bitter than regular, racemic PZQ. CONCLUSION: Our hypothesis is confirmed. We propose to use only the pure schistosomicidal component of PZQ, offering the advantage of halving the dose and expectedly improving the compliance due to the removal of the bitter taste. Therefore, (R-PZQ should be specifically suitable for the treatment of school-age children against schistosomiasis. With this finding, we would like to offer an additional incentive to the TDR's recommendation to

Cytokine Pattern of T Lymphocytes in Acute Schistosomiasis mansoni Patients following Treated Praziquantel Therapy

Science.gov (United States)

Silveira-Lemos, Denise; Fernandes Costa-Silva, Matheus; Cardoso de Oliveira Silveira, Amanda; Azevedo Batista, Mauricio; Alves Oliveira-Fraga, Lúcia; Soares Silveira, Alda Maria; Barbosa Alvarez, Maria Carolina; Martins-Filho, Olindo Assis; Gazzinelli, Giovanni; Corrêa-Oliveira, Rodrigo; Teixeira-Carvalho, Andréa

2013-01-01

Acute schistosomiasis is associated with a primary exposure and is more commonly seen in nonimmune individuals traveling through endemic regions. In this study, we have focused on the cytokine profile of T lymphocytes evaluated in circulating leukocytes of acute Schistosomiasis mansoni-infected patients (ACT group) before and after praziquantel treatment (ACT-TR group). Our data demonstrated increased values of total leukocytes, eosinophils, and monocytes in both groups. Interestingly, we have observed that patients treated with praziquantel showed increased values of lymphocytes as compared with noninfected group (NI) or ACT groups. Furthermore, a decrease of neutrophils in ACT-TR was observed when compared to ACT group. Analyses of short-term in vitro whole blood stimulation demonstrated that, regardless of the presence of soluble Schistosoma mansoni eggs antigen (SEA), increased synthesis of IFN-γ and IL-4 by T-cells was observed in the ACT group. Analyses of cytokine profile in CD8 T cells demonstrated higher percentage of IFN-γ and IL-4 cells in both ACT and ACT-TR groups apart from increased percentage of IL-10 cells only in the ACT group. This study is the first one to point out the relevance of CD8 T lymphocytes in the immune response induced during the acute phase of schistosomiasis. PMID:23401741

Cytokine Pattern of T Lymphocytes in Acute Schistosomiasis mansoni Patients following Treated Praziquantel Therapy

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Denise Silveira-Lemos

2013-01-01

Full Text Available Acute schistosomiasis is associated with a primary exposure and is more commonly seen in nonimmune individuals traveling through endemic regions. In this study, we have focused on the cytokine profile of T lymphocytes evaluated in circulating leukocytes of acute Schistosomiasis mansoni-infected patients (ACT group before and after praziquantel treatment (ACT-TR group. Our data demonstrated increased values of total leukocytes, eosinophils, and monocytes in both groups. Interestingly, we have observed that patients treated with praziquantel showed increased values of lymphocytes as compared with noninfected group (NI or ACT groups. Furthermore, a decrease of neutrophils in ACT-TR was observed when compared to ACT group. Analyses of short-term in vitro whole blood stimulation demonstrated that, regardless of the presence of soluble Schistosoma mansoni eggs antigen (SEA, increased synthesis of IFN-γ and IL-4 by T-cells was observed in the ACT group. Analyses of cytokine profile in CD8 T cells demonstrated higher percentage of IFN-γ and IL-4 cells in both ACT and ACT-TR groups apart from increased percentage of IL-10 cells only in the ACT group. This study is the first one to point out the relevance of CD8 T lymphocytes in the immune response induced during the acute phase of schistosomiasis.

Praziquantel degradation in marine aquarium water

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Amber Thomas

2016-04-01

Full Text Available Praziquantel (PZQ is a drug commonly utilized to treat both human schistosomiasis and some parasitic infections and infestations in animals. In the aquarium industry, PZQ can be administered in a “bath” to treat the presence of ectoparasites on both the gills and skin of fish and elasmobranchs. In order to fully treat an infestation, the bath treatment has to maintain therapeutic levels of PZQ over a period of days or weeks. It has long been assumed that, once administered, PZQ is stable in a marine environment throughout the treatment interval and must be mechanically removed, but no controlled experiments have been conducted to validate that claim. This study aimed to determine if PZQ would break down naturally within a marine aquarium below its 2 ppm therapeutic level during a typical 30-day treatment: and if so, does the presence of fish or the elimination of all living biological material impact the degradation of PZQ? Three 650 L marine aquarium systems, each containing 12 fish (French grunts: Haemulon flavolineatum, and three 650 L marine aquariums each containing no fish were treated with PZQ (2 ppm and concentrations were measured daily for 30 days. After one round of treatment, the PZQ was no longer detectable in any system after 8 (±1 days. The subsequent two PZQ treatments yielded even faster PZQ breakdown (non-detectable after 2 days and 2 ± 1 day, respectively with slight variations between systems. Linear mixed effects models of the data indicate that day and trial most impact PZQ degradation, while the presence of fish was not a factor in the best-fit models. In a completely sterilized marine system (0.5 L PZQ concentration remained unchanged over 15 days, suggesting that PZQ may be stable in a marine system during this time period. The degradation observed in non-sterile marine systems in this study may be microbial in nature. This work should be taken into consideration when providing PZQ bath treatments to marine animals

Triple co-administration of ivermectin, albendazole and praziquantel in zanzibar: a safety study.

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Khalfan A Mohammed

Full Text Available BACKGROUND: Public health interventions based on distribution of anthelminthic drugs against lymphatic filariasis (LF, onchocerciasis, soil-transmitted helminthiasis (STH and schistosomiasis have been implemented separately to date. A better use of available resources might be facilitated by a more coordinated approach to control such infections, including the possibility of co-administering the three recommended anthelminthic drugs through a single, large-scale intervention. METHODOLOGY/PRINCIPAL FINDINGS: Ivermectin, albendazole and praziquantel were co-administered to 5,055 children and adults living in areas endemic for LF, STH and schistosomiasis in Zanzibar, United Republic of Tanzania, during a pilot intervention aimed at elucidating and quantifying possible side-effects. Subsequently, these drugs were co-administered to about 700,000 individuals during a countrywide intervention targeting a large part of the total population of Zanzibar. Passive and active surveillance measures carried out during both interventions showed that side-effects attributable to the three drugs given at the same time were mild and self-limiting events. CONCLUSIONS/SIGNIFICANCE: Our data suggest that co-administration of ivermectin, albendazole and praziquantel is safe in areas where lymphatic filariasis, soil-transmitted helminthiasis and schistosomiasis are co-endemic and where several rounds of treatment with one or two drugs have been implemented in the past. Passive surveillance measures, however, should be continued and detection, management and reporting of possible side-effects should be considered a key component of any health intervention administering drugs.

Triple Co-Administration of Ivermectin, Albendazole and Praziquantel in Zanzibar: A Safety Study

Science.gov (United States)

Mohammed, Khalfan A.; Haji, Hamad J.; Gabrielli, Albis-Francesco; Mubila, Likezo; Biswas, Gautam; Chitsulo, Lester; Bradley, Mark H.; Engels, Dirk; Savioli, Lorenzo; Molyneux, David H.

2008-01-01

Background Public health interventions based on distribution of anthelminthic drugs against lymphatic filariasis (LF), onchocerciasis, soil-transmitted helminthiasis (STH) and schistosomiasis have been implemented separately to date. A better use of available resources might be facilitated by a more coordinated approach to control such infections, including the possibility of co-administering the three recommended anthelminthic drugs through a single, large-scale intervention. Methodology/Principal Findings Ivermectin, albendazole and praziquantel were co-administered to 5,055 children and adults living in areas endemic for LF, STH and schistosomiasis in Zanzibar, United Republic of Tanzania, during a pilot intervention aimed at elucidating and quantifying possible side-effects. Subsequently, these drugs were co-administered to about 700,000 individuals during a countrywide intervention targeting a large part of the total population of Zanzibar. Passive and active surveillance measures carried out during both interventions showed that side-effects attributable to the three drugs given at the same time were mild and self-limiting events. Conclusions/Significance Our data suggest that co-administration of ivermectin, albendazole and praziquantel is safe in areas where lymphatic filariasis, soil-transmitted helminthiasis and schistosomiasis are co-endemic and where several rounds of treatment with one or two drugs have been implemented in the past. Passive surveillance measures, however, should be continued and detection, management and reporting of possible side-effects should be considered a key component of any health intervention administering drugs. PMID:18235853

Immunization with tegument nucleotidases associated with a subcurative praziquantel treatment reduces worm burden following Schistosoma mansoni challenge

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Henrique K. Rofatto

2013-04-01

Full Text Available Schistosomiasis is a debilitating disease caused by flatworm parasites of the Schistosoma genus and remains a high public health impact disease around the world, although effective treatment with Praziquantel (PZQ has been available since the 1970s. Control of this disease would be greatly improved by the development of a vaccine, which could be combined with chemotherapy. The sequencing of the Schistosoma mansoni transcriptome and genome identified a range of potential vaccine antigens. Among these, three nucleotidases from the tegument of the parasite, presumably involved in purinergic signaling and nucleotide metabolism, were proposed as promising vaccine candidates: an alkaline phosphatase (SmAP, a phosphodiesterase (SmNPP-5 and a diphosphohydrolase (SmNTPDase. Herein, we evaluate the potential of these enzymes as vaccine antigens, with or without subcurative PZQ treatment. Immunization of mice with the recombinant proteins alone or in combination demonstrated that SmAP is the most immunogenic of the three. It induced the highest antibody levels, particularly IgG1, associated with an inflammatory cellular immune response characterized by high TNF-α and a Th17 response, with high IL-17 expression levels. Despite the specific immune response induced, immunization with the isolated or combined proteins did not reduce the worm burden of challenged mice. Nonetheless, immunization with SmAP alone or with the three proteins combined, together with subcurative PZQ chemotherapy was able to reduce the worm burden by around 40%. The immunogenicity and relative exposure of SmAP to the host immune system are discussed, as key factors involved in the apparently synergistic effect of SmAP immunization and subcurative PZQ treatment.

Replacing a failed mini-implant with a miniplate to prevent interruption during orthodontic treatment.

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Lee, Jin-Hwa; Choo, Hyeran; Kim, Seong-Hun; Chung, Kyu-Rhim; Giannuzzi, Lucille A; Ngan, Peter

2011-06-01

When mini-implants fail during orthodontic treatment, there is a need to have a backup plan to either replace the failed implant in the adjacent interradicular area or wait for the bone to heal before replacing the mini-implant. We propose a novel way to overcome this problem by replacement with a miniplate so as not to interrupt treatment or prolong treatment time. The indications, advantages, efficacy, and procedures for switching from a mini-implant to a miniplate are discussed. Two patients who required replacement of failed mini-implants are presented. In the first patient, because of the proximity of the buccal vestibule to the mini-implant, it was decided to replace the failed mini-implant by an I-shaped C-tube miniplate. In the second patient, radiolucencies were found around the failed mini-implants, making the adjacent alveolar bone unavailable for immediate placement of another mini-implant. In addition, the maxillary sinus pneumatization was expanded deeply into the interradicular spaces; this further mandated an alternative placement site. One failed mini-implant was examined under a scanning electron microscope for bone attachment. Treatment was completed in both patients after replacement with miniplates without interrupting the treatment mechanics or prolonging the treatments. Examination under the scanning electron microscope showed partial bone growth into the coating pores and titanium substrate interface even after thorough cleaning and sterilization. Replacement with a miniplate is a viable solution for failed mini-implants during orthodontic treatment. The results from microscopic evaluation of the failed mini-implant suggest that stringent guidelines are needed for recycling used mini-implants. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Immunological Consequences of Antihelminthic Treatment in Preschool Children Exposed to Urogenital Schistosome Infection

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Nadine Rujeni

2013-01-01

Full Text Available Urogenital schistosomiasis, due to Schistosoma haematobium, is endemic in sub-Saharan Africa. Control is by targeted treatment with praziquantel but preschool age children are excluded from control programs. Immunological studies on the effect of treatment at this young age are scarce. In light of studies in older individuals showing that praziquantel alters antischistosome immune responses and responses to bystander antigens, this study aims to investigate how these responses would be affected by treatment at this young age. Antibody responses directed against schistosome antigens, Plasmodium falciparum crude and recombinant antigens, and the allergen house dust mite were measured in children aged 3 to 5 years before and 6 weeks after treatment. The change in serological recognition of schistosome proteins was also investigated. Treatment augmented antischistosome IgM and IgE responses. The increase in IgE responses directed against adult worm antigens was accompanied by enhanced antigen recognition by sera from the children. Antibody responses directed against Plasmodium antigens were not significantly affected by praziquantel treatment nor were levels of allergen specific responses. Overall, praziquantel treatment enhanced, quantitatively and qualitatively, the antiworm responses associated with protective immunity but did not alter Plasmodium-specific responses or allergen-specific responses which mediate pathology in allergic disease.

Reduced uptake of mass treatment for schistosomiasis control in absence of food

DEFF Research Database (Denmark)

Muhumuza, Simon; Olsen, Annette; Katahoire, Anne

2015-01-01

the other, in addition to the education messages, received a pre-treatment snack shortly before mass treatment. The uptake of praziquantel in the snack schools was 94 % compared to 79 % in the non-snack schools. During mass treatment in 2014, no snack was provided. We compared the uptake of praziquantel....... mansoni infection. RESULTS: Uptake of praziquantel reduced from 93.9 to 78.0 % (p = 0.002) in the snack schools but was unchanged in the non-schools 78.7 and 70.4 % (p = 0.176). The occurence of side-effects attributable to praziquantel increased from 34.4 to 61.2 % (p = 0.001) in the snack schools...... but was unchanged in the non-snack schools; 46.9 and 53.2 % (p = 0.443). Although the prevalence of S. mansoni infection increased in both the snack and non-snack schools, the differences did not reach statistical significance;1.3 and 7.5 % (p = 0.051) and 14.1 and 22.0 % (p = 0.141), respectively. Similarly...

The impact of anthelmintic treatment intervention on malaria infection and anaemia in school and preschool children in Magu district, Tanzania

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Kinung'hi, Safari M.; Magnussen, Pascal; Kishamawe, Coleman

2015-01-01

study of 1546 children. Enrolled children were randomized to receive either repeated treatment with praziquantel and albendazole four times a year (intervention group, 394 children) or single dose treatment with praziquantel and albendazole once a year (control group, 371 children). Follow up...

Avaliação terapêutica do praziquantel (Embay 8440 na infecção humana pelo S. mansoni Therapeutical investigation of praziquantel in human infection due to Schistosoma mansoni

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Silvino Alves de Carvalho

1984-02-01

treated with praziquantel, single oral dose of 40 or 50 mg/kg BWT. Their ages ranged from 6 to 63 years and 33 cases (16.5% were under 15 years old. The main side-effects were: dizziness 27.5%; drowsiness 21.0%; abdominal cramps 17.5%; nausea 16.0%; diarrhea 9.0%; headache 7.5%; vomiting 4.0%; fever 2.0%; dysentery 1.0%; shivers 1.0%; rash 1.0% and urticaria 0.5%. The drug toxicity was evaluated by laboratory workout — blood counts, hepatic function tests (serum enzymes and bilirubin, kidney function tests (BUN and creatinine, EKG and EEG — performed before as well as after treatment. No relevant abnormality was found leading to clinical manifestations. Success of therapy was assessed in 115 cases through eight consecutive stool examinations performed during the six-month period following the drug administration. Both Hoffman's and Kato-Katz's techniques were used. Rectal biopsy was carried out in 62 patients out of 82 whose stool examinations were negative. Two positive cases were found indicating a 3.2% rate of false-negative results in relation to stool examinations. The cure rates varied from 65.2% in patients under 15 years old to 75.0% in those over this age. The mean rate was 71.3%. These results point out that praziquantel, at the used dose levels, is relatively efficaceous in the treatment of schistosomiasis mansoni and yields a low incidence of side effects and toxic reactions.

Utilização de fenbendazole e da associação febantel, pamoato de pirantel e praziquantel no controle de oxiurídeos em gerbis Use of fenbendazole and the febantel, pamoato of pirantel and praziquantel association in the control of oxiurids in jirds

OpenAIRE

H.H.S. Machado; F.F. Gomes; V.R.S. Fiuza; R.S. Toledo; F. C.R. de Oliveira

2007-01-01

Eighteen jirds were equally distributed in two treated and one control groups. The commercial products to the fenbendazole base (10mg) and the association of febantel (1.5mg), pirantel (1.44mg) and praziquantel (0.5mg) were orally administred in the concentration of 0.1ml in each group. The effectiveness of febendazole against oxiurids was 81.8%, 65.0 and 38.7% and for the association of febantel, pirantel and praziquantel was 72.7%, 73.8% and 51.0% on days 7, 14 and 21, respectively. Three a...

Intra-articular laser treatment plus Platelet Rich Plasma (PRP) significantly reduces pain in many patients who had failed prior PRP treatment

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Prodromos, Chadwick C.; Finkle, Susan; Dawes, Alexander; Dizon, Angelo

2018-02-01

INTRODUCTION: In our practice Platelet Rich Plasma (PRP) injections effectively reduce pain in most but not all arthritic patients. However, for patients who fail PRP treatment, no good alternative currently exists except total joint replacement surgery. Low level laser therapy (LLLT) on the surface of the skin has not been helpful for arthritis patients in our experience. However, we hypothesized that intra-articular laser treatment would be an effective augmentation to PRP injection and would increase its efficacy in patients who had failed prior PRP injection alone. METHODS: We offered Intra-articular Low Level Laser Therapy (IAL) treatment in conjunction with repeat PRP injection to patients who had received no benefit from PRP injection alone at our center. They were the treatment group. They were not charged for PRP or IAL. They also served as a historical control group since they had all had failed PRP treatment alone. 28 patients (30 joints) accepted treatment after informed consent. 22 knees, 4 hips, 2 shoulder glenohumeral joints and 1 first carpo-metacarpal (1st CMC) joint were treated RESULTS: All patients were followed up at 1 month and no adverse events were seen from the treatment. At 6 months post treatment 46% of patients had good outcomes, and at 1 year 17% still showed improvement after treatment. 11 patients failed treatment and went on to joint replacement. DISCUSSION: A single treatment of IAL with PRP salvaged 46% of patients who had failed PRP treatment alone, allowing avoidance of surgery and good pain control.

Potential cost-effectiveness of schistosomiasis treatment for reducing HIV transmission in Africa--the case of Zimbabwean women.

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Martial L Ndeffo Mbah

Full Text Available Epidemiological data from Zimbabwe suggests that genital infection with Schistosoma haematobium may increase the risk of HIV infection in young women. Therefore, the treatment of Schistosoma haematobium with praziquantel could be a potential strategy for reducing HIV infection. Here we assess the potential cost-effectiveness of praziquantel as a novel intervention strategy against HIV infection.We developed a mathematical model of female genital schistosomiasis (FGS and HIV infections in Zimbabwe that we fitted to cross-sectional data of FGS and HIV prevalence of 1999. We validated our epidemic projections using antenatal clinic data on HIV prevalence. We simulated annual praziquantel administration to school-age children. We then used these model predictions to perform a cost-effectiveness analysis of annual administration of praziquantel as a potential measure to reduce the burden of HIV in sub-Saharan Africa.We showed that for a variation of efficacy between 30-70% of mass praziquantel administration for reducing the enhanced risk of HIV transmission per sexual act due to FGS, annual administration of praziquantel to school-age children in Zimbabwe could result in net savings of US$16-101 million compared with no mass treatment of schistosomiasis over a ten-year period. For a variation in efficacy between 30-70% of mass praziquantel administration for reducing the acquisition of FGS, annual administration of praziquantel to school-age children could result in net savings of US$36-92 million over a ten-year period.In addition to reducing schistosomiasis burden, mass praziquantel administration may be a highly cost-effective way of reducing HIV infections in sub-Saharan Africa. Program costs per case of HIV averted are similar to, and under some conditions much better than, other interventions that are currently implemented in Africa to reduce HIV transmission. As a cost-saving strategy, mass praziquantel administration should be prioritized

Effectiveness of a pre-treatment snack on the uptake of mass treatment for schistosomiasis in Uganda

DEFF Research Database (Denmark)

Muhumuza, Simon; Olsen, Annette; Katahoire, Anne

2014-01-01

-treatment snack on uptake of mass treatment.Methods and Findings:In a cluster randomized trial carried out in Jinja district, Uganda, 12 primary schools were randomized into two groups; one received education messages for schistosomiasis prevention for two months prior to mass treatment, while the other......, in addition to the education messages, received a pre-treatment snack shortly before mass treatment. Four weeks after mass treatment, uptake of praziquantel was assessed among a random sample of 595 children in the snack schools and 689 children in the non-snack schools as the primary outcome. The occurrence...... of side effects and the prevalence and mean intensity of Schistosoma mansoni infection were determined as the secondary outcomes. Uptake of praziquantel was higher in the snack schools, 93.9% (95% CI 91.7%-95.7%), compared to that in the non-snack schools, 78.7% (95% CI 75.4%-81.7%) (p = 0...

Praziquantel synergistically enhances paclitaxel efficacy to inhibit cancer cell growth.

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Zhen Hua Wu

Full Text Available The major challenges we are facing in cancer therapy with paclitaxel (PTX are the drug resistance and severe side effects. Massive efforts have been made to overcome these clinical challenges by combining PTX with other drugs. In this study, we reported the first preclinical data that praziquantel (PZQ, an anti-parasite agent, could greatly enhance the anticancer efficacy of PTX in various cancer cell lines, including PTX-resistant cell lines. Based on the combination index value, we demonstrated that PZQ synergistically enhanced PTX-induced cell growth inhibition. The co-treatment of PZQ and PTX also induced significant mitotic arrest and activated the apoptotic cascade. Moreover, PZQ combined with PTX resulted in a more pronounced inhibition of tumor growth compared with either drug alone in a mouse xenograft model. We tried to investigate the possible mechanisms of this synergistic efficacy induced by PZQ and PTX, and we found that the co-treatment of the two drugs could markedly decrease expression of X-linked inhibitor of apoptosis protein (XIAP, an anti-apoptotic protein. Our data further demonstrated that down-regulation of XIAP was required for the synergistic interaction between PZQ and PTX. Together, this study suggested that the combination of PZQ and PTX may represent a novel and effective anticancer strategy for optimizing PTX therapy.

Short Communication: In Vitro Efficacy Testing of Praziquantel, Ivermectin, and Oxfendazole against Taenia Solium Cysts

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S. Cederberg

2012-01-01

Full Text Available Oxfendazole is recommended as the drug of choice for treating porcine cysticercosis. The drug does not kill brain cysts and is not registered for use in pigs. Latest its safety in the recommended dose has been questioned. The aim of this study was to investigate two alternative anthelminthics. The efficacy of praziquantel and ivermectin was compared to oxfendazole In Vitro on Taenia solium. Cysts of T. solium were isolated from infected pork and incubated in culture media together with the drugs. The degree of evagination was used as effect measurement and determined after 6 hours. Praziquantel had a half maximal effective concentration (EC50 of value 0.006 ± 0.001 μg/mL. Ivermectin did not show any impact on the evagination in concentrations from 0.001 to 30 μg/mL and neither did oxfendazole in concentrations from 0.001 to 50 μg/mL.

Utilização de fenbendazole e da associação febantel, pamoato de pirantel e praziquantel no controle de oxiurídeos em gerbis Use of fenbendazole and the febantel, pamoato of pirantel and praziquantel association in the control of oxiurids in jirds

Directory of Open Access Journals (Sweden)

H.H.S. Machado

2007-02-01

Full Text Available Eighteen jirds were equally distributed in two treated and one control groups. The commercial products to the fenbendazole base (10mg and the association of febantel (1.5mg, pirantel (1.44mg and praziquantel (0.5mg were orally administred in the concentration of 0.1ml in each group. The effectiveness of febendazole against oxiurids was 81.8%, 65.0 and 38.7% and for the association of febantel, pirantel and praziquantel was 72.7%, 73.8% and 51.0% on days 7, 14 and 21, respectively. Three applications of that dose of the tested medications, within intervals of 10 days, associated to hygiene, are recommended.

FAILED PRIMARY TREATMENT OF CALCANEAL FRACTURE. WHAT TO DO?

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Matej Andoljšek

2008-02-01

When conservative treatment fails, operative treatment is indicated in most patients withbone and joint problems. The goals of surgical treatment are pain relief and restoration oftalocalcaneal alignment. In lateral impingement, when subtalar joint and general alignmentof the tuber are preserved, removal of the bulged lateral wall could suffice. In suchcases a corrective osteotomy of the tuber is rarely indicated. In painfull subtalar arthrosisfusion is the only option. Limited fusion is preferable. »In situ« subtalar fusion is advisablein cases without malalignment or deformity. When we have arthrosis and varus/valgusdeformity with preserved height, arthrodesis with corrective osteotomy is indicated. In mostcases, where complex deformity is present, corrective subtalar distraction bone-blockarthrodesis should be done

Change in children's school behavior after mass administration of praziquantel for Schistosoma mansoni infection in endemic areas of western Kenya: A pilot study using the Behavioral Assessment System for Children (BASC-2).

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Musuva, Rosemary; Shen, Ye; Wei, Xianjue; Binder, Sue; Ivy, Julianne A; Secor, W Evan; Montgomery, Susan P; King, Charles H; Mwinzi, Pauline N M

2017-01-01

Schistosomiasis is a parasite-related chronic inflammatory condition that can cause anemia, decreased growth, liver abnormalities, and deficits in cognitive functioning among children. This study used the Behavior Assessment System for Children (BASC-2) to collect data on thirty-six 9-12 year old school-attending children's behavioral profiles in an Schistosoma mansoni-endemic area of western Kenya, before and after treatment with praziquantel for S. mansoni infection. BASC-2 T scores were significantly reduced post-treatment (p behavior categories including externalizing problems (hyperactivity, aggression, and conduct problems that are disruptive in nature), internalizing problems (anxiety, depression, somatization, atypicality, and withdrawal), school problems (academic difficulties, included attention problems and learning problems), and the composite behavioral symptoms index (BSI), signifying improved behavior. While the observed improvement in the 'positive' behavior category of adaptive skills (adaptability, functional communication, social skills, leadership, and study skills) was not statistically significant, there were significant improvements in two adaptive skills subcategories: social skills and study skills. Results of this study suggest that children have better school-related behaviors without heavy S. mansoni infection, and that infected children's behaviors, especially disruptive problem behaviors, improve significantly after praziquantel treatment.

Failed Pavlik harness treatment for DDH as a risk factor for avascular necrosis.

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Tiruveedhula, Madhu; Reading, Isabel C; Clarke, Nicholas M P

2015-03-01

Avascular necrosis (AVN) of the femoral head is an irreversible complication seen in the treatment of developmental dysplasia of hip (DDH) with the Pavlik harness. Its incidence is reported to be low after successful reduction of the hip but high if the hip is not concentrically relocated. We aim to investigate its incidence after failed Pavlik harness treatment. We prospectively followed up a group of children who failed Pavlik harness treatment for DDH treated at our institution by the senior author between 1988 and 2001 and compared their rates of AVN with a group of children who presented late and hence were treated surgically. AVN was graded as described by Kalamchi and MacEwen and only grade 2 to 4 AVN was considered significant and included in the analysis. Thirty-seven hips were included in the failed Pavlik group (group 1) and 86 hips in the no Pavlik group (group 2). Ten hips in group 1 developed AVN (27%), whereas only 7 hips in group 2 (8%) developed AVN; the odds of developing AVN after failed Pavlik treatment was 4.7 (95% confidence interval, 1.3-14.1) (P=0.009) with a relative risk of 3.32 (range, 1.37 to 8.05). There was no statistically significant association observed with duration of splintage and severity of AVN (Spearman's correlation, -0.46; P=0.18). However, there was a positive correlation noted with age at presentation and severity of AVN. Therefore, we advise close monitoring of hips in the Pavlik harness and discontinue its use if the hips are not reduced within 3 weeks. Level III.

A school-based cross-sectional survey of adverse events following co-administration of albendazole and praziquantel for preventive chemotherapy against urogenital schistosomiasis and soil-transmitted helminthiasis in Kwale County, Kenya.

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Njenga, Sammy M; Ng'ang'a, Paul M; Mwanje, Mariam T; Bendera, Fatuma S; Bockarie, Moses J

2014-01-01

Soil-transmitted helminths and schistosomiasis are mostly prevalent in developing countries due to poor sanitation and lack of adequate clean water. School-age children tend to be the target of chemotherapy-based control programmes because they carry the heaviest worm and egg burdens. The present study examines adverse events (AEs) experienced following co-administration of albendazole and praziquantel to school-age children in a rural area in Kwale County, Kenya. Children were treated with single doses of albendazole and praziquantel tablets and then interviewed using a questionnaire for post treatment AEs. Overall, 752 children, 47.6% boys, participated in the study. Their median (interquartile range) age was 12.0 (10.0-14.0) years. A total of 190 (25.3%) children reportedly experienced at least one AE. In total, 239 cases of AEs were reported with the most frequent being abdominal pains (46.3%), dizziness (33.2%) and nausea (21.1%). Majority of the reported AEs (80.8%) resolved themselves while 12.1% and 6.3% were countered by, respectively, self-medication and visiting a nearby health facility. More girls (60.5%) than boys (39.5%) reported AEs (P = 0.027). The AEs were mild and transient, and were no worse than those expected following monotherapy. The current study adds to the evidence base that dual administration of albendazole and praziquantel in school-based mass drug administration is safe with only mild adverse events noted.

An artemisinin derivative of praziquantel as an orally active antischistosomal agent.

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Lanlan Dong

Full Text Available Schistosomiasis is a major health problem in tropical and sub-tropical areas caused by species of trematode belonging to the genus Schistosoma. The treatment and control of this disease has been relying on the use of a single drug praziquantel. However, the drug resistance concern urged the development of new drugs against schistosoma. Here, we report our systematic biological evaluation of DW-3-15, a new lead compound developed based on our conjugation design rationale as an effective anti-schistosomal agent.The antischistosomal activity of DW-3-15 was systematically evaluated in S. japonicum infected mouse model for its stage-sensitivity and dose response. The results revealed that DW-3-15 exhibited 60-85% worm reduction rate against different development stage of worm. Scanning electron microscopy (SEM observation indicated that DW-3-15 may damage to the tegument of male schistosomes.Our results demonstrated that DW-3-15 showed potent anti-schistosomal activities in vivo. The results strongly support our conjugation design strategy of artemisinin analogs and further development of DW-3-15 as a new lead compound as anti-schistosomal agent.

Efficacy of a single dose of milbemycin oxime/praziquantel combination tablets, Milpro(®), against adult Echinococcus multilocularis in dogs and both adult and immature E. multilocularis in young cats.

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Cvejic, Dejan; Schneider, Claudia; Fourie, Josephus; de Vos, Christa; Bonneau, Stephane; Bernachon, Natalia; Hellmann, Klaus

2016-03-01

Two single-site, laboratory, negatively controlled, masked, randomised dose confirmation studies were performed: one in dogs, the other in cats. After a period of acclimatisation, both the dogs and cats were orally infected with Echinococcus multilocularis protoscoleces. In the dog study, 10 dogs received a single dose of Milpro® tablets at a minimum dose of 0.5 mg/kg milbemycin oxime and 5 mg/kg praziquantel 18 days post-infection and 10 dogs received no treatment. In the cat study, 10 cats received a single dose of Milpro® tablets at a minimum dose of 2 mg/kg milbemycin oxime and 5 mg/kg praziquantel 7 days post-infection, 10 cats received a single dose of the treatment 18 days post-infection and 10 cats remained untreated. In both studies, intestinal worm counts were performed 23 days post-infection at necropsy. No worms were retrieved from any of the 30 treated animals. Nine of 10 control dogs had multiple worms (geometric mean 91, arithmetic mean 304) and all 10 control cats had multiple worms (geometric mean 216, arithmetic mean 481). The difference in worm counts between all three treated groups and their controls was highly significant (ANOVA p values of log transformed data dogs and cats as well as for elimination of immature E. multilocularis in cats as evidenced by the effectiveness of treatment 7 days post-infection. The treatments were well accepted and tolerated, and there were no adverse drug reactions observed.

Single versus double dose praziquantel comparison on efficacy and Schistosoma mansoni re-infection in preschool-age children in Uganda

DEFF Research Database (Denmark)

Nalugwa, Allen; Nuwaha, Fred; Tukahebwa, Edridah Muheki

2015-01-01

BACKGROUND: Schistosoma mansoni infection is proven to be a major health problem of preschool-age children in sub-Saharan Africa, yet this age category is not part of the schistosomiasis control program. The objective of this study was to compare the impact of single and double dose praziquantel...... (PZQ) treatment on cure rates (CRs), egg reduction rates (ERRs) and re-infection rates 8 months later, in children aged 1-5 years living along Lake Victoria, Uganda. METHODOLOGY/PRINCIPAL FINDINGS: Infected children (n= 1017) were randomized to receive either a single or double dose of PZQ. Initially...... all children were treated with a single standard oral dose 40 mg/kg body weight of PZQ. Two weeks later a second dose was administered to children in the double dose treatment arm. Side effects were monitored at 30 minutes to 24 hours after each treatment. Efficacy in terms of CRs and ERRs for the two...

Change in children's school behavior after mass administration of praziquantel for Schistosoma mansoni infection in endemic areas of western Kenya: A pilot study using the Behavioral Assessment System for Children (BASC-2.

Directory of Open Access Journals (Sweden)

Rosemary Musuva

Full Text Available Schistosomiasis is a parasite-related chronic inflammatory condition that can cause anemia, decreased growth, liver abnormalities, and deficits in cognitive functioning among children.This study used the Behavior Assessment System for Children (BASC-2 to collect data on thirty-six 9-12 year old school-attending children's behavioral profiles in an Schistosoma mansoni-endemic area of western Kenya, before and after treatment with praziquantel for S. mansoni infection. BASC-2 T scores were significantly reduced post-treatment (p < 0.05 for each of the 'negative' behavior categories including externalizing problems (hyperactivity, aggression, and conduct problems that are disruptive in nature, internalizing problems (anxiety, depression, somatization, atypicality, and withdrawal, school problems (academic difficulties, included attention problems and learning problems, and the composite behavioral symptoms index (BSI, signifying improved behavior. While the observed improvement in the 'positive' behavior category of adaptive skills (adaptability, functional communication, social skills, leadership, and study skills was not statistically significant, there were significant improvements in two adaptive skills subcategories: social skills and study skills.Results of this study suggest that children have better school-related behaviors without heavy S. mansoni infection, and that infected children's behaviors, especially disruptive problem behaviors, improve significantly after praziquantel treatment.

Cytokine responses to the anti-schistosome vaccine candidate antigen glutathione-S-transferase vary with host age and are boosted by praziquantel treatment.

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Claire D Bourke

2014-05-01

Full Text Available Improved helminth control is required to alleviate the global burden of schistosomiasis and schistosome-associated pathologies. Current control efforts rely on the anti-helminthic drug praziquantel (PZQ, which enhances immune responses to crude schistosome antigens but does not prevent re-infection. An anti-schistosome vaccine based on Schistosoma haematobium glutathione-S-transferase (GST is currently in Phase III clinical trials, but little is known about the immune responses directed against this antigen in humans naturally exposed to schistosomes or how these responses change following PZQ treatment.Blood samples from inhabitants of a Schistosoma haematobium-endemic area were incubated for 48 hours with or without GST before (n = 195 and six weeks after PZQ treatment (n = 107. Concentrations of cytokines associated with innate inflammatory (TNFα, IL-6, IL-8, type 1 (Th1; IFNγ, IL-2, IL-12p70, type 2 (IL-4, IL-5, IL-13, type 17 (IL-17A, IL-21, IL-23p19 and regulatory (IL-10 responses were quantified in culture supernatants via enzyme-linked immunosorbent assay (ELISA. Factor analysis and multidimensional scaling were used to analyse multiple cytokines simultaneously.A combination of GST-specific type 2 (IL-5 and IL-13 and regulatory (IL-10 cytokines was significantly lower in 10-12 year olds, the age group at which S. haematobium infection intensity and prevalence peak, than in 4-9 or 13+ year olds. Following PZQ treatment there was an increase in the number of participants producing detectable levels of GST-specific cytokines (TNFα, IL-6, IL-8, IFNγ, IL-12p70, IL-13 and IL-23p19 and also a shift in the GST-specific cytokine response towards a more pro-inflammatory phenotype than that observed before treatment. Participant age and pre-treatment infection status significantly influenced post-treatment cytokine profiles.In areas where schistosomiasis is endemic host age, schistosome infection status and PZQ treatment affect the

Utilização de fenbendazole e da associação febantel, pamoato de pirantel e praziquantel no controle de oxiurídeos em gerbis

OpenAIRE

Machado,H.H.S.; Gomes,F.F.; Fiuza,V.R.S.; Toledo,R.S.; de Oliveira,F. C.R.

2007-01-01

Eighteen jirds were equally distributed in two treated and one control groups. The commercial products to the fenbendazole base (10mg) and the association of febantel (1.5mg), pirantel (1.44mg) and praziquantel (0.5mg) were orally administred in the concentration of 0.1ml in each group. The effectiveness of febendazole against oxiurids was 81.8%, 65.0 and 38.7% and for the association of febantel, pirantel and praziquantel was 72.7%, 73.8% and 51.0% on days 7, 14 and 21, respectively. Three a...

A comparative study on the efficacy of praziquantel and albendazole in the treatment of urinary schistosomiasis in Adim, Cross River State, Nigeria.

Science.gov (United States)

Ben, S A; Useh, M F

2017-09-01

Praziquantel (PZQ) is the current drug of choice for the treatment of urinary schistosomiasis in endemic areas. It is very efficacious, although the potential for the development of resistance has been reported in some endemic areas among human subjects and in animal studies. Its' limitation include high cost and administration of multiple numbers of tablets. Albendazole (ALB) is used in the treatment of intestinal helminths infection. It is a broad-spectrum single-dose antihelminthic with an excellent cure rate and safety criteria. Currently, it is not routinely used for the treatment of urinary schistosomiasis. Urine samples collected from 596 pupils aged between 2 and 16 years were processed and examined for the presence of ova of Schistosoma haematobium using a standard filtration technique. A total of 100 infected subjects were treated with a standard dose of PZQ (40 mg/kg body weight), while another group of 96 infected subjects were treated with ALB (400 mg for individuals above 3 years). A post-treatment study was conducted 1 month after treatment to assess their cure rate. The prevalence of S. haematobium infection in the study area was 32.8% (196/596). More males were infected (44.2%) (122/276) than females (23.1%) (74/320). The difference in the prevalence rate of infection by gender was statistically significant (X2=15.7>3.841, p0.05). PZQ gave a higher cure rate of 78.0% (78/100) compared with ALB (68.7%) (66/96). There was no statistically significant difference in the cure rate obtained with both drugs (X2=0.355>0.282, p>0.05). The intensity of egg excretion was greatly reduced in subjects who were not cured by the two drugs. The findings of this study suggest the use of ALB for the treatment of urinary schistosomiasis. We recommend further assessment of the efficacy of the drug in an area with higher morbidity of urinary schistosomiasis than the present study area. © The Author 2017. Published by Oxford University Press on behalf of Royal Society

Putting the treatment of paediatric schistosomiasis into context.

Science.gov (United States)

Mduluza, Takafira; Mutapi, Francisca

2017-04-07

Despite increased international efforts to control schistosomiasis using preventive chemotherapy, several challenges still exist in reaching the target populations. Until recently, preschool-aged children had been excluded from the recommended target population for mass drug administration, i.e. primary school children aged 6-15 years. Our studies and those of others provided the evidence base for the need to treat preschool-aged children that led to recommendations by the World Health Organization to include preschool-aged children in treatment programmes in 2010. The major challenge now lies in the unavailability of a child-size formulation of the appropriate anthelmintic drug, praziquantel.The currently available formulation of praziquantel presents several problems. First, it is a large tablet, making it difficult for young children and infants to swallow it and thus requires its breaking/crushing to allow for safe uptake. Second, it is bitter so it is often mixed with a sweetener to make it palatable for young children. Third, the current formulation of 600 mg does not allow for flexible dose adjustments for this age group. Thus, there is a need to formulate a child-appropriate praziquantel tablet.This paper discusses the target product profile for paediatric praziquantel, as well as knowledge gaps pertinent to the successful control of schistosome infection and disease in preschool-aged children.

Artemether as adjuvant therapy to praziquantel in murine Egyptian schistosomiasis mansoni.

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Mahmoud, M R; Botros, S S

2005-02-01

We investigated the activity of artemether (ART) against different developmental stages of schistosomes alone and in addition to praziquantel (PZQ). ART was administered orally (400 mg/kg) 4 and 6 wk postinfection (PI), 4 and 5 wk PI, or 4 or 6 wk PI alone and in addition to oral PZQ (500 x 2 mg/kg) 6 wk PI. Mice were killed in parallel to infected untreated controls 8 wk PI. Parasitological parameters and histological changes in the liver were studied. ART given 4 and 6 wk PI reduced worm burdens by 59 and 55% and tissue egg load by 96 and 90%, respectively. Moreover, eggs in different developmental stages were not found. The reduction in worm and egg burden (63 and 58%, and 96 and 99%, respectively) in mice treated with ART 4 and 5 wk or 4 and 6 wk PI was comparable with that in ART-treated mice at 4 or 6 wk PI. Compared with PZQ alone, combined treatment of PZQ and ART (4 and 5 wk or 4 and 6 wk PI) did not enhance worm eradication, but there was a complete absence of parasite eggs. Livers revealed no granulomata when ART was given 4 and 5 wk or 4 and 6 wk PI, with minimal central necrosis in those treated 4 and 6 wk PI. In conclusion, combined treatment of ART (4 and 6 wk PI) and PZQ resulted in >90% worm eradication and amelioration of Schistosoma mansoni eggs from the tissues, with minor histological changes in the liver.

Ureteroneocystostomy after failed dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux treatment.

Science.gov (United States)

Moreira-Pinto, João; Osório, Angélica; Pereira, Joana; Sousa, Catarina; de Castro, João Luís Ribeiro; Réis, Armando

2013-10-01

To report our experience of open ureteroneocystostomy after failed endoscopic treatment. Clinical charts of 787 children who entered our dextranomer/hyaluronic acid copolymer (DxHA) endoscopic injection program for vesicoureteral reflux (VUR) treatment between May 2000 and December 2009 were reviewed. Fifty-one of these patients were submitted to open ureteroneocystostomy for complete resolution of VUR. Twenty-eight patients (55%) were female. Median age at surgery was 65 months (range: 26-182). Median time going from first endoscopic injection until open surgery was 13 months (range 1-58). Surgical ureteral reimplantation was bilateral in 62.7% of the cases. Of a total of 83 operated ureters, nine were duplex ureters, nine were megaureters, six were ectopic, and two had periureteral diverticulum. Mean operative time was 70 min (range 45-120 min). There were no intra-operative complications. Follow-up VCUG showed complete resolution of VUR in 98% of patients. There was only one right-sided grade III VUR that persisted after bilateral reimplantation. It resolved with a single subureteral DxHA injection. Ureteroneocystostomy after a failed endoscopic treatment can achieve successful results in a high percentage of patients with minimal complications. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Efeito do praziquantel incorporado a lipossomas nos diferentes estágios de desenvolvimento dos ovos de Schistosoma mansoni

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T. F. FREZZA

2009-01-01

Full Text Available

A esquistossomose mansônica é causada pelo trematódeo digenético intravascular Schistosoma mansoni. Para o tratamento dessa enfermidade o praziquantel (PZQ e a oxamniquina (OXA são os fármacos escolhidos. No entanto, esses fármacos apresentam limitações quanto à ação e casos de resistência ou tolerância já foram relatados. Por esse motivo, são necessários os estudos de novas alternativas que visam melhorar os fármacos já existentes, como a incorporação desses em lipossomas. Este estudo verificou a ação do praziquantel incorporado a lipossomas (lip.PZQ sobre os ovos de S. mansoni, linhagem BH em camundongos Mus musculus (Swiss- SPF. Para tanto, foram testadas quatro doses de PZQ e lip.PZQ (47; 60; 250 e 300mg/kg sendo que parte dos camundongos foi tratada após 30 dias de infecção e outra após 45 dias. A análise do oograma mostrou que a dose lip.PZQ 300mg/kg administrada no 45º dia de infecção foi mais eficaz, pois reduziu a oviposição pelas fêmeas de S. mansoni. Palavras-chave: Schistosoma mansoni; praziquantel; lipossoma; oograma.

Efficacy of bath and orally administered praziquantel and fenbendazole against Lepidotrema bidyana Murray, a monogenean parasite of silver perch, Bidyanus bidyanus (Mitchell).

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Forwood, J M; Harris, J O; Deveney, M R

2013-11-01

We investigated the efficacy of praziquantel (PZQ) and fenbendazole (FBZ), each administered by bath and orally, against the monogenean Lepidotrema bidyana Murray, a gill parasite of the freshwater fish silver perch, Bidyanus bidyanus (Mitchell). PZQ and FBZ were each administered by bath at 10 mg L⁻¹ for 48 h and on surface-coated feed pellets at 75 mg kg⁻¹ per body weight (BW) per day for 6 days. Bath treatments of PZQ and FBZ had an efficacy of 99% and 91%, respectively, against adult L. bidyana. Oral treatments of PZQ and FBZ had an efficacy of 79% and 95%, respectively, against adult L. bidyana. Fish rejected feed pellets surface-coated with PZQ, suggesting that palatability of surface-coated PZQ-medicated feed is poor, which undermined efficacy. In all trials, some juvenile parasites were present on fish after treatment during efficacy assessment, indicating that efficacy may be lower against juvenile parasites or that recruitment occurred post-treatment, demonstrating that repeat treatments are necessary to effectively control L. bidyana in aquaculture. © 2013 John Wiley & Sons Ltd.

Human IgG1 Responses to Surface Localised Schistosoma mansoni Ly6 Family Members Drop following Praziquantel Treatment.

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Iain W Chalmers

Full Text Available The heptalaminate-covered, syncytial tegument is an important anatomical adaptation that enables schistosome parasites to maintain long-term, intravascular residence in definitive hosts. Investigation of the proteins present in this surface layer and the immune responses elicited by them during infection is crucial to our understanding of host/parasite interactions. Recent studies have revealed a number of novel tegumental surface proteins including three (SmCD59a, SmCD59b and Sm29 containing uPAR/Ly6 domains (renamed SmLy6A SmLy6B and SmLy6D in this study. While vaccination with SmLy6A (SmCD59a and SmLy6D (Sm29 induces protective immunity in experimental models, human immunoglobulin responses to representative SmLy6 family members have yet to be thoroughly explored.Using a PSI-BLAST-based search, we present a comprehensive reanalysis of the Schistosoma mansoni Ly6 family (SmLy6A-K. Our examination extends the number of members to eleven (including three novel proteins and provides strong evidence that the previously identified vaccine candidate Sm29 (renamed SmLy6D is a unique double uPAR/Ly6 domain-containing representative. Presence of canonical cysteine residues, signal peptides and GPI-anchor sites strongly suggest that all SmLy6 proteins are cell surface-bound. To provide evidence that SmLy6 members are immunogenic in human populations, we report IgG1 (as well as IgG4 and IgE responses against two surface-bound representatives (SmLy6A and SmLy6B within a cohort of S. mansoni-infected Ugandan males before and after praziquantel treatment. While pre-treatment IgG1 prevalence for SmLy6A and SmLy6B differs amongst the studied population (7.4% and 25.3% of the cohort, respectively, these values are both higher than IgG1 prevalence (2.7% for a sub-surface tegumental antigen, SmTAL1. Further, post-treatment IgG1 levels against surface-associated SmLy6A and SmLy6B significantly drop (p = 0.020 and p < 0.001, respectively when compared to rising Ig

Evaluation and treatment of failed shoulder instability procedures.

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Ho, Anthony G; Gowda, Ashok L; Michael Wiater, J

2016-09-01

Management of the unstable shoulder after a failed stabilization procedure can be difficult and challenging. Detailed understanding of the native shoulder anatomy, including its static and dynamic restraints, is necessary for determining the patient's primary pathology. In addition, evaluation of the patient's history, physical exam, and imaging is important for identifying the cause for failure after the initial procedure. Common mistakes include under-appreciation of bony defects, failure to recognize capsular laxity, technical errors, and missed associated pathology. Many potential treatment options exist for revision surgery, including open or arthroscopic Bankart repair, bony augmentation procedures, and management of Hill Sachs defects. The aim of this narrative review is to discuss in-depth the common risk factors for post-surgical failure, components for appropriate evaluation, and the different surgical options available for revision stabilization. Level of evidence Level V.

Defining Persistent Hotspots: Areas That Fail to Decrease Meaningfully in Prevalence after Multiple Years of Mass Drug Administration with Praziquantel for Control of Schistosomiasis.

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Kittur, Nupur; Binder, Sue; Campbell, Carl H; King, Charles H; Kinung'hi, Safari; Olsen, Annette; Magnussen, Pascal; Colley, Daniel G

2017-12-01

Preventive chemotherapy with praziquantel for schistosomiasis morbidity control is commonly done by mass drug administration (MDA). MDA regimen is usually based on prevalence in a given area, and effectiveness is evaluated by decreases in prevalence and/or intensity of infection after several years of implementation. Multiple studies and programs now find that even within well-implemented, multiyear, annual MDA programs there often remain locations that do not decline in prevalence and/or intensity to expected levels. We term such locations "persistent hotspots." To study and address persistent hotspots, investigators and neglected tropical disease (NTD) program managers need to define them based on changes in prevalence and/or intensity. But how should the data be analyzed to define a persistent hotspot? We have analyzed a dataset from an operational research study in western Tanzania after three annual MDAs using four different approaches to define persistent hotspots. The four approaches are 1) absolute percent change in prevalence; 2) percent change in prevalence; 3) change in World Health Organization guideline categories; 4) change (absolute or percent) in both prevalence and intensity. We compare and contrast the outcomes of these analyses. Our intent is to show how the same dataset yields different numbers of persistent hotspots depending on the approach used to define them. We suggest that investigators and NTD program managers use the approach most suited for their study or program, but whichever approach is used, it should be clearly stated so that comparisons can be made within and between studies and programs.

Reduced susceptibility to praziquantel among naturally occurring Kenyan isolates of Schistosoma mansoni.

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Sandra D Melman

2009-08-01

Full Text Available The near exclusive use of praziquantel (PZQ for treatment of human schistosomiasis has raised concerns about the possible emergence of drug-resistant schistosomes.We measured susceptibility to PZQ of isolates of Schistosoma mansoni obtained from patients from Kisumu, Kenya continuously exposed to infection as a consequence of their occupations as car washers or sand harvesters. We used a an in vitro assay with miracidia, b an in vivo assay targeting adult worms in mice and c an in vitro assay targeting adult schistosomes perfused from mice. In the miracidia assay, in which miracidia from human patients were exposed to PZQ in vitro, reduced susceptibility was associated with previous treatment of the patient with PZQ. One isolate ("KCW" that was less susceptible to PZQ and had been derived from a patient who had never fully cured despite multiple treatments was studied further. In an in vivo assay of adult worms, the KCW isolate was significantly less susceptible to PZQ than two other isolates from natural infections in Kenya and two lab-reared strains of S. mansoni. The in vitro adult assay, based on measuring length changes of adults following exposure to and recovery from PZQ, confirmed that the KCW isolate was less susceptible to PZQ than the other isolates tested. A sub-isolate of KCW maintained separately and tested after three years was susceptible to PZQ, indicative that the trait of reduced sensitivity could be lost if selection was not maintained.Isolates of S. mansoni from some patients in Kisumu have lower susceptibility to PZQ, including one from a patient who was never fully cured after repeated rounds of treatment administered over several years. As use of PZQ continues, continued selection for worms with diminished susceptibility is possible, and the probability of emergence of resistance will increase as large reservoirs of untreated worms diminish. The potential for rapid emergence of resistance should be an important

Effect of repeated mass drug administration with praziquantel and track and treat of taeniosis cases on the prevalence of taeniosis in Taenia solium endemic rural communities of Tanzania

DEFF Research Database (Denmark)

Braae, Uffe Christian; Magnussen, Pascal; Ndawi, Benedict

received MDA with praziquantel in 2012 (both districts) and in 2013 (Mbozi only). Three cross-sectional population-based surveys were performed in 2012 (R0), 2013 (R1), and 2014 (R2). In each survey approximately 3,000 participants of all ages were tested using copro-antigen-ELISA. The prevalence......This study evaluated the effect of mass drug administration (MDA) with praziquantel administered to school-aged children (SAC) combined with ‘track and treat’ of taeniosis cases on the prevalence of taeniosis. The study was conducted in 14 villages in Mbozi and Mbeya district, Tanzania. SAC.......004, OR 0.12 CI: 0.02-0.41) and R2 (p=0.001, OR 0.24, CI: 0.09-0.53) when comparing to R0. In Mbeya infection decreased at R1 (p=0.013, OR 0.14, CI: 0.02-0.55), but no difference was found for R2 (p=0. 089), compared to R0 among SAC. This study showed that school-based MDA with praziquantel in combination...

Treating refractory obsessive-compulsive disorder: what to do when conventional treatment fails?

Science.gov (United States)

Franz, Adelar Pedro; Paim, Mariana; Araújo, Rafael Moreno de; Rosa, Virgínia de Oliveira; Barbosa, Ísis Mendes; Blaya, Carolina; Ferrão, Ygor Arzeno

2013-01-01

Obsessive-compulsive disorder (OCD) is a chronic and impairing condition. A very small percentage of patients become asymptomatic after treatment. The purpose of this paper was to review the alternative therapies available for OCD when conventional treatment fails. Data were extracted from controlled clinical studies (evidence-based medicine) published on the MEDLINE and Science Citation Index/Web of Science databases between 1975 and 2012. Findings are discussed and suggest that clinicians dealing with refractory OCD patients should: 1) review intrinsic phenomenological aspects of OCD, which could lead to different interpretations and treatment choices; 2) review extrinsic phenomenological aspects of OCD, especially family accommodation, which may be a risk factor for non-response; 3) consider non-conventional pharmacological approaches; 4) consider non-conventional psychotherapeutic approaches; and 5) consider neurobiological approaches.

Treating refractory obsessive-compulsive disorder: what to do when conventional treatment fails?

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Adelar Pedro Franz

2013-01-01

Full Text Available Obsessive-compulsive disorder (OCD is a chronic and impairing condition. A very small percentage of patients become asymptomatic after treatment. The purpose of this paper was to review the alternative therapies available for OCD when conventional treatment fails. Data were extracted from controlled clinical studies (evidence-based medicine published on the MEDLINE and Science Citation Index/Web of Science databases between 1975 and 2012. Findings are discussed and suggest that clinicians dealing with refractory OCD patients should: 1 review intrinsic phenomenological aspects of OCD, which could lead to different interpretations and treatment choices; 2 review extrinsic phenomenological aspects of OCD, especially family accommodation, which may be a risk factor for non-response; 3 consider non-conventional pharmacological approaches; 4 consider non-conventional psychotherapeutic approaches; and 5 consider neurobiological approaches.

Breaking the Failed-State Cycle

National Research Council Canada - National Science Library

Haims, Marla C; Gompert, David C; Treverton, Gregory F; Stearns, Brooke K

2008-01-01

In their research and field experience, the authors have observed a wide gulf separating the treatment of the security problems of failed states from the treatment of those states economic problems...

LC determination of praziquantel in human plasma.

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Ridtitid, Wibool; Wongnawa, Malinee; Mahatthanatrakul, Werawath; Punyo, Jarurat; Sunbhanich, Methi

2002-04-01

A simple high-performance liquid chromatographic (HPLC) method for the determination of praziquantel in human plasma was developed and validated. The present method was described by adding drop-wise 0.2 M Zinc sulfate and acetonitrile to plasma sample for deproteinization. This method used a reversed-phase Spherisorb ODS 2 column (5 microm), 250 x 4.6 mm i.d. as a stationary phase with a mobile phase consisting of acetonitrile- methanol-water (36:10:54, v/v/v), a flow rate of 1.5 ml/min and UV detection wavelength of 217 nm. Diazepam was used as internal standard. The standard calibration curve was linear over the concentration range of 100-2000 ng/ml (r=0.999). The equation of a linear regression line was y=8.05E-04+7.25E-04x with slope and intercept values of 0.0007 and 0.0008, respectively. The limit of detection was 12.25 ng/ml and the limit of quantification was set at 100 ng/ml. The intra- and inter-day assay coefficients of variation (CV) were 3.0+/-1.7 and 6.3+/-1.9%, respectively. The percentage of recovery was 102.1+/-5.6. Therefore, the HPLC method described here was simple, rapid and reproducible since it did not require extraction and evaporation processes in sample preparation, which will reduce time-consuming or expensive sample preparation.

Effect of cyclodextrin complexation on the aqueous solubility and solubility/dose ratio of praziquantel.

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Maragos, Stratos; Archontaki, Helen; Macheras, Panos; Valsami, Georgia

2009-01-01

Praziquantel (PZQ), the primary drug of choice in the treatment of schistosomiasis, is a highly lipophilic drug that possesses high permeability and low aqueous solubility and is, therefore, classified as a Class II drug according to the Biopharmaceutics Classification System (BCS). In this work, beta-cyclodextrin (beta-CD) and hydroxypropyl-beta-cyclodextrin (HP-beta-CD) were used in order to determine whether increasing the aqueous solubility of a drug by complexation with CDs, a BCS-Class II compound like PZQ could behave as BCS-Class I (highly soluble/highly permeable) drug. Phase solubility and the kneading and lyophilization techniques were used for inclusion complex preparation; solubility was determined by UV spectroscopy. The ability of the water soluble polymer polyvinylpyrolidone (PVP) to increase the complexation and solubilization efficiency of beta-CD and HP-beta-CD for PZQ was examined. Results showed significant improvement of PZQ solubility in the presence of both cyclodextrins but no additional effect in the presence of PVP. The solubility/dose ratios values of PZQ-cyclodextrin complexes calculated considering the low (150 mg) and the high dose (600 mg) of PZQ, used in practice, indicate that PZQ complexation with CDs may result in drug dosage forms that would behave as a BCS-Class I depending on the administered dose.

Fatty acids oxidation and alternative energy sources detected in Taenia crassiceps cysticerci after host treatment with antihelminthic drugs.

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Fraga, Carolina Miguel; Costa, Tatiane Luiza; Bezerra, José Clecildo Barreto; de Souza Lino Junior, Ruy; Vinaud, Marina Clare

2012-05-01

Human cysticercosis caused by Taenia crassiceps is rare however it is considered of zoonotic risk. The treatment of the infected patients was successful when using albendazole or praziquantel. The active forms of albendazole inhibit the glucose uptake and the active forms of praziquantel alter glycogen levels and nutrients absorption. The aim of this study was to analyze the production of organic acids that indicate the oxidation of fatty acids and the use of alternative energy sources from T. crassiceps cysticerci removed from the peritoneal cavity of mice treated with low dosages of albendazole (5.75 and 11.5mg/kg) or praziquantel (3.83 and 7.67 mg/kg). The beta-hydroxibutyrate production was higher by the larval stage cysticerci in all treated groups and the propionate production was higher in final stage cysticerci treated with 11.5mg/kg of albendazole when compared to the control group. The larval stages of cysticerci from the groups treated with 5.75 mg/kg of albendazole and 3.83 mg/kg of praziquantel produced more urea than the initial and final stages which indicate amino acids breakdown. We conclude that it was possible to detect the fatty acid oxidation and amino acids breakdown which indicate the use of alternative energy production sources as the used dosages only cause a partial blockage of the glucose uptake and leads to metabolic alterations in the cysticerci. The metabolic behavior observed after host treatment was different from former descriptions of the in vitro one which indicates great host-parasite interaction. Copyright © 2012 Elsevier Inc. All rights reserved.

Barriers to treatment of failed or interferon ineligible patients in the era of DAA: single center study

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Kwang Il Seo

2017-03-01

Full Text Available Background/Aims Interferon-based treatment is not appropriate for a large number of patients with chronic hepatitis C for various medical and social reasons. Newly developed directly acting antivirals (DAAs have been used to treat chronic hepatitis C without severe adverse effects and have achieved a sustained viral response (SVR rate of 80-90% with short treatment duration. We were interested to determine whether all patients who failed to respond to or were ineligible for interferon-based therapy could be treated with DAAs. Methods Medical records of patients with positive serum anti-hepatitis C virus (HCV or HCV RNA between January 2009 and December 2013 were reviewed. Demographic, clinical, and treatment data were collected for analysis. Results A total of 876 patients were positive for both anti-HCV and HCV RNA. Of these, 244 patients were eligible for interferon, although this was associated with relapse in 39 (16% of patients. In total, 130 patients stopped interferon therapy (67% adverse effects, 28% non-adherent, 4% malignancy, 1% alcohol abuse and 502 patients were ineligible (66% medical contraindications, 25% non-adherent, 5% socioeconomic problems. Among 671 patients who were ineligible for or failed to respond to interferon therapy, more than 186 (27.7% could not be treated with DAA due to financial, social, or cancer-related conditions. Conclusions Newly developed DAAs are a promising treatment for patients with chronic hepatitis C who are ineligible for or failed to respond to interferon-based therapy. Nevertheless, not all chronic hepatitis C patients can be treated with DAAs due to various reasons.

