Sample records for prevent long-term complications

  1. Preeclampsia: Pathogenesis, Prevention, and Long-Term Complications. (United States)

    Jim, Belinda; Karumanchi, S Ananth


    Preeclampsia continues to afflict 5% to 8% of all pregnancies throughout the world and is associated with significant morbidity and mortality to the mother and the fetus. Although the pathogenesis of the disorder has not yet been fully elucidated, current evidence suggests that imbalance in angiogenic factors is responsible for the clinical manifestations of the disorder, and may explain why certain populations are risk. In this review, we begin by demonstrating the roles that angiogenic factors play in pathogenesis of preeclampsia and its complications in the mother and the fetus. We then continue to report on the use of angiogenic markers as biomarkers to predict and risk-stratify disease. Strategies to treat preeclampsia by correcting the angiogenic balance, either by promoting proangiogenic factors or by removing antiangiogenic factors in both animal and human studies, are discussed. We end the review by summarizing status of the current preventive strategies and the long-term cardiovascular outcomes of women afflicted with preeclampsia. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Long term complications of diabetes (United States)

    ... Long-term complications of diabetes To use the sharing features on this page, ... other tests. All these may help you keep complications of diabetes away. You will need to check your blood ...

  3. Preventable long-term complications of suprapubic cystostomy after spinal cord injury: Root cause analysis in a representative case report

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    Singh Gurpreet


    Full Text Available Abstract Background Although complications related to suprapubic cystostomies are well documented, there is scarcity of literature on safety issues involved in long-term care of suprapubic cystostomy in spinal cord injury patients. Case Presentation A 23-year-old female patient with tetraplegia underwent suprapubic cystostomy. During the next decade, this patient developed several catheter-related complications, as listed below: (1 Suprapubic catheter came out requiring reoperation. (2 The suprapubic catheter migrated to urethra through a patulous bladder neck, which led to leakage of urine per urethra. (3 Following change of catheter, the balloon of suprapubic catheter was found to be lying under the skin on two separate occasions. (4 Subsequently, this patient developed persistent, seropurulent discharge from suprapubic cystostomy site as well as from under-surface of pubis. (5 Repeated misplacement of catheter outside the bladder led to chronic leakage of urine along suprapubic tract, which in turn predisposed to inflammation and infection of suprapubic tract, abdominal wall fat, osteomyelitis of pubis, and abscess at the insertion of adductor longus muscle Conclusion Suprapubic catheter should be anchored securely to prevent migration of the tip of catheter into urethra and accidental dislodgment of catheter. While changing the suprapubic catheter, correct placement of Foley catheter inside the urinary bladder must be ensured. In case of difficulty, it is advisable to perform exchange of catheter over a guide wire. Ultrasound examination of urinary bladder is useful to check the position of the balloon of Foley catheter.

  4. Intermittent versus every-day mesalazine therapy in preventing complications of diverticular disease: a long-term follow-up study. (United States)

    Tursi, A; Di Mario, F; Brandimarte, G; Elisei, W; Picchio, M; Loperfido, S; Dal Bo', N; Ferrara, F; Marcello, R; Heras Salvat, H; Scarpignato, C


    Mesalazine seems to be effective in preventing recurrence of acute uncomplicated diverticulitis (AUD), but the optimal mesalazine scheme to achieve these results is still debated. To assess the effectiveness of two different mesalazine-based treatments in preventing recurrence of AUD and the occurrence of other complications of diverticular disease (DD) during a long-term follow-up. We reviewed 311 patients suffer from recent episode of AUD and undergoing to mesalazine treatment: 207 (group A, 105 males, median age 63 years, range 47-74 years) were treated with mesalazine 1.6 g for 10 days each month, whilst 104 (group B, 55 males, median age 65 years, range 50-72 years) were treated with mesalazine 1.6 g every day. Patients were followed-up every 6 months (median 7.5 months, range 5-13 months). Patients were followed-up for a mean time of 3 years (range 12-72 months). Overall, occurrence of complication recurred more frequently in group A than in group B (p = 0.030, log-rank test). Acute diverticulitis recurred in 17 (8.2%) patients in group A and in 3 (2.9%) in group B; diverticular bleeding occurred in 4 (1.9%) patients in group A and in 1 (0.96%) patient in group B; surgery was required in 3 (1.4%) patients in group A and in no (0%) patient in group B. This is the first study showing that long-term mesalazine treatment is significantly better that intermittent mesalazine treatment in preventing occurrence of DD complications after an attack of acute diverticulitis.

  5. Long-Term Effects of Goshajinkigan in Prevention of Diabetic Complications: A Randomized Open-Labeled Clinical Trial

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    K. Watanabe


    Full Text Available Objective. This clinical trial was designed to investigate whether goshajinkigan reduces the onset of diabetic complications or not. Materials and Methods. A total of 332 type 2 diabetic mellitus patients were registered from 9 clinical centers from March 2000 to August 2007. Patients were randomly assigned to take goshajinkigan extract powder, 2.5 grams for 3 times a day or no kampo therapy, additionally to the regular treatment. The primary endpoints were the onset of macrovascular diseases or progression of nephropathy or retinopathy. Statistical analysis was performed by the intention-to-treat method. Results. After 5 years of observation, 116 patients were submitted to analysis. Among them, no macrovascular events were observed in both groups. Although 43 participants had upstaging of retinopathy or nephropathy in total, there was no significant difference between goshajinkigan group and control group. Deterioration of ankle reflex was suppressed in goshajinkigan group. Also glycated hemoglobin, and fasting plasma glucose were decreased in the goshajinkigan group. Conclusion. Although the power of analysis was too low to demonstrate any effects of goshajinkigan on the progression of macrovascular diseases, retinopathy or nephropathy, goshajinkigan may be beneficial for diabetic neuropathy and glycemic control.

  6. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. (United States)


    Effective prevention is needed to combat the worldwide epidemic of type 2 diabetes. We investigated the long-term extent of beneficial effects of lifestyle intervention and metformin on diabetes prevention, originally shown during the 3-year Diabetes Prevention Program (DPP), and assessed whether these interventions reduced diabetes-associated microvascular complications. The DPP (1996-2001) was a randomised trial comparing an intensive lifestyle intervention or masked metformin with placebo in a cohort selected to be at very high risk of developing diabetes. All participants were offered lifestyle training at the end of the DPP. 2776 (88%) of the surviving DPP cohort were followed up in the DPP Outcomes Study (DPPOS, Sept 1, 2002, to Jan 2, 2014) and analysed by intention to treat on the basis of their original DPP assignment. During DPPOS, the original lifestyle intervention group was offered lifestyle reinforcement semi-annually and the metformin group received unmasked metformin. The primary outcomes were the development of diabetes and the prevalence of microvascular disease. For the assessment of microvascular disease, we used an aggregate microvascular outcome, composed of nephropathy, retinopathy, and neuropathy. During a mean follow-up of 15 years, diabetes incidence was reduced by 27% in the lifestyle intervention group (hazard ratio 0·73, 95% CI 0·65-0·83; pdiabetes were 55% in the lifestyle group, 56% in the metformin group, and 62% in the placebo group. The prevalences at the end of the study of the aggregate microvascular outcome were not significantly different between the treatment groups in the total cohort (placebo 12·4%, 95% CI 11·1-13·8; metformin 13·0%, 11·7-14·5; lifestyle intervention 11·3%, 10·1-12·7). However, in women (n=1887) the lifestyle intervention was associated with a lower prevalence (8·7%, 95% CI 7·4-10·2) than in the placebo (11·0%, 9·6-12·6) and metformin (11·2%, 9·7-12·9) groups, with reductions in the

  7. Radiotherapy for pituitary adenomas: long-term outcome and complications

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    Rim, Chai Hong; Yang, Dae Sik; Park, Young Je; Yoon, Won Sup; Lee, Jung AE; Kim, Chul Yong [Korea University Medical Center, Seoul (Korea, Republic of)


    's disease). Amenorrhea was abated in 7 of 10 patients, galactorrhea in 8 of 8 patients, acromegaly in 7 of 11 patients, Cushing's disease in 4 of 4 patients. Long-term complication was observed in 4 patients; 3 patients with cerebrovascular accident, 1 patient developed dementia. Of these patients, 3 of 4 received more than 60 Gy of irradiation. EBRT is highly effective in preventing recurrence and reducing mass effect of non-secreting adenoma. Effort to improve tumor control of secreting adenoma is required. Careful long-term follow-up is required when relatively high dose is applied. Modern radiosurgery or proton RT may be options to decrease late complications.

  8. Radiotherapy for pituitary adenomas: long-term outcome and complications

    International Nuclear Information System (INIS)

    Rim, Chai Hong; Yang, Dae Sik; Park, Young Je; Yoon, Won Sup; Lee, Jung AE; Kim, Chul Yong


    ). Amenorrhea was abated in 7 of 10 patients, galactorrhea in 8 of 8 patients, acromegaly in 7 of 11 patients, Cushing's disease in 4 of 4 patients. Long-term complication was observed in 4 patients; 3 patients with cerebrovascular accident, 1 patient developed dementia. Of these patients, 3 of 4 received more than 60 Gy of irradiation. EBRT is highly effective in preventing recurrence and reducing mass effect of non-secreting adenoma. Effort to improve tumor control of secreting adenoma is required. Careful long-term follow-up is required when relatively high dose is applied. Modern radiosurgery or proton RT may be options to decrease late complications.

  9. Long-term complications in Hodgkin's lymphoma survivors. (United States)

    Kilickap, Saadettin; Barista, Ibrahim; Ulger, Sukran; Celik, Ismail; Selek, Ugur; Güllü, Ibrahim; Yildiz, Ferah; Kars, Ayse; Ozisik, Yavuz; Tekuzman, Gülten


    Background. Although patients with Hodgkin's lymphoma (HL) achieve prolonged survival, long-term complications are a major cause of morbidity and mortality among long-term survivors of HL. Methods. We retrospectively evaluated long-term complications in 336 HL survivors treated between January 1990 and January 2006 at the Department of Medical Oncology of the Hacettepe University Institute of Oncology who were >16 years old at presentation. All patients were regularly followed up every 3 months for the first 2 years after complete response, biannually for 3 years, and annually after 5 years. Results. Median follow-up was 8.5 years. The mean age (±SD) of the patients at the time of diagnosis was 35.7 ± 13.1 years. The male to female ratio was 61%/39%. During follow-up, 29 second malignancies (8.6%) were diagnosed in 28 patients with HL; 22 were solid tumors and 7 were hematological malignancies. Forty-seven (14.0%) of all patients with HL were found to have thyroid abnormalities. During follow-up, 54 (16.1%) patients developed cardiovascular complications. Overall, 29 (8.6%) patients developed late pulmonary toxicities. The cumulative number of chronic viral infections was 13 (3.9%). Conclusions. Long-term survivors of HL need to be properly followed up not only for disease control but also for evaluation of possible late morbidities to minimize the consequences.

  10. Long-term complications of splenectomy in adult immune thrombocytopenia. (United States)

    Thai, Lan-Huong; Mahévas, Matthieu; Roudot-Thoraval, Françoise; Limal, Nicolas; Languille, Laetitia; Dumas, Guillaume; Khellaf, Mehdi; Bierling, Philippe; Michel, Marc; Godeau, Bertrand


    The recent large decrease in splenectomy use for chronic immune thrombocytopenia (ITP) is partly due to still-unsolved questions about long-term safety. We performed the first single-center exposed/unexposed cohort study evaluating the long-term incidence of splenectomy complications in patients with primary ITP. Overall, 83 patients who underwent splenectomy more than 10 years ago (exposed) were matched with 83 nonsplenectomized patients (unexposed) on the date of ITP diagnosis ±5 years, age and gender. After a median follow-up of 192 months (range 0.5-528), 43 patients (52%) achieved overall response after splenectomy. Splenectomized patients experienced more venous thromboembolism (VTE) than controls (n = 13 vs n = 2, P = 0.005). On multivariate analysis, splenectomy was an independent risk factor of VTE (hazard ratio = 4.006, P = 0.032 [95% confidence interval: 1.13-14.21]). Splenectomized patients presented more severe infections on long-term follow-up: all required hospitalization, and 5/26 (19%) infections led to severe sepsis or septic shock and to death for 3 cases (none in controls). However, the incidence of malignancy was similar in both groups, as was cardiovascular risk, which appeared to be related more to ITP than splenectomy. Finally, splenectomy did not significantly decrease overall survival. Despite the risk of thrombosis and severe sepsis, splenectomy remains an effective and curative treatment for ITP.

  11. A study of long-term complications associated with enteral ostomy and their contributory factors. (United States)

    Jayarajah, Umesh; Samarasekara, Asuramuni M P; Samarasekera, Dharmabandhu N


    Complications of ostomy significantly affect the quality of life of ostomates. There is little evidence on the rate of long-term complications in ostomates, especially from the developing countries which include Sri Lanka. This study was aimed to describe the long-term complications of enteral ostomies and their contributory factors. A retrospective analysis was carried out on 192 patients who underwent ostomy creation over a period of 5 years. Data on type of complications, age, sex, type of ostomy, type of surgery and perioperative care by enteric stoma therapist were gathered. Associations were established using Chi square test and multiple logistic regression. Out of 192 patients, only 146 patients presented regularly for follow up. The mean follow up duration was 28 months (range: 3-183). Around 34.2% developed surgical long-term complications related to the ostomy. Common complications were prolapse (n = 24, 16.4%), skin excoriation (n = 22, 15.1%) and parastomal hernia (n = 14, 9.6%). Overall complication rate was significantly less in loop ostomies (p ostomies (p ostomies (p < 0.05). Perioperative care by enteric stoma therapist reduced the overall and specific complications (p < 0.001). The overall complication rate in our cohort of patients was 34.2%. The perioperative care of a stoma therapist may be very effective in preventing complications particularly in a setting with limited resources.

  12. Feeding tube-related complications and problems in patients receiving long-term home enteral nutrition

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    Vasileios Alivizatos


    Full Text Available Aim: The aim of this study was to evaluate the long-term complications and problems related to gastrostomy and jejunostomy feeding tubes used for home enteral nutrition support and the effect these have on health care use. Materials and Methods: The medical records of 31 patients having gastrostomy (27 patients and jejunostomy (4 feeding tubes inserted in our Department were retrospectively studied. All were discharged on long-term (>3 months enteral nutrition and followed up at regular intervals by a dedicated nurse. Any problem or complication associated with tube feeding as well as the intervention, if any, that occurred, was recorded. Data were collected and analyzed. Results: All the patients were followed up for a mean of 17.5 months (4-78. The most frequent tube-related complications included inadvertent removal of the tube (broken tube, plugged tube; 45.1%, tube leakage (6.4%, dermatitis of the stoma (6.4%, and diarrhea (6.4%. There were 92 unscheduled health care contacts, with an average rate of such 2.9 contacts over the mean follow-up time of 17.5 months. Conclusion: In patients receiving long-term home enteral nutrition, feeding tube-related complications and problems are frequent and result in significant health care use. Further studies are needed to address their optimal prevention modalities and management.

  13. Memory Reactivation Enables Long-Term Prevention of Interference. (United States)

    Herszage, Jasmine; Censor, Nitzan


    The ability of the human brain to successively learn or perform two competing tasks constitutes a major challenge in daily function. Indeed, exposing the brain to two different competing memories within a short temporal offset can induce interference, resulting in deteriorated performance in at least one of the learned memories [1-4]. Although previous studies have investigated online interference and its effects on performance [5-13], whether the human brain can enable long-term prevention of future interference is unknown. To address this question, we utilized the memory reactivation-reconsolidation framework [2, 12] stemming from studies at the synaptic level [14-17], according to which reactivation of a memory enables its update. In a set of experiments, using the motor sequence learning task [18] we report that a unique pairing of reactivating the original memory (right hand) in synchrony with novel memory trials (left hand) prevented future interference between the two memories. Strikingly, these effects were long-term and observed a month following reactivation. Further experiments showed that preventing future interference was not due to practice per se, but rather specifically depended on a limited time window induced by reactivation of the original memory. These results suggest a mechanism according to which memory reactivation enables long-term prevention of interference, possibly by creating an updated memory trace integrating original and novel memories during the reconsolidation time window. The opportunity to induce a long-term preventive effect on memories may enable the utilization of strategies optimizing normal human learning, as well as recovery following neurological insults. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Long-term complications of JJ stent and its management: A 5 years review. (United States)

    Ray, Rajendra Prasad; Mahapatra, Rajkumar Singha; Mondal, Partha Pratim; Pal, Dilip Kumar


    To assess the long term complications of JJ stent, the management of complications and the role of endoscopic approach to manage these complications. Nineteen patients with indwelling JJ stent for a duration of more than 6 months were included in this study. Patients were assessed with X-ray KUB, USG KUB, blood urea, creatinine and DTPA renogram. Data were analyzed by Microsoft excel 2007. Out of 19 patients 12 (63.16%) were male and 7 (36.84%) were female. The mean age was 39.78 ± 13.69 years., Mean duration for which the stent was in situ was 29.56 months. The most common complication was broken stent, in 11 cases (57.89%). Other complications were migration in 5 (26.32%), encrustation in 2 (10.52%) and 1 case of (5.26%) stone formation. Eighteen cases were managed by endoscopic approaches. A total of 22 procedures were performed to treat the complications. Eleven cases were managed by a single procedure and 8 patients required multiple procedures. All were managed successfully with no death reported. Post-operative complications were seen in eight cases (42.11%). JJ stent related long-term complications are not uncommon and are usually seen after 6 months of indwelling time. Endourological procedure should be the initial approach with a high success rate. Coordinated use multimodality and technology helps in management of difficult cases. Open surgery is rarely required. Prevention of the complication by judicious use and early removal is the cornerstone.

  15. Long term complications of the intraprostatic spiral. Case report

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    Krogh, J


    A 76-year-old man had an intraprostatic spiral inserted to relieve bladder outlet obstruction that was caused by benign prostatic hypertrophy. After 30 months numerous complications had arisen including severe encrustations, urethral stricture, and sclerosis of the bladder neck. Regular replaceme...

  16. Unusual long-term complications of a splenic cyst.

    LENUS (Irish Health Repository)

    Ward, E V M


    Splenic cysts are relatively uncommon, and are usually asymptomatic. They are benign, typically treated conservatively and followed up with ultrasound examination, with few reported complications. We report a case of a simple splenic cyst that was followed up on imaging over a seven-year period. During that time, the cyst gradually enlarged from 5 cm to 12 cm in diameter, however the patient remained asymptomatic. After seven years, the patient was admitted with abdominal pain and a pelvic mass. The spleen was located within the pelvis, which was felt to be due to the weight of the cyst which caused the spleen to migrate out of its normal position. This case illustrates an extremely unusual complication, and suggests that while most splenic cysts may be managed conservatively, enlarging cysts may be prone to gravitational effects and prophylactic treatment should be considered.

  17. Unusual long-term complications of a splenic cyst.

    LENUS (Irish Health Repository)

    Ward, E V M


    Splenic cysts are relatively uncommon, and are usually asymptomatic. They are benign, typically treated conservatively and followed up with ultrasound examination, with few reported complications. We report a case of a simple splenic cyst that was followed up on imaging over a seven-year period. During that time, the cyst gradually enlarged from 5 cm to 12 cm in diameter, however the patient remained asymptomatic. After seven years, the patient was admitted with abdominal pain and a pelvic mass. The spleen was located within the pelvis, which was felt to be due to the weight of the cyst which caused the spleen to migrate out of its normal position. This case illustrates an extremely unusual complication, and suggests that while most splenic cysts may be managed conservatively, enlarging cysts may be prone to gravitational effects and prophylactic treatment should be considered.

  18. Long-Term Natural History and Complications of Collagenous Colitis

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    Hugh J Freeman


    Full Text Available Microscopic forms of colitis have been described, including collagenous colitis, a possibly heterogeneous disorder. Collagenous colitis most often appears to have an entirely benign clinical course that usually responds to limited treatment. Sometimes significant extracolonic disorders, especially arthritis, spondylitis, thyroiditis and skin disorders, such as pyoderma gangrenosum, dominate the clinical course and influence the treatment strategy. However, rare fatalities have been reported and several complications, some severe, have been attributed directly to the colitis. Toxic colitis and toxic megacolon may develop. Concomitant gastric and small intestinal inflammatory disorders have been described including celiac disease and more extensive collagenous inflammatory disease. Colonic ulceration has been associated with the use of nonsteroidal anti-inflammatory drugs, while other forms of inflammatory bowel disease, including ulcerative colitis and Crohn disease, may evolve directly from collagenous colitis. Submucosal ‘dissection’, colonic fractures, or mucosal tears and perforation, possibly from air insufflation during colonoscopy, have been reported. Similar changes may result from increased intraluminal pressures that may occur during radiological imaging of the colon. Neoplastic disorders of the colon may also occur during the course of collagenous colitis, including colon carcinoma and neuroendocrine tumours (ie, carcinoids. Finally, lymphoproliferative disease has been reported.

  19. Eye Complications and Markers of Morbidity and Mortality in Long-term Type 1 Diabetes

    DEFF Research Database (Denmark)

    Grauslund, Jakob


    The incidence of type 1 diabetes is rising all over the world. Furthermore, the increased life-expectancy of type 1 diabetic patients is likely to cause a higher number of diabetes-related micro- and macrovascular complications in the years to come. In order to examine the level of long......-term complications in type 1 diabetes as well as potential markers of micro- and macroangiopathy, a population-based cohort of Danish type 1 diabetic patients was examined in order to achieve the following aims: 1  To evaluate diabetic retinopathy as a long-term marker of all-cause mortality in type 1 diabetes...... (Paper I). 2  To estimate the long-term incidence and associated risk factors of blindness (Paper II) and cataract surgery (Paper III) in type 1 diabetes. 3  To use retinal vascular analyses in order to investigate the associations of long-term micro- and macrovascular complications and retinal vascular...

  20. Long-Term Outcome and Complications Following Prophylactic Laparoscopic-Assisted Gastropexy in Dogs. (United States)

    Loy Son, Natasha K; Singh, Ameet; Amsellem, Pierre; Kilkenny, Jessica; Brisson, Brigitte A; Oblak, Michelle L; Ogilvie, Adam T


    To characterize the short- and long-term outcome (>12 months), complications, and owner satisfaction following prophylactic laparoscopic-assisted gastropexy (LAG) in dogs. Retrospective study. Client-owned dogs (n = 49). Dogs that underwent prophylactic LAG at 2 veterinary academic hospitals were studied. Surgical time, anesthesia time, concurrent intra- and extra-abdominal procedures, and intraoperative and postoperative complications were recorded following review of medical records. Veterinarian and/or owner follow-up was obtained to determine outcome and satisfaction with LAG. Five of 49 dogs (10%) experienced complications related to abdominal access during LAG. Four percent (2/49) of dogs experienced an intraoperative complication. Follow-up information was available for 89% of dogs (44/49). Four dogs died of causes unrelated to LAG or gastric dilatation volvulus (GDV) in the follow-up period. Two dogs experienced major postoperative complications requiring additional veterinary intervention. Thirty percent (13 dogs) experienced a minor postoperative self-limiting wound-related complication. Median follow-up time was 698 days (range, 411-1825). No dogs experienced GDV. One hundred percent of dog owners were satisfied with LAG, would repeat the procedure in a future pet, and would recommend the procedure to a friend or family member. LAG was an effective procedure for prevention of GDV and was associated with high client satisfaction in this cohort of dogs. A moderate rate of postoperative wound complications occurred that were minor and self-limiting in nature. © Copyright 2016 by The American College of Veterinary Surgeons.

  1. Early and late complications among long-term colorectal cancer survivors with ostomy or anastomosis. (United States)

    Liu, Liyan; Herrinton, Lisa J; Hornbrook, Mark C; Wendel, Christopher S; Grant, Marcia; Krouse, Robert S


    Among long-term (>or=5 y) colorectal cancer survivors with permanent ostomy or anastomosis, we compared the incidence of medical and surgical complications and examined the relationship of complications with health-related quality of life. The incidence and effects of complications on long-term health-related quality of life among colorectal cancer survivors are not adequately understood. Participants (284 survivors with ostomies and 395 survivors with anastomoses) were long-term colorectal cancer survivors enrolled in an integrated health plan. Health-related quality of life was assessed via mailed survey questionnaires from 2002 to 2005. Information on colorectal cancer, surgery, comorbidities, and complications was obtained from computerized data and analyzed by use of survival analysis and logistic regression. Ostomy and anastomosis survivors were followed up for an average of 12.1 and 11.2 years, respectively. Within 30 days of surgery, 19% of ostomy survivors and 10% of anastomosis survivors experienced complications (P Ostomy was associated with long-term fistula (odds ratio, 5.4; 95% CI 1.4-21.2), and among ostomy survivors, fistula was associated with reduced health-related quality of life (P ostomy have more complications early in their survivorship period, but complications among anastomosis survivors catch up after 20 years, when the 2 groups have convergent complication rates. Among colorectal cancer survivors with ostomy, fistula has especially important implications for health-related quality of life.