Medicinal chemistry of antischistosomal drugs: Praziquantel and oxamniquine.

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da Silva, Vinícius Barros Ribeiro; Campos, Bruna Rafaella Koresch Leiva; de Oliveira, Jamerson Ferreira; Decout, Jean-Luc; do Carmo Alves de Lima, Maria

2017-07-01

Neglected tropical diseases (NTDs) are a group of diseases that, besides prevailing in poverty conditions, contribute to the maintenance of social inequality, being a strong barrier to a country development. Schistosomiasis, a NTD, is a tropical and subtropical disease caused by the trematode Schistosoma mansoni (Africa, Middle East, Caribbean, Brazil, Venezuela, Suriname), japonicum (China, Indonesia, the Philippines), mekongi (several districts of Cambodia and the Lao People's Democratic Republic), intercalatum and guianensis (areas of tropical rainforests in Central Africa) and hematobium (Middle East Africa, Corsica, France) whose adult forms inhabit the mesenteric vessels of the host, while the intermediate forms are found in the aquatic gastropod snails of the genus Biomphalaria. Currently, praziquantel (PZQ) is the first line drug chosen for the treatment of schistosomiasis according to the World Health Organization (WHO) Model List of Essential Medicines, 2015. PZQ chemotherapy is considered to be the most important development for decades in the treatment of schistosomiasis. Beside the PZQ, oxamniquine (OXA) has been first described in 1969 and launched in Brazil by Pfizer under the name of Mansil® for oral administration. It has a lower cost when compared to PZQ, being active in the intestinal and hepatosplenic infections caused exclusively by S. mansoni, single species in Brazil. Both PZQ and OXA have limitations, as low efficacy in the treatment of acute schistosomiasis, low activity against S. mansoni in immature stages and resistance or tolerance, which is the reason why further research are still necessary for the development of a second generation of antischistosomal drugs. For the development of new PZQ analogs, three main strategies can be adopted: (a) synthesis and evaluation of PZQ analogues; (b) rational design of new pharmacophores; (c) discovery of new active compounds from screening programs on a large scale. Such (b) approach is difficult

Activity of praziquantel on in vitro transformed Schistosoma mansoni sporocysts

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ACA Mattos

2006-10-01

Full Text Available Praziquantel (PZQ is effective against all the evolutive phases of Schistosoma mansoni. Infected Biomphalaria glabrata snails have their cercarial shedding interrupted when exposed to PZQ. Using primary in vitro transformed sporocysts, labeled with the probe Hoechst 33258 (indicator of membrane integrity, and lectin of Glycine max (specific for carbohydrate of N-acetylgalactosamine membrane, we evaluated the presence of lysosomes at this evolutive phase of S. mansoni, as well as the influence of PZQ on these acidic organelles and on the tegument of the sporocyst. Although the sporocyst remained alive, it was observed that there was a marked contraction of its musculature, and there occurred a change in the parasite's structure. Also, the acidic vesicles found in the sporocysts showed a larger delimited area after contact of the parasites with PZQ. Damages to the tegument was also observed, as show a well-marked labeling either with Hoechst 33258 or with lectin of Glycine max after contact of sporocysts with the drug. These results could partially explain the interruption/reduction mechanism of cercarial shedding in snails exposed to PZQ.

Dissolution and oral bioavailability enhancement of praziquantel by solid dispersions.

Science.gov (United States)

Liu, Yanyan; Wang, Tianzi; Ding, Wenya; Dong, Chunliu; Wang, Xiaoting; Chen, Jianqing; Li, Yanhua

2018-06-01

The aim of the present investigation was to enhance the solubility, dissolution, and oral bioavailability of praziquantel (PZQ), a poorly water-soluble BCS II drug (Biopharmaceutical Classification System), using a solid dispersion (SD) technique involving hydrophilic copolymers. The SD formulations were prepared by a solvent evaporation method with PZQ and PEG 4000 (polyethylene glycol 4000), PEG 6000, or P 188 polymers at various weight ratios or a combination of PEG 4000/P 188. The optimized SD formulation, which had the highest solubility in distilled water, was further characterized by its surface morphology, crystallinity, and dissolution in 0.1 M HCl with 0.2% w/v of sodium dodecyl sulfate (SDS). X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) revealed the amorphous form of PZQ in the SDs. Moreover, at an oral dosage of 5 mg/kg PZQ, the SDs had higher C max values and areas under the curve (AUCs) compared to those of commercial PZQ tablets. Preparation of PZQ-loaded SDs using PEG 4000/P 188 is a promising strategy to improve the oral bioavailability of PZQ.

Elucidating the influence of praziquantel nanosuspensions on the in vivo metabolism of Taenia crassiceps cysticerci.

Science.gov (United States)

Silva, Luciana Damacena; Arrúa, Eva Carolina; Pereira, Dayanne Amaral; Fraga, Carolina Miguel; Costa, Tatiane Luiza da; Hemphill, Andrew; Salomon, Claudio Javier; Vinaud, Marina Clare

2016-09-01

The aim of this work was to develop nanosuspensions of praziquantel (PZQ) and to evaluate their influence on the energetic metabolism of cysticerci inoculated in BALB/c mice. We analyzed metabolic alterations of glycolytic pathways and the tricarboxylic acid cycle in the parasite. The nanosuspensions were prepared by precipitation and polyvinyl alcohol (PVA), poloxamer 188 (P188) and poloxamer 407 (P407) were used as stabilizers. Nanosuspension prepared with PVA had a particle size of 100nm, while P188- and P407-based nanosuspensions had particle sizes of 74nm and 285nm, respectively. The zeta potential was -8.1, -8.6, and -13.2 for the formulations stabilized with PVA, P188 and P407, respectively. Treatments of T. crassiceps cysticerci-infected mice resulted in an increase in glycolysis organic acids, and enhanced the partial reversion of the tricarboxylic acid cycle, the urea cycle and the production of ketonic bodies in the parasites when compared to the groups treated with conventional PZQ. These data suggest that PZQ nanosuspensions greatly modified the energetic metabolism of cysticerci in vivo. Moreover, the remarkable metabolic alterations produced by the stabilizers indicate that further studies on nanoformulations are required to find potentially suitable nanomedicines. Copyright © 2016 Elsevier B.V. All rights reserved.

Failing Failed States

DEFF Research Database (Denmark)

Holm, Hans-Henrik

2002-01-01

coverage. A Danish survey of newsrooms shows that the national world-view and prevalent news criteria prevent consistent coverage. It is argued that politicians are the ones who determine national agendas: it is from political initiatives, rather than media coverage, that failing states and humanitarian......When states are failing, when basic state functions are no longer carried out, and when people have no security, humanitarian crises erupt. In confronting this problem, the stronger states have followed an ad hoc policy of intervention and aid. In some cases, humanitarian disasters have resulted...... from inaction. Often, the media are blamed. Politicians complain about the media when they interfere (the CNN effect), and when they do not. This article looks at how the media do cover failing states. Sierra Leone and Congo are used as examples. The analysis shows that there is little independent...

Evaluation of the Anti-schistosomal Effects of Turmeric (Curcuma longa) Versus Praziquantel in Schistosoma mansoni Infected Mice.

Science.gov (United States)

Hussein, Atef; Rashed, Samia; El Hayawan, Ibrahim; El-Sayed, Rabab; Ali, Hemat

2017-01-01

Curcumin is the major active ingredient of Curcuma longa L. , traditionally known as turmeric and has been shown to exhibit a wide range of pharmacological activities including anti-parasitic effect. However, it is found to be water-insoluble and has low bioavailability. The aim of this study was to explore the potential role of turmeric solved in olive oil either alone or in combination with praziquantel (PZQ) in treatment of schistosomiasis mansoni . The whole turmeric powder suspended in olive oil (as a solvent) is indicated to S. mansoni -infected mice aiming to study its potential therapeutic role, either alone or in combination with PZQ. Turmeric significantly reduced S. mansoni worm burden and complete absence of adult worms achieved in mice treated with combination of turmeric and PZQ. Turmeric has slight non-significant effect on the oogram pattern in all examined S. mansoni infected mice. Turmeric and PZQ found to exert a significant reduction of granuloma size in comparison with control. However, turmeric has a non-significant effect on granuloma number. On the other hand, turmeric or/and PZQ treated mice showed obvious improvement of pathology with mild cloudy swelling and less hydropic degeneration. Turmeric significantly reduced parasite worm burden, granuloma size and consequently the pathology of affected liver, it still far less effective than PZQ.

Similar cellular responses after treatment with either praziquantel or ...

African Journals Online (AJOL)

and age before being randomly allocated to one treatment, with either ..... Cioli D, Pica-Mattoccia L, Archer S. Antischistosomal drugs: past, present ... and .... approach to schistosome population dynamics and estimation of the life-span of ...

Effect of repeated mass drug administration with praziquantel and track and treat of taeniosis cases on the prevalence of taeniosis in Taenia solium endemic rural communities of Tanzania

DEFF Research Database (Denmark)

Braae, Uffe Christian; Magnussen, Pascal; Ndawi, Benedict

2017-01-01

This study evaluated the effect of mass drug administration (MDA) with praziquantel administered to school-aged children (SAC) combined with ‘track and treat’ of taeniosis cases in the general population on the copro-antigen (Ag) prevalence of taeniosis. The study was conducted in 14 villages in ...

Comparative in vivo antioxidant levels in Schistosoma mansoni infected mice treated with praziquantel or the essential oil of Melaleuca armillaris leaves.

Science.gov (United States)

Rizk, M; Ibrahim, N; El-Rigal, N

2012-10-15

Plant extracts are continuously investigated for their extensive inclusion of biologically active constituents that exert therapeutic activities against many diseases. The aim of this study was to assess the antioxidant/anti-schistosomal activities of the essential oil of the fresh leaves of Melaleuca armillaris (M. armillaris) compared to Praziquantel (PZQ) on normal and Schistosoma mansoni-infected mice. The oil was isolated by hydrodistillation and analyzed by gas chromatography/mass spectrometry (GC/MS). The oil was rich in 1,8-cineole (33.93%), terpinen-4-ol (18.79%), limonene (10.37%) and B-pinene (6.59%). M. armillaris oil (150 mg kg(-1), orally) was administered from the second week post infection twice per week for six weeks. PZQ (500 mg kg(-1), orally) was administered for two successive days 8 weeks post infection and mice sacrificed one week later. Total protein, Malondialdehyde (MDA), Glutathione (GSH), vitamins C and E, the antioxidant enzymes catalase and superoxide dismutase, as well as liver weights and liver/body weight were determined in the liver tissues. Results showed that, both treatments significantly ameliorated the disturbed levels ofGSH and MDA in infected mice. Both vitamins were significantly elevated after treatment with the oil while a significant increase in catalase accompanied by a pronounced decrease in SOD were obtained after treatment with PZQ. Both treatments markedly improved liver and body weights in infected mice compared to the infected-untreated ones. In conclusion, natural plant sources may be used as promising alternative agents to chemical drugs for schistosomiasis treatment, since the latter may result in drug-induced resistance arising from repeated use.

Effects of Nursing Care Based on Watson's Theory of Human Caring on Anxiety, Distress, And Coping, When Infertility Treatment Fails: A Randomized Controlled Trial.

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Durgun Ozan, Yeter; Okumuş, Hülya

2017-06-01

Introduction: The failure of infertility treatment leads to individual, familial, and social problems. The objective of this study was to evaluate the effectiveness of the nursing care program based on Watson's "Theory of Human Caring" on anxiety and distress caused by coping when the treatment fails. Methods: This study randomized controlled trial study was conducted from April to November 2012, with 86 Turkish women with infertility (intervention group: 45, control group: 41). Follow-up of 32 infertile women, who failed infertility treatment from intervention group, and 35 infertile women, who failed infertility treatment from control group, continued for another four weeks. Data were collected through Spiel Berger's State/Trait Anxiety Inventory, Distress Scale, and Ways of Coping Questionnaire. The analyses of data were conducted using SPSS ver 13. Results: The intervention and control groups significantly differed in terms of anxiety, distress, and coping levels. The intervention group's mean anxiety score decreased by thirteen points and distress by fourteen points (in a positive direction). The intervention group's mean positive coping style score increased. Whereas a negative increase was observed in the control group's values depending on the failure of the treatment. Conclusion: Watson's theory of human caring is recommended as a guide to nursing patients with infertility treatment to decrease levels of anxiety and distress, and to increase the positive coping style among infertile women.

Evaluation of the Anti-schistosomal Effects of Turmeric (Curcuma longa Versus Praziquantel in Schistosoma mansoni Infected Mice

Directory of Open Access Journals (Sweden)

Atef HUSSEIN

2017-12-01

Full Text Available AbstractBackground: Curcumin is the major active ingredient of Curcuma longa L., traditionally known as turmeric and has been shown to exhibit a wide range of pharmacological activities including anti-parasitic effect. However, it is found to be water-insoluble and has low bioavailability. The aim of this study was to explore the potential role of turmeric solved in olive oil either alone or in combination with praziquantel (PZQ in treatment of schistosomiasis mansoni.Methods: The whole turmeric powder suspended in olive oil (as a solvent is indicated to S. mansoni-infected mice aiming to study its potential therapeutic role, either alone or in combination with PZQ.Results: Turmeric significantly reduced S. mansoni worm burden and complete absence of adult worms achieved in mice treated with combination of turmeric and PZQ. Turmeric has slight non-significant effect on the oogram pattern in all examined S. mansoni infected mice. Turmeric and PZQ found to exert a significant reduction of granuloma size in comparison with control. However, turmeric has a non-significant effect on granuloma number. On the other hand, turmeric or/and PZQ treated mice showed obvious improvement of pathology with mild cloudy swelling and less hydropic degeneration.Conclusion: Turmeric significantly reduced parasite worm burden, granuloma size and consequently the pathology of affected liver, it still far less effective than PZQ.

[Influence of kaempferol on TGF-β1/Smads signal path in liver tissue of mice with Schistosoma japonicum infection].

Science.gov (United States)

Cai, Wen; Zhao, Lei; Li, Hua-rong; Zhang, Shu-ling

2014-08-01

To investigate the influence of kaempferol on transforming growth factor(TGF-β1/Smads signal tiransduction in liver tissue of mice with schistosomiasis liver fibrosis. Forty BALB/c mice were randomly divided into a normal control group (8 mice), a praziquantel group (8 mice ), and 4 praziquantel + kaempferol groups with different kaempferol dosages (5, 10, 15, 20 mg/kg respectively, 6 mice each group). Besides the normal control group, all the mice in the other 5 groups were infected with Schistosoma japonicum. After the infection for 6 weeks, the praziquantel group and the 4 praziquantel + kaempferol groups were treated with praziquantel 500 mg/(kg.d) for 2 d, then the mice in the praziquantel group were drenched with normal saline for 6 weeks, and those in the 4 praziquantel + kaempferol groups were drenched with kaempferol 5, 10, 15, 20 mg/kg respectively for 6 weeks. After the treatment, all the animals were sacrificed by the cervical dislocation method, and the area of egg granuloma and the degree of fibrosis in the livers of the mice were observed by HE and Masson staining. The expressions of TGF-β1, Smad2/3, Smad7 proteins were measured by the immunohistochemical method, and the mRNA levels of the 3 proteins were detected by RT-PCR. Compared with the mice in the praziquantel group, the areas of egg granuloma of the liver of the mice in the 4 praziquantel + kaempferol groups were smaller, and the degrees of the hepatic fibrosis of the mice were lesser, and their expressions of Smad2 and Smad3 at protein and their mRNA levels were significantly lower (all P kaempferol can significantly reduce the degrees of hepatic fibrosis and granuloma caused by schistosome eggs after the praziquantel treatment.

Surgical management of failed endoscopic treatment of pancreatic disease.

Science.gov (United States)

Evans, Kimberly A; Clark, Colby W; Vogel, Stephen B; Behrns, Kevin E

2008-11-01

Endoscopic therapy of acute and chronic pancreatitis has decreased the need for operative intervention. However, a significant proportion of patients treated endoscopically require definitive surgical management for persistent symptoms. Our aim was to determine which patients are likely to fail with endoscopic therapy, and to assess the clinical outcome of surgical management. Patients were identified using ICD-9 codes for pancreatic disease as well as CPT codes for endoscopic therapy followed by surgery. Patients with documented acute or chronic pancreatitis treated endoscopically prior to surgical therapy were included (N = 88). The majority of patients (65%) exhibited chronic pancreatitis due to alcohol abuse. Common indicators for surgery were: persistent symptoms, anatomy not amenable to endoscopic treatment and unresolved common bile duct or pancreatic duct strictures. Surgical salvage procedures included internal drainage of a pseudocyst or an obstructed pancreatic duct (46%), debridement of peripancreatic fluid collections (25%), and pancreatic resection (31%). Death occurred in 3% of patients. The most common complications were hemorrhage (16%), wound infection (13%), and pulmonary complications (11%). Chronic pancreatitis with persistent symptoms is the most common reason for pancreatic surgery following endoscopic therapy. Surgical salvage therapy can largely be accomplished by drainage procedures, but pancreatic resection is common. These complex procedures can be performed with acceptable mortality but also with significant risk for morbidity.

Loading of praziquantel in the crystal lattice of solid lipid nanoparticles - studies by DSC and SAXS

Energy Technology Data Exchange (ETDEWEB)

Souza, A.L.R.; Cassimiro, D.L.; Almeida, A.E.; Ribeiro, C.A.; Gremiao, M.P.D. [UNESP, Araraquara, SP (Brazil); Sarmento, V.H.V. [Universidade Federal de Sergipe (UFS), Itabaiana, SE (Brazil); Andreani, T.; Silva, A.M.; Souto, E.B. [Universidade de Tras-os-Montes e Alto Douro, Vila Real (Portugal)

2012-07-01

Full text: Praziquantel (PZQ) is the drug of choice for oral treatment of schistosomiasis and other fluke infections that affect humans. Its low oral bioavailability demands the development of innovative strategies to overcome the first pass metabolism. In this work, solid lipid nanoparticles loaded with PZQ (PZQ-SLN) were prepared by a modified oil-in-water microemulsion method selecting stearic acid as lipid phase after solubility screening studies. The mean particle size (Z-Ave) and zeta potential (ZP) were 500 nm and -34.0 mV, respectively. Morphology and shape of PZQ-SLN were analysed by scanning electron microscopy revealing the presence of spherical particles with smooth surface. Differential scanning calorimetry suggested that SLN comprised a less ordered arrangement of crystals and the drug was molecularly dispersed in the lipid matrix. No supercooled melts were detected. The entrapment efficiency (EE) and loading capacity of PZQ, determined by high performance liquid chromatography, were 99.0 and 17.5, respectively. Effective incorporation of PZQ into the particles was confirmed by small angle X-ray scattering revealing the presence of a lipid lamellar structure. Stability parameters of PZQ-SLN stored at room temperature (25 deg C) and at 4 deg C were checked by analysing Z-Ave, ZP and the EE for a period of 60 days Results showed a relatively long-term physical stability after storage at 4 deg C, without drug expulsion. (author)

Loading of praziquantel in the crystal lattice of solid lipid nanoparticles - studies by DSC and SAXS

International Nuclear Information System (INIS)

Souza, A.L.R.; Cassimiro, D.L.; Almeida, A.E.; Ribeiro, C.A.; Gremiao, M.P.D.; Sarmento, V.H.V.; Andreani, T.; Silva, A.M.; Souto, E.B.

2012-01-01

Full text: Praziquantel (PZQ) is the drug of choice for oral treatment of schistosomiasis and other fluke infections that affect humans. Its low oral bioavailability demands the development of innovative strategies to overcome the first pass metabolism. In this work, solid lipid nanoparticles loaded with PZQ (PZQ-SLN) were prepared by a modified oil-in-water microemulsion method selecting stearic acid as lipid phase after solubility screening studies. The mean particle size (Z-Ave) and zeta potential (ZP) were 500 nm and -34.0 mV, respectively. Morphology and shape of PZQ-SLN were analysed by scanning electron microscopy revealing the presence of spherical particles with smooth surface. Differential scanning calorimetry suggested that SLN comprised a less ordered arrangement of crystals and the drug was molecularly dispersed in the lipid matrix. No supercooled melts were detected. The entrapment efficiency (EE) and loading capacity of PZQ, determined by high performance liquid chromatography, were 99.0 and 17.5, respectively. Effective incorporation of PZQ into the particles was confirmed by small angle X-ray scattering revealing the presence of a lipid lamellar structure. Stability parameters of PZQ-SLN stored at room temperature (25 deg C) and at 4 deg C were checked by analysing Z-Ave, ZP and the EE for a period of 60 days Results showed a relatively long-term physical stability after storage at 4 deg C, without drug expulsion. (author)

Efficacy of praziquantel against Schistosoma mekongi and Opisthorchis viverrini: a randomized, single-blinded dose-comparison trial.

Directory of Open Access Journals (Sweden)

Leonore Lovis

Full Text Available BACKGROUND: Schistosomiasis and opisthorchiasis are of public health importance in Southeast Asia. Praziquantel (PZQ is the drug of choice for morbidity control but few dose comparisons have been made. METHODOLOGY: Ninety-three schoolchildren were enrolled in an area of Lao PDR where Schistosoma mekongi and Opisthorchis viverrini coexist for a PZQ dose-comparison trial. Prevalence and intensity of infections were determined by a rigorous diagnostic effort (3 stool specimens, each examined with triplicate Kato-Katz before and 28-30 days after treatment. Ninety children with full baseline data were randomized to receive PZQ: the 40 mg/kg standard single dose (n = 45 or a 75 mg/kg total dose (50 mg/kg+25 mg/kg, 4 hours apart; n = 45. Adverse events were assessed at 3 and 24 hours posttreatment. PRINCIPAL FINDINGS: Baseline infection prevalence of S. mekongi and O. viverrini were 87.8% and 98.9%, respectively. S. mekongi cure rates were 75.0% (95% confidence interval (CI: 56.6-88.5% and 80.8% (95% CI: 60.6-93.4% for 40 mg/kg and 75 mg/kg PZQ, respectively (P = 0.60. O. viverrini cure rates were significantly different at 71.4% (95% CI: 53.4-84.4% and 96.6% (95% CI: not defined, respectively (P = 0.009. Egg reduction rates (ERRs against O. viverrini were very high for both doses (>99%, but slightly lower for S. mekongi at 40 mg/kg (96.4% vs. 98.1% and not influenced by increasing diagnostic effort. O. viverrini cure rates would have been overestimated and no statistical difference between doses found if efficacy was based on a minimum sampling effort (single Kato-Katz before and after treatment. Adverse events were common (96%, mainly mild with no significant differences between the two treatment groups. CONCLUSIONS/SIGNIFICANCE: Cure rate from the 75 mg/kg PZQ dose was more efficacious than 40 mg/kg against O. viverrini but not against S. mekongi infections, while ERRs were similar for both doses. TRIAL REGISTRATION: Controlled

Urgent Bypass Surgery Following Failed Endovascular Treatment in Acute Symptomatic Stroke Patient With MCA Occlusion.

Science.gov (United States)

Lee, Chang Yeob; Kim, Chang Hyun; Lee, Chang-Young; Sohn, Sung-Il; Hong, Jeong-Ho

2017-01-01

Although the benefits of extracranial-intracranial bypass surgery remain controversial, there is some surgical rationale for the augmentation of cerebral blood flow in cases of acute ischemic stroke with hemodynamic instability. We report a case of a 62-year-old woman who suddenly developed right hemiplegia and global aphasia. Initial magnetic resonance imaging and magnetic resonance angiography revealed a small acute ischemic lesion in left parietal lobe with occlusion at the left middle cerebral artery. We performed an endovascular thrombectomy, which failed. Her neurological deficits remained unchanged. On the basis of immediate postendovascular magnetic resonance perfusion, diffusion-weighted imaging (DWI), and neurological examination, an obvious clinical-DWI and a DWI-perfusion-weighted imaging mismatch were detected. We decided to perform emergency superficial temporal artery to middle cerebral artery bypass to prevent further progression of cerebral ischemia. On a 3-month follow-up, neurological deficits remained minimal motor aphasia and dysarthria. Following failed endovascular treatment in patients with acute symptoms attributed to major cerebral artery occlusion, we recommend immediate multimodal neuroimaging. If there are clinical-DWI and DWI-perfusion-weighted imaging mismatch indications, surgical revascularization could be considered as the next salvageable strategy.

Therapeutical evaluation of different dose regimens of praziquantel in schistosomiasis mansoni, based on the quantitative oogram technique

Directory of Open Access Journals (Sweden)

Aloísio Sales da Cunha

1987-10-01

Full Text Available A clinical trial involving 80 patients of both sexes, from ages 15 to 55, with chronic intestinal or hepatointestinal schistosomiasis mansoni, was carried out to evaluate the therapeutical efficacy of different dose regimens of praziquantel. The patients were randomly allocated into four groups with an equal number of cases and were then treated with one of the following dosages: 60 mg/kg for 1 day; 60 mg/kg daily for 2 days; 60 mg/kg daily for 3 days; and 30 mg/kg daily for 6 days. The assessment of parasitological cure was based on the quantitative oogram technique through rectal mucosa biopsies which were undertaken prior to, as well as, 1,2,4 and 6 months post-treatment. Concurrently, stool examinations according to the qualitative Hoffman, Pons & Janer (HPJ and the quantitative Kato-Katz (K-K methods were also performed. The best tolerability was observed with 30 mg/kg daily for 6 days whereas the highest incidence of side-effects (mainly dizziness and nausea was found with 60 mg/kg daily for 3 days. No serious adverse drug reaction has occurred. The achieved cure rates were: 25% with 60 mg/kg for 1 day; 60% with 60 mg/kg daily for 2 days; 89.5% with 60 mg/kg daily for 3 days; and 90% with 30 mg/kg daily for 6 days. At the same time there has been a downfall of 64%, 73%, 87% and 84% respectively, in the median number of viable S. mansoni ova per gram of tissue. Thus, a very clear direct correlation between dose and effect could be seen. The corresponding cure rates according to stool examinations by HPJ were 39%, 80%, 100% and 95%; by K-K 89%, 100%, 100% and 100%. This discrepancy in results amongst the three parasitological methods is certainly due to their unequal accuracy. In fact, when the number of viable eggs per gram of tissue fell below 5,000 the difference in the percentage of false negative findings between HPJ (28% and K-K (80% became significative. When this number dropped to less than 2,000 the percentage of false negative

Efficacy and Safety of Tribendimidine Against Clonorchis sinensis

OpenAIRE

Qian, Men-Bao; Yap, Peiling; Yang, Yi-Chao; Liang, Hai; Jiang, Zhi-Hua; Li, Wei; Tan, Yu-Guang; Zhou, Hui; Utzinger, Jürg; Zhou, Xiao-Nong; Keiser, Jennifer

2017-01-01

In this randomized open-label trial, tribendimidine was shown to have an efficacy comparable to praziquantel for the treatment of Clonorchis sinensis infection. Patients treated with praziquantel experienced significantly more adverse events than tribendimidine recipients.

Effect of praziquantel administration on hepatic stereology of mice infected with Schistosoma mansoni and fed a low-protein diet

Directory of Open Access Journals (Sweden)

L.A. Barros

2009-09-01

Full Text Available A study was undertaken to investigate the effect of administering praziquantel (PZQ, focusing on the liver stereological findings of malnourished mice infected with Schistosoma mansoni. Thirty female Swiss Webster mice (age: 21 days; weight: 8-14 g were fed either a low-protein diet (8% or standard chow (22% protein for 15 days. Five mice in each group were infected with 50 cercariae each of the BH strain (Brazil. PZQ therapy (80 mg/kg body weight, per day was started on the 50th day of infection and consisted of daily administration for 5 days. Volume density (hepatocytes, sinusoids and hepatic fibrosis was determined by stereology using a light microscope. Body weight gain and total serum albumin levels were always lower in undernourished mice. Our stereological study demonstrated that treatment increased both volume density of hepatocytes in mice fed standard chow (47.56%, treated group and 12.06%, control and low-protein chow (30.98%, treated group and 21.44%, control, and hepatic sinusoids [standard chow (12.52%, treated group and 9.06%, control, low-protein chow (14.42%, treated group and 8.46%, control], while hepatic fibrosis was reduced [standard chow (39.92%, treated group and 78.88%, control and low-protein chow (54.60%, treated group and 70.10%, control]. On the other hand, mice fed low-protein chow decreased density volume of hepatocytes and hepatic fibrosis. In conclusion, our findings indicate that treatment with PZQ ameliorates hepatic schistosomiasis pathology even in mice fed a low-protein diet.

Closed External Fixation for Failing or Failed Femoral Shaft Plating in a Developing Country.

Science.gov (United States)

Aliakbar, Adil; Witwit, Ibrahim; Al-Algawy, Alaa A Hussein

2017-08-01

Femoral shaft fractures are one of the common injuries that is treated by open reduction, with internal fixation by plate and screws or intramedullary nailing, which can achieve a high union rate. To evaluate the outcome of using closed external fixation to augment a failing plate; with signs of screw loosening and increasing bone/plate gap; a failed plate; broken plate; screws completely out of bone with redisplacement of fracture. A retrospective study on 18 patients, aged between 17-42 years, who presented between 6-18 weeks after initial surgical fixation, with pain, difficulty in limb function, deformity and abnormal movement at fracture site, was done. X-Rays showed plating failure with acceptable amount of callus, which unfortunately had refractured. Cases associated with infection and no radiological evidence of callus formation were excluded from this study. Closed reduction was done by manipulation, then fracture fixation by AO external fixator. The patients were encouraged for full weight bearing as early as possible with dynamization later on. Of the 18 patients who underwent external fixation after close reduction, 15 cases showed bone healing in a period between 11-18 weeks (mean of 14.27 weeks) with good alignment (Radiologically). Removal of external fixator was done followed by physical therapy thereafter. Closed external fixation for treatment of failing or failed femoral plating, achieves good success rate and has less complications, is a short time procedure, especially in a hospital with limited resources.

Our Treatment Approaches in Severe Maxillofacial Injuries Occurring After Failed Suicide Attempts Using Long-Barreled Guns.

Science.gov (United States)

Kucuker, Ismail; Şimşek, Tekin; Keles, Musa Kemal; Yosma, Engin; Aksakal, Ibrahim Alper; Demir, Ahmet

2016-03-01

Maxillofacial traumas with long-barreled guns may sometimes cause catastrophic results by means of smashing in facial structures. In these patients, reconstruction strategies of both fragmented/lost soft and hard tissues still remain controversial. In their clinic, the authors treated 5 patients with severely injured face after failed suicide attempt between 2008 and 2013. In this study, the authors aimed to present their clinical experiences on these severely injured maxillofacial gunshot traumas and offer a treatment algorithm to gain a result as possible as satisfactory in terms of functionality and appearance.

Efficacy of pneumodilation in achalasia after failed Heller myotomy.

Science.gov (United States)

Saleh, C M G; Ponds, F A M; Schijven, M P; Smout, A J P M; Bredenoord, A J

2016-11-01

Heller myotomy is an effective treatment for the majority of achalasia patients. However, a small proportion of patients suffer from persistent or recurrent symptoms after surgery and they are usually subsequently treated with pneumodilation (PD). Data on the efficacy of PD as secondary treatment for achalasia are scarce. Therefore, this study aimed to investigate the efficacy of PD as treatment for achalasia patients suffering from persistent or recurrent symptoms after Heller myotomy. Patients with recurrent or persistent symptoms (Eckardt score >3) after Heller myotomy were selected. Patients were treated with PD, using a graded distension protocol with balloon sizes ranging from 30 to 40 mm. After each dilation symptoms were assessed to evaluate whether a subsequent dilation with a larger balloon size was required. Patients with recurrent or persistent symptoms (Eckardt score >3) after treatment with a 40-mm balloon were identified as failures. Twenty-four patients were included in total; 15 patients with achalasia type I, seven with achalasia type II and two with achalasia type III. Median relapse time was 2.5 years after Heller myotomy (IQR: 9 years and 3 months). Three patients were not suitable for PD; one patient was morbidly obese and not fit for any form of sedation and two had a siphon-shaped esophagus leaving 21 patients to treat. Eight patients were successfully treated with a single 30-mm balloon dilation (median follow-up time: 6.5 years; IQR: 7.5 years). Four patients required dilations with 30- and 35-mm balloons (median follow-up time: 11 years; IQR: 3 years). Nine patients failed on the 35-mm balloon dilation and underwent a subsequent dilation with a 40-mm balloon, and all failed on this balloon as well. Thus, PD was successful in 12 of the 21 treatable patients, resulting in a success rate of 57% for treatable patients or 50% for all patients. Baseline Eckardt scores were also higher in those that failed (median: 8; IQR: 2) than those that

Formulation, characterization and pharmacokinetics of praziquantel-loaded hydrogenated castor oil solid lipid nanoparticles.

Science.gov (United States)

Xie, Shuyu; Pan, Baoliang; Wang, Ming; Zhu, Luyan; Wang, Fenghua; Dong, Zhao; Wang, Xiaofang; Zhou, WenZhong

2010-07-01

The purpose of this study was to formulate praziquantel (PZQ)-loaded hydrogenated castor oil (HCO) solid lipid nanoparticles (SLN) to enhance the bioavailability and prolong the systemic circulation of the drug. PZQ was encapsulated into HCO nanoparticles by a hot homogenization and ultrasonication method. The physicochemical characteristics of SLN were investigated by optical microscope, scanning electron microscopy and photon correlation spectroscopy. Pharmacokinetics were studied after oral, subcutaneous and intramuscular administration in mice. The diameter, polydispersivity index, zeta potential, encapsulation efficiency and loading capacity of the nanoparticles were 344.0 +/- 15.1 nm, 0.31 +/- 0.08, -16.7 +/- 0.5 mV, 62.17 +/- 6.53% and 12.43 +/- 1.31%, respectively. In vitro release of PZQ-loaded HCO-SLN exhibited an initial burst release followed by a sustained release. SLN increased the bioavailability of PZQ by 14.9-, 16.1- and 2.6-fold, and extended the mean residence time of the drug from 7.6, 6.6 and 8.2 to 95.9, 151.6 and 48.2 h after oral, subcutaneous and intramuscular administration, respectively. The PZQ-loaded HCO-SLN could be a promising formulation to enhance the pharmacological activity of PZQ.

Use of flow-diverting stents as salvage treatment following failed stent-assisted embolization of intracranial aneurysms.

Science.gov (United States)

Heiferman, Daniel M; Billingsley, Joshua T; Kasliwal, Manish K; Johnson, Andrew K; Keigher, Kiffon M; Frudit, Michel E; Moftakhar, Roham; Lopes, Demetrius K

2016-07-01

Flow-diverting stents, including the Pipeline embolization device (PED) and Silk, have been beneficial in the treatment of aneurysms previously unable to be approached via endovascular techniques. Recurrent aneurysms for which stent-assisted embolization has failed are a therapeutic challenge, given the existing intraluminal construct with continued blood flow into the aneurysm. We report our experience using flow-diverting stents in the repair of 25 aneurysms for which stent-assisted embolization had failed. Nineteen (76%) of these aneurysms at the 12-month follow-up showed improved Raymond class occlusion, with 38% being completely occluded, and all aneurysms demonstrated decreased filling. One patient developed a moderate permanent neurologic deficit. Appropriate stent sizing, proximal and distal construct coverage, and preventing flow diverter deployment between the previously deployed stent struts are important considerations to ensure wall apposition and prevention of endoleak. Flow diverters are shown to be a reasonable option for treating previously stented recurrent cerebral aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

In-core sipping method for the identification of failed fuel assemblies

International Nuclear Information System (INIS)

Wu Zhongwang; Zhang Yajun

2000-01-01

The failed fuel assembly identification system is an important safety system which ensures safe operations of reactor and immediate treatment of failed fuel rod cladding. The system uses an internationally recognized method to identify failed fuel assemblies in a reactor with fuel element cases. The in-core sipping method is customary used to identify failed fuel assemblies during refueling or after fuel rod cladding failure accidents. The test is usually performed after reactor shutdown by taking samples from each fuel element case while the cases are still in their original core positions. The sample activity is then measured to identify failed fuel assemblies. A failed fuel assembly identification system was designed for the NHR-200 based on the properties of the NHR-200 and national requirements. the design provides an internationally recognized level of safety to ensure the safety of NHR-200

Intestinal Parasites and Anthelmintic Treatments in a Laboratory Colony of Wild-caught African Pouched Rats (Cricetomys ansorgei)

Science.gov (United States)

Cullin, Cassandra O; Sellers, Matthew S; Rogers, Erin R; Scott, Kathleen E; Lee, Danielle N; Ophir, Alexander G; Jackson, Todd A

2017-01-01

African giant pouched rats (Cricetomys spp.) are large rodents native to subSaharan Africa. Wild-caught pouched rats identified as Cricetomys ansorgei (n = 49) were imported from Tanzania. A survey of gastrointestinal parasitism by fecal flotation revealed the presence of multiple parasites, including Nippostrongylus spp., Heterakis spp., Trichuris spp., Hymenolepis spp., Raillietina spp., and Eimeria spp. Oral self-administered fenbendazole (150 ppm), topical moxidectin (2 mg/kg), pyrantel pamoate (15 mg/kg), piperazine (100 mg/kg daily), and injectable ivermectin (0.25 mg/kg) were used to determine effective treatment options for the gastrointestinal parasites present in the colony. Pyrantel pamoate in a treat vehicle and piperazine in water bottles were easily administered and significantly reduced the numbers of animals shedding Nippostrongylus spp. and Heterakis spp. during the study. Moxidectin and ivermectin were clinically ineffective at reducing fecal egg shedding. Fenbendazole was most effective at clearing infection with Trichuris spp. Although 10 mg/kg praziquantel was ineffective, a single dose of 30 mg/kg praziquantel significantly reduced the number of African pouched rats that shed cestode embryos. A combination treatment may be necessary to successfully treat all parasites present in any given animal. PMID:28935004

In Vitro Fertilization Outcomes After Placement of Essure Microinserts in Patients With Hydrosalpinges Who Previously Failed In Vitro Fertilization Treatment: A Multicenter Study.

Science.gov (United States)

Cohen, Shlomo B; Bouaziz, Jerome; Schiff, Eyal; Simon, Alexander; Nadjary, Michel; Goldenberg, Mordechai; Orvieto, Raoul; Revel, Ariel

2016-01-01

To investigate whether hysteroscopic proximal tubal occlusion with Essure microinserts (Conceptus Inc.; Bayer, AG, North Rhine-Westphalia, Germany) can improve pregnancy rates in patients with hydrosalpinges who had failed in vitro fertilization (IVF) treatment. A prospective cohort study. University-affiliated tertiary centers. Twenty-four consecutive women with hydrosalpinges who had failed IVF treatment were included. Hysteroscopic placement of Essure microinserts for hydrosalpinx blockage followed by IVF treatment. Ongoing pregnancy and live birth rates were recorded. Of the 24 patients undergoing a total of 42 IVF cycles after Essure insertion, 18 (75% of patients and 42.8% of IVF cycle attempts) conceived and 16 delivered live births (66.6% of patients and 38.1% of IVF cycle attempts). Hysteroscopic proximal occlusion of hydrosalpinges with Essure microinserts is a valuable alternative to laparoscopic salpingectomy, resulting in reasonable pregnancy rates. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Development of a brazilian nanoencapsulated drug for schistosomiasis treatment

Directory of Open Access Journals (Sweden)

Laís Bastos da Fonseca

2013-11-01

Full Text Available Schistosomiasis is a parasitic disease that, according to the World Health Organization, constitutes a major public health problem associated with severe morbidity, mostly children in preschool age. The administration of drugs in children always constitutes a difficult task, especially when formulations are not developed specifically for pediatric use, when high doses of drug are required and the drug has a bitter taste, as in the case of praziquantel. Polymer nanoparticles are promising systems for development of encapsulated drugs with low water solubility and bitter taste, due to the good physical and chemical stability, adequate biocompatibility and simple manufacturing processes. Moreover, they can enhance the bioavailabili-ty and reduce variability of treatment among patients. Poly (methyl methacrylate doped with praziquantel was produced through a miniemulsion polymerization pro-cess to compose a pediatric pharmaceutical suspension. Nanoparticles were cha-racterized in terms of physico-chemical properties, toxicological properties and biological activity in mice, being concluded that obtained results were satisfactory. The results were encapsulation rate around 90%, absence of chemical interaction drug - polymer and the presence of biological activity. A collaborative approach was used for this development, involving national partnerships and independent funding mechanisms, a powerful pathway for development of drugs for neglected diseases.

One-stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair

Directory of Open Access Journals (Sweden)

Hong-Bin Li

2016-01-01

Full Text Available The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft (LMG after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years (range: 4-45 years. Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients (group 1, and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 (group 2. The median LMG urethroplasty length was 5.6 ± 1.6 cm (range: 4-13 cm. The mean follow-up was 34.7 months (range: 10-58 months, and complications developed in 12 of 56 patients (21.4%, including urethrocutaneous fistulas in 7 (6 in group 1, 1 in group 2 and neourethral strictures in 5 (4 in group 1, 1 in group 2. The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient′s age.

Persistent postpartum haemorrhage after failed arterial ligation: value of pelvic embolisation

Energy Technology Data Exchange (ETDEWEB)

Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Boudiaf, Mourad; Dahan, Henri; Dref, Olivier le [Hopital Lariboisiere AP-HP et Universite Diderot-Paris 7, Department of Abdominal and Interventional Imaging, Paris (France); Morel, Olivier; Barranger, Emmanuel [Hopital Lariboisiere AP-HP, Department of Obstetrics and Gynecology, Paris (France); Gayat, Etienne; Mebazaa, Alexandre [Hopital Lariboisiere AP-HP, Department of Anesthesiology and Intensive Care Medicine, Paris (France)

2010-07-15

To evaluate the role and efficacy of pelvic embolisation in the treatment of persistent postpartum haemorrhage after failed arterial ligation and to identify the complications of this procedure in this specific population. The clinical files and angiographic examinations of 12 consecutive women (mean age 32 years) who were treated with pelvic embolisation because of persistent, severe postpartum haemorrhage after failed arterial ligation were reviewed. Angiography revealed that persistent bleeding was due to incomplete arterial ligation (n = 4) or the presence of newly developed anastomotic routes (n = 8). In 11 women, pelvic embolisation stopped the bleeding. Hysterectomy was needed in one woman with retained placenta. Two complications due to pelvic embolisation, including leg ischaemia and transient sciatic nerve ischaemia, were identified, both after internal iliac artery ligation. In women with persistent postpartum haemorrhage after failed arterial ligation, pelvic embolisation is an effective treatment in most cases. However, embolisation of the anastomotic routes that contribute to persistent bleeding may result in ischaemic complications. These potential complications reaffirm that arterial ligation should not be the favoured option for postpartum haemorrhage and that special care must be given during pelvic embolisation after failed arterial ligation. (orig.)

Schistosomiasis and HIV-1 infection in rural Zimbabwe: effect of treatment of schistosomiasis on CD4 cell count and plasma HIV-1 RNA load

DEFF Research Database (Denmark)

Kallestrup, Per; Zinyama, Rutendo; Gomo, Exnevia

2005-01-01

To determine whether treatment of schistosomiasis has an effect on the course of human immunodeficiency virus type 1 (HIV-1) infection, individuals with schistosomiasis and with or without HIV-1 infection were randomized to receive praziquantel treatment at inclusion or after a delay of 3 months......; 287 participants were included in the study, and 227 (79%) were followed up. Among the 130 participants who were coinfected, those who received early treatment (n=64) had a significantly lower increase in plasma HIV-1 RNA load than did those who received delayed treatment (n=66) (P...

Modulation of expression and activity of cytochrome P450s and alteration of praziquantel kinetics during murine schistosomiasis

Directory of Open Access Journals (Sweden)

Mara A Gotardo

2011-03-01

Full Text Available In this study, we investigated the expression and activity of liver cytochrome P450s (CYPs and praziquantel (PZQ kinetics in mice infected with Schistosoma mansoni. Swiss Webster (SW mice of both genders were infected (100 cercariae on postnatal day 10 and killed on post-infection days (PIDs 30 or 55. Non-infected mice of the same age and sex served as controls. Regardless of mouse sex, infection depressed the activities of CYP1A [ethoxy/methoxy-resorufin-O-dealkylases (EROD/MROD], 2B9/10 [pentoxy/benzyloxy-resorufin-O-dealkylases (PROD, BROD], 2E1 [p-nitrophenol-hydroxylase (PNPH] and 3A11 [erythromycin N-demethylase (END] on PID 55 but not on PID 30. On PID 55, infection decreased liver CYP mRNA levels (real-time reverse transcription-polymerase chain reaction. On PID 30, whereas mRNA levels remained unaltered in males, they were depressed in females. Plasma PZQ (200 and 400 mg/kg body weight intraperitoneally levels were measured (high-performance liquid chromatography at different post-treatment intervals. In males and females, infection delayed the PZQ clearance on PID 55, but not on PID 30. Therefore, it can be concluded that schistosomiasis down-modulated CYP expression and activity and delayed PZQ clearance on PID 55, when a great number of parasite eggs were lodged in the liver. On PID 30, when egg-laying was initiated by the worms, no change of CYP expression and activity was found, except for a depression of CYP1A2 and 3A11 mRNAs in female mice.

Biopharmaceutical characterization of praziquantel cocrystals and cyclodextrin complexes prepared by grinding.

Science.gov (United States)

Cugovčan, Martina; Jablan, Jasna; Lovrić, Jasmina; Cinčić, Dominik; Galić, Nives; Jug, Mario

2017-04-15

Mechanochemical activation using several different co-grinding additives was applied as a green chemistry approach to improve physiochemical and biopharmaceutical properties of praziquantel (PZQ). Liquid assisted grinding with an equimolar amount of citric acid (CA), malic acid (MA), salicylic acid (SA) and tartaric acid (TA) gained in cocrystal formation, which all showed pH-dependent solubility and dissolution rate. However, the most soluble cocrystal of PZQ with MA was chemically unstable, as seen during the stability testing. Equimolar cyclodextrin complexes prepared by neat grinding with amorphous hydroxypropyl-β-cyclodextrin (HPβCD) and randomly methylated β-cyclodextrin (MEβCD) showed the highest improvement in drug solubility and the dissolution rate, but only PZQ/HPβCD product presented an acceptable chemical and photostability profile. A combined approach, by co-grinding the drug with both MA and HPβCD in equimolar ratio, also gave highly soluble amorphous product which again was chemical instable and therefore not suitable for the pharmaceutical use. Studies on Caco-2 monolayer confirmed the biocompatibility of PZQ/HPβCD complex and showed that complexation did not adversely affect the intrinsically high PZQ permeability (P app (PZQ)=(3.72±0.33)×10 -5 cms -1 and P app (PZQ/HPβCD)=(3.65±0.21)×10 -5 cms -1 ; p>0.05). All this confirmed that the co-grinding with the proper additive is as a promising strategy to improve biopharmaceutical properties of the drug. Copyright © 2017 Elsevier B.V. All rights reserved.

Patients with a failed renal transplant.

Science.gov (United States)

Marcén, R; Teruel Briones, J L

2011-03-01

Despite the advances in the care of recipients and in immunosuppression, long-term graft survival has experienced little improvement in the last 10 years. An important number of recipients present progressive loss of graft function and have to be readmitted on dialysis therapy. Before starting dialysis, these patients are re-exposed to the complications of chronic renal failure but there are no specific guidelines for their treatment. The Kidney Disease Quality Initiative Advisory Board clinical practice guidelines given for the non-transplant chronic kidney disease patients have been recommended for ameliorating their clinical situation and the rate of progression of graft failure. The time when dialysis has to be restarted and the type of dialysis procedure, hemodialysis or peritoneal dialysis, are under discusion. But there is no evidence about the superiority of either type of dialysis procedure. Systematic graft nephrectomy has been considered to improve the inflammatory status of the patients with a failed graft which could contribute to a worse control of some complications such as anemia and to the increased rates of cardiovascular mortality. As in the patients with primary end-stage renal disease, retransplantation is the best treatment for a patient with a failed graft. Due to the shortage of organs for transplantation the number of patients who are retransplanted has remained stable. Recurrent diseases such as glomerulonephritis, lyphoproliferative diseases, BK virus nephopathy and previous non-adherence to the treatment do not necessarily preclude retransplantation.

Morphological Characteristics of Schistosoma mansoni PZQ-Resistant and -Susceptible Strains Are Different in Presence of Praziquantel

Science.gov (United States)

Pinto-Almeida, António; Mendes, Tiago; de Oliveira, Rosimeire Nunes; Corrêa, Sheila de Andrade Penteado; Allegretti, Silmara Marques; Belo, Silvana; Tomás, Ana; Anibal, Fernanda de Freitas; Carrilho, Emanuel; Afonso, Ana

2016-01-01

Schistosomiasis is one of the most common human parasitic diseases whose socioeconomic impact is only surpassed by malaria. Praziquantel (PZQ) is the only drug commercially available for the treatment of all schistosome species causing disease in humans. However, there has been stronger evidences of PZQ-resistance on Schistosoma mansoni and thus it is very important to study the phenotypic characteristics associated with it. The aim of this study was to evaluate morphological alterations in S. mansoni PZQ-resistant adult worms and eggs, by comparing a PZQ- resistant strain obtained under PZQ drug pressure with a PZQ-susceptible strain. For this, scanning electronic microscopy was used to assess tegumental responsiveness of both strains under PZQ exposure, and optical microscopy allowed the monitoring of worms and eggs in the presence of the drug. Those assays showed that PZQ-susceptible worms exposed to the drug had more severe tegumental damages than the resistant one, which had only minor alterations. Moreover, contrary to what occurred in the susceptible strain, resistant worms were viable after PZQ exposure and gradually regaining full motility after removal of the drug. Eggs from resistant strain parasites are considerably smaller than those from susceptible strain. Our results suggest that there might be a difference in the tegument composition of the resistant strain and that worms are less responsive to PZQ. Changes observed in egg morphology might imply alterations in the biology of schistosomes associated to PZQ-resistance, which could impact on transmission and pathology of the disease. Moreover, we propose a hypothetical scenario where there is a different egg tropism of the S. mansoni resistant strain. This study is the first comparing two strains that only differ in their resistance characteristics, which makes it a relevant step in the search for resistance determinants. PMID:27199925

Accuracy of urine circulating cathodic antigen test for the diagnosis of Schistosoma mansoni in preschool-aged children before and after treatment.

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Jean T Coulibaly

Full Text Available BACKGROUND: The Kato-Katz technique is widely used for the diagnosis of Schistosoma mansoni, but shows low sensitivity in light-intensity infections. We assessed the accuracy of a commercially available point-of-care circulating cathodic antigen (POC-CCA cassette test for the diagnosis of S. mansoni in preschool-aged children before and after praziquantel administration. METHODOLOGY: A 3-week longitudinal survey with a treatment intervention was conducted in Azaguié, south Côte d'Ivoire. Overall, 242 preschoolers (age range: 2 months to 5.5 years submitted two stool and two urine samples before praziquantel administration, and 86 individuals were followed-up posttreatment. Stool samples were examined with duplicate Kato-Katz thick smears for S. mansoni. Urine samples were subjected to POC-CCA cassette test for S. mansoni, and a filtration method for S. haematobium diagnosis. PRINCIPAL FINDINGS: Before treatment, the prevalence of S. mansoni, as determined by quadruplicate Kato-Katz, single CCA considering 'trace' as negative (t-, and single CCA with 'trace' as positive (t+, was 23.1%, 34.3% and 64.5%, respectively. Using the combined results (i.e., four Kato-Katz and duplicate CCA(t- as diagnostic 'gold' standard, the sensitivity of a single Kato-Katz, a single CCA(t- or CCA(t+ was 28.3%, 69.7% and 89.1%, respectively. Three weeks posttreatment, the sensitivity of a single Kato-Katz, single CCA(t- and CCA(t+ was 4.0%, 80.0% and 84.0%, respectively. The intensity of the POC-CCA test band reaction was correlated with S. mansoni egg burden (odds ratio = 1.2, p = 0.04. CONCLUSIONS/SIGNIFICANCE: A single POC-CCA cassette test appears to be more sensitive than multiple Kato-Katz thick smears for the diagnosis of S. mansoni in preschool-aged children before and after praziquantel administration. The POC-CCA cassette test can be recommended for the rapid identification of S. mansoni infections before treatment. Additional studies are warranted

Desenvolvimento e validação de modelos multivariados usando PLS para quantificação de febantel, pamoato de pirantel e praziquantel utilizando uv e iv

OpenAIRE

Piantavini, Mario Sérgio

2014-01-01

Orientador : Prof. Dr. Roberto Pantarolo Co-orientador : Prof. Dr. Marcelo M. de Sena Tese (doutorado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Ciências Farmacêuticas. Defesa: Curitiba, 30/04/2014 Inclui referências Área de concentração: Insumos, medicamentos e correlatos Resumo: O Pamoato de Pirantel, Febantel e o Praziquantel são fármacos antiparasitários utilizados para o tratamento de helmintíases. Estas são doenças que pode...

Brief Report: HIV Drug Resistance in Adults Failing Early Antiretroviral Treatment: Results From the HIV Prevention Trials Network 052 Trial.

Science.gov (United States)

Fogel, Jessica M; Hudelson, Sarah E; Ou, San-San; Hart, Stephen; Wallis, Carole; Morgado, Mariza G; Saravanan, Shanmugam; Tripathy, Srikanth; Hovind, Laura; Piwowar-Manning, Estelle; Sabin, Devin; McCauley, Marybeth; Gamble, Theresa; Zhang, Xinyi C; Eron, Joseph J; Gallant, Joel E; Kumwenda, Johnstone; Makhema, Joseph; Kumarasamy, Nagalingeswaran; Chariyalertsak, Suwat; Hakim, James; Badal-Faesen, Sharlaa; Akelo, Victor; Hosseinipour, Mina C; Santos, Breno R; Godbole, Sheela V; Pilotto, Jose H; Grinsztejn, Beatriz; Panchia, Ravindre; Mayer, Kenneth H; Chen, Ying Q; Cohen, Myron S; Eshleman, Susan H

2016-07-01

Early initiation of antiretroviral treatment (ART) reduces HIV transmission and has health benefits. HIV drug resistance can limit treatment options and compromise use of ART for HIV prevention. We evaluated drug resistance in 85 participants in the HIV Prevention Trials Network 052 trial who started ART at CD4 counts of 350-550 cells per cubic millimeter and failed ART by May 2011; 8.2% had baseline resistance and 35.3% had resistance at ART failure. High baseline viral load and less education were associated with emergence of resistance at ART failure. Resistance at ART failure was observed in 7 of 8 (87.5%) participants who started ART at lower CD4 cell counts.

Method for repairing failed fuel

International Nuclear Information System (INIS)

Shakudo, Taketomi.

1986-01-01

Purpose: To repair fuel elements that became failed during burnup in a reactor or during handling. Method: After the surface in the vicinity of a failed part of a fuel element is cleaned, a socket made of a shape-memory alloy having a ring form or a horseshoe form made by cutting a part of the ring form is inserted into the failed position according to the position of the failed fuel element. The shape memory alloy socket remembers a slightly larger inside diameter in its original phase (high-temperature side) than the outside diameter of the cladding tube and also a slightly larger inside diameter of the socket in the martensite phase (low-temperature side) than the outside diameter of the cladding tube, such that the socket can easily be inserted into the failed position. The socket, inserted into the failed part of the cladding tube, is heated by a heating jig. The socket recovers the original phase, and the shape also tends to recover a smaller diameter than the outside diameter of the cladding tube that has been remembered, and accordingly the failed part of the cladding tube is fastened with a great force and the failed part is fully closed with the socket, thus keeping radioactive materials from going out. (Horiuchi, T.)

Inhibition or knockdown of ABC transporters enhances susceptibility of adult and juvenile schistosomes to Praziquantel.

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Ravi S Kasinathan

2014-10-01

Full Text Available Parasitic flatworms of the genus Schistosoma cause schistosomiasis, a neglected tropical disease that affects hundreds of millions. Treatment of schistosomiasis depends almost entirely on the drug praziquantel (PZQ. Though essential to treating and controlling schistosomiasis, a major limitation of PZQ is that it is not active against immature mammalian-stage schistosomes. Furthermore, there are reports of field isolates with heritable reductions in PZQ susceptibility, and researchers have selected for PZQ-resistant schistosomes in the laboratory. P-glycoprotein (Pgp; ABCB1 and other ATP binding cassette (ABC transporters remove a wide variety of toxins and xenobiotics from cells, and have been implicated in multidrug resistance (MDR. Changes in ABC transporter structure or expression levels are also associated with reduced drug susceptibility in parasitic helminths, including schistosomes. Here, we show that the activity of PZQ against schistosome adults and juveniles ex vivo is potentiated by co-administration of either the highly potent Pgp inhibitor tariquidar or combinations of inhibitors targeting multiple ABC multidrug transporters. Adult worms exposed to sublethal PZQ concentrations remain active, but co-administration of ABC transporter inhibitors results in complete loss of motility and disruption of the tegument. Notably, juvenile schistosomes (3-4 weeks post infection, normally refractory to 2 µM PZQ, become paralyzed when transporter inhibitors are added in combination with the PZQ. Experiments using the fluorescent PZQ derivative (R-PZQ-BODIPY are consistent with the transporter inhibitors increasing effective intraworm concentrations of PZQ. Adult worms in which expression of ABC transporters has been suppressed by RNA interference show increased responsiveness to PZQ and increased retention of (R-PZQ-BODIPY consistent with an important role for these proteins in setting levels of PZQ susceptibility. These results indicate that

Intrauterine adhesions as a risk factor for failed first-trimester pregnancy termination.

Science.gov (United States)

Luk, Janelle; Allen, Rebecca H; Schantz-Dunn, Julianna; Goldberg, Alisa B

2007-10-01

Risk factors for failed first-trimester surgical abortion include endometrial distortion caused by leiomyomas, uterine anomalies and malposition and cervical stenosis. This report introduces intrauterine adhesions as an additional risk factor. A multiparous woman presented for pregnancy termination at 6 weeks' gestation. Three suction-curettage attempts failed to remove what appeared to be an intrauterine pregnancy. Rising beta-hCG levels and concern for an interstitial ectopic pregnancy prompted a diagnostic laparoscopy and exploratory laparotomy without the identification of an ectopic pregnancy. After methotrexate treatment failed, the patient underwent ultrasound-guided hysteroscopy and suction curettage using a cannula with a whistle-cut aperture for the successful removal of a pregnancy implanted behind intrauterine adhesions. Intrauterine adhesions are a cause of failed surgical abortion. Ultrasound-guided hysteroscopy may be required for diagnosis.

Engaging Future Failing States

Science.gov (United States)

2011-03-23

military missions in the Middle East, the Balkans, Africa, Asia , and South America. There is an increasing proliferation of failed and failing states...disparity, overpopulation , food security, health services availability, migration pressures, environmental degradation, personal and 22 community

Albendazole-praziquantel interaction in healthy volunteers: kinetic disposition, metabolism and enantioselectivity

Science.gov (United States)

Lima, Renata Monteiro; Ferreira, Maria Augusta Drago; de Jesus Ponte Carvalho, Teresa Maria; Dumêt Fernandes, Bruno José; Takayanagui, Osvaldo Massaiti; Garcia, Hector Hugo; Coelho, Eduardo Barbosa; Lanchote, Vera Lucia

2011-01-01

AIM This study investigated the kinetic disposition, metabolism and enantioselectivity of albendazole (ABZ) and praziquantel (PZQ) administered alone and in combination to healthy volunteers. METHODS A randomized crossover study was carried out in three phases (n = 9), in which some volunteers started in phase 1 (400 mg ABZ), others in phase 2 (1500 mg PZQ), and the remaining volunteers in phase 3 (400 mg ABZ + 1500 mg PZQ). Serial blood samples were collected from 0–48 h after drug administration. Pharmacokinetic parameters were calculated using a monocompartmental model with lag time and were analyzed using the Wilcoxon test; P≤ 0.05. RESULTS The administration of PZQ increased the plasma concentrations of (+)-ASOX (albendazole sulphoxide) by 264% (AUC 0.99 vs. 2.59 µg ml−1 h), (−)-ASOX by 358% (0.14 vs. 0.50 µg ml−1 h) and albendazole sulfone (ASON) by 187% (0.17 vs. 0.32 µg ml−1 h). The administration of ABZ did not change the kinetic disposition of (+)-(S)-PZQ (–)-(R)-4-OHPZQ or (+)-(S)-4-OHPZQ, but increased the plasma concentration of (–)-(R)-PZQ by 64.77% (AUC 0.52 vs. 0.86 µg ml−1 h). CONCLUSIONS The pharmacokinetic interaction between ABZ and PZQ in healthy volunteers was demonstrated by the observation of increased plasma concentrations of ASON, both ASOX enantiomers and (–)-(R)-PZQ. Clinically, the combination of ABZ and PZQ may improve the therapeutic efficacy as a consequence of higher concentration of both active drugs. On the other hand, the magnitude of this elevation may represent an increased risk of side effects, requiring, certainly, reduction of the dosage. However, further studies are necessary to evaluate the efficacy and safety of this combination. PMID:21395645

Long-term outcome of urethroplasty after failed urethrotomy versus primary repair.