    Liu, Liyan; Herrinton, Lisa J.; Hornbrook, Mark C.; Wendel, Christopher S.; Grant, Marcia; Krouse, Robert S.


    Purpose Among long-term (≥5 years) colorectal cancer survivors with permanent ostomy or anastomosis, we compared the incidence of medical and surgical complications and examined the relationship of complications with health-related quality of life. Background The incidence and effects of complications on long-term health-related quality of life among colorectal cancer survivors are not adequately understood. Methods Participants (284 ostomy/395 anastomosis) were long-term colorectal cancer survivors enrolled in an integrated health plan. Health-related quality of life was assessed via mailed survey questionnaire in 2002–2005. Information on colorectal cancer, surgery, co-morbidities, and complications was obtained from computerized data and analyzed using survival analysis and logistic regression. Results Ostomy and anastomosis survivors were followed an average 12.1 and 11.2 years, respectively. Within 30 days of surgery, 19% of ostomy and 10% of anastomosis survivors experienced complications (pOstomy was associated with long-term fistula (odds ratio 5.4; 95% CI 1.4–21.2), and among ostomy survivors, fistula was associated with reduced health-related quality of life (postomy have more complications early in their survivorship period, but complications among anastomosis survivors catch up after 20 years, when the two groups have convergent complication rates. Among colorectal cancer survivors with ostomy, fistula has especially important implications for health-related quality of life. PMID:20087096

  3. Long-term complications and side effects of bariatric surgery: a systematic review

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    Alfonso Enrique Martínez-Núñez


    Full Text Available Background and objective: Bariatric surgery is a procedure that has gained popularity in the last decades as a treatment for obesity and is generally regarded as safe and effective in the short term, though the complications on the long term have been poorly described. We aim to review studies with long term follow-up reporting complications after a bariatric procedure. Method: A search was conducted on the data bases MEDLINE, EBSCO, Cochrane Library, and Google Scholar, and also scanning through references list in publications. We included cohort studies and clinical trials published from January 1st 2014 to April 15th 2017 with a follow up ≥ 5 years, retention rate above 50%, written in the following languages; English, Spanish, or Portuguese. We conducted qualitative bias assessment and analysis of heterogeneity. Result: Only four studies met the inclusion criteria, all of them were conducted with different bariatric procedures (vertical sleeve gastrectomy, laparoscopic sleeve gastrectomy, laparoscopic adjustable gastric banding, and billiopancreatic diversion with or without duodenal shift. Study design, outcome assessment, and complication definition were highly heterogeneous. The most frequent long term complications were gastroesophageal reflux disease, several nutritional deficits, incisional hernias, and failure to weight loss. Conclusions: There is insufficient evidence to ensure the quantity and severity of long-term complications of bariatric surgery.

  4. Double bypass for inoperable pancreatic malignancy at laparotomy: postoperative complications and long-term outcome (United States)

    Ausania, F; Vallance, AE; Manas, DM; Prentis, JM; Snowden, CP; White, SA; Charnley, RM; French, JJ; Jaques, BC


    INTRODUCTION Between 4% and 13% of patients with operable pancreatic malignancy are found unresectable at the time of surgery. Double bypass is a good option for fit patients but it is associated with high risk of postoperative complications. The aim of this study was to identify pre-operatively which patients undergoing double bypass are at high risk of complications and to assess their long-term outcome. METHODS Of the 576 patients undergoing pancreatic resections between 2006 and 2011, 50 patients who underwent a laparotomy for a planned pancreaticoduodenectomy had a double bypass procedure for inoperable disease. Demographic data, risk factors for postoperative complications and pre-operative anaesthetic assessment data including the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) and cardiopulmonary exercise testing (CPET) were collected. RESULTS Fifty patients (33 men and 17 women) were included in the study. The median patient age was 64 years (range: 39–79 years). The complication rate was 50% and the in-hospital mortality rate was 4%. The P-POSSUM physiology subscore and low anaerobic threshold at CPET were significantly associated with postoperative complications (p=0.005 and p=0.016 respectively) but they were unable to predict them. Overall long-term survival was significantly shorter in patients with postoperative complications (9 vs 18 months). Postoperative complications were independently associated with poorer long-term survival (p=0.003, odds ratio: 3.261). CONCLUSIONS P-POSSUM and CPET are associated with postoperative complications but the possibility of using them for risk prediction requires further research. However, postoperative complications following double bypass have a significant impact on long-term survival and this type of surgery should therefore only be performed in specialised centres. PMID:23131226

  5. Long-term survival in nasopharyngeal carcinoma and late complications of irradiation

    International Nuclear Information System (INIS)

    Furukawa, Mitsuru; Komori, Takashi; Ishiguro, Hideyo; Takimoto, Toru; Umeda, Ryozo


    Irradiation remains the mainstay of treatment of nasopharyngeal carcinoma in the primary site and the neck. We studied the long-term effects of irradiation in five patients who have survived ten or more years after treatment without recurrence of disease, and we were impressed by the rarity of disabling complications of the treatment. Minor complications were common, and especially troublesome were xerostomia, dental caries, postnasal crusting and neck weakness. (author)

  6. Intrathecal baclofen in multiple sclerosis and spinal cord injury: complications and long-term dosage evolution. (United States)

    Draulans, Nathalie; Vermeersch, Kristof; Degraeuwe, Bart; Meurrens, Tom; Peers, Koen; Nuttin, Bart; Kiekens, Carlotte


    To investigate the long-term dosage evolution and complication rate of intrathecal baclofen use in multiple sclerosis and spinal cord injury patients, based on a large population with a long follow-up. Retrospective data analysis. Academic hospital. Patients with multiple sclerosis (n = 81) or spinal cord injury (n = 49) having an intrathecal baclofen pump implanted at the University Hospitals Leuven between 1988 and 2009. Medical records review of included patients in August 2010. Complications linked to intrathecal baclofen therapy. Daily baclofen dosage after 3 and 6 months, and yearly thereafter. Data on dosage evolution were analysed using a mixed-effect linear model. In 130 patients with a mean follow-up of 63 months, comprising 797 pump years, 104 complications were recorded. This corresponds to a complication rate of 0.011 per month, equally divided among both groups. Seventy-eight of these complications were catheter related. The mean dosage of baclofen stabilizes two years after implantation at 323 µg/day in the multiple sclerosis population. In spinal cord injury patients the daily dose only stabilizes after five years at a significantly higher dosage (504 µg/day). No significant increase in dosage is seen in the long term. In multiple sclerosis and spinal cord injury patients, intrathecal baclofen therapy has a complication rate of 1% per month. Complications are mainly due to catheter-related problems (74%). The intrathecal baclofen dosage stabilizes in the long term, indicating that long-term tolerance, defined as progressive diminution of the susceptibility to the effects of a drug, is not present.

  7. Long-term risk of complications after mid-urethral sling IVS implantation

    Directory of Open Access Journals (Sweden)

    Grzegorz Surkont


    Full Text Available [b]Introduction[/b]. Results of short-term evaluation of multifilament microporous midurethral tape IVS differ a great deal. During the first year of implantation, erosions have been observed in 0%–26% of operated women. Long-term observations are rare. They suggest high risk of extrusion and infection even after years of implantation. [b]Objective[/b]. The purpose of the study was to evaluate long-term risk of complications after IVS implantation. Material and methods. Between 2001–2005, 72 women were operated on with the use of IVS mid-urethral tape. [b]Results[/b]. Two women had vaginal erosions during the first 3 months after the operation. Twelve women had vaginal erosions, purulent vaginal discharge, with IVS tape sticking out of the abdominal wall or vagina, and abdominal abscess. These complications were diagnosed between 9 months and 6 years after IVS implantation. The patients were operated on vaginally and open abdominally, 1–5 times because of complications after IVS implantation. [b]Conclusions[/b]. In the case of post-IVS complication, as much tape as possible should be excised. Long-term follow up on patients with IVS implantation should be recommended to the centres where IVS tape was used, even to patients after removal of the tape. Risk of erosion, extrusion and infection after midurethral multifilament microporous IVS tape implantation is too high – which is the reason it should no longer be used.

  8. Potential Long-Term Complications of Endovascular Stent Grafting for Blunt Thoracic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Larry E. Miller


    Full Text Available Blunt thoracic aortic injury (BTAI is a rare, but lethal, consequence of rapid deceleration events. Most victims of BTAI die at the scene of the accident. Of those who arrive to the hospital alive, expedient aortic intervention significantly improves survival. Thoracic endovascular aortic repair (TEVAR has been accepted as the standard of care for BTAI at many centers, primarily due to the convincing evidence of lower mortality and morbidity in comparison to open surgery. However, less attention has been given to potential long-term complications of TEVAR for BTAI. This paper focuses on these complications, which include progressive aortic expansion with aging, inadequate stent graft characteristics, device durability concerns, long-term radiation exposure concerns from follow-up computed tomography scans, and the potential for (Victims of Modern Imaging Technology VOMIT.

  9. Radiological evaluation of long term complications of oral rehabilitations of thin ridges with titanium blade implants

    Directory of Open Access Journals (Sweden)

    P. Diotallevi


    Full Text Available Aim: The aim of this study was to assess the sensitivity of orthopantomography (OPT in the diagnosis of long term complications in oral rehabilitations with blade implants. Materials and methods A total of 235 blade implants in 189 patients, inserted between 1988 and 2003, were retrospectively analyzed. The records consisted of a first OPT taken between January and December 2010, and a second one 12 months after. The evaluation of implant health considered: integrity of the blade, normal radiological representation of the bone around the implant, dense and cortical appearance of bone around the implant collar. The evaluation of radiological complications considered: implant fracture, bone resorption around the implant, recession of the bone around the implant collar. Results The sensitivity of the panoramic evaluation was equal to 100%. The complications detected were 5 cases of periimplantitis, 9 cases of bone pericervical bone recession and 3 cases of fracture of the implant body. In cases of pericervical bone resorption the following radiological check up 12 months after the first one showed the progression of the disease in 6 out of 9 cases, with irreversible implant failure. In subjects with a radiological pattern of implant health there were no complications in the subsequent check up after 12 months. In the subjects with complications the specificity was equal to 100%. Conclusion The radiographic evaluation by the means of OPT has shown high sensitivity in the diagnosis of long term complications of oral rehabilitations with blade implants and allows prompt therapeutic interventions. Radiological complications appeared mostly in the long term check ups and mainly consisted in recession of the bone around the neck or around the entire implant. More rarely implant fractures occurred, which, in the case of blades, sometimes were not associated with any clinical symptoms: therefore, postsurgical evaluation should not be separated from

  10. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. (United States)

    Jiang, Nan; Deng, Jing-Yu; Ding, Xue-Wei; Ke, Bin; Liu, Ning; Zhang, Ru-Peng; Liang, Han


    To investigate the impact of prognostic nutritional index (PNI) on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy. The data for 386 patients with gastric cancer were extracted and analyzed between January 2003 and December 2008 in our center. The patients were divided into two groups according to the cutoff value of the PNI: those with a PNI ≥ 46 and those with a PNI gastric cancer patients.

  11. [Cervical disc hernia decompensation complicated by postoperative transitory tetraparesia about long-term haemodialysis patient]. (United States)

    Caltot, E; Hélaine, L; Cadic, A; Muller, C; Arvieux, C-C


    We report a case of a 51-year-old man who underwent a third kidney transplantation that was complicated by tetraparesia due to a C5-C6 cervical disc hernia decompensation in the immediate postoperative period. Preoperative consultation for long-term haemodialysis patients could be perfected by further neurological investigation and additional imagery. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  12. Long-term prevention of diabetic nephropathy: an audit

    DEFF Research Database (Denmark)

    Schjoedt, K.J.; Hansen, H.P.; Tarnow, L.


    AIMS/HYPOTHESIS: In type 1 diabetic patients with microalbuminuria not receiving antihypertensive treatment, an increase in urinary AER (UAER) of 6-14%/year and a risk of developing diabetic nephropathy (DN) of 3-30%/year have been reported. We audited the long-term effect of blocking the renin......-angiotensin-aldosterone system (RAAS) with an ACE inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in microalbuminuric type 1 diabetic patients on progression of microalbuminuria and development of DN. METHODS: All patients with type 1 diabetes and persistent microalbuminuria (30-300 mg/24 h) were identified (n=227...

  13. Long-term Postoperative Nutritional Status Affects Prognosis Even After Infectious Complications in Gastric Cancer. (United States)

    Kiuchi, Jun; Komatsu, Shuhei; Kosuga, Toshiyuki; Kubota, Takeshi; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Ichikawa, Daisuke; Otsuji, Eigo


    This study was designed to investigate the clinical impact of postoperative serum albumin level on severe postoperative complications (SPCs) and prognosis. Data for a total of 728 consecutive patients who underwent curative gastrectomy for gastric cancer between 2004 and 2013 were retrospectively analyzed. From these patients, a propensity score-matched analysis was performed based on 14 clinicopathological and surgical factors. Short-term decrease in postoperative serum albumin level was not associated with the occurrence of SPCs. Regarding long-term decrease in serum albumin level, a decrease of ≥0.5 g/dl at 3 months did not affect the long-term survival of patients without SPCs, but was related to a significantly poorer prognosis in patients with SPCs. By multivariate analysis, long-term decrease of serum albumin level was an independent prognostic factor in patients with SPCs. Long-term postoperative nutritional status as shown by a low level of albumin was related to prognosis in patients with SPCs. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  14. Modelling Gaucher disease progression: long-term enzyme replacement therapy reduces the incidence of splenectomy and bone complications

    NARCIS (Netherlands)

    van Dussen, Laura; Biegstraaten, Marieke; Dijkgraaf, Marcel Gw; Hollak, Carla Em


    Long-term complications and associated conditions of type 1 Gaucher Disease (GD) can include splenectomy, bone complications, pulmonary hypertension, Parkinson disease and malignancies. Enzyme replacement therapy (ERT) reverses cytopenia and reduces organomegaly. To study the effects of ERT on

  15. Right ventricular pacemaker lead position is associated with differences in long-term outcomes and complications. (United States)

    Witt, Chance M; Lenz, Charles J; Shih, Henry H; Ebrille, Elisa; Rosenbaum, Andrew N; van Zyl, Martin; Aung, Htin; Manocha, Kevin K; Deshmukh, Abhishek J; Hodge, David O; Mulpuru, Siva K; Cha, Yong-Mei; Espinosa, Raul E; Asirvatham, Samuel J; Mcleod, Christopher J


    Cardiac pacing from the right ventricular apex is associated with detrimental long-term effects and nonapical pacing locations may be associated with improved outcomes. There is little data regarding complications with nonapical lead positions. The aim of this study was to assess long-term outcomes and lead-related complications associated with differing ventricular lead tip position. All adult patients who underwent dual-chamber pacemaker implantation from 2004 to 2014 were included if they had postprocedure chest radiographs amenable to lead position determination. Long-term outcomes and lead-related complication rates were recorded. These were compared at 5 years between: (1) apical and septal leads, (2) apical and nonseptal nonapical (NSNA), and (3) apical and septal with >40% ventricular pacing. We retrospectively evaluated 3,450 patients, which included 238 with a septal position and 733 with NSNA lead positions. Septal lead position was associated with a lower mortality compared to apical leads (24% vs. 31%, P = 0.02). In patients with greater than 40% pacing, septal leads were associated with significantly higher rates of incident atrial fibrillation compared to apical leads (49% vs. 34%, P = 0.04). NSNA positions were associated with a significantly higher rate of lead dislodgement (4% vs. 2%, P = 0.005) and need for revision (8% vs. 5%, P = 0.005). Septal pacemaker lead position is associated with a lower mortality compared to apically placed leads, but a higher incidence of atrial fibrillation with higher percentage ventricular pacing. NSNA lead locations are associated with more complications and should be avoided. © 2017 Wiley Periodicals, Inc.

  16. Impact of Procedure-Related Complications on Long-term Islet Transplantation Outcome. (United States)

    Caiazzo, Robert; Vantyghem, Marie-Christine; Raverdi, Violeta; Bonner, Caroline; Gmyr, Valery; Defrance, Frederique; Leroy, Clara; Sergent, Geraldine; Hubert, Thomas; Ernst, Oliver; Noel, Christian; Kerr-Conte, Julie; Pattou, François


    Pancreatic islet transplantation offers a promising biotherapy for the treatment of type 1 diabetes, but this procedure has met significant challenges over the years. One such challenge is to address why primary graft function still remains inconsistent after islet transplantation. Several variables have been shown to affect graft function, but the impact of procedure-related complications on primary and long-term graft functions has not yet been explored. Twenty-six patients with established type 1 diabetes were included in this study. Each patient had two to three intraportal islet infusions to obtain 10,000 islet equivalent (IEQ)/kg in body weight, equaling a total of 68 islet infusions. Islet transplantation consisted of three sequential fresh islet infusions within 3 months. Islet infusions were performed surgically or under ultrasound guidance, depending on patient morphology, availability of the radiology suite, and patient medical history. Prospective assessment of adverse events was recorded and graded using "Common Terminology Criteria for adverse events in Trials of Adult Pancreatic Islet Transplantation." There were no deaths or patients dropouts. Early complications occurred in nine of 68 procedures. β score 1 month after the last graft and optimal graft function (β score ≥7) rate were significantly lower in cases of procedure-related complications (P = 0.02, P = 0.03). Procedure-related complications negatively impacted graft function (P = 0.009) and was an independent predictive factor of long-term graft survival (P = 0.033) in multivariate analysis. Complications occurring during radiologic or surgical intraportal islet transplantation significantly impair primary graft function and graft survival regardless of their severity.

  17. Long-Term Outcomes for the Promoting CARE Suicide Prevention Program (United States)

    Hooven, Carole; Herting, Jerald R.; Snedker, Karen A.


    Objectives: To provide a long-term look at suicide risk from adolescence to young adulthood for former participants in Promoting CARE, an indicated suicide prevention program. Methods: Five hundred ninety-three suicide-vulnerable high school youth were involved in a long-term follow-up study. Latent class growth models identify patterns of change…

  18. Does osteoprotegerin relate to micro- and macrovascular complications in long-term type 1 diabetes?

    DEFF Research Database (Denmark)

    Grauslund, Jakob; Rasmussen, Lars M; Green, Anders


    was 1257 pg/ml (range 379-5706 pg/ml). In univariate analyses, OPG was related to age, duration of diabetes, female gender, nephropathy and inversely to diastolic blood pressure. In an age- and sex-adjusted model, higher levels of OPG were associated with a higher risk of nephropathy (OR 2.54, 95......Abstract Purpose. Markers of micro- and macrovascular disease are needed in type 1 diabetes in order to identify patients at risk of severe complications. Osteoprotegerin (OPG) is expressed in vascular myocytes, and increasing levels have been reported in type 1 diabetes. Consequently, we...... investigated OPG as a non-invasive marker of micro- and macrovascular complications in long-term type 1 diabetic patients. Methods. This was a cross-sectional study of 200 type 1 diabetic patients with long diabetes duration from a population-based cohort from Fyn County, Denmark. Patients were examined...

  19. Evaluation of short- and long-term complications after endoscopically assisted gastropexy in dogs. (United States)

    Dujowich, Mauricio; Keller, Mattew E; Reimer, S Brent


    To determine short- and long-term complications in clinically normal dogs after endoscopically assisted gastropexy. Prospective case series. 24 dogs. Endoscopically assisted gastropexy was performed on each dog. Dogs were evaluated laparoscopically at 1 or 6 months after surgery to assess integrity of the gastropexy. Long-term outcome was determined via telephone conversations conducted with owners > or = 1 year after surgery. Mean +/- SD gastropexy length was 4.5 +/- 0.9 cm, and mean duration of surgery was 22 +/- 5 minutes. One dog had a partially rotated stomach at the time of insufflation, which was corrected by untwisting the stomach with Babcock forceps. Two dogs vomited within 4 weeks after surgery, but the vomiting resolved in both dogs. Four dogs had diarrhea within 4 weeks after surgery, which resolved without medical intervention. In all dogs, the gastropexy site was firmly adhered to the abdominal wall at the level of the pyloric antrum. Long-term follow-up information was available for 23 dogs, none of which had any episodes of gastric dilatation-volvulus a mean of 1.4 years after gastropexy. Endoscopically assisted gastropexy can be a simple, fast, safe, and reliable method for performing prophylactic gastropexy in dogs. At 1 and 6 months after gastropexy, adequate placement and adhesion of the gastropexy site to the body wall was confirmed. Such a procedure could maximize the benefits of minimally invasive surgery, such as decreases in morbidity rate and anesthetic time. This technique appeared to be suitable as an alternative to laparoscopic-assisted gastropexy.

  20. Intratympanic steroid prevents long-term spiral ganglion neuron loss in experimental meningitis

    DEFF Research Database (Denmark)

    Worsøe, Lise Lotte; Brandt, C.T.; Lund, S.P.


    Hypothesis: Intratympanic steroid treatment prevents hearing loss and cochlear damage in a rat model of pneumococcal meningitis. Background: Sensorineural hearing loss is a long-term complication of meningitis affecting up to a third of survivors. Streptococcus pneumoniae is the bacterial species...... for 3 days. Hearing loss and cochlear damage were assessed by distortion product otoacoustic emissions, auditory brainstem response at 16 kHz, and spiral ganglion neuron density. Results: Fifty-six days after infection, auditory brainstem response showed no significant differences between groups...... in the spiral ganglion compared with both intratympanic and systemic saline (p = 0.0082 and p = 0.0089; Mann-Whitney test). Histology revealed fibrosis of the tympanic membrane and cavity in steroid-treated animals, which plausibly caused the low-frequency hearing loss. Conclusion: Intratympanic betamethasone...

  1. Long-term pulmonary complications of chemical weapons exposure in former poison gas factory workers. (United States)

    Nishimura, Yoshifumi; Iwamoto, Hiroshi; Ishikawa, Nobuhisa; Hattori, Noboru; Horimasu, Yasushi; Ohshimo, Shinichiro; Fujitaka, Kazunori; Kondo, Keiichi; Hamada, Hironobu; Awai, Kazuo; Kohno, Nobuoki


    Sulfur mustard (SM) and lewisite are vesicant chemical warfare agents that can cause skin blistering and chronic lung complications. During 1929-1945, a Japanese factory produced poisonous gases, which included SM, lewisite and other chemical weapons. The aim of this study was to investigate the chest computed tomography (CT) findings among long-term survivors who worked at this factory. During 2009-2012, we evaluated chest CT findings from 346 long-term survivors who worked at the poison gas factory. Skin lesions were used as an indicator of significant exposure to vesicant agents. Among the 346 individuals, 53 (15%) individuals experienced skin lesions while working at the factory, and chest CT revealed abnormal findings in 179 individuals (52%). Emphysema was the most common CT finding and was observed in 75 individuals (22%), while honeycombing was observed in 8 individuals (2%). Emphysema and honeycombing were more prevalent among individuals with skin lesions, compared to individuals without skin lesions. Multivariate analyses revealed significant associations between the presence of emphysema and skin lesions (p = 0.008). Among individuals who never smoked, individuals with skin lesions (n = 26) exhibited a significantly higher rate of emphysema, compared to individuals without skin lesions (n = 200) (35% versus 7%, respectively; p chemical warfare agents.

  2. [Participation as Target of Social Medicine and Nursing Care: - Legal Definition of Long-Term Care Dependency - Strategies to Prevent Long-Term Care Dependency]. (United States)

    Nüchtern, Elisabeth; Gansweid, Barbara; Gerber, Hans; von Mittelstaedt, Gert


    Objective: By the "Second Bill to Strengthen Long-Term Care", a new concept of long-term care dependency will be introduced, valid from 2017. Long-term care dependency according to Social Code XI will be defined covering more aspects than today. Therefore, the working group "Nursing Care" of the division "Social Medicine in Practice and Rehabilitation" in the German Society for Social Medicine and Prevention presents their results after working on the social medicine perspective of the definition and prevention of long-term care dependency. Methods: Both the definition and strategies to prevent long-term care dependency are systematically taken into consideration from the point of view of social medicine on the basis of the International Classification of Functioning, Disability and Health (ICF), as long-term care dependency means a defined condition of disability. Results: Both the current and the new concept of long-term care dependency focus activity limitations. The perspective of social medicine considers the interactions of health condition, its effects on daily activities and personal as well as environmental factors. From this point of view approaches for social benefits concerning prevention and rehabilitation can be identified systematically so as to work against the development and progression of long-term care dependency. The reference to the ICF can facilitate the communication between different professions. The new "graduation" of long-term care dependency would allow an international "translation" referring to the ICF. Conclusion: Experts from the field of social medicine as well as those of nursing care, care-givers and nursing researchers have in common the objective that persons in need of nursing care can participate in as many aspects of life of importance to them in an autonomous and self-determined way. The point of view of social medicine on long-term care dependency is fundamental for all occupational groups that are involved and for their

  3. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma

    DEFF Research Database (Denmark)

    Jacobsen, L; Niggemann, B; Dreborg, S


    BACKGROUND: 3-year subcutaneous specific immunotherapy (SIT) in children with seasonal allergic rhinoconjunctivitis reduced the risk of developing asthma during treatment and 2 years after discontinuation of SIT (5-year follow-up) indicating long-term preventive effect of SIT. OBJECTIVE: We......: Specific immunotherapy has long-term clinical effects and the potential of preventing development of asthma in children with allergic rhino conjunctivitis up to 7 years after treatment termination....