Science.gov (United States)

Barbagli, G; Palminteri, E; Lazzeri, M; Guazzoni, G; Turini, D

2001-06-01

A urethral stricture recurring after repeat urethrotomy challenges even a skilled urologist. To address the question of whether to repeat urethrotomy or perform open reconstructive surgery, we retrospectively review a series of 93 patients comparing those who underwent primary repair versus those who had undergone urethrotomy and underwent secondary treatment. From 1975 to 1998, 93 males between age 13 and 78 years (mean 39) underwent surgical treatment for bulbar urethral stricture. In 46 (49%) of the patients urethroplasty was performed as primary repair, and in 47 (51%) after previously failed urethrotomy. The strictures were localized in the bulbous urethra without involvement of penile or membranous tracts. The etiology was ischemic in 37 patients, traumatic in 23, unknown in 17 and inflammatory in 16. To simplify evaluation of the results, the clinical outcome was considered either a success or a failure at the time any postoperative procedure was needed, including dilation. In our 93 patients primary urethroplasty had a final success rate of 85%, and after failed urethrotomy 87%. Previously failed urethrotomy did not influence the long-term outcome of urethroplasty. The long-term results of different urethroplasty techniques had a final success rate ranging from 77% to 96%. We conclude that failed urethrotomy does not condition the long-term result of surgical repair. With extended followup, the success rate of urethroplasty decreases with time but it is in fact still higher than that of urethrotomy.

A PKM2 signature in the failing heart

Science.gov (United States)

Rees, Meredith L.; Subramaniam, Janani; Li, Yuanteng; Hamilton, Dale J.; Frazier, O. Howard; Taegtmeyer, Heinrich

2015-01-01

A salient feature of the failing heart is metabolic remodeling towards predominant glucose metabolism and activation of the fetal gene program. Sunitinib is a multitargeted receptor tyrosine kinase inhibitor used for the treatment of highly vascularized tumors. In diabetic patients, sunitinib significantly decreases blood glucose. However, a considerable proportion of sunitinib-treated patients develop cardiac dysfunction or failure. We asked whether sunitinib treatment results in shift towards glycolysis in the heart. Glucose uptake by the heart was increased fivefold in mice treated with sunitinib. Transcript analysis by qPCR revealed an induction of genes associated with glycolysis and reactivation of the fetal gene program. Additionally, we observed a shift in the enzyme pyruvate kinase from the adult M1 (PKM1) isoform to the fetal M2 (PKM2) isoform, a hallmark of the Warburg Effect. This novel observation led us to examine whether a similar shift occurs in human heart failure. Examination of tissue from patients with heart failure similarly displayed an induction of PKM2. Moreover, this phenomenon was partially reversed following mechanical unloading. We propose that pyruvate kinase isoform switching represents a novel feature of the fetal gene program in the failing heart. PMID:25735978

Management of the failed posterior/multidirectional instability patient.

Science.gov (United States)

Forsythe, Brian; Ghodadra, Neil; Romeo, Anthony A; Provencher, Matthew T

2010-09-01

Although the results of operative treatment of posterior and multidirectional instability (P-MDI) of the shoulder have improved, they are not as reliable as those treated for anterior instability of the shoulder. This may be attributed to the complexities in the classification, etiology, and physical examination of a patient with suspected posterior and multidirectional instability. Failure to address the primary and concurrent lesion adequately and the development of pain and/or stiffness are contributing factors to the failure of P-MDI procedures. Other pitfalls include errors in history and physical examination, failure to recognize concomitant pathology, and problems with the surgical technique or implant failure. Patulous capsular tissues and glenoid version also play in role management of failed P-MDI patients. With an improved understanding of pertinent clinical complaints and physical examination findings and the advent of arthroscopic techniques and improved implants, successful strategies for the nonoperative and operative management of the patient after a failed posterior or multidirectional instability surgery may be elucidated. This article highlights the common presentation, physical findings, and radiographic workup in a patient that presents after a failed P-MDI repair and offers strategies for revision surgical repair.

Repeat transcatheter aortic valve implantation using a latest generation balloon-expandable device for treatment of failing transcatheter heart valves.

Science.gov (United States)

Schaefer, Andreas; Treede, Hendrik; Seiffert, Moritz; Deuschl, Florian; Schofer, Niklas; Schneeberger, Yvonne; Blankenberg, Stefan; Reichenspurner, Hermann; Schaefer, Ulrich; Conradi, Lenard

2016-01-15

Paravalvular leakage (PVL) is a known complication of transcatheter aortic valve implantation (TAVI) and is associated with poor outcome. Besides balloon-post-dilatation, valve-in-valve (ViV) procedures can be taken into consideration to control this complication. Herein we present initial experience with use of the latest generation balloon-expandable Edwards Sapien 3® (S3) transcatheter heart valve (THV) for treatment of failing THVs. Between 01/2014 and 12/2014 three patients (two male, age: 71-80 y, log EUROScore I: 11.89 - 32.63) with failing THVs were refered to our institution for further treatment. THV approach with secondary implantation of an S3 was chosen after mutual agreement of the local interdisciplinary heart team at an interval of 533-1119 days from the index procedure. The performed procedures consisted of: S3 in Sapien XT, JenaValve and CoreValve. Successful transfemoral implantation with significant reduction of PVL was achieved in all cases. No intraprocedural complications occurred regarding placement of the S3 with a postprocedural effective orifice area (EOA) of 1.5-2.5 cm(2) and pressure gradients of max/mean 14/6-36/16 mmHg. 30-day mortality was 0%. At the latest follow-up of 90-530 days, all patients are alive and well with satisfactory THV function. Regarding VARC-2 criteria one major bleeding and one TIA was reported. In the instance of moderate or severe aortic regurgitation after TAVI, S3 ViV deployment is an excellent option to reduce residual regurgitation to none or mild. For further assertions concerning functional outcomes long-term results have to be awaited.

Infection status and risk factors associated with urinary schistosomiasis among school-going children in the Ndumo area of uMkhanyakude district in KwaZulu-Natal, South Africa two years post-treatment.

Science.gov (United States)

Kabuyaya, Muhubiri; Chimbari, Moses John; Mukaratirwa, Samson

2018-04-18

To assess the efficacy of praziquantel of infected children with Schistosoma haematobium over a 2year period in the Ndumo area of uMkhanyakude district, South Africa. This cohort study enrolled 173 school-going children in September 2017 that participated in a baseline survey conducted in 2015 in the Ndumo area. Questionnaire interviews were conducted to collect information on the risk factors related to transmission of schistosomiasis and filtration technique was performed to detect Schistosoma haematobium eggs in urine. Infection intensity was classified as light and heavy. A Chi square test was performed to assess association between variables with 95% confidence interval and p-value=0.05 was considered significant. Of the 173 participants screened two years post-treatment, 10 were infected and six were new infection cases while 4 were re-infections. The intensity of infection decreased significantly (P value=0.001) in the follow-up survey compare to the baseline survey. However, no significant difference was found among the risk factors of schistosomiasis 2 years later. The prevalence of S. haematobium decreased significantly in the cohort 2 years post praziquantel treatment during persistent drought in the area. Risk factors which were significantly associated with schistosomiasis at baseline were not two years following treatment. Copyright © 2018. Published by Elsevier Ltd.

Therapeutic efficacy of milbemycin oxime/praziquantel oral formulation (Milbemax® against Thelazia callipaeda in naturally infested dogs and cats

Directory of Open Access Journals (Sweden)

Motta Bruna

2012-05-01

Full Text Available Abstract Background Over the last few decades, canine and feline thelaziosis caused by Thelazia callipaeda eye worms has gained the attention of the veterinary community due to the spread of this ocular infestation in geographical areas previously regarded as non endemic. The therapeutic efficacy of milbemycin oxime/praziquantel tablets (Milbemax® against T. callipaeda was tested in naturally infested dogs and cats. Methods From January 2009 to July 2011 a placebo controlled and randomized field study was conducted in T. callipaeda endemic areas of Switzerland (CH and Italy (ITA involving client-owned animals. Dogs (n = 56 and cats (n = 31 were physically examined at enrolment Day 0 (D0 and twice afterwards (D7 and D14. Infested animals were orally treated with Milbemax® or with placebo tablets on D0 and, if an animal was found still infested with T. callipaeda, also on D7. On D14 nematodes were flushed from the conjunctiva, identified and counted. Results Out of 56 dogs, 43 were included in the statistical analysis, whereas 13 were excluded because the products under investigation were not administered with food, as required by the label. On D7 and D14, 72.7% and 90.9% of treated dogs were eye worm free, whereas in the placebo group 95.2% and 76.2% still harbored nematodes, resulting in a mean percentage worm count reduction for the Milbemax® group of 86.1% and 96.8%, respectively. Both results were significantly higher (p = 0.0001 than the placebo group. Out of the 31 cats included in the study at D7 and D14, 53.3% and 73.3% treated with Milbemax® were free of T. callipaeda, while 81.3% and 73.3 in the placebo group were still harbouring eye worms, resulting in a mean percentage worm count reduction for the treated group of 62.2% and 80.0%, respectively. Both results were significantly higher (p = 0.0106 and p = 0.0043 than the placebo group. Conclusions The commercial formulation of milbemycin oxime at the minimal dose

The Role of Praziquantel- chemoprophylaxis and UV-attenuated Vaccine in Protecting Mice Against S. Mansoni Infection

International Nuclear Information System (INIS)

Gad, H.S.M.

1999-01-01

Potential control of schistosomiasis rely on multiple and integrated strategies, including vaccine production, chemotherapy and combination between chemotherapy and vaccination. The present work was conducted to evaluate the efficacy of combined PZQ- treatment with PZQ-chemoprophylaxis (PZQ-pretreatment) and UV-attenuated cercarial vaccination for the control of schistosomiasis. In the present work the induced levels of protection induced in vaccinated and vaccinated-PZQ-treated as well as, PZQ-pretreated and PZQ-pretreated followed by PZQ-treatment will be discussed. Results revealed that UV-Irradiated Vaccinated and vaccinated-PZQ-treated and PZQ-pretreated followed by PZQ-treated post challenged groups induced high levels of worm burdens reduction and mild pathological changes in both liver and intestine. Meanwhile, PZQ-pretreated alone failed to induce significant protection

Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up.

Science.gov (United States)

Kröger, Christoph; Schweiger, Ulrich; Sipos, Valerija; Kliem, Sören; Arnold, Ruediger; Schunert, Tanja; Reinecker, Hans

2010-12-01

There is evidence from case studies suggesting that adapted dialectical behavior therapy (DBT) for borderline personality disorder (BPD) and eating disorders (ED) might improve disorder related complaints. Twenty-four women with BPD (9 with comorbid anorexia nervosa [AN] and 15 with bulimia nervosa [BN]), who already had failed to respond to previous eating-disorder related inpatient treatments were consecutively admitted to an adapted inpatient DBT program. Assessment points were at pre-treatment, post-treatment, and 15-month follow-up. At follow-up, the remission rate was 54% for BN, and 33% for AN. Yet 44% of women with AN crossed over to BN and one woman additionally met the criteria of AN. For women with AN, the mean weight was not significantly increased at post-treatment, but had improved at follow-up. For women with BN, the frequency of binge-eating episodes was reduced at post-treatment as well as at follow-up. Self-rated eating-related complaints and general psychopathology, as well as ratings on global psychosocial functioning, were significantly improved at post-treatment and at follow-up. Although these findings support the assumption that the adapted DBT inpatient program is a potentially efficacious treatment for those who failed to respond to previous eating-disorder related inpatient treatments, remission rates and maintained eating-related psychopathology also suggest that this treatment needs further improvement. 2010 Elsevier Ltd. All rights reserved.

Field clinical study evaluating the efficacy and safety of an oral formulation containing milbemycin oxime/praziquantel (Milbemax®, Novartis Animal Health) in the chemoprevention of the zoonotic canine infection by Dirofilaria repens.

Science.gov (United States)

Di Cesare, Angela; Braun, Gabriele; Di Giulio, Emanuela; Paoletti, Barbara; Aquilino, Vincenzo; Bartolini, Roberto; La Torre, Francesco; Meloni, Silvana; Drake, Jason; Pandolfi, Federico; Avolio, Stefania; Traversa, Donato

2014-07-29

Dirofilaria repens is the causative agent of subcutaneous dirofilariosis of dogs, other animals and humans. This nematode is transmitted by mosquitoes of Aedes, Anopheles and Culex genera. In dogs, the parasite may cause subclinical infection or cutaneous signs. Recently, D. repens has emerged and spread in different geographical areas, with an increase of cases in dogs and humans. Chemoprevention in dogs in endemic areas is the most reliable approach for controlling this infection. This paper describes a randomized, blocked and multicentric clinical field study investigating the efficacy of an oral, chewable formulation containing milbemycin oxime/praziquantel (Milbemax®, Novartis Animal Health) in the chemoprevention of subcutaneous dirofilariosis in dogs. This study was conducted in endemic areas of Italy. A total of 249 dogs, at two sites, negative for D. repens, were allocated into two groups (i.e. Treated -T1 vs Untreated-T2) with a ratio of 1:1, and subjected to clinical visits and blood sampling once monthly until the end of the study. All blood samples were microscopically and genetically examined. Animals belonging to T1 group received a minimum target dose of 0.5 mg/kg bodyweight of milbemycin oxime and 5 mg/kg of praziquantel in commercial tablets (Milbemax®) according body weight once every 4 weeks. Animals of group T2 were not treated with Milbemax® but received, when necessary, specific parasiticide treatments. The study duration was 336 ± 2 days for each dog. A total of 219 dogs completed the study (i.e. 111 in T1 and 108 in T2), while 30 dogs (i.e. 13 in T1, 17 in T2) were withdrawn for a variety of reasons unrelated to administration of Milbemax®. The percentages of animals not showing microfilariae of D. repens were 100% (111 animals) in T1 and 94.7% (108 animals out of 114) in group T2. Milbemax® was shown to be safe in treated dogs. The results of this study confirm that the monthly use of Milbemax® in dogs is effective and safe for the

Surgical Reimplantation for the Correction of Vesicoureteral Reflux following Failed Endoscopic Injection

Directory of Open Access Journals (Sweden)

Boris Chertin

2011-01-01

Full Text Available Purpose. In recent years, endoscopic injection became the procedure of choice for the correction of vesicoureteral reflux in the majority of the centers. Unfortunately, endoscopic treatment is not always successful and sometimes requires more than one trial to achieve similar results to that of an open reimplantation surgery. Our aim of this study is to evaluate the feasibility and success rate of open ureteral reimplantation following failed endoscopic procedure. Patients and Methods. During 2004–2010, we evaluated 16 patients with persistent vesicoureteral reflux (grades II–IV following failed endoscopic treatment. All patients underwent open ureteral reimplantation. All patients were followed with an ultrasound 6 weeks following surgery and every 6 months thereafter for an average of 22 months. Voiding cystography was performed at 3 months after surgery. Results. During unilateral open ureteral reimplantation, the implanted deposit from previous procedures was either excised, drained, or incorporated into the neotunnel with the ureter. Vesicoureteral reflux was resolved in all patients with 100% success rate. No new hydronephrosis or signs of obstruction developed in any of the patients. qDMSA renal scan was available in 8 patients showing improvement of function in 5 and stable function in 3, and no new scars were identified. Conclusions. Open ureteral reimplantation is an excellent choice for the correction of failed endoscopic treatment in children with vesicoureteral reflux.

Dams designed to fail

Energy Technology Data Exchange (ETDEWEB)

Penman, A. [Geotechnical Engineering Consultants, Harpenden (United Kingdom)

2004-09-01

New developments in geotechnical engineering have led to methods for designing and constructing safe embankment dams. Failed dams can be categorized as those designed to fail, and those that have failed unexpectedly. This presentation outlined 3 dam failures: the 61 m high Malpasset Dam in France in 1959 which killed 421; the 71 m high Baldwin Hills Dam in the United States in 1963 which killed 5; and, the Vajont Dam in Italy in 1963 which killed 2,600 people. Following these incidents, the International Commission for Large Dams (ICOLD) reviewed regulations on reservoir safety. The 3 dams were found to have inadequate spillways and their failures were due to faults in their design. Fuse plug spillways, which address this problem, are designed to fail if an existing spillway proves inadequate. They allow additional discharge to prevent overtopping of the embankment dam. This solution can only be used if there is an adjacent valley to take the additional discharge. Examples of fuse gates were presented along with their effect on dam safety. A research program is currently underway in Norway in which high embankment dams are being studied for overtopping failure and failure due to internal erosion. Internal erosion has been the main reason why dams have failed unexpectedly. To prevent failures, designers suggested the use of a clay blanket placed under the upstream shoulder. However, for dams with soft clay cores, these underblankets could provide a route for a slip surface and that could lead to failure of the upstream shoulder. It was concluded that a safe arrangement for embankment dams includes the use of tipping gates or overturning gates which always fail at a required flood water level. Many have been installed in old and new dams around the world. 14 refs., 19 figs.

Failed endotracheal intubation

Directory of Open Access Journals (Sweden)

Sheykhol Islami V

1995-07-01

Full Text Available The incidence of failed intubation is higher in obstetric than other surgical patients. Failed intubation was the 2nd commonest cause of mortality during anesthesia. Bearing in mind that failre to intubate may be unavoidable in certain circumstances, it is worth reviewing. The factors, which may contribute to a disastrous out come. Priorities of subsequent management must include maintaining oxygenation and preventing aspiration of gastric contents. Fiber optic intubation is now the technique of choice with a high success rate and with least trauma to the patient.

Statistical Requirements For Pass-Fail Testing Of Contraband Detection Systems

International Nuclear Information System (INIS)

Gilliam, David M.

2011-01-01

Contraband detection systems for homeland security applications are typically tested for probability of detection (PD) and probability of false alarm (PFA) using pass-fail testing protocols. Test protocols usually require specified values for PD and PFA to be demonstrated at a specified level of statistical confidence CL. Based on a recent more theoretical treatment of this subject [1], this summary reviews the definition of CL and provides formulas and spreadsheet functions for constructing tables of general test requirements and for determining the minimum number of tests required. The formulas and tables in this article may be generally applied to many other applications of pass-fail testing, in addition to testing of contraband detection systems.

Interventions for treating schistosomiasis mansoni.

Science.gov (United States)

Saconato, H; Atallah, A

2000-01-01

Schistosomiasis is a parasite that is carried by freshwater snails. The intestinal form infects the intestine, liver and spleen and can be fatal. The objective of this review was to assess the effects of oxamniquine or praziquantel for treating Schistosomiasis mansoni We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Lilacs and reference lists of articles. The Revista da Sociedade Brasileira de Medicina Tropical and Brazilian Tropical Medicine Congress abstracts were handsearched Randomised and quasi-randomised trials comparing oxamniquine and/or praziquantel to placebo for the treatment of Schistosomiasis mansoni. Two reviewers independently assessed trial quality and extracted data. Thirteen trials met the inclusion criteria. Praziquantel and oxamniquine were effective in curing Schistosoma mansoni infection when compared to placebo. In Africa, praziquantel 40 mg/Kg is more effective than oxamniquine 15 mg/Kg in individuals older than 14 years (OR 3.54, 95%CI 1.70, 7.38), but no difference was found when compared with oxamniquine 30 mg/Kg (OR 0.29, 95%CI 0.08, 1.01). In Brazil, praziquantel was equally effective when compared with oxamniquine in individuals older than 14 years (OR 1.70, 95%CI 0.83, 3.49). Both drugs appear safe. There was no difference in reinfection rate between zinc supplementation and placebo (OR 0.82, 95%CI 0.47, 1.41). IPraziquantel and oxamniquine both appear to be effective for the treatment of Schistosomiasis mansoni, although lower doses of oxamniquine (less than 30 milligrams per kilogram) may not be as effective.

Imported coenurosis in sheep

International Nuclear Information System (INIS)

Schweizer, G.; Grünenfelder, F.; Sydler, T.; Rademacher, N.; Braun, U.; Deplazes, P.

2006-01-01

Thirteen sheep from a milk producing farm in the Canton of Grisons that presented chronic coenurosis were examined and subjected to treatment trials at the veterinary hospital in Zurich. Symptoms were first observed around two months after the import of two dogs from Italy (Abruzza) of which one was infected with Taenia multiceps and Echinococcus granulosus. The most frequently observed clinical symptoms of the sheep were reduced general condition, circling, reduced menace reflex, apathy, unsteady gait and head tilt. Analyses of cerebrospinal fluid revealed an increased leucocyte count in 3 sheep and eosinophilia in 4 sheep. In 4 animals that underwent computertomography, one or more hypodense, definable lesions were found in the brain. In 2 sheep surgical treatment and in 10 animals medical treatment with either Praziquantel (n=8) or Oxfendazol (n=2) was attempted. Only one animal treated with Praziquantel needed not to be euthanized. At necropsy, one or two coenurus cysts could be found either in a side ventricle (n=2), in the cerebellum (n=3) or in the cerebrum (n=7). The locations corresponded with the clinical findings. Despite Praziquantel or Oxfendazol treatment, living protoscoleces could be found in the parasite cysts [de

Modified rerouting procedure for failed peroneal tendon dislocation surgery.

Science.gov (United States)

Gaulke, R; Hildebrand, F; Panzica, M; Hüfner, T; Krettek, C

2010-04-01

Recurrent dislocation of the peroneal tendons following operative treatment is relatively uncommon, but can be difficult to treat. We asked whether subligamental transposition of the peroneus brevis tendon, fibular grooving, and reattachment of the superior peroneal retinaculum for failed peroneal tendon dislocation surgery would achieve a stable fixation of the peroneal tendons and whether there would be restrictions of ROM or instability of the hindfoot. We reviewed six female patients (mean age, 24.5 years) with general laxity of joints preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. Within 1 year postoperatively no recurrence was found. In two ankles the extension was restricted 5 degrees to 10 degrees . In another pronation and supination was restricted 5 degrees each. Stability of the ankle increased in four patients and stayed unchanged in two. AOFAS score increased from a mean value of 36 +/- 20.6 preoperatively to 90 +/- 7 postoperatively at 1 year. We conclude transposition of the peroneus brevis tendon is a reasonable treatment for failed peroneal tendon dislocation surgery. Level IV, therapeutic study (prospective case series). See Guidelines for Authors for a complete description of levels of evidence.

Intranasal Oxytocin Failed to Affect Chimpanzee (Pan troglodytes) Social Behavior

Science.gov (United States)

Calcutt, Sarah E.; Burke, Kimberly; de Waal, Frans B. M.

2017-01-01

Oxytocin has been suggested as a treatment to promote positive social interactions in people with Autism Spectrum Disorders (ASD). However, it is difficult to test this effect outside of the laboratory in realistic social situations. One way to resolve this issue is to study behavioral changes in closely related species with complex social relationships, such as chimpanzees. Here, we use captive, socially housed chimpanzees to evaluate the effects of oxytocin in a socially complex environment. After administering intranasal oxytocin or a placebo to an individual chimpanzee (total n = 8), she was returned to her social group. An experimenter blind to the condition measured the subject's social behavior. We failed to find a behavioral difference between conditions. As one of the goals for oxytocin administration as a treatment for ASD is increasing prosocial behaviors during ‘real world’ encounters, it is problematic that we failed to detect behavioral changes in our closest living relatives. However, our null findings may be related to methodological challenges such as determining an effective dose of oxytocin for chimpanzees and how long oxytocin takes to cross the blood-brain barrier. Thus, more research on intranasal oxytocin dosing and uptake are needed to continue exploring whether oxytocin changes social behavior in naturalistic settings and as a treatment for ASD. PMID:28845444

FAILED FUEL DISPOSITION STUDY

International Nuclear Information System (INIS)

THIELGES, J.R.

2004-01-01

In May 2004 alpha contamination was found on the lid of the pre-filter housing in the Sodium Removal Ion Exchange System during routine filter change. Subsequent investigation determined that the alpha contamination likely came from a fuel pin(s) contained in an Ident-69 (ID-69) type pin storage container serial number 9 (ID-69-9) that was washed in the Sodium Removal System (SRS) in January 2004. Because all evidence indicated that the wash water interacted with the fuel, this ID49 is designated as containing a failed fuel pin with gross cladding defect and was set aside in the Interim Examination and Maintenance (IEM) Cell until it could be determined how to proceed for long term dry storage of the fuel pin container. This ID49 contained fuel pins from the driver fuel assembly (DFA) 16392, which was identified as a Delayed Neutron Monitor (DNM) leaker assembly. However, this DFA was disassembled and the fuel pin that was thought to be the failed pin was encapsulated and was not located in this ID49 container. This failed fuel disposition study discusses two alternatives that could be used to address long term storage for the contents of ID-69-9. The first alternative evaluated utilizes the current method of identifying and storing DNM leaker fuel pin(s) in tubes and thus, verifying that the alpha contamination found in the SRS came from a failed pin in this pin container. This approach will require unloading selected fuel pins from the ID-69, visually examining and possibly weighing suspect fuel pins to identify the failed pin(s), inserting the failed pin(s) in storage tubes, and reloading the fuel pins into ID49 containers. Safety analysis must be performed to revise the 200 Area Interim Storage Area (ISA) Final Safety Analysis Report (FSAR) (Reference 1) for this fuel configuration. The second alternative considered is to store the failed fuel as-is in the ID-69. This was evaluated to determine if this approach would comply with storage requirements. This

FAILED FUEL DISPOSITION STUDY

Energy Technology Data Exchange (ETDEWEB)

THIELGES, J.R.

2004-12-20

In May 2004 alpha contamination was found on the lid of the pre-filter housing in the Sodium Removal Ion Exchange System during routine filter change. Subsequent investigation determined that the alpha contamination likely came from a fuel pin(s) contained in an Ident-69 (ID-69) type pin storage container serial number 9 (ID-69-9) that was washed in the Sodium Removal System (SRS) in January 2004. Because all evidence indicated that the wash water interacted with the fuel, this ID49 is designated as containing a failed fuel pin with gross cladding defect and was set aside in the Interim Examination and Maintenance (IEM) Cell until it could be determined how to proceed for long term dry storage of the fuel pin container. This ID49 contained fuel pins from the driver fuel assembly (DFA) 16392, which was identified as a Delayed Neutron Monitor (DNM) leaker assembly. However, this DFA was disassembled and the fuel pin that was thought to be the failed pin was encapsulated and was not located in this ID49 container. This failed fuel disposition study discusses two alternatives that could be used to address long term storage for the contents of ID-69-9. The first alternative evaluated utilizes the current method of identifying and storing DNM leaker fuel pin(s) in tubes and thus, verifying that the alpha contamination found in the SRS came from a failed pin in this pin container. This approach will require unloading selected fuel pins from the ID-69, visually examining and possibly weighing suspect fuel pins to identify the failed pin(s), inserting the failed pin(s) in storage tubes, and reloading the fuel pins into ID49 containers. Safety analysis must be performed to revise the 200 Area Interim Storage Area (ISA) Final Safety Analysis Report (FSAR) (Reference 1) for this fuel configuration. The second alternative considered is to store the failed fuel as-is in the ID-69. This was evaluated to determine if this approach would comply with storage requirements. This

Radiological evaluation of failed total hip replacement

International Nuclear Information System (INIS)

Raspa, V.; Aldrovandi, S.; Pompei, G.

1988-01-01

The retrospective study of 50 operated cases of cemented total hip replacement and a review of the literature enabled the authors to define the radiological features of the above-mentioned condition. These features include one or more of the following signs: calcar reabsorption, lacunar erosions, modified relatioships between the prosthesis components, sepsis and loosening, periarticular calcifications dislocation and fracture of prosthesis components. Careful evaluation of these radiological features is extremely important for both an early diagnosis of failed total hip replacement and the choice of an adequate surgical treatment

Critical thinking: are the ideals of OBE failing us or are we failing the ...

African Journals Online (AJOL)

Critical thinking: are the ideals of OBE failing us or are we failing the ideals of OBE? K Lombard, M Grosser. Abstract. No Abstract. South African Journal of Education Vol. 28 (4) 2008: pp. 561-580. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

The impact of a school health programme on the prevalence and morbidity of urinary schistosomiasis in Mwera Division, Pangani District, Tanzania

DEFF Research Database (Denmark)

Magnussen, P; Ndawi, B; Sheshe, A K

2001-01-01

in class 5 (median age 14 years, range 11-17) by urine filtration techniques. Treatment was administered as 40 mg/kg praziquantel in a single dose at the beginning of the school year. The programme was implemented by schoolteachers and coordinated by the District Health Management Team in collaboration......The prevalence of urinary schistosomiasis among schoolchildren in Pangani District (Tanzania) was assessed rapidly by a questionnaire approach. Based on the results, a strategy of selective treatment with praziquantel was adopted. Eleven primary schools in Mwera Division, Pangani District...... parents pay for the treatment of children with episodes of visible haematuria during the school year. Communities also participated in the improvement of sanitary installations at the schools....

Which female cancer patients fail to receive fertility counseling before treatment in the state of Georgia?

Science.gov (United States)

Chin, Helen B; Howards, Penelope P; Kramer, Michael R; Mertens, Ann C; Spencer, Jessica B

2016-12-01

To assess which characteristics are associated with failure to receive fertility counseling among a cohort of young women diagnosed with cancer. Population-based cohort study. Not applicable. A total of 1,282 cancer survivors, of whom 1,116 met the inclusion criteria for the analysis. None. The main outcome in this study was whether or not women reported receiving any information at the time of their cancer diagnosis on how cancer treatment might affect their ability to become pregnant. Forty percent of cancer survivors reported that they did not receive fertility counseling at the time of cancer diagnosis. Women were more likely to fail to receive counseling if they had only a high school education or less or if they had given birth. Cancer-related variables that were associated with a lack of counseling included not receiving chemotherapy as part of treatment and diagnosis with certain cancer types. Counseling about the risk of infertility and available fertility preservation options is important to cancer patients. Additionally, counseling can make women aware of other adverse reproductive outcomes, such as early menopause and its associated symptoms. Less-educated women and parous women are at particular risk of not getting fertility-related information. Programs that focus on training not just the oncologist, but also other health care providers involved with cancer care, to provide fertility counseling may help to expand access. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Follow up of infertile patients after failed ART cycles: a preliminary report from Iran and Turkey.

Science.gov (United States)

Khalili, Mohammad Ali; Kahraman, Semra; Ugur, Mete Gurol; Agha-Rahimi, Azam; Tabibnejad, Nasim

2012-03-01

Assisted reproductive technology (ART) has become an established and increasingly successful form of treatment for infertility. However, significant numbers of cycles fail after embryo transfer (ET) and it becomes necessary to follow up the infertile couples after failed ART treatments. The main goal was to follow up the infertile patients after failed IVF/ICSI+ET treatments in Iran and Turkey. 198 infertile couples from Iran and 355 infertile couples from Turkey were followed up after IVF/ICSI failures. The patients' demographic data, the couples' decisions about continuation of treatment and the spontaneous pregnancy rates were compared in the two countries. The drop-out rate was higher in Iran (28.3%) than in Turkey (23.4%). The reasons for treatment discontinuation in Iran and Turkey were: financial problem (33.9% vs. 41%), hopeless (10.7% vs. 22.9%), fear of drug side-effects (7.1% vs. 12%), achieving pregnancy (37.5% vs. 19.6%), child adoption (5.4% vs. 2.4%), lack of spouse cooperation (5.4% vs. 2.4%), and divorce (0% vs. 2.4%). Spontaneous pregnancy was significantly higher in Iran (10.1%) than in Turkey (3.9%). There was correlation between duration of infertility and female factor infertility with spontaneous pregnancy. Since the majority of couples that discontinued treatment had financial problems, it is essential for health professionals to support infertile couples during their childlessness crisis. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Treatment of Schistosoma mansoni with miltefosine in vitro enhances serological recognition of defined worm surface antigens.

Directory of Open Access Journals (Sweden)

Marwa H El-Faham

2017-08-01

Full Text Available Miltefosine, an anti-cancer drug that has been successfully repositioned for treatment of Leishmania infections, has recently also shown promising effects against Schistosoma spp targeting all life cycle stages of the parasite. The current study examined the effect of treating Schistosoma mansoni adult worms with miltefosine on exposure of worm surface antigens in vitro.In an indirect immunofluorescence assay, rabbit anti-S.mansoni adult worm homogenate and anti-S. mansoni infection antisera gave strong immunofluorescence of the S. mansoni adult worm surface after treatment with miltefosine, the latter antiserum having previously been shown to synergistically enhance the schistosomicidal activity of praziquantel. Rabbit antibodies that recognised surface antigens exposed on miltefosine-treated worms were recovered by elution off the worm surface in low pH buffer and were used in a western immunoblotting assay to identify antigenic targets in a homogenate extract of adult worms (SmWH. Four proteins reacting with the antibodies in immunoblots were purified and proteomic analysis (MS/MS combined with specific immunoblotting indicated they were the S. mansoni proteins: fructose-1,6 bisphosphate aldolase (SmFBPA, Sm22.6, alkaline phosphatase and malate dehydrogenase. These antibodies were also found to bind to the surface of 3-hour schistosomula and induce immune agglutination of the parasites, suggesting they may have a role in immune protection.This study reveals a novel mode of action of miltefosine as an anti-schistosome agent. The immune-dependent hypothesis we investigated has previously been lent credence with praziquantel (PZQ, whereby treatment unmasks parasite surface antigens not normally exposed to the host during infection. Antigens involved in this molecular mechanism could have potential as intervention targets and antibodies against these antigens may act to increase the drug's anti-parasite efficacy and be involved in the development

Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: Final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472)

Energy Technology Data Exchange (ETDEWEB)

Kitrou, Panagiotis M., E-mail: panoskitrou@gmail.com [Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion 26504 (Greece); Katsanos, Konstantinos [Department of Interventional Radiology, Guy' s and St. Thomas’ Hospitals, NHS Foundation Trust, King' s Health Partners, London SE1 7EH (United Kingdom); Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris [Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion 26504 (Greece)

2015-03-15

Highlights: •1-Year target lesion primary patency significantly higher after PCB application compared to plain balloon angioplasty in the failing dialysis access. •Significant difference in favor of PCB in cumulative primary patency of AVGs at 1 year. •No significant difference in cumulative primary patency of AVFs treated with PCB at 1 year. •Cost effectiveness analysis performed. •Paclitaxel-coated balloon angioplasty proves to be a cost-effective option for treating dialysis access. -- Abstract: Objective: To report the final results and cost-effectiveness analysis of a prospective randomized controlled trial investigating drug-eluting balloon (DEB) versus plain balloon angioplasty (BA) for the treatment of failing dialysis access ( (NCT01174472)). Methods: 40 patients were randomized to angioplasty with either DEB (n = 20) or BA (n = 20) for treatment of significant venous stenosis causing a failing dialysis access. Both arteriovenous fistulas (AVF) and synthetic arteriovenous grafts (AVG) were included. Angiographic follow up was scheduled every two months. Primary endpoints were technical success and target lesion primary patency at 1 year. Cumulative and survival analysis was performed. Incremental net benefit (INB) and incremental cost effectiveness ratio (ICER) were calculated and the cost-effectiveness acceptability curve (CEAC) was drawn. Results: Baseline variables were equally distributed between the two groups. At 1 year, cumulative target lesion primary patency was significantly higher after DEB application (35% vs. 5% after BA, p < 0.001). Overall, median primary patency was 0.64 years in case of DEB vs. 0.36 years in case of BA (p = 0.0007; unadjusted HR = 0.27 [95%CI: 0.13–0.58]; Cox adjusted HR = 0.23 [95%CI: 0.10–0.50]). ICER was 2198 Euros (€) per primary patency year of dialysis access gained. INB was 1068€ (95%CI: 31–2105€) for a willingness-to-pay (WTP) threshold of 5000€ (corresponding acceptability probability >97

Failing Decision

DEFF Research Database (Denmark)

Knudsen, Morten

2014-01-01

Recently the Danish subway trains have begun to announce “on time” when they arrive at a station on time. This action reflects a worrying acceptance of the normality of failure. If trains were generally expected to be on time, there would be no reason to – triumphantly – announce it. This chapter...... by an interest in failure as one way of improving understanding of present-day decision making in organizations.......Recently the Danish subway trains have begun to announce “on time” when they arrive at a station on time. This action reflects a worrying acceptance of the normality of failure. If trains were generally expected to be on time, there would be no reason to – triumphantly – announce it. This chapter...... deals not with traffic delays, but with failing decisions in organizations. The assumption of this chapter is that failing decisions today are as normal as delayed trains. Instead of being the exception, failure is part of the everyday reproduction of organizations – as an uncontrolled effect but also...

Late Prosthetic Shoulder Hemiarthroplasty after Failed Management of Complex Proximal Humeral Fractures

Directory of Open Access Journals (Sweden)

A. Panagopoulos

2013-01-01

Full Text Available Background. The purpose of this study was to report our experience with shoulder hemiarthroplasty in the context of old trauma. Methods. 33 patients with failed treatment for a complex proximal humeral fracture underwent prosthetic hemiarthroplasty. There were 15 men and 18 women with a mean age of 58.1 years. The average period from initial treatment was 14.9 months. Sequelae included 11 malunions, 4 nonunions, 15 cases with avascular necrosis (AVN and 3 neglected posterior locked dislocations. Follow up investigation included radiological assessment and clinical evaluation using the Constant score and a visual analogue pain scale. Results. After a mean follow up of 82.5 months the median Constant score was 75.7 points, improved by 60% in comparison to preoperative values. Greater tuberosity displacement, large cuff tears and severe malunion were the factors most affected outcome. No cases of stem loosening or severe migration were noted. 60% of the patients were able to do activities up to shoulder level compared with 24% before reconstruction. Conclusions. Late shoulder hemiarthroplasty is technically difficult and the results are inferior to those reported for acute humeral head replacement, nonetheless remains a satisfactory reconstructive option when primary treatment fails.

Simulating fail-stop in asynchronous distributed systems

Science.gov (United States)

Sabel, Laura; Marzullo, Keith

1994-01-01

The fail-stop failure model appears frequently in the distributed systems literature. However, in an asynchronous distributed system, the fail-stop model cannot be implemented. In particular, it is impossible to reliably detect crash failures in an asynchronous system. In this paper, we show that it is possible to specify and implement a failure model that is indistinguishable from the fail-stop model from the point of view of any process within an asynchronous system. We give necessary conditions for a failure model to be indistinguishable from the fail-stop model, and derive lower bounds on the amount of process replication needed to implement such a failure model. We present a simple one-round protocol for implementing one such failure model, which we call simulated fail-stop.

A rapid stability indicating LC-method for determination of praziquantel in presence of its pharmacopoeial impurities

Directory of Open Access Journals (Sweden)

Hisham Hashem

2017-02-01

Full Text Available This study reports for the first time about a stability indicating RP-HPLC method for quantitative determination of Praziquantel (PZQ in bulk powder and dosage form and in presence of its pharmacopoeial impurities. The chromatographic separation was carried out on (Caltrex AI® calixarene column, a relatively new packing material. Chromatography was done using an isocratic binary mobile phase consisting of ACN and 25 mM ammonium acetate (NH4Ac in the ratio of 40:60 at flow rate of 1 mL min−1, 30 °C and 210 nm wavelength for detection. The elution time of PZQ was found to be 6.15 ± 0.03 min. The method was validated for system suitability, linearity, precision, limits of detection and quantitation, specificity, stability and robustness. The robustness study was done for small changes in temperature, flow rate, wavelength of detection and % of ACN in mobile phase. Stability tests were done through exposure of the analyte solution to five different stress conditions: Reflux with 1 N HCl, reflux with 1 N NaOH, reflux with 30% H2O2, thermal degradation of powder and exposure to UV radiation. Limits of detection and quantification were found to be 0.56 and 1.70 μg mL−1, respectively. The recovery value of this method was 100.30% ± 1.10 and the reproducibility was within 1.31.

Understanding low uptake of mass treatment for intestinal schistosomiasis among school children

DEFF Research Database (Denmark)

Muhumuza, Simon; Olsen, Annette; Nuwaha, Fred

2015-01-01

among school children is low and to suggest strategies for improved uptake. This was a cross-sectional qualitative study in which 24 focus group discussions and 15 key informant interviews were conducted 2 months after MDA. The focus group discussions were held with school children in twelve primary...... schools and the key informant interviews were held with school teachers, sub-county health assistants and the District Vector Control Officer. The study shows that the low uptake of praziquantel among school children is a result of a complex interplay between individual, interpersonal, institutional......, yet many parents cannot meet the cost of a daily meal due to the prevailing poverty in the area. It is concluded that strategies to improve uptake of praziquantel among school children need to be multi-pronged addressing not only the preparation and motivation of teachers and health education...

Posterior transpedicular approach with circumferential debridement and anterior reconstruction as a salvage procedure for symptomatic failed vertebroplasty

OpenAIRE

Chiu, Yen-Chun; Yang, Shih-Chieh; Chen, Hung-Shu; Kao, Yu-Hsien; Tu, Yuan-Kun

2015-01-01

Background Complications and failure of vertebroplasty, such as cement dislodgement, cement leakage, or spinal infection, usually result in spinal instability and neural element compression. Combined anterior and posterior approaches are the most common salvage procedure for symptomatic failed vertebroplasty. The purpose of this study is to evaluate the feasibility and efficacy of a single posterior approach technique for the treatment of patients with symptomatic failed vertebroplasty. Metho...

Why did occidental modernity fail in the Arab Middle East: the failed modern state?

OpenAIRE

Sardar, Aziz

2011-01-01

This thesis asks a straightforward but nevertheless a complex question, that is: Why did modernity fail in the Arab Middle East? The notion of modernity in this thesis signifies the occidental modernity which reached the region in many different forms and through various channels. This occidental modernity had an impact on many areas and changed the societies and politics of the region. But these changes stopped short of reaching modernity, in other words it failed to change the society from ...

Mini review on chemotherapy of taeniasis and cysticercosis due to Taenia solium in Asia, and a case report with 20 tapeworms in China.

Science.gov (United States)

Ito, A; Li, T; Chen, X; Long, C; Yanagida, T; Nakao, M; Sako, Y; Okamoto, M; Wu, Y; Raoul, F; Giraudoux, P; Craig, P S

2013-06-01

A 43-year-old Tibetan woman living in northwest Sichuan, China, confirmed to be a taeniasis carrier of Taenia solium was treated with pumpkin seeds combined with Areca nut extract in October 2009. All 20 tapeworms except one without scolex were expelled under good conditions. She was free of secondary cysticercosis within one year follow up. Although the first choice for treatment of taeniasis is still praziquantel, it may often cause serious side effect on asymptomatic cysticercosis cases to suddenly become symptomatic within a half day of the treatment. Therefore, the problems in treatment of taeniasis and/or cysticercosis in Asia are briefly overviewed, since other platyhelminthic diseases including schistosomiasis, opisthorchiasis etc. are more common and praziquantel is strongly recommended for mass treatment of these trematodiases with no idea on the co-infection with eggs of T. solium which cause asymptomatic cysticercosis.

Rapid clearance of Schistosoma mansoni circulating cathodic antigen after treatment shown by urine strip tests in a Ugandan fishing community 

DEFF Research Database (Denmark)

Kildemoes, Anna O.; Vennervald, Birgitte J.; Tukahebwa, Edridah M.

2017-01-01

treatments. The study was designed as a series of cross-sectional urine and stool sample collections from 446 individuals nested in a two-arm randomised single blinded longitudinal clinical trial cohort matched by gender and age (ClinicalTrials.gov Identifier: NCT00215267) receiving one or two praziquantel...... and confirmed the added beneficial effect of a second treatment at two weeks after baseline. Furthermore, presence of hookworm was found not to be a confounder for CCA test specificity. Twenty-four hours post treatment measures of mean CCA scores showed significant reductions. In conclusion, removal of CCA...... in response to treatment is detectable as a decline in CCA in urine already after 24 hours. This has relevance for use and interpretation of laboratory based and point-of-care CCA tests in terms of treatment efficacy and re-infection proportions as this measure provides information on the presence of all...

Neglected City Narratives And Failed Rebranding

DEFF Research Database (Denmark)

Mousten, Birthe; Locmele, Gunta

2017-01-01

Rīga, Latvia went through a failed rebranding process as the forerunner of its status as a European Capital of Culture (2014). The same thing happened in Aarhus, Denmark. Aarhus will be a European Capital of Culture (2017) and leading to this, it went through a failed rebranding process. Based on...

When Organization Fails: Why Authority Matters

DEFF Research Database (Denmark)

Blaschke, Steffen

2015-01-01

Review of: James R. Taylor and Elizabeth J. Van Every / When Organization Fails: Why Authority Matters. (New York: Routledge, 2014. 220 pp. ISBN: 978 0415741668)......Review of: James R. Taylor and Elizabeth J. Van Every / When Organization Fails: Why Authority Matters. (New York: Routledge, 2014. 220 pp. ISBN: 978 0415741668)...

Comparing omeprazole with fluoxetine for treatment of patients with heartburn and normal endoscopy who failed once daily proton pump inhibitors: double-blind placebo-controlled trial.

Science.gov (United States)

Ostovaneh, M R; Saeidi, B; Hajifathalian, K; Farrokhi-Khajeh-Pasha, Y; Fotouhi, A; Mirbagheri, S S; Emami, H; Barzin, G; Mirbagheri, S A

2014-05-01

Patients with heartburn but without esophageal erosion respond less well to proton pump inhibitors (PPIs). There is a growing body of evidence implicating the role of psychological comorbidities in producing reflux symptoms. Pain modulators improve symptoms in patients with other functional gastrointestinal disorders. We aimed to compare the efficacy of fluoxetine with omeprazole and placebo to achieve symptomatic relief in patients with heartburn and normal endoscopy who failed once daily PPIs. Endoscopy-negative patients with heartburn who failed once daily PPIs were randomly allocated to receive 6 weeks treatment of fluoxetine, omeprazole, or placebo. Random allocation was stratified according to ambulatory pH monitoring study. Percentage of heartburn-free days and symptom severity was assessed. Sixty patients with abnormal and 84 patients with normal pH test were randomized. Subjects receiving fluoxetine experienced more improvement in percentage of heartburn-free days (median 35.7, IQR 21.4-57.1) than those on omeprazole (median 7.14, IQR 0-50, p heartburn-free days (median improvement, 57.1, IQR 35.7-57.1 vs 13.9, IQR, 0-45.6 and 7.14, 0-23.8, respectively, p heartburn and normal endoscopy who failed once daily PPIs. The superiority of fluoxetine was mostly attributed to those with normal esophageal pH rather than those with abnormal pH (ClinicalTrials.gov, number NCT01269788). © 2014 John Wiley & Sons Ltd.

7 CFR 983.52 - Failed lots/rework procedure.

Science.gov (United States)

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Failed lots/rework procedure. 983.52 Section 983.52..., ARIZONA, AND NEW MEXICO Regulations § 983.52 Failed lots/rework procedure. (a) Substandard pistachios... committee may establish, with the Secretary's approval, appropriate rework procedures. (b) Failed lot...

Effect of praziquantel on the differential expression of mouse hepatic genes and parasite ATP binding cassette transporter gene family members during Schistosoma mansoni infection.

Directory of Open Access Journals (Sweden)

Melissa C Sanchez

2017-06-01

Full Text Available Schistosomiasis is a chronic parasitic disease caused by sexually dimorphic blood flukes of the genus Schistosoma. Praziquantel (PZQ is the only drug widely available to treat the disease but does not kill juvenile parasites. Here we report the use of next generation sequencing to study the transcriptional effect of PZQ on murine hepatic inflammatory, immune and fibrotic responses to Schistosoma mansoni worms and eggs. An initial T helper cell 1 (Th1 response is induced against schistosomes in mice treated with drug vehicle (Vh around the time egg laying begins, followed by a T helper cell 2 (Th2 response and the induction of genes whose action leads to granuloma formation and fibrosis. When PZQ is administered at this time, there is a significant reduction in egg burden yet the hepatic Th1, Th2 and fibrotic responses are still observed in the absence of granuloma formation suggesting some degree of gene regulation may be induced by antigens released from the dying adult worms. Quantitative real-time PCR was used to examine the relative expression of 16 juvenile and adult S. mansoni genes during infection and their response to Vh and PZQ treatment in vivo. While the response of stress genes in adult parasites suggests the worms were alive immediately following exposure to PZQ, they were unable to induce transcription of any of the 9 genes encoding ATP-binding cassette (ABC transporters tested. In contrast, juvenile schistosomes were able to significantly induce the activities of ABCB, C and G family members, underscoring the possibility that these efflux systems play a major role in drug resistance.

Anthelmintic efficacies of a tablet formula of ivermectin-praziquantel on horses experimentally infected with three Strongylus species.

Science.gov (United States)

Bonneau, Stephane; Maynard, Laurence; Tomczuk, Krzysztof; Kok, Dawid; Eun, Hyone-Myong

2009-09-01

In this blinded randomized and controlled study, the anthelmintic efficacy of a tablet formula of ivermectin-praziquantel was evaluated in horses experimentally infected with three species of Strongylus larvae. Eighteen previously dewormed horses were inoculated on study day 0 with third-stage larvae of Strongylus vulgaris, Strongylus equinus, and Strongylus edentatus. The horses were randomly allocated to three groups (n = 6): test-drug (tablet formula), positive-control (reference gel), and negative-control (placebo tablet). On day 56, the horses were treated once with the respective drugs. On day 95, the horses were sacrificed, and necropsy examinations were performed to assess the status of the parasite burden (L4 and immature L5) and pathological lesions on selected organs and tissues. By the criteria of worm counts, the test-drug and positive-control showed, respectively, 100% and 97.3% anthelmintic efficacies on S. vulgaris, 100% and 81.4% on S. equinus, and equally 100% on S. edentatus. However, the efficacies on S. equinus and S. edentatus should be taken only as face values considering their respective low worm counts in the placebo group. The S. vulgaris-induced arterial lesions were also reduced in the test-drug and positive-control groups with efficacies of 73.9% and 62.9%, respectively. No adverse reactions were observed with either of the drugs. Our data demonstrate that the Equimax tablet formula was as safe and efficacious as the gel formula anthelmintic on large strongyles in horses.

Failed manual removal of the placenta after vaginal delivery

DEFF Research Database (Denmark)

Bjurström, Johanna; Collins, Sally; Langhoff-Roos, Jens

2018-01-01

PURPOSE: A retained placenta after vaginal delivery where manual removal of placenta fails is a clinical challenge. We present six cases that illustrate the heterogeneity of the condition and discuss the etiology and terminology as well as the clinical management. METHODS: Members of the European...... and the UK provide examples of various treatment strategies such as ultrasound-guided vaginal removal, removal of the placenta through a hysterotomy and just leaving the placenta in situ. The placentas were all retained, but it was only possible to diagnose abnormal invasion in the one case, which had...

Impact of combined intermittent preventive treatment of malaria and helminths on anaemia, sustained attention, and recall in Northern Ghanaian schoolchildren

DEFF Research Database (Denmark)

Opoku, Ernest Cudjoe; Olsen, Annette; Browne, Edmund

2016-01-01

albendazole plus praziquantel compared to albendazole plus praziquantel on anaemia, sustained attention, and recall in schoolchildren. DESIGN: This three-arm, open-label intervention study was carried out in Ghana among class three schoolchildren. Artemether-lumefantrine and albendazole were co...... to measure haemoglobin (Hb), while the code transmission test (CTT), adapted from the Test of Everyday Attention for Children (TEA-Ch), was used to measure sustained attention and recall before-and-after interventions in June 2011 and June 2012. RESULTS: We observed significant malaria parasite prevalence...... and deworming reduced prevalence of anaemia and improved sustained attention and recall in schoolchildren. Best results for sustained attention and recall were seen in Study Arm 2....

[Investigation of the clinical usefullness of leukocytapheresis on rheumatoid arthritis resistant to or failed with the other treatments].

Science.gov (United States)

Sawada, Jin; Kimoto, Osamu; Suzuki, Daisuke; Shimoyama, Kumiko; Ogawa, Noriyoshi

2009-12-01

To examine therapeutic effect of leukocytapheresis (LCAP) for rheumatoid arthritis (RA) resistant to various treatments. Thirteen patients with RA (mean age : 60.8+/-11.4, male : female=5 : 8), 1 who were resistant to disease-modifying anti-rheumatic drugs (DMARDs) and biologics, or 2 who failed with those medicines because of side effects or complications. We performed LCAP, which was carried out once a week for a total of five sessions, with a throughput of about 0.1 L/kg. Before and after LCAP, we evaluated the effect of LCAP therapy. DAS28 (CRP) score was 5.70+/-1.12 before LCAP, 4.57+/-1.19 (P<0.05) just after the final LCAP and 4.83+/-1.35 (P<0.05) about 4 weeks after LCAP. DAS28 score decreased in all patients after LCAP. No serious adverse events were observed except temporary anemia. LCAP therapy may be useful and safe for patients with RA resistant to conventional medication. Patients who show good clinical response by LCAP needs to be clarified.

Failed fuel detector

International Nuclear Information System (INIS)

Martucci, J.A.

1975-01-01

A failed fuel detection apparatus is described for a nuclear reactor having a liquid cooled core comprising a gas collection hood adapted to engage the top of the suspect assembly and means for delivering a stripping gas to the vicinity of the bottom of the suspect fuel assembly. (U.S.)

Failed fuel detection method

International Nuclear Information System (INIS)

Utamura, Motoaki; Urata, Megumu.

1976-01-01

Object: To detect failed fuel element in a reactor with high precision by measuring the radioactivity concentrations for more than one nuclides of fission products ( 131 I and 132 I, for example) contained in each sample of coolant in fuel channel. Method: The radioactivity concentrations in the sampled coolant are obtained from gamma spectra measured by a pulse height analyser after suitable cooling periods according to the half-lives of the fission products to be measured. The first measurement for 132 I is made in two hours after sampling, and the second for 131 I is started one day after the sampling. Fuel element corresponding to the high radioactivity concentrations for both 131 I and 132 I is expected with certainty to have failed

Contemporary management of patients with high-risk non-muscle-invasive bladder cancer who fail intravesical BCG therapy.

Science.gov (United States)

Yates, D R; Rouprêt, M

2011-08-01

It is advocated that patients with high-risk non-muscle-invasive bladder cancer (NMIBC) receive an adjuvant course of intravesical Bacille Calmette-Guerin (BCG) as first-line treatment. However, a substantial proportion of patients will 'fail' BCG, either early with persistent (refractory) disease or recur late after a long disease-free interval (relapsing). Guideline recommendation in the 'refractory' setting is radical cystectomy, but there are situations when extirpative surgery is not feasible due to competing co-morbidity, a patient's desire for bladder preservation or reluctance to undergo surgery. In this review, we discuss the contemporary management of NMIBC in patients who have failed prior BCG and are not suitable for radical surgery and highlight the potential options available. These options can be categorised as immunotherapy, chemotherapy, device-assisted therapy and combination therapy. However, the current data are still inadequate to formulate definitive recommendations, and data from ongoing trials and maturing studies will give us an insight into whether there is a realistic efficacious second-line treatment for patients who fail intravesical BCG but are not candidates for definitive surgery.

Comparing an in vivo egg reduction test and in vitro egg hatching assay for different anthelmintics against Fasciola species, in cattle.

Science.gov (United States)

Arafa, Waleed M; Shokeir, Khalid M; Khateib, Abdelrahman M

2015-11-30

This study aimed to compare between the efficiency of in vivo fecal egg reduction test (FERT) and in vitro egg hatching assay (EHA) in evaluating of the anti-Fasciola activity of albendazole, triclabendazole, oxyclozanide and praziquantel. A field trial was carried out on fifty naturally Fasciola infected cattle that were divided equally into 5 groups (A-E). On day zero; groups A-D were drenched with albendazole, triclabendazole, oxyclozanide or praziquantel, respectively, while the remaining one, group E, was kept as untreated control. Fecal egg counts of the different groups were conducted weekly over a period of one month post-treatment. In vitro, commercial albendazole and oxyclozanide were diluted to 0.0002, 0.002, 0.02, 0.2 and 2.0 μg/ml, while commercial triclabendazole and praziquantel were diluted to concentrations of 25, 50, 75 and 100 μg/ml with dimethyl sulfoxide (DMSO). In vivo, at the 2nd week post-treatment, triclabendazole and oxyclozanide showed 100% fecal egg reduction (FER), and albendazole had a maximum of 73.7% reduction (P egg counts. In vitro, triclabendazole treated Fasciola gigantica eggs showed early embryonic lysis with zero% hatching at the different concentrations (P egg development and hatching percentage of oxyclozanide or praziquantel treated groups. In conclusion, the efficacy of triclabendazole and albendazole as fasciolicdes could be predicted by Egg Hatching Assay (EHA). Meanwhile fasciolicide activity of oxyclozanide could not be assessed with EHA. Based on in vivo and in vitro findings, paraziquantel did not show any fasciolicide effect. Copyright © 2015 Elsevier B.V. All rights reserved.

Method of detecting a failed fuel

International Nuclear Information System (INIS)

Utamura, Motoaki; Urata, Megumi; Uchida, Shunsuke.

1976-01-01

Object: To improve detection accuracy of a failed fuel by eliminating a coolant temperature distribution in a fuel assembly. Structure: A failed fuel is detected from contents of nuclear fission products in a coolant by shutting off an upper portion of a fuel assembly provided in the coolant and by sampling the coolant in the fuel assembly. Temperature distribution in the fuel assembly is eliminated, by injecting the higher temperature coolant than that of the coolant inside and outside the fuel assembly when sampling, and thereby replacing the existing coolant in the fuel assembly for the higher temperature coolant. The failed fuel is detected from contents of the fission products existing in the coolant, by sampling the higher temperature coolant of the fuel assembly after a temperature passed. (Moriyama, K.)

Patient-related risk factors for requiring surgical intervention following a failed injection for the treatment of medial and lateral epicondylitis.

Science.gov (United States)

Degen, Ryan M; Cancienne, Jourdan M; Camp, Christopher L; Altchek, David W; Dines, Joshua S; Werner, Brian C

2017-11-01

To identify risk factors for failure of a therapeutic injection leading to operative management of both medial and lateral epicondylitis. A national database was used to query Medicare Standard Analytic Files from 2005-2012 for patients treated with therapeutic injections for medial or lateral epicondylitis using CPT codes for injections associated with corresponding ICD-9 diagnostic codes (726.31 and 726.32, respectively). Those who subsequently underwent surgical treatment following injection were identified. A multivariate binomial logistic regression analysis was utilized to evaluate patient-related risk factors for requiring surgery within 2 years after therapeutic injection. 1,837 patients received therapeutic injections for medial epicondylitis. 52 (2.8%) required ipsilateral surgery at a mean of 429 ± 28 days post-injection. Risk factors for requiring surgical intervention included age lateral epicondylitis. 201 (3.1%) required subsequent surgery at a mean of 383 ± 128 days' post-injection. Risk factors included age lateral epicondylitis is low (~3%). Risk factors for failing a therapeutic injection include age  30) for medial epicondylitis and age lateral epicondylitis. Patients with these identified risk factors presenting with medial or lateral epicondylitis should be cautioned that they carry a higher risk of subsequent surgical treatment. Therapeutic, III.

Failed fuel rod detector

Energy Technology Data Exchange (ETDEWEB)

Uchida, Katsuya; Matsuda, Yasuhiko

1984-05-02

The purpose of the project is to enable failed fuel rod detection simply with no requirement for dismantling the fuel assembly. A gamma-ray detection section is arranged so as to attend on the optional fuel rods in the fuel assembly. The fuel assembly is adapted such that a gamma-ray shielding plate is detachably inserted into optional gaps of the fuel rods or, alternatively, the fuel assembly can detachably be inserted to the gamma-ray shielding plate. In this way, amount of gaseous fission products accumulated in all of the plenum portions in the fuel rods as the object of the measurement can be determined without dismantling the fuel assembly. Accordingly, by comparing the amounts of the gaseous fission products, the failed fuel rod can be detected.

Dynamics of paediatric urogenital schistosome infection, morbidity and treatment: a longitudinal study among preschool children in Zimbabwe.

Science.gov (United States)

Osakunor, Derick Nii Mensah; Mduluza, Takafira; Midzi, Nicholas; Chase-Topping, Margo; Mutsaka-Makuvaza, Masceline Jenipher; Chimponda, Theresa; Eyoh, Enwono; Mduluza, Tariro; Pfavayi, Lorraine Tsitsi; Wami, Welcome Mkululi; Amanfo, Seth Appiah; Murray, Janice; Tshuma, Clement; Woolhouse, Mark Edward John; Mutapi, Francisca

2018-01-01

Recent research has shown that in schistosome-endemic areas preschool-aged children (PSAC), that is, ≤5 years, are at risk of infection. However, there exists a knowledge gap on the dynamics of infection and morbidity in this age group. In this study, we determined the incidence and dynamics of the first urogenital schistosome infections, morbidity and treatment in PSAC. Children (6 months to 5 years) were recruited and followed up for 12 months. Baseline demographics, anthropometric and parasitology data were collected from 1502 children. Urinary morbidity was assessed by haematuria and growth-related morbidity was assessed using standard WHO anthropometric indices. Children negative for Schistosoma haematobium infection were followed up quarterly to determine infection and morbidity incidence. At baseline, the prevalence of S haematobium infection and microhaematuria was 8.5% and 8.6%, respectively. Based on different anthropometric indices, 2.2%-8.2% of children were malnourished, 10.1% underweight and 18.0% stunted. The fraction of morbidity attributable to schistosome infection was 92% for microhaematuria, 38% for stunting and malnutrition at 9%-34%, depending on indices used. S haematobium -positive children were at greater odds of presenting with microhaematuria (adjusted OR (AOR)=25.6; 95% CI 14.5 to 45.1) and stunting (AOR=1.7; 95% CI 1.1 to 2.7). Annual incidence of S haematobium infection and microhaematuria was 17.4% and 20.4%, respectively. Microhaematuria occurred within 3 months of first infection and resolved in a significant number of children, 12 weeks post-praziquantel treatment, from 42.3% to 10.3%; P<0.001. We demonstrated for the first time the incidence of schistosome infection in PSAC, along with microhaematuria, which appears within 3 months of first infection and resolves after praziquantel treatment. A proportion of stunting and malnutrition is attributable to S haematobium infection. The study adds scientific evidence to the calls for

Antifibrotic effect of xanthohumol in combination with praziquantel is associated with altered redox status and reduced iron accumulation during liver fluke-associated cholangiocarcinogenesis

Directory of Open Access Journals (Sweden)

Wassana Jamnongkan

2018-01-01

Full Text Available Cholangiocarcinoma (CCA caused by infection of the liver fluke Opisthorchis viverrini, (Ov is the major public health problem in northeast Thailand. Following Ov infection the subsequent molecular changes can be associated by reactive oxygen species (ROS induced chronic inflammation, advanced periductal fibrosis, and cholangiocarcinogenesis. Notably, resistance to an activation of cell death in prolonged oxidative stress conditions can occur but some damaged/mutated cells could survive and enable clonal expansion. Our study used a natural product, xanthohumol (XN, which is an anti-oxidant and anti-inflammatory compound, to examine whether it could prevent Ov-associated CCA carcinogenesis. We measured the effect of XN with or without praziquantel (PZ, an anti-helminthic treatment, on DNA damage, redox status change including iron accumulation and periductal fibrosis during CCA genesis induced by administration of Ov and N-dinitrosomethylamine (NDMA in hamsters. Animals were randomly divided into four groups: group I, Ov infection and NDMA administration (ON; group II, Ov infection and NDMA administration and PZ treatment (ONP; the latter 2 groups were similar to group I and II, but group III received additional XN (XON and group IV received XN plus PZ (XONP. The results showed that high 8-oxodG (a marker of DNA damage was observed throughout cholangiocarcinogenesis. Moreover, increased expression of CD44v8-10 (a cell surface in regulation of the ROS defense system, whereas decreased expression of phospho-p38MAPK (a major ROS target, was found during the progression of the bile duct cell transformation. In addition, high accumulation of iron and expression of transferrin receptor-1 (TfR-1 in both malignant bile ducts and inflammatory cells were detected. Furthermore, fibrosis also increased with the highest level being on day 180. On the other hand, the groups of XN with or without PZ supplementations showed an effective reduction in all the

Pass/fail patterns of candidates who failed COMLEX-USA level 2-PE because of misrepresentation of clinical findings on postencounter notes.

Science.gov (United States)

Langenau, Erik E; Sandella, Jeanne M

2011-07-01

In 2007, The National Board of Osteopathic Medical Examiners (NBOME) instituted a policy to address the accuracy and integrity of postencounter written documentation recorded during the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation (COMLEX-USA Level 2-PE). This policy was instituted not only to protect the integrity of the examination, but also to highlight that overdocumentation of clinical findings not obtained during patient encounters may jeopardize patient safety. To investigate overall and domain pass/fail patterns of candidates who misrepresented clinical findings with regard to past and subsequent performance on COMLEX-USA Level 2-PE. Specifically, to investigate what percentage of candidates failed because of misrepresentation on first attempts and how they performed on subsequent administrations, as well as the previous performance patterns of candidates who failed because of misrepresentation on examination retakes. Historical records from NBOME's COMLEX-USA Level 2-PE database (testing cycles 2007-2008, 2008-2009, and 2009-2010) were used to analyze overall and domain pass/fail patterns of candidates who failed at least once because of misrepresentation of clinical findings. Of the 24 candidates who failed because of misrepresentation of postencounter (SOAP) notes, 20 candidates (83%) were first-time examinees. Four candidates (17%) were repeating the examination, 2 of whom were making a third attempt to pass. Among these 20 candidates who failed because of misrepresentation of clinical findings on their first attempt, 19 passed on their next attempt. At the time of study analysis, all but 2 candidates eventually passed the examination in subsequent attempts. Among candidates found to have misrepresented clinical findings on postencounter written documentation on COMLEX-USA Level 2-PE, no pattern existed between their past or subsequent performance with regard to overall or domain pass/fail results. The vast

Log-binomial models: exploring failed convergence.

Science.gov (United States)

Williamson, Tyler; Eliasziw, Misha; Fick, Gordon Hilton

2013-12-13

Relative risk is a summary metric that is commonly used in epidemiological investigations. Increasingly, epidemiologists are using log-binomial models to study the impact of a set of predictor variables on a single binary outcome, as they naturally offer relative risks. However, standard statistical software may report failed convergence when attempting to fit log-binomial models in certain settings. The methods that have been proposed in the literature for dealing with failed convergence use approximate solutions to avoid the issue. This research looks directly at the log-likelihood function for the simplest log-binomial model where failed convergence has been observed, a model with a single linear predictor with three levels. The possible causes of failed convergence are explored and potential solutions are presented for some cases. Among the principal causes is a failure of the fitting algorithm to converge despite the log-likelihood function having a single finite maximum. Despite these limitations, log-binomial models are a viable option for epidemiologists wishing to describe the relationship between a set of predictors and a binary outcome where relative risk is the desired summary measure. Epidemiologists are encouraged to continue to use log-binomial models and advocate for improvements to the fitting algorithms to promote the widespread use of log-binomial models.

Role of integrated approach of yoga therapy in a failed post-total knee replacement of bilateral knees

Directory of Open Access Journals (Sweden)

John Ebnezar

2014-01-01

Full Text Available OA Knee is the most common arthritis. Knee replacement Surgeries are being done increasingly in the present times. This has led to the violation of the standard indications and when knees are replaced ignoring other co - musculoskeletal conditions it results in the surgery failing early. This is about a patient who encountered a failed TKR due to improper selection as patient had bilateral OA Hip that was ignored in the initial stages. To overcome the problem she was advised bilateral hip replacement which would leave her with four replacements in the lower limb. She refused surgery and was told there are no alternative treatment options. This patient underwent a 3 week integrated course of IAYT at our center and she made a remarkable recovery. IAYT is a good non-surgical treatment that can be affective both before and after knee replacement and it should be considered as the first choice of treatment before surgery.

Failed fuel detection device

International Nuclear Information System (INIS)

Sudo, Takayuki.

1983-01-01

Purpose: To enable early and sure detection of failed fuels by automatically changing the alarm set value depending on the operation states of a nuclear reactor. Constitution: Gaseous fission products released into coolants are transferred further into cover gases and then introduced through a pipeway to a failed fuel detector. The cover gases introduced from the pipeway to the pipeway or chamber within the detection device are detected by a radiation detector for the radiation dose of the gaseous fission products contained therein. The detected value is converted and amplified as a signal and inputted to a comparator. While on the other hand, a signal corresponding to the reactor power is converted by an alarm setter into a set value and inputted to the comparator. In such a structure, early and sure detection can be made for the fuel failures. (Yoshino, Y.)

Chemometric quality inspection control of pyrantel pamoate, febantel and praziquantel in veterinary tablets by mid infrared spectroscopy.

Science.gov (United States)

Piantavini, Mário S; Pontes, Flávia L D; Uber, Caroline P; Stremel, Dile P; Sena, Marcelo M; Pontarolo, Roberto

2014-05-05

This paper describes the development and validation of a new multivariate calibration method based on diffuse reflectance mid infrared spectroscopy for direct and simultaneous determination of three veterinary pharmaceutical drugs, pyrantel pamoate, praziquantel and febantel, in commercial tablets. The best synergy interval partial least squares (siPLS) model was obtained by selecting three spectral regions, 3715-3150, 2865-2583, and 2298-1733 cm(-1), preprocessed by first derivative and Savitzky-Golay smoothing followed by mean centering. This model was built with five latent variables and provided root mean square errors of prediction (RMSEP) equal or lower than 0.69 mg per 100 mg of powder for the three analytes. The method was validated according the appropriate regulations through the estimate of figures of merit, such as trueness, precision, linearity, analytical sensitivity, bias and residual prediction deviation (RPD). Then, it was applied to three different veterinary pharmaceutical formulations found in the Brazilian market, in a situation of multi-product calibration, since the excipient composition of these commercial products, which was not known a priori, was modeled by an experimental design that scanned the likely content range of the possible constituents. The results were verified with high performance liquid chromatography with diode array detection (HPLC-DAD) and high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) and were in agreement with the predicted values at 95% confidence level. The developed method presented the advantages of being simple, rapid, solvent free, and about ten times faster than the HPLC ones. Copyright © 2014 Elsevier B.V. All rights reserved.

Chemometric quality inspection control of pyrantel pamoate, febantel and praziquantel in veterinary tablets by mid infrared spectroscopy

Science.gov (United States)

Piantavini, Mário S.; Pontes, Flávia L. D.; Uber, Caroline P.; Stremel, Dile P.; Sena, Marcelo M.; Pontarolo, Roberto

This paper describes the development and validation of a new multivariate calibration method based on diffuse reflectance mid infrared spectroscopy for direct and simultaneous determination of three veterinary pharmaceutical drugs, pyrantel pamoate, praziquantel and febantel, in commercial tablets. The best synergy interval partial least squares (siPLS) model was obtained by selecting three spectral regions, 3715-3150, 2865-2583, and 2298-1733 cm-1, preprocessed by first derivative and Savitzky-Golay smoothing followed by mean centering. This model was built with five latent variables and provided root mean square errors of prediction (RMSEP) equal or lower than 0.69 mg per 100 mg of powder for the three analytes. The method was validated according the appropriate regulations through the estimate of figures of merit, such as trueness, precision, linearity, analytical sensitivity, bias and residual prediction deviation (RPD). Then, it was applied to three different veterinary pharmaceutical formulations found in the Brazilian market, in a situation of multi-product calibration, since the excipient composition of these commercial products, which was not known a priori, was modeled by an experimental design that scanned the likely content range of the possible constituents. The results were verified with high performance liquid chromatography with diode array detection (HPLC-DAD) and high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) and were in agreement with the predicted values at 95% confidence level. The developed method presented the advantages of being simple, rapid, solvent free, and about ten times faster than the HPLC ones.

Prevalence of Schistosoma mansoni infection and the therapeutic efficacy of praziquantel among school children in Manna District, Jimma Zone, southwest Ethiopia

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Mitiku Bajiro

2016-10-01

Full Text Available Abstract Background Intestinal schistosomiasis is one of the neglected tropical parasitic diseases caused by Schistosoma mansoni. Currently, the control measures for the disease are mainly based on mass drug administration (MDA with praziquantel (PZQ targeting the school-age children. In Ethiopia, the potential foci for schistosomiasis and therapeutic efficacy of PZQ among school-age children remain poorly explored. Therefore, we determined both the prevalence and intensity of S. mansoni infection and the therapeutic efficacy of PZQ among school children in the Manna District (new foci for S. mansoni, Jimma Zone, southwest Ethiopia. Methods A cross-sectional study was conducted among the school children aged between 6 and 18 years in three primary schools in Manna district from March to April 2014. For diagnosis of S. mansoni, a single stool sample was obtained from each child and processed using single Kato Katz and examined under light microscopy. A questionnaire was used to collect demographic information of the school children participated in the study. School children excreting eggs of S. mansoni were administered with 40 mg/kg of PZQ and re-examined after three weeks post-treatment. The therapeutic efficacy of PZQ against S. mansoni was evaluated by means of cure rate and egg reduction rate. Results The overall prevalence of S. mansoni among the school children in the three primary schools in Manna District was 24.0 %. Higher prevalence was recorded for males 25.6 % (61/238 than for females 22.5 % (59/262. Majority (27.5 % of infection intensity was light with mean faecal egg count (FEC of 202 eggs per gram (EPG. The therapeutic efficacy of PZQ at a dose of 40 mg/kg was highly efficient (cure rate of 99.1 % and egg reduction rate of 99.9 % among the school children in the three primary schools in Manna District. Conclusions The school children in the three primary schools of Manna District, Jimma Zone were at moderate risk of the

Browse Title Index

African Journals Online (AJOL)

2003), Evaluation of the OptiMAL Test for Rapid Diagnosis of Malaria, Abstract PDF ... Evidence of Long Term Benefit of Praziquantel Treatment Against ... the parasitic contamination of edible locally produced dry season ...

Failed fuel action plan guidelines: Special report

International Nuclear Information System (INIS)

1987-11-01

The objective of this document is to provide a generic guideline that can be used to formulate a failed fuel action plan (FFAP) for specific application by a utility. This document is intended to be part of a comprehensive fuel reliability monitoring, management, and improvement program. The utilities may utilize this document as one resource in developing a failed fuel action plan. This document is not intended to be used as a failed fuel action plan standard. This document is intended to provide guidance on: management responsibilities; fuel performance parameters; cost/benefit analysis; action levels; long-term improvement methods; and data collection, analysis, and trending. 3 refs., 4 figs., 6 tabs

The failing firm defence: merger policy and entry

OpenAIRE

Mason, Robin; Weeds, Helen

2003-01-01

This Paper considers the 'failing firm defence'. Under this principle, found in most antitrust jurisdictions, a merger that would otherwise be blocked due to its adverse effect on competition is permitted when the firm to be acquired is a failing firm, and an alternative, less detrimental merger is unavailable. Competition authorities have shown considerable reluctance to accept the failing firm defence, and it has been successfully used in just a handful of cases. The Paper considers the def...

[Laparoscopic Heller myotomy after failed POEM and multiple balloon dilatations : Better late than never].

Science.gov (United States)

Giulini, L; Dubecz, A; Stein, H J

2017-04-01

Despite the lack of long-term results, peroral endoscopic myotomy (POEM) has been increasingly propagated as a feasible alternative to pneumatic balloon dilatation (BD) and laparoscopic Heller myotomy (LHM) in patients with achalasia. After a long-term follow-up, a large percentage of patients reported recurrence of dysphagia. It is unclear which kind of procedure (redo POEM or LHM) should be utilized in these patients with failed POEM. We report the case of a 37-year-old female patient with type I achalasia who was successfully treated with LHM after a failed POEM procedure. After the manometric diagnosis of type I achalasia, the patient was treated with six balloon dilatations within a period of 5 months. Because of the persistence of symptoms a POEM procedure was performed with no relief and the patient was referred for surgical treatment. An esophagography showed a pronounced widening of the middle and the distal esophagus with a persistent narrowing of the lower esophageal sphincter (LES) and because of these indications LHM was performed. The intraoperative examination revealed extensive scarring of the submucosal layer with the muscularis mucosae of the distal esophagus; nevertheless, it was possible to carry out a 5 cm long cardiomyotomy without mucosal injury. The operation was completed with a Dor fundoplication. There were no postoperative complications. After surgery the patient reported an immediate and complete relief of dysphagia. The published experiences with POEM seem to show promising short-term results in terms of dysphagia relief; however, the few available mid-term analyses demonstrated no essential advantages when compared to LHM; therefore, the LHM must still be considered the gold standard procedure for definitive treatment of achalasia. According to our case report, LHM was shown to be a safe and effective although laborious treatment option due to scarring even after failed treatment by POEM.

Coping Styles of Failing Brunei Vocational Students

Science.gov (United States)

Mundia, Lawrence; Salleh, Sallimah

2017-01-01

Purpose: The purpose of this paper is to determine the prevalence of two types of underachieving students (n = 246) (active failing (AF) and passive failing (PF)) in Brunei vocational and technical education (VTE) institutions and their patterns of coping. Design/methodology/approach: The field survey method was used to directly reach many…

Prostatic Artery Embolization After Failed Urological Interventions for Benign Prostatic Obstruction: A Case Series of Three Patients

Energy Technology Data Exchange (ETDEWEB)

Bhatia, Shivank S., E-mail: sbhatia1@med.miami.edu; Dalal, Ravi, E-mail: rdalal@med.miami.edu [University of Miami – Miller School of Medicine, Department of Radiology (United States); Gomez, Christopher, E-mail: Cgomez7@med.miami.edu [University of Miami – Miller School of Medicine, Department of Urology (United States); Narayanan, Govindarajan, E-mail: gnarayanan@med.miami.edu [University of Miami – Miller School of Medicine, Department of Radiology (United States)

2016-08-15

Benign prostate obstruction with associated lower urinary tract symptoms is a common diagnosis with multiple minimally invasive treatment options available. Herein, the authors describe three patients who failed prior different urological interventions who underwent prostate artery embolization with a subsequent improvement in symptoms. The positive response suggests that embolization may be an effective treatment alternative in this subset of patients.

Contribution of targeted saliva screening for congenital CMV-related hearing loss in newborns who fail hearing screening.

Science.gov (United States)

Ari-Even Roth, Daphne; Lubin, Daniel; Kuint, Jacob; Teperberg-Oikawa, Michal; Mendelson, Ella; Strauss, Tzipora; Barkai, Galia

2017-11-01

We previously reported a 2.2% rate of infants born with sensorineural hearing loss (SNHL) due to congenital cytomegalovirus (cCMV) infection identified by universal neonatal screen for cCMV using saliva. To evaluate the contribution of targeted saliva screening for cCMV to the detection of infants born with cCMV-related SNHL who failed universal newborn hearing screening (UNHS). We retrospectively reviewed the audiological and medical records of infants who failed UNHS and were tested for cCMV using saliva sample prior to discharge at Sheba Medical Center between 2014 and 2015. Positive cases were confirmed by urine sample. Two hundred (1%) of the 19 830 infants tested during the study period failed in-hospital hearing screening. A saliva specimen was obtained prior to discharge in 187 infants (93.5% of those who failed UNHS). In 178 infants saliva testing was performed at ≤21 days of chronological age and yielded results. cCMV infection was identified in 4/178 tested infants (2.25%, 95% CI 0.8% to 5.3%), of whom three were diagnosed with SNHL (1.7%, 95% CI 0.5% to 4.4%) and offered antiviral treatment. Two of the tested infants (1.12%, 95% CI 0.2% to 3.6%) were diagnosed with cCMV solely due to failure in UNHS. Occult central nervous system (CNS) symptoms of cCMV infection were detected in 2/4 infants following targeted investigation. Targeted cCMV screening in newborns who failed UNHS contributed to the early detection of infants born with cCMV-related isolated SNHL or with occult CNS symptoms who could potentially benefit from antiviral treatment. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Solid lipid nanoparticle suspension enhanced the therapeutic efficacy of praziquantel against tapeworm

Directory of Open Access Journals (Sweden)

Xie S

2011-10-01

Full Text Available Shuyu Xie1,*, Baoliang Pan1,*, Baoxin Shi2, Zhuangzhi Zhang2, Xu Zhang2, Ming Wang1, Wenzhong Zhou11Department of Preventive Veterinary Medicine, College of Veterinary Medicine, China Agricultural University, Beijing, People’s Republic of China; 2Veterinary Research Institute, Xinjiang Academy of Animal Science, Xinjiang, People’s Republic of China *These authors contributed equally to this study Abstract: Hydatid disease caused by tapeworm is an increasing public health and socioeconomic concern. In order to enhance the therapeutic efficacy of praziquantel (PZQ against tapeworm, PZQ-loaded hydrogenated castor oil solid lipid nanoparticle (PZQ-HCO-SLN suspension was prepared by a hot homogenization and ultrasonication method. The stability of the suspension at 4°C and room temperature was evaluated by the physicochemical characteristics of the nanoparticles and in-vitro release pattern of the suspension. Pharmacokinetics was studied after subcutaneous administration of the suspension in dogs. The therapeutic effect of the novel formulation was evaluated in dogs naturally infected with Echinococcus granulosus. The results showed that the drug recovery of the suspension was 97.59% ± 7.56%. Nanoparticle diameter, polydispersivity index, and zeta potential were 263.00 ± 11.15 nm, 0.34 ± 0.06, and -11.57 ± 1.12 mV, respectively and showed no significant changes after 4 months of storage at both 4°C and room temperature. The stored suspensions displayed similar in-vitro release patterns as that of the newly prepared one. SLNs increased the bioavailability of PZQ 5.67-fold and extended the mean residence time of the drug from 56.71 to 280.38 hours. Single subcutaneous administration of PZQ-HCO-SLN suspension obtained enhanced therapeutic efficacy against tapeworm in infected dogs. At the dose of 5 mg/kg, the stool-ova reduction and negative conversion rates and tapeworm removal rate of the suspension were 100%, while the native PZQ were 91

Critical analysis of cystic echinococcosis control programs and praziquantel use in South America, 1974-2010 Análisis crítico de los programas de control de la equinococosis quística y uso del prazicuantel en América del Sur, 1974-2010

Directory of Open Access Journals (Sweden)

Edmundo Larrieu

2012-01-01

Full Text Available Cystic echinococcosis (CE is one of the most prevalent zoonoses in Argentina, Brazil, Chile, Peru, and Uruguay. Control programs in South America were originally modeled after programs developed in insular territories, such as Tasmania and New Zealand. The advent and proven effectiveness of praziquantel, plus the experience of insular models, produced high expectations for rapid advances; however, after 30 years of praziquantel use, no endemic area in South America has obtained eradication. In fact, only modest gains in CE control have been made and impact on prevalence among humans has been slight. A major impediment has been the infrastructure needed to administer praziquantel to dogs in rural areas 8 times per year over numerous years, a requirement for rapid attack stage 1. Such an infrastructure has not been financially or politically sustainable in endemic areas, which tend to be the poorest. On the other hand, certain areas in Argentina have had success with simple and economically viable alternatives. Based primarily on continuous field work supported by the local community, these strategies have significantly decreased transmission to humans, the health sector's main objective. In addition, new possibilities and tools, such as the EG95 vaccine, are being evaluated; as are early detection and treatment of asymptomatic carriers.La equinococosis quística (EQ es una de las zoonosis más prevalentes en Argentina, Brasil, Chile, Perú y Uruguay. Los programas de control en América del Sur fueron originalmente hechos a imitación de los programas desarrollados en territorios insulares, como Tasmania y Nueva Zelandia. El advenimiento y la eficacia comprobada del prazicuantel, sumados a la experiencia de los modelos insulares, dieron lugar a altas expectativas de adelantos rápidos; sin embargo, después de 30 años de uso del prazicuantel, ninguna zona endémica en América del Sur ha logrado la erradicación de la enfermedad. De hecho, solo

Who Really Failed? Commentary

Science.gov (United States)

Maiuri, Katherine M.; Leon, Raul A.

2012-01-01

Scott Jaschik's (2010) article "Who Really Failed?" details the experience of Dominique Homberger, a tenured faculty member at Louisiana State University (LSU) who was removed from teaching her introductory biology course citing student complaints in regards to "the extreme nature" of the grading policy. This removal has…

Abortion: Strong's counterexamples fail

DEFF Research Database (Denmark)

Di Nucci, Ezio

2009-01-01

This paper shows that the counterexamples proposed by Strong in 2008 in the Journal of Medical Ethics to Marquis's argument against abortion fail. Strong's basic idea is that there are cases--for example, terminally ill patients--where killing an adult human being is prima facie seriously morally...

Impact of hookworm infection and deworming on anaemia in non-pregnant populations: a systematic review.

Science.gov (United States)

Smith, Jennifer L; Brooker, Simon

2010-07-01

To summarise age- and intensity-stratified associations between human hookworm infection and anaemia and to quantify the impact of treatment with the benzimidazoles, albendazole and mebendazole, on haemoglobin and anaemia in non-pregnant populations. Electronic databases (MEDLINE, EMBASE, PubMed) were searched for relevant studies published between 1980 and 2009, regardless of language, and researchers contacted about potential data. Haemoglobin concentration (Hb) was compared between uninfected individuals and individuals harbouring hookworm infections of different intensities, expressed as standardised mean differences (SMD) and 95% confidence intervals (CI). Meta-analysis of randomised control trials (RCTs) investigated the impact of treatment on Hb and anaemia. Twenty-three cross-sectional studies, six pre- and post-intervention studies and 14 trials were included. Among cross-sectional studies, moderate- and heavy-intensity hookworm infections were associated with lower Hb in school-aged children, while all levels of infection intensity were associated with lower Hb in adults. Among RCTs using albendazole, impact of treatment corresponded to a 1.89 g/l increase (95%CI: 0.13-3.63) in mean Hb while mebendazole had no impact. There was a positive impact of 2.37 g/l (95%CI: 1.33-3.50) on mean Hb when albendazole was co-administered with praziquantel, but no apparent additional benefit of treatment with benzimidazoles combined with iron supplementation. The mean impact of treatment with benzimidazoles alone on moderate anaemia was small (relative risk (RR) 0.87) with a larger effect when combined with praziquantel (RR 0.61). Anaemia is most strongly associated with moderate and heavy hookworm infection. The impact of anthelmintic treatment is greatest when albendazole is co-administered with praziquantel.

Efficacy of integrated school based de-worming and prompt malaria treatment on helminths -Plasmodium falciparum co-infections: A 33 months follow up study

Directory of Open Access Journals (Sweden)

Chadukura Vivian

2011-06-01

Full Text Available Abstract Background The geographical congruency in distribution of helminths and Plasmodium falciparum makes polyparasitism a common phenomenon in Sub Saharan Africa. The devastating effects of helminths-Plasmodium co-infections on primary school health have raised global interest for integrated control. However little is known on the feasibility, timing and efficacy of integrated helminths-Plasmodium control strategies. A study was conducted in Zimbabwe to evaluate the efficacy of repeated combined school based antihelminthic and prompt malaria treatment. Methods A cohort of primary schoolchildren (5-17 years received combined Praziquantel, albendazole treatment at baseline, and again during 6, 12 and 33 months follow up surveys and sustained prompt malaria treatment. Sustained prompt malaria treatment was carried out throughout the study period. Children's infection status with helminths, Plasmodium and helminths-Plasmodium co-infections was determined by parasitological examinations at baseline and at each treatment point. The prevalence of S. haematobium, S. mansoni, STH, malaria, helminths-Plasmodium co-infections and helminths infection intensities before and after treatment were analysed. Results Longitudinal data showed that two rounds of combined Praziquantel and albendazole treatment for schistosomiasis and STHs at 6 monthly intervals and sustained prompt malaria treatment significantly reduced the overall prevalence of S. haematobium, S. mansoni, hookworms and P. falciparum infection in primary schoolchildren by 73.5%, 70.8%, 67.3% and 58.8% respectively (p P. f + schistosomes, and P. f + STHs + schistosomes co-infections were reduced by 68.0%, 84.2%, and 90.7%, respectively. The absence of anti-helminthic treatment between the 12 mth and 33 mth follow-up surveys resulted in the sharp increase in STHs + schistosomes co-infection from 3.3% at 12 months follow up survey to 10.7%, slightly more than the baseline level (10.3% while other

Detection of IgG1 and IgG4 subtypes reactive against potato apyrase in schistosomiasis patients

Directory of Open Access Journals (Sweden)

Priscila de Faria-Pinto

2010-07-01

Full Text Available In this paper, we showed for the first time that the conserved domains within Schistosoma mansoni ATP diphosphohydrolase isoforms, shared with potato apyrase, possess epitopes for the IgG1 and IgG4 subtypes, as 24 (80% of the 30 schistosomiasis patients were seropositive for this vegetable protein. The analyses for each patient cured (n = 14 after treatment (AT with praziquantel revealed variable IgG1 and IgG4 reactivity against potato apyrase. Different antigenic epitopes shared between the vegetable and parasite proteins could be involved in susceptibility or resistance to S. mansoni AT with praziquantel and these possibilities should be explored.

The use of a prosthetic inlay resurfacing as a salvage procedure for a failed cartilage repair.

Science.gov (United States)

Dhollander, Aad Alfons Maria; Almqvist, Karl Fredrik; Moens, Kris; Vandekerckhove, Pieter-Jan; Verdonk, René; Verdonk, Peter; Victor, Jan

2015-08-01

This study was designed to describe the clinical and radiographical outcome of the HemiCAP(®) resurfacing system as a salvage treatment for a failed index cartilage procedure. Fourteen patients were treated consecutively and clinically prospectively followed for a mean period of 26.1 ± 12.8 months. All patients were previously treated for their cartilage lesion. Radiographical data were analysed based on the Kellgren and Lawrence system. The patients involved in this study demonstrated a gradual clinical improvement in time. However, radiographically significant osteoarthritic changes were observed during the follow-up period. The position of the HemiCAP(®) resurfacing system was adequate in all cases, and no signs of loosening were observed during the follow-up period. The HemiCAP(®) resurfacing system is feasible as a salvage treatment for a failed index cartilage procedure and resulted in a gradual clinical improvement. However, the favourable clinical outcome was not confirmed by the radiographical findings. IV.

Development of failed fuel detection system for PWR (III)

International Nuclear Information System (INIS)

Hwang, Churl Kew; Kang, Hee Dong; Jeong, Seung Ho; Cho, Byung Sub; Yoon, Byeong Joo; Yoon, Jae Seong

1987-12-01

Ultrasonic transducers satisfying the conditions for failed fuel rod detection for failed fuel rod detection have been designed and built. And performance tests for them have been carried out. Ultrasonic signal processing units, a manipulator guiding the ultrasonic probe through the fuel assembly lanes and its control units have been constructed. The performance of the system has been verified experimentally to be successful in failed fuel rod detection. (Author)

Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: a single center prospective study.

Science.gov (United States)

Onimaru, Manabu; Inoue, Haruhiro; Ikeda, Haruo; Yoshida, Akira; Santi, Esperanza Grace; Sato, Hiroki; Ito, Hiroaki; Maselli, Roberta; Kudo, Shin-ei

2013-10-01

Surgical Heller myotomy has high rates of successful long-term results, but failed cases still remain. Moreover, the treatment strategy in patients with surgical myotomy failure is controversial. Recently, peroral endscopic myotomy (POEM) was reported to be efficient and safe in primary treatment of achalasia. In this study, we aimed to evaluate the efficacy and safety of POEM for surgical myotomy failure as a rescue second-line treatment, and we discuss the treatment options adapted in achalasia recurrence. A total of 315 consecutive achalasia patients received POEM from September 2008 to December 2012 in our hospital. Eleven (3.5%) patients who had persistent or recurrent achalasia and had received surgical myotomy as a first-line treatment from other hospitals were included in this study. Patient background, barium swallow studies, esophagogastroduodenoscopy (EGD), manometry, and symptom scores were prospectively evaluated. In principle, all patients in whom surgical myotomy failed received pneumatic balloon dilatation (PBD) as the first line "rescue" treatment, and only if PBD failed were patients considered for rescue POEM. The PBD alone was effective in 1 patient, and in the remaining 10 patients, rescue POEM was performed successfully without complications. Three months after rescue POEM, significant reduction in lower esophageal sphincter (LES) resting pressures (22.1 ± 6.6 mmHg vs 10.9 ± 4.5 mmHg, p myotomy were excellent. Long-term results are awaited. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Laparoscopic revision of failed antireflux operations.

Science.gov (United States)

Serafini, F M; Bloomston, M; Zervos, E; Muench, J; Albrink, M H; Murr, M; Rosemurgy, A S

2001-01-01

A small number of patients fail fundoplication and require reoperation. Laparoscopic techniques have been applied to reoperative fundoplications. We reviewed our experience with reoperative laparoscopic fundoplication. Reoperative laparoscopic fundoplication was undertaken in 28 patients, 19 F and 9 M, of mean age 56 years +/- 12. Previous antireflux procedures included 19 open and 12 laparoscopic antireflux operations. Symptoms were heartburn (90%), dysphagia (35%), and atypical symptoms (30%%). The mean interval from antireflux procedure to revision was 13 months +/- 4.2. The mean DeMeester score was 78+/-32 (normal 14.7). Eighteen patients (64%) had hiatal breakdown, 17 (60%) had wrap failure, 2 (7%) had slipped Nissen, 3 (11%) had paraesophageal hernias, and 1 (3%) had an excessively tight wrap. Twenty-five revisions were completed laparoscopically, while 3 patients required conversion to the open technique. Complications occurred in 9 of 17 (53%) patients failing previous open fundoplications and in 4 of 12 patients (33%) failing previous laparoscopic fundoplications and included 15 gastrotomies and 1 esophagotomy, all repaired laparoscopically, 3 postoperative gastric leaks, and 4 pneumothoraces requiring tube thoracostomy. No deaths occurred. Median length of stay was 5 days (range 2-90 days). At a mean follow-up of 20 months +/- 17, 2 patients (7%) have failed revision of their fundoplications, with the rest of the patients being essentially asymptomatic (93%). The results achieved with reoperative laparoscopic fundoplication are similar to those of primary laparoscopic fundoplications. Laparoscopic reoperations, particularly of primary open fundoplication, can be technically challenging and fraught with complications. Copyright 2001 Academic Press.

Effects of anti-schistosomal chemotherapy on immune responses, protection and immunity. II. Concomitant immunity and immunization with irradiated cercariae

International Nuclear Information System (INIS)

Tawfik, A.F.; Colley, D.G.

1986-01-01

Resistance of mice to challenge infections of Schistosoma mansoni was evaluated before and after elimination of their primary, established S. mansoni infections with the chemotherapeutic drug praziquantel. Mice treated after either 10 or 20 weeks of primary infection were challenged 6 or 10 weeks after treatment. Mice infected for for 10 weeks prior to treatment expressed progressively less resistance 6 and 10 weeks after treatment. By 10 weeks after treatment significant levels of protection were no longer observed. Resistance waned more slowly if mice were treated 20 weeks after infection, and there was still significant expression of resistance to challenge 10 weeks after treatment. A separate set of experiments evaluated the use of highly irradiated cercariae as a vaccine in mice that had been previously infected with S. mansoni and cured with praziquantel. It was observed that effective immunizations were possible in previously infected mice. These studies demonstrate that established resistance waned after treatment and the rate of loss of protection was dependent upon the duration of infection prior to treatment. Furthermore, the irradiated cercarial vaccine studies indicate that in the murine model induction of immunological resistance was feasible following chemotherapeutic treatment of infected populations

Rescue of failed filtering blebs with ab interno trephination.

Science.gov (United States)

Shihadeh, Wisam A; Ritch, Robert; Liebmann, Jeffrey M

2006-06-01

We evaluated the effectiveness of ab interno automated trephination as a technique for rescuing failed mature filtering blebs. A retrospective chart review of 40 failed blebs of 38 patients who had a posttrephination follow-up period of at least 3 months was done. With success defined as intraocular pressure (IOP) control with other modalities of management. Complications were few. We believe that ab interno trephination is an excellent option for rescuing selected failed filtering blebs.

Peroral endoscopic remyotomy for failed Heller myotomy: a prospective single-center study.

Science.gov (United States)

Zhou, P H; Li, Q L; Yao, L Q; Xu, M D; Chen, W F; Cai, M Y; Hu, J W; Li, L; Zhang, Y Q; Zhong, Y S; Ma, L L; Qin, W Z; Cui, Z

2013-01-01

Recurrence/persistence of symptoms occurs in approximately 20 % of patients after Heller myotomy for achalasia. Controversy exists regarding the therapy for patients in whom Heller myotomy has failed. The aim of the current study was to evaluate the efficacy and feasibility of peroral endoscopic myotomy (POEM), a new endoscopic myotomy technique, for patients with failed Heller myotomy. A total of 12 patients with recurrence/persistence of symptoms after Heller myotomy, as diagnosed by established methods and an Eckardt score of ≥ 4, were prospectively included. The primary outcome was symptom relief during follow-up, defined as an Eckardt score of ≤ 3. Secondary outcomes were procedure-related adverse events, lower esophageal sphincter (LES) pressure on manometry, reflux symptoms, and medication use before and after POEM. All 12 patients underwent successful POEM after a mean of 11.9 years (range 2 - 38 years) from the time of the primary Heller myotomy. No serious complications related to POEM were encountered. During a mean follow-up period of 10.4 months (range 5 - 14 months), treatment success was achieved in 11/12 patients (91.7 %; mean score pre- vs. post-treatment 9.2 vs. 1.3; P Heller myotomy resulting in short-term symptom relief in > 90 % of cases. Previous Heller myotomy may make subsequent endoscopic remyotomy more challenging, but does not prevent successful POEM. © Georg Thieme Verlag KG Stuttgart · New York.

77 FR 9846 - Source of Income From Qualified Fails Charges

Science.gov (United States)

2012-02-21

... temporary regulations noted that no trading practice existed at that time for fails charges on securities other than Treasuries, but that if a fails charge trading practice pertaining to other securities was... sources within the United States, and the income from the qualified fails charge is treated as effectively...

Why Companies Fail? The Boiling Frog Syndrome

OpenAIRE

Ozcan, Rasim

2018-01-01

Why nations fail? An answer is given by Acemoglu and Robinson (2012) by pointing out the importance of institutions for an economy that leads to innovations for economic growth. Christensen (2012) asks a similar question for a firm and diagnoses why companies fail. In this study, I relate Acemoglu and Robinson (2012) with Christensen (2012) in order to better understand how to make companies more prosperous, more powerful, healthier, and live longer via innovations.

Cervical Retrograde Spinal Cord Stimulation Lead Placement to Treat Failed Back Surgery Syndrome: A Case Report

NARCIS (Netherlands)

Helmond, N. van; Kardaszewski, C.N.; Chapman, K.B.

2017-01-01

Spinal cord stimulation is an effective treatment modality for refractory neuropathic pain conditions, but the placement of leads can be challenging due to unforeseen anatomical variations. We used a retrograde C7-T1 approach to place a lead at the bottom of T8 in a patient suffering from failed

Outcomes of reintervention after failed urethroplasty.

Science.gov (United States)

Ekerhult, Teresa Olsen; Lindqvist, Klas; Peeker, Ralph; Grenabo, Lars

2017-02-01

Urethroplasty is a procedure that has a high success rate. However, there exists a small subgroup of patients who require multiple procedures to achieve an acceptable result. This study analyses the outcomes of a series of patients with failed urethroplasty. This is a retrospective review of 82 failures out of 407 patients who underwent urethroplasty due to urethral stricture during the period 1999-2013. Failure was defined as the need for an additional surgical procedure. Of the failures, 26 patients had penile strictures and 56 had bulbar strictures. Meatal strictures were not included. The redo procedures included one or multiple direct vision internal urethrotomies, dilatations or new urethroplasties, all with a long follow-up time. The patients underwent one to seven redo surgeries (mean 2.4 procedures per patient). In the present series of patients, endourological procedures cured 34% (28/82) of the patients. Ten patients underwent multiple redo urethroplasties until a satisfactory outcome was achieved; the penile strictures were the most difficult to cure. In patients with bulbar strictures, excision with anastomosis and substitution urethroplasty were equally successful. Nevertheless, 18 patients were defined as treatment failures. Of these patients, nine ended up with clean intermittent self-dilatation as a final solution, five had perineal urethrostomy and four are awaiting a new reintervention. Complicated cases need centralized professional care. Despite the possibility of needing multiple reinterventions, the majority of patients undergoing urethroplasty have a good chance of successful treatment.

Ahmed glaucoma valve implantation for refractory glaucoma after sequential failed trabeculectomy

Directory of Open Access Journals (Sweden)

Zhi-Qin Wu

2016-07-01

Full Text Available AIM: To evaluate the safety and efficacy of Ahmed glaucoma valve implantation for refractory glaucoma after sequential failed trabeculectomy. METHODS: Thirty-six patients(36 eyeswith prior failed sequential trabeculectomy who underwent Ahmed glaucoma valve implantation were included. The intraocular pressure(IOP, best corrected visual acuity(BCVAand complications were ovserved and all the patients were followed up at least for 12mo. RESULTS: Mean preoperative IOP was 35.20±7.28mmHg and reduced to 10.15±3.34, 11.23±3.56, 15.63±5.72, 17.17±5.47, 17.73±6.23,19.76±5.43mmHg at 1, 2wk, 1, 3, 6 and 12mo after surgery, which was significant different from the preoperative level(t=12.643, 11.837, 10.324, 8.839, 8.462, 8.046, all PZ=-0.420, P>0.05. At 12mo after operation, the complete success rate reached 78% and the conditional success rate reached 92%. There were 5 eyes complicated with shallow anterior chamber, 3 eye complicated with anterior chamber hemorrhage, which all recovered after additional treatments. Late complications included valve exposure and encapsulated cystic blebs around the plate. Severe corneal endothelium loss occurred in 1 patient. CONCLUSION: Ahmed glaucoma valve implantation is effective in reducing IOP at 1-year follow-up in refractory glaucoma patients with prior sequential failed trabeculectomy, but we should fully understand and attach great importance to all kinds of complications that may occur.

7 CFR 983.152 - Failed lots/rework procedure.

Science.gov (United States)

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Failed lots/rework procedure. 983.152 Section 983.152..., ARIZONA, AND NEW MEXICO Rules and Regulations § 983.152 Failed lots/rework procedure. (a) Inshell rework procedure for aflatoxin. If inshell rework is selected as a remedy to meet the aflatoxin regulations of this...

Urinary tract pathology in some Schistosoma haematobium infected ...

African Journals Online (AJOL)

AJB SERVER

2007-01-18

Jan 18, 2007 ... 6°E. Ihieve-Ogben is located within the guinea savanna region of the state. The villagers ... Pseudopolyp is defined as an outgrowth of the wall, attached by a .... treatment with Praziquantel among school children in Southern.

Ultrasonics aids the identification of failed fuel rods

International Nuclear Information System (INIS)

Anon.

1985-01-01

Over a number of years Brown Boveri Reaktor of West Germany has developed and commercialized an ultrasonic failed fuel rod detection system. Sipping has up to now been the standard technique for failed fuel detection, but sipping can only indicate whether or not an assembly contains defective rods; the BBR system can tell which rod is defective. (author)

Reliability testing of failed fuel location system

International Nuclear Information System (INIS)

Vieru, G.

1996-01-01

This paper presents the experimental reliability tests performed in order to prove the reliability parameters for Failed Fuel Location System (FFLS), equipment used to detect in which channel of a particular heat transport loop a fuel failure is located, and to find in which channel what particular bundle pair is failed. To do so, D20 samples from each reactor channel are sequentially monitored to detect a comparatively high level of delayed neutron activity. 15 refs, 8 figs, 2 tabs

Failing by design.

Science.gov (United States)

McGrath, Rita Gunther

2011-04-01

It's hardly news that business leaders work in increasingly uncertain environments, where failures are bound to be more common than successes. Yet if you ask executives how well, on a scale of one to 10, their organizations learn from failure, you'll often get a sheepish "Two-or maybe three" in response. Such organizations are missing a big opportunity: Failure may be inevitable but, if managed well, can be very useful. A certain amount of failure can help you keep your options open, find out what doesn't work, create the conditions to attract resources and attention, make room for new leaders, and develop intuition and skill. The key to reaping these benefits is to foster "intelligent failure" throughout your organization. McGrath describes several principles that can help you put intelligent failure to work. You should decide what success and failure would look like before you start a project. Document your initial assumptions, test and revise them as you go, and convert them into knowledge. Fail fast-the longer something takes, the less you'll learn-and fail cheaply, to contain your downside risk. Limit the number of uncertainties in new projects, and build a culture that tolerates, and sometimes even celebrates, failure. Finally, codify and share what you learn. These principles won't give you a means of avoiding all failures down the road-that's simply not realistic. They will help you use small losses to attain bigger wins over time.

[Results of revision after failed surgical treatment for traumatic anterior shoulder instability].

Science.gov (United States)

Lópiz-Morales, Y; Alcobe-Bonilla, J; García-Fernández, C; Francés-Borrego, A; Otero-Fernández, R; Marco-Martínez, F

2013-01-01

Persistent or recurrent glenohumeral instability after a previous operative stabilization can be a complex problem. Our aim is to establish the incidence of recurrence and its revision surgery, and to analyse the functional results of the revision instability surgery, as well as to determine surgical protocols to perform it. A retrospective analysis was conducted on 16 patients with recurrent instability out of 164 patients operated on between 1999 and 2011. The mean follow-up was 57 months and the mean age was 29 years. To evaluate functional outcome we employed Constant, Rowe, UCLA scores and the visual analogue scale. Of the 12 patients who failed the initial arthroscopic surgery, 6 patients underwent an arthroscopic antero-inferior labrum repair technique, 4 using open labrum repair techniques, and 2 coracoid transfer. The two cases of open surgery with recurrences underwent surgery for coracoid transfer. Results of the Constant score were excellent or good in 64% of patients. Surgical revision of instability is a complex surgery essentially for two reasons: the difficulty in recognising the problem, and the technical demand (greater variety and the increasingly complex techniques). Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

Weeded Out? Gendered Responses to Failing Calculus.

Science.gov (United States)

Sanabria, Tanya; Penner, Andrew

2017-06-01

Although women graduate from college at higher rates than men, they remain underrepresented in science, technology, engineering, and mathematics (STEM) fields. This study examines whether women react to failing a STEM weed-out course by switching to a non-STEM major and graduating with a bachelor's degree in a non-STEM field. While competitive courses designed to weed out potential STEM majors are often invoked in discussions around why students exit the STEM pipeline, relatively little is known about how women and men react to failing these courses. We use detailed individual-level data from the National Educational Longitudinal Study (NELS) Postsecondary Transcript Study (PETS): 1988-2000 to show that women who failed an introductory calculus course are substantially less likely to earn a bachelor's degree in STEM. In doing so, we provide evidence that weed-out course failure might help us to better understand why women are less likely to earn degrees.

DECOFF Probabilities of Failed Operations

DEFF Research Database (Denmark)

Gintautas, Tomas

2015-01-01

A statistical procedure of estimation of Probabilities of Failed Operations is described and exemplified using ECMWF weather forecasts and SIMO output from Rotor Lift test case models. Also safety factor influence is investigated. DECOFF statistical method is benchmarked against standard Alpha-factor...

Failed fuel detection device

International Nuclear Information System (INIS)

Kawai, Masayoshi; Hayashida, Yoshihisa; Niidome, Jiro.

1985-01-01

Purpose: To prevent intrusion of background neutrons to neutron detectors thereby improve the S/N ratio of the detectors in the failed fuel detection device of LMFBR type reactors. Constitution: Neutrons from the reactor core pass through the gaps around the penetration holes in which the primary pipeways pass through the concrete shielding walls and pass through the gaps between the thermal shielding members and the neutron moderating shielding members of the failed fuel detection device and then intrude into the neutron detectors. In view of the above, inner neutron moderating shielding members and movable or resilient neutron shielding members are disposed to the inside of the neutron moderating shielding member. Graphite or carbon hydrides such as paraffin or synthetic resin with a large neutron moderation effect are used as the outer moderating shielding member and materials such as boron or carbon are used for the inner members. As a result, the background neutrons are shielded by the inner neutron moderating shielding members and the resilient neutron shielding members, by which the S/N ratio of the neutron detectors can be increased to 2 - 4 times. (Moriyama, K.)

Failed fuel detector

International Nuclear Information System (INIS)

Kogure, Sumio; Seya, Toru; Watanabe, Masaaki.

1976-01-01

Purpose: To enhance the reliability of a failed fuel detector which detects radioactivity of nuclear fission products leaked out from fuel elements in cooling water. Constitution: Collected specimen is introduced into a separator and co-existing material considered to be an impediment is separated and removed by ion exchange resins, after which this specimen is introduced into a container housing therein a detector to systematically measure radioactivity. Thereby, it is possible to detect a signal lesser in variation in background, and inspection work also becomes simple. (Kawakami, Y.)

Why did the League of Nations fail?

OpenAIRE

Jari Eloranta

2011-01-01

Why did the League of Nations ultimately fail to achieve widespread disarmament, its most fundamental goal? This article shows that the failure of the League of Nations had two important dimensions: (1) the failure to provide adequate security guarantees for its members (like an alliance); (2) the failure of this organization to achieve the disarmament goals it set out in the 1920s and 1930s. Thus, it was doomed from the outset to fail, due to built-in institutional contradictions. It can als...

Failed pelvic pouch substituted by continent ileostomy.

Science.gov (United States)

Wasmuth, H H; Tranø, G; Wibe, A; Endreseth, B H; Rydning, A; Myrvold, H E

2010-07-01

The long-term failure rate of ileal pouch-anal anastomosis (IPAA) is 10-15%. When salvage surgery is unsuccessful, most surgeons prefer pouch excision with conventional ileostomy, thus sacrificing 40-50 cm of ileum. Conversion of a pelvic pouch to a continent ileostomy (CI, Kock pouch) is an alternative that preserves both the ileal surface and pouch properties. The aim of the study was to evaluate clinical outcome after the construction of a CI following a failed IPAA. During 1984-2007, 317 patients were operated with IPAA at St Olavs Hospital and evaluated for failure, treatment and outcome. Seven patients with IPAA failure had CI. Four patients with IPAA failure referred from other hospitals underwent conversion to CI and are included in the final analysis. Seven patients had a CI constructed from the transposing pelvic pouch and four had the pelvic pouch removed and a new continent pouch constructed from the distal ileum. Median follow up after conversion to CI was 7 years (0-17 years). Two CI had to be removed due to fistulae. One patient needed a revision of the nipple valve due to pouch loosening. At the end of follow-up, 8 of the 11 patients were fully continent. One patient with Crohn's disease had minor leakage. In patients with pelvic pouch failure, the possibility of conversion to CI should be presented to the patient as an alternative to pouch excision and permanent ileostomy. The advantage is the continence and possibly a better body image. Construction of a CI on a new ileal segment may be considered, but the consequences of additional small bowel loss and risk of malnutrition if the Kock pouch fails should be appraised.

Failed total carpometacarpal joint prosthesis of the thumb

DEFF Research Database (Denmark)

Hansen, Torben Bæk; Homilius, Morten

2010-01-01

Total joint prosthesis in carpometacarpal joint arthritis of the thumb often fails. Loosening of the implant is often treated by resection arthroplasty, and we reviewed 10 patients, mean age 54 years (range 47-63) who were treated by resection arthroplasty after a failed total joint prosthesis. T...... in eight of 10 patients, but the mean Disabilities of the arm, shoulder, and hand (DASH) scores, self-reported pinch-grip-related function, and pain were comparable with our earlier published results with the Elektra carpometacarpal total joint prosthesis.......Total joint prosthesis in carpometacarpal joint arthritis of the thumb often fails. Loosening of the implant is often treated by resection arthroplasty, and we reviewed 10 patients, mean age 54 years (range 47-63) who were treated by resection arthroplasty after a failed total joint prosthesis....... The male:female ratio was 1:4 and the mean duration of observation 32 months (range 6-52). In three patients the revised implant was a MOJE uncemented carpometacarpal joint prosthesis and in seven patients an Elektra uncemented one. At follow-up grip strength was reduced to less than 90% of the other hand...

Simultaneous determination of praziquantel, pyrantel embonate, febantel and its active metabolites, oxfendazole and fenbendazole, in dog plasma by liquid chromatography/mass spectrometry.

Science.gov (United States)

Klausz, Gabriella; Keller, Éva; Sára, Zoltán; Székely-Körmöczy, Péter; Laczay, Péter; Ary, Kornélia; Sótonyi, Péter; Róna, Kálmán

2015-12-01

A liquid chromatography-electrospray-mass spectrometry method (LC/MS) has been developed and validated for determination of praziquantel (PZQ), pyrantel (PYR), febantel (FBT), and the active metabolites fenbendazole (FEN) and oxfendazole (OXF), in dog plasma, using mebendazole as internal standard (IS). The method consists of solid-phase extractions on Strata-X polymeric cartridges. Chromatographic separation was carried out on a Phenomenex Gemini C6 -Phenyl column using binary gradient elution containing methanol and 50 mm ammonium-formate (pH 3). The method was linear (r(2)  ≥ 0.990) over concentration ranges of 3-250 ng/mL for PYR andFEB, 5-250 ng/mL for OXF and FEN, and 24-1000 ng/mL for PZQ. The mean precisions were 1.3-10.6% (within-run) and 2.5-9.1% (between-run), and mean accuracies were 90.7-109.4% (within-run) and 91.6-108.2% (between-run). The relative standard deviations (RSD) were <9.1%. The mean recoveries of five targeted compounds from dog plasma ranged from 77 to 94%.The new LC/MS method described herein was fully validated and successfully applied to the bioequivalence studies of different anthelmintic formulations such as tablets containing PZQ, PYR embonate and FBT in dogs after oral administration. Copyright © 2015 John Wiley & Sons, Ltd.

Thermal analysis of the failed equipment storage vault system

International Nuclear Information System (INIS)

Jerrell, J.; Lee, S.Y.; Shadday, A.

1995-07-01

A storage facility for failed glass melters is required for radioactive operation of the Defense Waste Processing Facility (DWPF). It is currently proposed that the failed melters be stored in the Failed Equipment Storage Vaults (FESV's) in S area. The FESV's are underground reinforced concrete structures constructed in pairs, with adjacent vaults sharing a common wall. A failed melter is to be placed in a steel Melter Storage Box (MSB), sealed, and lowered into the vault. A concrete lid is then placed over the top of the FESV. Two melters will be placed within the FESV/MSB system, separated by the common wall. There is no forced ventilation within the vault so that the melter is passively cooled. Temperature profiles in the Failed Equipment Storage Vault Structures have been generated using the FLOW3D software to model heat conduction and convection within the FESV/MSB system. Due to complexities in modeling radiation with FLOW3D, P/THERMAL software has been used to model radiation using the conduction/convection temperature results from FLOW3D. The final conjugate model includes heat transfer by conduction, convection, and radiation to predict steady-state temperatures. Also, the FLOW3D software has been validated as required by the technical task request

Analysis of failed nuclear plant components

International Nuclear Information System (INIS)

Diercks, D.R.

1993-01-01

Argonne National Laboratory has conducted analyses of failed components from nuclear power-generating stations since 1974. The considerations involved in working with an analyzing radioactive components are reviewed here, and the decontamination of these components is discussed. Analyses of four failed components from nuclear plants are then described to illustrate the kinds of failures seen in service. The failures discussed are (1) intergranular stress-corrosion cracking of core spray injection piping in a boiling water reactor, (2) failure of canopy seal welds in adapter tube assemblies in the control rod drive head of a pressurized water reactor, (3) thermal fatigue of a recirculation pump shaft in a boiling water reactor, and (4) failure of pump seal wear rings by nickel leaching in a boiling water reactor

Analysis of failed nuclear plant components

International Nuclear Information System (INIS)

Diercks, D.R.

1992-07-01

Argonne National Laboratory has conducted analyses of failed components from nuclear power generating stations since 1974. The considerations involved in working with and analyzing radioactive components are reviewed here, and the decontamination of these components is discussed. Analyses of four failed components from nuclear plants are then described to illustrate the kinds of failures seen in service. The failures discussed are (a) intergranular stress corrosion cracking of core spray injection piping in a boiling water reactor, (b) failure of canopy seal welds in adapter tube assemblies in the control rod drive head of a pressure water reactor, (c) thermal fatigue of a recirculation pump shaft in a boiling water reactor, and (d) failure of pump seal wear rings by nickel leaching in a boiling water reactor

Development of failed fuel detection and location system in sodium-cooled large reactor. Sampling method of failed fuels under the slit

International Nuclear Information System (INIS)

Aizawa, Kousuke; Fujita, Kaoru; Kamide, Hideki; Kasahara, Naoto

2010-01-01

A conceptual design study of Japan Sodium-cooled Fast Reactor (JSFR) is in progress as an issue of the 'Fast Reactor Cycle Technology Development (FaCT)' project in Japan. JSFR adopts a Selector-Valve mechanism for the failed fuel detection and location (FFDL) system. The Selector-Valve FFDL system identifies failed fuel subassemblies by sampling sodium from each fuel subassembly outlet and detecting fission product. One of the JSFR design features is employing an upper internal structure (UIS) with a radial slit, in which an arm of fuel handling machine can move and access the fuel assemblies under the UIS. Thus, JSFR cannot place sampling nozzles right above the fuel subassemblies located under the slit. In this study, the sampling method for indentifying under-slit failed fuel subassemblies has been demonstrated by water experiments. (author)

Failing States or Failing Models?: Accounting for the Incidence of State Collapse

OpenAIRE

Martin Doornbos

2010-01-01

In recent years the notion and phenomenon of .failingÿ states - states deemed incapable to fulfil the basic tasks of providing security for their populace -, has been rapidly drawing attention. I will start off with a closer look at the inci- dence of fragile states and state failure, more specifically of state collapse. Connected with this, I will raise the question of differential degrees of propensity to failure and collapse among contemporary state systems, and to point to apparent region...

Editorial Commentary: In a World of Endless Options, Is There a Single Solution? Management Options for Failed Anterior Instability Surgery in Athletes.

Science.gov (United States)

Matzkin, Elizabeth

2018-05-01

There are many options to manage anterior instability of the shoulder. The management of athletes who have failed previous operative stabilization can make choosing a treatment solution difficult. A modified Latarjet without capsulolabral repair has been demonstrated to be a good choice when treating failed stabilization in a high-risk population with sufficient return to play and outcomes. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Aneurysms with persistent filling after failed treatment with the Pipeline embolization device.

Science.gov (United States)

Daou, Badih; Atallah, Elias; Chalouhi, Nohra; Starke, Robert M; Oliver, Jeffrey; Montano, Maria; Jabbour, Pascal; Rosenwasser, Robert H; Tjoumakaris, Stavropoula I

2018-05-04

OBJECTIVE The Pipeline embolization device (PED) has become a valuable tool in the treatment of cerebral aneurysms. Although failures with PED treatment have been reported, the characteristics and course of these aneurysms remain a topic of uncertainty. METHODS Electronic medical records and imaging studies were reviewed for all patients treated with the PED between July 2010 and March 2015 to identify characteristics of patients and aneurysms with residual filling after PED treatment. RESULTS Of 316 cases treated at a single institution, 281 patients had a long-term follow-up. A total of 52 (16.4%) aneurysms with residual filling were identified and constituted the study population. The mean patient age in this population was 58.8 years. The mean aneurysm size was 10.1 mm ± 7.15 mm. Twelve aneurysms were fusiform (23%). Of the aneurysms with residual filling, there were 20 carotid ophthalmic (CO) aneurysms (20% of all CO aneurysms treated), 10 other paraclinoid aneurysms (16.4% of all paraclinoid aneurysms), 7 posterior communicating artery (PCoA) aneurysms (21.9% of all PCoA aneurysms), 7 cavernous internal carotid artery (ICA) aneurysms (14.9% of all cavernous ICA aneurysms), 4 vertebrobasilar (VB) junction aneurysms (14.8% of all VB junction aneurysms), and 3 middle cerebral artery (MCA) aneurysms (25% of all MCA aneurysms). Eleven patients underwent placement of more than one PED (21.2%), with a mean number of devices of 1.28 per case. Eight of 12 aneurysms were previously treated with a stent (15.4%). Nineteen patients underwent re-treatment (36.5%); the 33 patients who did not undergo re-treatment (63.5%) were monitored by angiography or noninvasive imaging. In multivariate analysis, age older than 65 years (OR 2.65, 95% CI 1.33-5.28; p = 0.05), prior stent placement across the target aneurysm (OR 2.94, 95% CI 1.15-7.51; p = 0.02), aneurysm location in the distal anterior circulation (MCA, PCoA, and anterior choroidal artery: OR 2.72, 95% CI 1.19-6.18; p

Analysis of failed nuclear plant components

Science.gov (United States)

Diercks, D. R.

1993-12-01

Argonne National Laboratory has conducted analyses of failed components from nuclear power- gener-ating stations since 1974. The considerations involved in working with and analyzing radioactive compo-nents are reviewed here, and the decontamination of these components is discussed. Analyses of four failed components from nuclear plants are then described to illustrate the kinds of failures seen in serv-ice. The failures discussed are (1) intergranular stress- corrosion cracking of core spray injection piping in a boiling water reactor, (2) failure of canopy seal welds in adapter tube assemblies in the control rod drive head of a pressurized water reactor, (3) thermal fatigue of a recirculation pump shaft in a boiling water reactor, and (4) failure of pump seal wear rings by nickel leaching in a boiling water reactor.

The association of platelets with failed patent ductus arteriosus closure after a primary course of indomethacin or ibuprofen: a systematic review and meta-analysis.