  4. Technique, Complication, and Long-Term Outcome for Endovascular Treatment of Iliac Artery Occlusion

    International Nuclear Information System (INIS)

    Ozkan, Ugur; Oguzkurt, Levent; Tercan, Fahri


    high technical success rate with favorable long-term patency rate. Success of recanalization increases with use of the antegrade approach and with the presence of a stump of artery before the occlusion.

  5. Morfeo Study II: Clinical Course and Complications in Patients With Long-Term Disorders of Consciousness. (United States)

    Romaniello, Caterina; Bertoletti, Erik; Matera, Nunzio; Farinelli, Marina; Pedone, Vincenzo


    The life expectancy of patients with disorders of consciousness (DOCs) is ever-increasing, but little is known about their clinical course over late stages. Several issues (premorbid conditions, complications and pressure sores) are to be considered for their effect on clinical outcome, risk of death and recovery of functional performance. Unfortunately, in late stages of long-term rehabilitation, these aspects are still more neglected than in acute and postacute stages. The aim of this study was to investigate the clinical course and the complications of patients in the late stages of DOCs and to explore the relationship between mortality and specific biomarkers. A total of 112 patients, admitted over 10 years in a dedicated ward, were retrospectively studied. Sociodemographic data, preadmission and inpatient clinical features were collected. Disability Rating Scale scores, complications including pressure sores and blood markers were assessed monthly. Data were analyzed through descriptive statistics and correlations using SPSS. Most patients were men older than 50 years with a nontraumatic etiology and a history of hypertension (42.86%). The most common complication was pneumonia (76.79%). No association was found between sex and mortality or between etiology and mortality (P > 0.05). Mortality correlated significantly with sepsis (ρ = 0.253), albumin (ρ = -0.558), hemoglobin (ρ = -0.354) and white blood cells (ρ = 0.243). Only 42% of patients remained unchanged at Disability Rating Scale evaluation. These data confirmed that DOCs are not static conditions and they require ongoing monitoring and assessment of clinical status, level of consciousness and laboratory biomarkers. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  6. Long-term maternal recall of obstetric complications in schizophrenia research.

    LENUS (Irish Health Repository)

    Walshe, Muriel


    Obstetric complications (OCs) are consistently implicated in the aetiology of schizophrenia. Information about OCs is often gathered retrospectively, from maternal interview. It has been suggested that mothers of people with schizophrenia may not be accurate in their recollection of obstetric events. We assessed the validity of long term maternal recall by comparing maternal ratings of OCs with those obtained from medical records in a sample of mothers of offspring affected and unaffected with psychotic illness. Obstetric records were retrieved for 30 subjects affected with psychosis and 40 of their unaffected relatives. The Lewis-Murray scale of OCs was completed by maternal interview for each subject blind to the obstetric records. There was substantial agreement between maternal recall and birth records for the summary score of "definite" OCs, birth weight, and most of the individual items rated, with the exception of antepartum haemorrhage. There were no significant differences in the validity of recall or in errors of commission by mothers for affected and unaffected offspring. These findings indicate that several complications of pregnancy and delivery are accurately recalled by mother\\'s decades after they occurred. Furthermore, there is no indication that mothers are less accurate in recalling OCs for their affected offspring than their unaffected offspring. When comparing women with and without recall errors, we found those with recall errors to have significantly worse verbal memory than women without such errors. Assessing the cognition of participants in retrospective studies may allow future studies to increase the reliability of their data.

  7. How Do You Motivate Long-Term Behavior Change to Prevent Cancer? (United States)

    John P. Pierce PhD, a professor in the Department of Family and Preventive Medicine at the University of California, San Diego and Director of Population Science at Moores Cancer Center, presented "How Do You Motivate Long-Term Behavior Change to Prevent Cancer?" 

  8. The metabolic syndrome in long-term cancer survivors, an important target for secondary preventive measures

    NARCIS (Netherlands)

    Nuver, J; Smit, AJ; Postma, A; Sleijfer, DT; Gietema, JA

    With increasing numbers of cancer survivors, attention has been drawn to long-term complications of curative cancer treatment, including a range of metabolic disorders. These metabolic disorders often resemble the components of the so-called metabolic syndrome, or syndrome X, which is an important

  9. Long-term maternal recall of obstetric complications in schizophrenia research. (United States)

    Walshe, Muriel; McDonald, Colm; Boydell, Jane; Zhao, Jing Hua; Kravariti, Eugenia; Touloupoulou, Timothea; Fearon, Paul; Bramon, Elvira; Murray, Robin M; Allin, Matthew


    Obstetric complications (OCs) are consistently implicated in the aetiology of schizophrenia. Information about OCs is often gathered retrospectively, from maternal interview. It has been suggested that mothers of people with schizophrenia may not be accurate in their recollection of obstetric events. We assessed the validity of long term maternal recall by comparing maternal ratings of OCs with those obtained from medical records in a sample of mothers of offspring affected and unaffected with psychotic illness. Obstetric records were retrieved for 30 subjects affected with psychosis and 40 of their unaffected relatives. The Lewis-Murray scale of OCs was completed by maternal interview for each subject blind to the obstetric records. There was substantial agreement between maternal recall and birth records for the summary score of "definite" OCs, birth weight, and most of the individual items rated, with the exception of antepartum haemorrhage. There were no significant differences in the validity of recall or in errors of commission by mothers for affected and unaffected offspring. These findings indicate that several complications of pregnancy and delivery are accurately recalled by mother's decades after they occurred. Furthermore, there is no indication that mothers are less accurate in recalling OCs for their affected offspring than their unaffected offspring. When comparing women with and without recall errors, we found those with recall errors to have significantly worse verbal memory than women without such errors. Assessing the cognition of participants in retrospective studies may allow future studies to increase the reliability of their data. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. The exon-3 deleted growth hormone receptor polymorphism predisposes to long-term complications of acromegaly

    NARCIS (Netherlands)

    Wassenaar, M. J. E.; Biermasz, N. R.; Pereira, A. M.; van der Klaauw, A. A.; Smit, J. W. A.; Roelfsema, F.; van der Straaten, T.; Cazemier, M.; Hommes, D. W.; Kroon, H. M.; Kloppenburg, M.; Guchelaar, H.-J.; Romijn, J. A.


    The aim of the study was to evaluate the impact of the genomic deletion of exon 3 of the GH receptor (d3GHR) on long-term clinical outcome of acromegaly in a well-characterized cohort of patients with long-term remission of acromegaly. We conducted a cross-sectional study. The presence of the d3GHR

  11. Long-term Impact of Prevention Programs to Promote Effective Parenting: Lasting Effects but Uncertain Processes


    Sandler, Irwin; Schoenfelder, Erin; Wolchik, Sharlene; MacKinnon, David


    This chapter reviews findings from 46 randomized experimental trials of preventive parenting interventions. The findings of these trials provide evidence of effects to prevent a wide range of problem outcomes and to promote competencies from one to twenty years later. However, there is a paucity of evidence concerning the processes that account for program effects. Three alternative pathways are proposed as a framework for future research on the long-term effects of preventive parenting progr...

  12. Long-Term Outcomes and Complications in Patients With Craniopharyngioma: The British Columbia Cancer Agency Experience

    Energy Technology Data Exchange (ETDEWEB)

    Lo, Andrea C., E-mail: [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Howard, A. Fuchsia [School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (Canada); Nichol, Alan; Sidhu, Keerat; Abdulsatar, Farah [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Hasan, Haroon [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Goddard, Karen [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada)


    Purpose: We report long-term outcomes and complications of craniopharyngioma patients referred to our institution. Methods and Materials: Between 1971 and 2010, 123 consecutive patients received primary treatment for craniopharyngioma in British Columbia and were referred to our institution. The median age was 30 years (range, 2-80 years). Thirty-nine percent of patients were treated primarily with subtotal resection (STR) and radiation therapy (RT), 28% with STR alone, 15% with gross total resection, 11% with cyst drainage (CD) alone, 5% with CD+RT, and 2% with RT alone. Eight percent of patients received intracystic bleomycin (ICB) therapy. Results: Median follow-up was 8.9 years, and study endpoints were reported at 10 years. Ten-year Kaplan-Meier progression-free survival (PFS) was 46%. Patients treated with STR+RT or CD+RT had the highest PFS (82% and 83%, respectively). There were no significant differences between PFS after adjuvant versus salvage RT (84% vs 74%, respectively; P=.6). Disease-specific survival (DSS) was 88%, and overall survival (OS) was 80%. Primary treatment modality did not affect DSS or OS, while older age was a negative prognostic factor for OS but not DSS. Kaplan-Meier rates for visual deterioration, anterior pituitary hormone deficiency, diabetes insipidus, seizure disorder, and cerebrovascular events (CVE) due to treatment, not tumor progression, were 27%, 76%, 45%, 16%, and 11%, respectively. The CVE rate was 29% in patients who received ICB compared to 10% in those who did not (P=.07). Conclusions: We report favorable PFS in patients with craniopharyngioma, especially in those who received RT after surgery. DSS and OS rates were excellent regardless of primary treatment modality. We observed a high incidence of hypopituitarism, visual deterioration, and seizure disorder. Eleven percent of patients experienced CVEs after treatment. There was a suggestion of increased CVE risk in patients treated with ICB.

  13. Early neurologic complications and long-term sequelae of childhood bacterial meningitis in a limited-resource country (Kosovo). (United States)

    Namani, Sadie A; Koci, Bulëza M; Milenković, Zvonko; Koci, Remzie; Qehaja-Buçaj, Emine; Ajazaj, Lindita; Mehmeti, Murat; Ismaili-Jaha, Vlora


    Since neurologic complications of childhood bacterial meningitis are encountered frequently despite antibiotic treatments, the purpose of this study was to analyze early neurologic complications and long-term sequelae of bacterial meningitis in children in a limited-resource country (Kosovo) This study uses a retrospective chart review of children treated for bacterial meningitis in two study periods: 277 treated during years 1997-2002 and 77 children treated during years 2009-2010. Of the 277 vs 77 children treated for bacterial meningitis, 60 (22%) vs 33 (43%) patients developed early neurologic complications, while there were 15 (5.4%) vs 2 (2.6%) deaths. The most frequent early neurologic complications were the following: subdural effusions (13 vs 29%), recurrent seizures (11 vs 8%), and hydrocephalus (3 vs 3%). The relative risk (95% confidence interval) for neurologic complications was the highest in infants (3.56 (2.17-5.92) vs 2.69 (1.62-4.59)) and in cases caused by Haemophilus influenzae 1.94 (1.09-3.18) vs Streptococcus pneumoniae 2.57(1.26-4.47). Long-term sequelae were observed in 10 vs 12% of children, predominantly in infants. The most frequent long-term sequelae were late seizures 9 vs 1%, neuropsychological impairment 1 vs 5%, and deafness 1 vs 3%. In both study periods, the most frequent early neurologic complications of childhood bacterial meningitis were subdural effusions. Long-term sequelae were observed in 10% of children, with late seizures, neuropsychological impairment, and deafness being the most common one. Age prior to 12 months was risk factor for both early neurologic complications and long-term sequelae of bacterial meningitis in children.

  14. Long-term ocular complications in aphakic versus pseudophakic eyes of children with juvenile idiopathic arthritis-associated uveitis

    NARCIS (Netherlands)

    Sijssens, K. M.; Los, L. I.; Rothova, A.; Schellekens, P. A. W. J. F.; van de Does, P.; Stilma, J. S.; de Boer, H. J.

    Aim To evaluate the long-term follow-up of aphakic and pseudophakic eyes of children with juvenile idiopathic arthritis (JIA)-associated uveitis with a special interest in whether intraocular lens implantation increases the risk of developing ocular complications. Methods Data were obtained from the

  15. Retinal Vessel Calibers Predict Long-term Microvascular Complications in Type 1 Diabetes

    DEFF Research Database (Denmark)

    Broe, Rebecca; Rasmussen, Malin L; Frydkjaer-Olsen, Ulrik


    Diabetic neuropathy, nephropathy, and retinopathy cause significant morbidity in patients with type 1 diabetes, even though improvements in treatment modalities delay the appearance and reduce the severity of these complications. To prevent or further delay the onset, it is necessary to better.......5-1 disc diameter from the disc margin were measured and summarized as the central artery and vein equivalents. In multiple regression analyses, we found wider venular diameters and smaller arteriolar diameters were both predictive of the 16-year development of nephropathy, neuropathy, and proliferative...

  16. [Dynamics of tooth decay prevalence in children receiving long-term preventive program in school dental facilities]. (United States)

    Avraamova, O G; Kulazhenko, T V; Gabitova, K F


    The paper presents the assessment of tooth decay prevalence in clinically homogenous groups of children receiving long-term preventive program (PP) in school dental facilities. Five-years PP were introduced in clinical practice in 2 Moscow schools. Preventive treatment was performed by dental hygienist. The results show that systematic preventive treatment in school dental offices starting from elementary school allows reducing dental caries incidence 46-53% and stabilize the incidence of caries complications. It should be mentioned though that analysis of individualized outcomes proves heterogeneity of study results despite of equal conditions of PP. Potentially significant hence is early diagnostics and treatment of initial caries forms as demineralization foci, especially in children with intensive tooth decay. Optimization of pediatric dentist and dental hygienist activity in school dental facilities is the main factor of caries prevention efficiency.

  17. The role of long-term antibiotics in the prevention of infection in postoperative cardiac surgeries

    International Nuclear Information System (INIS)

    Shahid, U.; Arain, M.A.; Dar, M.I.; Khan, A.B.; Aftab, S.; Manan, A.U.


    To compare the effect of long-term (7 days) versus short-term (2 days) postoperative antibiotics in preventing postoperative infective complications in patients who have undergone open-heart surgeries. Cardiac patients (n=42), operated for valvular disease (36%), coronary artery bypass grafting (50%), or septal repair (14%), were included in our study. Patients were prospectively randomized into two groups. Group A (n=21) patients received oral antibiotics for 7 days, whereas group B (n=21) patients were given the same for 2 days postoperative. Pre-operative and intraoperative variables were equal in both groups. Total leukocyte count and temperature were monitored daily until the patients were discharged. The chest and leg wounds were inspected daily for any signs of infection. Sputum and urine cultures were sent for selected patients in case of respiratory tract infection or urinary tract infection, respectively. Each patient was followed until the next routine visit in outpatient department. In group A, 3 patients (14%), developed infection postoperatively, whereas in group B, 13 patients (62%) (p =0.001) had to be started on oral or intravenous antibiotics as a result of developing either wound infection, a positive sputum culture, a positive urine culture or a localized infection elsewhere. Mean ward stay in group A was 4.8 +- 4.5 days and in group B 6.5 +- 4.1 days (p =0.011). In this series, there was a significantly higher frequency of infection and longer hospital stay in patients who received antibiotics for 2 days postoperatively as compared to those who received antibiotics for 7 days. (author)

  18. A fall prevention guideline for older adults living in long-term care facilities. (United States)

    Jung, D; Shin, S; Kim, H


    Falls are among the most frequent critical health problems for older adults over 65 years of age and often result in consequential injuries. This study developed a guideline covering risk factors and interventions for falls in order to prevent them from occurring in long-term care facilities. This study was grounded in the methodological approach of the Scottish Intercollegiate Guideline Network for establishing evidence-based guidelines: (1) establishment of the target population and scope of the guideline, (2) systematic literature review and critical analysis, (3) determination of the recommendation grade, (4) development of a draft nursing intervention guideline and algorithm, (5) expert evaluation of the draft nursing intervention guideline, and (6) confirmation of the final intervention guideline and completion of the algorithm. The resulting evidence-based fall prevention guideline consists of a three-step factor assessment and a three-step intervention approach. The resulting guideline was based on the literature and clinical experts. Further research is required to test the guideline's feasibility in across long term care facilities. This guideline can be used by nurses to screen patients who are at a high risk of falling to provide patient interventions to help prevent falls. Considering the high rate of falls at long-term care facilities and the absence of evidence-based guidelines to prevent them, additional studies on falls at long-term care facilities are necessary. Meanwhile, given prior research that indicates the importance of human resources in the application of such guidelines, continuous investigations are needed as to whether the research outcomes are actually conveyed to nurses. © 2014 International Council of Nurses.

  19. School-based smoking prevention programs with the promise of long-term effects

    Directory of Open Access Journals (Sweden)

    Flay Brian R


    Full Text Available Abstract I provide a systematic review of trials of school-based smoking prevention programs that had at least 15 sessions, preferably with some in high school, that reported significant short-term effects, and that included long-term follow-up. This is supplemented with a description of some other programs that produce short-term effects that portend large long-term effects. I conclude that school-based programs can have long-term effects of practical importance it they: include 15 or more sessions over multiple years, including some in high school; use the social influence model and interactive delivery methods; include components on norms, commitment not to use, intentions not to use, and training and practice in the use of refusal and other life skills; and use peer leaders in some role. School-based programs of this type can reduce smoking onset by 25–30%, and school plus community programs can reduce smoking onset by 35–40% by the end of high school. Some early childhood programs that do not have smoking prevention as their main aim, including home nursing, the Good Behavior Game, the Positive Action program and others, seem to change the developmental trajectories of children so that they are less likely to engage in multiple problem behaviors, including smoking, as adolescents. This review makes it clear that effective school-based smoking prevention programs exist and can be adopted, adapted and deployed with success – and should be.

  20. A 4-year prospective study on long-term complications of type 2 diabetic patients: the Thai DMS diabetes complications (DD.Comp.) project. (United States)

    Potisat, Somkiat; Krairittichai, Udom; Jongsareejit, Amporn; Sattaputh, Charnvate; Arunratanachote, Woranut


    To assess the clinical course of long-term diabetic complications; diabetic retinopathy, nephropathy, and foot problems in Thai patients with type 2 diabetes. Patients with type 2 diabetes were followed for four years between March 2006 and September 2010. Seven hospitals in all levels of care under the Ministry of Public Health Thailand were included in the present study. A physical examination and a diabetic complications assessment were performed each year during the study period, by physician specialists in the related areas. Among 1,120 patients who participated in the present study, 705 (62.95%) patients completed the 4-year follow-up time. There were 88 (7.86%) patients reported deaths during the present study period. The mean age was 59.14 +/- 10.12 years. The average duration of diabetes was 7.30 +/- 6.14 years. Approximately 57.32% of patients had a family history of diabetes. The average plasma glucose level and HbA1C were 153 to 160 mg/dl and 8.25 to 8.75%. Moreover less than one-fourth of patients had HbA1C below 7%. The prevalence for diabetic retinopathy and nephropathy were approximately 23.7% and 38.3%. In addition, more than 15% of patients had diabetic foot problems, loss of protective sensation and pedal pulse deficit. Finally, the incidence rates were 80.1 per 1,000 person-years (95% CI 69.7, 91.8) for diabetic retinopathy, and 91.1 per 1,000 person-years (95% CI 78.8, 105.1) for diabetic nephropathy Problems regarding poor diabetes control exist in Thai diabetes patients. It results in high prevalence and incidence of diabetic complications. As such, it is crucial to establish the country's diabetes management plan as well as evaluate the long-term complications in diabetic patients annually, in order for patients to receive the benefits of early treatment and prevent further complications.

  1. Retinal vascular fractals predict long-term microvascular complications in type 1 diabetes mellitus

    DEFF Research Database (Denmark)

    Broe, Rebecca; Rasmussen, Malin L; Frydkjaer-Olsen, Ulrik


    : We included 180 patients with type 1 diabetes in a 16 year follow-up study. In baseline retinal photographs (from 1995), all vessels in a zone 0.5-2.0 disc diameters from the disc margin were traced using Singapore Institute Vessel Assessment-Fractal image analysis software. Artefacts were removed......AIMS/HYPOTHESIS: Fractal analysis of the retinal vasculature provides a global measure of the complexity and density of retinal vessels summarised as a single variable: the fractal dimension. We investigated fractal dimensions as long-term predictors of microvasculopathy in type 1 diabetes. METHODS....... Retinal fractal analysis therefore is a potential tool for risk stratification in type 1 diabetes....

  2. Evaluation of the pharmacoeconomics of drugs used for the treatment of long-term complications of sulfur mustard

    Directory of Open Access Journals (Sweden)

    Yunes Panahi


    Full Text Available Sulfur Mustard (SM, a cytotoxic vesicant chemical warfare agent, has powerful irritant and blistering effects on the skin, eyes and respiratory tract. Since during the Iraq-Iran war, many Iranian soldiers and civilians were exposed to SM, there are several victims still suffering from long-term cutaneous, ocular and pulmonary complications. Currently, there is no definite treatment for long-term complications of SM, and only supportive medical care is being taken to minimize the symptoms. In this study, we compared the cost-effectiveness of common drugs that are used against long-term SM-induced complications in Iranian patients. In this review article, electronic databases were checked using the following key words: sulfur mustard, lung, skin, eye, cost-effectiveness, pharmacoeconomics and treatment. Abstracts of non-English papers and proceedings of congresses on SM were also assessed. Among the studied drugs, high-dose oral N-acetyl cysteine and long-acting inhaled corticosteroids against respiratory complications, topical corticosteroids and oral antihistamines against cutaneous complications and non-steroidal anti-inflammatory drugs and corticosteroids ophthalmic drops against ocular complications were found to be cost-effective. Usage of different drugs in the treatment of SM injuries in Iran, have imposed a significant economic burden to patients and their families because many drugs that are effective against chemical injuries are not covered by insurance. In addition, the development of more effective drugs in this field is considered as an urgent demand that should be noticed by the pharmaceutical industry.

  3. Tracheostomy Complications in Institutionalized Children with Long-term Tracheostomy and Ventilator Dependence. (United States)

    Wilcox, Lyndy J; Weber, Brittany C; Cunningham, Tina D; Baldassari, Cristina M


    (1) To identify tracheostomy complications in institutionalized children with chronic tracheostomy. (2) To determine factors that predispose to development of tracheostomy complications in institutionalized children with chronic tracheostomy. Case series with chart review over 10 years. Tertiary children's hospital. Children were included if they underwent tracheostomy before 21 years of age and resided at a pediatric nursing facility. Most children were ventilator dependent and had severe comorbid medical conditions, including developmental delay and cerebral palsy. The number of tracheostomy complications and unplanned hospital admissions were recorded. Interventions for tracheostomy complications were also reviewed. Thirty-two institutionalized children with chronic tracheostomy were included. The mean age at time of tracheostomy was 5.4 years, with a mean duration of institutionalization of 9.1 years. Twenty-seven children (84%) experienced tracheostomy complications. The total number of complications was 79. The most common tracheostomy complications identified were peristomal granulation (n = 13) and suprastomal granulation (n = 12). Age at time of tracheostomy, duration of institutionalization, and ventilator dependence did not predict the likelihood of developing a complication. Of 32 patients, 20 were evaluated in the emergency room during the study, and there were 48 unplanned admissions for tracheostomy-related complications during the study. Forty-five urgent direct laryngoscopy and bronchoscopy procedures were performed in a total of 20 children with tracheostomy complications. Tracheostomy complications are common in institutionalized children with chronic tracheostomy and are challenging to manage. Further research is necessary to determine novel ways to reduce tracheostomy complications in this population. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  4. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer (United States)

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian


    Abstract Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm2/m2 for women and 40.8 cm2/m2 for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. PMID:27043677

  5. Long-term complications following tibial plateau levelling osteotomy in small dogs with tibial plateau angles > 30°. (United States)

    Knight, Rebekah; Danielski, Alan


    Tibial plateau levelling osteotomy (TPLO) is commonly performed for surgical management of cranial cruciate ligament (CCL) disease. It has been suggested that small dogs may have steeper tibial plateau angles (TPAs) than large dogs, which has been associated with increased complication rates after TPLO. A retrospective study was performed to assess the rate and nature of long-term complications following TPLO in small dogs with TPAs>30°. Medical records were reviewed for dogs with TPAs>30° treated for CCL rupture by TPLO with a 2.0 mm plate over a five-year period. Radiographs were assessed to determine TPA, postoperative tibial tuberosity width and to identify any complication. Up-to-date medical records were obtained from the referring veterinary surgeon and any complications in the year after surgery were recorded. The effects of different variables on complication rate were assessed using logistic regression analysis. Minor complications were reported in 22.7 per cent of cases. This is similar to or lower than previously reported complication rates for osteotomy techniques in small dogs and dogs with steep TPAs. A smaller postoperative TPA was the only variable significantly associated with an increased complication rate. No major complications were identified. © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Successful heel pressure ulcer prevention program in a long-term care setting. (United States)

    Lyman, Vicky


    Heel pressure ulcers (PUs) are common in long-term healthcare settings. Early identification of risk and the use of preventive measures are central to reducing the morbidity, mortality, and high medical costs associated with heel PUs. A Quality Improvement Process was initated based on a tailored protocol, in-service education program, and a heel protective device was approved by the US Food and Drug Administration. The Braden Scale was used to evaluate PU risk in 550 patients in a long-term healthcare facility. Patients with a Braden Scale score of 18 or less and with 1 of 7 high-risk comorbidities were considered at high risk for PUs, and this prompted a more aggressive prevention program that included a protocol for reducing the risk of heel ulceration. The number of hospital-acquired heel PUs during the 6-month preintervention period was 39. Following the intervention, there were 2 occurrences, representing a 95% reduction in heel ulcers between the 2 periods. After the cost of 2 heel protectors for 550 at-risk patients was subtracted from the estimated cost of treating the 37 heel ulcers prevented, the estimated cost savings was calculated to be between $12,400 and $1,048,400.

  7. Impact of postoperative complications on readmission and long-term survival in patients following surgery for colorectal cancer. (United States)

    Slankamenac, Ksenija; Slankamenac, Maja; Schlegel, Andrea; Nocito, Antonio; Rickenbacher, Andreas; Clavien, Pierre-Alain; Turina, Matthias


    It is well known that specific postoperative complications such as stroke influence readmissions and overall survival (OS) after surgery for colorectal cancer (CRC). Whether overall hospital morbidity is associated with increased risk of readmission and poorer long-term survival is unknown. New tools are available to accurately quantify overall morbidity, such as the comprehensive complication index (CCI). The aim is to evaluate the impact of complications on readmission and overall survival (OS) in patients operated for colorectal cancer. Postoperative complications of patients undergoing surgery for CRC were assessed over a 5-year period using the Clavien-Dindo classification, and overall morbidity was assessed by using the CCI. Individual scores were analyzed regarding their association with readmission and OS by using the multivariate logistic and Cox proportional-hazards regression analysis, respectively. Two hundred eighty-four patients were operated for CRC, of which 22 (8%) were readmitted. One hundred five patients (37%) developed at least one postoperative complication during the hospital stay. While single complications or the use of severe complication only (grade ≥IIIb) was not associated with readmission, overall morbidity (CCI) predicted readmission (OR 1.02 (95% CI 1.0-1.04), p = 0.044). Similarly, morbidity assessed by the CCI had a significant negative predictive value on OS, e.g., patients with a CCI of 20 were 22% more likely to die within a 5-year follow-up, when compared to patients with a CCI of 10 (p = 0.022). Overall combined morbidity as assessed by the CCI leads to more frequent readmission, and is associated with poorer long-term survival after surgery for CRC.

  8. Long-term impact of prevention programs to promote effective parenting: lasting effects but uncertain processes. (United States)

    Sandler, Irwin N; Schoenfelder, Erin N; Wolchik, Sharlene A; MacKinnon, David P


    This article reviews findings from 46 randomized experimental trials of preventive parenting interventions. The findings of these trials provide evidence of effects to prevent a wide range of problem outcomes and to promote competencies from one to 20 years later. However, there is a paucity of evidence concerning the processes that account for program effects. Three alternative pathways are proposed as a framework for future research on the long-term effects of preventive parenting programs: (a) through program effects on parenting skills, perceptions of parental efficacy, and reduction in barriers to effective parenting; (b) through program-induced reductions in short-term problems of youth that persist over time, improvements in youth adaptation to stress, and improvements in youth belief systems concerning the self and their relationships with others; and (c) through effects on contexts in which youth become involved and on youth-environment transactions.

  9. Sports injuries in young athletes: long-term outcome and prevention strategies. (United States)

    Maffulli, Nicola; Longo, Umile Giuseppe; Spiezia, Filippo; Denaro, Vincenzo


    Physical activity plays a significant role in the physical and emotional well-being of a child. In the past 15 to 20 years, there has been a dramatic increase in sports participation at a young age, which has offered numerous health benefits, including self-esteem, confidence, team play, fitness, agility, and strength. Children are playing sports at younger ages. This article assesses the long-term outcome of sports injuries in young athletes, with suggestions on how to prevent such injuries. There are no definitive epidemiological data on withdraw from sports activities due to injury in young athletes. Disturbed physeal growth as a result of injury can result in length discrepancy, angular deformity, or altered joint mechanics, and may cause significant long-term disability. Sequelae of Osgood-Schlatter lesion include painful ossicle in the distal patellar tendon. Fragmentation or separation of the apophysis appears to be the result of adaptive changes to the increased stress that occurs in overuse activities. The presence of these changes undeniably demonstrates an osseous reaction, although they are not disabling. Promotion of a physically active lifestyle is encouraged worldwide, particularly with regard to the many health benefits. Reduction of only a moderate proportion of all sports injuries is of significance for the young athletes' health and could have a long-term economic impact on health care costs. It is therefore important to convince medical doctors, physical therapists, athletic trainers and coaches, as well as athletes of the necessity to implement active prevention measures in their therapy and training programs, thus decreasing the injury and re-injury rate and enhancing athletic performance.

  10. Long-term complications of polyethylene glycol injection to the face. (United States)

    Altintas, Hande; Odemis, Mustafa; Bilgi, Selcuk; Cakmak, Ozcan


    Currently, filling, smoothing, or recontouring the face through the use of injectable fillers is one of the most popular forms of cosmetic surgery. Because these materials promise a more youthful appearance without anesthesia in a noninvasive way, various fillers have been used widely in different parts of the world. However, most of these fillers have not been approved by the Food and Drug Administration, and their applications might cause unpleasant disfiguring complications. This report describes a case of foreign body granuloma in the cheeks secondary to polyethylene glycol injection and shows the possible complications associated with the use of facial fillers.

  11. Curcumin Prevents Acute Neuroinflammation and Long-Term Memory Impairment Induced by Systemic Lipopolysaccharide in Mice

    Directory of Open Access Journals (Sweden)

    Vincenzo Sorrenti


    Full Text Available Systemic lipopolysaccharide (LPS induces an acute inflammatory response in the central nervous system (CNS (“neuroinflammation” characterized by altered functions of microglial cells, the major resident immune cells of the CNS, and an increased inflammatory profile that can result in long-term neuronal cell damage and severe behavioral and cognitive consequences. Curcumin, a natural compound, exerts CNS anti-inflammatory and neuroprotective functions mainly after chronic treatment. However, its effect after acute treatment has not been well investigated. In the present study, we provide evidence that 50 mg/kg of curcumin, orally administered for 2 consecutive days before a single intraperitoneal injection of a high dose of LPS (5 mg/kg in young adult mice prevents the CNS immune response. Curcumin, able to enter brain tissue in biologically relevant concentrations, reduced acute and transient microglia activation, pro-inflammatory mediator production, and the behavioral symptoms of sickness. In addition, short-term treatment with curcumin, administered at the time of LPS challenge, anticipated the recovery from memory impairments observed 1 month after the inflammatory stimulus, when mice had completely recovered from the acute neuroinflammation. Together, these results suggest that the preventive effect of curcumin in inhibiting the acute effects of neuroinflammation could be of value in reducing the long-term consequences of brain inflammation, including cognitive deficits such as memory dysfunction.

  12. [Short-term and long-term fetal heart rate variability after amnioinfusion treatment of oligohydramnios complicated pregnancy]. (United States)

    Machalski, T; Sikora, J; Bakon, I; Magnucki, J; Grzesiak-Kubica, E; Szkodny, E


    Results of computerised analysis of cardiotocograms obtained in the group of 21 pregnancies complicated by idiopathic oligohydramnios are presented in the study. Amnioinfusion procedures were administered serially in local anesthesia with ultrasound and colour Doppler control on the base of oligohydramnios criteria by Phelan. The analysis was based on KOMPOR software created by ITAM Zabrze based on PC computer connected to Hewlett-Packard Series 50A cardiotocograph. Significant short-term variability increase just after amnioinfusion procedure from 5.55 ms to 8.24 ms and after 24 hours up to 7.25 ms was found, while significant long-term variability values changes were not observed.

  13. Isolated unilateral cytomegalovirus retinitis: a rare long-term complication after pediatric liver transplantation. (United States)

    Squires, James E; Sisk, Robert A; Balistreri, William F; Kohli, Rohit


    To highlight the rare yet devastating complication of CMV retinitis in a minimally immunosuppressed patient eight yr after liver transplantation for biliary atresia. A 22-yr-old female status-post deceased donor liver transplant at age 13 secondary to biliary atresia receiving single agent immunosuppression presented with acute, unilateral, profound decrease in visual acuity. The patient was diagnosed to have acute onset unilateral CMV retinitis. Retinal examination uncovered classical appearance of retinal whitening and retinal hemorrhages with extensive macular involvement. CMV retinitis can occur as a late complication following liver transplantation. Additionally, CMV retinal disease can occur in the absence of laboratory evidence of CMV infection and independent of additional clinical features suggesting CMV disease. Currently, there is no standard of care regarding screening for CMV retinitis, and thus, further research is needed to define the need for potential changes in current clinical practices and post-transplant screening protocols. © 2012 John Wiley & Sons A/S.

  14. Long-term follow-up of treatment for synthetic mesh complications. (United States)

    Hansen, Brooke L; Dunn, Guinn Ellen; Norton, Peggy; Hsu, Yvonne; Nygaard, Ingrid


    The objectives of this study are (1) to describe the presenting symptoms, findings, and treatment and (2) to describe the self-reported improvement and function at least 6 months after presentation in women presenting to 1 urogynecology division for complications associated with synthetic vaginal mesh. Women evaluated between 2006 and 2011 were identified by diagnostic codes. We abstracted information from the medical record and attempted to contact all women to complete a follow-up telephone survey questionnaire consisting of several validated instruments. A total of 111 women were evaluated for complications associated with synthetic vaginal mesh. The mean interval from index surgery was 2.4 years. Of these, 84% were referred from outside hospitals. Index surgeries included vaginal mesh kits/vaginally placed mesh (47%), midurethral mesh slings (37%), abdominally placed vaginal mesh (11%), and vaginal mesh kit with concomitantly placed mesh sling (5%). The most common complications were extrusion (65%), contraction (17%), and chronic pelvic pain (16%). A total of 98 women underwent some type of treatment (85 surgical) by urogynecologists, pelvic pain specialists, or physical therapists. Eighty-four (76%) provided follow-up information at mean interval since presentation of 2.3 years. At follow-up, the mean (SD) Pelvic Floor Distress Inventory score was 98 (67), the mean (SD) EQ-5D index score was 0.69 (0.23), and 22% reported vaginal discharge, 15% vaginal bleeding or spotting, and 45% sexual abstinence due to problems related to mesh. A total of 71% reported being overall better, whereas 29% were the same or worse. Two years after tertiary care level multidisciplinary treatment of vaginal mesh complications, many women still report symptoms that negatively impact their quality of life.

  15. Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study. (United States)

    Dal, Jakob; Feldt-Rasmussen, Ulla; Andersen, Marianne; Kristensen, Lars Ø; Laurberg, Peter; Pedersen, Lars; Dekkers, Olaf M; Sørensen, Henrik Toft; Jørgensen, Jens Otto L


    Valid data on acromegaly incidence, complications and mortality are scarce. The Danish Health Care System enables nationwide studies with complete follow-up and linkage among health-related databases to assess acromegaly incidence, prevalence, complications and mortality in a population-based cohort study. All incident cases of acromegaly in Denmark (1991-2010) were identified from health registries and validated by chart review. We estimated the annual incidence rate of acromegaly per 10(6) person-years (py) with 95% confidence intervals (95% CIs). For every patient, 10 persons were sampled from the general population as a comparison cohort. Cox regression and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used. Mean age at diagnosis (48.7 years (CI: 95%: 47.2-50.1)) and annual incidence rate (3.8 cases/10(6) persons (95% CI: 3.6-4.1)) among the 405 cases remained stable. The prevalence in 2010 was 85 cases/10(6) persons. The patients were at increased risk of diabetes mellitus (HR: 4.0 (95% CI: 2.7-5.8)), heart failure (HR: 2.5 (95% CI: 1.4-4.5)), venous thromboembolism (HR: 2.3 (95% CI: 1.1-5.0)), sleep apnoea (HR: 11.7 (95% CI: 7.0-19.4)) and arthropathy (HR: 2.1 (95% CI: 1.6-2.6)). The complication risk was also increased before the diagnosis of acromegaly. Overall mortality risk was elevated (HR: 1.3 (95% CI: 1.0-1.7)) but uninfluenced by treatment modality. (i) The incidence rate and age at diagnosis of acromegaly have been stable over decades, and the prevalence is higher than previously reported. (ii) The risk of complications is very high even before the diagnosis. (iii) Mortality risk remains elevated but uninfluenced by mode of treatment. © 2016 European Society of Endocrinology.

  16. Preventing pressure ulcers in long-term care: a cost-effectiveness analysis. (United States)

    Pham, Ba'; Stern, Anita; Chen, Wendong; Sander, Beate; John-Baptiste, Ava; Thein, Hla-Hla; Gomes, Tara; Wodchis, Walter P; Bayoumi, Ahmed; Machado, Márcio; Carcone, Steven; Krahn, Murray


    Pressure ulcers are common in many care settings, with adverse health outcomes and high treatment costs. We evaluated the cost-effectiveness of evidence-based strategies to improve current prevention practice in long-term care facilities. We used a validated Markov model to compare current prevention practice with the following 4 quality improvement strategies: (1) pressure redistribution mattresses for all residents, (2) oral nutritional supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry skin, and (4) foam cleansing for high-risk residents requiring incontinence care. Primary outcomes included lifetime risk of stage 2 to 4 pressure ulcers, quality-adjusted life-years (QALYs), and lifetime costs, calculated according to a single health care payer's perspective and expressed in 2009 Canadian dollars (Can$1 = US$0.84). Strategies cost on average $11.66 per resident per week. They reduced lifetime risk; the associated number needed to treat was 45 (strategy 1), 63 (strategy 4), 158 (strategy 3), and 333 (strategy 2). Strategy 1 and 4 minimally improved QALYs and reduced the mean lifetime cost by $115 and $179 per resident, respectively. The cost per QALY gained was approximately $78 000 for strategy 3 and $7.8 million for strategy 2. If decision makers are willing to pay up to $50 000 for 1 QALY gained, the probability that improving prevention is cost-effective is 94% (strategy 4), 82% (strategy 1), 43% (strategy 3), and 1% (strategy 2). The clinical and economic evidence supports pressure redistribution mattresses for all long-term care residents. Improving prevention with perineal foam cleansers and dry skin emollients appears to be cost-effective, but firm conclusions are limited by the available clinical evidence.

  17. Decreased renal function and hypertension are long-term complications of extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Williams, C.M.; Kaude, J.V.; Newman, R.C.; Peterson, J.C.; Thomas, W.C.


    Quantitative radionuclide renography performed in 21 patients 17-21 months after extracorporeal shock wave lithotripsy showed a significant decrease in the percentage of effective renal plasma flow (%ERPF) of the treated kidney; in five (24%) patients the %ERPF had decreased by more than 5 percentage units. In seven (8%) of 91 patients sustained hypertension developed that required pharmacologic treatment after lithotripsy. Decreased %ERPF of a treated kidney and hypertension may be related to a Page kidney or similar process resulting from renal trauma and hemorrhage occurring as a side effect of lithotripsy. Hypertension is an important complication of lithotripsy in about 8% of patients

  18. Long-term outcome of pregnancy complicating with severe aplastic anemia under supportive care. (United States)

    Chen, Kuan-Ju; Chang, Yao-Lung; Chang, Horng; Su, Shen-Yuan; Peng, Hsiu-Huei; Chang, Shuenn-Dyh; Chao, An-Shine


    Pregnancy associated with aplastic anemia (AA) is a rare and heterogeneous disorder. We aimed to identify and evaluate the maternal and pregnant outcomes of pregnancy-associated severe AA treated with supportive care. A 25-year retrospective study was conducted at in a single center between 1990 and 2014 with pregnancy associated severe AA. In addition, relevant published cases of antenatally diagnosed pregnancy-associated severe AA after 1990 were identified by PubMed. The main goal was to determine the impact of various risk factors on maternal and fetal outcomes. 15 women with 18 pregnancies were enrolled. With addition of the published reports in literature, a total of 36 cases were included for reference review. Univariate analysis showed that low platelet counts (<2.0 × 10 9 /L), bone marrow hypocellularity (<25%), and late diagnosis during pregnancy were predictors of poor maternal outcomes (P < 0.05). The complication rate of pregnancy outcomes was 53.3%, including preterm delivery, small gestational age (SGA), preterm premature ruptured of membranes (PPROM) and preeclampsia. This study identified the risk factors of mortality and morbidity in pregnant women with severe AA, as well as the obstetrical complications associated with neonatal outcome. Copyright © 2017. Published by Elsevier B.V.

  19. Early hospital readmission for gastrointestinal-related complications predicts long-term mortality after pancreatectomy. (United States)

    Hicks, Caitlin W; Tosoian, Jeffrey J; Craig-Schapiro, Rebecca; Valero, Vicente; Cameron, John L; Eckhauser, Frederic E; Hirose, Kenzo; Makary, Martin A; Pawlik, Timothy M; Ahuja, Nita; Weiss, Matthew J; Wolfgang, Christopher L


    The purpose of this study was to investigate the prognostic significance of early (30-day) hospital readmission (EHR) on mortality after pancreatectomy. Using a prospectively collected institutional database linked with a statewide dataset, we evaluated the association between EHR and overall mortality in all patients undergoing pancreatectomy at our tertiary institution (2005 to 2010). Of 595 pancreatectomy patients, EHR occurred in 21.5%. Overall mortality was 29.4% (median follow-up 22.7 months). Patients with EHR had decreased survival compared with those who were not readmitted (P = .011). On multivariate analysis adjusting for baseline group differences, EHR for gastrointestinal-related complications was a significant independent predictor of mortality (hazard ratio 2.30, P = .001). In addition to known risk factors, 30-day readmission for gastrointestinal-related complications following pancreatectomy independently predicts increased mortality. Additional studies are necessary to identify surgical, medical, and social factors contributing to EHR, as well as interventions aimed at decreasing postpancreatectomy morbidity and mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Long-term efficacy of denture cleansers in preventing Candida spp. biofilm recolonization on liner surface

    Directory of Open Access Journals (Sweden)

    Ana Paula Coelho Vieira


    Full Text Available This study evaluated the long-term efficacy of denture cleansers against Candida spp. biofilm recolonization on liner surface. Specimens were fabricated of a poly(methyl methacrylate-based denture liner and had their surface roughness evaluated at baseline and after cleansing treatments. C. albicans or C. glabrata biofilms were formed on liner surface for 48 h, and then the specimens were randomly assigned to one of cleaning treatments: two alkaline peroxides (soaking for 3 or 15 min, 0.5% sodium hypochlorite (10 min or distilled water (control; 15 min. After the treatments, the specimens were sonicated to disrupt the biofilm, and residual cells were counted (cell/mL. Long-term effectiveness of the cleaning processes was determined by submitting a set of cleaned specimens to biofilm growth conditions for 48 h followed by estimation of cell counts. The topography of specimens after cleaning treatments was analyzed by SEM. Data were analyzed by ANOVA and Tukey's test (α; = 0.05. Results of cell count estimation showed significant differences in cleanliness among the treatments (p 0.05 was observed among the Candida species regarding the recolonization condition. Alkaline denture cleansers showed similar cleaning performance and both differed from the control (p < 0.001. Sodium hypochlorite was the only treatment that removed biofilm efficiently, since no viable cells were found after its use. In conclusion, alkaline peroxide denture cleansers were not effective in removing Candida spp. biofilm from denture liner surfaces and preventing biofilm recolonization.

  1. Long-term antibiotics for preventing recurrent urinary tract infection in children. (United States)

    Williams, Gabrielle; Craig, Jonathan C


    Urinary tract infection (UTI) is common in children. Symptoms include fever, lethargy, anorexia, and vomiting. UTI is caused by Escherichia coli in over 80% of cases and treatment is a course of antibiotics. Due to acute illness caused by UTI and the risk of pyelonephritis-induced permanent kidney damage, many children are given long-term antibiotics aimed at preventing recurrence. To determine the efficacy and harms of long-term antibiotics to prevent recurrent UTI in children. In November 2010 we searched without language restriction MEDLINE, EMBASE, CENTRAL (in the Cochrane Library), the Cochrane Renal Group's Specialised Register, reference lists of review articles and contacted content experts. Randomised comparisons of antibiotics with other antibiotics, placebo or no treatment to prevent recurrent UTI. Two authors independently assessed and extracted information. A random-effects model was used to estimate risk ratio (RR) and risk difference (RD) for recurrent UTI with 95% confidence intervals (CI). Twelve studies (1557 children) were identified with six (five analysed, 1069 children) comparing antibiotics with placebo/no treatment. Duration of antibiotic prophylaxis varied from 10 weeks to 12 months. Compared to placebo/no treatment, when all studies were included, antibiotics did not appear to reduce the risk of symptomatic UTI (RR 0.75, 95% CI 0.36 to 1.53) however when we evaluated the effects of antibiotics in studies with low risk of bias, there was a statistically significant reduction (RR 0.68, 95% CI 0.48 to 0.95). The effect was similar in children with vesicoureteric reflux (VUR) (RR 0.65, 95% CI 0.39 to 1.07) compared to those without VUR (RR 0.56, 95% CI 0.15 to 2.12). There was no consistency in occurrence of adverse events. Three studies reported antibiotic resistance, showing a non-significant increased risk for resistance to the antibiotic in the active treatment groups (RR 2.4, 95% CI 0.62 to 9.26).Five studies (4 analysed, 367 children

  2. Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population. (United States)

    Ouslander, Joseph G; Maslow, Katie


    Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  3. Experiences of occupational physicians with the implementation of indicated prevention for long term sickness absence. (United States)

    de Brouwer, Carin P M; Verdonk, Petra; van Amelsvoort, Ludovic G P M; Jansen, Nicole W H; Kant, IJmert; Widdershoven, Guy A M


    Functioning including work participation, is an emerging challenge in occupational health. The prevention of long term sickness absence (LTSA) through a strategy involving screening and structured early consultation (preventive strategy) was proven effective and can address participation issues. Implementation of this strategy has proven difficult. The aim of this study is to investigate the experiences of occupational physicians (OPs) delivering a structured early consultation to office workers, in order to enhance implementation of the strategy. In this case study, a mixed method design was used. Interviews and surveys were conducted to obtain an in-depth picture of OPs experiences. Factors hindering implementation in relation to the OPs were difficulties in communicating the risk of future sick leave, prioritization of other tasks, maintaining a reactive approach due to work pressure, preference for prevention on the level of the work environment, privacy issues related to labeling workers to have mental or psychosocial issues, and the biomedical model being the mental model in use. Implementation of the preventive strategy seems to require a more profound focus on the biopsychosocial approach. Training of relevant skills is important to achieve a focus on prevention and fostering health over the lifespan.

  4. Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study

    DEFF Research Database (Denmark)

    Dal, Jakob; Feldt-Rasmussen, Ulla; Andersen, Marianne


    sampled from the general population as a comparison cohort. Cox regression and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used. RESULTS: Mean age at diagnosis (48.7 years (CI: 95%: 47.2-50.1)) and annual incidence rate (3.8 cases/10(6) persons (95% CI: 3.6-4.1)) among the 405 cases...... (HR: 2.1 (95% CI: 1.6-2.6)). The complication risk was also increased before the diagnosis of acromegaly. Overall mortality risk was elevated (HR: 1.3 (95% CI: 1.0-1.7)) but uninfluenced by treatment modality. CONCLUSION: (i) The incidence rate and age at diagnosis of acromegaly have been stable over...