Science.gov (United States)

Mitra, Souvik; Chan, Anthony K; Paes, Bosco A

2017-01-01

To conduct a meta-analysis of the association of platelet counts and pharmacotherapeutic failure in preterms with a patent ductus arteriosus (PDA). MEDLINE, Embase, Science Citation Index, abstracts and conference proceedings were searched, and principal authors contacted. Included studies reported indomethacin or ibuprofen use for PDA closure, compared a group which failed treatment versus a group which did not and reported the association between platelet counts and indomethacin or ibuprofen failure. Two reviewers independently screened results and assessed methodological quality using the Newcastle-Ottawa Scale. Results are expressed as mean difference in platelet counts and summary odds ratios (OR) using a random effects model. 1105 relevant studies were identified; eight involving 1087 preterms were included. Platelet counts were significantly lower in infants who failed pharmacotherapy (Meandifference:-30.88 × 10 9 /L; 95% CI:-45.69 × 10 9 ,-16.07 × 10 9 /L; I2 = 24%; p heterogeneity  =   0.24). Similar results were obtained based on either pharmacotherapeutic agent. Treatment failure was also significantly associated with pre-treatment thrombocytopenia (summary OR:1.75; 95% CI:1.23-2.49, I2 = 36%, p heterogeneity  =   0.20). Platelet counts are significantly lower in preterms who fail primary treatment for PDA. Pre-treatment thrombocytopenia is associated with higher odds of failure. Further cohort studies reporting platelet counts in prostaglandin inhibitor failure are needed for meta-analyses to firmly establish or refute a stronger association.

Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus.

Science.gov (United States)

Trindade, Arvind J; Inamdar, Sumant; Kothari, Shivangi; Berkowitz, Joshua; McKinley, Matthew; Kaul, Vivek

2017-09-01

Radiofrequency ablation (RFA) for dysplastic Barrett's esophagus (BE) is highly effective. RFA failures are infrequent but can be a challenging cohort to manage. There are limited data on the feasibility of liquid nitrogen cryospray ablation for complete eradication of dysplasia (CE-D) and/or intestinal metaplasia (CE-IM) after RFA has failed to achieve CE-IM in patients with dysplastic BE. This is a retrospective review from two medical centers of prospectively maintained databases looking at patients that underwent liquid nitrogen cryospray ablation for refractory intestinal metaplasia post failed RFA. Eighteen patients were identified that met inclusion criteria. Eleven patients had persistent dysplasia and IM following RFA and seven had persistent non-dysplastic IM. More than 80% of patients were male with long-segment BE (median length 8 cm). Seventy two percent of patients with dysplasia achieved CE-D after cryotherapy. Fifty percent (9/18) of all RFA failures achieved CE-IM with cryotherapy. In comparison, RFA has a CE-IM of 78% in a less challenging treatment naïve cohort from a large-scale meta-analysis of 3802 patients. No adverse events occurred in our cohort. Cryospray ablation is feasible and safe for achieving CE-D and CE-IM after RFA failure. The CE-D rates are high with cryotherapy in this population. CE-IM with cryotherapy is acceptable in this difficult-to-treat cohort when compared to CE-IM rates with RFA in dysplastic BE treatment naïve patients (50% vs 78%). © 2017 Japan Gastroenterological Endoscopy Society.

Endovascular recanalization of native chronic total occlusions in patients with failed lower-extremity bypass grafts.

Science.gov (United States)

Wrigley, Clinton W; Vance, Ansar; Niesen, Timothy; Grilli, Christopher; Velez, J Daniel; Agriantonis, Demetrios J; Kimbiris, George; Garcia, Mark J; Leung, Daniel A

2014-09-01

To investigate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTOs) in patients with failed lower-extremity bypass grafts. Retrospective review of 19 limbs in 18 patients with failed lower-extremity bypass grafts that underwent recanalization of native arterial occlusions between February 2009 and April 2013 was performed. Nine of the limbs presented with acute ischemia and 10 presented with chronic ischemia, including eight with critical limb ischemia and two with disabling claudication. The mean patency of the failed bypass grafts (63% venous) was 27 months. All limbs had Transatlantic Inter-Society Consensus class D lesions involving the native circulation. Technical success of the endovascular recanalization procedure was achieved in all but one limb (95%). The mean ankle brachial indices before and after treatment were 0.34 and 0.73, respectively. There were no major complications or emergency amputations. Mean patient follow-up was 64 weeks, and two patients were lost to follow-up. Primary patency rates at 3, 6, and 12 months were 87%, 48%, and 16%, respectively. Successful secondary procedures were performed in seven patients, with secondary patency rates at 3, 6, and 12 months of 88%, 73%, and 44%, respectively. Limb salvage rates at 12 and 24 months were 94% and 65%, and amputation-free survival rates at 12 and 24 months were 87% and 60%, respectively. Endovascular recanalization of native CTOs in patients with failed lower-extremity bypass grafts is technically feasible and safe and results in acceptable limb salvage. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Experience with failed or damaged spent fuel and its impacts on handling

International Nuclear Information System (INIS)

Bailey, W.J.

1989-12-01

Spent fuel management planning needs to include consideration of failed or damaged spent light-water reactor (LWR) fuel. Described in this paper, which was prepared under the Commercial Spent Fuel Management (CSFM) Program that is sponsored by the US Department of Energy (DOE), are the following: the importance of fuel integrity and the behavior of failed fuel, the quantity and burnup of failed or damaged fuel in storage, types of defects, difficulties in evaluating data on failed or damaged fuel, experience with wet storage, experience with dry storage, handling of failed or damaged fuel, transporting of fuel, experience with higher burnup fuel, and conclusions. 15 refs

Accessory Meningeal Arterial Supply to the Posterior Nasal Cavity: Another Reason for Failed Endovascular Treatment of Epistaxis

International Nuclear Information System (INIS)

Duncan, I.C.; Santos, C. Dos

2003-01-01

A patient with intractable posterior epistaxis was treated with embolization of the ipsilateral sphenopalatine and facial arteries and contralateral sphenopalatine artery. She continued to bleed despite a seemingly adequate embolization procedure. A second angiogram revealed a significant collateral blood supply to the posterior nasal cavity from the accessory meningeal artery not identified during the first procedure. This was then embolized with no further epistaxis encountered. This case demonstrates yet another collateral arterial pathway that might account for a failed embolization

I Failed the edTPA

Science.gov (United States)

Kuranishi, Adam; Oyler, Celia

2017-01-01

In this article, co-written by a teacher and a professor, the authors examine possible explanations for why Adam (first author), a New York City public school special educator, failed the edTPA, a teacher performance assessment required by all candidates for state certification. Adam completed a yearlong teaching residency where he was the special…

Method of detecting failed fuels

International Nuclear Information System (INIS)

Ishizaki, Hideaki; Suzumura, Takeshi.

1982-01-01

Purpose: To enable the settlement of the temperature of an adequate filling high temperature pure water by detecting the outlet temperature of a high temperature pure water filling tube to a fuel assembly to control the heating of the pure water and detecting the failed fuel due to the sampling of the pure water. Method: A temperature sensor is provided at a water tube connected to a sipping cap for filling high temperature pure water to detect the temperature of the high temperature pure water at the outlet of the tube, and the temperature is confirmed by a temperature indicator. A heater is controlled on the basis of this confirmation, an adequate high temperature pure water is filled in the fuel assembly, and the pure water is replaced with coolant. Then, it is sampled to settle the adequate temperature of the high temperature coolant used for detecting the failure of the fuel assembly. As a result, the sipping effect does not decrease, and the failed fuel can be precisely detected. (Yoshihara, H.)

Pass-fail grading: laying the foundation for self-regulated learning.

Science.gov (United States)

White, Casey B; Fantone, Joseph C

2010-10-01

Traditionally, medical schools have tended to make assumptions that students will "automatically" engage in self-education effectively after graduation and subsequent training in residency and fellowships. In reality, the majority of medical graduates out in practice feel unprepared for learning on their own. Many medical schools are now adopting strategies and pedagogies to help students become self-regulating learners. Along with these changes in practices and pedagogy, many schools are eliminating a cornerstone of extrinsic motivation: discriminating grades. To study the effects of the switch from discriminating to pass-fail grading in the second year of medical school, we compared internal and external assessments and evaluations for a second-year class with a discriminating grading scale (Honors, High Pass, Pass, Fail) and for a second-year class with a pass-fail grading scale. Of the measures we compared (MCATs, GPAs, means on second-year examinations, USMLE Step 1 scores, residency placement, in which there were no statistically significant changes), the only statistically significant decreases (lower performance with pass fail) were found in two of the second-year courses. Performance in one other course also improved significantly. Pass-fail grading can meet several important intended outcomes, including "leveling the playing field" for incoming students with different academic backgrounds, reducing competition and fostering collaboration among members of a class, more time for extracurricular interests and personal activities. Pass-fail grading also reduces competition and supports collaboration, and fosters intrinsic motivation, which is key to self-regulated, lifelong learning.

Usefulness of pumpkin seeds combined with areca nut extract in community-based treatment of human taeniasis in northwest Sichuan Province, China.

Science.gov (United States)

Li, Tiaoying; Ito, Akira; Chen, Xingwang; Long, Changping; Okamoto, Munehiro; Raoul, Francis; Giraudoux, Patrick; Yanagida, Tetsuya; Nakao, Minoru; Sako, Yasuhito; Xiao, Ning; Craig, Philip S

2012-11-01

Taeniasis refers to the infection with adult tapeworms of Taenia spp. in the upper small intestine of humans, which is also a cause of cysticercosis infection in either both humans and/or animals. Currently the most commonly applied anthelminthics for treatment of taeniasis are praziquantel and niclosamide. Praziquantel is very effective, but has the risk of induction of epileptic seizures or convulsions in carriers with asymptomatic concurrent neurocysticercosis. In contrast, niclosamide is safe and effective, but is not readily available in many endemic countries including China. In the current community-based study, we assessed the curative effect of either pumpkin seeds or areca nut extract alone in taeniasis, and also looked at synergistic effects of these two herb drugs on tapeworms. In the study group with the pumpkin seed/areca nut extract treatment, 91 (79.1%) of 115 suspected taeniasis cases (with a history of expulsion of proglottids within the previous one year) released whole tapeworms, four (3.5%) expelled incomplete strobila, and no tapeworms or proglottids were recovered in the remaining 20 cases. In these 115 persons, 45 were confirmed as taeniasis before treatment by microscopy and/or coproPCR. Forty (88.9%) of 45 confirmed cases eliminated intact worms following treatment. The mean time period for complete elimination of tapeworms in 91 taeniasis cases was 2 h (range 20 min to 8 h 30 min), and 89.0% (81) of 91 patients discharged intact worms within 3h after drug administration. In Control Group A with treatment of pumpkin seeds alone, 75.0% (9/12) of confirmed taeniasis cases expelled whole tapeworms, but the mean time period for complete elimination was about 14 h 10 min (range 3 h 20 min to 21 h 20 min), which was much longer than that (2 h) for the study group, whereas in Control Group B treated with areca nut extract alone, only 63.6% (7/11) of taeniasis cases discharged whole tapeworms, and the mean time period was 6 h 27 min (range 1-22 h

Plasma Brightenings in a Failed Solar Filament Eruption

Energy Technology Data Exchange (ETDEWEB)

Li, Y.; Ding, M. D., E-mail: yingli@nju.edu.cn [School of Astronomy and Space Science, Nanjing University, Nanjing 210023 (China)

2017-03-20

Failed filament eruptions are solar eruptions that are not associated with coronal mass ejections. In a failed filament eruption, the filament materials usually show some ascending and falling motions as well as generating bright EUV emissions. Here we report a failed filament eruption (SOL2016-07-22) that occurred in a quiet-Sun region observed by the Atmospheric Imaging Assembly on board the Solar Dynamics Observatory . In this event, the filament spreads out but gets confined by the surrounding magnetic field. When interacting with the ambient magnetic field, the filament material brightens up and flows along the magnetic field lines through the corona to the chromosphere. We find that some materials slide down along the lifting magnetic structure containing the filament and impact the chromosphere, and through kinetic energy dissipation, cause two ribbon-like brightenings in a wide temperature range. There is evidence suggesting that magnetic reconnection occurs between the filament magnetic structure and the surrounding magnetic fields where filament plasma is heated to coronal temperatures. In addition, thread-like brightenings show up on top of the erupting magnetic fields at low temperatures, which might be produced by an energy imbalance from a fast drop of radiative cooling due to plasma rarefaction. Thus, this single event of a failed filament eruption shows the existence of a variety of plasma brightenings that may be caused by completely different heating mechanisms.

Revision surgery for failed thermal capsulorrhaphy.

Science.gov (United States)

Park, Hyung Bin; Yokota, Atsushi; Gill, Harpreet S; El Rassi, George; McFarland, Edward G

2005-09-01

With the failure of thermal capsulorrhaphy for shoulder instability, there have been concerns with capsular thinning and capsular necrosis affecting revision surgery. To report the findings at revision surgery for failed thermal capsulorrhaphy and to evaluate the technical effects on subsequent revision capsular plication. Case series; Level of evidence, 4. Fourteen patients underwent arthroscopic evaluation and open reconstruction for a failed thermal capsulorrhaphy. The cause of the failure, the quality of the capsule, and the ability to suture the capsule were recorded. The patients were evaluated at follow-up for failure, which was defined as recurrent subluxations or dislocations. The origin of the instability was traumatic (n = 6) or atraumatic (n = 8). At revision surgery in the traumatic group, 4 patients sustained failure of the Bankart repair with capsular laxity, and the others experienced capsular laxity alone. In the atraumatic group, all patients experienced capsular laxity as the cause of failure. Of the 14 patients, the capsule quality was judged to be thin in 5 patients and ablated in 1 patient. A glenoid-based capsular shift could be accomplished in all 14 patients. At follow-up (mean, 35.4 months; range, 22 to 48 months), 1 patient underwent revision surgery and 1 patient had a subluxation, resulting in a failure rate of 14%. Recurrent capsular laxity after failed thermal capsular shrinkage is common and frequently associated with capsular thinning. In most instances, the capsule quality does not appear to technically affect the revision procedure.

National intelligence estimates and the Failed State Index.

Science.gov (United States)

Voracek, Martin

2013-10-01

Across 177 countries around the world, the Failed State Index, a measure of state vulnerability, was reliably negatively associated with the estimates of national intelligence. Psychometric analysis of the Failed State Index, compounded of 12 social, economic, and political indicators, suggested factorial unidimensionality of this index. The observed correspondence of higher national intelligence figures to lower state vulnerability might arise through these two macro-level variables possibly being proxies of even more pervasive historical and societal background variables that affect both.

Failed State and the Mandate of Peacekeeping Operations

OpenAIRE

Eka Nizmi, Yusnarida

2011-01-01

By 1990, Somalia had become a good example of what was becoming known as a “failed state”- a people without a government strong enough to govern the country or represent it in International organizations; a country whose poverty, disorganization, refugee flows, political instability, and random warfare had the potential to spread across borders and threaten the stability of other states and the peace of the region.[1] At the end of the cold war there were several such failed states in Africa,...

Retaliation against reporters of unequal treatment: Failing employee protection in The Netherlands

NARCIS (Netherlands)

Svensson, Jorgen S.; van Genugten, M.L.

2013-01-01

Purpose – Equal treatment in the workplace is considered one of the most fundamental rights of employees. This right also implies that employees must be able to address any form of unequal treatment freely and effectively, without fear of retaliation. The purpose of this paper is to investigate the

Enhanced Morbidity of Pectoralis Major Myocutaneous Flap Used for Salvage after Previously Failed Oncological Treatment and Unsuccessful Reconstructive Head and Neck Surgery

Directory of Open Access Journals (Sweden)

Christiana Maria Ribeiro Salles Vanni

2012-01-01

Full Text Available Introduction. The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF has been widely used in these specific situations due to its reliability and low rate of failure or complications. Objectives. Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction. Methods. A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria. Results. Reconstruction was successful in 13 cases (76.5%, with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5% and were specifically related to the flap in nine instances (52.9%. An association was identified between the development of major complications and reconstruction of the hypopharynx (=0.013 as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (=0.002. The former condition is also associated with major reconstruction failure (=0.018. An even lower incidence of major complications was noted in patients under the age of 53 (=0.044. Conclusion. Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF.

A method of failed fuel detection

International Nuclear Information System (INIS)

Uchida, Shunsuke; Utamura, Motoaki; Urata, Megumu.

1976-01-01

Object: To keep the coolant fed to a fuel assembly at a level below the temperature of existing coolant to detect a failed fuel with high accuracy without using a heater. Structure: When a coolant in a coolant pool disposed at the upper part of a reactor container is fed by a coolant feed system into a fuel assembly through a cap to fill therewith and exchange while forming a boundary layer between said coolant and the existing coolant, the temperature distribution of the feed coolant is heated by fuel rods so that the upper part is low whereas the lower part is high. Then, the lower coolant is upwardly moved by the agitating action and fission products leaked through a failed opening at the lower part of the fuel assembly and easily extracted by the sampling system. (Yoshino, Y.)

Fail-safe reactivity compensation method for a nuclear reactor

Science.gov (United States)

Nygaard, Erik T.; Angelo, Peter L.; Aase, Scott B.

2018-01-23

The present invention relates generally to the field of compensation methods for nuclear reactors and, in particular to a method for fail-safe reactivity compensation in solution-type nuclear reactors. In one embodiment, the fail-safe reactivity compensation method of the present invention augments other control methods for a nuclear reactor. In still another embodiment, the fail-safe reactivity compensation method of the present invention permits one to control a nuclear reaction in a nuclear reactor through a method that does not rely on moving components into or out of a reactor core, nor does the method of the present invention rely on the constant repositioning of control rods within a nuclear reactor in order to maintain a critical state.

Fail-safe first wall for preclusion of little leakage

International Nuclear Information System (INIS)

Shibui, Masanao; Nakahira, Masataka; Tada, Eisuke; Takatsu, Hideyuki

1994-05-01

Leakages although excluded by design measures would occur most probably in highly stressed areas, weldments and locations without possibility to classify the state by in-service inspection. In a water-cooled first wall, allowable leak rate of water is generally very small, and therefore, locating of the leak portion under highly activated environment will be very difficult and be time-consuming. The double-wall concept is promising for the ITER first wall, because it can be made fail-safe by the application of the leak-before-break and the multiple load path concepts, and because it has a potential capability to solve the little leak problem. When the fail safe strength is well defined, subcritical crack growth in the damaged wall can be permitted. This will enable to detect stable leakage of coolant without deteriorating plasma operation. The paper deals with the little leak problem and presents method for evaluating small leak rate of a liquid coolant from crack-like defects. The fail-safe first wall with the double-wall concept is also proposed for preclusion of little leakage and its fail-safety is discussed. (author)

Case reports of Dipylidium caninum; a pet associated infection.

Science.gov (United States)

Wijesundera, M D; Ranaweera, R L

1989-03-01

Two cases of Dipylidium caninum (dog tape worm) infection occurring in children are reported for the first time in Sri Lanka. The diagnosis and treatment with praziquantel, a new broad spectrum antiplatyhelmintic, are described. The importance of this pet associated infection is discussed with special reference to preventive measures.

Failed fuel detector

International Nuclear Information System (INIS)

Onodera, Koichi.

1981-01-01

Purpose: To improve the reliability of detecting the failure of a fuel rod by imparting a wire disconnection detecting function to a central electrode at the center of a failure mode thereto. Constitution: A wire disconnection detecting terminal is provided at the terminal opposite to the signal output terminal of a central electrode in a failed fuel detector used for detecting the failure of a fuel rod in an atomic power plant using liquid metal as a coolant, and a voltage monitor for monitoring the terminal voltage is connected to the terminal. The disconnection of the central electrode is detected by the failure of the output of the voltage monitor, and an alarm is thus generated. (Aizawa, K.)

Method for detecting a failed fuel

International Nuclear Information System (INIS)

Utamura, Motoaki; Urata, Megumu; Uchida, Shunsuke.

1976-01-01

Purpose: To provide a method for the detection of failed fuel by pouring hot water, in which pouring speed of liquid to be poured and temperature of the liquid are controlled to prevent the leakage of the liquid. Constitution: The method comprises blocking the top of a fuel assembly arranged in coolant to stop a flow of coolant, pouring a liquid higher in temperature than that of coolant into the fuel assembly, sampling the liquid poured, and measuring the concentration of radioactivity of coolant already subjected to sampling to detect a failed fuel. At this time, controlling is made so that the pouring speed of the poured liquid is set to about 25 l/min, and an increased portion of temperature from the temperature of liquid to the temperature of coolant is set to a level less than about 15 0 C. (Furukawa, Y.)

Fail-safe logic elements for use with reactor safety systems

International Nuclear Information System (INIS)

Bobis, J.P.; McDowell, W.P.

1976-01-01

A complete fail-safe trip circuit is described which utilizes fail-safe logic elements. The logic elements used are analog multipliers and active bandpass filter networks. These elements perform Boolean operations on a set of AC signals from the output of a reactor safety-channel trip comparator

Utility of Covered Stents for Revision of Aging Failing Synthetic Hemodialysis Grafts: A Report of Three Cases

International Nuclear Information System (INIS)

Silas, Anne M.; Bettmann, Michael A.

2003-01-01

Three aging failing hemodialysis polytetrafluoroethylene bypass shunts, average age 44 months, previously percutaneously revised with balloon angioplasty, presented with pseudoaneurysms and recurrent thrombosis. All were treated with percutaneous covered stent placement within their affected limbs. One graft was ligated 1 month after treatment for infected overlying skin ulcer, though this graft was subsequently surgically revised with interposition graft and the covered stent portion remains functional at 19 month follow-up. The 18- and 13- month follow- up of the remaining 2 patients shows that the covered stents remained patent and they are functional and being successfully and routinely punctured for dialysis. In this elderly population, the use of covered stents may prolong the functional life of failing hemodialysis bypass grafts, reducing the number of percutaneous and surgical interventions and further sparing other vascular access sites

The effect of treatment on the age-antibody relationship in children infected with Schistosoma mansoni and Schistosoma haematobium

Directory of Open Access Journals (Sweden)

Mutapi Francisca

2002-01-01

Full Text Available The effect of praziquantel treatment on the age-antibody relationship was studied in 174 children aged between 6 and 17 years from a schistosome endemic area in Zimbabwe. The children were co-infected with Schistosoma mansoni and S. haematobium with infection prevalences of 74% and 53% respectively. Antibody levels for the isotypes IgA, IgE, IgM, IgG1, IgG2, IgG3 and IgG4, directed against soluble egg antigen were measured using an indirect ELISA assay. Treatment resulted in a significant increase in levels of IgG2 and IgG3 while levels of IgA decreased significantly. In untreated children there were significant decreases in levels of IgG4. Treatment also resulted in significant alteration in the age-antibody profiles for the isotypes IgE, IgM, IgG1 and IgG2 in treated children but not in untreated children. The results are discussed in the context of factors believed to give rise to the age-antibody relationship; i.e. age-related exposure patterns, age-related development of acquired immunity, age-related hormonal changes and age-related changes in innate susceptibility to infection.

Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

Energy Technology Data Exchange (ETDEWEB)

Courtney, Malachi; Ayyagari, Raj R. [Yale School of Medicine, Yale New Haven Hospital, New Haven, CT (United States); Division of Interventional Radiology, Department of Radiology, 789 Howard Avenue, P.O. Box 208042, New Haven, CT (United States)

2015-06-15

Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

International Nuclear Information System (INIS)

Courtney, Malachi; Ayyagari, Raj R.

2015-01-01

Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

Systems with randomly failing repairable components

DEFF Research Database (Denmark)

Der Kiureghian, Armen; Ditlevsen, Ove Dalager; Song, Junho

2005-01-01

Closed-form expressions are derived for the steady-state availability, mean rate of failure, mean duration of downtime and reliability of a general system with randomly and independently failing repairable components. Component failures are assumed to be homogeneous Poisson events in time and rep...

Setting and validating the pass/fail score for the NBDHE.

Science.gov (United States)

Tsai, Tsung-Hsun; Dixon, Barbara Leatherman

2013-04-01

This report describes the overall process used for setting the pass/fail score for the National Board Dental Hygiene Examination (NBDHE). The Objective Standard Setting (OSS) method was used for setting the pass/fail score for the NBDHE. The OSS method requires a panel of experts to determine the criterion items and proportion of these items that minimally competent candidates would answer correctly, the percentage of mastery and the confidence level of the error band. A panel of 11 experts was selected by the Joint Commission on National Dental Examinations (Joint Commission). Panel members represented geographic distribution across the U.S. and had the following characteristics: full-time dental hygiene practitioners with experience in areas of preventive, periodontal, geriatric and special needs care, and full-time dental hygiene educators with experience in areas of scientific basis for dental hygiene practice, provision of clinical dental hygiene services and community health/research principles. Utilizing the expert panel's judgments, the pass/fail score was set and then the score scale was established using the Rasch measurement model. Statistical and psychometric analysis shows the actual failure rate and the OSS failure rate are reasonably consistent (2.4% vs. 2.8%). The analysis also showed the lowest error of measurement, an index of the precision at the pass/fail score point and that the highest reliability (0.97) are achieved at the pass/fail score point. The pass/fail score is a valid guide for making decisions about candidates for dental hygiene licensure. This new standard was reviewed and approved by the Joint Commission and was implemented beginning in 2011.

Efficacy of repeated 5-fluorouracil needling for failing and failed filtering surgeries based on simple gonioscopic examination

Directory of Open Access Journals (Sweden)

Rashad MA

2012-12-01

Full Text Available Mohammad A RashadOphthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, EgyptPurpose: To evaluate the success rate of a modified bleb needling technique in eyes with previous glaucoma surgery that had elevated intraocular pressure.Methods: A retrospective study of 24 eyes of 24 patients that underwent repeated bleb needling performed for failing and failed blebs on slit lamp with 5-fluorouracil (5-FU injections on demand. This was performed after gonioscopic examination to define levels of filtration block.Results: There was significant reduction of mean IOP from 36.91 mmHg to 14.73 mmHg at the final follow-up (P < 0.001. The overall success rate was 92%.Conclusion: Repeated needling with adjunctive 5-FU proved a highly effective, safe alternative to revive filtration surgery rather than another medication or surgery.Keywords: bleb, failure, 5-FU, needling, gonioscopy

Forma tumoral da neurocisticercose: exerese de cisticerco de 70x77 mm e tratamento com praziquantel: relato de caso

Directory of Open Access Journals (Sweden)

Benedicto Oscar Colli

1984-06-01

Full Text Available O caso descrito refere-se a paciente do sexo feminino, com 22 anos, com história de dois episódios de crise convulsiva lateralizada à direita, hemiparesia direita e disfasia. O exame neurológico mostrou ainda edema de papila bilateral. A tomografia computadorizada (TC do crânio mostrou um cisto de 70x77 mm, ocupando a região fronto-parieto-temporal esquerda, ocasionando grande desvio da linha média, além de outras lesões menores, semelhantes, esparsas no parênquima. Com o diagnóstico de neurocisticercose foi submetida a craniotomia, sendo removidos o cisto maior (cisticerco racemoso e pequeno cisticerco cortical (10x10 mm para exame. Teve alta 13 dias após a cirurgia, com regressão completa do quadro neurológico, exceto o edema de papila (regressão parcial. Um mês após foi submetida a tratamento com praziquantel (50 mg/kg/dia durante 20 dias. O exame de LCR foi normal antes deste tratamento e, durante ele, apresentou reação celular eosinofílica, com positivação da reação de fixação de complemento para a cisticercose, ambas transitórias. A TC prévia ao tratamento mostrou várias áreas hipodensas de 10 a 40 mm, esparsas no parênquima, inclusive na área operada- A TC realizada três meses após mostrou diminuição do número de cistos do parênquima, persistindo apenas uma área hipodensa de 20 mm no local operado e dilatação do corno frontal do ven-trículo do mesmo lado. A evolução clínica foi excelente e o exame neurológico foi normal 3 meses depois.

Very Preterm Infants Failing CPAP Show Signs of Fatigue Immediately after Birth

Science.gov (United States)

Siew, Melissa L.; van Vonderen, Jeroen J.; Hooper, Stuart B.; te Pas, Arjan B.

2015-01-01

Objective To investigate the differences in breathing pattern and effort in infants at birth who failed or succeeded on continuous positive airway pressure (CPAP) during the first 48 hours after birth. Methods Respiratory function recordings of 32 preterm infants were reviewed of which 15 infants with a gestational age of 28.6 (0.7) weeks failed CPAP and 17 infants with a GA of 30.1 (0.4) weeks did not fail CPAP. Frequency, duration and tidal volumes (VT) of expiratory holds (EHs), peak inspiratory flows, CPAP-level and FiO2-levels were analysed. Results EH incidence increased CPAP-fail and CPAP-success infants. At 9-12 minutes, CPAP-fail infants more frequently used smaller VTs, 0-9 ml/kg and required higher peak inspiratory flows. However, CPAP-success infants often used large VTs (>9 ml/kg) with higher peak inspiratory flows than CPAP-fail infants (71.8 ± 15.8 vs. 15.5 ± 5.2 ml/kg.s, p CPAP-fail infants required higher FiO2 (0.31 ± 0.03 vs. 0.21 ± 0.01), higher CPAP pressures (6.62 ± 0.3 vs. 5.67 ± 0.26 cmH2O) and more positive pressure-delivered breaths (45 ± 12 vs. 19 ± 9%) (p CPAP-fail infants more commonly used lower VTs and required higher peak inspiratory flow rates while receiving greater respiratory support. VT was less variable and larger VT was infrequently used reflecting early signs of fatigue. PMID:26052947

Pictorial essay: Role of ultrasound in failed carpal tunnel decompression

Directory of Open Access Journals (Sweden)

Rajesh Botchu

2012-01-01

Full Text Available USG has been used for the diagnosis of carpal tunnel syndrome. Scarring and incomplete decompression are the main causes for persistence or recurrence of symptoms. We performed a retrospective study to assess the role of ultrasound in failed carpal tunnel decompression. Of 422 USG studies of the wrist performed at our center over the last 5 years, 14 were for failed carpal tunnel decompression. Scarring was noted in three patients, incomplete decompression in two patients, synovitis in one patient, and an anomalous muscle belly in one patient. No abnormality was detected in seven patients. We present a pictorial review of USG findings in failed carpal tunnel decompression.

Pictorial essay: Role of ultrasound in failed carpal tunnel decompression.

Science.gov (United States)

Botchu, Rajesh; Khan, Aman; Jeyapalan, Kanagaratnam

2012-01-01

USG has been used for the diagnosis of carpal tunnel syndrome. Scarring and incomplete decompression are the main causes for persistence or recurrence of symptoms. We performed a retrospective study to assess the role of ultrasound in failed carpal tunnel decompression. Of 422 USG studies of the wrist performed at our center over the last 5 years, 14 were for failed carpal tunnel decompression. Scarring was noted in three patients, incomplete decompression in two patients, synovitis in one patient, and an anomalous muscle belly in one patient. No abnormality was detected in seven patients. We present a pictorial review of USG findings in failed carpal tunnel decompression.

Effect of some parasitic infection on neurotransmitters in the brain of experimentally infected mice before and after treatment.

Science.gov (United States)

Abdel Ghafar, A E; Elkowrany, S E; Salem, S A; Menaisy, A A; Fadel, W A; Awara, W M

1996-08-01

The effects of some parasitic infection (bilharziasis, toxocariasis and trichinosis) on the brain of experimentally infected mice were investigated. Eighty animals were classified into four groups, group I contained five non infected animals as a control group. The other groups each contained twenty-five mice infected with Schistosoma mansoni (group II), Toxocara canis (group III) and Trichinella spiralis (group IV). Each infected group was divided into two subgroups (a,b). Subgroup (a) left untreated and subgroups (b) treated by praziquantel (in group II) and mebendazole (in group III and IV). Histopathological and immunological examination using peroxidase antiperoxidase (PAP) technique and neurotransmitters estimation (nor-epinephrine, dopamine and serotonine) were carried. In the untreated animals, there were mild histopathological changes and mild antigenic deposition in subgroups (IIa and IIIa) and marked changes in subgroup (IVa). There were significant decrease in dopamine in subgroup (IIIa), not improved after treatment (subgroup IIIb) and significant decrease in nor-epinephrine and serotonine in subgroup (IVa) improved after treatment in subgroup (IVb). The neurotransmitters changes may explain the motor, behavioural and emotional changes that occurred with these parasites.

Detection device for the failed position in fuels

International Nuclear Information System (INIS)

Tokunaga, Kensuke; Nomura, Teiji; Hiruta, Koji

1985-01-01

Purpose: To detect the failed position of a fuel assembly with ease and safety. Constitution: A fuel assembly is tightly closed in a sipper tube equipped with a gas supply tube and a gas exhaust tube at the upper portion and a purified water injection tube and a draining tube at the lower end. Then, water in the sipper tube is drained to the lower portion of the fuel assembly by the pressure of gases while opening the gas supply tube and the draining tube, and closing the exhaust tube and the injection tube. Then, after closing the gas supply tube and the draining tube while opening theexhaust tube and the injection tube, purified water is injected into the sipper tube from the injection tube to an optional height till the fuel assembly is immersed. Then, after leaving for a predetermined of time, water is sampled and the radioactive material density therein is measured. By changing the injection level of the purified water, since the radioactive material density changes at the failed position, the failed position can be detected with ease. (Sekiya, K.)

An open-label pilot study of pulsed electromagnetic field therapy in the treatment of failed back surgery syndrome pain

Directory of Open Access Journals (Sweden)

Harper WL

2014-12-01

Full Text Available Wayne L Harper,1 William K Schmidt,2 Nicole J Kubat,3 Richard A Isenberg41Tarheel Clinical Research, LLC, Raleigh, NC, USA; 2NorthStar Consulting, LLC, Davis, CA, USA; 3Nicole Kubat Consulting, Pasadena, CA, USA; 4Regenesis Biomedical, Inc., Scottsdale, AZ, USAAbstract: Persistent pain following back surgery remains a major treatment challenge. The primary objective of this open-label exploratory study was to investigate the analgesic effectiveness of pulsed electromagnetic field therapy administered twice daily over a 45-day period in 34 subjects (68% female with persistent or recurrent pain following back surgery. A secondary goal was to guide the design of future randomized controlled trials that could target responsive subpopulations. All predefined primary and secondary outcomes, including change in pain intensity (PI, physical function (Oswestry Disability Index, analgesic consumption, and overall well-being (Patient Global Impression of Change, are reported. A responder analysis (≥30% reduction in PI versus baseline was added as a post hoc evaluation. Safety outcomes, as well as results of a cost-avoidance survey, are also summarized. Of the 30 per-protocol subjects who completed the study, 33% reported a clinically meaningful (≥30% reduction in PI. A higher response rate (60% was reported for subjects who had undergone discectomy prior to the trial compared to subjects who had undergone other types of surgical interventions (decompression or fusion without discectomy. Improvements in PI were paralleled by improvements in secondary outcomes. Relative to baseline, responders reported an average 44% and 55% reduction in back PI and leg PI (respectively, and an average 13% improvement in Oswestry Disability Index scores. In the per-protocol population, 50% of responders and 12% of nonresponders reported less analgesia consumption at the end of treatment versus baseline. Sixty-seven percent of per-protocol responders and 0% of

Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion

Directory of Open Access Journals (Sweden)

Jaimin Shah

2017-01-01

Full Text Available Background. The detection of a morbidly adherent placenta (MAP in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal placental implantation. If these patients have a first trimester missed abortion and fail medical management, it is important that providers have a heightened suspicion for a MAP. Case. A 24-year-old G4P3003 with 3 prior cesarean deliveries underwent multiple rounds of failed medical management for a missed abortion. She had a dilation and curettage that was complicated by a significant hemorrhage and ultimately required an urgent hysterectomy. Conclusion. When patients fail medical management for a missed abortion, providers need to assess the patient’s risk factors for a MAP. If risk factors are present, a series of specific evaluations should be triggered to rule out a MAP and help further guide management. Early diagnosis of a MAP allows providers to coordinate a multidisciplinary treatment approach and thoroughly counsel patients. Ensuring adequate resources and personnel at a tertiary hospital is essential to provide the highest quality of care and improve outcomes.

Underachievement, Failing Youth and Moral Panics

Science.gov (United States)

Smith, Emma

2010-01-01

This paper considers contemporary "moral panics" around the underachievement of boys in school examinations in the UK and America. In the UK, in particular, the underachievement of boys is central to current "crisis accounts" about falling standards and failing pupils. "Underachievement" is a familiar word to those…

Profile of an epidemiological study of urinary schistosomiasis in two ...

African Journals Online (AJOL)

McRoy

Children who played/bathed and collected fresh water snails had higher risks of infection with urinary schistosomiasis in the area. Conclusion: The study draws attention to the health hazards posed by urinary schistosomiasis among children in in the studied area ... praziquantel delivery in mass treatment effort.[6] In. Nigeria ...

Management of failed rotator cuff repair: a systematic review

Science.gov (United States)

Lädermann, Alexandre; Denard, Patrick J; Burkhart, Stephen S

2016-01-01

Importance Recurrent tear after rotator cuff repair (RCR) is common. Conservative, and open and arthroscopic revisions, have been advocated to treat these failures. Aim or objective The purpose of this systematic review was to evaluate the different options for managing recurrent rotator cuff tears. Evidence review A search was conducted of level I through 4 studies from January 2000 to October 2015, to identify studies reporting on failed RCR. 10 articles were identified. The overall quality of evidence was very low. Findings Mid-term to long-term follow-up of patients treated conservatively revealed acceptable results; a persistent defect is a well-tolerated condition that only occasionally requires subsequent surgery. Conservative treatment might be indicated in most patients, particularly in case of posterosuperior involvement and poor preoperative range of motion. Revision surgery might be indicated in a young patient with a repairable lesion, a 3 tendon tear, and in those with involvement of the subscapularis. Conclusions and relevance The current review indicates that arthroscopic revision RCR can lead to improvement in functional outcome despite a high retear rate. Further studies are needed to develop specific rehabilitation in the case of primary rotator cuff failure, to better understand the place of each treatment option, and, in case of repair, to optimise tendon healing. PMID:27134759

A rapid-exchange monorail stent system for salvage of failing femoropopliteal bypass grafts.

Science.gov (United States)

Jahnke, Thomas; Brossmann, Joachim; Walluscheck, Knut; Heller, Martin; Müller-Hülsbeck, Stefan

2003-08-01

To analyze the safety and effectiveness of a new monorail stent system for the treatment of failing femoropopliteal bypass grafts. Acute distal occlusions or stenoses of femoropopliteal bypass grafts were treated with balloon-expandable stents (13 or 18-mm diameter) pre-mounted on a monorail balloon catheter system. The delivery system was assessed subjectively for (1). compatibility with the sheath, (2). lesion crossing potential, (3). radiopacity, (4). flexibility of the catheter, (5). adequacy of stent expansion, and (5). balloon refolding. In 8 failing bypass grafts with distal lesions, the delivery system successfully deployed the stent at the desired location. Sheath compatibility, catheter flexibility, lesion crossing, and stent expansion were rated "excellent" by all examiners for the 18-mm device. Radiopacity of the mounted stent was graded "good" before and during positioning, but only "sufficient" following expansion. For this type of lesion, the investigators rated the overall performance of the device superior to conventional "over-the-wire" systems. The monorail balloon-expandable stent delivery system provides rapid introduction of the device over the guidewire, and its low profile facilitates the use of small sheaths to minimize access-site complications.

Posterior transpedicular approach with circumferential debridement and anterior reconstruction as a salvage procedure for symptomatic failed vertebroplasty.

Science.gov (United States)

Chiu, Yen-Chun; Yang, Shih-Chieh; Chen, Hung-Shu; Kao, Yu-Hsien; Tu, Yuan-Kun

2015-02-10

Complications and failure of vertebroplasty, such as cement dislodgement, cement leakage, or spinal infection, usually result in spinal instability and neural element compression. Combined anterior and posterior approaches are the most common salvage procedure for symptomatic failed vertebroplasty. The purpose of this study is to evaluate the feasibility and efficacy of a single posterior approach technique for the treatment of patients with symptomatic failed vertebroplasty. Ten patients with symptomatic failed vertebroplasty underwent circumferential debridement and anterior reconstruction surgery through a single-stage posterior transpedicular approach (PTA) from January 2009 to December 2011 at our institution. The differences of visual analog scale (VAS), neurologic status, and vertebral body reconstruction before and after surgery were recorded. The clinical outcomes of patients were categorized as excellent, good, fair, or poor based on modified Brodsky's criteria. The symptomatic failed vertebroplasty occurred between the T11 and L3 vertebrae with one- or two-level involvement. The average VAS score was 8.3 (range, 7 to 9) before surgery, significantly decreased to 3.2 (range, 2 to 4) after surgery (p surgery was 17.3° (range, 4° to 35°) (p surgery was 1 mm (range, 0 to 2). The neurologic status of Frankel's scale significantly improved after surgery (p = 0.014) and at 1 year after surgery (p = 0.046). No one experienced severe complications such as deep wound infection or neurologic deterioration. All patients achieved good or excellent outcomes after surgery based on modified Brodsky's criteria (p surgery with circumferential debridement and anterior reconstruction technique provides good clinical outcomes and low complication rate, which can be considered as an alternative method to combined anterior and posterior approaches for patients with symptomatic failed vertebroplasty.

Failed fuel detection and location of LMFBR

International Nuclear Information System (INIS)

Mimoto, Yasuhide; Hukuda, Tooru; Nakamoto, Koichiro

1974-01-01

This is a summary report on Failed Fuel Detection and Location Methods of liquid metal cooled fast breeder reactors, and describes an outline of related research and development conducted by PNC. (auth.)

Biceps tenodesis is a viable option for salvage of failed SLAP repair.

Science.gov (United States)

Werner, Brian C; Pehlivan, Hakan C; Hart, Joseph M; Lyons, Matthew L; Gilmore, C Jan; Garrett, Cara B; Carson, Eric W; Diduch, David R; Miller, Mark D; Brockmeier, Stephen F

2014-08-01

Outcomes of arthroscopic superior labral anterior-posterior (SLAP) repairs have been well reported with generally favorable outcomes. Unfortunately, a percentage of patients remain dissatisfied or suffer further injury after SLAP repair and may seek additional treatment. The purpose of this study was to evaluate the surgical outcomes of biceps tenodesis for failed SLAP repairs. A retrospective review of all patients undergoing biceps tenodesis was completed. Inclusion criteria were previous SLAP repair and subsequent revision biceps tenodesis. Exclusion criteria were additional shoulder procedures including rotator cuff repair, instability procedures, and preoperative frozen shoulder. Objective outcomes were postoperative assessments with Constant score, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Veterans RAND 36-Item Health Survey. Physical examination was conducted to determine postoperative range of motion and strength compared with the nonoperative shoulder. A cohort of 24 patients was identified, and of these, 17 patients (71%) completed the study at 2 years' follow-up. The average postoperative Constant score was 84.4; American Shoulder and Elbow Surgeons score, 75.5; Single Assessment Numeric Evaluation score, 73.1%; Simple Shoulder Test score, 9.2; and Veterans RAND 36-Item Health Survey score, 76.1. Postoperative range of motion of the operative shoulder returned to near that of the asymptomatic nonoperative shoulder. Workers' compensation status led to inferior results. Options for patients with a failed prior SLAP repair are limited. As a salvage operation for failed SLAP repair, biceps tenodesis serves the majority of patients well, with favorable outcomes by validated measures and excellent shoulder range of motion and elbow strength at 2 years' follow-up. Workers' compensation status may predispose patients to poorer outcomes. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board

Triggered activity and automaticity in ventricular trabeculae of failing human and rabbit hearts

NARCIS (Netherlands)

Vermeulen, J. T.; McGuire, M. A.; Opthof, T.; Coronel, R.; de Bakker, J. M.; Klöpping, C.; Janse, M. J.

1994-01-01

The aim of the study was to assess the occurrence of triggered activity and automaticity in ventricular trabeculae from failing human hearts and normal and failing rabbit hearts during exposure to a normal and altered extracellular environment. Ventricular trabeculae were harvested from failing

Weak and Failing States: Evolving Security Threats and U.S. Policy

National Research Council Canada - National Science Library

Wyler, Liana S

2008-01-01

.... national security goal since the end of the Cold War. Numerous U.S. government documents point to several threats emanating from states that are variously described as weak, fragile, vulnerable, failing, precarious, failed, in crisis, or collapsed...

The Reputational Consequences of Failed Replications and Wrongness Admission among Scientists.

Directory of Open Access Journals (Sweden)

Adam K Fetterman

Full Text Available Scientists are dedicating more attention to replication efforts. While the scientific utility of replications is unquestionable, the impact of failed replication efforts and the discussions surrounding them deserve more attention. Specifically, the debates about failed replications on social media have led to worry, in some scientists, regarding reputation. In order to gain data-informed insights into these issues, we collected data from 281 published scientists. We assessed whether scientists overestimate the negative reputational effects of a failed replication in a scenario-based study. Second, we assessed the reputational consequences of admitting wrongness (versus not as an original scientist of an effect that has failed to replicate. Our data suggests that scientists overestimate the negative reputational impact of a hypothetical failed replication effort. We also show that admitting wrongness about a non-replicated finding is less harmful to one's reputation than not admitting. Finally, we discovered a hint of evidence that feelings about the replication movement can be affected by whether replication efforts are aimed one's own work versus the work of another. Given these findings, we then present potential ways forward in these discussions.

The Reputational Consequences of Failed Replications and Wrongness Admission among Scientists.

Science.gov (United States)

Fetterman, Adam K; Sassenberg, Kai

2015-01-01

Scientists are dedicating more attention to replication efforts. While the scientific utility of replications is unquestionable, the impact of failed replication efforts and the discussions surrounding them deserve more attention. Specifically, the debates about failed replications on social media have led to worry, in some scientists, regarding reputation. In order to gain data-informed insights into these issues, we collected data from 281 published scientists. We assessed whether scientists overestimate the negative reputational effects of a failed replication in a scenario-based study. Second, we assessed the reputational consequences of admitting wrongness (versus not) as an original scientist of an effect that has failed to replicate. Our data suggests that scientists overestimate the negative reputational impact of a hypothetical failed replication effort. We also show that admitting wrongness about a non-replicated finding is less harmful to one's reputation than not admitting. Finally, we discovered a hint of evidence that feelings about the replication movement can be affected by whether replication efforts are aimed one's own work versus the work of another. Given these findings, we then present potential ways forward in these discussions.

Failure to Fail in a Final Pre-Service Teaching Practicum

Science.gov (United States)

Danyluk, Patricia J.; Luhanga, Florence; Gwekwerere, Yovita N.; MacEwan, Leigh; Larocque, Sylvie

2015-01-01

This article presents a Canadian perspective on the issue of failure to fail in Bachelor of Education programs. The issue of failure to fail in Bachelor of Education programs is one that had not been explored in any great detail. What literature does exist focuses on the strain that a teacher experiences when s/he mentors a student teacher…

"To big to fail"-doktrinen står for fald?

DEFF Research Database (Denmark)

Grosen, Anders

2010-01-01

Hvis præsident Barack Obama får sin vilje, skal den klassiske "too big to fail"-bankdoktrin afløses af en "small enough to fail"-doktrin. Det fremgår af præsidentens planer om at opdele storbankerne i mindre enheder og forbyde bankernes handelsaktiviteter for egen regning. Hvis Barack Obama får...

[Fractographic analysis of clinically failed anterior all ceramic crowns].

Science.gov (United States)

DU, Qian; Zhou, Min-bo; Zhang, Xin-ping; Zhao, Ke

2012-04-01

To identify the site of crack initiation and propagation path of clinically failed all ceramic crowns by fractographic analysis. Three clinically failed anterior IPS Empress II crowns and two anterior In-Ceram alumina crowns were retrieved. Fracture surfaces were examined using both optical stereo and scanning electron microscopy. Fractographic theory and fracture mechanics principles were applied to disclose the damage characteristics and fracture mode. All the crowns failed by cohesive failure within the veneer on the labial surface. Critical crack originated at the incisal contact area and propagated gingivally. Porosity was found within the veneer because of slurry preparation and the sintering of veneer powder. Cohesive failure within the veneer is the main failure mode of all ceramic crown. Veneer becomes vulnerable when flaws are present. To reduce the chances of chipping, multi-point occlusal contacts are recommended, and layering and sintering technique of veneering layer should also be improved.

When the science fails and the ethics works: 'Fail-safe' ethics in the FEM-PrEP study.

Science.gov (United States)

Kingori, Patricia

2015-12-01

This paper will explore the concept of 'fail safe' ethics in the FEM PrEP trial, and the practice of research and ethics on the ground. FEM-PrEP examined the efficacy of PrEP in African women after promising outcomes in research conducted with MSM. This was a hugely optimistic time and FEM-PrEP was mobilised using rights-based ethical arguments that women should have access to PrEP. This paper will present data collected during an ethnographic study of frontline research workers involved in FEM-PrEP. During our discussions, 'fail-safe' ethics emerged as concept that encapsulated their confidence that their ethics could not fail. However, in 2011, FEM-PrEP was halted and deemed a failure. The women involved in the study were held responsible because contrary to researcher's expectations they were not taking the oral PrEP being researched. This examination of FEM-PrEP will show that ethical arguments are increasingly deployed to mobilise, maintain and in some cases stop trials in ways which, at times, are superseded or co-opted by other interests. While promoting the interests of women, rights-based approaches are argued to indirectly justify the continuation of individualised, biomedical interventions which have been problematic in other women-centred trials. In this examination of FEM-PrEP, the rights-based approach obscured: ethical concerns beyond access to PrEP; the complexities of power relationships between donor and host countries; the operations of the HIV industry in research-saturated areas and the cumulative effect of unfilled expectations in HIV research and how this has shaped ideas of research and ethics.

A Scientific Investigation into why Firms Fail: A Model of corporate ...

African Journals Online (AJOL)

A Scientific Investigation into why Firms Fail: A Model of corporate health trajectory. ... to analyse the data of 20 banks, 10 which failed and 10 that is successful. Key words: Corporate collapse, trajectories of failure, bank failure, bank distress, ...

A model of nonparticipation in alcohol treatment programs.

Science.gov (United States)

Burton, T L; Williamson, D L

1997-01-01

Why do the vast majority of those who suffer harm from drinking fail to obtain treatment? Based on a review of research literature and educational and treatment program materials, a model of nonparticipation in treatment is proposed whereby particular population groups are separated out according to whether or not they exhibit specified characteristics related to both harm from drinking and attitudes towards treatment. Eleven groups have been identified in the model, each of which has different reasons for failing to seek and/or obtain treatment. It is suggested that differing educational program messages should be sent to each group. While the model does not purport to be wholly inclusive of all nonparticipation, it offers a basis for addressing the variety of disparate groups that suffer harm from drinking but do not obtain treatment.

Assessing the potential cost of a failed Doha round

OpenAIRE

Antoine Bouet

2010-01-01

This study offers new conclusions on the economic cost of a failed Doha Development Agenda (DDA). We assess potential outcome of the Doha Round as well as four protectionist scenarios using the MIRAGE Computable General Equilibrium (CGE) model. In a scenario where applied tariffs of World Trade Organization (WTO) economies would go up to currently bound tariff rates, world trade would decrease by 7.7 % and world welfare by US$353 billion. The economic cost of a failed DDA is here evaluated by...

Current progress in the development and use of artemether for chemoprophylaxis of major human schistosome parasites.

Science.gov (United States)

Utzinger, J; Xiao, S; Keiser, J; Chen, M; Zheng, J; Tanner, M

2001-12-01

Human schistosomiasis, a chronic and debilitating parasitic disease of the tropics, is ranked second after malaria in terms of public health importance. At present, there is no vaccine available, and chemotherapy is the cornerstone of schistosomiasis control. Praziquantel is the drug of choice. Oxamniquine has become difficult to obtain and metrifonate has recently been withdrawn from the market. Rapid re-infection following treatment and concern about praziquantel resistance called for the search of novel drugs for prevention and cure of schistosomiasis. Significant progress has been made with artemether, the methyl ether of dihydroartemisinin, already widely used for the treatment of malaria. The present article reviews the literature that led to the development of artemether for chemoprophylaxis in schistosomiasis, and it summarises the experiences so far obtained with its use to control schistosomiasis in different endemic settings. Topics covered include an overview of the global burden of schistosomiasis and approaches for its control; the nature and features of artemisinin and related derivatives, initially discovered as antimalarials, other bioactivities, and their recent discovery of antischistosomal properties; a historic account disclosing the antischistosomal activity of artemether; in vivo assessment of drug susceptibility of different developmental stages of schistosome parasites; artemether-induced pathology evidenced by scanning and transmission electron microscopy; the possible mechanism of action; in vivo studies with combination therapy of artemether and praziquantel; results of randomised controlled clinical trials of oral artemether for the prevention of patent infection and morbidity; and, ultimately the translation of this knowledge into public health action in different endemic settings towards a more integrated approach of schistosomiasis control.

7 CFR 1951.264 - Action when borrower fails to cooperate, respond or graduate.

Science.gov (United States)

2010-01-01

... Analyzing Credit Needs and Graduation of Borrowers § 1951.264 Action when borrower fails to cooperate, respond or graduate. (a) When borrowers with other than FCP loans fail to: (1) Provide information... appeal the decision. (b) If an FCP borrower fails to cooperate after a lender expresses a willingness to...

Non-surgical retreatment of a failed apicoectomy without retrofilling using white mineral trioxide aggregate as an apical barrier.

Science.gov (United States)

Stefopoulos, Spyridon; Tzanetakis, Giorgos N; Kontakiotis, Evangelos G

2012-01-01

Root-end resected teeth with persistent apical periodontitis are usually retreated surgically or a combination of non-surgical and surgical retreatment is employed. However, patients are sometimes unwilling to be subjected to a second surgical procedure. The apical barrier technique that is used for apical closure of immature teeth with necrotic pulps may be an alternative to non-surgically retreat a failed apicoectomy. Mineral trioxide aggregate (MTA) has become the material of choice in such cases because of its excellent biocompatibility, sealing ability and osseoinductive properties. This case report describes the non-surgical retreatment of a failed apicoectomy with no attempt at retrofilling of a maxillary central incisor. White MTA was used to induce apical closure of the wide resected apical area. Four-year follow-up examination revealed an asymptomatic, fully functional tooth with a satisfactory healing of the apical lesion. White MTA apical barrier may constitute a reliable and efficient technique to non-surgically retreat teeth with failed root-end resection. The predictability of such a treatment is of great benefit for the patient who is unwilling to be submitted to a second surgical procedure.

Synthesis Report on the understanding of failed LMFBR fuel element performance

International Nuclear Information System (INIS)

Plitz, H.; Bagley, K.; Harbourne, B.

1990-07-01

In the coarse of LMFBR operation fuel element failures cannot entirely be avoided as experienced during the operation of PFR, PHENIX and KNK II, where 44 failed fuel elements have been registered between 1978 and 1989. In earlier irradiations, post irradiation examinations showed mixed oxide pin diameter increases up to pin pitch distance, urging to stress reactor safety questions on the potential of fuel pin failure propagation within pin bundles. The chemical interaction of sodium with mixed oxide fuel is regarded to be the key for the understanding of failed fuel behavior. Valuable results on the failed fuel pin behavior during operation were obtained from the SILOE sodium loop test. Based on the bulk of experience with the detection of fuel pin failures, with the continued operation and with the handling of failed pins respectively elements, one can state: 1. All fuel pin failures have been detected securely in time and have been located. 2. Small defects are developing slowly. 3. Even large defects at end-of-life pins resulted in limited fuel loss. 4. Clad failures behave benign in main aspects. 5. The chemical interaction of sodium with mixed oxide is an important factor in the behavior of failed fuel pins, especially at high burnup. 6. Despite different pin designs and different operation conditions, on the basis of 44 failed elements in PFR, PHENIX and KNK II no pin-to-pin propagation was observed and fuel release was rather low, often not detectable. 7. In no case hazard conditions affecting reactor safety have been experienced

Closure of oroantral communication with buccal fat pad after removing bilateral failed zygomatic implants: A case report and 6-month follow-up.

Science.gov (United States)

Peñarrocha-Oltra, David; Alonso-González, Rocio; Pellicer-Chover, Hilario; Aloy-Prósper, Amparo; Peñarrocha-Diago, María

2015-02-01

The aim of this study was to assess the use of buccal fat pad (BFP) technique as an option to close oroantral communications (OAC) after removing failed zygomatic implants in a patient with a severely resorbed maxilla, and to determine the degree of patient satisfaction. A 64-year-old woman presented recurrent sinusitis and permanent oroantral communication caused by bilateral failed zygomatic implants, 3 years after prosthetic loading. Zygomatic implants were removed previous antibiotic treatment and the BFP flap technique was used to treat the OAC and maxillary defect. The degree of patient satisfaction after treatment was assessed through a visual analogue scale (VAS). At 6-months follow-up, patient showed complete healing and good function and the results in terms of phonetics, aesthetics and chewing were highly rated by the patient. Key words:Bichat fat pad, buccal fat pad, zygomatic implants, oroantral communication.

Allogeneic Hematopoietic Stem Cell Transplantation Is an Effective Salvage Therapy for Patients with Chronic Myeloid Leukemia Presenting with Advanced Disease or Failing Treatment with Tyrosine Kinase Inhibitors.

Science.gov (United States)

Nair, Anish P; Barnett, Michael J; Broady, Raewyn C; Hogge, Donna E; Song, Kevin W; Toze, Cynthia L; Nantel, Stephen H; Power, Maryse M; Sutherland, Heather J; Nevill, Thomas J; Abou Mourad, Yasser; Narayanan, Sujaatha; Gerrie, Alina S; Forrest, Donna L

2015-08-01

Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only known curative therapy for chronic myeloid leukemia (CML); however, it is rarely utilized given the excellent long-term results with tyrosine kinase inhibitor (TKI) treatment. The purpose of this study is to examine HSCT outcomes for patients with CML who failed TKI therapy or presented in advanced phase and to identify predictors of survival, relapse, and nonrelapse mortality (NRM). Fifty-one patients with CML underwent HSCT for advanced disease at diagnosis (n = 15), TKI resistance as defined by the European LeukemiaNet guidelines (n = 30), TKI intolerance (n = 2), or physician preference (n = 4). At a median follow-up of 71.9 months, the 8-year overall survival (OS), event-free survival (EFS), relapse, and NRM were 68%, 46%, 41%, and 23%, respectively. In univariate analysis, predictors of OS included first chronic phase (CP1) disease status at HSCT (P = .0005), European Society for Blood and Marrow Transplantation score 1 to 4 (P = .04), and complete molecular response (CMR) to HSCT (P treatment to optimize transplantation outcomes. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Salvage of a failed open gastrocutaneous fistula repair with an endoscopic over-the-scope clip

Directory of Open Access Journals (Sweden)

Joshua Jaramillo

2016-05-01

Full Text Available Once enteral access via gastrostomy tube (G-tube is no longer indicated, the tube is typically removed in clinic with a high probability of spontaneous closure. When spontaneous closure is not achieved, the formation of a gastrocutaneous fistula (GCF is possible. The incidence of GCF is directly related with the length of time the tube has been placed. When conservative management fails, surgical intervention is the standard treatment. Endoscopic techniques have been described for primary closure of GCF in adults including banding and cauterizing of the fistula tract with placement of a standard endoscopic clip. Over-the-scope clips (OTSC have recently been reported in primary GCF closure in children (Wright et al., 2015. In patients with skin irritation surrounding a GCF making surgical repair difficult, endoscopic OTSC closure provides particular benefit. It is our belief that this is the first case report of endoscopically salvaging a leak from a failed open GCF repair.

Peginterferon alfa-2b and ribavirin: effective in patients with hepatitis C who failed interferon alfa/ribavirin therapy.

Science.gov (United States)

Poynard, Thierry; Colombo, Massimo; Bruix, Jordi; Schiff, Eugene; Terg, Ruben; Flamm, Steven; Moreno-Otero, Ricardo; Carrilho, Flair; Schmidt, Warren; Berg, Thomas; McGarrity, Thomas; Heathcote, E Jenny; Gonçales, Fernando; Diago, Moises; Craxi, Antonio; Silva, Marcelo; Bedossa, Pierre; Mukhopadhyay, Pabak; Griffel, Louis; Burroughs, Margaret; Brass, Clifford; Albrecht, Janice

2009-05-01

Treatment with peginterferon alfa and ribavirin produces a sustained virologic response (SVR) in approximately 60% of hepatitis C virus (HCV)-infected patients. Alternate options are needed for patients who relapse or do not respond to therapy. This prospective, international, multicenter, open-label study evaluated efficacy and safety of peginterferon alfa-2b (1.5 microg/kg/wk) plus weight-based ribavirin (800-1400 mg/day) in 2333 chronic HCV-infected patients with significant fibrosis/cirrhosis whose previous interferon alfa/ribavirin therapy failed. Patients with undetectable HCV-RNA at treatment week (TW) 12 received 48 weeks of therapy; patients with detectable HCV-RNA at TW12 could enter maintenance studies at TW18; 188 patients with low/detectable HCV-RNA at TW12 continued therapy at the investigator's request. Overall, 22% of the patients attained SVR (56% with undetectable HCV-RNA and 12% with low/detectable HCV-RNA at TW12). SVR was better in relapsers (38%) than nonresponders (14%), regardless of previous treatment, and in patients previously treated with interferon-alfa/ribavirin (25%) than peginterferon alfa-ribavirin (17%). Predictors of response in patients with undetectable HCV-RNA at TW12 were genotype (2/3 vs 1, respectively; odds ratio [OR] 2.4; P 600,000 IU/mL; OR, 1.4; P = .0223). These factors plus previous treatment and response were overall predictors of SVR. Safety was similar among fibrosis groups. Peginterferon alfa-2b plus weight-based ribavirin is effective and safe in patients who failed interferon alfa/ribavirin therapy. Genotype, baseline viral load, and fibrosis stage were predictors of response.

Cryopreserved embryo transfer: adjacent or non-adjacent to failed fresh long GnRH-agonist protocol IVF cycle.

Science.gov (United States)

Volodarsky-Perel, Alexander; Eldar-Geva, Talia; Holzer, Hananel E G; Schonberger, Oshrat; Reichman, Orna; Gal, Michael

2017-03-01

The optimal time to perform cryopreserved embryo transfer (CET) after a failed oocyte retrieval-embryo transfer (OR-ET) cycle is unknown. Similar clinical pregnancy rates were recently reported in immediate and delayed CET, performed after failed fresh OR-ET, in cycles with the gonadotrophin-releasing hormone (GnRH) antagonist protocol. This study compared outcomes of CET performed adjacently (<50 days, n = 67) and non-adjacently (≥50 to 120 days, n = 62) to the last OR-day of cycles with the GnRH agonist down-regulation protocol. Additional inclusion criteria were patients' age 20-38 years, the transfer of only 1-2 cryopreserved embryos, one treatment cycle per patient and artificial preparation for CET. Significantly higher implantation, clinical pregnancy and live birth rates were found in the non-adjacent group than in the adjacent group: 30.5% versus 11.3% (P = 0.001), 41.9% versus 17.9% (P = 0.003) and 32.3% versus 13.4% (P = 0.01), respectively. These results support the postponement of CET after a failed OR-ET for at least one menstrual cycle, when a preceding long GnRH-agonist protocol is used. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Diggers failing to become diggers

DEFF Research Database (Denmark)

Jensen, Lars

Mining has in recent years emerged as a national discourse in Australia as the combined result of the mining boom and national anxieties over the GFC featured prominently in references to Australia as a failed competitive state (the folding of manufacturing, where the closure of car factories pla...... to the broader issue of how mining relates to the question of the society Australia wants to be – on the scale from ecological sanctuary to global quarry....

The role of ethnicity in treatment refractory schizophrenia.

Science.gov (United States)

Teo, Celine; Borlido, Carol; Kennedy, James L; De Luca, Vincenzo

2013-02-01

The goal of this research was to describe the relationship between treatment resistant schizophrenia, defined using the APA criteria and ethnic background in patients with schizophrenia spectrum disorders in a Canadian sample. A secondary goal was to analyze the number of antipsychotics failed due to side effects and number of antipsychotics failed due to non-response. We included 497 patients diagnosed with schizophrenia spectrum disorders using the SCID. The medication history was extracted from the electronic health records. Data collection included demographics (sex, age, ethnicity), principal diagnosis according to SCID (Diagnostic and Statistical Manual of Mental Disorders, 4th edition), duration of mental illness, number of psychiatric admissions and treatment information. If patients were on clozapine or polypharmacy treatment, this was recorded at the time of the SCID interview. Additional data, including prior antipsychotic history, were collected from the health records. Thirty per cent of the patients were classified as resistant according to the APA criteria. There were significantly more white European subjects in the treatment resistant group (p=0.031). The duration of illness was significantly higher in the resistant group then in the non-resistant group (21.0 vs 15.1 years; p<0.001). Patients who were treatment resistant were more likely to be on polypharmacy compared with non-resistant patients (p=0.001; OR=2.424; 95%CI=1.446-4.065). When we considered the number of drug trials failed due to non response and drug trial failed because of side effects, we found a strong negative correlation in both white Europeans and non-white Europeans. White European ethnicity is associated with treatment resistant schizophrenia. In addition, patients with treatment-resistant schizophrenia were on polypharmacy at higher rate than non resistant patients. Copyright © 2013. Published by Elsevier Inc.

Examination of a failed fifth wheel coupling

CSIR Research Space (South Africa)

Fernandes, PJL

1998-03-01

Full Text Available Examination of a fifth wheel coupling which had failed in service showed that it had been modified and that the operating handle had been moved from its original design position. This modification completely eliminated the safety device designed...

MRI as a problem-solving tool in unexplained failed total hip replacement following conventional assessment

International Nuclear Information System (INIS)

Johnston, Ciaran; Kerr, Jennifer; Ford, Stephanie; Eustace, Stephen; O'Byrne, John

2007-01-01

To evaluate MRI as a problem-solving tool for patients with an unexplained failed total hip replacement following conventional radiological assessment. Patients' informed consent was obtained in all cases. Institutional review board approval was obtained. Twenty-eight patients with unexplained failed total hip replacements following conventional radiological assessment underwent additional MR imaging with an optimised turbo-spin echo sequence. Images were reviewed by two musculoskeletal radiologists by consensus and compared with findings at surgery, or following response to image-guided intervention or clinical follow-up. Of the 28 patients, MRI revealed an unsuspected diagnosis explaining the cause of prosthesis failure in 15 patients. In eight of 15 patients in this group, subsequent minimally invasive image-guided intervention obviated the need for revision total hip replacement. No cause for prosthesis failure was identified in 13 patients. MRI may be successfully undertaken in patients following total hip replacement, and, when performed, it frequently leads to an unsuspected diagnosis, allowing informed patient treatment. In this study it allowed the identification of an unsuspected diagnosis in over 50% of cases. (orig.)

Specific schistosomiasis treatment as a strategy for disease control

Directory of Open Access Journals (Sweden)

José Rodrigues Coura

2010-07-01

Full Text Available The great hope for schistosomiasis treatment began with the development of oxamniquine and praziquantel. These drugs can be administered orally in a single dose and have a high curative power with minor side effects. In this study, we carried out a field experiment involving a population of 3,782 people. The population was examined at four localities in Minas Gerais within the valleys of the Doce and Jequitinhonha Rivers. In this cohort, there were 1,790 patients infected with Schistosoma mansoni (47.3% and we showed that only 1,403 (78.4% could be treated with oxamniquine in a single dose of 12.5-20 mg/kg orally. The other 387 (21.6% were not treated during the first stage because of contraindications (pregnancy or impeditive diseases, absences or refusals. It was observed that, on average, 8.8-17% of the infected patients continued to excrete S. mansoni eggs at the end of the 2nd month after treatment and 30-32% of the cohort was infected by the end of the 24th month. In one of the areas that we followed-up for a total of 30 years, the prevalence of the infection with S. mansoni fell from 60.8-19.3% and the hepatosplenic form of the disease dropped from 5.8-1.3%. We conclude that specific treatment of schistosomiasis reduces the prevalence of infection in the short-term and the morbidity due to schistosomiasis in medium to long-term time frames, but does not help to control disease transmission.

Endoscopic treatment of prepatellar bursitis.

Science.gov (United States)

Huang, Yu-Chih; Yeh, Wen-Lin

2011-03-01

Operative treatment of prepatellar bursitis is indicated in intractable bursitis. The most common complication of surgical treatment for prepatellar bursitis is skin problems. For traumatic prepatellar bursitis, we propose a protocol of outpatient endoscopic surgery under local anaesthesia. From September 1996 to February 2001, 60 cases of failed nonoperative treatment for prepatellar bursitis were included. The average age was 33.5 ± 11.1 years (range 21-55). The average operation duration was 18 minutes. Two to three mini-arthroscopic portals were used in our series. No sutures or a simple suture was needed for the portals after operation. After follow-up for an average of 36.3 months, all patients are were symptom-free and had regained knee function. None of the population had local tenderness or hypo-aesthesia around their wound. Their radiographic and sonographic examinations showed no recurrence of bursitis. Outpatient arthroscopic bursectomy under local anaesthesia is an effective procedure for the treatment of post-traumatic prepatellar bursitis after failed conservative treatments. Both the cosmetic results and functional results were satisfactory.

Very Preterm Infants Failing CPAP Show Signs of Fatigue Immediately after Birth.

Directory of Open Access Journals (Sweden)

Melissa L Siew

Full Text Available To investigate the differences in breathing pattern and effort in infants at birth who failed or succeeded on continuous positive airway pressure (CPAP during the first 48 hours after birth.Respiratory function recordings of 32 preterm infants were reviewed of which 15 infants with a gestational age of 28.6 (0.7 weeks failed CPAP and 17 infants with a GA of 30.1 (0.4 weeks did not fail CPAP. Frequency, duration and tidal volumes (VT of expiratory holds (EHs, peak inspiratory flows, CPAP-level and FiO2-levels were analysed.EH incidence increased 9 ml/kg with higher peak inspiratory flows than CPAP-fail infants (71.8 ± 15.8 vs. 15.5 ± 5.2 ml/kg.s, p <0.05. CPAP-fail infants required higher FiO2 (0.31 ± 0.03 vs. 0.21 ± 0.01, higher CPAP pressures (6.62 ± 0.3 vs. 5.67 ± 0.26 cmH2O and more positive pressure-delivered breaths (45 ± 12 vs. 19 ± 9% (p <0.05.At 9-12 minutes after birth, CPAP-fail infants more commonly used lower VTs and required higher peak inspiratory flow rates while receiving greater respiratory support. VT was less variable and larger VT was infrequently used reflecting early signs of fatigue.

Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement.

Science.gov (United States)

de Ruiter, M H T; Apperloo, R C; Milstein, D M J; de Lange, J

2017-11-01

Maxillomandibular advancement (MMA) is an alternative therapeutic option that is highly effective for treating obstructive sleep apnoea (OSA). MMA provides a solution for OSA patients that have difficulty accepting lifelong treatments with continuous positive airway pressure or mandibular advancement devices. The goal of this study was to investigate the different characteristics that determine OSA treatment success/failure after MMA. The apnoea-hypopnoea index (AHI) was used to determine the success or failure of OSA treatment after MMA. Sixty-two patients underwent MMA for moderate and severe OSA. A 71% success rate was observed with a mean AHI reduction of 69%. A statistically significant larger neck circumference was measured in patients with failed OSA treatments following MMA (P=0.008), and older patients had failed OSA treatments with MMA: 58 vs. 53 years respectively (P=0.037). Cephalometric analysis revealed no differences between successful and failed OSA treatment outcomes. There was no difference in maxillary and mandibular advancements between success and failed MMA-treated OSA patients. The complications most frequently reported following MMA were sensory disturbances in the inferior alveolar nerve (60%) and malocclusion (24%). The results suggest that age and neck girth may be important factors that could predict susceptibility to OSA treatment failures by MMA. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Integration of TB and ART services fails to improve TB treatment ...

African Journals Online (AJOL)

The median CD4+ count of HIV-positive patients was 152 cells/μl (interquartile range (IQR) 71 - 277) for integrated facilities and 148 cells/μl (IQR 67 - 260) for single-service facilities. There was no statistical difference in the TB treatment outcome profile between integrated and single-service facilities for all TB patients (p=0.

Safety and Efficacy of Transcatheter Aortic Valve Replacement in the Treatment of Pure Aortic Regurgitation in Native Valves and Failing Surgical Bioprostheses

DEFF Research Database (Denmark)

Sawaya, Fadi J; Deutsch, Marcus-André; Seiffert, Moritz

2017-01-01

%, respectively). Independent predictors of 30-day mortality were body mass index 8%, major vascular or access complication, and moderate to severe AR. In the failing SHV group, device success, early safety, and clinical efficacy were 71%, 90%, and 77%, respectively...

Resitting or Compensating a Failed Examination: Does It Affect Subsequent Results?

Science.gov (United States)

Arnold, Ivo

2017-01-01

Institutions of higher education commonly employ a conjunctive standard setting strategy, which requires students to resit failed examinations until they pass all tests. An alternative strategy allows students to compensate a failing grade with other test results. This paper uses regression discontinuity design to compare the effect of first-year…

Hip arthroplasty in failed intertrochanteric fractures in elderly

Directory of Open Access Journals (Sweden)

Javahir A Pachore

2013-01-01

Full Text Available Background: Failed intertrochanteric fractures in elderly patients are surgical challenge with limited options. Hip arthroplasty is a good salvage procedure even though it involves technical issues such as implant removal, bone loss, poor bone quality, trochanteric nonunion and difficulty of surgical exposure. Materials and Methods: 30 patients of failed intertrochanteric fractures where hip arthroplasty was done between May 2008 and December 2011 were included in study. 13 were males and 17 were females with average age of 67.3 years. There were 2 cemented bipolar arthroplasties, 19 uncemented bipolar, 4 cemented total hip arthroplasty and 5 uncemented total hip arthroplasties. 16 patients had a trochanteric nonunion, which was treated by tension band principles. Total hip was considered where there was acetabular damage due to the penetration of implant. Results: The average followup was 20 months (range 6-48 months. Patients were followed up from 6 to 48 months with average followup of 20 months. None of the patients were lost to followup. There was no dislocation. All patients were ambulatory at the final followup. Conclusion: A predictable functional outcome can be achieved by hip arthroplasty in elderly patients with failed intertrochanteric fractures. Though technically demanding, properly performed hip arthroplasty can be a good salvage option for this patient group.

Post-deportation risks for failed asylum seekers

Directory of Open Access Journals (Sweden)

Jill Alpes

2017-02-01

Full Text Available What happens to people who are deported after their asylum applications have failed? Many who are deported are at risk of harm when they return to their country of origin but there is little monitoring done of deportation outcomes.

The Value of Failing in Career Development: A Chaos Theory Perspective

Science.gov (United States)

Pryor, Robert G. L.; Bright, James E. H.

2012-01-01

Failing is a neglected topic in career development theory and counselling practice. Most theories see failing as simply the opposite of success and something to be avoided. It is contended that the Chaos Theory of Careers with its emphasis on complexity, uncertainty and consequent human imitations, provides a conceptually coherent account of…

Identify too big to fail banks and capital insurance: An equilibrium approach

OpenAIRE

Katerina Ivanov

2017-01-01

The objective of this paper is develop a rational expectation equilibrium model of capital insurance to identify too big to fail banks. The main results of this model include (1) too big to fail banks can be identified explicitly by a systemic risk measure, loss betas, of all banks in the entire financial sector; (2) the too big to fail feature can be largely justified by a high level of loss beta; (3) the capital insurance proposal benefits market participants and reduces the systemic risk; ...

Fail-safe computer-based plant protection systems

International Nuclear Information System (INIS)

Keats, A.B.

1983-01-01

A fail-safe mode of operation for computers used in nuclear reactor protection systems was first evolved in the UK for application to a sodium cooled fast reactor. The fail-safe properties of both the hardware and the software were achieved by permanently connecting test signals to some of the multiplexed inputs. This results in an unambiguous data pattern, each time the inputs are sequentially scanned by the multiplexer. The ''test inputs'' simulate transient excursions beyond defined safe limits. The alternating response of the trip algorithms to the ''out-of-limits'' test signals and the normal plant measurements is recognised by hardwired pattern recognition logic external to the computer system. For more general application to plant protection systems, a ''Test Signal Generator'' (TSG) is used to compute and generate test signals derived from prevailing operational conditions. The TSG, from its knowledge of the sensitivity of the trip algorithm to each of the input variables, generates a ''test disturbance'' which is superimposed upon each variable in turn, to simulate a transient excursion beyond the safe limits. The ''tripped'' status yielded by the trip algorithm when using data from a ''disturbed'' input forms part of a pattern determined by the order in which the disturbances are applied to the multiplexer inputs. The data pattern formed by the interleaved test disturbances is again recognised by logic external to the protection system's computers. This fail-safe mode of operation of computer-based protection systems provides a powerful defence against common-mode failure. It also reduces the importance of software verification in the licensing procedure. (author)

Clinical Evidence for Spinal Cord Stimulation for Failed Back Surgery Syndrome (FBSS): Systematic Review.

Science.gov (United States)

Kapural, Leonardo; Peterson, Erika; Provenzano, David A; Staats, Peter

2017-07-15

A systematic review. A systematic literature review of the clinical data from prospective studies was undertaken to assess the efficacy of spinal cord stimulation (SCS) in the treatment of failed back surgery syndrome (FBSS) in adults. For patients with unrelenting back pain due to mechanical instability of the spine, degenerative disc disease, spinal injury, or deformity, spinal surgery is a well-accepted treatment option; however, even after surgical intervention, many patients continue to experience chronic back pain that can be notoriously difficult to treat. Clinical evidence suggests that for patients with FBSS, repeated surgery will not likely offer relief. Additionally, evidence suggests long-term use of opioid pain medications is not effective in this population, likely presents additional complications, and requires strict management. A systematic literature review was performed using several bibliographic databases, prospective studies in adults using SCS for FBSS were included. SCS has been shown to be a safe and efficacious treatment for this patient population. Recent technological developments in SCS offer even greater pain relief to patients' refractory to other treatment options, allowing patients to regain functionality and improve their quality of life with significant reductions in pain. N/A.

Merger incentives and the failing firm defense

NARCIS (Netherlands)

Bouckaert, J.M.C.; Kort, P.M.

2014-01-01

The merger incentives between profitable firms differ fundamentally from the incentives of a profitable firm to merge with a failing firm. We investigate these incentives under different modes of price competition and Cournot behavior. Our main finding is that firms strictly prefer exit of the

Considerations for handling failed fuel at the Barnwell Nuclear Fuel Plant

International Nuclear Information System (INIS)

Anderson, R.T.; Cholister, R.J.

1982-05-01

The impact of failed fuel receipt on reprocessing operations is qualitatively described. It appears that extended storage of fuel, particularly with advanced storage techniques, will increase the quantity of failed fuel, the nature and possibly the configuration of the fuel. The receipt of failed fuel at the BNFP increases handling problems, waste volumes, and operator exposure. If it is necessary to impose special operating precautions to minimize this impact, a loss in plant throughput will result. Hence, ideally, the reprocessing plant operator would take every reasonable precaution so that no failed fuel is received. An alternative policy would be to require that failed fuel be placed in a sealed canister. In the latter case the canister must be compatible with the shipping cask and suitable for in-plant storage. A required inspection of bare fuel would be made at the reactor prior to shipping off-site. This would verify fuel integrity. These requirements are obviously idealistic. Due to the current uncertain status of reprocessing and the need to keep reactors operating, business or governmental policy may be enacted resulting in the receipt of a negotiated quantity of non-standard fuel (including failed fuel). In this situation, BNFP fuel receiving policy based soley on fuel cladding integrity would be difficult to enforce. There are certain areas where process incompatibility does exist and where a compromise would be virtually impossible, e.g., canned fuel for which material or dimensional conflicts exist. This fuel would have to be refused or the fuel would require recanning prior to shipment. In other cases, knowledge of the type and nature of the failure may be acceptable to the operator. A physical inspection of the fuel either before shipment or after the cask unloading operation would be warranted. In this manner, concerns with pool contamination can be identified and the assembly canned if deemed necessary

More than 100 Colleges Fail Education Department's Test of Financial Strength

Science.gov (United States)

Blumenstyk, Goldie

2009-01-01

A newly compiled analysis by the U.S. Department of Education and obtained by "The Chronicle" shows that 114 private nonprofit degree-granting colleges were in such fragile financial condition at the end of their last fiscal year that they failed the department's financial-responsibility test. Colleges that fail the test are subject to extra…

Perceived adherence barriers among patients failing second-line ...

African Journals Online (AJOL)

Perceived adherence barriers among patients failing second-line antiretroviral therapy in Khayelitsha, South Africa. W Barnett, G Patten, B Kerschberger, K Conradie, DB Garone, G van Cutsem, CJ Colvin ...

[Using an ovarian drilling by hydrolaparoscopy or recombinant follicle stimulating hormone plus metformin to treat polycystic ovary syndrome: Why a randomized controlled trial fail?].

Science.gov (United States)

Fernandez, H; Cedrin-Durnerin, I; Gallot, V; Rongieres, C; Watrelot, A; Mayenga-Mankezi, J-M; Arnoux, A

2015-10-01

To evaluate pregnancy rates after randomized controlled trial (RCT) between ovarian drilling by fertiloscopy or ovarian hyperstimulation+insemination+metformine after clomifène citrate (cc) treatment fails. Randomized controlled trial with 126 patients in each arm in 9 university centers. After 6-9 months of stimulation by cc, 2 groups were randomized: group 1, ovarian drilling with bipolar energy versus group 2: 3 months treatment by metformine followed by 3 hyperstimulation by FSH+insemination. The success rate was pregnancy rate above 12 weeks. RCT was stopped after the screening of 40 patients. In spite of the low number of patients, the pregnancy rate is significantly higher in medical group 8/16 versus 3/18 (p=0.04). The causes of fail of RCT were in relationship with difficulties of inclusion, with absence of final agreement by team included. Moreover, RCT between medical and surgical management is often root of difficulties for patients who decline surgical strategy. However, medical treatment appeared better than drilling in this RCT. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

What if the Doha Round Fails? Implications for Canadian Agriculture

OpenAIRE

Gifford, Michael N.; McCalla, Alex F.; Meilke, Karl D.

2008-01-01

Many commentators assume that the WTO Doha Round negotiations have already failed and that this failure will not matter for Canadian agriculture. Neither view is correct. Most countries appear willing to make the effort needed to bring the negotiations to a make or break point in early 2008. If the Doha Round does eventually fail, an important opportunity to make the agricultural trading system significantly less distorted, more open and fair will have been lost. For Canadian agriculture, the...

"Too big to fail" or "Too non-traditional to fail"?: The determinants of banks' systemic importance

OpenAIRE

Moore, Kyle; Zhou, Chen

2013-01-01

This paper empirically analyzes the determinants of banks' systemic importance. In constructing a measure on the systemic importance of financial institutions we find that size is a leading determinant. This confirms the usual "Too big to fail'' argument. Nevertheless, banks with size above a sufficiently high level have equal systemic importance. In addition to size, we find that the extent to which banks engage in non-traditional banking activities is also positively related to ...

Failed magnetic resonance imaging examinations due to claustrophobia

International Nuclear Information System (INIS)

Sarji, S.A.; Abdullah, B.J.J.; Kumar, G.; Tan, A.H.; Narayanan, P.

1998-01-01

A recognised cause of incomplete or cancelled MRI examinations is anxiety and claustrophobic symptoms in patients undergoing MR scanning. This appears to be a problem in many MRI centres in Western Europe and North America, where it is said to be costly in terms of loss of valuable scan time, and has led to researchers suggesting several anxiety reducing approaches for MRI. To determine the incidence of failed MRI examination among our patients and if there are any associations with a patient's sex, age and education level, we studied claustrophobia that led to premature termination of the MRI examination in the University Malaya Medical Centre (UMMC) in 3324 patients over 28 months. The incidence of failed MRI examinations due to claustrophobia in the UMMC was found to be only 0.54%. There are associations between claustrophobia in MRI with the patients' sex, age and level of education. The majority of those affected were male patients and young patients in the 25-45-year age group. The patients' education level appears to be the strongest association with failed MRI examinations due to claustrophobia, where the majority of the affected were highly educated individuals. Claustrophobia in MRI is more of a problem among the educated individuals or patients from a higher socio-economic group, which may explain the higher incidence in Western European and North American patients. Copyright (1998) Blackwell Science Pty Ltd

Long-Term Course of Failed Back Surgery Syndrome (FBSS Patients Receiving Integrative Korean Medicine Treatment: A 1 Year Prospective Observational Multicenter Study.

Directory of Open Access Journals (Sweden)

Jinho Lee

Full Text Available With increase of spine surgeries, failed back surgery syndrome (FBSS prevalence is also rising. While complementary and alternative medicine (CAM is commonly used for low back pain (LBP, there are no studies reporting use of integrative Korean medicine in FBSS patients.Patients with pain continuing after back surgery or recurring within 1 year and visual analogue scale (VAS of LBP or leg pain of ≥6 (total n = 120 were recruited at 2 hospital sites from November 2011 to September 2014. Weekly sessions of integrative Korean medicine treatment were conducted for 16 weeks (herbal medicine, acupuncture/electroacupuncture, pharmacopuncture/bee venom pharmacopuncture, and Chuna manual therapy with additional follow-ups at 24 weeks and 1 year. Outcome measures included VAS of LBP and leg pain (primary outcome, Oswestry Disability Index (ODI, Short-Form 36 (SF-36, medical use, and patient global impression of change (PGIC.VAS of LBP and leg pain improved at 6 months (LBP from 6.1±2.0 at baseline to 2.9±2.3; and leg pain from 5.4±2.6 to 2.4±2.5, respectively. Eighty patients (66.7% showed improvement of 50% or more in main pain of LBP or leg pain from baseline. Disability and quality of life also improved at 6 months (ODI from 41.3±12.3 at baseline to 23.6±13.6; and SF-36 from 42.8±14.5 to 62.7±16.8. At 1 year follow-up, conventional medical management use decreased, improvement in pain and disability was maintained, and 79.2% reported improvement of PGIC.Despite limitations as an observational study, integrative Korean medicine treatment showed positive results in pain, function, and quality of life of FBSS patients.

Identify too big to fail banks and capital insurance: An equilibrium approach

Directory of Open Access Journals (Sweden)

Katerina Ivanov

2017-09-01

Full Text Available The objective of this paper is develop a rational expectation equilibrium model of capital insurance to identify too big to fail banks. The main results of this model include (1 too big to fail banks can be identified explicitly by a systemic risk measure, loss betas, of all banks in the entire financial sector; (2 the too big to fail feature can be largely justified by a high level of loss beta; (3 the capital insurance proposal benefits market participants and reduces the systemic risk; (4 the implicit guarantee subsidy can be estimated endogenously; and lastly, (5 the capital insurance proposal can be used to resolve the moral hazard issue. We implement this model and document that the too big to fail issue has been considerably reduced in the pro-crisis period. As a result, the capital insurance proposal could be a useful macro-regulation innovation policy tool

Failed surrogate conceptions: social and ethical aspects of preconception disruptions during commercial surrogacy in India.

Science.gov (United States)

Mitra, Sayani; Schicktanz, Silke

2016-09-19

During a commercial surrogacy arrangement, the event of embryo transfer can be seen as the formal starting point of the arrangement. However, it is common for surrogates to undergo a failed attempt at pregnancy conception or missed conception after an embryo transfer. This paper attempts to argue that such failed attempts can be understood as a loss. It aims to reconstruct the experiences of loss and grief of the surrogates and the intended parents as a consequence of their collective failure to conceive a surrogate pregnancy. Drawing on a qualitative study conducted over a period of eight months between 2014 and 2015 at two fertility clinics in Delhi and two in Kolkata, India, this paper examines the experiences of the surrogates and the intended parents when faced with missed conceptions or failed conceptions during a surrogacy arrangement. We argue that while the surrogate grieves the non-arrival of a 'good news' as an uncertain loss, the intended parents experience yet another, failure in addition to the losses they might have incurred during their previous fertility treatments. The body of the surrogate becomes a site of 'a lost opportunity'. The surrogate embodies a loss in her quest to achieve social mobility and the intended parents experience a disembodied pregnancy loss. This very emotional experience stands in stark contrast to the conceptualisation of such failed attempts as non-events within the discourse of the surrogacy industry. The experience of loss of the intended parents is recognised but their grief is given no space. We argue that such ambiguity around the nature of losses resulting out of a missed or failed conception during surrogacy is an outcome of lack of interpersonal relationship between the surrogate and the intended parents. Since commercial surrogacy is a relational process, the only way in which the experiences of losses and failures of the actors at the preconception stage can be better addressed is through developing close

Retreatment with sofosbuvir/velpatasvir in cirrhotic patients with genotype-4 who failed a previous interferon-free regimen: a case series.

Science.gov (United States)

Boglione, Lucio; Pinna, Simone Mornese; Lupia, Tommaso; Cariti, Giuseppe; Di Perri, Giovanni

2018-02-14

The novel available interferon (IFN)-free regimens significantly improved the sustained virological response (SVR) in patients with chronic hepatitis C (CHC), without important side effects and with shorter duration of treatment. In a subset of patients, however, the treatment failure (TF) was due to the presence of resistance-associated substitutions (RAS) that lead to virological breakthrough (BT) or relapse. We analysed in this case series the role of RAS on the TF in cirrhotic patients with genotype (GT)4, treated with a previous IFN-free regimen, and retreated with the combination of sofosbuvir (SOF)/velpatasvir (VEL) for 12 or 24 weeks, without ribavirin (RBV). We included in this analysis all patients with GT4 who failed a previous IFN-free treatment, with the presence of RAS at BT or relapse. All patients were retreated with a fixed combination of SOF/VEL for 12/24 weeks, without RBV. We evaluated the SVR and the MELD score change after the treatment. Seven patients were described. All were cirrhotic, Child-Pugh A (n=5), B (n=2); baseline RAS were detected in 4/7 subjects; at post-treatment detection, NS5 RAS were: F28S (n=1), Q30K (n=2), S30G (n=1), NS3 were: S122R (n=1), S122G (n=2), D168V (n=3). All retreated patients gained SVR. MELD score improved in all subjects with a median change of 3 points. No significant side effects or adverse events were reported. The combination SOF/VEL could be considered for the retreatment of cirrhotic GT4 patients who failed a previous IFN-free treatment with the presence of RAS in NS3 or NS5 regions.

Retreatment with sofosbuvir/velpatasvir in cirrhotic patients with genotype 4 who failed a previous interferon-free regimen: a case series.

Science.gov (United States)

Boglione, Lucio; Pinna, Simone Mornese; Lupia, Tommaso; Cariti, Giuseppe; Di Perri, Giovanni

2018-02-14

The novel available interferon (IFN)-free regimens significantly improved the sustained virological response (SVR) in patients with chronic hepatitis C (CHC), without important side-effects and with shorter duration of treatment. In a subset of patients, however, the treatment failure (TF) was due to the presence of resistance-associated substitutions (RAS) that lead to virological breakthrough (BT) or relapse. We analyzed in this case-series the role of RAS on the TF in cirrhotic patients with GT4, treated with a previous IFN-free regimen, and retreated with the combination of sofosbuvir (SOF)/velpatasvir (VEL) for 12 or 24 weeks, without ribavirin (RBV). We included in this analysis all patients with GT4 who failed a previous IFN-free treatment, with the presence of RAS at BT or relapse. All patients were retreated with a fixed combination of SOF/VEL for 12/24 weeks, without RBV. We evaluated the SVR and the MELD score change after the treatment. Seven patients were described. All were cirrhotic, Child-Pug A (n=5), B (n=2); baseline RAS were detected in 4/7 subjects; at post-treatment detection, NS5 RAS were: F28S (n=1), Q30K (n=2), S30G (n=1), NS3 were: S122R (n=1), S122G (n=2), D168V (n=3). All retreated patients gained the SVR. MELD score improved in all subjects with a median change of 3 points. No significant side-effects or adverse events were reported. The combination SOF/VEL could be considered for the retreatment of cirrhotic GT4 patients who failed a previous IFN-free treatment with the presence of RAS in NS3 or NS5 regions.

All-Arthroscopic Revision Eden-Hybinette Procedure for Failed Instability Surgery: Technique and Preliminary Results.

Science.gov (United States)

Giannakos, Antonios; Vezeridis, Peter S; Schwartz, Daniel G; Jany, Richard; Lafosse, Laurent

2017-01-01

To describe the technique of an all-arthroscopic Eden-Hybinette procedure in the revision setting for treatment of a failed instability procedure, particularly after failed Latarjet, as well as to present preliminary results of this technique. Between 2007 and 2011, 18 shoulders with persistent instability after failed instability surgery were treated with an arthroscopic Eden-Hybinette technique using an autologous bicortical iliac crest bone graft. Of 18 patients, 12 (9 men, 3 women) were available for follow-up. The average follow-up was 28.8 months (range, 15 to 60 months). A Latarjet procedure was performed as an index surgery in 10 patients (83%). Two patients (17%) had a prior arthroscopic Bankart repair. Eight patients (67%) obtained a good or excellent result, whereas 4 patients (33%) reported a fair or poor result. Seven patients (58%) returned to sport activities. A positive apprehension test persisted in 5 patients (42%), including 2 patients (17%) with recurrent subluxations. The Rowe score increased from 30.00 to 78.33 points (P Instability Index score showed a good result of 28.71% (603 points). The average anterior flexion was 176° (range, 150° to 180°), and the average external rotation was 66° (range, 0° to 90°). Two patients (16.67%) showed a progression of glenohumeral osteoarthritic changes, with each patient increasing by one stage in the Samilson-Prieto classification. All 4 patients (33%) with a fair or poor result had a nonunion identified on postoperative computed tomography scan. An all-arthroscopic Eden-Hybinette procedure in the revision setting for failed instability surgery, although technically demanding, is a safe, effective, and reproducible technique. Although the learning curve is considerable, this procedure offers all the advantages of arthroscopic surgery and allows reconstruction of glenoid defects and restoration of shoulder stability in this challenging patient population. In our hands, this procedure yields good

The effect of a health communication campaign on compliance with mass drug administration for schistosomiasis control in western Kenya--the SCORE project.

Science.gov (United States)

Omedo, Martin; Ogutu, Michael; Awiti, Alphonce; Musuva, Rosemary; Muchiri, Geoffrey; Montgomery, Susan P; Secor, W Evan; Mwinzi, Pauline

2014-11-01

Compliance with mass drug administration (MDA) can be affected by rumors and mistrust about the drug. Communication campaigns are an effective way to influence attitudes and health behaviors in diverse public health contexts, but there is very little documentation about experiences using health communications in schistosomiasis control programs. A qualitative study was conducted with community health workers (CHWs) as informants to explore the effect of a health communication campaign on their experiences during subsequent praziquantel MDA for schistosomiasis. Discussions were audio-recorded, transcribed verbatim, translated into English where applicable, and analyzed thematically using ATLAS.ti software. According to the CHWs, exposure to mass media messages improved awareness of the MDA, which in turn, led to better treatment compliance. Our findings suggest that communication campaigns influence health behaviors and create awareness of schistosomiasis control interventions, which may ultimately improve praziquantel MDA. © The American Society of Tropical Medicine and Hygiene.

Modified Mathieu repair for failed surgery for hypospadias ...

African Journals Online (AJOL)

A.Z.M. Anwar

Received 24 June 2014; received in revised form 3 August 2014; accepted 31 August ... Objectives: To present our experience with the use of modified Mathieu urethroplasty for failed hypospadias ... Overall success was achieved in 31/38.

Results of Latarjet Coracoid Transfer to Revise Failed Arthroscopic Instability Repairs

OpenAIRE

Nicholson, Gregory P.; Rahman, Zain; Verma, Nikhil N.; Romeo, Anthony A.; Cole, Brian J.; Gupta, Anil Kumar; Bruce, Benjamin

2014-01-01

Objectives: Arthroscopic instability repair has supplanted open techniques to anatomically reconstruct anteroinferior instability pathology. Arthroscopic technique can fail for a variety of reasons. We have utilized the Latarjet as a revision option in failed arthroscopic instability repairs when there is altered surgical anatomy, capsular deficiency and/or glenoid bone compromise and recurrent glenohumeral instability. Methods: We reviewed 51 shoulders (40 ?, 11?) that underwent Latarjet cor...

Effects of ozone on the pain and disability in patients with failed back surgery syndrome

Directory of Open Access Journals (Sweden)

Danilo Costa Barbosa

Full Text Available Summary Introduction: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS, which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. Objective: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. Method: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS, Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI, Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. Results: The patients showed significant pain relief, but no improvement was observed in the functional scales. Conclusion: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.

Failed rib region prediction in a human body model during crash events with precrash braking.

Science.gov (United States)

Guleyupoglu, B; Koya, B; Barnard, R; Gayzik, F S

2018-02-28

The objective of this study is 2-fold. We used a validated human body finite element model to study the predicted chest injury (focusing on rib fracture as a function of element strain) based on varying levels of simulated precrash braking. Furthermore, we compare deterministic and probabilistic methods of rib injury prediction in the computational model. The Global Human Body Models Consortium (GHBMC) M50-O model was gravity settled in the driver position of a generic interior equipped with an advanced 3-point belt and airbag. Twelve cases were investigated with permutations for failure, precrash braking system, and crash severity. The severities used were median (17 kph), severe (34 kph), and New Car Assessment Program (NCAP; 56.4 kph). Cases with failure enabled removed rib cortical bone elements once 1.8% effective plastic strain was exceeded. Alternatively, a probabilistic framework found in the literature was used to predict rib failure. Both the probabilistic and deterministic methods take into consideration location (anterior, lateral, and posterior). The deterministic method is based on a rubric that defines failed rib regions dependent on a threshold for contiguous failed elements. The probabilistic method depends on age-based strain and failure functions. Kinematics between both methods were similar (peak max deviation: ΔX head = 17 mm; ΔZ head = 4 mm; ΔX thorax = 5 mm; ΔZ thorax = 1 mm). Seat belt forces at the time of probabilistic failed region initiation were lower than those at deterministic failed region initiation. The probabilistic method for rib fracture predicted more failed regions in the rib (an analog for fracture) than the deterministic method in all but 1 case where they were equal. The failed region patterns between models are similar; however, there are differences that arise due to stress reduced from element elimination that cause probabilistic failed regions to continue to rise after no deterministic failed region would be

"Badminton Player-Coach" Interactions between Failing Students

Science.gov (United States)

Mascret, Nicolas

2011-01-01

Background: Physical education teachers often use the player-coach dyad in individual opposition sports so that students can obtain information on their actions and then better regulate them. This type of work also develops methodological and social skills. However, the task of observing a partner often poses problems for failing students, who…

Childhood obesity: parents fail to recognise, general practitioners fail to act.

LENUS (Irish Health Repository)

White, A

2012-01-01

General Practitioners (GPs) have an important role to play in recognition of and intervention against childhood obesity in Ireland. Data were collected prospectively on a cohort of children aged 4-14 and their parents (n = 101 pairs) who attended consecutively to a semi-rural group general practice. Parents estimated their child\\'s weight status. Actual weight status was determined for both parent and child using the United States Centres\\' for Disease Control\\'s BMI-for-age references. 15 (14.9%) of the children and 49 (51.6%) of the parents were overweight or obese. While 71 (95.5%) of normal weight status children were correctly identified, parents showed poor concordance in identifying their children as overweight 2 (18.2%) or obese 0 (0%). BMI was only evidently recorded in the clinical records of 1 out of 15 cases of overweight children identified. With parents failing to recognise childhood obesity, GPs have a responsibility in tackling this problem at a family level.

Phospholamban Is Downregulated by pVHL-Mediated Degradation through Oxidative Stress in Failing Heart

Directory of Open Access Journals (Sweden)

Shunichi Yokoe

2017-10-01

Full Text Available The E3 ubiquitin ligase, von Hippel–Lindau (VHL, regulates protein expression by polyubiquitination. Although the protein VHL (pVHL was reported to be involved in the heart function, the underlying mechanism is unclear. Here, we show that pVHL was upregulated in hearts from two types of genetically dilated cardiomyopathy (DCM mice models. In comparison with the wild-type mouse, both DCM mice models showed a significant reduction in the expression of phospholamban (PLN, a potent inhibitor of sarco(endoplasmic reticulum Ca2+-ATPase, and enhanced interaction between pVHL and PLN. To clarify whether pVHL is involved in PLN degradation in failing hearts, we used carbonylcyanide m-chlorophenylhydrazone (CCCP, a mitochondrial membrane potential (MMP-lowering reagent, to mimic the heart failure condition in PLN-expressing HEK293 cells and found that CCCP treatment resulted in PLN degradation and increased interaction between PLN and pVHL. However, these effects were reversed with the addition of N-acetyl-l-cysteine. Furthermore, the co-transfection of VHL and PLN in HEK293 cells decreased PLN expression under oxidative stress, whereas knockdown of VHL increased PLN expression both under normal and oxidative stress conditions. Together, we propose that oxidative stress upregulates pVHL expression to induce PLN degradation in failing hearts.

Operational studies on the control of Taenia solium taeniasis/cysticercosis in Ecuador.

Science.gov (United States)

Cruz, M; Davis, A; Dixon, H; Pawlowski, Z S; Proano, J

1989-01-01

A large-scale study in Loja and El Oro Provinces, Ecuador, demonstrated that population-based treatment of human taeniasis with a low dose of praziquantel is feasible and effective for the short-term control of transmission of Taenia solium in hyperendemic areas. Chemotherapeutic intervention also effectively promoted local preventive measures and contributed greatly to the elaboration of a long-term control programme.

Operational studies on the control of Taenia solium taeniasis/cysticercosis in Ecuador

OpenAIRE

1989-01-01

A large-scale study in Loja and El Oro Provinces, Ecuador, demonstrated that population-based treatment of human taeniasis with a low dose of praziquantel is feasible and effective for the short-term control of transmission of Taenia solium in hyperendemic areas. Chemotherapeutic intervention also effectively promoted local preventive measures and contributed greatly to the elaboration of a long-term control programme.

Development of failed element monitoring system for PWR

International Nuclear Information System (INIS)

Liu Yupu; Liu Haojie

2005-01-01

Aiming at the existent problems of failed element monitoring system in the PWR, the detector, the spiral tube, the neutron-moderator and the shielding of neutron bas improved on in this task. These improvements decrease the backgrounds effectively, raise the work stability of the detectors and resolve the failed element error action problem which can not be resolved for the long time, and the detecting sensitivity is raise ten times. The γ-ray detector is arranged spiral with outside, so the γ-rays with shorter half-life can be detected. The structure of gross gamma detection station has improved, so the solid angle is expanded, the transmissivity of γ-rays and β-rays are increased, and the ratio of signal to background is raised. The measurement instrument has been intellectualized. This system is above criticism for the users in operation. (authors)

The Art of Saving a Failing School

Science.gov (United States)

Stein, Les

2012-01-01

While the debate continues over whether to close failing schools or attempt fixing them, the author asserts that the solution most often lies in assigning strong leaders to them who will take definite and immediate action. Reviewing his own success turning around schools, he says creating a sense of urgency, unloading poor performing staff, and…

Successful Laparoscopically Assisted Transcervical Suction Evacuation of Interstitial Pregnancy following Failed Methotrexate Injection in a Community Hospital Setting

Directory of Open Access Journals (Sweden)

Rani B. Fritz

2014-01-01

Full Text Available We report on a case of a patient with an early diagnosed cornual ectopic pregnancy following failed methotrexate treatment. The patient was subsequently taken to the operating room for a laparoscopic guided transcervical suction curettage of the cornual ectopic. The surgery was successful and the patient was followed up until her urine pregnancy test was negative. We conclude that in properly selected patients, cornual ectopic pregnancy may be treated with transcervical suction curettage.

Securing Failed Inner-City Communities: The Military's Role

National Research Council Canada - National Science Library

Khan, Oral

1997-01-01

This study examines the threat to internal security posed by violent gangs. This threat was found to be particularly acute in inner-city communities that have over time devolved to a status that the author classified as failed communities...

Transition from failing dentition to complete-arch implant rehabilitation with a staged approach: a 3-year clinical report.

Science.gov (United States)

Papaspyridakos, Panos; Chronopoulos, Vasilios

2014-09-01

The transition of patients from failing dentition to complete-arch implant rehabilitation often means that the patient is rendered edentulous and has to wear a removable complete denture for a time. Many patients find this objectionable. A staged treatment approach provides a fixed interim prosthesis for use throughout the rehabilitation process, allowing patient comfort and prosthodontic control. This clinical report describes a staged approach protocol with a new type of interim prosthesis. The prosthesis is supported by hopeless teeth and the soft tissues of the maxillary tuberosities and mandibular retromolar pads for the complete-arch implant rehabilitation of a patient with failing dentition. This protocol allows for a fixed interim prosthesis with combined tooth and mucosa or implant support during the entire rehabilitation process, thus avoiding the use of complete dentures. The implants and prostheses were functioning successfully after 3 years of clinical service. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Schistogram changes after administration of antischistosomal drugs in mice at the early phase of Schistosoma mansoni infection

Directory of Open Access Journals (Sweden)

Andrea Cassia Simoes Vimieiro

2013-11-01

Full Text Available Mice infected with Schistosoma mansoni were treated with oxamniquine, praziquantel, artesunate at the pre-patent phase, aiming at observing schistogram alterations. Half of the animals were perfused five days post-treatment for counting and classification of immature worms, based on pre-established morphological criteria (schistogram; the remaining animals were evaluated 42 or 100 days after infection and perfusion of the portal-system was performed for collection and counting of adult worms and oogram. It was observed that oxamniquine and artesunate treatment administered at the pre-postural phase causes significant reduction in the number of immature and adult worms. However, there was little reduction with praziquantel when used at the dose of 400 mg/kg for treatments administered 14, 15, 21 or 23 days post-infection. Artesunate was responsible for significant alterations in development of young worms, as well as for a higher number of worms presenting intestinal damages. Immature adult worms were detected in mice treated with artesunate or oxamniquine at the pre-patent phase of infection and recovered by perfusion 100 days after infection. Schistogram proved to be a very useful tool for experimental evaluation of the activity of antischistosomal drugs and a good model to identify the most sensitive stages to drugs.

SU-E-T-148: Benchmarks and Pre-Treatment Reviews: A Study of Quality Assurance Effectiveness

International Nuclear Information System (INIS)

Lowenstein, J; Nguyen, H; Roll, J; Walsh, A; Tailor, A; Followill, D

2015-01-01

Purpose: To determine the impact benchmarks and pre-treatment reviews have on improving the quality of submitted clinical trial data. Methods: Benchmarks are used to evaluate a site’s ability to develop a treatment that meets a specific protocol’s treatment guidelines prior to placing their first patient on the protocol. A pre-treatment review is an actual patient placed on the protocol in which the dosimetry and contour volumes are evaluated to be per protocol guidelines prior to allowing the beginning of the treatment. A key component of these QA mechanisms is that sites are provided timely feedback to educate them on how to plan per the protocol and prevent protocol deviations on patients accrued to a protocol. For both benchmarks and pre-treatment reviews a dose volume analysis (DVA) was performed using MIM softwareTM. For pre-treatment reviews a volume contour evaluation was also performed. Results: IROC Houston performed a QA effectiveness analysis of a protocol which required both benchmarks and pre-treatment reviews. In 70 percent of the patient cases submitted, the benchmark played an effective role in assuring that the pre-treatment review of the cases met protocol requirements. The 35 percent of sites failing the benchmark subsequently modified there planning technique to pass the benchmark before being allowed to submit a patient for pre-treatment review. However, in 30 percent of the submitted cases the pre-treatment review failed where the majority (71 percent) failed the DVA. 20 percent of sites submitting patients failed to correct their dose volume discrepancies indicated by the benchmark case. Conclusion: Benchmark cases and pre-treatment reviews can be an effective QA tool to educate sites on protocol guidelines and to minimize deviations. Without the benchmark cases it is possible that 65 percent of the cases undergoing a pre-treatment review would have failed to meet the protocols requirements.Support: U24-CA-180803

Counselor Liability for Failing to Report Child Abuse.

Science.gov (United States)

Knapp, Samuel

1983-01-01

Describes the laws regarding counselor liability for failure to report child abuse and state laws designating mandated reporters of suspected child abuse. Notes how the law protects mandated reporters. Discusses criminal penalties for those who fail to report suspected abuse. (RC)

Functional desensitization to isoproterenol without reducing cAMP production in canine failing cardiocytes.

Science.gov (United States)

Laurent, C E; Cardinal, R; Rousseau, G; Vermeulen, M; Bouchard, C; Wilkinson, M; Armour, J A; Bouvier, M

2001-02-01

To corroborate alterations in the functional responses to beta-adrenergic receptor (beta-AR) stimulation with changes in beta-AR signaling in failing cardiomyocytes, contractile and L-type Ca(2+) current responses to isoproterenol along with stimulated cAMP generation were compared among cardiomyocytes isolated from canines with tachycardia-induced heart failure or healthy hearts. The magnitude of shortening of failing cardiomyocytes was significantly depressed (by 22 +/- 4.4%) under basal conditions, and the maximal response to isoproterenol was significantly reduced (by 45 +/- 18%). Similar results were obtained when the responses in the rate of contraction and rate of relaxation to isoproterenol were considered. The L-type Ca(2+) current amplitude measured in failing cardiomyocytes under basal conditions was unchanged, but the responses to isoproterenol were significantly reduced compared with healthy cells. Isoproterenol-stimulated cAMP generation was similar in sarcolemmal membranes derived from the homogenates of failing (45 +/- 6.8) and healthy cardiomyocytes (52 +/- 8.5 pmol cAMP. mg protein(-1). min(-1)). However, stimulated cAMP generation was found to be significantly reduced when the membranes were derived from the homogenates of whole tissue (failing: 67 +/- 8.1 vs. healthy: 140 +/- 27.8 pmol cAMP. mg protein(-1). min(-1)). Total beta-AR density was not reduced in membranes derived from either whole tissue or isolated cardiomyocyte homogenates, but the beta(1)/beta(2) ratio was significantly reduced in the former (failing: 45/55 vs. healthy: 72/28) without being altered in the latter (failing: 72/28, healthy: 77/23). We thus conclude that, in tachycardia-induced heart failure, reduction in the functional responses of isolated cardiomyocytes to beta-AR stimulation may be attributed to alterations in the excitation-contraction machinery rather than to limitation of cAMP generation.

The association between detected drug resistance mutations and CD4(+) T-cell decline in HIV-positive individuals maintained on a failing treatment regimen

DEFF Research Database (Denmark)

Schultze, Anna; Paredes, Roger; Sabin, Caroline

2018-01-01

BACKGROUND: To analyse the effect of drug resistance mutations (DRM) on CD4 cell trends in HIV-positive people maintained on virologically failing antiretroviral therapy (ART). METHODS: Individuals from two large cohorts experiencing virological failure (VF) while maintained on ART with >1 CD4...

Survey of Accepted Practice following Failed Intubation for Emergency Caesarean Delivery

Directory of Open Access Journals (Sweden)

Daniel Soltanifar

2015-01-01

Full Text Available Background. There is no consensus on the optimum management of failed tracheal intubation in emergency cesarean delivery performed for fetal compromise. The decision making process on whether to wake the patient or continue anesthesia with a supraglottic airway device is an underexplored area. This survey explores perceptions and experiences of obstetric anesthetists managing failed intubation. Methods. Anesthetists attending the Group of Obstetric Anaesthetists London (GOAL Meeting in April 2014 were surveyed. Results. Ninety-three percent of anesthetists surveyed would not always wake the patient in the event of failed intubation for emergency cesarean delivery performed for fetal compromise. The median (interquartile range of perceived acceptability of continuing anesthesia with a well-fitting supraglottic airway device, assessed using a visual analogue scale (0–100; 0 completely unacceptable; 100 completely acceptable, was 90 [22.5]. Preoperative patient consent regarding the use of a supraglottic airway device for surgery in the event of failed intubation would affect the decision making of 40% of anaesthetists surveyed. Conclusion. These results demonstrate that a significant body of anesthetists with a subspecialty interest in obstetric anesthesia in the UK would not always wake up the patient and would continue with anesthesia and surgery with a supraglottic airway device in this setting.

John F. Kennedy's back: chronic pain, failed surgeries, and the story of its effects on his life and death.

Science.gov (United States)

Pait, T Glenn; Dowdy, Justin T

2017-09-01

The 35th president of the United States, John F. Kennedy (JFK), experienced chronic back pain beginning in his early 20s. He underwent a total of 4 back operations, including a discectomy, an instrumentation and fusion, and 2 relatively minor surgeries that failed to significantly improve his pain. The authors examined the nature and etiology of JFK's back pain and performed a detailed investigation into the former president's numerous medical evaluations and treatment modalities. This information may lead to a better understanding of the profound effects that JFK's chronic back pain and its treatment had on his life and presidency, and even his death.

Long-Term Follow-Up of Resistance-Associated Substitutions in Hepatitis C Virus in Patients in Which Direct Acting Antiviral-Based Therapy Failed.

Science.gov (United States)

Yoshida, Kanako; Hai, Hoang; Tamori, Akihiro; Teranishi, Yuga; Kozuka, Ritsuzo; Motoyama, Hiroyuki; Kawamura, Etsushi; Hagihara, Atsushi; Uchida-Kobayashi, Sawako; Morikawa, Hiroyasu; Enomoto, Masaru; Murakami, Yoshiki; Kawada, Norifumi

2017-05-03

We evaluated the transition of dominant resistance-associated substitutions (RASs) in hepatitis C virus during long-term follow-up after the failure of DAAs (direct acting antivirals)-based therapy. RASs in non-structure (NS)3/4A, NS5A, NS5B, and deletions in NS5A from 20 patients who failed simeprevir/pegylated-interferon/ribavirin (SMV/PEG-IFN/RBV) and 25 patients who failed daclatasvir/asunaprevir (DCV/ASV) treatment were examined by direct sequencing. With respect to SMV/PEG-IFN/RBV treatment, RAS was detected at D168 in NS3/4A but not detected in NS5A and NS5B at treatment failure in 16 of 20 patients. During the median follow-up period of 64 weeks, the RAS at D168 became less dominant in 9 of 16 patients. Among 25 DCV/ASV failures, RASs at D168, L31, and Y93 were found in 57.1%, 72.2%, and 76.9%, respectively. NS5A deletions were detected in 3 of 10 patients treated previously with SMV/PEG-IFN/RBV. The number of RASs in the breakthrough patients exceeded that in relapsers (mean 3.9 vs. 2.7, p < 0.05). RAS at D168 in NS3/4A became less dominant in 6 of 15 patients within 80 weeks. Y93H emerged at the time of relapse, then decreased gradually by 99% at 130 weeks post-treatment. Emerged RASs were associated with the clinical course of treatment and could not be detected during longer follow-up.

Limb Salvage After Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy.

Science.gov (United States)

Vaudreuil, Nicholas J; Fourman, Mitchell S; Wukich, Dane K

2017-03-01

Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. The overall rate of limb salvage was 82.3% (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level III, retrospective case series.

Rescue EUS-guided intrahepatic biliary drainage for malignant hilar biliary stricture after failed transpapillary re-intervention.

Science.gov (United States)

Minaga, Kosuke; Takenaka, Mamoru; Kitano, Masayuki; Chiba, Yasutaka; Imai, Hajime; Yamao, Kentaro; Kamata, Ken; Miyata, Takeshi; Omoto, Shunsuke; Sakurai, Toshiharu; Watanabe, Tomohiro; Nishida, Naoshi; Kudo, Masatoshi

2017-11-01

Treatment of unresectable malignant hilar biliary stricture (UMHBS) is challenging, especially after failure of repeated transpapillary endoscopic stenting. Endoscopic ultrasonography-guided intrahepatic biliary drainage (EUS-IBD) is a recent technique for intrahepatic biliary decompression, but indications for its use for complex hilar strictures have not been well studied. The aim of this study was to assess the feasibility and safety of EUS-IBD for UMHBS after failed transpapillary re-intervention. Retrospective analysis of all consecutive patients with UMHBS of Bismuth II grade or higher who, between December 2008 and May 2016, underwent EUS-IBD after failed repeated transpapillary interventions. The technical success, clinical success, and complication rates were evaluated. Factors associated with clinical ineffectiveness of EUS-IBD were explored. A total of 30 patients (19 women, median age 66 years [range 52-87]) underwent EUS-IBD for UMHBS during the study period. Hilar biliary stricture morphology was classified as Bismuth II, III, or IV in 5, 13, and 12 patients, respectively. The median number of preceding endoscopic interventions was 4 (range 2-14). EUS-IBD was required because the following procedures failed: duodenal scope insertion (n = 4), accessing the papilla after duodenal stent insertion (n = 5), or achieving desired intrahepatic biliary drainage (n = 21). Technical success with EUS-IBD was achieved in 29 of 30 patients (96.7%) and clinical success was attained in 22 of these 29 (75.9%). Mild peritonitis occurred in three of 30 (10%) and was managed conservatively. Stent dysfunction occurred in 23.3% (7/30). There was no procedure-related mortality. On multivariable analysis, Bismuth IV stricture predicted clinical ineffectiveness (odds ratio = 12.7, 95% CI 1.18-135.4, P = 0.035). EUS-IBD may be a feasible and effective rescue alternative with few major complications after failed transpapillary endoscopic re-intervention in patients

When myasthenia gravis is deemed refractory: clinical signposts and treatment strategies

Science.gov (United States)

Mantegazza, Renato; Antozzi, Carlo

2018-01-01

The prognosis for patients with myasthenia gravis (MG) has improved significantly over the past half century, including substantial reductions in mortality and morbidity. However, approximately 10% of patients fails to respond adequately to current therapies and are considered treatment refractory, or treatment intolerant, and up to 80% have disease that fails to achieve complete stable remission. Although patients with autoantibodies to muscle-specific tyrosine kinase (anti-MuSK positive) are more likely to become treatment refractory than those with autoantibodies to the acetylcholine receptor (anti-AChR positive), each of these serotypes is substantially represented in the refractory MG population. Other risk factors for becoming treatment refractory include history of thymoma or thymectomy and female sex. A modified treatment algorithm for MG is proposed: patients who have disease that fails to respond to the stepwise approach to therapy, are treatment intolerant, or who require chronic rescue measures despite ongoing therapy, should be considered treatment refractory and emerging therapies should be considered. Three emerging monoclonal antibody-based therapies are discussed: the anti-B-cell agent rituximab; the terminal complement activation inhibitor eculizumab; and belimumab, which targets B-cell activating factor. Increased understanding of molecular pathophysiology and accurate antibody subtyping in MG should lead to the use of new therapeutic agents and successful management of treatment-refractory patients. PMID:29403543

Management of failed spinal anaesthesia for caesarean section

African Journals Online (AJOL)

based on an intent-to-treat analysis. Of these, 10 ... testing the level of a spinal block, nor is there an algorithm on how ... scenarios of failed spinal anaesthesia was distributed to 51 government hospitals in KwaZulu-Natal, South Africa (SA).

Why does Centralisation fail to internalise Policy Externalities?

NARCIS (Netherlands)

A.J. Dur (Robert); H.J. Roelfsema (Hein)

2002-01-01

textabstractCentralisation of political decision making often fails to produce the desired results. For instance, it is frequently argued that decision making within the European Union results in overspending and overregulation in some policy areas, while too low spending and too little regulation

Looked-but-failed-to-see-errors in traffic

DEFF Research Database (Denmark)

Herslund, Mai-Britt; Jørgensen, N O

2003-01-01

Danish studies of traffic accidents at priority intersections have shown a particular type of accidents. In these accidents a car driver supposed to give way has collided with a bicycle rider on the priority road. Often the involved car drivers have maintained that they did not see the bicycle...... looking in the direction where the other parties were but have not seen (i.e. perceived the presence of) the other road user. This paper describes two studies approaching this problem.One study is based on 10 self-reported near accidents. It does show that "looked-but-failed-to-see" events do occur...... until immediately before the collision even though the bicycle must have been clearly visible.Similar types of accidents have been the subject of studies elsewhere. In literature they are labelled "looked-but-failed-to-see", because it seems clear that in many cases the car drivers have actually been...

Assessment of efficacy and safety of praziquantel in the treatment of ...

African Journals Online (AJOL)

This study assessed the efficacy and safety of PZQ in school-aged children in four ... All pupils were also treated with a single dose of PZQ at 40 mg/kg. ... The presence of S. haematobium was neither age nor sex dependent (p>0.05).

Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant during retreatment of failed endodontic cases.

Science.gov (United States)

Zerella, Joseph A; Fouad, Ashraf F; Spångberg, Larz S W

2005-12-01

The purpose of this in vivo investigation is to compare the effect of a slurry of Ca(OH)2 mixed in aqueous 2% chlorhexidine (CHX) versus aqueous Ca(OH)2 slurry alone on the disinfection of the pulp space of failed root-filled teeth during endodontic retreatment. Forty single-rooted previously root-filled teeth with associated periradicular lesions were included. The teeth were nonsurgically retreated and medicated over 3 treatment visits with 7-10-day intervals with either Ca(OH)2 in water or Ca(OH)2 in 2% aqueous CHX. Root canal cultures were collected in fluid thioglycollate, and bacterial growth was assessed by turbidity daily for 1 week, then weekly for an additional 3 weeks. The presence of enterococci in the root canals at the initial treatment session was determined. Of the total sample population, 12 of 40 (30%) were positive for bacteria before root filling. The control medication disinfected 12 of 20 (60%) teeth including 2 of 4 teeth originally diagnosed with enterococci. The experimental medication resulted in disinfected 16 of 20 (80%) teeth at the beginning of the third appointment. None of the teeth originally containing enterococci showed remaining growth. This difference between the overall positive cultures was not statistically significant (P > .05). Canal dressing with a mixture of 2% CHX and Ca(OH)2 slurry is as efficacious as aqueous Ca(OH)2 on the disinfection of failed root-filled teeth.

Severe male infertility after failed ICSI treatment-a phenomenological study of men's experiences

Directory of Open Access Journals (Sweden)

Hellström Anna-Lena

2011-02-01

Full Text Available Abstract Background Male-factor infertility underlies approximately 30% of infertility in couples seeking treatment; of which 10% is due to azoospermia. The development of assisted reproductive technology (ART, enabling the use of epididymal or testicular sperm for fertilization of the partner's oocytes, has made biological fatherhood possible for men with obstructive azoospermia. There is limited knowledge of men's experience of their own infertility. The aim of this study was to describe men's experiences of obstructive azoospermia infertility. Methods Eight men with obstructive azoospermia, who had terminated Swedish public health system ART treatment two years previously without subsequent childbirth, were interviewed using a descriptive phenomenological method. Results The essence of the phenomenon is expressed with a metaphor: climbing a mountain step by step with the aim of reaching the top, i.e. having a child and thus a family with a child. Four constituents are included (1 inadequacy followed by a feeling of redress (2 marginalisation, (3 chivalry (4 extension of life and starting a family as driving forces. Conclusions Knowledge of men's experiences of their own infertility is important as a supporting measure to increase the quality of care of infertile couples. By adopting this facet of gender perspective in fertility treatment guidelines, care can hopefully be optimized.