  5. [Role of long-term follow-up in management of late-onset post-hematopoietic stem cell transplant complications]. (United States)

    Asano-Mori, Yuki

    As the number of long-term survivors after allogeneic hematopoietic stem cell transplantation (HSCT) has increased owing to advances in transplantation and supportive care techniques, the health and welfare of these survivors have come into focus. However, they are still at risks for various complications, including chronic graft-versus-host disease, infectious diseases, and secondary cancers even in the late period, which can not only interfere with the patient's quality of life (QOL) but also lead to death. The importance of long-term follow-up (LTFU) and management have been recently recognized, and nationwide systems to promote LTFU care in patients receiving HSCT, such as medical fee revision, publication of a LTFU guideline unique to Japan, and preparation of patient pocketbook, is under consideration. The number of medical facilities at LTFU outpatient clinic is also increasing; therefore, an optimal comprehensive support system may be established sooner or later. However, self-management by patients is essential to overcome late complications as well as to improve QOL after HSCT. Healthcare professionals should collaborate and continue to make the greatest possible efforts to educate patients regarding the risks of late complications and their prevention.

  6. Tenon’s Cyst Presenting as a Long-Term Complication following Incision Cataract Surgery

    Directory of Open Access Journals (Sweden)

    Prabhakar Srinivasapuram Krishnacharya


    Full Text Available Context. Tenon’s cyst or conjunctival cyst formation is not uncommon late complication of traditional extracapsular cataract surgery; however, few reports are available in the literature. Aims. Large cystic swellings were clinically diagnosed as filtering blebs at the cataract incision site in two patients. The purpose of the case presentation is to discuss the factors leading to cyst formation, visual loss and cyst recurrence after its excision. Patients and Methods. Case 1. Sixty-one-year-old male patient presented with a bleb at superior limbal region in the right eye, two years after cataract surgery. Case 2. A giant bleb was found at the same region in the right eye of a 65-year-old male patient, eight years after cataract surgery. Results. Complete excision of the cyst was performed with conjunctival autograft in the first patient and followed up for two years. No recurrence of the cyst was observed. Internal wound gaping was seen on gonioscopy in the second patient. Conclusions. Unstable scleral tunnel could explain bleb formation in both the patients. Complete bleb excision with conjunctival auto-graft resulted in closure of the defect with no bleb recurrence during two-year follow-up. Over-filtration causing hypotonic maculopathy was the reason for decreased vision in the second case.

  7. Lithium prevents long-term neural and behavioral pathology induced by early alcohol exposure. (United States)

    Sadrian, B; Subbanna, S; Wilson, D A; Basavarajappa, B S; Saito, M


    Fetal alcohol exposure can cause developmental defects in offspring known as fetal alcohol spectrum disorder (FASD). FASD symptoms range from obvious facial deformities to changes in neuroanatomy and neurophysiology that disrupt normal brain function and behavior. Ethanol exposure at postnatal day 7 in C57BL/6 mice induces neuronal cell death and long-lasting neurobehavioral dysfunction. Previous work has demonstrated that early ethanol exposure impairs spatial memory task performance into adulthood and perturbs local and interregional brain circuit integrity in the olfacto-hippocampal pathway. Here we pursue these findings to examine whether lithium prevents anatomical, neurophysiological, and behavioral pathologies that result from early ethanol exposure. Lithium has neuroprotective properties that have been shown to prevent ethanol-induced apoptosis. Here we show that mice co-treated with lithium on the same day as ethanol exposure exhibit dramatically reduced acute neurodegeneration in the hippocampus and retain hippocampal-dependent spatial memory as adults. Lithium co-treatment also blocked ethanol-induced disruption in synaptic plasticity in slice recordings of hippocampal CA1 in the adult mouse brain. Moreover, long-lasting dysfunctions caused by ethanol in olfacto-hippocampal networks, including sensory-evoked oscillations and resting state coherence, were prevented in mice co-treated with lithium. Together, these results provide behavioral and physiological evidence that lithium is capable of preventing or reducing immediate and long-term deleterious consequences of early ethanol exposure on brain function. Copyright © 2012 IBRO. Published by Elsevier Ltd. All rights reserved.

  8. Early childhood family intervention and long-term obesity prevention among high-risk minority youth. (United States)

    Brotman, Laurie Miller; Dawson-McClure, Spring; Huang, Keng-Yen; Theise, Rachelle; Kamboukos, Dimitra; Wang, Jing; Petkova, Eva; Ogedegbe, Gbenga


    To test the hypothesis that family intervention to promote effective parenting in early childhood affects obesity in preadolescence. Participants were 186 minority youth at risk for behavior problems who enrolled in long-term follow-up studies after random assignment to family intervention or control condition at age 4. Follow-up Study 1 included 40 girls at familial risk for behavior problems; Follow-up Study 2 included 146 boys and girls at risk for behavior problems based on teacher ratings. Family intervention aimed to promote effective parenting and prevent behavior problems during early childhood; it did not focus on physical health. BMI and health behaviors were measured an average of 5 years after intervention in Study 1 and 3 years after intervention in Study 2. Youth randomized to intervention had significantly lower BMI at follow-up relative to controls (Study 1 P = .05; Study 2 P = .006). Clinical impact is evidenced by lower rates of obesity (BMI ≥95th percentile) among intervention girls and boys relative to controls (Study 2: 24% vs 54%, P = .002). There were significant intervention-control group differences on physical and sedentary activity, blood pressure, and diet. Two long-term follow-up studies of randomized trials show that relative to controls, youth at risk for behavior problems who received family intervention at age 4 had lower BMI and improved health behaviors as they approached adolescence. Efforts to promote effective parenting and prevent behavior problems early in life may contribute to the reduction of obesity and health disparities.

  9. Management of Long-Term Complications of HIV Disease: Focus on Cardiovascular Disease. (United States)

    Currier, Judith S


    HIV-infected individuals on effective antiretroviral therapy experience a number of non-AIDS noncommunicable diseases, such as cardiovascular disease, more frequently than uninfected individuals. Common pathways for such diseases are chronic immune activation and inflammation, including the prolonged inflammation associated with lower nadir CD4+ cell count. Prevention and treatment of non-AIDS conditions include treatment of traditional risk factors, lifestyle interventions, earlier initiation of antiretroviral therapy, and potentially therapies specifically targeting inflammation and immune activation (eg, statins). This article summarizes a presentation by Judith S. Currier, MD, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in New York, New York, in February 2017.

  10. Calf Augmentation and Restoration: Long-Term Results and the Review of the Reported Complications. (United States)

    Niechajev, Igor; Krag, Christen


    Augmentation or reconstruction of the calves is indicated in patients with thin legs, for bodybuilders, or when there is a defect after an injury or illness. The principle of placing implants under the investing crural fascia was worked out in the 1980s. The senior author (I.N.) introduced many technical modifications and improvements for this operation, among them the new instrument, an inserter for the calf implants. Presented patient material is unique in that the more challenging reconstructive cases almost equal the numbers of the aesthetic cases. During the years 1991 through 2016, 50 patients underwent 60 calf contour corrections. Indications were aesthetic in 23 patients, six were bodybuilders, and 21 underwent lower leg reconstruction because of deformity caused by illness. According to evaluation by the surgeon, excellent-to-good results were obtained in 30 out of 37 followed patients. Patients rated their results as very good (18), good (10), acceptable (7) and bad (2). One 28-year-old professional bodybuilder sustained acute anterior compartment syndrome in one leg. Implants were removed 16 h after surgery, but he developed ischaemia in the anterior compartment leading to the necrosis of muscles. After several surgical operations, including microsurgical transfer of the innervated central caput of the quadriceps femoris muscle, he could resume his bodybuilding activities. Other complications were minor and manageable. Calf augmentation, performed properly, has evolved to be a safe, efficient and aesthetically pleasing operation. The possibility of acute compartment syndrome should be kept in mind. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  11. Long-term secondary prevention of acute myocardial infarction (SEPAT) - guidelines adherence and outcome. (United States)

    Ergatoudes, Constantinos; Thunström, Erik; Rosengren, Annika; Björck, Lena; Bengtsson Boström, Kristina; Falk, Kristin; Fu, Michael


    A number of registry studies have reported suboptimal adherence to guidelines for cardiovascular prevention during the first year after acute myocardial infarction (AMI). However, only a few studies have addressed long-term secondary prevention after AMI. This study evaluates prevention guideline adherence and outcome of guideline-directed secondary prevention in patients surviving 2 years after AMI. Patients aged 18-85 years at the time of their index AMI were consecutively identified from hospital discharge records between July 2010 and December 2011 in Gothenburg, Sweden. All patients who agreed to participate in the study (16.2%) were invited for a structured interview, physical examinations and laboratory analysis 2 years after AMI. Guideline-directed secondary preventive goals were defined as optimally controlled blood pressure, serum cholesterol, glucose, regular physical activity, smoking cessation and pharmacological treatment. The mean age of the study cohort (n = 200) at the index AMI was 63.0 ± 9.7 years, 79% were men. Only 3.5% of the cohort achieved all six guideline-directed secondary preventive goals 2 years after infarction. LDL therapy was used by 97% of the patients, beta-blockers by 83.0%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers by 76.5% and statins by 88.5%. During follow-up, non-fatal adverse cardiovascular events (cardiac hospitalization, recurrent acute coronary syndrome, angina pectoris, new percutaneous coronary intervention, new onset of atrial fibrillation, post-infarct heart failure, pacemaker implantation, stroke/transient ischemic attack (TIA), cardiac surgery and cardiac arrest) occurred in 47% of the cohort and readmission due to cardiac causes in 30%. Our data showed the failure of secondary prevention in our daily clinical practice and high rate of non-fatal adverse cardiovascular events 2 years after AMI.

  12. Long-term health and medical cost impact of smoking prevention in adolescence. (United States)

    Wang, Li Yan; Michael, Shannon L


    To estimate smoking progression probabilities from adolescence to young adulthood and to estimate long-term health and medical cost impacts of preventing smoking in today's adolescents. Using data from the National Longitudinal Study of Adolescent Health (Add Health), we first estimated smoking progression probabilities from adolescence to young adulthood. Then, using the predicted probabilities, we estimated the number of adolescents who were prevented from becoming adult daily smokers as a result of a hypothetical 1 percentage point reduction in the prevalence of ever smoking in today's adolescents. We further estimated lifetime medical costs saved and quality-adjusted life years (QALYs) gained as a result of preventing adolescents from becoming adult daily smokers. All costs were in 2010 dollars. Compared with never smokers, those who had tried smoking at baseline had higher probabilities of becoming current or former daily smokers at follow-up regardless of baseline grade or sex. A hypothetical 1 percentage point reduction in the prevalence of ever smoking in 24.5 million students in 7th-12th grades today could prevent 35,962 individuals from becoming a former daily smoker and 44,318 individuals from becoming a current daily smoker at ages 24-32 years. As a result, lifetime medical care costs are estimated to decrease by $1.2 billion and lifetime QALYs is estimated to increase by 98,590. Effective smoking prevention programs for adolescents go beyond reducing smoking prevalence in adolescence; they also reduce daily smokers in young adulthood, increase QALYs, and reduce medical costs substantially in later life. This finding indicates the importance of continued investment in effective youth smoking prevention programs. Published by Elsevier Inc.

  13. Long-term consequences of nutrition and growth in early childhood and possible preventive interventions. (United States)

    Adair, Linda S


    Maternal nutritional deficiencies and excesses during pregnancy, and faster infant weight gain in the first 2 years of life are associated with increased risk of noncommunicable diseases (NCDs) in adulthood. The first 1,000 days of life (from conception until the child reaches age 2 years) represent a vulnerable period for programming of NCD risk, and are an important target for prevention of adult disease. This paper takes a developmental perspective to identify periconception, pregnancy, and infancy nutritional stressors, and to discuss mechanisms through which they influence later disease risk with the goal of informing age-specific interventions. Low- and middle-income countries need to address the dual burden of under- and overnutrition by implementing interventions to promote growth and enhance survival and intellectual development without increasing chronic disease risk. In the absence of good evidence from long-term follow-up of early life interventions, current recommendations for early life prevention of adult disease presume that interventions designed to optimize pregnancy outcomes and promote healthy infant growth and development will also reduce chronic disease risk. These include an emphasis on optimizing maternal nutrition prior to pregnancy, micronutrient adequacy in the preconception period and during pregnancy, promotion of breastfeeding and high-quality complementary foods, and prevention of obesity in childhood and adolescence. © 2014 Nestec Ltd., Vevey/S. Karger AG, Basel.

  14. Primary prevention and screening practices among long-term breast cancer survivors. (United States)

    Mandelzweig, Lori; Chetrit, Angela; Amitai, Tova; Silverman, Barbara; Siegelmann-Danieli, Nava; Sadetzki, Siegal


    Parallel to increasing survival of breast cancer (BC) patients, a need has arisen to characterize the follow-up required to improve and maintain their health. Our study aimed to assess changes in lifestyle habits over time among the study population, compare compliance rates of selected primary and secondary prevention practices between long-term BC survivors and an age-matched comparison group, and identify factors associated with compliance to these practices. The study population comprised 250 Israeli BC survivors, diagnosed with BC between 1999 and 2003, without evidence of disease after 8-12 years, and 250 women with no cancer history, individually matched to survivors by age and area of residence. Data collection and analysis were conducted during August 2012-June 2015 and included socio-demographic variables, lifestyle habits, health promotion by the family physician, and participation in screening procedures and prevention measures. Higher performance rates of mammography and colonoscopy among BC survivors were observed, as well as a greater likelihood of receiving an influenza vaccine and undergoing a bone mineral density scan (adjusted-ORs: 7.7, 1.48, 1.42, and 2.59, respectively) compared to controls. Factors identified with compliance to selected practices were age, higher levels of education and income, never smoking, and strenuous physical activity. The survivors adopted healthier lifestyles, which were similar to those of women who never had cancer. About 10 years after BC diagnosis, the survivors generally comply with primary and secondary prevention practices.

  15. Long-term outcomes of surgery for choledochal cysts: a single-institution study focusing on follow-up and late complications. (United States)

    Mukai, Motoi; Kaji, Tatsuru; Masuya, Ryuta; Yamada, Koji; Sugita, Koshiro; Moriguchi, Tomoe; Onishi, Shun; Yamada, Waka; Kawano, Takafumi; Machigashira, Seiro; Nakame, Kazuhiko; Takamatsu, Hideo; Ieiri, Satoshi


    The late postoperative complications of choledochal cyst (CC) surgery are serious and include intrahepatic stones and biliary carcinoma; therefore, long-term follow-up is crucial. The subjects of this retrospective study were patients who underwent surgery for CC at Kagoshima University Hospital between April, 1984 and December, 2016. We analyzed the operative results, early and late postoperative complications, and postoperative follow-up rate. The study population comprised 110 CC patients (male/female: 33/77) with a median age at surgery of 4 years, 3 months (range 12 days-17 years). The patients underwent hepaticoduodenostomy (n = 1; 0.9%) or hepaticojejunostomy (n = 109; 99.1%). Late complications included intrahepatic bile duct (IHBD) dilatation (n = 1; 0.9%), IHBD stones (n = 3; 2.7%), and adhesive ileus (n = 4; 3.6%). There was no incidence of biliary carcinoma in this series. The rates of follow-up at our institute within 10 years of surgery and more than 20 years after surgery were 69.2% (18 of 26) and 14.5% (8 of 55), respectively. The follow-up rate after definitive surgery declined with time. Late complications were observed within 20 years, but biliary carcinoma was not observed. The follow-up rate should be increased to detect late complications. Moreover, patient education on long-term follow up is essential to prevent life-threatening events after definitive surgery for CC.

  16. Evaluation of long-term cosmetic results and complications following breast conserving surgery and radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Fujishiro, Satsuki; Mitsumori, Michihide; Kokubo, Masaki; Nagata, Yasushi; Sasai, Keisuke; Hiraoka, Masahiro; Kodama, Hiroshi


    Long-term cosmetic outcomes and complications were evaluated in 109 patients with breast cancer who had been treated by breast conservation therapy. Patients received radiation therapy at Kyoto University Hospital following quadrantectomy and level II or III axillary node dissection. Factors that might influence long-term cosmetic results were also analyzed. Irradiation to the breast was administered in 2 Gy fractions, 5 times a week for a total of 50 Gy in all patients. Cobalt-60 γ-rays were used in 108 patients with the exception of 1 patient who received 6 Mev X-ray. Some patients with positive or close margins received boost irradiation of 10 Gy using electron beams to the primary tumor bed. Cosmetic outcome was assessed by both a scoring method and breast retraction assessment (BRA). Forty-seven percent of patients were assessed as excellent to good before radiation therapy. The percent of excellent to good decreased shortly after termination of radiation therapy, but gradually improved and stabilized by 3 years. Seventy percent of patients showed a score of excellent to good 5 years after treatment. The average BRA of the 109 patients was 3.0 cm. This did not change between 3 and 5 years after treatment. A significant correlation between cosmetic score and BRA was shown at all follow-up times. Factors such as age over 50 years (p=0.008), tumor location in the outer quadrant (p=0.02) and boost irradiation (p=0.03) significantly affected the cosmetic score. Arm edema and restriction of shoulder movement were observed in 22% and 49% at the start of radiation therapy, these improved within approximately 3 years and 1 year after treatment, respectively. Mild skin change was observed in 60% of patients even 5 years after treatment. The results indicate that cosmetic outcome after breast conservation therapy is clinically acceptable, and the complication rate is low. (author)

  17. Hydrocephalus: an underrated long-term complication of microvascular decompression for trigeminal neuralgia. A single institute experience. (United States)

    Muratorio, Francesco; Tringali, G; Levi, V; Ligarotti, G K I; Nazzi, V; Franzini, A A


    Hydrocephalus is a common complication of posterior fossa surgery, but its real incidence after microvascular decompression (MVD) for idiopathic trigeminal neuralgia (TN) still remains unclear. The aim of this study was to focus on the potential association between MVD and hydrocephalus as a surgery-related complication. All patients who underwent MVD procedure for idiopathic TN at our institute between 2009 and 2014 were reviewed to search for early or late postoperative hydrocephalus. There were 259 consecutive patients affected by idiopathic TN who underwent MVD procedure at our institution between 2009 and 2014 (113 men, 146 women; mean age 59 years, range 30-87 years; mean follow-up 40.92 months, range 8-48 months). Nine patients (3.47 %) developed communicating hydrocephalus after hospital discharge and underwent standard ventriculo-peritoneal shunt. No cases of acute hydrocephalus were noticed. Our study suggests that late communicating hydrocephalus may be an underrated potential long-term complication of MVD surgery.

  18. A long-term risk-benefit analysis of low-dose aspirin in primary prevention. (United States)

    Wu, I-Chen; Hsieh, Hui-Min; Yu, Fang-Jung; Wu, Meng-Chieh; Wu, Tzung-Shiun; Wu, Ming-Tsang


    The long-term risk-benefit effect of occasional and regular use of low-dose aspirin (≤ 100 mg per day) in primary prevention of vascular diseases and cancers was calculated. One representative database of 1 000 000 participants from Taiwan's National Health Insurance scheme in 1997-2000 was used. The potential study subjects were those aged 30-95 years, were found not to have been prescribed aspirin before 1 January 2000, but to have first been prescribed low-dose aspirin (≤ 100 mg per day) after that date and were followed up to 31 December 2009. Participants prescribed low-dose aspirin risk. A total of 1720 pairs were analysed. During the study period, haemorrhage and ischaemia occurred in 25 (1·45%) and 67 participants (3·90%) in occasional users and 69 (4·01%) and 100 participants (5·81%) in regular users, whereas cancer occurred in 32 participants (1·86%) in occasional users and 26 participants (1·51%) in regular users. The crude and adjusted net clinical risks of low-dose aspirin use between the two frequency of users (≥ 80% vs. prevention against major vascular diseases and cancer. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

  19. Complications and long-term follow-up results in titanium mesh cage reconstruction after cervical corpectomy. (United States)

    Nakase, Hiroyuki; Park, Young-Su; Kimura, Hajime; Sakaki, Toshisuke; Morimoto, Tetsuya


    The incidence of the complications and long-term outcome with a minimum 2-year follow-up of anterior cervical reconstruction using titanium mesh cage is evaluated. Relevant literature was also reviewed to discuss the potential risk factors of the complications of this procedure. From 1999 to 2003, 26 patients with cervical spine disorders, (12 patients with OPLL, 7 with cervical spondylosis, 3 with vertebral tumors, 2 with osteomyelitis, and 2 with traumatic lesions) were operated on by this procedure. The series included 14 males and 12 females with a mean age of 60.9 years. Corpectomy was performed on 1 (14 cases), 2 (12 cases). Autologous bone fragments were taken from the excised vertebra. The average improvement rate as scored on the neurosurgical cervical spine scale was 67.4%. The average follow-up period was 54.3 months (range, 24 to 72 months) in 21 who were followed up, and bone union was observed in all cases (22/22 cases) that could be followed up for more than 6 months postoperatively. The average time required for fusion was 6.7 months. Postoperative complications included dyspnea (1 case) and cerebrospinal fluid leakage (2 cases), which was treated by lumbar drainage, without any additional repair operation. No hardware-related complications or adjacent segment degenerative changes were encountered during the follow-up periods. This reconstruction technique yielded good clinical results and helped to avoid complications associated with harvesting bone from the iliac crest donor site. However, risk factors related to the method should be carefully considered.

  20. Long-Term Evaluation of Changes in Operative Technique and Hardware-Related Complications With Deep Brain Stimulation. (United States)

    Falowski, Steven M; Ooi, Yinn Cher; Bakay, Roy A E


    Deep brain stimulation is the most frequent neurosurgical procedure for movement disorders. While this elective procedure carries a low-risk profile, it is not free of complications. As a new procedure, the pattern of complications changed with experience and modification of surgical technique and equipment. This review analyzes the most common hardware-related complications that may occur and techniques to avoid them. It is a retrospective review of 432 patients undergoing 1077 procedures over a 14-year period by one surgeon with emphasis on the analysis of surgical technique and the changes over time. Comparisons were made pre and postimplementation of different surgical techniques over different time periods. The epochs relate to the learning curve, new equipment, and new techniques. Overall lead revision was observed at 5.7%, extension revision at 3.2%, infection rate at 1.2%, infarct without intracerebral hemorrhage at 0.8%, and intracerebral hemorrhage at 2.5% with a permanent deficit of 0.2%. An analysis and change in surgical technique which involved isolating the lead from the skin surface at both the cranial and retro-auricular incision also demonstrated a substantial decrease in lead fracture rate and infection rate. There was no mortality. This large series of patients and long-term follow-up demonstrates that risks are very low in comparison with other neurosurgical procedures, but DBS is still an elective procedure that necessitates extensive care and precision. In a rapidly evolving field, attention to surgical technique is imperative and will keep rates of complications at a minimum. © 2015 International Neuromodulation Society.

  1. Long term prevention of disturbance induces the collapse of a dominant species without altering ecosystem function. (United States)

    Yu, Qiang; Wu, Honghui; Wang, Zhengwen; Flynn, Dan F B; Yang, Hao; Lü, Fumei; Smith, Melinda; Han, Xingguo


    Limitation of disturbances, such as grazing and fire, is a key tool for nature reserve management and ecological restoration. While the role of these disturbances in shaping ecosystem structure and functioning has been intensively studied, less is known about the consequences of long-term prevention of grazing and fire. Based on a 31-year study, we show that relative biomass of the dominant grass, Leymus chinensis, of grasslands in northern China declined dramatically, but only after 21 years of exclusion of fire and grazing. However, aboveground net primary productivity (ANPP) did not decline accordingly due to compensatory responses of several subdominant grass species. The decline in dominance of L. chinensis was not related to gradually changing climate during the same period, whereas experimentally imposed litter removal (simulating fire), mowing (simulating grazing), fire and moderate grazing enhanced dominance of L. chinensis significantly. Thus, our findings show that disturbances can be critical to maintain the dominance of key grass species in semiarid grassland, but that the collapse of a dominant species does not necessarily result in significant change in ANPP if there are species in the community capable of compensating for loss of a dominant.

  2. A Single Long-Term Acute Care Hospital Experience with a Pressure Ulcer Prevention Program. (United States)

    Young, Daniel L; Borris-Hale, Cathy; Falconio-West, Margaret; Chakravarthy, Debashish


    The occurrence of pressure ulcers (PrUs) challenges care facilities. Few studies report PrU reduction efforts in long-term acute care (LTAC). This study described the PrU reduction efforts of a single, LTAC facility using the Medline Pressure Ulcer Prevention Program (mPUPP). This study was a quasi-experimental, quality improvement project, with pre- and postmeasurement design. Outcomes were tracked for 24 months. The mPUPP was implemented in month 11. Education for caregivers was provided through an interactive web-based suite. In addition, all Patient Care Technicians attended a 4-week 1-hour inservice. New skin care products were implemented. The facility also implemented an algorithm for treatment of wounds. There was a significant reduction in the mean monthly hospital-acquired PrU (nPrU) rate when preprogram is compared to postprogram. Sustainable nPrU reduction can be achieved with mPUPP. LTAC hospitals could expect to reduce nPrU with education and incentive of caregivers. © 2014 Association of Rehabilitation Nurses.

  3. The long term economic impact of severe obstetric complications for women and their children in Burkina Faso.

    Directory of Open Access Journals (Sweden)

    Patrick G C Ilboudo

    Full Text Available This study investigates the long term economic impact of severe obstetric complications for women and their children in Burkina Faso, focusing on measures of food security, expenditures and related quality of life measures. It uses a hospital based cohort, first visited in 2004/2005 and followed up four years later. This cohort of 1014 women consisted of two main groups of comparison: 677 women who had an uncomplicated delivery and 337 women who experienced a severe obstetric complication which would have almost certainly caused death had they not received hospital care (labelled a "near miss" event. To analyze the impact of such near miss events as well as the possible interaction with the pregnancy outcome, we compared household and individual level indicators between women without a near miss event and women with a near miss event who either had a live birth, a perinatal death or an early pregnancy loss. We used propensity score matching to remove initial selection bias. Although we found limited effects for the whole group of near miss women, the results indicated negative impacts: a for near miss women with a live birth, on child development and education, on relatively expensive food consumption and on women's quality of life; b for near miss women with perinatal death, on relatively expensive foods consumption and children's education and c for near miss women who had an early pregnancy loss, on overall food security. Our results showed that severe obstetric complications have long lasting consequences for different groups of women and their children and highlighted the need for carefully targeted interventions.

  4. Complications Associated with Long-Term Disposition of Newly-Generated Transuranic Waste: A National Laboratory Perspective

    International Nuclear Information System (INIS)

    Orchard, B.J.; Harvego, L.A.; Carlson, T.L.; Grant, R.P.


    The Idaho National Laboratory (INL) is a multipurpose national laboratory delivering specialized science and engineering solutions for the U.S. Department of Energy (DOE). Sponsorship of INL was formally transferred to the DOE Office of Nuclear Energy, Science and Technology (NE) by Secretary Spencer Abraham in July 2002. The move to NE, and designation as the DOE lead nuclear energy laboratory for reactor technology, supports the nation's expanding nuclear energy initiatives, placing INL at the center of work to develop advanced Generation IV nuclear energy systems; nuclear energy/hydrogen coproduction technology; advanced nuclear energy fuel cycle technologies; and providing national security answers to national infrastructure needs. As a result of the Laboratory's NE mission, INL generates both contact-handled and remote-handled transuranic (TRU) waste from ongoing operations. Generation rates are relatively small and fluctuate based on specific programs and project activities being conducted; however, the Laboratory will continue to generate TRU waste well into the future in association with the NE mission. Currently, plans and capabilities are being established to transfer INL's contact-handled TRU waste to the Advanced Mixed Waste Treatment Plant (AMWTP) for certification and disposal to the Waste Isolation Pilot Plant (WIPP). Remote-handled TRU waste is currently placed in storage at the Materials and Fuels Complex (MFC). In an effort to minimize future liabilities associated with the INL NE mission, INL is evaluating and assessing options for the management and disposition of all its TRU waste on a real-time basis at time of generation. This paper summarizes near-term activities to minimize future re handling of INL's TRU waste, as well as, potential complications associated with the long-term disposition of newly-generated TRU waste. Potential complications impacting the disposition of INL newly-generated TRU waste include, but are not limited to: (1

  5. Automated telephone communication systems for preventive healthcare and management of long-term conditions. (United States)

    Posadzki, Pawel; Mastellos, Nikolaos; Ryan, Rebecca; Gunn, Laura H; Felix, Lambert M; Pappas, Yannis; Gagnon, Marie-Pierre; Julious, Steven A; Xiang, Liming; Oldenburg, Brian; Car, Josip


    Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone's touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (; for papers published between 1980 and June 2015. Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. We used standard Cochrane methods to select and extract data and to appraise eligible studies. We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders

  6. Long-term effects of a parenting preventive intervention on young adults' painful feelings about divorce. (United States)

    Christopher, Caroline; Wolchik, Sharlene; Tein, Jenn-Yun; Carr, Colleen; Mahrer, Nicole E; Sandler, Irwin


    This study examined whether the New Beginnings Program (NBP), a parenting preventive intervention for divorced mothers that was designed to reduce children's postdivorce mental health problems, reduced painful feelings about divorce in young adults whose families had participated 15 years earlier. This study also explored whether NBP participation reduced the relations between young adults' painful feelings about divorce and their concurrent internalizing, externalizing, and substance use problems. Participants (M = 25.6 years; 50% female; 88% Caucasian) were from 240 families that had been recruited into a randomized experimental trial (NBP vs. literature control). Data from the pretest and 15-year follow-up were used. NBP participants reported less feelings of seeing life through a filter of divorce (e.g., thinking about how the divorce causes continued struggles for them) than those in the control condition. Program effects on maternal blame and acceptance of the divorce were moderated by pretest risk, a composite of divorce-related stressors and externalizing problems. NBP participants with elevated risk at program entry had lower levels of maternal blame. Program participation was associated with higher acceptance for those with elevated risk at program entry but lower acceptance for those with low risk at program entry. Program participation decreased the relations between maternal blame, acceptance of the divorce and filter of divorce and some, but not all, of the adjustment outcomes. These findings suggest that programs designed to help families after divorce have benefits in terms of long-term feelings about parental divorce as well as their relations with adjustment problems. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  7. Importance of employee vaccination against influenza in preventing cases in long-term care facilities. (United States)

    Wendelboe, Aaron M; Avery, Catherine; Andrade, Bernardo; Baumbach, Joan; Landen, Michael G


    Employees of long-term care facilities (LTCFs) who have contact with residents should be vaccinated against influenza annually to reduce influenza incidence among residents. This investigation estimated the magnitude of the benefit of this recommendation. The New Mexico Department of Health implemented active surveillance in all of its 75 LTCFs during influenza seasons 2006-2007 and 2007-2008. Information about the number of laboratory-confirmed cases of influenza and the proportion vaccinated of both residents and direct-care employees in each facility was collected monthly. LTCFs reporting at least 1 case of influenza (defined alternately by laboratory confirmation or symptoms of influenza-like illness [ILI]) among residents were compared with LTCFs reporting no cases of influenza. Regression modeling was used to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between employee vaccination coverage and the occurrence of influenza outbreaks. Covariates included vaccination coverage among residents, the staff-to-resident ratio, and the proportion of filled beds. Seventeen influenza outbreaks were reported during this 2-year period of surveillance. Eleven of these were laboratory confirmed (n = 21 residents) and 6 were defined by ILI (n = 40 residents). Mean influenza vaccination coverage among direct-care employees was 51% in facilities reporting outbreaks and 60% in facilities not reporting outbreaks (P = .12). Increased vaccination coverage among direct-care employees was associated with fewer reported outbreaks of laboratory-confirmed influenza (aOR, 0.97 [95% CI, 0.95-0.99]) and ILI (aOR, 0.98 [95% CI, 0.96-1.00]). High vaccination coverage among direct-care employees helps to prevent influenza in LTCFs.

  8. Human papillomavirus-based cervical cancer prevention: long-term results of a randomized screening trial. (United States)

    Denny, Lynette; Kuhn, Louise; Hu, Chih-Chi; Tsai, Wei-Yann; Wright, Thomas C


    Screen-and-treat approaches to cervical cancer prevention are an attractive option for low-resource settings, but data on their long-term efficacy are lacking. We evaluated the efficacy of two screen-and-treat approaches through 36 months of follow-up in a randomized trial. A total of 6637 unscreened South African women aged 35-65 years who were tested for the presence of high-risk human papillomavirus (HPV) DNA in cervical samples underwent visual inspection of the cervix using acetic acid staining and HIV serotesting. Of these, 6555 were randomly assigned to three study arms: 1) HPV-and-treat, in which all women with a positive HPV DNA test result underwent cryotherapy; 2) visual inspection-and-treat, in which all women with a positive visual inspection test result underwent cryotherapy; or 3) control, in which further evaluation or treatment was delayed for 6 months. All women underwent colposcopy with biopsy at 6 months. All women who were HPV DNA- or visual inspection-positive at enrollment, and a subset of all other women had extended follow-up to 36 months (n = 3639) with yearly colposcopy. The endpoint-cervical intraepithelial neoplasia grade 2 or worse (CIN2+)-was analyzed using actuarial life-table methods. All statistical tests were two-sided. After 36 months, there was a sustained statistically significant decrease in the cumulative detection of CIN2+ in the HPV-and-treat arm compared with the control arm (1.5% vs 5.6%, difference = 4.1%, 95% confidence interval [CI] = 2.8% to 5.3%, P cryotherapy.

  9. An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long Term Care (United States)

    Yap, Tracey L.; Kennerly, Susan M.; Bergstrom, Nancy; Hudak, Sandra L.; Horn, Susan D.


    Pressure ulcers (PrUs) have consistently resisted prevention efforts in long term care (LTC) facilities nationwide. Recent research has described cueing innovations that – when selected according to the assumptions and resources of particular facilities – support best practices of PrU prevention. This paper synthesizes that research into a unified, dynamic logic model to facilitate effective staff implementation of a PrU prevention program. PMID:26066791

  10. A second chance--reoperation in patients with failed surgery for intractable epilepsy: long-term outcome, neuropsychology and complications. (United States)

    Grote, Alexander; Witt, Juri-Alexander; Surges, Rainer; von Lehe, Marec; Pieper, Madeleine; Elger, Christian E; Helmstaedter, Christoph; Ormond, D Ryan; Schramm, Johannes; Delev, Daniel


    Resective surgery is a safe and effective treatment of drug-resistant epilepsy. If surgery has failed reoperation after careful re-evaluation may be a reasonable option. This study was to summarise the risks and benefits of reoperation in patients with epilepsy. This is a retrospective single centre study comprising clinical data, long-term seizure outcome, neuropsychological outcome and postoperative complications of patients, who had undergone a second resective epilepsy surgery from 1989 to 2009. A total of 66 patients with median follow-up of 10.3 years were included into the study. Fifty-one patients (77%) had surgery for temporal lobe epilepsy, the remaining 15 cases for extra-temporal lobe epilepsies. The most frequent histological findings were tumours (n=33, 50%), followed by dysplasia, gliosis (n=11, each) and hippocampus sclerosis (n=9). The main reasons for seizure recurrence were incomplete resection (59.1%) of the putative epileptogenic lesion. After reoperation 46 patients (69.7%) were completely seizure-free International League Against Epilepsy 1 (ILAE 1) at the last available follow-up. The neuropsychological evaluation demonstrated that repeated losses in the same cognitive domain, that is, successive changes from better to worse performance categories, were rare and that those losses after first surgery were followed by improvement rather than decline. However, reoperations lead to an increased rate of permanent neurological deficits (9%), overall surgical complications (9%) and visual field deficits (67%). Reoperation after failed resective epilepsy surgery led to approximately 70% long-time seizure freedom and reasonable neuropsychological outcome. There is an increased risk of permanent postoperative neurological deficits, which should be taken into consideration when counselling for reoperation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  11. Blocking Synaptic Removal of GluA2-Containing AMPA Receptors Prevents the Natural Forgetting of Long-Term Memories. (United States)

    Migues, Paola Virginia; Liu, Lidong; Archbold, Georgina E B; Einarsson, Einar Ö; Wong, Jacinda; Bonasia, Kyra; Ko, Seung Hyun; Wang, Yu Tian; Hardt, Oliver


    The neurobiological processes underpinning the natural forgetting of long-term memories are poorly understood. Based on the critical role of GluA2-containing AMPA receptors (GluA2/AMPARs) in long-term memory persistence, we tested in rats whether their synaptic removal underpins time-dependent memory loss. We found that blocking GluA2/AMPAR removal with the interference peptides GluA23Y or G2CT in the dorsal hippocampus during a memory retention interval prevented the normal forgetting of established, long-term object location memories, but did not affect their acquisition. The same intervention also preserved associative memories of food-reward conditioned place preference that would otherwise be lost over time. We then explored whether this forgetting process could play a part in behavioral phenomena involving time-dependent memory change. We found that infusing GluA23Y into the dorsal hippocampus during a 2 week retention interval blocked generalization of contextual fear expression, whereas infusing it into the infralimbic cortex after extinction of auditory fear prevented spontaneous recovery of the conditioned response. Exploring possible physiological mechanisms that could be involved in this form of memory decay, we found that bath application of GluA23Y prevented depotentiation, but not induction of long-term potentiation, in a hippocampal slice preparation. Together, these findings suggest that a decay-like forgetting process that involves the synaptic removal of GluA2/AMPARs erases consolidated long-term memories in the hippocampus and other brain structures over time. This well regulated forgetting process may critically contribute to establishing adaptive behavior, whereas its dysregulation could promote the decline of memory and cognition in neuropathological disorders. The neurobiological mechanisms involved in the natural forgetting of long-term memory and its possible functions are not fully understood. Based on our previous work describing the

  12. Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility. (United States)

    Murray, Meghan T; Jackson, Olivia; Cohen, Bevin; Hutcheon, Gordon; Saiman, Lisa; Larson, Elaine; Neu, Natalie


    We evaluated the collective impact of several infection prevention and control initiatives aimed at reducing acute respiratory infections (ARIs) in a pediatric long-term care facility. ARIs did not decrease overall, though the proportion of infections associated with outbreaks and average number of cases per outbreak decreased. Influenza rates decreased significantly. Infect Control Hosp Epidemiol 2016;37:859-862.

  13. A universal long-term flu vaccine may not prevent severe epidemics

    Directory of Open Access Journals (Sweden)

    Blower Sally


    Full Text Available Abstract Background Recently, the promise of a new universal long-term flu vaccine has become more tangible than ever before. Such a vaccine would protect against very many seasonal and pandemic flu strains for many years, making annual vaccination unnecessary. However, due to complacency behavior, it remains unclear whether the introduction of such vaccines would maintain high and stable levels of vaccination coverage year after year. Findings To predict the impact of universal long-term flu vaccines on influenza epidemics we developed a mathematical model that linked human cognition and memory with the transmission dynamics of influenza. Our modeling shows that universal vaccines that provide short-term protection are likely to result in small frequent epidemics, whereas universal vaccines that provide long-term protection are likely to result in severe infrequent epidemics. Conclusions Influenza vaccines that provide short-term protection maintain risk awareness regarding influenza in the population and result in stable vaccination coverage. Vaccines that provide long-term protection could lead to substantial drops in vaccination coverage and should therefore include an annual epidemic risk awareness programs in order to minimize the risk of severe epidemics.

  14. Long-term outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma. (United States)

    Tsukube, Takuro; Haraguchi, Tomonori; Okada, Yasushi; Matsukawa, Ritsu; Kozawa, Shuichi; Ogawa, Kyoichi; Okita, Yutaka


    The management of acute type A aortic dissection complicated by coma remains controversial. We previously reported an excellent rate of recovery of consciousness provided aortic repair was performed within 5 hours of the onset of symptoms. This study evaluates the early and long-term outcomes using this approach. Between August 2003 and July 2013, of the 241 patients with acute type A aortic dissection brought to the Japanese Red Cross Kobe Hospital and Hyogo Emergency Medical Center, 30 (12.4%) presented with coma; Glasgow Coma Scale was less than 11 on arrival. Surgery was performed in 186 patients, including 27 (14.5%) who were comatose. Twenty-four comatose patients underwent successful aortic repair immediately (immediate group). Their mean age was 71.0 ± 11.1 years, Glasgow Coma Scale was 6.5 ± 2.4, and prevalence of carotid dissection was 79%. For brain protection, deep hypothermia with antegrade cerebral perfusion was used, and postoperative induced hypothermia was performed. Neurologic evaluations were performed using the Glasgow Coma Scale, National Institutes of Health Stroke Scale, and modified Rankin Scale. In the immediate group, the time from the onset of symptoms to arrival in the operating theater was 222 ± 86 minutes. Hospital mortality was 12.5%. Full recovery of consciousness was achieved in 79% of patients in up to 30 days. Postoperative Glasgow Coma Scale and National Institutes of Health Stroke Scale improved significantly when compared with the preoperative score (P coma were satisfactory. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  15. Compliant flooring for fall injury prevention in long-term care


    Lachance, Chantelle


    A promising strategy for reducing the incidence and severity of fall-related injuries in long-term care (LTC) is to decrease the ground surface stiffness, and the subsequent forces applied to the body parts at impact, through installation of compliant flooring. Evidence about the feasibility of compliant flooring in LTC is extremely limited. My PhD research addresses this gap by conducting a comprehensive, multimethod evaluation of compliant flooring. Specifically, I investigate the feasibili...

  16. Impact of aspirin and statins on long-term survival in patients hospitalized with acute myocardial infarction complicated by heart failure

    DEFF Research Database (Denmark)

    Lewinter, Christian; Bland, John M; Crouch, Simon


    AIMS: Aspirin and statins are established therapies for acute myocardial infarction (MI), but their benefits in patients with chronic heart failure (HF) remain elusive. We investigated the impact of aspirin and statins on long-term survival in patients hospitalized with acute MI complicated by HF...

  17. Complications, effectiveness, and long term follow-up of fecal microbiota transfer by nasoduodenal tube for treatment of recurrent Clostridium difficile infection

    NARCIS (Netherlands)

    van Beurden, Yvette H.; De Groot, Pieter F.; van Nood, Els; Nieuwdorp, Max; Keller, Josbert J.; Goorhuis, Abraham


    Fecal microbiota transfer (FMT) is an effective treatment for recurrent Clostridium difficile infection (CDI), but data on procedure-related complications and long-term outcome are scarce. All patients treated with FMT for recurrent CDI at the Academic Medical Center between July 2010 and January

  18. Solid transport in mountain rivers: monitoring techniques and long term assessment as flood prevention tools (United States)

    Longoni, Laura; Brambilla, Davide; Ivanov, Vladislav; Messa, Giacomo; Veronelli, Andrea; Radice, Alessio; Papini, Monica


    Floods are calamitous phenomena with an ever-increasing frequency around the globe, that often result in socio-economic damage and casualties. The role of the solid fraction in the river dynamic has been widely debated in the last decade and its importance is recognized as critical and not negligible in flood simulations as it has been evidenced that the severity of an event is often the result of the coupling of a flood wave with elevated solid transport rates. Nevertheless, assessing the quantity of sediment mobilized in a particular event is not feasible without a long term analysis of the river's dynamics and its morphological evolution since it is defined by past events. This work is focused on the techniques to improve knowledge about sediment production and transport through hydrological networks as a necessary component of a wise flood prevention planning. In particular, a multidisciplinary approach that combines hydraulic and geological knowledge is required in order to understand the evolution of the river sediment and how it will influence the following critical event. The methods are presented through a case study in Italy where a series of different approaches have been integrated to gain a comprehensive understanding of the problem: the sediment movement has been studied by a Eulerian as well as a Lagrangian approaches while hydraulic properties of the stream have been measured. The research started with an attempt to monitor sediment movements: in June 2016 300 sample pebbles, equipped with RFID (Radio Frequency IDentification) transponders, have been deployed in the river and tracked after every major rainfall event. The obtained data-set has been combined with a morphological analysis and a river flow discharge computed through PIV (Particle Image Velocimetry) method in order to identify the relation between a given rainfall event and sediment transport. Moreover, critical sediment size has been estimated from field data using three approaches: two

  19. The long-term evolution of rectosigmoidal complications in carcinoma of the uterine cervix treated exclusively with irradiation

    International Nuclear Information System (INIS)

    Pernot, M.; Bey, P.; Stines, J.; Hoffstetter, S.


    We made a retrospective analysis of 216 patients with carcinoma of the uterine cervix treated, from 1973 to 1978, with irradiation alone (177 patients with carcinoma of the cervix and 39 patients with carcinoma of the cervical stump). Of the 177 patients with carcinoma of the cervix, 25 patients were suffering from recto-sigmoidal complications, which in only 3% of them were considered serious. Of the 39 patients with carcinoma of the cervical stump, nine presented complications; in 5,1% the complications were regarded as serious. A good correlation existed between the degree of severity of the rectal symptoms and the Cumulative Maximal Rectal Dose (C.M.R.D.); on the other hand, a correlation could not be ascertained between the severity of the sigmoidal symptoms and the same C.M.R.D. Patients with severe sigmoidal complications, who had developed a stricture, had always received a dose higher than 80 Gy. The most serious rectosigmoidal complications occurred essentially in two situations: in patients in whom following the brachytherapy the central area had been inadequately shielded during the external irradiation. In patients who received a dose of external irradiation in excess of 50 Gy before brachytherapy. In order to prevent these complications, it is advisable to irradiate the pelvic area with doses of 40 to 45 Gy before brachytherapy, and to complete at once the irradiation of the node areas (with central shielding); the dose transmitted to the pelvic wall by brachytherapy must be calculated and included in the total dose administered. The 7 to 12 year follow-up after therapy showed that only 5 patients out of 216 developed severe complications. The crude survival rate of the 3 to 5 year follow-up of patients with carcinoma of the uterine cervix treated exclusively with irradiation between 1973 and 1978 was: T1 83,7 and 77,5%, T2 67,3 and 61,8 %, T3 42,2 and 31,3% [fr

  20. Prevention of fall-related injuries in long-term care: a randomized controlled trial of staff education. (United States)

    Ray, Wayne A; Taylor, Jo A; Brown, Anne K; Gideon, Patricia; Hall, Kathi; Arbogast, Patrick; Meredith, Sarah


    Fall-related injuries, a major public health problem in long-term care, may be reduced by interventions that improve safety practices. Previous studies have shown that safety practice interventions can reduce falls; however, in long-term care these have relied heavily on external funding and staff. The aim of this study was to test whether a training program in safety practices for staff could reduce fall-related injuries in long-term care facilities. A cluster randomization clinical trial with 112 qualifying facilities and 10,558 study residents 65 years or older and not bedridden. The intervention was an intensive 2-day safety training program with 12-month follow-up. The training program targeted living space and personal safety; wheelchairs, canes, and walkers; psychotropic medication use; and transferring and ambulation. The main outcome measure was serious fall-related injuries during the follow-up period. There was no difference in injury occurrence between the intervention and control facilities (adjusted rate ratio, 0.98; 95% confidence interval, 0.83-1.16). For residents with a prior fall in facilities with the best program compliance, there was a nonsignificant trend toward fewer injuries in the intervention group (adjusted rate ratio, 0.79; 95% confidence interval, 0.57-1.10). More intensive interventions are required to prevent fall-related injuries in long-term care facilities.

  1. Long-term efficacy of denture cleansers in preventing Candida spp. biofilm recolonization on liner surface. (United States)

    Vieira, Ana Paula Coelho; Senna, Plínio Mendes; Silva, Wander José da; Del Bel Cury, Altair Antoninha


    This study evaluated the long-term efficacy of denture cleansers against Candida spp. biofilm recolonization on liner surface. Specimens were fabricated of a poly(methyl methacrylate)-based denture liner and had their surface roughness evaluated at baseline and after cleansing treatments. C. albicans or C. glabrata biofilms were formed on liner surface for 48 h, and then the specimens were randomly assigned to one of cleaning treatments: two alkaline peroxides (soaking for 3 or 15 min), 0.5% sodium hypochlorite (10 min) or distilled water (control; 15 min). After the treatments, the specimens were sonicated to disrupt the biofilm, and residual cells were counted (cell/mL). Long-term effectiveness of the cleaning processes was determined by submitting a set of cleaned specimens to biofilm growth conditions for 48 h followed by estimation of cell counts. The topography of specimens after cleaning treatments was analyzed by SEM. Data were analyzed by ANOVA and Tukey's test (α; = 0.05). Results of cell count estimation showed significant differences in cleanliness among the treatments (p 0.05) was observed among the Candida species regarding the recolonization condition. Alkaline denture cleansers showed similar cleaning performance and both differed from the control (p recolonization.

  2. Untreated Peristomal Skin Complications among Long-Term Colorectal Cancer Survivors with Ostomies: Lessons from a Study of Family Caregiving (United States)

    McMullen, Carmit K.; Wasserman, Joseph; Altschuler, Andrea; Grant, Marcia; Hornbrook, Mark C.; Liljestrand, Petra; Briggs, Catherine; Krouse, Robert S.