Helminths in horses : use of selective treatment for the control of strongyles

Directory of Open Access Journals (Sweden)

S. Matthee

2004-06-01

Full Text Available The current level of anthelmintic resistance in the horse-breeding industry is extremely high and therefore more emphasis is being placed on studies that focus on the judicious use of anthelmintic products. The aims of the study were to: 1 establish if there is variation in the egg excretion pattern of strongyles between the different age classes of Thoroughbred horses in the Western Cape Province (WCP, 2 test if a selective treatment approach successfully reduces the number of anthelmintic treatments and maintains acceptably low helminth burdens in adult Thoroughbred horses, and 3 evaluate the efficacy of subsampling large horse herds for faecal egg counts (FECs to monitor the strongyle burden. In 2001 the FECs of 4 adult mare, 5 yearling and 3 weanling herds from 8 different farms were compared in the WCP. Within the mare herds there were generally fewer eggexcreting individuals with lower mean FECs compared with the younger age classes. Individual faecal samples were collected every 3-4 weeks from 52 adult Thoroughbred mares from 1 farm in the WCP during a 12-month period (2002/2003. Animals with strongyle FECs > 100 eggs per gram (epg were treated with an ivermectin-praziquantel combination drug (Equimax oral paste, Virbac. The mean monthly strongyle FEC for the entire group was < 300 epg throughout the study and the number of treatments was reduced by 50 %. Resampling methods showed that an asymptote to mean FEC was reached at 55 animals for each of the pooled weanling, yearling and mare egg counts. Resampling within 4 different mare herds recorded asymptotes of between 24 and 28 animals. Subsampling entire herds for FECs therefore provided an effective approach to treatment management. This study demonstrates that selective treatment is both a practical and an effective approach to the management of anthelmintic resistance.

ISAT promises fail-safe computer-based reactor protection

International Nuclear Information System (INIS)

Anon.

1989-01-01

AEA Technology's ISAT system is a multiplexed microprocessor-based reactor protection system which has very extensive self-monitoring capabilities and is inherently fail safe. It provides a way of addressing software reliability problems that have tended to hamper widespread introduction of computer-based reactor protection. (author)

Strongyle egg reappearance period after moxidectin treatment and its relationship with management factors in UK equine populations.

Science.gov (United States)

Tzelos, Thomas; Barbeito, Jessica S G; Nielsen, Martin K; Morgan, Eric R; Hodgkinson, Jane E; Matthews, Jacqueline B

2017-04-15

Parasitic nematodes, particularly cyathostomins, are ubiquitous in grazing horses world-wide. Considerable burdens of cyathostomin larvae can encyst in the large intestinal wall. The most recommended treatment against these pathogenic stages is moxidectin. Information is required on how effective moxidectin is against cyathostomin populations in different regions. The objectives here were to determine the efficacy of moxidectin treatment and estimate the strongyle egg reappearance period (ERP) after treatment in several equine populations, to confirm the type of strongyle nematodes present and to identify other (i.e. management) factors associated with shortened ERP. Eight yards were recruited and moxidectin in combination with praziquantel administered to all horses (n=261). Faecal egg count (FEC) analysis was performed at weeks 0, 2, 6, 10 and 12 after treatment to determine efficacy and ERP. The ERP was estimated using two previously published methods. Morphological identification of cultured third stage larvae from the sample population was compared to a Strongylus vulgaris-specific end-point PCR to examine the presence of S. vulgaris in samples before and after treatment. Strongyle egg shedding patterns were also compared to worm management practices at each site. At 2 weeks post-treatment, moxidectin was highly effective (faecal egg count reduction range, 99.9-100%). The strongyle ERP ranged from 6 weeks to >12 weeks depending on the calculation method applied. Only cyathostomin larvae were detected by morphological identification. The results from the coprocultures and PCR showed that S. vulgaris was absent before and after treatment. Analysis revealed that regular faecal removal from pasture was associated with lower average FEC and lower prevalence of egg shedding. Copyright © 2017 Elsevier B.V. All rights reserved.

A Human Case of Zoonotic Dog Tapeworm, Dipylidium caninum (Eucestoda: Dilepidiidae), in China.

Science.gov (United States)

Jiang, Peng; Zhang, Xi; Liu, Ruo Dan; Wang, Zhong Quan; Cui, Jing

2017-02-01

We described a human case of zoonotic dog tapeworm, Dipylidium caninum (Eucestoda: Dilepidiidae), rarely occurring in China. The mother of a 17 month-old boy noted the appearance of small white and active worms over a month period in her son's feces, but the boy was asymptomatic except mild diarrhea. We observed 3 tapeworm proglottids resembling cucumber seeds in his stool sample. Microscopically, each proglottid had 2 genital pores, 1 on each lateral edge, and numerous egg capsules in the uterus. The patient was successfully treated with a single oral dose of praziquantel. Adult worms were recovered in the diarrheic stool after praziquantel treatment and purgation. His family had household pet dogs for several years, and he might have acquired the infection by ingestion of infected fleas of his pet dogs. A history of dog or cat pets and flea bites may be important clues to diagnosis of D. caninum infection. The infected pets should also be treated.

An optimal inspection strategy for randomly failing equipment

International Nuclear Information System (INIS)

Chelbi, Anis; Ait-Kadi, Daoud

1999-01-01

This paper addresses the problem of generating optimal inspection strategies for randomly failing equipment where imminent failure is not obvious and can only be detected through inspection. Inspections are carried out following a condition-based procedure. The equipment is replaced if it has failed or if it shows imminent signs of failure. The latter state is indicated by measuring certain predetermined control parameters during inspection. Costs are associated with inspection, idle time and preventive or corrective actions. An optimal inspection strategy is defined as the inspection sequence minimizing the expected total cost per time unit over an infinite span. A mathematical model and a numerical algorithm are developed to generate an optimal inspection sequence. As a practical example, the model is applied to provide a machine tool operator with a time sequence for inspecting the cutting tool. The tool life time distribution and the trend of one control parameter defining its actual condition are supposed to be known

We still fail to account for Mendel's observations.

Science.gov (United States)

Porteous, John W

2004-08-16

The present article corrects common textbook accounts of Mendel's experiments by re-establishing what he wrote and how he accounted for his observations. It notes the long-established tests for the validity of any explanations that purport to explain observations obtained by experiment. Application of these tests to Mendel's paper shows that the arguments he used to explain his observations were internally consistent but were, on one crucial issue, implausible. The same tests are applied to the currently accepted explanation for Mendel's observations. The currently favoured explanation for Mendel's observations is untenable. It misrepresents Mendel, fails to distinguish between the parameters and the variables of any system of interacting components, its arguments are inconsistent, it repeats the implausibility in Mendel's paper, fails to give a rational explanation for his observed 3:1 trait ratio and cannot explain why this ratio is not always observed in experimental practice. A rational explanation for Mendel's observations is initiated. Readers are challenged to complete the process before a further article appears.

Sealed source and device design safety testing: Technical report on the findings of task 4 -- Investigation of failed Nitinol brachytherapy wire. Volume 2

International Nuclear Information System (INIS)

Benac, D.J.; Burghard, H.C.

1996-03-01

This report covers an investigation of the nature and cause of failure in Nitinol brachytherapy sourcewires. The investigation was initiated after two clinical incidents in which sourcewires failed during or immediately after a treatment. The investigation determined that the two clinical Nitinol sourcewires failed in a brittle manner, which is atypical for Nitinol. There were no material anomalies or subcritical flaws to explain the brittle failures. The bend tests also demonstrated that neither moist environment, radiation, nor low-temperature structural transformation was a likely root cause of the failures. However, degradation of the PTFE was consistently evident, and those sourcewires shipped or stored with PTFE sleeves consistently failed in laboratory bend tests. On the basis of the results of this study, it was concluded that the root cause of the in-service failures of the sourcewires was environmentally induced embrittlement due to the breakdown of the PTFE protective sleeves in the presence of the high-radiation field and subsequent reaction or interaction of the breakdown products with the Nitinol alloy

Failed (leaking) spent fuel management and storage in the Paks NPP

International Nuclear Information System (INIS)

Burjan, T.

2011-01-01

At the cycle 22, unit 4, Paks NPP the fissile contents raised irregularly in the water of the primary circuit. At the end of the cycle sipping tests were performed for the entire core to find out the leaking fuel assembly primarily responsible for this phenomenon. The identified leaking assembly temporarily was placed in the Spent Fuel Relaxing Pool. For measuring environmental impact of leaking assemblies an investigation program was developed and implemented. The assessment covered the following: effects of the leaking fuel on the water of relaxing pool and on the gaseous emissions in case open storage; in case when the leaking cassette is in a special hermetical storage case, how much gas is collected in the locked case and what is its composition; how to change the measured sipping test signal depending on relaxing time of leaking fuel cassettes. Based on the evaluation of the investigation program results the NPP modified the operational instructions for the treatment and storage of failed fuel assemblies. (author)

Does the volume of supplemental intraligamentary injections affect the anaesthetic success rate after a failed primary inferior alveolar nerve block? A randomized-double blind clinical trial.

Science.gov (United States)

Aggarwal, V; Singla, M; Miglani, S; Kohli, S; Sharma, V; Bhasin, S S

2018-01-01

To investigate the efficacy of 0.2 mL vs. 0.6 mL of 2% lidocaine when given as a supplementary intraligamentary injection after a failed inferior alveolar nerve block (IANB). Ninety-seven adult patients with symptomatic irreversible pulpits received an IANB and root canal treatment was initiated. Pain during treatment was recorded using a visual analogue scale (Heft-Parker VAS). Patients with unsuccessful anaesthesia (n = 78) randomly received intraligamentary injection of either 0.2 mL or 0.6 mL of 2% lidocaine with 1 : 80 000 epinephrine. Root canal treatment was reinitiated. Success after primary injection or supplementary injection was defined as no or mild pain (HP VAS score ≤54 mm) during access preparation and root canal instrumentation. Heart rate was monitored using a finger pulse oximeter. The anaesthetic success rates were analysed with Pearson chi-square test at 5% significance levels. The heart rate changes were analysed using t-tests. The intraligamentary injections with 0.2 mL solution gave an anaesthetic success rate of 64%, whilst the 0.6 mL was successful in 84% of cases with failed primary IANB. (χ 2  = 4.3, P = 0.03). There was no significant effect of the volume of intraligamentary injection on the change in heart rate. Increasing the volume of intraligamentary injection improved the success rates after a failed primary anaesthetic injection. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Operational studies on the control of Taenia solium taeniasis/cysticercosis in Ecuador.

Science.gov (United States)

Cruz, M.; Davis, A.; Dixon, H.; Pawlowski, Z. S.; Proano, J.

1989-01-01

A large-scale study in Loja and El Oro Provinces, Ecuador, demonstrated that population-based treatment of human taeniasis with a low dose of praziquantel is feasible and effective for the short-term control of transmission of Taenia solium in hyperendemic areas. Chemotherapeutic intervention also effectively promoted local preventive measures and contributed greatly to the elaboration of a long-term control programme. PMID:2805217

Post-irradiation examination of a failed PHWR fuel bundle of KAPS-2

International Nuclear Information System (INIS)

Mishra, Prerna; Unnikrishnan, K.; Viswanathan, U.K.; Shriwastaw, R.S.; Singh, J.L.; Ouseph, P.M.; Alur, V.D.; Singh, H.N.; Anantharaman, S.; Sah, D.N.

2006-08-01

Detailed post irradiation examination was carried out on a PHWR fuel bundle irradiated at Kakrapar Atomic Power Station unit 2 (KAPS-2). The fuel bundle had failed early in life at a low burnup of 387 MWd/T. Non destructive and destructive examination was carried out to identify the cause of fuel failure. Visual examination and leak testing indicated failure in two fuel pins of the outer ring of the bundle in the form of axial cracks near the end plug location. Ultrasonic testing of the end cap weld indicated presence of lack of fusion type defect in the two fuel pins. No defect was found in other fuel pins of the bundle. Metallographic examination of fuel sections taken from the crack location in the failed fuel pin showed extensive restructuring of fuel. The centre temperature of the fuel had exceeded 1700 degC at this location in the failed fuel pin, whereas fuel centre temperature in the un-failed fuel pin was only about 1300 degC. Severe fuel clad interaction was observed in the failed fuel pin at and near the location of failure but no such interaction was observed in the un-failed fuel pins. Several incipient cracks originating from the inside surface were found in the cladding near failure location in addition to the main through wall crack. The incipient cracks were filled with interaction products and hydride platelets were present at tip of the cracks. It was concluded from the observations that the primary cause of failure was the presence of a part-wall defect in the end cap weld of the fuel pins. These defects opened up during reactor operation leading to steam ingress into the fuel, which caused high fuel centre temperature and severe fuel-cladding interaction resulting in secondary failures. A more stringent inspection and quality control of end plug weld during fabrication using ultrasonic test has been recommended to avoid such failure. (author)

Assessment of global guidelines for preventive chemotherapy against schistosomiasis and soil-transmitted helminthiasis: a cost-effectiveness modelling study.

Science.gov (United States)

Lo, Nathan C; Lai, Ying-Si; Karagiannis-Voules, Dimitrios-Alexios; Bogoch, Isaac I; Coulibaly, Jean T; Bendavid, Eran; Utzinger, Jürg; Vounatsou, Penelope; Andrews, Jason R

2016-09-01

WHO guidelines recommend annual treatment for schistosomiasis or soil-transmitted helminthiasis when prevalence in school-aged children is at or above a threshold of 50% and 20%, respectively. Separate treatment guidelines are used for these two helminthiases, and integrated community-wide treatment is not recommended. We assessed the cost-effectiveness of changing prevalence thresholds and treatment guidelines under an integrated delivery framework. We developed a dynamic, age-structured transmission and cost-effectiveness model that simulates integrated preventive chemotherapy programmes against schistosomiasis and soil-transmitted helminthiasis. We assessed a 5-year treatment programme with praziquantel (40 mg/kg per treatment) against schistosomiasis and albendazole (400 mg per treatment) against soil-transmitted helminthiasis at 75% coverage. We defined strategies as highly cost-effective if the incremental cost-effectiveness ratio was less than the World Bank classification for a low-income country (gross domestic product of US$1045 per capita). We calculated the prevalence thresholds for cost-effective preventive chemotherapy of various strategies, and estimated treatment needs for sub-Saharan Africa. Annual preventive chemotherapy against schistosomiasis was highly cost-effective in treatment of school-aged children at a prevalence threshold of 5% (95% uncertainty interval [UI] 1·7-5·2; current guidelines recommend treatment at 50% prevalence) and for community-wide treatment at a prevalence of 15% (7·3-18·5; current recommendation is unclear, some community treatment recommended at 50% prevalence). Annual preventive chemotherapy against soil-transmitted helminthiasis was highly cost-effective in treatment of school-aged children at a prevalence of 20% (95% UI 5·4-30·5; current guidelines recommend treatment at 20% prevalence) and the entire community at 60% (35·3-85·1; no guidelines available). When both helminthiases were co-endemic, prevalence

Management of the athlete with a failed shoulder instability procedure.

Science.gov (United States)

Gwathmey, F Winston; Warner, Jon J P

2013-10-01

The athlete with a failed instability procedure requires a thoughtful and systematic approach to achieve a good outcome. Goals of treatment should be defined and realistic expectations should be set. Revision stabilization has a high rate of recurrent instability, low rates of return to play, and low clinical outcome scores. Fundamental to successful revision surgery is choosing the correct procedure. The decision is straightforward in athletes with clear factors that predict recurrence (significant glenoid bone loss, engaging Hill-Sachs lesions) because only a bony procedure can restore the articular arc of the glenoid. Arthroscopic revision Bankart repair may be appropriate in those athletes who have an obvious Bankart tear and no bone loss after a traumatic reinjury. The challenge for the shoulder surgeon is identifying the best surgery for the athlete who does not have such clear-cut indications. Each factor that has the potential to lead to a poor outcome needs to be collected and calculated. Patient factors (age, laxity, type and level of sport), injury factors (mechanism of injury, capsulolabral injury, glenoid bone loss, Hill-Sachs lesion), and technical factors (previous surgery performed, integrity of repair, scarring) must be integrated into the treatment algorithm. Based on this collection of factors, the shoulder surgeon should be prepared to provide the athlete with the surgery that provides the best chance to return to playing sports and the lowest risk of recurrent instability. Copyright © 2013 Elsevier Inc. All rights reserved.

CT findings in ten patients with failed renal allografts: comparison with findings in functional grafts

International Nuclear Information System (INIS)

Gayer, Gabriela; Apter, Sara; Katz, Rama; Ben-David, Aharon; Katzir, Ze'ev; Hertz, Marjorie

2000-01-01

Our aim is to report the computed tomography (CT) features of the long-term failed renal allograft. Ten patients with failed renal transplants in whom the graft was left in situ underwent CT for various unrelated indications. The majority of the failed grafts showed marked shrinkage and coarse punctate diffuse parenchymal calcifications. Small cysts were seen in four grafts. A long-term failed renal transplant appeared on CT as a small rounded soft tissue mass. The graft was almost always heavily calcified. Lack of awareness of the nature of such a mass may mislead the radiologist in interpreting it as a space-occupying lesion

Why good projects fail anyway.

Science.gov (United States)

Matta, Nadim F; Ashkenas, Ronald N

2003-09-01

Big projects fail at an astonishing rate--more than half the time, by some estimates. It's not hard to understand why. Complicated long-term projects are customarily developed by a series of teams working along parallel tracks. If managers fail to anticipate everything that might fall through the cracks, those tracks will not converge successfully at the end to reach the goal. Take a companywide CRM project. Traditionally, one team might analyze customers, another select the software, a third develop training programs, and so forth. When the project's finally complete, though, it may turn out that the salespeople won't enter in the requisite data because they don't understand why they need to. This very problem has, in fact, derailed many CRM programs at major organizations. There is a way to uncover unanticipated problems while the project is still in development. The key is to inject into the overall plan a series of miniprojects, or "rapid-results initiatives," which each have as their goal a miniature version of the overall goal. In the CRM project, a single team might be charged with increasing the revenues of one sales group in one region by 25% within four months. To reach that goal, team members would have to draw on the work of all the parallel teams. But in just four months, they would discover the salespeople's resistance and probably other unforeseen issues, such as, perhaps, the need to divvy up commissions for joint-selling efforts. The World Bank has used rapid-results initiatives to great effect to keep a sweeping 16-year project on track and deliver visible results years ahead of schedule. In taking an in-depth look at this project, and others, the authors show why this approach is so effective and how the initiatives are managed in conjunction with more traditional project activities.

α1A-Subtype adrenergic agonist therapy for the failing right ventricle.

Science.gov (United States)

Cowley, Patrick M; Wang, Guanying; Joshi, Sunil; Swigart, Philip M; Lovett, David H; Simpson, Paul C; Baker, Anthony J

2017-12-01

Failure of the right ventricle (RV) is a serious disease with a poor prognosis and limited treatment options. Signaling by α 1 -adrenergic receptors (α 1 -ARs), in particular the α 1A -subtype, mediate cardioprotective effects in multiple heart failure models. Recent studies have shown that chronic treatment with the α 1A -subtype agonist A61603 improves function and survival in a model of left ventricular failure. The goal of the present study was to determine if chronic A61603 treatment is beneficial in a RV failure model. We used tracheal instillation of the fibrogenic antibiotic bleomycin in mice to induce pulmonary fibrosis, pulmonary hypertension, and RV failure within 2 wk. Some mice were chronically treated with a low dose of A61603 (10 ng·kg -1 ·day -1 ). In the bleomycin model of RV failure, chronic A61603 treatment was associated with improved RV fractional shortening and greater in vitro force development by RV muscle preparations. Cell injury markers were reduced with A61603 treatment (serum cardiac troponin I, RV fibrosis, and expression of matrix metalloproteinase-2). RV oxidative stress was reduced (using the probes dihydroethidium and 4-hydroxynonenal). Consistent with lowered RV oxidative stress, A61603 was associated with an increased level of the cellular antioxidant superoxide dismutase 1 and a lower level of the prooxidant NAD(P)H oxidase isoform NOX4. In summary, in the bleomycin model of RV failure, chronic A61603 treatment reduced RV oxidative stress, RV myocyte necrosis, and RV fibrosis and increased both RV function and in vitro force development. These findings suggest that in the context of pulmonary fibrosis, the α 1A -subtype is a potential therapeutic target to treat the failing RV. NEW & NOTEWORTHY Right ventricular (RV) failure is a serious disease with a poor prognosis and no effective treatments. In the mouse bleomycin model of RV failure, we tested the efficacy of a treatment using the α 1A -adrenergic receptor subtype

16 CFR 23.22 - Disclosure of treatments to gemstones.

Science.gov (United States)

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Disclosure of treatments to gemstones. 23.22... JEWELRY, PRECIOUS METALS, AND PEWTER INDUSTRIES § 23.22 Disclosure of treatments to gemstones. It is unfair or deceptive to fail to disclose that a gemstone has been treated if: (a) The treatment is not...

Nitrosourea-based chemotherapy for low grade gliomas failing initial treatment with temozolomide.

Science.gov (United States)

Kaloshi, Gentian; Sierra del Rio, Monica; Ducray, François; Psimaras, Dimitri; Idbaih, Ahmed; Laigle-Donadey, Florence; Taillibert, Sophie; Houillier, Caroline; Dehais, Caroline; Omuro, Antonio; Sanson, Marc; Delattre, Jean-Yves; Hoang-Xuan, Khe

2010-12-01

There is a growing evidence of using Temozolomide as upfront therapy for progressive low grade gliomas. No data exist on the efficacy of nitrosoureas as an alternative to radiotherapy in those patients who progress after Temozolomide. We retrospectively reviewed 30 patients with median age of 46 years. Twenty-one patients had pure oligodendrogliomas. Thirteen patients had a non-enhancing tumor at progression after Temozolomide. The chromosomes 1p/19q were co-deleted in 5 cases and retained in 10 cases. Response rate was 10% (3 minor responses achieved in non-enhancing tumors). Tolerance was acceptable (17% grade III and IV myelosupression). Median PFS was 6.5 months. Median OS from start of salvage treatment was 23.4 months. Tumors without contrast enhancement demonstrated a better prognosis than those with contrast enhancement both in term of PFS (P = 0.0003) and OS (P = 0.0006). Chromosomes 1p/19q codeletion was not predictive for objective response to salvage treatment but correlated with a better PFS (P = 0.02). In conclusion, salvage NU chemotherapy provide disappointing results in TMZ-pretreated low grade gliomas (LGG), which should be treated in priority by conventional radiotherapy especially in LGG that display contrast enhancement at progression.

Salvage Flexor Hallucis Longus Transfer for a Failed Achilles Repair: Endoscopic Technique.

Science.gov (United States)

Gonçalves, Sérgio; Caetano, Rubén; Corte-Real, Nuno

2015-10-01

Flexor hallucis longus (FHL) transfer is a well-established treatment option in failed Achilles tendon (AT) repair and has been routinely performed as an open procedure. We detail the surgical steps needed to perform an arthroscopic transfer of the FHL for a chronic AT rupture. The FHL tendon is harvested as it enters in its tunnel beneath the sustentaculum tali; a tunnel is then drilled in the calcaneus as near to the AT footprint as possible. By use of a suture-passing device, the free end of the FHL is advanced to the plantar aspect of the foot. After adequate tension is applied to the construct, the tendon is fixed in place with an interference screw in an inside-out fashion. This minimally invasive approach is a safe and valid alternative to classic open procedures with the obvious advantages of preserving the soft-tissue envelope and using a biologically intact tendon.

BENEFITS OF SHIRODKAR STITCH IN WOMEN WITH FAILED ...

African Journals Online (AJOL)

2011-06-06

Jun 6, 2011 ... This is a case series presentation of 14 cases where Shirodkar stitch was inserted after failed McDonald stitch. The patients were either self referrals or from Obstetricians in Eastern Africa region. All the patients were able to carry the pregnancies to term and were delivered by Caesarean section.

Optimising cluster survey design for planning schistosomiasis preventive chemotherapy.

Directory of Open Access Journals (Sweden)

Sarah C L Knowles

2017-05-01

Full Text Available The cornerstone of current schistosomiasis control programmes is delivery of praziquantel to at-risk populations. Such preventive chemotherapy requires accurate information on the geographic distribution of infection, yet the performance of alternative survey designs for estimating prevalence and converting this into treatment decisions has not been thoroughly evaluated.We used baseline schistosomiasis mapping surveys from three countries (Malawi, Côte d'Ivoire and Liberia to generate spatially realistic gold standard datasets, against which we tested alternative two-stage cluster survey designs. We assessed how sampling different numbers of schools per district (2-20 and children per school (10-50 influences the accuracy of prevalence estimates and treatment class assignment, and we compared survey cost-efficiency using data from Malawi. Due to the focal nature of schistosomiasis, up to 53% simulated surveys involving 2-5 schools per district failed to detect schistosomiasis in low endemicity areas (1-10% prevalence. Increasing the number of schools surveyed per district improved treatment class assignment far more than increasing the number of children sampled per school. For Malawi, surveys of 15 schools per district and 20-30 children per school reliably detected endemic schistosomiasis and maximised cost-efficiency. In sensitivity analyses where treatment costs and the country considered were varied, optimal survey size was remarkably consistent, with cost-efficiency maximised at 15-20 schools per district.Among two-stage cluster surveys for schistosomiasis, our simulations indicated that surveying 15-20 schools per district and 20-30 children per school optimised cost-efficiency and minimised the risk of under-treatment, with surveys involving more schools of greater cost-efficiency as treatment costs rose.

Detecting failed elements on phased array ultrasound transducers using the Edinburgh Pipe Phantom

Science.gov (United States)

Inglis, Scott; Pye, Stephen D

2016-01-01

Aims Imaging faults with ultrasound transducers are common. Failed elements on linear and curvilinear array transducers can usually be detected with a simple image uniformity or ‘paperclip’ test. However, this method is less effective for phased array transducers, commonly used in cardiac imaging. The aim of this study was to assess whether the presence of failed elements could be detected through measurement of the resolution integral (R) using the Edinburgh Pipe Phantom. Methods A 128-element paediatric phased array transducer was studied. Failed elements were simulated using layered polyvinyl chloride (PVC) tape as an attenuator and measurements of resolution integral were carried out for several widths of attenuator. Results All widths of attenuator greater than 0.5 mm resulted in a significant reduction in resolution integral and low contrast penetration measurements compared to baseline (p tests to detect failed elements on phased array transducers. Particularly encouraging is the result for low contrast penetration as this is a quick and simple measurement to make and can be performed with many different test objects, thus enabling ‘in-the-field’ checks. PMID:27482276

A fail-safe design for X-ray safety shutters

International Nuclear Information System (INIS)

Cramer, W.E.; Port, E.A.

1982-01-01

The purpose of any safety shutter device is to help minimize radiation exposure to personnel. Many such devices for analytical X-ray work may fail in a mode with great potential for injury. The authors present a design that may be used to modify any existing mechanical or electro-mechanical system that utilizes a gate which blocks an aperture to control exposure. The system is of 'fail-safe' design, as defined in the National Bureau of Standards Handbook 111 (American National Standards Institute, 1972); One in which all reasonable anticipated failures of indicator or safety components will cause the equipment to respond in a mode ensuring that personnel are safe from exposure to radiation. The system has visible indicators that make the user aware that a particular failure has occurred; in addition, X-ray generation ceases. (Auth.)

14C release from failed spent fuel containers

International Nuclear Information System (INIS)

Pescatore, C.

1990-01-01

Partially failed containers may provide a meaningful barrier to the release of gaseous radionuclides. A modeling approach is outlined and sample calculations are provided that show the effects on release due to a limited perforation area, to decreasing temperature, and to the partial occlusion of the perforated area by corrosion products. 8 refs., 2 tabs

In situ repair of a failed compression fitting

Science.gov (United States)

Wolbert, Ronald R.; Jandrasits, Walter G.

1986-01-01

A method and apparatus for the in situ repair of a failed compression fitg is provided. Initially, a portion of a guide tube is inserted coaxially in the bore of the compression fitting and locked therein. A close fit dethreading device is then coaxially mounted on the guide tube to cut the threads from the fitting. Thereafter, the dethreading device and guide tube are removed and a new fitting is inserted onto the dethreaded fitting with the body of the new fitting overlaying the dethreaded portion. Finally, the main body of the new fitting is welded to the main body of the old fitting whereby a new threaded portion of the replacement fitting is precisely coaxial with the old threaded portion. If needed, a bushing is located on the dethreaded portion which is sized to fit snugly between the dethreaded portion and the new fitting. Preferably, the dethreading device includes a cutting tool which is moved incrementally in a radial direction whereby the threads are cut from the threaded portion of the failed fitting in increments.

We still fail to account for Mendel's observations

Directory of Open Access Journals (Sweden)

Porteous John W

2004-08-01

Full Text Available Abstract Background The present article corrects common textbook accounts of Mendel's experiments by re-establishing what he wrote and how he accounted for his observations. It notes the long-established tests for the validity of any explanations that purport to explain observations obtained by experiment. Application of these tests to Mendel's paper shows that the arguments he used to explain his observations were internally consistent but were, on one crucial issue, implausible. The same tests are applied to the currently accepted explanation for Mendel's observations. Conclusions The currently favoured explanation for Mendel's observations is untenable. It misrepresents Mendel, fails to distinguish between the parameters and the variables of any system of interacting components, its arguments are inconsistent, it repeats the implausibility in Mendel's paper, fails to give a rational explanation for his observed 3:1 trait ratio and cannot explain why this ratio is not always observed in experimental practice. A rational explanation for Mendel's observations is initiated. Readers are challenged to complete the process before a further article appears.

Combined effectiveness of anthelmintic chemotherapy and WASH among HIV-infected adults.

Directory of Open Access Journals (Sweden)

Arianna R Means

2018-01-01

Full Text Available Current global helminth control guidelines focus on regular deworming of targeted populations for morbidity control. However, water, sanitation, and hygiene (WASH interventions may also be important for reducing helminth transmission. We evaluated the impact of different potential helminth protective packages on infection prevalence, including repeated treatment with albendazole and praziquantel with and without WASH access.We conducted a cohort study nested within a randomized trial of empiric deworming of HIV-infected adults in Kenya. Helminth infections and infection intensity were diagnosed using semi-quantitative real-time PCR. We conducted a manual forward stepwise model building approach to identify if there are packages of interventions that may be protective against an STH infection of any species (combined outcome and each helminth species individually. We conducted secondary analyses using the same approach only amongst individuals with no anthelmintis exposure. We used interaction terms to test for potential intervention synergy. Approximately 22% of the 701 stool samples provided were helminth-infected, most of which were of low to moderate intensity. The odds of infection with any STH species were lower for individuals who were treated with albendazole (aOR:0.11, 95%CI: 0.05, 0.20, p<0.001, adjusting for age and sex. Although most WASH conditions demonstrated minimal additional benefit in reducing the probability of infection with any STH species, access to safe flooring did appear to offer some additional protection (aOR:0.34, 95%CI: 0.20, 0.56, p<0.001. For schistosomiasis, only treatment with praziquantel was protective (aOR:0.30 95%CI: 0.14, 0.60, p = 0.001. Amongst individuals who were not treated with albendazole or praziquantel, the most protective intervention package to reduce probability of STH infections included safe flooring (aOR:0.34, 95%CI: 0.20, 0.59, p<0.001 and latrine access (aOR:0.59, 95%CI: 0.35, 0.99, p = 0

Novel use of platelet-rich fibrin matrix and MTA as an apical barrier in the management of a failed revascularization case.

Science.gov (United States)

Yadav, Pankaj; Pruthi, Preeti Jain; Naval, Ruchika Roongta; Talwar, Sangeeta; Verma, Mahesh

2015-08-01

We report management of a failed revascularization/revitalization case, which could be due to inadequate removal of biofilm and bacteria in dentinal tubules. The use of an apical matrix barrier in form of a platelet-rich fibrin (PRF) membrane for stabilization of MTA in root end apexification procedure is described. The canal was cleansed of old MTA present in the cervical third using H files, irrigated using saline and finally irrigated with 2.5% NaOCl and saline. To obtain canal disinfection, calcium hydroxide paste was temporized in the canal. In subsequent appointments, PRF was placed at the root tip followed by 5-mm apical plug with mineral trioxide aggregate. One week later, the root canal was obturated with thermoplasticized gutta-percha. A 6-month and a 2-year follow ups showed reduction of periapical radiolucency and adequately functional tooth. One-visit apexification techniques provide an alternative treatment for failed revascularization cases. Follow up confirmed complete healing periradicularly. Apexification in one step using an apical barrier of PRF and a plug of MTA can be considered a predictable treatment and may be an alternative to long-term revascularization failures. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Failed fuel detection device

International Nuclear Information System (INIS)

Doi, Akira.

1994-01-01

The device of the present invention concerns a failed fuel detection device for a nuclear reactor, such as an FBR type reactor, using electroconductive coolants. A sampling port is disposed at the upper portion of the fuel assembly so as to cover the assembly, so that coolants in the fuel assembly are sampled to improve a device for detecting fuel failure. That is, when coolants in the fuel assembly are sampled from the sampling port, the flow of electroconductive coolants in an sampling tube is detected by a flowmeter, to control an electromagnetic pump. The flow of electroconductive coolants is stopped against the waterhead pressure and dynamic pressure of the conductive coolants, and a predetermined amount of the coolants is pumped up to the sampling tank. Gas is supplied to the pumped up coolants so that fissile products are transferred from the coolants to a gas phase. Radiation in the gas in a gas recycling system is measured to detect presence of fuel failure. (I.S.)

Design study and comparative evaluation of JSFR failed fuel detection system

Energy Technology Data Exchange (ETDEWEB)

Aizawa, K.; Chikazawa, Y.; Ishikawa, N. [Japan Atomic Energy Agency JAEA, 4002 Narita, Oarai, Higashi-ibaraki-gun, Ibaraki 311-1393 (Japan); Kubo, S. [Japan Atomic Power Company JAPC (Japan); Okazaki, H.; Mito, M. [Mitsubishi FBR Systems, Inc. MFBR (Japan); Tozawa, K. [Fuji Electric Co., Ltd. (Japan); Hayashi, M. [MitsubishiElectric Corporation (Japan)

2012-07-01

A conceptual design study of an advanced sodium-cooled fast reactor JSFR has progressed in the 'Fast Reactor Cycle Technology Development (FaCT) 'project in Japan. JSFR has two failed fuel detection systems in the core. One is a failed fuel detection (FFD) system which continuously monitors a fission product from failed fuel subassembly. The other is a failed fuel detection and location (FFDL) system which locates when it receives signals from FFD. The FFD system consists of a FFD-DN which detects delayed neutron (DN) in sodium and a FFD-CG which detects fission products in the cover gas of the reactor vessel. In this study, requirements to the FFD-DN and the FFD-DN design to meet the requirements were investigated for the commercial and demonstration JSFR. In the commercial JSFR, a sampling type FFD which collects sodium from the reactor vessel by sampling lines for DN detectors was adopted. The performances have been investigated and confirmed by a fluid analysis in the reactor upper plenum. In the demonstration JSFR, the performance of DN detectors installed on the primary cold-leg piping has been confirmed. For the FFDL systems, experiences in the previous fast reactors and the R and D of FFDL system for JSFR were investigated. This study focuses on the Selector-Valve and the Tagging-Gas FFDL systems. Operation experiences of the Selector-valve FFDL system were accumulated in PFR and Phenix. Tagging-gas system experiences were accumulated in EBR-II and FFTF. The feasibility of both FFDL systems for JSFR was evaluated. (authors)

Randomised study of Casodex 50 MG monotherapy vs orchidectomy in the treatment of metastatic prostate cancer. The Scandinavian Casodex Cooperative Group

DEFF Research Database (Denmark)

Iversen, P; Tveter, K; Varenhorst, E

1996-01-01

% in the orchidectomy group. Treatment failed in 51 patients in the orchidectomy group and 66 showed a subjective response. Treatment failed in 86 patients treated with Casodex and 40 patients showed a subjective response. Patients treated with Casodex maintained their sexual interest better than those...

Earthquake recurrence models fail when earthquakes fail to reset the stress field

Science.gov (United States)

Tormann, Thessa; Wiemer, Stefan; Hardebeck, Jeanne L.

2012-01-01

Parkfield's regularly occurring M6 mainshocks, about every 25 years, have over two decades stoked seismologists' hopes to successfully predict an earthquake of significant size. However, with the longest known inter-event time of 38 years, the latest M6 in the series (28 Sep 2004) did not conform to any of the applied forecast models, questioning once more the predictability of earthquakes in general. Our study investigates the spatial pattern of b-values along the Parkfield segment through the seismic cycle and documents a stably stressed structure. The forecasted rate of M6 earthquakes based on Parkfield's microseismicity b-values corresponds well to observed rates. We interpret the observed b-value stability in terms of the evolution of the stress field in that area: the M6 Parkfield earthquakes do not fully unload the stress on the fault, explaining why time recurrent models fail. We present the 1989 M6.9 Loma Prieta earthquake as counter example, which did release a significant portion of the stress along its fault segment and yields a substantial change in b-values.

14C release from failed spent fuel containers

International Nuclear Information System (INIS)

Pescatore, C.

1989-01-01

Partially failed containers may provide a meaningful barrier to the release of gaseous 14 CO 2 . A modeling approach is outlined and sample calculations are provided that show the effect on release due to a limited perforation area, to decreasing temperature, and to partial occlusion of the perforated area by corrosion products. 5 refs., 4 tabs

Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty

DEFF Research Database (Denmark)

Aasvang, E K; Laursen, M B; Madsen, J

2018-01-01

include the risk for intraoperative failed spinal anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small-scale studies suggest incidences from 1 to 17%; however, no multi-institutional large data exists on failed spinal incidence and related factors during THA....../TKA, hindering evidence-based information and potential anaesthesia stratification. METHODS: In a sub-analysis, data from a prospective study on spinal anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general anaesthesia. Potential perioperative factors (age, gender, American...... Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from spinal administration until end of surgery) were analysed with logistic regression for relation to failed spinal anaesthesia. RESULTS: In all, 1451 patients were included for analysis...

Benefits of extra begging fail to compensate for immunological costs in southern shrike (Lanius meridionalis nestlings.

Directory of Open Access Journals (Sweden)

Gregorio Moreno-Rueda

Full Text Available Theoretical models aimed at explaining the evolution of honest, informative begging signals employed by nestling birds to solicit food from their parents, require that dishonest signalers incur a net viability cost in order to prevent runaway escalation of signal intensity over evolutionary time. Previous attempts to determine such a cost empirically have identified two candidate physiological costs associated with exaggerated begging: a growth and an immunological cost. However, they failed to take into account the fact that those costs are potentially offset by the fact that nestlings that invest more in begging are also likely to obtain more food. In this study, we test experimentally whether a 25% increase in ingested food compensates for growth and immunological costs of extra begging in southern shrike (Lanius meridionalis nestlings. Three nestmates matched by size were given three treatments: low begging, high begging-same food intake, and high begging-extra food intake. We found that, while a higher food intake did effectively compensate for the growth cost, it failed to compensate for the immunological cost, measured as T-cell mediated immune response against an innocuous mitogen. Thus, we show for the first time that escalated begging has an associated physiological net cost likely to affect nestling survival negatively.

Understanding "Failed" Markets: Conflicting Logics and Dissonance in Attempts to Price the Priceless Child

NARCIS (Netherlands)

Vermeulen, P.A.M.; Ansari, S.; Lounsbury, M.; Gehman, J.; Lounsbury, M.; Greenwood, R.

2017-01-01

While scholars have developed increasingly well-developed accounts of institutional change, little attention has been paid to how change is resisted and, in particular, how efforts to marketize fail. We draw on the institutional logics perspective to guide analysis of an empirical case of the failed

The Failed Image and the Possessed

DEFF Research Database (Denmark)

Suhr, Christian

2015-01-01

This article asks if the recurrent queries regarding the value of images in visual anthropology could find new answers by exploring responses to visual media in neo-orthodox Islam. It proposes that the visual display of the photographic image shares a curious resemblance to the bodies of people...... possessed by invisible spirits called jinn. The image as a failed example or model of reality works like the possessed body as an amplifier of invisibility pointing towards that which cannot be seen, depicted visually, or represented in writing. This suggests a negative epistemology in which images obtain...

Why fish oil fails: a comprehensive 21st century lipids-based physiologic analysis.

Science.gov (United States)

Peskin, B S

2014-01-01

The medical community suffered three significant fish oil failures/setbacks in 2013. Claims that fish oil's EPA/DHA would stop the progression of heart disease were crushed when The Risk and Prevention Study Collaborative Group (Italy) released a conclusive negative finding regarding fish oil for those patients with high risk factors but no previous myocardial infarction. Fish oil failed in all measures of CVD prevention-both primary and secondary. Another major 2013 setback occurred when fish oil's DHA was shown to significantly increase prostate cancer in men, in particular, high-grade prostate cancer, in the Selenium and Vitamin E Cancer Prevention Trial (SELECT) analysis by Brasky et al. Another monumental failure occurred in 2013 whereby fish oil's EPA/DHA failed to improve macular degeneration. In 2010, fish oil's EPA/DHA failed to help Alzheimer's victims, even those with low DHA levels. These are by no means isolated failures. The promise of fish oil and its so-called active ingredients EPA / DHA fails time and time again in clinical trials. This lipids-based physiologic review will explain precisely why there should have never been expectation for success. This review will focus on underpublicized lipid science with a focus on physiology.

The Effect of Dexmedetomidine on Lumbar Epidural Injection for Failed Back Surgery Syndrome

Directory of Open Access Journals (Sweden)

Ashraf Eskandr

2016-01-01

Full Text Available Purpose. Failed back surgery syndrome is a chronic pain condition requiring rapid, effective, and efficient management. This study evaluates the effect of adding dexmedetomidine to lumbar epidural steroids in patients with failed back surgery syndrome. Methods. Fifty patients suffering from failed back surgery syndrome were randomly assigned to one of two groups, receiving an epidural injection of 20 mL of either a mixture of betamethasone (14 mg and bupivacaine 0.5 mg (group C or a mixture of betamethasone (14 mg, bupivacaine 0.5 mg, and dexmedetomidine (0.5 μg/kg (group D adjusted to the volume with normal saline. The effect was evaluated using visual analogue scale (VAS, analgesic requirement, and Oswestry disability index 2 weeks, 4 weeks, 8 weeks, and 12 weeks after injection. Results. VAS and ibuprofen consumption showed a significant reduction in group D. The Oswestry disability index was significantly improved in group D. There were no records of hypotension, bradycardia, sedation, or hypoxemia in both groups. Conclusion. The present study demonstrated potential safe and effective usage of adding dexmedetomidine to epidural steroid to control pain in patients with failed back surgery syndrome.

Fail forward: Mitigating failure in energy research and innovation

DEFF Research Database (Denmark)

Brix, Jacob

2015-01-01

Almost three quarters of all innovation projects disappoint or fail. Instead of 'wasting' human and financial resources on energy projects that end up being terminated or ineffectual, this study offers a potential antidote coined the 'Origins of Failure in Energy Innovation' (OFEI) model. Based o...

The dilemma of the failed state thesis in post-9/11 world affairs

Directory of Open Access Journals (Sweden)

A. Schoeman

2008-07-01

Full Text Available The 9/11 terrorist attacks shifted the emphasis of failed states as just a regional humanitarian problem to one that could present a global security threat. In this regard US policymakers, especially, identified failed states as possible terrorist threats. However, this renewed attention to the study of state failure has exposed a number of theoretical weaknesses in this body of literature. The latter could mainly be ascribed to the way in which US policy makers have often used generalised definitions of failed states and then applied it to states that are perceived as threats. Another problem is the fact that government sponsored research institutes and think tanks are operating independently from university academics. This situation has caused theoretical confusion as conditions in failed states are often interpreted differently resulting in the development of a number of opposing theories, definitions and confusing classification models. The body of literature is further accused of endorsing a “Weberian” definition (ideal type of the state against which degrees of “failure” in non-complying states are measured. This article will investigate the extent of these theoretical weaknesses and expose the dangers of following an approach that seem to misinterpret the political realities of developing states (often regarded as failed – this despite having an extensive popular following. It will further focus on possible alternative approaches – or the formulation of ideas that are better suited and relevant to the often unique internal political, social and economic dynamics of unstable states.

Economy Over Security: Why Crises Fail to Impact Economic Behavior in East Asia

Science.gov (United States)

2017-12-01

SECURITY: WHY CRISES FAIL TO IMPACT ECONOMIC BEHAVIOR IN EAST ASIA by Aaron R. Sipos December 2017 Thesis Advisor: Michael Glosny Second...REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE ECONOMY OVER SECURITY: WHY CRISES FAIL TO IMPACT ECONOMIC BEHAVIOR IN EAST...release. Distribution is unlimited. 12b. DISTRIBUTION CODE 13. ABSTRACT (maximum 200 words) This study examines changes in economic behavior in

Water (electrolyte) balance after abdominal therapeutic treatment

Energy Technology Data Exchange (ETDEWEB)

Cionini, L; Becciolini, A; Giannardi, G [Florence Univ. (Italy). Istituto di Radiologia

1976-07-01

Total body water, plasma volume and Na space have been studied in 34 patients receiving external radiotherapy on the pelvic region. Determinations were made on the same patients before, and half-way treatment; in a few cases, some determinations were also repeated after the end of treatment. The results failed to show any appreciable modification of the different parameters studied.

Detector for failed fuel elements

International Nuclear Information System (INIS)

Ito, Masaru.

1979-01-01

Purpose: To provide automatic monitor for the separation or reactor water and sampling water, in a failed fuel element detector using a sipping chamber. Constitution: A positional detector for the exact mounting of a sipping chamber on a channel box and a level detector for the detection of complete discharge of cooling water in the sipping chamber are provided in the sipping chamber. The positional detector is contacted to the upper end of the channel box and operated when the sipping chamber is correctly mounted to the fuel assemblies. The level detector comprises a float and a limit switch and it is operated when the water in the sipping chamber is discharged by a predetermined amount. Isolation of reactor water and sampling water are automatically monitored by the signal from these two detectors. (Ikeda, J.)

Laparoscopic reoperation with total fundoplication for failed Heller myotomy: is it a possible option? Personal experience and review of literature.

Science.gov (United States)

Rossetti, Gianluca; del Genio, Gianmattia; Maffettone, Vincenzo; Fei, Landino; Brusciano, Luigi; Limongelli, Paolo; Pizza, Francesco; Tolone, Salvatore; Di Martino, Maria; del Genio, Federica; del Genio, Alberto

2009-01-01

Laparoscopic Heller myotomy with antireflux procedure seems the procedure of choice in the treatment of patients with esophageal achalasia. Persistent or recurrent symptoms occur in 10% to 20% of patients. Few reports on reoperation after failed Heller myotomy have been published. No author has reported the realization of a total fundoplication in these patient groups. The aim of this study is to evaluate the efficacy of laparoscopic reoperation with the realization of a total fundoplication after failed Heller myotomy for esophageal achalasia. From 1992 to December 2007, 5 out of a series of 242 patients (2.1%), along with 2 patients operated elsewhere, underwent laparoscopic reintervention for failed Heller myotomy. Symptoms leading to reoperation included persistent dysphagia in 3 patients, recurrent dysphagia in another 3, and heartburn in 1 patient. Mean time from the first to the second operation was 49.7 months (range, 4-180 months). Always, the intervention was completed via a laparoscopic approach and a Nissen-Rossetti fundoplication was realized or left in place after a complete Heller myotomy. Mean operative time was 160 minutes (range, 60-245 minutes). Mean postoperative hospital stay was 3.1 +/- 1.5 days. No major morbidity or mortality occurred. At a mean follow-up of 16.1 months, reoperation must be considered successful in 5 out of 7 patients (71.4%). The dysphagia DeMeester score fell from 2.71 +/- 0.22 to 0.91 +/- 0.38 postoperatively. The regurgitation score changed from 2.45 +/- 0.34 to 0.68 +/- 0.23. Laparoscopic reoperation for failed Heller myotomy with the realization of a total fundoplication is safe and is associated with good long-term results if performed by an experienced surgeon in a center with a long tradition of esophageal surgery.

Challenges and achievements of instrumentation for failed fuel identification in PFBR

International Nuclear Information System (INIS)

Upadhyay, Chandra Kant; Sivaramakrishna, M.; Nageswaran, A.; Nagaraj, C.P.; Madhusoodanan, K.; Krishnakumar, B.

2010-01-01

Failed fuel identification system is provided to locate and remove the failed fuel sub assembly. It comprises of selector valve mechanism to sample the flow from each assembly and associated instrumentation to detect the activity in the sample, indicating the clad failure of the respective subassembly. The development includes sampling pump, its power supply, motor to rotate the selector valve, encoder, brake, gear box, neutron detectors and Instrumentation and Control for all these with interlocks and related logic. These systems are expected to work under many physical constraints and in harsh environmental conditions, such as high temperature. This paper discusses the various challenges and achievements towards this system design. (author)

Moving from control to elimination of schistosomiasis in sub-Saharan Africa: time to change and adapt strategies.

Science.gov (United States)

Tchuem Tchuenté, Louis-Albert; Rollinson, David; Stothard, J Russell; Molyneux, David

2017-02-20

Schistosomiasis is a water borne parasitic disease of global importance and with ongoing control the disease endemic landscape is changing. In sub-Saharan Africa, for example, the landscape is becoming ever more heterogeneous as there are several species of Schistosoma that respond in different ways to ongoing preventive chemotherapy and the inter-sectoral interventions currently applied. The major focus of preventive chemotherapy is delivery of praziquantel by mass drug administration to those shown to be, or presumed to be, at-risk of infection and disease. In some countries, regional progress may be uneven but in certain locations there are very real prospects to transition from control into interruption of transmission, and ultimately elimination. To manage this transition requires reconsideration of some of the currently deployed diagnostic tools used in surveillance and downward realignment of existing prevalence thresholds to trigger mass treatment. A key challenge will be maintaining and if possible, expanding the current donation of praziquantel to currently overlooked groups, then judging when appropriate to move from mass drug administration to selective treatment. In so doing, this will ensure the health system is adapted, primed and shown to be cost-effective to respond to these changing disease dynamics as we move forward to 2020 targets and beyond.

Feasibility of salvage interstitial microwave thermal therapy for prostate carcinoma following failed brachytherapy: studies in a tissue equivalent phantom

International Nuclear Information System (INIS)

McCann, Claire; Kumaradas, J Carl; Gertner, Mark R; Davidson, Sean R H; Dolan, Alfred M; Sherar, Michael D

2003-01-01

Thermal therapy is an experimental treatment to destroy solid tumours by heating them to temperatures ranging from 55 deg C to 90 deg C, inducing thermal coagulation and necrosis of the tumour. We are investigating the feasibility of interstitial microwave thermal therapy as a salvage treatment for prostate cancer patients with local recurrence following failed brachytherapy. Due to the electrical and thermal conductivity of the brachytherapy seeds, we hypothesized that the seeds could scatter the microwave energy and cause unpredictable heating. To investigate this, a 915 MHz helical antenna was inserted into a muscle-equivalent phantom with and without brachytherapy seeds. Following a 10 W, 5 s input to the antenna, the temperature rise was used to calculate absorbed power, also referred to as specific absorption rate (SAR). Plane wave models based on Maxwell's equations were also used to characterize the electromagnetic scattering effect of the seeds. In addition, the phantom was heated with 8 W for 5 min to quantify the effect of the seeds on the temperature distribution during extended heating. SAR measurements indicated that the seeds had no significant effect on the shape and size of the SAR pattern of the antenna. However, the plane wave simulations indicated that the seeds could scatter the microwave energy resulting in hot spots at the seed edges. Lack of experimental evidence of these hot spots was probably due to the complex polarization of the microwaves emitted by the helical antenna. Extended heating experiments also demonstrated that the seeds had no significant effect on the temperature distributions and rates of temperature rise measured in the phantom. The results indicate that brachytherapy seeds are not a technical impediment to interstitial microwave thermal therapy as a salvage treatment following failed brachytherapy

49 CFR 26.47 - Can recipients be penalized for failing to meet overall goals?

Science.gov (United States)

2010-10-01

... Goals, Good Faith Efforts, and Counting § 26.47 Can recipients be penalized for failing to meet overall... administer your program in good faith. (b) If you do not have an approved DBE program or overall goal, or if you fail to implement your program in good faith, you are in noncompliance with this part. ...

Organization Theory: Bright Prospects for a Permanently Failing Field

NARCIS (Netherlands)

P.P.M.A.R. Heugens (Pursey)

2008-01-01

textabstractOrganization theory is a paradoxical field of scientific inquiry. It has struggled for more than fifty years to develop a unified theory of organizational effectiveness under girded by a coherent set of assumptions, and it has thus far failed to produce one. Yet, by other standards it is

IS TREATMENT-RESISTANCE IN PSYCHIATRIC DISORDERS A TRAP FOR POLYPHARMACY?

OpenAIRE

Jašović-Gašić, Miroslava

2015-01-01

Background: Nowadays, more and more mental health professionals manage patients who fail treatment for major psychiatric disorders. There is not a consensus on how to deal with treatment-resistance patients, but usually psychiatrists result to polypharmacy. Method: In reviewing the evidence based clinical research we will try to answer some questions about treatment-resistant psychiatric disorders. Treatment-resistant symptoms complicate the clinical course of all psychiatric diso...

Failed magmatic eruptions: Late-stage cessation of magma ascent

Science.gov (United States)

Moran, S.C.; Newhall, C.; Roman, D.C.

2011-01-01

When a volcano becomes restless, a primary question is whether the unrest will lead to an eruption. Here we recognize four possible outcomes of a magmatic intrusion: "deep intrusion", "shallow intrusion", "sluggish/viscous magmatic eruption", and "rapid, often explosive magmatic eruption". We define "failed eruptions" as instances in which magma reaches but does not pass the "shallow intrusion" stage, i. e., when magma gets close to, but does not reach, the surface. Competing factors act to promote or hinder the eventual eruption of a magma intrusion. Fresh intrusion from depth, high magma gas content, rapid ascent rates that leave little time for enroute degassing, opening of pathways, and sudden decompression near the surface all act to promote eruption, whereas decreased magma supply from depth, slow ascent, significant enroute degassing and associated increases in viscosity, and impingement on structural barriers all act to hinder eruption. All of these factors interact in complex ways with variable results, but often cause magma to stall at some depth before reaching the surface. Although certain precursory phenomena, such as rapidly escalating seismic swarms or rates of degassing or deformation, are good indicators that an eruption is likely, such phenomena have also been observed in association with intrusions that have ultimately failed to erupt. A perpetual difficulty with quantifying the probability of eruption is a lack of data, particularly on instances of failed eruptions. This difficulty is being addressed in part through the WOVOdat database. Papers in this volume will be an additional resource for scientists grappling with the issue of whether or not an episode of unrest will lead to a magmatic eruption.

Why Fish Oil Fails: A Comprehensive 21st Century Lipids-Based Physiologic Analysis

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B. S. Peskin

2014-01-01

Full Text Available The medical community suffered three significant fish oil failures/setbacks in 2013. Claims that fish oil’s EPA/DHA would stop the progression of heart disease were crushed when The Risk and Prevention Study Collaborative Group (Italy released a conclusive negative finding regarding fish oil for those patients with high risk factors but no previous myocardial infarction. Fish oil failed in all measures of CVD prevention—both primary and secondary. Another major 2013 setback occurred when fish oil’s DHA was shown to significantly increase prostate cancer in men, in particular, high-grade prostate cancer, in the Selenium and Vitamin E Cancer Prevention Trial (SELECT analysis by Brasky et al. Another monumental failure occurred in 2013 whereby fish oil’s EPA/DHA failed to improve macular degeneration. In 2010, fish oil’s EPA/DHA failed to help Alzheimer’s victims, even those with low DHA levels. These are by no means isolated failures. The promise of fish oil and its so-called active ingredients EPA / DHA fails time and time again in clinical trials. This lipids-based physiologic review will explain precisely why there should have never been expectation for success. This review will focus on underpublicized lipid science with a focus on physiology.

[Hospitals failing minimum volumes in 2004: reasons and consequences].

Science.gov (United States)

Geraedts, M; Kühnen, C; Cruppé, W de; Blum, K; Ohmann, C

2008-02-01

In 2004 Germany introduced annual minimum volumes nationwide on five surgical procedures: kidney, liver, stem cell transplantation, complex oesophageal, and pancreatic interventions. Hospitals that fail to reach the minimum volumes are no longer allowed to perform the respective procedures unless they raise one of eight legally accepted exceptions. The goal of our study was to investigate how many hospitals fell short of the minimum volumes in 2004, whether and how this was justified, and whether hospitals that failed the requirements experienced any consequences. We analysed data on meeting the minimum volume requirements in 2004 that all German hospitals were obliged to publish as part of their biannual structured quality reports. We performed telephone interviews: a) with all hospitals not achieving the minimum volumes for complex oesophageal, and pancreatic interventions, and b) with the national umbrella organisations of all German sickness funds. In 2004, one quarter of all German acute care hospitals (N=485) performed 23,128 procedures where minimum volumes applied. 197 hospitals (41%) did not meet at least one of the minimum volumes. These hospitals performed N=715 procedures (3.1%) where the minimum volumes were not met. In 43% of these cases the hospitals raised legally accepted exceptions. In 33% of the cases the hospitals argued using reasons that were not legally acknowledged. 69% of those hospitals that failed to achieve the minimum volumes for complex oesophageal and pancreatic interventions did not experience any consequences from the sickness funds. However, one third of those hospitals reported that the sickness funds addressed the issue and partially announced consequences for the future. The sickness funds' umbrella organisations stated that there were only sparse activities related to the minimum volumes and that neither uniform registrations nor uniform proceedings in case of infringements of the standards had been agreed upon. In spite of the

Delay factors in failed construction projects in southwestern Nigeria ...

African Journals Online (AJOL)

This study was carried out with a view to showing the contribution of delay factors in the overall consideration of failed construction projects in south western Nigeria. This is considered necessary because the traditional view of construction project failure as consisting mainly of structural or functional failures tends to excuse ...

Targeted Gene-Silencing Reveals the Functional Significance of Myocardin Signaling in the Failing Heart

Science.gov (United States)

Torrado, Mario; Iglesias, Raquel; Centeno, Alberto; López, Eduardo; Mikhailov, Alexander T.

2011-01-01

Background Myocardin (MYOCD), a potent transcriptional coactivator of smooth muscle (SM) and cardiac genes, is upregulated in failing myocardium in animal models and human end-stage heart failure (HF). However, the molecular and functional consequences of myocd upregulation in HF are still unclear. Methodology/Principal Findings The goal of the present study was to investigate if targeted inhibition of upregulated expression of myocd could influence failing heart gene expression and function. To this end, we used the doxorubicin (Dox)-induced diastolic HF (DHF) model in neonatal piglets, in which, as we show, not only myocd but also myocd-dependent SM-marker genes are highly activated in failing left ventricular (LV) myocardium. In this model, intra-myocardial delivery of short-hairpin RNAs, designed to target myocd variants expressed in porcine heart, leads on day 2 post-delivery to: (1) a decrease in the activated expression of myocd and myocd-dependent SM-marker genes in failing myocardium to levels seen in healthy control animals, (2) amelioration of impaired diastolic dysfunction, and (3) higher survival rates of DHF piglets. The posterior restoration of elevated myocd expression (on day 7 post-delivery) led to overexpression of myocd-dependent SM-marker genes in failing LV-myocardium that was associated with a return to altered diastolic function. Conclusions/Significance These data provide the first evidence that a moderate inhibition (e.g., normalization) of the activated MYOCD signaling in the diseased heart may be promising from a therapeutic point of view. PMID:22028870

Targeted gene-silencing reveals the functional significance of myocardin signaling in the failing heart.

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Mario Torrado

Full Text Available BACKGROUND: Myocardin (MYOCD, a potent transcriptional coactivator of smooth muscle (SM and cardiac genes, is upregulated in failing myocardium in animal models and human end-stage heart failure (HF. However, the molecular and functional consequences of myocd upregulation in HF are still unclear. METHODOLOGY/PRINCIPAL FINDINGS: The goal of the present study was to investigate if targeted inhibition of upregulated expression of myocd could influence failing heart gene expression and function. To this end, we used the doxorubicin (Dox-induced diastolic HF (DHF model in neonatal piglets, in which, as we show, not only myocd but also myocd-dependent SM-marker genes are highly activated in failing left ventricular (LV myocardium. In this model, intra-myocardial delivery of short-hairpin RNAs, designed to target myocd variants expressed in porcine heart, leads on day 2 post-delivery to: (1 a decrease in the activated expression of myocd and myocd-dependent SM-marker genes in failing myocardium to levels seen in healthy control animals, (2 amelioration of impaired diastolic dysfunction, and (3 higher survival rates of DHF piglets. The posterior restoration of elevated myocd expression (on day 7 post-delivery led to overexpression of myocd-dependent SM-marker genes in failing LV-myocardium that was associated with a return to altered diastolic function. CONCLUSIONS/SIGNIFICANCE: These data provide the first evidence that a moderate inhibition (e.g., normalization of the activated MYOCD signaling in the diseased heart may be promising from a therapeutic point of view.