    This ethnography of family caregiving explored why peristomal skin complications are both common and undertreated among colorectal cancer (CRC) survivors with intestinal ostomies. We sought to identify factors that hinder or facilitate prompt detection and treatment of ostomy and skin problems. We collected data through in-depth interviews with 31 cancer survivors and their family caregivers, fieldwork, structured assessments, and medical records review. We analyzed data using qualitative theme and matrix analyses. We found that survivors who received help changing the skin barrier around their stoma had fewer obstacles to detection and treatment of peristomal skin complications. Half of the survivors received unpaid help with ostomy care. All such help came from spouses. Married couples who collaborated in ostomy care reported that having assistance in placing the ostomy appliance helped with preventing leaks, detecting skin changes, and modifying ostomy care routines. Survivors who struggled to manage ostomy care independently reported more obstacles to alleviating and seeking treatment for skin problems. Nurses who encounter CRC survivors with ostomies can improve treatment of peristomal skin problems by asking patients and caregivers about ostomy care and skin problems, examining the peristomal area, and facilitating routine checkups with a wound, ostomy and continence nurse. PMID:22119975

  3. Toward an Effective Long-Term Strategy for Preventing Motor Vehicle Crashes and Injuries

    Directory of Open Access Journals (Sweden)

    Anthony R. Mawson


    Full Text Available Casualties due to motor vehicle crashes (MVCs include some 40,000 deaths each year in the United States and one million deaths worldwide. One strategy that has been recommended for improving automobile safety is to lower speed limits and enforce them with speed cameras. However, motor vehicles can be hazardous even at low speeds whereas properly protected human beings can survive high-speed crashes without injury. Emphasis on changing driver behavior as the focus for road safety improvements has been largely unsuccessful; moreover, drivers today are increasingly distracted by secondary tasks such as cell phone use and texting. Indeed, the true limiting factor in vehicular safety is the capacity of human beings to sense and process information and to make rapid decisions. Given that dramatic reductions in injuries and deaths from MVCs have occurred over the past century due to improvements in safety technology, despite increases in the number of vehicles on the road and miles driven per vehicle, we propose that an effective long-term strategy for reducing MVC-related injury would be continued technological innovation in vehicle design, aimed at progressively removing the driver from routine operational decision-making. Once this is achieved, high rates of speed could be achieved on open highways, with minimal risk of crashes and injury to occupants and pedestrians.

  4. Toward an effective long-term strategy for preventing motor vehicle crashes and injuries. (United States)

    Mawson, Anthony R; Walley, E Kenneth


    Casualties due to motor vehicle crashes (MVCs) include some 40,000 deaths each year in the United States and one million deaths worldwide. One strategy that has been recommended for improving automobile safety is to lower speed limits and enforce them with speed cameras. However, motor vehicles can be hazardous even at low speeds whereas properly protected human beings can survive high-speed crashes without injury. Emphasis on changing driver behavior as the focus for road safety improvements has been largely unsuccessful; moreover, drivers today are increasingly distracted by secondary tasks such as cell phone use and texting. Indeed, the true limiting factor in vehicular safety is the capacity of human beings to sense and process information and to make rapid decisions. Given that dramatic reductions in injuries and deaths from MVCs have occurred over the past century due to improvements in safety technology, despite increases in the number of vehicles on the road and miles driven per vehicle, we propose that an effective long-term strategy for reducing MVC-related injury would be continued technological innovation in vehicle design, aimed at progressively removing the driver from routine operational decision-making. Once this is achieved, high rates of speed could be achieved on open highways, with minimal risk of crashes and injury to occupants and pedestrians.

  5. Reduction in inappropriate prevention of urinary tract infections in long-term care facilities. (United States)

    Rummukainen, Maija-Liisa; Jakobsson, Aino; Matsinen, Maire; Järvenpää, Salme; Nissinen, Antti; Karppi, Pertti; Lyytikäinen, Outi


    Urinary tract infection (UTI) is the most common diagnosis made in prescribing antimicrobials in long-term care facilities (LTCF). The diagnostic criteria for UTI vary among institutions and prescribers. Our aim was to reduce the inappropriate use of antimicrobials in LTCFs. A team comprising infectious disease consultant, infection control nurse, and geriatrician visited all LTCFs for older persons (2,321 patients in 25 primary care hospitals and 39 nursing homes and dementia units) in the Central Finland Healthcare District (population 267,000) during 2004-2005. The site visits consisted of a structured interview concerning patients, ongoing systematic antimicrobials, and diagnostic practices for UTI. Following the visits, regional guidelines for prudent use of antimicrobials in LTCFs were published, and the use of antimicrobials was followed up by an annual questionnaire. The proportions of patients receiving antimicrobials in 2005, 2006, 2007, and 2008 were 19.9%, 16.9%, 16.2%, and 15.4%, respectively. Most of the antibiotics were used for UTI (range by year, 66.6%-81.1%). From 2005 through 2008, the proportion of patients on antibiotic prophylaxis for UTI decreased from 13% to 6%. The decrease was statistically significant in both types of settings. The visits and guidelines were associated with a reduction in the usage of antimicrobials. To sustain this, UTI surveillance and close collaboration between infection control experts and LTCFs are crucial. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  6. Garcinia kola aqueous suspension prevents cerebellar neurodegeneration in long-term diabetic rat - a type 1 diabetes mellitus model. (United States)

    Farahna, Mohammed; Seke Etet, Paul F; Osman, Sayed Y; Yurt, Kıymet K; Amir, Naheed; Vecchio, Lorella; Aydin, Isınsu; Aldebasi, Yousef H; Sheikh, Azimullah; Chijuka, John C; Kaplan, Süleyman; Adem, Abdu


    The development of compounds able to improve metabolic syndrome and mitigate complications caused by inappropriate glycemic control in type 1 diabetes mellitus is challenging. The medicinal plant with established hypoglycemic properties Garcinia kola Heckel might have the potential to mitigate diabetes mellitus metabolic syndrome and complications. We have investigated the neuroprotective properties of a suspension of G. kola seeds in long-term type 1 diabetes mellitus rat model. Wistar rats, made diabetic by single injection of streptozotocin were monitored for 8 months. Then, they were administered with distilled water or G. kola oral aqueous suspension daily for 30 days. Body weight and glycemia were determined before and after treatment. After sacrifice, cerebella were dissected out and processed for stereological quantification of Purkinje cells. Histopathological and immunohistochemical analyses of markers of neuroinflammation and neurodegeneration were performed. Purkinje cell counts were significantly increased, and histopathological signs of apoptosis and neuroinflammation decreased, in diabetic animals treated with G. kola compared to diabetic rats given distilled water. Glycemia was also markedly improved and body weight restored to non-diabetic control values, following G. kola treatment. These results suggest that G. kola treatment improved the general condition of long-term diabetic rats and protected Purkinje cells partly by improving the systemic glycemia and mitigating neuroinflammation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. PKMζ inhibition prevents the metaplastic change induced by conditioned taste aversion on insular cortex long-term potentiation in vivo. (United States)

    Ángeles-Durán, Sandybel; Ramos-Languren, Laura E; Escobar, Martha L


    The activity history of a given neuron or pathway has been suggested to influence its future responses to synaptic inputs. In particular, training in several learning tasks produces a metaplastic change, that is, a change in the ability to induce subsequent synaptic plasticity. Experimental evidence shows that the maintenance of long term memory and long-term potentiation (LTP) requires the persistent action of the atypical protein kinase Cisoform, protein kinase M ζ (PKM ζ ). Recent work has demonstrated that the inactivation of PKM ζ in the insular cortex (IC) abolishes conditioned taste aversion (CTA) long term memory. Our previous studies in the IC have demonstrated that the induction of LTP in the basolateral amygdaloid nucleus (Bla)-IC projection previous to CTA training enhances the retention of this task. Moreover, recently, we have observed that CTA training blocks the subsequent induction of LTP in the Bla-IC projection. The aim of the present study was to investigate the participation of PKM ζon the CTA-dependent modification of the ability to induce subsequent LTP in the Bla-IC projection in vivo . Thus, we have delivered high-frequency stimulation in the Bla-IC projection in order to induce in vivo IC-LTP in the rats that underwent or did not have an impairment of CTA retention due to the intracortical administration of the selective PKM ζ pseudosubstrate inhibitory peptide, ZIP. Our results show that the microinfusion of ZIP into the IC of the behaving rats impairs long-term memory of CTA and prevents its effects on IC-LTP. These results indicate that PKM ζ is a key component of the cellular mechanisms necessary for the persistence of lasting memory traces as well as for those underlying metaplastic changes in neocortex, contributing to the persistence of aversive memories.

  8. Long term complications of diabetes and co-morbidities contributing to atherosclerosis in diabetic population of Mirpur, Azad Kashmir

    International Nuclear Information System (INIS)

    Tariq, C.; Afzal, W.


    Objective: To ascertain the prevalence of diabetes mellitus and its chronic complications along with co-morbidities contributing to atherosclerosis in the diabetic population of Mirpur, Azad Kashmir. Methods: The cross-sectional study and was carried out at the Divisional Headquarter Hospital, Mirpur, Azad Kashmir, between January and August 2012. The patients selected were established diabetics. Data was collected through special questionnaire. SPSS version 14 was used to analyse the data. Results: A total 3602 patients were interviewed initially. Of them 318 were diabetics; the prevalence rate being 8.83%. Of the 318 study subjects, 24 (7.3%) had a history of stroke; 4 (1.3%) had history of transient ischaemic attack; 17 (5.3%) had history of myocardial infarction; 27 (8.5%) and had a history of angina. Foot ulcers were present in 22 (6.9%) and 3 (0.9%) had an amputation. Diabetic retinopathy was found in 95 (29.9%), diabetic nephropathy in 25 (7.9%) and diabetic neuropathy in 126 (39.6%). Co-morbid hypertension was found in 153 (48.1%) of cases whereas co-morbid hypercholesterolaemia was found in 66 (20.8%) and 56.9% had family history of diabetes mellitus. Overall, 34 (10.7%) were smokers. Conclusion: Diabetes is responsible for significant morbidity and mortality. Co-morbidities like hypertension and hypercholesterolaemia must be aggressively treated to prevent coronary heart disease. (author)

  9. Perioperative hyperoxia - Long-term impact on cardiovascular complications after abdominal surgery, a post hoc analysis of the PROXI trial

    DEFF Research Database (Denmark)

    Fonnes, Siv; Gogenur, Ismail; Sondergaard, Edith Smed


    BACKGROUND: Increased long-term mortality was found in patients exposed to perioperative hyperoxia in the PROXI trial, where patients undergoing laparotomy were randomised to 80% versus 30% oxygen during and after surgery. This post hoc follow-up study assessed the impact of perioperative hyperoxia...... included myocardial infarction, other heart disease, and acute coronary syndrome or death. Data were analysed in the Cox proportional hazards model. RESULTS: The primary outcome, acute coronary syndrome, occurred in 2.5% versus 1.3% in the 80% versus 30% oxygen group; HR 2.15 (95% CI 0.96-4.84). Patients...

  10. Effects of urinary bladder retroflexion and surgical technique on postoperative complication rates and long-term outcome in dogs with perineal hernia: 41 cases (2002-2009). (United States)

    Grand, Jean-Guillaume; Bureau, Stéphane; Monnet, Eric


    To evaluate the effects of urinary bladder retroflexion (UBR) and surgical technique on postoperative complication rates and long-term outcome in dogs with perineal hernia. Retrospective case series. 41 client-owned dogs with perineal hernia that underwent surgery between November 2002 and November 2009. Medical records were reviewed for information on dog signalment, history, physical examination findings, ultrasonographic findings, surgical techniques, intraoperative complications, duration of hospital stay, postoperative complications, and long-term outcome. 31 dogs had no UBR, and 10 dogs had UBR. Internal obturator muscle transposition (IOMT) was performed in 20 dogs, and a cystopexy or colopexy was performed before the IOMT (LapIOMT) in 21. Postoperative complications included tenesmus (n = 8) and urinary incontinence (1). Rates of postoperative complications were not significantly different between the no-UBR and UBR groups or between the IOMT and LapIOMT groups. Thirty-two dogs were free of clinical signs at the time of the study. The median disease-free interval did not differ significantly between dogs in the no-UBR and UBR groups, but it was significantly lower in the LapIOMT group than in the IOMT group. None of the 7 dogs with UBR that were treated without cystopexy developed recurrence of UBR. UBR was not associated with an increased rate of postoperative complications relative to no UBR and had no effect on the long-term outcome in dogs with perineal hernia. The use of IOMT alone may be recommended for clinical use because LapIOMT offered no clear advantage.

  11. Comparative effectiveness of long term drug treatment strategies to prevent asthma exacerbations: network meta-analysis

    NARCIS (Netherlands)

    Loymans, Rik J. B.; Gemperli, Armin; Cohen, Judith; Rubinstein, Sidney M.; Sterk, Peter J.; Reddel, Helen K.; Jüni, Peter; ter Riet, Gerben


    To determine the comparative effectiveness and safety of current maintenance strategies in preventing exacerbations of asthma. Systematic review and network meta-analysis using Bayesian statistics. Cochrane systematic reviews on chronic asthma, complemented by an updated search when appropriate.

  12. Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study.

    Directory of Open Access Journals (Sweden)

    Clemens Becker

    Full Text Available BACKGROUND: Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany. METHODS: In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure. RESULTS: In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG and control group (CG. During the one-year intervention period femoral fracture rates were 33.6 (IG and 41.0/1000 person years (CG, respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93 in residents exposed to the fall and fracture prevention program compared to residents from CG. CONCLUSIONS: The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes.

  13. Right retroperitoneoscopic living donor nephrectomy does not increase surgical complications in the recipient and leads to excellent long-term outcome. (United States)

    Schaumeier, Maria Johanna; Nagy, Alexandra; Dell-Kuster, Salome; Rosenthal, Rachel; Schaub, Stefan; Dickenmann, Michael; Gurke, Lorenz; Wolff, Thomas


    Right-sided retroperitoneoscopic living donor nephrectomy (LDN) has been shown to be safe for the donor but it is unknown whether the short renal vein is associated with complications or an impaired long-term outcome in the recipient. In this retrospective cohort study, consecutive transplant recipients after retroperitoneoscopic LDN were enrolled. Complications occurring within 1 year were classified according to the Clavien-Dindo Classification for Surgical Complications and analysed using multivariable logistic regression. Predictors of 1-year creatinine clearance were analysed with multivariable linear regression. Cox proportional hazard models were used to analyse graft survival. Of the 251 recipients, 193 (77%) received a left kidney and 58 (23%) a right kidney. Surgical complications of Clavien-Dindo grade 3 or higher were comparable in recipients of right and left kidneys (33% vs 29%, odds ratio 0.98, 95% confidence interval [CI] 0.50, 1.94). The occurrence of a surgical complication had a significant impact on creatinine clearance at 1 year (decrease of 6 ml/min/m2, p = 0.016). Vascular complications in right kidneys were more common but were all corrected without impact on graft survival. One-year graft-survival was similar in recipients of right (98.3%) and left (96.9%) kidneys, as was creatinine clearance one year after transplantation (mean difference 3.3 ml/min/m2, 95% CI -1.5, 8.1; p = 0.175). After a median follow-up of 5 years, neither the side (hazard ratio 1.56, 95% CI 0.67, 3.63) nor surgical complications (hazard ratio 1.44, 95% CI 0.65, 3.19) were associated with graft failure. Right retroperitoneoscopic LDN does not compromise the outcome of transplantation. Surgical complications, long-term graft function and graft survival were comparable in right and left kidneys.

  14. Long-term effect of altered nutrition induced by litter size manipulation and cross-fostering in suckling male rats on development of obesity risk and health complications. (United States)

    Mozeš, Stefan; Sefčíková, Zuzana; Raček, L'ubomír


    We investigated the long-term effect of pre-weaning nutrition on positive and/or adverse regulation of obesity risk and health complications in male Sprague-Dawley rats. Two experimental models were used in the present work: (1) To induce postnatal over- or normal nutrition, the litter size was adjusted to 4 (small litters-SL) and to 10 pups (normal litters-NL) in the nest, (2) in suckling pups at day 10, we used cross-fostering to identify the effect of altered dietary environment on their future body fat regulation, food intake, blood pressure, and the duodenal and jejunal alkaline phosphatase activity. After weaning, these control (NL, SL) and cross-fostered (NL-SL, SL-NL) groups were exposed to standard laboratory diet. On day 50, the SL in comparison with NL rats became heavier and displayed enhanced adiposity accompanied by significantly increased systolic blood pressure (19%) and duodenal (16%) and jejunal (21%) alkaline phosphatase (AP) activity. The impact of pre-weaning over-nutrition of NL-SL pups was associated with long-lasting positive effect on obesity. In contrast, SL-NL rats submitted until weaning to the opposite normalized feeding condition on day 50 showed significantly decreased fat deposition (21%), systolic blood pressure (20%), and AP activity in duodenum and jejunum (14%). These results contribute to a better understanding of how early-acquired dietary habits determine the attenuation or prevention of obesity development in later life and can provide some benefit for optimizing the future dietary strategies in young and adult obese individuals.

  15. Renal denervation prevents long-term sequelae of ischemic renal injury (United States)

    Kim, Jinu; Padanilam, Babu J.


    Signals that drive interstitial fibrogenesis after renal ischemia reperfusion injury remain undefined. Sympathetic activation is manifest even in the early clinical stages of chronic kidney disease and is directly related to disease severity. A role for renal nerves in renal interstitial fibrogenesis in the setting of ischemia reperfusion injury has not been studied. In male 129S1/SvImJ mice, ischemia reperfusion injury induced tubulointerstitial fibrosis as indicated by collagen deposition and profibrotic protein expression 4 to 16 days after the injury.. Leukocyte influx, proinflammatory protein expression, oxidative stress, apoptosis, and cell cycle arrest at G2/M phase were enhanced after ischemia reperfusion injury. Renal denervation at the time of injury or up to 1 day post-injury improved histology, decreased proinflammatory/profibrotic responses and apoptosis, and prevented G2/M cell cycle arrest in the kidney. Treatment with afferent nerve-derived calcitonin gene-related peptide (CGRP) or efferent nerve-derived norepinephrine in denervated and ischemia reperfusion injury-induced kidneys mimicked innervation, restored inflammation and fibrosis, induced G2/M arrest, and enhanced TGF-β1 activation. Blocking norepinephrine or CGRP function using respective receptor blockers prevented these effects. Consistent with the in vivo study, treatment with either norepinephrine or CGRP induced G2/M cell cycle arrest in HK-2 proximal tubule cells, whereas antagonists against their respective receptors prevented G2/M arrest. Thus, renal nerve stimulation is a primary mechanism and renal nerve-derived factors drive epithelial cell cycle arrest and the inflammatory cascade causing interstitial fibrogenesis after ischemia reperfusion injury. PMID:25207878

  16. Long-term phenylbutyrate administration prevents memory deficits in Tg2576 mice by decreasing Abeta. (United States)

    Ricobaraza, Ana; Cuadrado-Tejedor, Mar; Garcia-Osta, Ana


    Aberrations in protein folding, processing, and/or degradation are common features of neurodegenerative diseases, such as Alzheimer's disease (AD). Sodium 4-phenylbutyrate (PBA) is a well-known histone deacetylase inhibitor, which increases gene transcription of a number of genes, and also exerts neuroprotective effects. PBA acts as a chemical chaperone reducing the load of mutant or unfolded proteins during cellular stress. Previously, we reported that 5-week administration of PBA reinstated memory loss and dendritic spine densities in the Tg2576 mouse model of AD. In this study we reported that chronic administration of PBA, starting before the onset of disease symptoms (6 month-old) prevents age-related memory deficits in Tg2576 mice. The amelioration of the memory impairment is associated to a decrease in amyloid beta pathology and the glial fibrillary acidic protein (GFAP), suggesting that inflammation was reduced in PBA-treated animals. Together, the beneficial effects of PBA make it a promising agent for the prevention of AD.

  17. Experiences of a long-term randomized controlled prevention trial in a maiden environment: Estonian Postmenopausal Hormone Therapy trial

    Directory of Open Access Journals (Sweden)

    Rahu Mati


    Full Text Available Abstract Background Preventive drugs require long-term trials to show their effectiveness or harms and often a lot of changes occur during post-marketing studies. The purpose of this article is to describe the research process in a long-term randomized controlled trial and discuss the impact and consequences of changes in the research environment. Methods The Estonian Postmenopausal Hormone Therapy trial (EPHT, originally planned to continue for five years, was planned in co-operation with the Women's International Study of Long-Duration Oestrogen after Menopause (WISDOM in the UK. In addition to health outcomes, EPHT was specifically designed to study the impact of postmenopausal hormone therapy (HT on health services utilization. Results After EPHT recruited in 1999–2001 the Women's Health Initiative (WHI in the USA decided to stop the estrogen-progestin trial after a mean of 5.2 years in July 2002 because of increased risk of breast cancer and later in 2004 the estrogen-only trial because HT increased the risk of stroke, decreased the risk of hip fracture, and did not affect coronary heart disease incidence. WISDOM was halted in autumn 2002. These decisions had a major influence on EPHT. Conclusion Changes in Estonian society challenged EPHT to find a balance between the needs of achieving responses to the trial aims with a limited budget and simultaneously maintaining the safety of trial participants. Flexibility was the main key for success. Rapid changes are not limited only to transiting societies but are true also in developed countries and the risk must be included in planning all long-term trials. The role of ethical and data monitoring committees in situations with emerging new data from other studies needs specification. Longer funding for preventive trials and more flexibility in budgeting are mandatory. Who should prove the effectiveness of an (old drug for a new preventive indication? In preventive drug trials companies may

  18. Long-Term Risk for Aortic Complications After Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Versus Marfan Syndrome. (United States)

    Itagaki, Shinobu; Chikwe, Joanna P; Chiang, Yuting P; Egorova, Natalia N; Adams, David H


    Bicuspid aortic valves are associated with valve dysfunction, ascending aortic aneurysm and dissection. Management of the ascending aorta at the time of aortic valve replacement (AVR) in these patients is controversial and has been extrapolated from experience with Marfan syndrome, despite the absence of comparative long-term outcome data. This study sought to assess whether the natural history of thoracic aortopathy after AVR in patients with bicuspid aortic valve disease is substantially different from that seen in patients with Marfan syndrome. In this retrospective comparison, outcomes of 13,205 adults (2,079 with bicuspid aortic valves, 73 with Marfan syndrome, and 11,053 control patients with acquired aortic valve disease) who underwent primary AVR without replacement of the ascending aorta in New York State between 1995 and 2010 were compared. The median follow-up time was 6.6 years. The long-term incidence of thoracic aortic dissection was significantly higher in patients with Marfan syndrome (5.5 ± 2.7%) compared with those with bicuspid valves (0.55 ± 0.21%) and control group patients (0.41 ± 0.08%, p Marfan syndrome (10.8 ± 4.4%) compared with those with bicuspid valves (4.8 ± 0.8%) and control group patients (1.4 ± 0.2%) (p Marfan syndrome were significantly more likely to undergo thoracic aortic surgery in late follow-up (10.4 ± 4.3%) compared with those with bicuspid valves (2.5 ± 0.6%) and control group patients (0.50 ± 0.09%) (p Marfan syndrome compared with those with bicuspid aortic valves confirm that operative management of patients with bicuspid aortic valves should not be extrapolated from Marfan syndrome and support discrete treatment algorithms for these different clinical entities. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. Long term follow-up of a tobacco prevention and cessation program in cystic fibrosis patients. (United States)

    Ortega-García, Juan Antonio; Perales, Joseph E; Cárceles-Álvarez, Alberto; Sánchez-Sauco, Miguel Felipe; Villalona, Seiichi; Mondejar-López, Pedro; Pastor-Vivero, María Dolores; Mira Escolano, Pilar; James-Vega, Diana Carolina; Sánchez-Solís, Manuel


    This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (p < 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p = <0.01). Cotinine was significantly correlated with both active and passive exposure (p<0.01) with a significant reduction of cotinine levels from 63.13 (28.58-97.69) to 20.56 (0.86-40.27) ng/ml (p<0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05-1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF.