Long term study on the effect of mollusciciding with niclosamide in stream habitats on the transmission of schistosomiasis mansoni after community-based chemotherapy in Makueni District, Kenya

DEFF Research Database (Denmark)

Kariuki, Henry C.; Madsen, Henry; Ouma, John H.

2013-01-01

BACKGROUND: Schistosoma mansoni infection is a persistent public health problem in many Kenyan communities. Although praziquantel is available, re-infection after chemotherapy treatment is inevitable, especially among children. Chemotherapy followed by intermittent mollusciciding of habitats...... rainfall data were collected monthly, and annual parasitological surveys were undertaken in each village. The mollusciciding protocol was adapted to local conditions, and simplified to improve prospects for widespread application. RESULTS: After the initial reduction in prevalence attributable...

Treatment outcomes of using inhalation sedation for comprehensive dental care.

Science.gov (United States)

Madouh, M; BaniHani, A; Tahmassebi, J F

2018-02-01

To assess the outcomes of dental treatment under inhalation sedation within a UK specialist hospital setting. This was a retrospective cohort study of the case notes of patients under 17 years of age who received dental treatment using inhalation sedation at a UK specialist setting during the period 2006-2011. Treatment outcomes were categorised into five groups: (1) treatment completed as planned, (2) modified treatment completed, (3) treatment abandoned in sedation unit and patient referred for treatment under general analgesia (GA), (4) treatment abandoned in sedation unit and patient referred for treatment under local analgesia (LA), (5) child failed to return to complete treatment. In total, the case notes of 453 patients were evaluated. The mean age of the patients was 10.3 ± 2.9 years. Treatment was completed successfully in 63.6% of the cases, 15.9% were referred for treatment under GA, 11.2% failed to return to complete the treatment, 7.1% received modified treatment completed, and only 2.2% were referred for treatment under LA. Treatment outcomes were significantly associated with patient`s age (p = 0.002). The treatment outcome "treatment abandoned and child referred to be treated under GA" had significantly lower mean patient ages than the other outcomes. The majority of children referred for inhalation sedation, completed their course of treatment. A significantly higher proportion of those in the younger age group required GA to complete their treatment.

Failed tracheal intubation using a laryngoscope and intubating laryngeal mask.

Science.gov (United States)

Asai, T; Hirose, T; Shingu, K

2000-04-01

To report unexpected failed tracheal intubation using a laryngoscope and an intubating laryngeal mask, and difficult ventilation via a facemask, laryngeal mask and intubating laryngeal mask, in a patient with an unrecognized lingual tonsillar hypertrophy. A 63-yr-old woman, who had undergone clipping of an aneurysm seven weeks previously, was scheduled for ventriculo-peritoneal shunt. At the previous surgery, there had been no difficulty in ventilation or in tracheal intubation. Her trachea remained intubated nasally for 11 days after surgery. Preoperatively, her consciousness was impaired. There were no restrictions in head and neck movements or mouth opening. The thyromental distance was 7 cm. After induction of anesthesia, manual ventilation via a facemask with a Guedel airway was suboptimal and the chest expanded insufficiently. At laryngoscopy using a Macintosh or McCoy device, only the tip of the epiglottis, but not the glottis, could be seen, and tracheal intubation failed. There was a partial obstruction during manual ventilation through either the intubating laryngeal mask or conventional laryngeal mask; intubation through each device failed. Digital examination of the pharynx, after removal of the laryngeal mask, indicated a mass occupying the vallecula. Lingual tonsillar hypertrophy (1 x 1 x 2 cm) was found to be the cause of the failure. Awake fibrescope-aided tracheal intubation was accomplished. Unexpected lingual tonsillar hypertrophy can cause both ventilation and tracheal intubation difficult, and neither the laryngeal mask nor intubating laryngeal mask may be helpful in the circumstances.

Why Young People Fail To Get and Hold Jobs.

Science.gov (United States)

New York State Dept. of Labor, Albany.

This booklet provides advice to young people seeking their first jobs on how to avoid the pitfalls that have caused others to lose jobs or fail to be hired. Topics discussed in short, one-page sections include appearance, attitude and behavior, ignorance of labor market facts, misrepresentation, sensitivity about a physical defect, unrealistic…

MAGNETIC RESONANCE IMAGING IN FAILED BACK SURGERY SYNDROME

OpenAIRE

SEN, KK; SINGH, AMARJIT

1999-01-01

The failed back surgery syndrome (FBSS) is a severe, long-lasting, disabling and relatively frequent (5-10%) complication of lumbosacral spine surgery. Wrong level surgery, inadequate surgical techniques, vertebral instability, recurrent disc herniation, and lumbosacral fibrosis are the most frequent causes of FBSS. The results after repeated surgery on recurrent disc herniations are comparable to those after the first intervention, whereas repeated surgery for fibrosis gives only 30-35% succ...

Role of laparohysteroscopy in women with normal pelvic imaging and failed ovulation stimulation with intrauterine insemination

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K Jayakrishnan

2010-01-01

Full Text Available Context: Women with primary infertility and no obvious pelvic pathology on clinical evaluation and imaging are either treated empirically or further investigated by laparoscopy. Aims: The role of diagnostic laparoscopy in women who fail to conceive after empirical treatment with ovulation induction and intrauterine insemination was evaluated. Settings and Design: Retrospective study at a private infertility center. Materials and Methods: A study of patients who underwent diagnostic laparoscopy between 1 st January 2001 and 31 st December 2008 was performed. Those patients who had no detectable pathology based on history, physical examination, and ultrasound and had treatment for three or more cycles in the form of ovulation induction and IUI were included in the study. Moderate and severe male factor infertility and history of any previous surgery were exclusion criteria. Statistical Analysis Used: Data were statistically analyzed using Statistics Package for Social Sciences (ver. 16.0; SPSS Inc., Chicago. Results: Of the 127 women who underwent diagnostic laparoscopy and hysteroscopy, 87.4% ( n= 111 of patients had positive findings. Significant pelvic pathology (moderate endometriosis, pelvic inflammatory disease, and tubal pathology was seen in 26.8% of cases. Conclusion: One in four women had significant pelvic pathology where treatment could possibly improve future fertility. Diagnostic laparoscopy has a role in infertile women with no obvious abnormality before they proceed to more aggressive treatments.

Treatment of fissure in ano-revisited | Gupta | African Health Sciences

African Journals Online (AJOL)

Methods: This paper outlines a brief account of the present scenario of different techniques available for the treatment of chronic anal fissure. Conclusion: Medical manipulation of the internal sphincter should be a first-line treatment in anal fissure. When this fails or fissures recur, lateral subcutaneous internal sphincterotomy ...

Attitudes toward clinical and traditional treatment for the Buruli ulcer ...

African Journals Online (AJOL)

Satisfaction with clinical treatment is not higher than with traditional medicine; people tend to turn to clinical medicine after traditional treatments fail. Few social stigmas result from the disease other than avoidance of the unsightly ulcer and the unpleasant smell, and among children, some teasing. The major concern ...

Establishing Pass/Fail Criteria for Bronchoscopy Performance

DEFF Research Database (Denmark)

Konge, Lars; Clementsen, Paul; Larsen, Klaus Richter

2012-01-01

Background: Several tools have been created to assess competence in bronchoscopy. However, educational guidelines still use an arbitrary number of performed procedures to decide when basic competency is acquired. Objectives: The purpose of this study was to define pass/fail scores for two...... method. In the first we compared bronchoscopy performance scores of 14 novices with the scores of 14 experienced consultants to find the score that best discriminated between the two groups. In the second we asked an expert group of 7 experienced bronchoscopists to judge how a borderline trainee would...

30 CFR 75.803 - Fail safe ground check circuits on high-voltage resistance grounded systems.

Science.gov (United States)

2010-07-01

... High-Voltage Distribution § 75.803 Fail safe ground check circuits on high-voltage resistance grounded systems. [Statutory Provisions] On and after September 30, 1970, high-voltage, resistance grounded systems... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Fail safe ground check circuits on high-voltage...

Naturalistic study of olanzapine in treatment-resistaant ...

African Journals Online (AJOL)

Naturalistic study of olanzapine in treatment-resistaant schizophrenia and acute mania, depression and obsessional disorder. ... Whereas the Fiji government provides all aspects of mental health care services free of charge to its citizens, many schizophrenics have failed to respond to classical antipsychotic drugs.

Treating refractory obsessive-compulsive disorder: what to do when conventional treatment fails? Tratando o transtorno obsessivo-compulsivo refratário: o que fazer quando tratamentos convencionais falham?

Directory of Open Access Journals (Sweden)

Adelar Pedro Franz

2013-01-01

Full Text Available Obsessive-compulsive disorder (OCD is a chronic and impairing condition. A very small percentage of patients become asymptomatic after treatment. The purpose of this paper was to review the alternative therapies available for OCD when conventional treatment fails. Data were extracted from controlled clinical studies (evidence-based medicine published on the MEDLINE and Science Citation Index/Web of Science databases between 1975 and 2012. Findings are discussed and suggest that clinicians dealing with refractory OCD patients should: 1 review intrinsic phenomenological aspects of OCD, which could lead to different interpretations and treatment choices; 2 review extrinsic phenomenological aspects of OCD, especially family accommodation, which may be a risk factor for non-response; 3 consider non-conventional pharmacological approaches; 4 consider non-conventional psychotherapeutic approaches; and 5 consider neurobiological approaches.O transtorno obsessivo-compulsivo (TOC é uma doença crônica e incapacitante. Uma pequena porcentagem de pacientes se torna assintomática após o tratamento. O objetivo deste trabalho foi revisar as alternativas terapêuticas para o tratamento de TOC quando os tratamentos convencionais falham. Os dados foram extraídos de estudos clínicos controlados (medicina baseada em evidências publicados nas bases de dados MEDLINE e Science Citation Index/Web of Science entre 1975 e de 2012. Os resultados são discutidos e sugerem as seguintes abordagens para profissionais que lidam com TOC refratário: 1 rever aspectos fenomenológicos intrínsecos ao TOC, o que pode levar a entendimentos diferenciados e à escolhas terapêuticas distintas; 2 rever aspectos fenomenológicos extrínsecos ao TOC, principalmente acomodação familiar, que pode ser fator de risco para a não resposta; 3 considerar abordagens farmacológicas não convencionais; 4 considerar abordagens psicoterapêuticas não convencionais; e 5 considerar

Treatment of patients with acute colonic diverticulitis complicated by abscess formation

DEFF Research Database (Denmark)

Gregersen, Rasmus; Mortensen, Laura Quitzau; Burcharth, Jakob

2016-01-01

by indication. Diverticular abscesses with diameters less than 3 cm might be sufficiently treated with antibiotics, while the best treatment for larger abscesses remains uncertain. Acute surgery should be reserved for critically ill patients failing non-operative treatment. Further research is needed...... to determine the best treatment for different sizes and types of diverticular abscesses, preferably randomized controlled trials....

Importance of local skin treatments during radiotherapy for prevention and treatment of radio-induced epithelitis

International Nuclear Information System (INIS)

Chargari, C.; Fromantin, I.; Kirova, Y.M.; Chargari, C.

2009-01-01

Radio-epithelitis represents a common problem, for which treatments are characterized by a great heterogeneity. The present review of literature focuses on data referenced in Pub med/Medline and published in French/English. Despite a real preclinical rationale, aloe vera and trolamine failed to demonstrate any benefit in the prophylactic settings. In a prospective assessment phase III assessment, Calendula officinalis was shown to be superior to trolamine for the prevention of radio-epithelitis. In the curative settings, sucrafalte failed to demonstrate any benefit. The benefit of dermo-corticoids was suggested in terms of erythema and itching. Promising clinical results are available with hyaluronic acid (M.A. S065D and Ialugen) and silver leaf may reduce the intensity of cutaneous radio-induced side effects. Data from the literature are conflicting, making real the difficulty to adopt from clinical trials any proof-of-principle strategy. Considering these uncertainties, several strategies are allowed. New topics are under investigation. Present data from the literature highlight the need for further trials, in order to propose evidence-based treatments and to harmonize clinical practice. (authors)

Primary care and addiction treatment: lessons learned from building bridges across traditions.

Science.gov (United States)

Stanley, A H

1999-01-01

A primary care unit combined with residential addiction treatment allows patients with addictive disease and chronic medical or psychiatric problems to successfully complete the treatment. These are patients who would otherwise fail treatment or fail to be considered candidates for treatment. Health care providers should have a background in primary care and have the potential to respond professionally to clinical problems in behavioral medicine. Ongoing professional training and statistical quality management principles can maintain morale and productivity. Health education is an integral part of primary care. The costs of such concurrent care when viewed in the context of the high societal and economic costs of untreated addictive disease and untreated chronic medical problems are low. The principles used to develop this primary care unit can be used to develop health care units for other underserved populations. These principles include identification of specific health care priorities and continuity of rapport with the target population and with addiction treatment staff.

'HAs fail to consult Irish people in UK'.

Science.gov (United States)

1992-11-10

Health authorities are failing to consult local people on their health needs, a conference on the mental health of Irish people living in the UK heard last week. Consulting Irish people was often only 'symbolic', despite the requirements of the NHS and Community Care Act, conference Chair Padraic Kenna, Director of Innisfree Housing Association, told delegates. 'The Irish caught the boat in the 1950s only to miss the boat ever since,' he said.

Failed back surgery syndrome: review and new hypotheses

OpenAIRE

Bordoni, Bruno; Marelli,Fabiola

2016-01-01

Bruno Bordoni,1,2 Fabiola Marelli2 1Department of Cardiology, Foundation Don Carlo Gnocchi, IRCCS, Institute of Hospitalization and Care, S Maria Nascente, Milan, 2School CRESO, Osteopathic Centre for Research and Studies, Falconara Marittima, Ancona, Italy Abstract: Failed back surgery syndrome (FBSS) is a term used to define an unsatisfactory outcome of a patient who underwent spinal surgery, irrespective of type or intervention area, with persistent pain in the lumbosacral region with or ...

Failed Ventriculoperitoneal Shunt: Is Retrograde Ventriculosinus Shunt a Reliable Option?

Science.gov (United States)

Oliveira, Matheus Fernandes de; Teixeira, Manoel Jacobsen; Reis, Rodolfo Casimiro; Petitto, Carlo Emanuel; Gomes Pinto, Fernando Campos

2016-08-01

Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications. In this preliminary report we describe our initial experience with retrograde ventriculosinus shunt (RVSS) after failed VPS. In 3 consecutive cases we applied RVSS to treat hydrocephalus in shunt-dependent patients who had previously undergone VPS revision and in which peritoneal space was full of adhesions and fibrosis. RVSS was performed as described by Shafei et al., with some modifications to each case. All 3 patients kept the same clinical profile after RVSS, with no perioperative or postoperative complications. However, revision surgery was performed in the first operative day in 1 out of 3 patients, in which the catheter was not positioned in the superior sagittal sinus. We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence. Copyright © 2016 Elsevier Inc. All rights reserved.

A dynamic fail-safe approach to the design of computer-based safety systems

International Nuclear Information System (INIS)

Smith, I.C.; Miller, M.

1994-01-01

For over 30 years AEA Technology has carried out research and development in the field of nuclear instrumentation and protection systems. Throughout the course of this extensive period of research and development the dominant theme has been the achievement of fully fail-safe designs. These are defined as designs in which the failure of any single component will result in the unit output reverting to a demand for trip action status. At an early stage it was recognized that the use of dynamic rather than static logic could ease the difficulties inherent in achieving a fail-safe design. The first dynamic logic systems coupled logic elements magnetically. The paper outlines the evolution from these early concepts of a dynamic fail-safe approach to the design of computer-based safety systems. Details are given of collaboration between AEA Technology and Duke Power Co. to mount an ISAT TM demonstration at Duke's Oconee Nuclear Power Station

Outcome of the use of tension-free vaginal tape in women with mixed urinary incontinence, previous failed surgery, or low valsalva pressure.

Science.gov (United States)

Abdel-Hady, El-Said; Constantine, Glyn

2005-02-01

To assess the safety and efficacy of the use of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with mixed incontinence, previous failed incontinence surgery or low valsalva leak point pressure (VLPP). Six hundred and fifty-eight women with SUI underwent the TVT procedure. These included women with mixed stress and urge incontinence (n=128), previous surgery for SUI (n=118), low VLPP (n=80), and those over 70 years old (n=68). The procedure was carried out under spinal anesthetic and operative and immediate postoperative data was collected for all women. Six-month follow-up data was available on 454 women, with the first 300 women completing a quality of life (QOL) questionnaire before and after surgery. The overall subjective cure rate at 6 months was 91%, with 8% of women reporting significant (>50%) improvement in their symptoms. Subgroups with a body mass index > 30, age > 70 years, coexisting instability, previous failed surgery, and low VLPP showed cure rates of 81-89%. QOL improvements for all groups were highly significant. Significant complications included voiding difficulties in 29 women (4.4%), retropubic hematomas in four (0.6%), and thromboembolic episodes in three (0.5%). The simplicity and high efficacy of the TVT makes it the first choice for the treatment of women with SUI, including those with more complex problems or coexisting risk factors.

The ugly twins: Failed global sourcing projects and their substitutes

NARCIS (Netherlands)

Schiele, Holger; Horn, Philipp; Horn, Philipp; Werner, Welf

2010-01-01

Purpose of the paper and literature addressed: Analyzing the impact of failed global sourcing projects on the entire commodity group and exploring isomorphism as potential antecedent to the observed phenomenon. The paper is embedded in the global sourcing literature, as well as isomorphism and total

Short-term outcome of posterior anorectal myectomy for treatment of ...

African Journals Online (AJOL)

Purpose: Many children with idiopathic constipation (IC) fail to improve with bowel management program. The role of surgical treatment in this subset of patients with intractable IC is still controversial. The aim of this study was to assess the outcome of anorectal myectomy in treatment of intractable IC. Patients and methods: ...

Transportation of failed or damaged foreign research reactor spent nuclear fuel

International Nuclear Information System (INIS)

Messick, C.E.; Mustin, T.P.; Massey, C.D.

1998-01-01

Since resuming the Foreign Research Reactor Spent Nuclear Fuel (FRR SNF) Acceptance Program in 1996, the Program has had to deal with difficult issues associated with the transportation of failed or damaged spent fuel. In several instances, problems with failed or damaged fuel have prevented the acceptance of the fuel at considerable cost to both the Department of Energy (DOE) and research reactor operators. In response to the problems faced by the Acceptance Program, DOE has undertaken significant steps to better define the spent fuel acceptance criteria. DOE has worked closely with the U.S. Nuclear Regulatory Commission to address failed or damaged research reactor spent fuel and to identify cask certificate issues which must be resolved by cask owners and foreign regulatory authorities. The specific issues associated with the transport of Materials Testing Reactor (MTR)-type FRR SNF will be discussed. The information presented will include U.S. Nuclear Regulatory Commission regulatory issues, cask certificate issues, technical constraints, and lessons learned. Specific information will also be provided on the latest efforts to revise DOE's Appendix B, Transport Package (Cask) Acceptance Criteria. The information presented in this paper will be important to foreign research reactor operators, shippers, and cask vendors, so that appropriate amendments to the Certificate of Compliance for spent fuel casks can be submitted in a timely manner to facilitate the safe and scheduled transport of FRR SNF

Mapping of schistosomiasis and soil-transmitted helminthiasis in the regions of centre, East and West Cameroon.

Directory of Open Access Journals (Sweden)

Louis-Albert Tchuem Tchuenté

Full Text Available BACKGROUND: Schistosomiasis and soil-transmitted helminthiasis (STH are widely distributed in Cameroon. Although mass drug administration (MDA of mebendazole is implemented nationwide, treatment with praziquantel was so far limited to the three northern regions and few health districts in the southern part of Cameroon, based on previous mapping conducted 25 years ago. To update the disease distribution map and determine where treatment with praziquantel should be extended, mapping surveys were conducted in three of the seven southern regions of Cameroon, i.e. Centre, East and West. METHODOLOGY: Parasitological surveys were conducted in April-May 2010 in selected schools in all 63 health districts of the three targeted regions, using appropriate research methodologies, i.e. Kato-Katz and urine filtration. PRINCIPAL FINDINGS: The results showed significant variation of schistosomiasis and STH prevalence between schools, villages, districts and regions. Schistosoma mansoni was the most prevalent schistosome species, with an overall prevalence of 5.53%, followed by S. haematobium (1.72% and S. guineensis (0.14%. The overall prevalence of schistosomiasis across the three regions was 7.31% (95% CI: 6.86-7.77%. The prevalence for Ascaris lumbricoides was 11.48 (95% CI: 10.93-12.04%, Trichuris trichiura 18.22% (95% CI: 17.56-18.90% and hookworms 1.55% (95% CI: 1.35-1.78%, with an overall STH prevalence of 24.10% (95% CI: 23.36-24.85% across the three regions. STH was more prevalent in the East region (46.57%; 95% CI: 44.41-48.75% in comparison to the Centre (25.12; 95% CI: 24.10-26.17% and West (10.49%; 95% CI: 9.57-11.51% regions. CONCLUSIONS/SIGNIFICANCE: In comparison to previous data, the results showed an increase of schistosomiasis transmission in several health districts, whereas there was a significant decline of STH infections. Based on the prevalence data, the continuation of annual or bi-annual MDA for STH is recommended, as well as an

Mapping of schistosomiasis and soil-transmitted helminthiasis in the regions of centre, East and West Cameroon.

Science.gov (United States)

Tchuem Tchuenté, Louis-Albert; Kamwa Ngassam, Romuald Isaka; Sumo, Laurentine; Ngassam, Pierre; Dongmo Noumedem, Calvine; Nzu, Deguy D'or Luogbou; Dankoni, Esther; Kenfack, Christian Mérimé; Gipwe, Nestor Feussom; Akame, Julie; Tarini, Ann; Zhang, Yaobi; Angwafo, Fru Fobuzski

2012-01-01

Schistosomiasis and soil-transmitted helminthiasis (STH) are widely distributed in Cameroon. Although mass drug administration (MDA) of mebendazole is implemented nationwide, treatment with praziquantel was so far limited to the three northern regions and few health districts in the southern part of Cameroon, based on previous mapping conducted 25 years ago. To update the disease distribution map and determine where treatment with praziquantel should be extended, mapping surveys were conducted in three of the seven southern regions of Cameroon, i.e. Centre, East and West. Parasitological surveys were conducted in April-May 2010 in selected schools in all 63 health districts of the three targeted regions, using appropriate research methodologies, i.e. Kato-Katz and urine filtration. The results showed significant variation of schistosomiasis and STH prevalence between schools, villages, districts and regions. Schistosoma mansoni was the most prevalent schistosome species, with an overall prevalence of 5.53%, followed by S. haematobium (1.72%) and S. guineensis (0.14%). The overall prevalence of schistosomiasis across the three regions was 7.31% (95% CI: 6.86-7.77%). The prevalence for Ascaris lumbricoides was 11.48 (95% CI: 10.93-12.04%), Trichuris trichiura 18.22% (95% CI: 17.56-18.90%) and hookworms 1.55% (95% CI: 1.35-1.78%), with an overall STH prevalence of 24.10% (95% CI: 23.36-24.85%) across the three regions. STH was more prevalent in the East region (46.57%; 95% CI: 44.41-48.75%) in comparison to the Centre (25.12; 95% CI: 24.10-26.17%) and West (10.49%; 95% CI: 9.57-11.51%) regions. In comparison to previous data, the results showed an increase of schistosomiasis transmission in several health districts, whereas there was a significant decline of STH infections. Based on the prevalence data, the continuation of annual or bi-annual MDA for STH is recommended, as well as an extension of praziquantel in identified moderate and high risk communities for

Can the failing firm defence rule be counterproductive?

OpenAIRE

Helder Vasconcelos

2013-01-01

The present paper investigates the role of the failing firm defence (FFD) concept in the merger control process within a Cournot setting where (i) endogenous mergers are motivated by prospective efficiency gains and (ii) mergers must be submitted to an antitrust authority that might demand partial divestiture for approval. The findings show that when the FFD concept is one of the tools available for controlling the merger process, firms can strategically embark on a merger that makes other fi...

Why Do Large Infrastructure Projects Often Fail?

DEFF Research Database (Denmark)

Lando, Henrik

The paper reports, in a systematic manner, the views of a group of experienced practitioners on why large infrastructure projects often fail. The views, centering on the role played by the Owner (the Client or Buyer), can be summarized as follows:The owner should be aware of the need of clarity...... when it comes to own priorities, requirements, decision making authority, and risk allocation, and such clarity together with measures intended to secure a cooperative spirit, including a balanced sharing of risk and conflict resolution schemes that secure a quick resolution of conflicts, are central...... elements in securing successful projects....

Re-enactment of power economy legislation failed

International Nuclear Information System (INIS)

Heller, W.

2002-01-01

Comment on the failed vote in the German Federal Parliament about the re-enactment of power economy legislation. The amendments were mainly intended to translate into national law the EU Single Market Directive of June 22, 1998 about common regulations of the gas market. The legislative process had included a mediation procedure between the two chambers of parliament, i.e. the Bundestag and the Bundesrat, had been rejected once more by the Bundesrat, and was to have been adopted by an absolute majority vote of the Bundestag, the so-called Chancellor's majority, still in this parliamentary term. (orig.)

Solutions for Failing High Schools: Converging Visions and Promising Models.

Science.gov (United States)

Legters, Nettie; Balfanz, Robert; McPartland, James

Promising solutions to the failings of traditional comprehensive high schools were reviewed to identify basic principles and strategies for improving high schools nationwide. Selected research studies, policy documents, and promising high school programs were reviewed. The review revealed the following principles for helping high schools better…

Fail-safe system for activity cooled supersonic and hypersonic aircraft. [using liquid hydrogen fuel

Science.gov (United States)

Jones, R. A.; Braswell, D. O.; Richie, C. B.

1975-01-01

A fail-safe-system concept was studied as an alternative to a redundant active cooling system for supersonic and hypersonic aircraft which use the heat sink of liquid-hydrogen fuel for cooling the aircraft structure. This concept consists of an abort maneuver by the aircraft and a passive thermal protection system (TPS) for the aircraft skin. The abort manuever provides a low-heat-load descent from normal cruise speed to a lower speed at which cooling is unnecessary, and the passive TPS allows the aircraft skin to absorb the abort heat load without exceeding critical skin temperature. On the basis of results obtained, it appears that this fail-safe-system concept warrants further consideration, inasmuch as a fail-safe system could possibly replace a redundant active cooling system with no increase in weight and would offer other potential advantages.

Unicameral bone cyst: a retrospective study of three surgical treatments.

Science.gov (United States)

Sung, Anthony D; Anderson, Megan E; Zurakowski, David; Hornicek, Francis J; Gebhardt, Mark C

2008-10-01

Between 1979 and 2004, 167 patients younger than 20 years were treated surgically for humeral or femoral unicameral bone cysts with either injection of corticosteroids (steroids), curettage plus bone grafting (curettage), or a combination injection of steroids, demineralized bone matrix, and bone marrow aspirate (SDB) at Children's Hospital of Boston and Massachusetts General Hospital (mean followup, 7.3 years; range, 1 month-27 years). Outcomes included treatment failure (defined clinically as subsequent pathologic fracture or need for retreatment to prevent pathologic fracture) and complications. Information was obtained from medical records and by telephone questionnaire. After one treatment, 84% of cysts treated with steroids experienced failed treatment versus 64% with curettage and 50% with SDB. For unicameral bone cysts requiring retreatment (regardless of first treatment), 76% retreated with steroids had failed treatment versus 63% with curettage and 71% with SDB. Curettage was associated with the lowest rate of posttreatment pathologic fractures and highest rate of pain and other complications. Multivariate logistic regression indicated treatment with steroids alone and younger age were independent predictors of failure. We believe SDB is a reasonable first treatment for unicameral bone cysts in the humerus and femur in patients younger than 20 years, being less invasive yet comparable to curettage in preventing recurrence.

Characteristics of successful and failed mentoring relationships: a qualitative study across two academic health centers.

Science.gov (United States)

Straus, Sharon E; Johnson, Mallory O; Marquez, Christine; Feldman, Mitchell D

2013-01-01

To explore the mentor-mentee relationship with a focus on determining the characteristics of effective mentors and mentees and understanding the factors influencing successful and failed mentoring relationships. The authors completed a qualitative study through the Departments of Medicine at the University of Toronto Faculty of Medicine and the University of California, San Francisco, School of Medicine between March 2010 and January 2011. They conducted individual, semistructured interviews with faculty members from different career streams and ranks and analyzed transcripts of the interviews, drawing on grounded theory. The authors completed interviews with 54 faculty members and identified a number of themes, including the characteristics of effective mentors and mentees, actions of effective mentors, characteristics of successful and failed mentoring relationships, and tactics for successful mentoring relationships. Successful mentoring relationships were characterized by reciprocity, mutual respect, clear expectations, personal connection, and shared values. Failed mentoring relationships were characterized by poor communication, lack of commitment, personality differences, perceived (or real) competition, conflicts of interest, and the mentor's lack of experience. Successful mentorship is vital to career success and satisfaction for both mentors and mentees. Yet challenges continue to inhibit faculty members from receiving effective mentorship. Given the importance of mentorship on faculty members' careers, future studies must address the association between a failed mentoring relationship and a faculty member's career success, how to assess different approaches to mediating failed mentoring relationships, and how to evaluate strategies for effective mentorship throughout a faculty member's career.

Perceived adherence barriers among patients failing second-line antiretroviral therapy in Khayelitsha, South Africa

Directory of Open Access Journals (Sweden)

W Barnett

2013-11-01

Full Text Available Background. The recent scale-up of antiretroviral therapy (ART coverage in resource-limited settings has greatly improved access to treatment. However, increasing numbers of patients are failing first- and second-line ART. Objective. To examine factors affecting adherence to second-line ART from the perspective of clinic staff and patients, assessing both individual and structural perceived barriers. Methods. Research was conducted at a large primary care tuberculosis (TB/HIV clinic in Khayelitsha, a peri-urban township in Cape Town, South Africa. Participants were drawn from a Médecins Sans Frontières-run programme to support patients failing second-line ART. A qualitative research approach was used, combining multiple methodologies including key informant interviews with staff (n=11, in-depth interviews with patients (n=10 and a Photovoice workshop (n=11. Responses and photographs were coded by content; data were transformed into variables and analysed accordingly. Results. Staff identified drinking, non-disclosure, not using condoms and pill fatigue as barriers to ART adherence, while patients identified side-effects, not using condoms and a lack of understanding concerning medication timing. With respect to service delivery, staff identified a need for continued counselling and educational support following ART initiation. Patients were concerned about missing medical records and poor staff attitudes in the clinic. Conclusion. These findings identify discrepancies between provider and patient perceptions of barriers to, and facilitators of adherence, as well as of service delivery solutions. This highlights the need for on-going counselling and education following ART initiation, improved quality of counselling, and improved methods to identify and address specific barriers concerning medication adherence.

Perceptions about interventions to control schistosomiasis among the Lake Victoria island communities of Koome, Uganda.

Directory of Open Access Journals (Sweden)

Richard E Sanya

2017-10-01

Full Text Available Praziquantel-based mass treatment is the main approach to controlling schistosomiasis mansoni in endemic areas. Interventions such as provision and use of safe water, minimising contact with infested water, disposal of stool in latrines and snail control provide key avenues to break the transmission cycle and can sustain the benefits of mass treatment in the long term. Efforts are also being made to develop a schistosomiasis vaccine which, if effective, might reduce the incidence of re-infection after treatment. However, any interventions deployed need to be acceptable to, and sustainable by, the target communities.In this qualitative study, we investigated the perceptions of six Lake Victoria island communities of Koome, Uganda, about interventions to control Schistosoma mansoni infection and their willingness to participate in Schistosoma vaccine trials. Thirty-two in-depth interviews, 12 key informant interviews and 10 focus group discussions were conducted. Data were analysed using a thematic content approach.Intestinal schistosomiasis was not regarded as a serious health problem because a mass treatment programme is in place. However, the communities lack safe water sources and latrines. Mass treatment with praziquantel, safe water supplies and use of toilets were deemed the most acceptable interventions by the participants. The communities are willing to participate in Schistosoma vaccine trials.Knowledge of a community's perception about interventions to control schistosomiasis can be valuable to policy makers and programme implementers intending to set up interventions co-managed by the community members. In this study, the views of the Lake Victoria island communities of Koome are presented. This study also provides data to guide further work on alternative interventions such as Schistosoma vaccine trials in these communities.

Perceptions about interventions to control schistosomiasis among the Lake Victoria island communities of Koome, Uganda.

Science.gov (United States)

Sanya, Richard E; Tumwesige, Edward; Elliott, Alison M; Seeley, Janet

2017-10-01

Praziquantel-based mass treatment is the main approach to controlling schistosomiasis mansoni in endemic areas. Interventions such as provision and use of safe water, minimising contact with infested water, disposal of stool in latrines and snail control provide key avenues to break the transmission cycle and can sustain the benefits of mass treatment in the long term. Efforts are also being made to develop a schistosomiasis vaccine which, if effective, might reduce the incidence of re-infection after treatment. However, any interventions deployed need to be acceptable to, and sustainable by, the target communities. In this qualitative study, we investigated the perceptions of six Lake Victoria island communities of Koome, Uganda, about interventions to control Schistosoma mansoni infection and their willingness to participate in Schistosoma vaccine trials. Thirty-two in-depth interviews, 12 key informant interviews and 10 focus group discussions were conducted. Data were analysed using a thematic content approach. Intestinal schistosomiasis was not regarded as a serious health problem because a mass treatment programme is in place. However, the communities lack safe water sources and latrines. Mass treatment with praziquantel, safe water supplies and use of toilets were deemed the most acceptable interventions by the participants. The communities are willing to participate in Schistosoma vaccine trials. Knowledge of a community's perception about interventions to control schistosomiasis can be valuable to policy makers and programme implementers intending to set up interventions co-managed by the community members. In this study, the views of the Lake Victoria island communities of Koome are presented. This study also provides data to guide further work on alternative interventions such as Schistosoma vaccine trials in these communities.

Self-expandable metal stent placement in a child for treatment of achalasia after failed Heller myotomy.

Science.gov (United States)

Gugig, Roberto; Muñoz Jurado, Guillermo; Huang, Clifton; Oleas, Roberto; Robles-Medranda, Carlos

2018-01-01

Background and study aims  Childhood achalasia treatment remains inconclusive. What is next after myotomy failure? Repeated pneumatic-dilation put patients at greater risk of perforation with possible symptom recurrence. We report on a 12-year-old patient with a 1-year history of achalasia whom underwent Heller myotomy with fundoplication and recurred with symptoms 1 week after surgery. Pneumatic dilatation was considered but not done because of the risk of esophageal perforation. The decision was made to place a fully covered self-expanding metallic stent (FC-SEMS) for 3 months, which resolved the stenosis as confirmed by esophagram. The patient has remained asymptomatic since the procedure was performed 2 years ago. FC-SEMS is an alternative for treatment of refractory achalasia in children who do not respond to conventional treatment.

Winning Connections? Special Interests and the Sale of Failed Banks

NARCIS (Netherlands)

D. Igan (Deniz); T. Lambert (Thomas); W.B. Wagner (Wolf); Q. Zhang (Quxian)

2017-01-01

textabstractWe study how lobbying affects the resolution of failed banks, using a sample of FDIC auctions between 2007 and 2014. We show that bidding banks that lobby regulators have a higher probability of winning an auction. In addition, the FDIC incurs higher costs in such auctions, amounting to

Characteristics of failed fertilized oocytes in patients with severe obesity

Directory of Open Access Journals (Sweden)

E A Pigarova

2012-12-01

Full Text Available Реферат по статье: Machtinger R, Combelles CM, Missmer SA, Correia KF, Fox JH, Racowsky C. The association between severe obesity and characteristics of failed fertilized oocytes. Hum Reprod. 2012 Nov;27(11:3198-207.

Longer treatment with alternative non-drug reinforcement fails to reduce resurgence of cocaine or alcohol seeking in rats.

Science.gov (United States)

Nall, Rusty W; Craig, Andrew R; Browning, Kaitlyn O; Shahan, Timothy A

2018-04-02

Provision of alternative non-drug reinforcement is among the most effective methods for treating substance use disorders. However, when alternative reinforcers become unavailable during treatment interruptions or upon cessation of treatment, relapse often occurs. Relapse following the loss of alternative reinforcement is known as resurgence. One factor that could reduce resurgence is longer duration of treatment with alternative reinforcement, but the available data are mixed. Further, the effects of length of treatment have previously only been examined with food seeking. The present experiments directly examined if duration of treatment impacted the magnitude of resurgence of cocaine or alcohol seeking in rats. First, rats were trained to self-administer cocaine (Experiment 1) or alcohol (Experiment 2) by performing a target behavior. Second, target behavior was extinguished and performing an alternative behavior produced an alternative non-drug (i.e., food) reinforcer. Finally, resurgence was assessed following removal of alternative reinforcement after either 5 or 20 sessions of treatment. Treatment duration did not differentially affect resurgence of cocaine seeking in Experiment 1 or Alcohol seeking in Experiment 2. These results suggest that extended treatment with alternative non-drug reinforcement may not decrease propensity to relapse. Further, these results may have implications for treatment of substance use disorders and for theories of resurgence. Copyright © 2017 Elsevier B.V. All rights reserved.

The potential cost of a failed doha round:

OpenAIRE

Bouet, Antoine; Debucquet, David Laborde

2009-01-01

"In times of economic turmoil, countries might decide to increase current tariff rates to protect domestic industries or raise revenues in order to finance domestic programs. Using the highest applied or bound rate imposed by countries from 1995 to 2008 as an indicator, this study presents several scenarios regarding the economic costs of a failed Doha Round and a subsequent rush into protectionism. For example, in a scenario where the applied tariffs of major economies would go all the way u...

Percutaneous Gastrostomy in Patients Who Fail or Are Unsuitable for Endoscopic Gastrostomy

International Nuclear Information System (INIS)

Thornton, Frank J.; Varghese, Jose C.; Haslam, Philip J.; McGrath, Frank P.; Keeling, Frank; Lee, Michael J.

2000-01-01

Purpose: Percutaneous endoscopic gastrostomy (PEG) is not possible or fails in some patients. We aimed to categorize the reasons for PEG failure, to study the success of percutaneous radiologic gastrostomy (PRG) in these patients, and to highlight the associated technical difficulties and complications.Methods: Forty-two patients (28 men, 14 women; mean age 60 years, range 18-93 years) in whom PEG failed or was not possible, underwent PRG. PEG failure or unsuitability was due to upper gastrointestinal tract obstruction or other pathology precluding PEG in 15 of the 42 patients, suboptimal transillumination in 22 of 42 patients, and advanced cardiorespiratory decompensation precluding endoscopy in five of 42 patients. T-fastener gastropexy was used in all patients and 14-18 Fr catheters were inserted.Results: PRG was successful in 41 of 42 patients (98%). CT guidance was required in four patients with altered upper gastrointestinal anatomy. PRG failed in one patient despite CT guidance. In the 16 patients with high subcostal stomachs who failed PEG because of inadequate transillumination, intercostal tube placement was required in three and cephalad angulation under the costal margin in six patients. Major complications included inadvertent placement of the tube in the peritoneal cavity. There was one case of hemorrhage at the gastrostomy site requiring transfusion and one case of superficial gastrostomy site infection requiring tube removal. Minor complications included superficial wound infection in six patients, successfully treated with routine wound toilette.Conclusion: We conclude that PRG is a safe, well-tolerated and successful method of gastrostomy and gastrojejunostomy insertion in the technically difficult group of patients who have undergone an unsuccessful PEG. In many such cases optimal clinical evaluation will suggest primary referral for PRG as the preferred option

Distribution of Spiked Drugs between Milk Fat, Skim Milk, Whey, Curd, and Milk Protein Fractions: Expansion of Partitioning Models.

Science.gov (United States)

Lupton, Sara J; Shappell, Nancy W; Shelver, Weilin L; Hakk, Heldur

2018-01-10

The distributions of eight drugs (acetaminophen, acetylsalicylic acid/salicylic acid, ciprofloxacin, clarithromycin, flunixin, phenylbutazone, praziquantel, and thiamphenicol) were determined in milk products (skim milk, milk fat, curd, whey, and whey protein) and used to expand a previous model (from 7 drugs to 15 drugs) for predicting drug distribution. Phenylbutazone and praziquantel were found to distribute with the lipid and curd phases (≥50%). Flunixin distribution was lower but similar in direction (12% in milk fat, 39% in curd). Acetaminophen, ciprofloxacin, and praziquantel preferentially associated with casein proteins, whereas thiamphenicol and clarithromycin associated preferentially to whey proteins. Regression analyses for log [milk fat]/[skim milk] and log [curd]/[whey] had r 2 values of 0.63 and 0.67, respectively, with p of <0.001 for 15 drugs (7 previously tested and 8 currently tested). The robustness of the distribution model was enhanced by doubling the number of drugs originally tested.

Chronic orchialgia: Review of treatments old and new

OpenAIRE

Tojuola, Bayo; Layman, Jeffrey; Kartal, Ibrahim; Gudelogul, Ahmet; Brahmbhatt, Jamin; Parekattil, Sijo

2016-01-01

Introduction: Chronic orchialgia is historically and currently a challenging disease to treat. It is a diagnostic and therapeutic challenge for physicians. Conservative therapy has served as the first line of treatment. For those who fail conservative therapy, surgical intervention may be required. We aim to provide a review of currently available surgical options and novel surgical treatment options. Methods: A review of current literature was performed using PubMed. Literature discussing...

Why the NEA and AFT Sought To Merge--and Failed.

Science.gov (United States)

Fusarelli, Lance D.; Cooper, Bruce S.

1999-01-01

Four key reasons underlie the push for teacher union solidarity in 1998: desire to fulfill Al Shanker's dream of a unified mission, to end union competition, to bolster Democratic Party weaknesses, and to stop privatization. The NEA/AFT merger failed because of conflicting organizational cultures and teachers' gradualist, localist, and…

Abnormal mitochondrial respiration in failed human myocardium.

Science.gov (United States)

Sharov, V G; Todor, A V; Silverman, N; Goldstein, S; Sabbah, H N

2000-12-01

Chronic heart failure (HF) is associated with morphologic abnormalities of cardiac mitochondria including hyperplasia, reduced organelle size and compromised structural integrity. In this study, we examined whether functional abnormalities of mitochondrial respiration are also present in myocardium of patients with advanced HF. Mitochondrial respiration was examined using a Clark electrode in an oxygraph cell containing saponin-skinned muscle bundles obtained from myocardium of failed explanted human hearts due to ischemic (ICM, n=9) or idiopathic dilated (IDC, n=9) cardiomyopathy. Myocardial specimens from five normal donor hearts served as controls (CON). Basal respiratory rate, respiratory rate after addition of the substrates glutamate and malate (V(SUB)), state 3 respiration (after addition of ADP, V(ADP)) and respiration after the addition of atractyloside (V(AT)) were measured in scar-free muscle bundles obtained from the subendocardial (ENDO) and subepicardial (EPI) thirds of the left ventricular (LV) free wall, interventricular septum and right ventricular (RV) free wall. There were no differences in basal and substrate-supported respiration between CON and HF regardless of etiology. V(ADP)was significantly depressed both in ICM and IDC compared to CON in all the regions studied. The respiratory control ratio, V(ADP)/V(AT), was also significantly decreased in HF compared to CON. In both ICM and IDC, V(ADP)was significantly lower in ENDO compared to EPI. The results indicate that mitochondrial respiration is abnormal in the failing human heart. The findings support the concept of low myocardial energy production in HF via oxidative phosphorylation, an abnormality with a potentially impact on global cardiac performance. Copyright 2000 Academic Press.

Transportation of failed or damaged foreign research reactor spent nuclear fuel

International Nuclear Information System (INIS)

Messick, Charles E.; Mustin, Tracy P.; Massey, Charles D.

1999-01-01

Since initiating the Foreign Research Reactor Spent Nuclear Fuel (FRR SNF) Acceptance Program in 1996, the Program has had to deal with difficult issues associated with the transportation of failed or damaged spent fuel. In several instances, problems with failed or damaged fuel have prevented the acceptance of the fuel at considerable cost to both the Department of Energy and research reactor operators. In response to the problems faced by the Acceptance Program, DOE has undertaken significant steps to better define the spent fuel acceptance criteria. DOE has worked closely with the U.S. Nuclear Regulatory Commission to address failed or damaged research reactor spent fuel causing a degradation of the fuel assembly exposing fuel meat and to identify cask certificate issues which must be resolved by cask owners and foreign regulatory authorities. The specific issues and implementation challenges associated with the transport of MTR type FRR SNF will be discussed. The information presented will include U.S. Nuclear Regulatory Commission regulatory issues, cask certificate issues, technical constraints, implementation status, and lessons learned. Specific information will also be provided on the latest efforts to revise DOE's Appendix B, Transport Package (Cask) Acceptance Criteria. The information presented in this paper will be of interest to foreign research reactor operators, shippers, and cask vendors in evaluating the condition of their fuel to ensure it can be transported in accordance with appropriate cask certificate requirements. (author)

Fears for literacy and numeracy as new nurses fail basic tests.

Science.gov (United States)

Learner, Sue

2006-08-16

The Nursing and Midwifery Council (NMC) has voiced concern over nurses' poor levels of English and maths after a third of newly qualified nurses failed a basic test set by a hospital as part of anew selection process.

Recent Advances in Behavioral Addiction Treatments: Focusing on Mechanisms of Change

OpenAIRE

Longabaugh, Richard; Magill, Molly

2011-01-01

In the latter half of the 20th century, research on behavioral treatments for addictions aimed to develop and test effective treatments. Among treatments found to be at least moderately effective, direct comparisons failed to reveal consistent superiority of one approach over another. This ubiquitous finding held true despite underlying theories that differed markedly in their proposed causal processes related to patient change. In the 21st century the focus of treatment research is increasin...

Successful Treatment of Advanced Metastatic Prostate Cancer following Chemotherapy Based on Molecular Profiling

Directory of Open Access Journals (Sweden)

Charles E. Myers

2012-03-01

Full Text Available After Taxotere fails, treatment options for metastatic prostate cancer are limited. The three drugs with FDA approval in this setting, Jevtana, Provenge and Zytiga, are associated with median survivals of less than 2 years. In part, the impact on survival is the result of low response rates, indicating a significant proportion of patients exhibiting de novo resistance to these agents. An alternate approach is to let treatment selection be governed by gene expression profiling so that the treatment is tailored to the specific patient. Here, we report a case of metastatic prostate cancer with a dramatic response to treatment selected based on molecular profiling. This patient had failed LHRH agonist, bicalutamide, Taxotere, and doxorubicin. Molecular profiling showed overexpression of the androgen receptor and he had a dramatic response of measurable disease to second-line hormonal therapy with ketoconazole, estrogen and Leukine.

Does compliance with amblyopia management improve following supervised occlusion treatment?

Science.gov (United States)

El-Ghrably, I A; Longville, D; Gnanaraj, L

2007-01-01

To demonstrate improvement in compliance following supervised occlusion therapy for amblyopia in children who had failed to respond to outpatient treatment. Retrospective review of the visual outcome of 30 children who were admitted to an ophthalmology ward for 1-day intensive supervised occlusion. These children had documented poor compliance and previously failed to respond to the outpatient occlusion treatment. During their stay a trained ophthalmology nurse educated parents regarding amblyopia and the benefits of occlusion therapy. Visual acuity (VA) of the amblyopic and fellow eyes was recorded on admission, discharge, and at each subsequent visit. The compliance was recorded from parent's history and also indirectly by noticing improvement in vision. The mean supervised occlusion was 7.4 hours (range 4-12 hours). The compliance with occlusion therapy improved in 23 children (77%) after discharge. The mean duration of occlusion after discharge improved to 4 hours (range 1-12 hours). The mean follow-up was 18 months (range 4-24 months). Though there was no dramatic improvement in VA at discharge there was a statistically significant improvement in VA between admission and last recorded VA (pocclusion following discharge, 21 (91%) gained at least one line of acuity in their amblyopic eye on the last assessment of their VA and five of them achieved 6/12. Of the seven children who did not comply with occlusion following discharge, only one patient gained one line improvement in his amblyopic eye. This study shows that supervised occlusion treatment and parental education was effective in children who had initially failed traditional outpatient treatment.

Why CCR2 and CCR5 blockade failed and why CCR1 blockade might still be effective in the treatment of rheumatoid arthritis

OpenAIRE

Lebre, M.C.; Vergunst, C.E.; Choi, I.Y.K.; Aarrass, S.; Oliveira, A.S.F.; Wyant, T.; Horuk, R.; Reedquist, K.A.; Tak, P.P.

2011-01-01

BACKGROUND: The aim of this study was to provide more insight into the question as to why blockade of CCR1, CCR2, and CCR5 may have failed in clinical trials in rheumatoid arthritis (RA) patients, using an in vitro monocyte migration system model. METHODOLOGY/PRINCIPAL FINDINGS: Monocytes from healthy donors (HD; n = 8) or from RA patients (for CCR2 and CCR5 antibody n = 8; for CCR1 blockade n = 13) were isolated from peripheral blood and pre-incubated with different concentrations of either ...

Failing States as Epidemiologic Risk Zones: Implications for Global Health Security.

Science.gov (United States)

Hirschfeld, Katherine

Failed states commonly experience health and mortality crises that include outbreaks of infectious disease, violent conflict, reductions in life expectancy, and increased infant and maternal mortality. This article draws from recent research in political science, security studies, and international relations to explore how the process of state failure generates health declines and outbreaks of infectious disease. The key innovation of this model is a revised definition of "the state" as a geographically dynamic rather than static political space. This makes it easier to understand how phases of territorial contraction, collapse, and regeneration interrupt public health programs, destabilize the natural environment, reduce human security, and increase risks of epidemic infectious disease and other humanitarian crises. Better understanding of these dynamics will help international health agencies predict and prepare for future health and mortality crises created by failing states.

Characteristics of Successful and Failed Mentoring Relationships: A Qualitative Study Across Two Academic Health Centers

Science.gov (United States)

Straus, Sharon E.; Johnson, Mallory O.; Marquez, Christine; Feldman, Mitchell D.

2013-01-01

Purpose To explore the mentor–mentee relationship with a focus on determining the characteristics of effective mentors and mentees and understanding the factors influencing successful and failed mentoring relationships. Method The authors completed a qualitative study through the Departments of Medicine at the University of Toronto Faculty of Medicine and the University of California, San Francisco, School of Medicine between March 2010 and January 2011. They conducted individual, semistructured interviews with faculty members from different career streams and ranks and analyzed transcripts of the interviews, drawing on grounded theory. Results The authors completed interviews with 54 faculty members and identified a number of themes, including the characteristics of effective mentors and mentees, actions of effective mentors, characteristics of successful and failed mentoring relationships, and tactics for successful mentoring relationships. Successful mentoring relationships were characterized by reciprocity, mutual respect, clear expectations, personal connection, and shared values. Failed mentoring relationships were characterized by poor communication, lack of commitment, personality differences, perceived (or real) competition, conflicts of interest, and the mentor’s lack of experience. Conclusions Successful mentorship is vital to career success and satisfaction for both mentors and mentees. Yet challenges continue to inhibit faculty members from receiving effective mentorship. Given the importance of mentorship on faculty members’ careers, future studies must address the association between a failed mentoring relationship and a faculty member’s career success, how to assess different approaches to mediating failed mentoring relationships, and how to evaluate strategies for effective mentorship throughout a faculty member’s career. PMID:23165266

Systemic Chemotherapy as Salvage Treatment for Locally Advanced Rectal Cancer Patients Who Fail to Respond to Standard Neoadjuvant Chemoradiotherapy.

Science.gov (United States)

Sclafani, Francesco; Brown, Gina; Cunningham, David; Rao, Sheela; Tekkis, Paris; Tait, Diana; Morano, Federica; Baratelli, Chiara; Kalaitzaki, Eleftheria; Rasheed, Shahnawaz; Watkins, David; Starling, Naureen; Wotherspoon, Andrew; Chau, Ian

2017-06-01

The potential of chemotherapy as salvage treatment after failure of neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC) has never been explored. We conducted a single-center, retrospective analysis to address this question. Patients with newly diagnosed LARC who were inoperable or candidates for extensive (i.e., beyond total mesorectal excision [TME]) surgery after long-course chemoradiotherapy and who received salvage chemotherapy were included. The primary objective was to estimate the proportion of patients who became suitable for TME after chemotherapy. Forty-five patients were eligible (39 candidates for extensive surgery and 6 unresectable). Previous radiotherapy was given concurrently with chemotherapy in 43 cases (median dose: 54.0 Gy). Oxaliplatin- and irinotecan-based salvage chemotherapy was administered in 40 (88.9%) and 5 (11.1%) cases, respectively. Eight patients (17.8%) became suitable for TME after chemotherapy, 10 (22.2%) ultimately underwent TME with clear margins, and 2 (4.4%) were managed with a watch and wait approach. Additionally, 13 patients had extensive surgery with curative intent. Three-year progression-free survival and 5-year overall survival in the entire population were 30.0% (95% confidence interval [CI]: 15.0-46.0) and 44.0% (95% CI: 26.0-61.0), respectively. For the curatively resected and "watch and wait" patients, these figures were 52.0% (95% CI: 27.0-73.0) and 67.0% (95% CI: 40.0-84.0), respectively. Systemic chemotherapy may be an effective salvage strategy for LARC patients who fail to respond to chemoradiotherapy and are inoperable or candidates for beyond TME surgery. According to our study, one out of five patients may become resectable or be spared from an extensive surgery after systemic chemotherapy. High-quality evidence to inform the optimal management of rectal cancer patients who are inoperable or candidates for beyond total mesorectal excision surgery following standard chemoradiotherapy is

Methodology of failed section location in case of leaks in PGN-200M sectional steam generator

International Nuclear Information System (INIS)

Kuznetsov, A.A.; Govorov, P.P.; Nosov, Yu.V.; Karavaev, A.P.

2009-01-01

The article considers a way of the failed section location when indications of water-sodium reaction emerge in PGN-200M sectional steam generator of the BN-600 power unit. The selection of diagnostic parameters used to locate the failed section is justified. Various alternative locations of leaks have been simulated [ru

Treatment failure in patients with epilepsy -Exploring causes of ineffectiveness and adverse effects

NARCIS (Netherlands)

Gombert-Handoko, K.B.

2009-01-01

Epilepsy is a neurological disorder that leads to seizures affecting a variety of mental and physical functions. Antiepileptic drugs are the mainstay of treatment. However, in one third of patients treatment fails: patients keep getting seizures or experience bothersome side effects. In this thesis

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

OpenAIRE

Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Ramirez-Fuentes, Cristina; Leal Blanquet, Joan; Gelber, Pablo-Eduardo; Monllau García, Juan Carlos

2017-01-01

Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical ...

Efficacy of ginger-based treatments against infection with Gyrodactylus turnbulli in the guppy (Poecilia reticulata (Peters)).

Science.gov (United States)

Levy, G; Zilberg, D; Paladini, G; Fridman, S

2015-04-30

Monogenean infections of commercially farmed fishes are responsible for significant economic losses and existing chemical therapeutants, often stressful to the fish, pose associated risks. As part of a recent trend to move towards the use of alternative, plant-based remedies for commonly occurring aquaculture-related diseases, the efficiency of ginger (Zingiber officinale) was investigated against the monogenean parasite Gyrodactylus turnbulli in the guppy. In vitro trials revealed the clear anti-parasitic effects of ginger. Ethanolic and aqueous extracts, prepared from freeze dried ginger, were tested. An increase in extract concentration was associated with reduced time to parasite immobilisation, with ethanolic extract being more efficient; at 75 and 200ppt aqueous ginger extract parasites died at 65.6±2.8 and 1.8±0.2min, respectively, whereas at 5 and 40ppt ethanolic extract parasites died at 26.1±0.7 and 4.9±0.3min, respectively. Bathing G. turnbulli-infected fish in ethanolic ginger extract (i.e. 5 and 7.5ppt for 90 and 30min, respectively) significantly reduced infection prevalence and intensity when compared to the water and ethanol controls. The higher concentration (i.e. 7.5ppt) proved as equally effective as Praziquantel, the conventionally used chemical treatment for gyrodactylosis, with the fish appearing to be completely cleared of the infection in both cases. Oral treatments of G. turnbulli-infected guppies with diets supplemented with 10 and 20% ginger powder proved to be ineffective in decreasing parasite load. These findings demonstrate that immersion in ginger extract offers an effective, alternative treatment against monogenean infection in fish. Copyright © 2015 Elsevier B.V. All rights reserved.

Considerations on Fail Safe Design for Design Basis Accident (DBA) vs. Design Extension Condition (DEC): Lesson Learnt from the Fukushima Accident

International Nuclear Information System (INIS)

Ha, Jun Su; Kim, Sungyeop

2014-01-01

The fail safety design is referred to as an inherently safe design concept where the failure of an SSC (System, Structure or Component) leads directly to a safe condition. Usually the fail safe design has been devised based on the design basis accident (DBAs), because the nuclear safety has been assured by securing the capability to safely cope with DBAs. Currently regards have been paid to the DEC (Design Extension Condition) as an extended design consideration. Hence additional attention should be paid to the concept of the fail safe design in order to consider the DEC, accordingly. In this study, a case chosen from the Fukushima accident is studied to discuss the issue associated with the fail safe design in terms of DBA and DEC standpoints. For the fail safe design to be based both on the DBA and the DEC, a Mode Changeable Fail Safe Design (MCFSD) is proposed in this study. Additional discussions on what is needed for the MCFSD to be applied in the nuclear safety are addressed as well. One of the lessons learnt from the Fukushima accident should include considerations on the fail-safe design in a changing regulatory framework. Currently the design extension condition (DEC) including severe accidents should be considered during designing and licensing NPPs. Hence concepts on the fail safe design need to be changed to be based on not only the DBA but also the DEC. In this study, a case on a fail-safe design chosen from the Fukushima accident is studied to discuss the issue associated with the fail safe design in terms of DBA and DEC conditions. For the fail safe design to be based both on the DBA and the DEC, a Mode Changeable Fail Safe Design (MCFSD) is proposed in this study. Additional discussions on what is needed for the MCFSD to be applied in the nuclear safety are addressed as well

Clinical Outcomes Associated with a Failed Infant Car Seat Challenge.

Science.gov (United States)

Shah, Malika D; Dookeran, Keith A; Khan, Janine Y

2017-01-01

To assess comorbid conditions and clinical outcomes among late preterm and low birth weight term infants (Baby Unit. This was a retrospective chart review of consecutive infants who failed ICSC on the Mother-Baby Unit and were subsequently admitted to the neonatal intensive care unit at Prentice Women's Hospital between January 1, 2009, and December 31, 2015. Regression models were used to estimate risk differences (RDs) with 95% CIs for factors related to length of stay. A total of 148 infants were studied (43% male; 37% delivered via cesarean). ICSC failure in the Mother-Baby Unit was due to desaturation, bradycardia, and tachypnea in 59%, 37%, and 4% of infants, respectively. During monitoring on the neonatal intensive care unit, 39% of infants experienced apnea (48% in preterm vs 17% in term infants) in the supine position, 19% received phototherapy, and 2% and 6.8% received nasogastric and thermoregulatory support, respectively. Univariate predictors of increased duration of stay (days) were younger gestational age, apnea, nasogastric support, intravenous fluids, and antibiotics (all P < .05). In multivariable analysis adjusted for gestational age and discharge weight, only apnea (RD, 4.87; 95% CI, 2.99-6.74; P < .001), administration of antibiotics (RD, 3.25; 95% CI, 0.29-6.21; P < .032), and intravenous fluid support (RD, 4.87; 95% CI, 0.076-9.66; P < .047) remained independent predictors of a longer duration of stay. Infants who failed ICSC were at risk for comorbid conditions that prolonged hospital stay beyond the neonatal intensive care unit observation period. Almost one-half of late preterm infants who failed ICSC had apnea events in the supine position. Copyright © 2016 Elsevier Inc. All rights reserved.

Blood Fluke Exploitation of Innate-Adaptive Immune Interactions to Facilitate Parasite Development

Science.gov (United States)

2007-01-01

epidemiology 25:1292-1300. 7. Alonso , D., J. Munoz, J. Gascon, M. E. Valls, and M. Corachan. 2006. Failure of standard treatment with praziquantel in two...of naive and memory CD8 T cells in vivo. Nature immunology 1:426-432. 105. Pearce, E. J., A. Cheever, S. Leonard, M. Covalesky, R. Fernandez - Botran...Transactions of the Royal Society of Tropical Medicine and Hygiene 48:3–4. 149 148. Garcia , S., J. DiSanto, and B. Stockinger. 1999. Following the