  20. Long-term Effects of Hepatitis B Immunization of Infants in Preventing Liver Cancer. (United States)

    Chang, Mei-Hwei; You, San-Lin; Chen, Chien-Jen; Liu, Chun-Jen; Lai, Ming-Wei; Wu, Tzee-Chung; Wu, Shu-Fen; Lee, Chuan-Mo; Yang, Sheng-Shun; Chu, Heng-Cheng; Wang, Tsang-Eng; Chen, Bor-Wen; Chuang, Wan-Long; Soon, Maw-Soan; Lin, Ching-Yih; Chiou, Shu-Ti; Kuo, Hsu-Sung; Chen, Ding-Shinn


    The incidence of hepatocellular carcinoma (HCC) increases with age, but protective antibody responses decrease with time after infants are immunized against hepatitis B virus (HBV). We investigated whether immunization of infants against HBV prevents their developing HCC as adults. We also searched for strategies to maximize the cancer-preventive effects. We collected data from 2 Taiwan HCC registry systems on 1509 patients (6-26 years old) diagnosed with HCC from 1983 through 2011. Data on history of HBV immunization and prenatal maternal levels of HBV antigens of all HCC patients born after July 1984 were retrieved from the HBV immunization data bank of the Taiwan Center for Disease Control. We collected data on birth cohort-specific populations (6-26 years old) of Taiwan using the National Household Registry System. Rates of HCC incidence per 10(5) person-years were derived by dividing the number of patients with HCC by the person-years of the general population. Relative risks (RR) for HCC were estimated by Poisson regression analysis in vaccinated vs unvaccinated birth cohorts. We stratified patients by age group to evaluate the association of birth cohorts and HCC risks. Of the 1509 patients with HCC, 1343 were born before, and 166 were born after, the HBV vaccination program began. HCC incidence per 10(5) person-years was 0.92 in the unvaccinated cohort and 0.23 in the vaccinated birth cohorts. The RRs for HCC in patients 6-9 years old, 10-14 years old, 15-19 years old, and 20-26 years old who were vaccinated vs unvaccinated were 0.26 (95% confidence interval [CI], 0.17-0.40), 0.34 (95% CI, 0.25-0.48), 0.37 (95% CI, 0.25-0.51), and 0.42 (95% CI, 0.32-0.56), respectively. The RR for HCC in 6- to 26-year-olds was lower in the later vs the earlier cohorts (born in 1992-2005 vs 1986-1992; P Taiwan, immunization of infants against HBV reduces their risk of developing HCC as children and young adults. Improving HBV vaccination strategies and overcoming risk

  1. Preventing microvascular complications in type 1 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Vijay Viswanathan


    Full Text Available Patients with complications of diabetes such as retinopathy, nephropathy, and cardiovascular complications have increased hospital stay with greater economic burden. Prevention of complications should be started before the onset of type 1 diabetes mellitus (T1DM by working on risk factors and thereafter by intervention upon confirmatory diagnosis which can prevent further damage to β-cells. The actual risk of getting microvascular complications like microalbuminuria and retinopathy progression starts at glycated hemoglobin (HbA1c level of 7%. As per the American Diabetes Association, a new pediatric glycemic control target of HbA1c 20 years as compared to patients <10 years of age. Screening of these complications should be done regularly, and appropriate preventive strategies should be followed. Angiotensin converting enzyme inhibitors and angiotensin II receptor blocker reduce progression from microalbuminuria to macroalbuminuria and increase the regression rate to normoalbuminuria. Diabetic microvascular complications can be controlled with tight glycemic therapy, dyslipidemia management and blood pressure control along with renal function monitoring, lifestyle changes, including smoking cessation and low-protein diet. An integrated and personalized care would reduce the risk of development of microvascular complications in T1DM patients. The child with diabetes who receives limited care is more likely to develop long-term complications at an earlier age. Screening for subclinical complications and early interventions with intensive therapy is the need of the hour.

  2. Preventing microvascular complications in type 1 diabetes mellitus (United States)

    Viswanathan, Vijay


    Patients with complications of diabetes such as retinopathy, nephropathy, and cardiovascular complications have increased hospital stay with greater economic burden. Prevention of complications should be started before the onset of type 1 diabetes mellitus (T1DM) by working on risk factors and thereafter by intervention upon confirmatory diagnosis which can prevent further damage to β-cells. The actual risk of getting microvascular complications like microalbuminuria and retinopathy progression starts at glycated hemoglobin (HbA1c) level of 7%. As per the American Diabetes Association, a new pediatric glycemic control target of HbA1c 20 years as compared to patients <10 years of age. Screening of these complications should be done regularly, and appropriate preventive strategies should be followed. Angiotensin converting enzyme inhibitors and angiotensin II receptor blocker reduce progression from microalbuminuria to macroalbuminuria and increase the regression rate to normoalbuminuria. Diabetic microvascular complications can be controlled with tight glycemic therapy, dyslipidemia management and blood pressure control along with renal function monitoring, lifestyle changes, including smoking cessation and low-protein diet. An integrated and personalized care would reduce the risk of development of microvascular complications in T1DM patients. The child with diabetes who receives limited care is more likely to develop long-term complications at an earlier age. Screening for subclinical complications and early interventions with intensive therapy is the need of the hour. PMID:25941647

  3. Tail docking in pigs: a review on its short- and long-term consequences and effectiveness in preventing tail biting

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    Eleonora Nannoni


    Full Text Available In spite of European legislation attempting to limit this practice, tail docking is nowadays the only preventive measure against tail biting which is widely adopted by farmers. Docking consists in amputating, usually without anaesthesia or analgesia, the distal part of the tail, in order to reduce its attractiveness and to sensitize it, increasing avoidance behaviour in the bitten pig. Tail docking results in both acute and chronic effects on pig welfare, and its effectiveness in preventing tail biting is limited, since it reduces the symptoms of a behavioural disorder, but does not address the underlying causes. The aim of the present paper is to review the available literature on the effects of tail docking on swine welfare. Although from a practical standpoint the welfare risks arising from tail docking may appear to be negligible compared to those arising during and after tail biting outbreaks, it should be considered that, apart from acute physiological and behavioural responses, tail docking may also elicit long-term effects on weight gain, tail stump sensitivity and animal freedom to express their normal behaviour. Such chronic effects have been poorly investigated so far. Besides, studies evaluating the effectiveness of anaesthetics or analgesic treatments are often conflicting. Within this framework, further research is recommended in order to reduce the acute and chronic pain and discomfort experienced by the animals, until preventive measures (e.g., environmental enrichment, stocking densities are broadly adopted to prevent tail biting.

  4. Untreated Peristomal Skin Complications among Long-Term Colorectal Cancer Survivors with Ostomies: Lessons from a Study of Family Caregiving


    McMullen, Carmit K.; Wasserman, Joseph; Altschuler, Andrea; Grant, Marcia; Hornbrook, Mark C.; Liljestrand, Petra; Briggs, Catherine; Krouse, Robert S.


    This ethnography of family caregiving explored why peristomal skin complications are both common and undertreated among colorectal cancer (CRC) survivors with intestinal ostomies. We sought to identify factors that hinder or facilitate prompt detection and treatment of ostomy and skin problems. We collected data through in-depth interviews with 31 cancer survivors and their family caregivers, fieldwork, structured assessments, and medical records review. We analyzed data using qualitative the...

  5. Contemporary Reflections on the Safety of Long-Term Aspirin Treatment for the Secondary Prevention of Cardiovascular Disease (United States)

    Fanaroff, Alexander C.; Roe, Matthew T.


    Aspirin has been the cornerstone of therapy for the secondary prevention treatment of patients with cardiovascular disease since landmark trials were completed in the late 1970s and early 1980s that demonstrated the efficacy of aspirin for reducing the risk of ischemic events. Notwithstanding the consistent benefits demonstrated with apirin for both acute and chronic cardiovascular disease, there are a number of toxicities associated with aspirin that have been showcased by recent long-term clinical trials that have included an aspirin monotherapy arm. As an inhibitor of cyclooxygenase, aspirin impairs gastric mucosal protective mechanisms. Prior trials have shown that up to 15–20% of patients developed gastrointestinal symptoms with aspirin monotherapy and roughly 1% of patients per year had a clinically significant bleeding event, including 1 in 1000 patients who suffered an intracranial or fatal bleed. These risks have been shown to be compounded for patients with acute coronary syndromes (ACS) and those undergoing percutaneous coronary intervention (PCI), who are also treated with other anti-thrombotic agents during the acute care/procedural period, as well as for an extended time period afterwards. Given observations of substantial increases in bleeding rates from many prior long-term clinical trials that have evaluated aspirin together with other oral platelet inhibitors or oral anti-coagulants, the focus of contemporary research has pivoted towards tailored anti-thrombotic regimens that attempt to either shorten the duration of exposure to aspirin or replace aspirin with an alternative anti-thrombotic agent. While these shifts are occurring, the safety profile of aspirin when used for the secondary prevention treatment of patients with established cardiovascular disease deserves further consideration. PMID:27028617

  6. Effect of the long-term care prevention project on the motor functions and daily life activities of the elderly. (United States)

    Wada, Yoshihiro; Sakuraba, Keisyoku; Kubota, Atsushi


    [Purpose] The purpose of this study was to verify the effects of the long-term care prevention project and develop an effective program. [Subjects] A total of 81 elderly people (age, 79 ± 5.1 years; height, 149.2 ± 9.2 cm; weight, 54.2 ± 11.4 kg). [Methods] Grip, knee extension muscular strength, 10 m walking speed, and Timed Up and Go time were measured for evaluation of motor functions, and the "Locomo 25", a 25-question risk assessment questionnaire, was used as the judgment criterion for evaluation of daily life activities, with measurements being taken at the beginning of the project and after three months. [Results] In the motor functions evaluation, significant differences were observed in 10 m walking speed, Timed Up and Go time, and knee extension strength. In the daily life activities evaluation, scores for pain, rising movement, standing movement, indoor walking, outdoor walking, and fear of falling were significantly reduced. In addition, a significant correlation was also observed between motor functions and daily life activities. [Conclusion] The result of this study indicated that the long-term care prevention project is effective in maintaining or improving muscular strength and mitigating pain in the elderly and that it is an effective program for maintaining daily life activities. We were also able to show that it would be effective to develop programs with a low exercise intensity that can be performed on a continuing by the elderly.

  7. An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long-term Care. (United States)

    Yap, Tracey L; Kennerly, Susan M; Bergstrom, Nancy; Hudak, Sandra L; Horn, Susan D


    Pressure ulcers have consistently resisted prevention efforts in long-term care facilities nationwide. Recent research has described cueing innovations that-when selected according to the assumptions and resources of particular facilities-support best practices of pressure ulcer prevention. This article synthesizes that research into a unified, dynamic logic model to facilitate effective staff implementation of a pressure ulcer prevention program.

  8. Delayed Complications and Long-Term Management of Sulfur Mustard Poisoning: A Narrative Review of Recent Advances by Iranian Researchers Part ІІ: Clinical Management and Therapy

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    Leila Etemad


    Full Text Available The present study aimed to review and discuss the recommended and recently suggested protocols by Iranian researchers for a long-term treatment of delayed complications of sulfur mustard (DCSM in veterans. As indicated clinically, patients who suffer from delayed ocular complications of sulfur mustard (DOCS benefit from treatments for dry eyes, therapeutic contact lenses, amniotic membrane transplantation; blepharorrhaphy, tarsorrhaphy, limbal stem cell transplantation; corneal transplantation, topical steroids, and immunosuppressive. In spite of penetrating keratoplasty, lamellar keratoplasty and keratolimbal allograft had a good long-term survival. Delayed respiratory complications (DRCS are the most common effects and life-threatening in Iranian veterans. The recommended treatment protocols include regular clinical evaluations, respiratory physiotherapy and rehabilitation, N-acetyl cysteine; warm humidified air, long-acting 2-agonists, and inhaled corticosteroids. Azithromycin has also been effective in improving clinical conditions, pulmonary function tests, inflammatory indexes, and life quality of the veterans. Interferon gamma (IFN-γ and helium: oxygen combination were also used in severe DRCS with good results. Some of the delayed cutaneous complications (DCCS such as itching affects the quality of life of victims. Regular but not frequent showering and bathing, applying sunscreen compounds, topical corticosteroids, and systemic antihistamines reduce the problems of DCCS patients. Several compounds such as capsaicin cream, pimecrolimus, IFN-γ, phenol-menthol; Aloe vera/olive oil cream, cetirizine, doxepine, and hydroxyzine were evaluated in DCCS patients with some benefits. The physicians in charge of veterans emphasize the importance of a healthy lifestyle, appropriate financial/social/cultural supports, and a degree of reassurance and supportive care on the clinical improvement of patients.

  9. Long-term cumulative survival and mechanical complications of single-tooth Ankylos Implants: focus on the abutment neck fractures. (United States)

    Shim, Hye Won; Yang, Byoung-Eun


    To evaluate the cumulative survival rate (CSR) and mechanical complications of single-tooth Ankylos® implants. This was a retrospective clinical study that analyzed 450 single Ankylos® implants installed in 275 patients between December 2005 and December 2012. The main outcomes were survival results CSR and implant failure) and mechanical complications (screw loosening, fracture, and cumulative fracture rate [CFR]). The main outcomes were analyzed according to age, sex, implant length or diameter, bone graft, arch, and position. The 8-year CSR was 96.9%. Thirteen (2.9%) implants failed because of early osseointegration failure in 3, marginal bone loss in 6, and abutment fracture in 4. Screw loosening occurred in 10 implants (2.2%), and 10 abutment fractures occurred. All abutment fractures were located in the neck, and concurrent screw fractures were observed. The CSR and rate of screw loosening did not differ significantly according to factors. The CFR was higher in middle-aged patients (5.3% vs 0.0% in younger and older patients); for teeth in a molar position (5.8% vs 0.0% for premolar or 1.1% for anterior position); and for larger-diameter implants (4.5% for 4.5 mm and 6.7% for 5.5 mm diameter vs 0.5% for 3.5 mm diameter) (all Pabutment fractures (2.2%) were observed and some fractures resulted in implant failures. Middle-aged patients, the molar position, and a large implant diameter were associated with a high incidence of abutment fracture.

  10. Long-term cannabidiol treatment prevents the development of social recognition memory deficits in Alzheimer's disease transgenic mice. (United States)

    Cheng, David; Spiro, Adena S; Jenner, Andrew M; Garner, Brett; Karl, Tim


    Impairments in cognitive ability and widespread pathophysiological changes caused by neurotoxicity, neuroinflammation, oxidative damage, and altered cholesterol homeostasis are associated with Alzheimer's disease (AD). Cannabidiol (CBD) has been shown to reverse cognitive deficits of AD transgenic mice and to exert neuroprotective, anti-oxidative, and anti-inflammatory properties in vitro and in vivo. Here we evaluate the preventative properties of long-term CBD treatment in male AβPPSwe/PS1ΔE9 (AβPP × PS1) mice, a transgenic model of AD. Control and AD transgenic mice were treated orally from 2.5 months of age with CBD (20 mg/kg) daily for 8 months. Mice were then assessed in the social preference test, elevated plus maze, and fear conditioning paradigms, before cortical and hippocampal tissues were analyzed for amyloid load, oxidative damage, cholesterol, phytosterols, and inflammation. We found that AβPP × PS1 mice developed a social recognition deficit, which was prevented by CBD treatment. CBD had no impact on anxiety or associative learning. The prevention of the social recognition deficit was not associated with any changes in amyloid load or oxidative damage. However, the study revealed a subtle impact of CBD on neuroinflammation, cholesterol, and dietary phytosterol retention, which deserves further investigation. This study is the first to demonstrate CBD's ability to prevent the development of a social recognition deficit in AD transgenic mice. Our findings provide the first evidence that CBD may have potential as a preventative treatment for AD with a particular relevance for symptoms of social withdrawal and facial recognition.

  11. Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities. (United States)

    Jakobsen, Gunn Signe; Småstuen, Milada Cvancarova; Sandbu, Rune; Nordstrand, Njord; Hofsø, Dag; Lindberg, Morten; Hertel, Jens Kristoffer; Hjelmesæth, Jøran


    The association of bariatric surgery and specialized medical obesity treatment with beneficial and detrimental outcomes remains uncertain. To compare changes in obesity-related comorbidities in patients with severe obesity (body mass index ≥40 or ≥35 and at least 1 comorbidity) undergoing bariatric surgery or specialized medical treatment. Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included). Bariatric surgery (n = 932, 92% gastric bypass) or specialized medical treatment (n = 956) including individual or group-based lifestyle intervention programs. Primary outcomes included remission and new onset of hypertension based on drugs dispensed according to the Norwegian Prescription Database. Prespecified secondary outcomes included changes in comorbidities. Adverse events included complications retrieved from the Norwegian Patient Registry and a local laboratory database. Among 1888 patients included in the study, the mean (SD) age was 43.5 (12.3) years (1249 women [66%]; mean [SD] baseline BMI, 44.2 [6.1]; 100% completed follow-up at a median of 6.5 years [range, 0.2-10.1]). Surgically treated patients had a greater likelihood of remission and lesser likelihood for new onset of hypertension (remission: absolute risk [AR], 31.9% vs 12.4%); risk difference [RD], 19.5% [95% CI, 15.8%-23.2%], relative risk [RR], 2.1 [95% CI, 2.0-2.2]; new onset: AR, 3.5% vs 12.2%, RD, 8.7% [95% CI, 6.7%-10.7%], RR, 0.4 [95% CI, 0.3-0.5]; greater likelihood of diabetes remission: AR, 57.5% vs 14.8%; RD, 42.7% [95% CI, 35.8%-49.7%], RR, 3.9 [95% CI, 2.8-5.4]; greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7]; and

  12. Gastroesophageal reflux disease and Barrett's esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. (United States)

    Genco, Alfredo; Soricelli, Emanuele; Casella, Giovanni; Maselli, Roberta; Castagneto-Gissey, Lidia; Di Lorenzo, Nicola; Basso, Nicola


    Morbidly obese patients are affected by gastroesophageal reflux disease (GERD) and hiatal hernia (HH) more frequently than lean patients. Because of conflicting results, the indication to sleeve gastrectomy (SG) in patients with GERD is still debated. To evaluate the incidence of GERD on the basis of clinical, endoscopic, and histologic data in patients undergoing SG. University hospital, Rome, Italy. From July 2007 to January 2010, 162 patients underwent primary SG. Preoperatively all patients underwent visual analogue scale (VAS) evaluation of GERD symptoms, proton pump inhibitors (PPIs) consumption recording, and esophagogastroduodenoscopy (EGD). Stomach resection started 6 cm from pylorus on a 48Fr bougie. Staple line was reinforced by an oversewing suture. A postoperative clinical control with VAS evaluation, PPI consumption, and EGD was proposed to all patients. Three patients were excluded because of the occurrence of major postoperative complications. A total of 110 patients accepted to take part in the study (follow-up rate: 69.1%). At a mean 58 months of follow-up, incidence of GERD symptoms, VAS mean score, and PPI intake significantly increased compared with preoperative values (68.1% versus 33.6%: Preflux was found in 73.6% and 74.5% of cases, respectively. A significant increase in the incidence and in the severity of erosive esophagitis (EE) was evidenced, whereas nondysplastic Barrett's esophagus (BE) was newly diagnosed in 19 patients (17.2%). No significant correlations were found between GERD symptoms and endoscopic findings. In the present series the incidence of EE and of BE in SG patients was considerably higher than that reported in the current literature, and it was not related to GERD symptoms. Endoscopic surveillance after SG should be advocated irrespective of the presence of GERD symptoms. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  13. Delayed Complications and Long-term Management of Sulfur Mustard Poisoning: Recent Advances by Iranian Researchers (Part І of ІІ

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    Emadodin Darchini-Maragheh


    Full Text Available Chemical warfare agents are the most brutal weapons among the weapons of mass destruction. Sulfur mustard (SM is a potent toxic alkylating agent known as “the King of the Battle Gases”. SM has been the most widely used chemical weapon during the wars. It was widely used in World War I. Thereafter, it was extensively employed by the Iraqi troops against the Iranian military personnel and even civilians in the border cities of Iran and Iraq in the period between 1983 and 1988. Long-term incapacitating properties, significant environmental persistence, lack of an effective antidote, and relative ease of manufacturing have kept SM a potential agent for both terrorist and military uses. Even 3 decades after SM exposure, numerous delayed complications among Iranian victims are still being reported by researchers. The most common delayed complications have been observed in the respiratory tracts of chemically injured Iranian war veterans. Also, skin lesions and eye disorders have been observed in most Iranian SM-exposed war veterans in the delayed phase of SM intoxication. Thus, extensive research has been conducted on Iranian war veterans during the past decades. Nevertheless, major gaps still continue to exist in the SM literature. Part І of this paper will discuss the delayed complications and manifestations of exposure to SM among Iranian victims of the Iran–Iraq conflict. Part ІІ, which will appear in the next issue of Iran J Med Sci, will discuss the long-term management and therapy of SM-exposed patients.

  14. [Long-term efficacy of laser peripheral iridotomy in preventing progression in eyes with pigment dispersion syndrome]. (United States)

    Qing, Guoping; Zhang, Shaodan; Wang, Huaizhou; Wang, Tao; Wang, Shuhua; Chen, Hong; Wang, Hua; Wang, Ningli


    To evaluate the long-term efficacy of laser peripheral iridotomy (LPI) in preventing deterioration in eyes with pigment dispersion syndrome (PDS). A cohort study. Nineteen patients with PDS were treated with LPI and followed up periodically in Beijing Tongren Eye Center from May 2006 to April 2007. One eye of each patient was chosen randomly for the study. Main investigating items included iris configuration, intraocular pressure (IOP), anterior chamber pigmentation, and visual field analysis. The average follow-up period was (6.5 ± 0.3) years. A paired sample t test was used to determine whether there is a significant difference between average values of pre- and post-LPI IOP and mean deviation of Humphrey visual field analysis in these PDS eyes. The average age of the 19 patients were (35.8 ± 7.1) years on admission. The initial IOP of the 19 eyes was (24.7 ± 2.2) mmHg (1 mmHg = 0.133 kPa) before LPI. The mean deviation (MD) of Humphrey visual field analysis (VFA) were (-1.82 ± 1.26) dB (-4.34--0.28 dB) . All 19 eyes had concave iris and heavy trabecular pigmentation. The iris became flat in all PDS eyes after the laser treatment. At the last follow-up visit, the average IOP was 14.8 ± 2.0 (12-20) mmHg, which was statistically lower than that of baseline (t = 11.49, P pigmentation reduced obviously in 16 eyes. No deterioration or new visual field defect was detected in any of the PDS eyes. MD of the last VFA was -1.79 ± 1.21 (-4.39--0.21 dB) . There was no statistical difference between MD of the last VFA and baseline (t = -0.26, P = 0.798). The long-term follow-up results showed that LPI prevents progression effectively in eyes with PDS.

  15. Preventive effect of theanine intake on stress-induced impairments of hippocamapal long-term potentiation and recognition memory. (United States)

    Tamano, Haruna; Fukura, Kotaro; Suzuki, Miki; Sakamoto, Kazuhiro; Yokogoshi, Hidehiko; Takeda, Atsushi


    Theanine, γ-glutamylethylamide, is one of the major amino acid components in green tea. On the basis of the preventive effect of theanine intake after birth on mild stress-induced attenuation of hippocamapal CA1 long-term potentiation (LTP), the present study evaluated the effect of theanine intake after weaning on stress-induced impairments of LTP and recognition memory. Young rats were fed water containing 0.3% theanine for 3 weeks after weaning and subjected to water immersion stress for 30min, which was more severe than tail suspension stress for 30s used previously. Serum corticosterone levels were lower in theanine-administered rats than in the control rats even after exposure to stress. CA1 LTP induced by a 100-Hz tetanus for 1s was inhibited in the presence of 2-amino-5-phosphonovalerate (APV), an N-methyl-d-aspartate (NMDA) receptor antagonist, in hippocampal slices from the control rats and was attenuated by water immersion stress. In contrast, CA1 LTP was not significantly inhibited in the presence of APV in hippocampal slices from theanine-administered rats and was not attenuated by the stress. Furthermore, object recognition memory was impaired in the control rats, but not in theanine-administered rats. The present study indicates the preventive effect of theanine intake after weaning on stress-induced impairments of hippocampal LTP and recognition memory. It is likely that the modification of corticosterone secretion after theanine intake is involved in the preventive effect. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Long-term effects of adolescent marijuana use prevention on adult mental health services utilization: the midwestern prevention project. (United States)

    Riggs, Nathaniel R; Pentz, Mary Ann


    Evaluated were effects of a drug abuse(1) prevention program, previously shown to prevent marijuana use in adolescence, on adulthood mental health service use. Analyses were conducted on 961 6th (41%) and 7th (59%) grade participants randomly assigned to intervention or control groups at baseline in 1984. These participants were followed-up through 2003 representing 15 waves of data collection. Eighty-five percent of participants were Caucasian and 56% were female. The hypothesis was that direct program effects on early adulthood mental health service use would be mediated by program effects on high school marijuana use trajectories. Structural equation models, imputing for missing data, demonstrated that MPP (Midwestern Prevention Project) program effects on mental health were mediated by the marijuana use growth curve intercept. Findings support the role of early adolescent drug use prevention programs in impacting later mental health problems. The study's limitations are noted.

  17. Measuring Success in Obesity Prevention: A Synthesis of Health Promotion Switzerland's Long-Term Monitoring and Evaluation Strategy

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    Günter Ackermann


    Full Text Available Aims: Since 2007, Health Promotion Switzerland has implemented a national priority program for a healthy body weight. This article provides insight into the methodological challenges and results of the program evaluation. Methods: Evaluation of the long-term program required targeted monitoring and evaluation projects addressing different outcome levels. The evaluation was carried out according to the Swiss Model for Outcome Classification (SMOC, a model designed to classify the effects of health promotion and prevention efforts. Results: The results presented in this article emphasize both content and methods. The national program successfully achieved outcomes on many different levels within complex societal structures. The evaluation system built around the SMOC enabled assessment of program progress and the development of key indicators. However, it is not possible to determine definitively to what extent the national program helped stabilize the prevalence of obesity in Switzerland. Conclusion: The model has shown its utility in providing a basis for evaluation and monitoring of the national program. Continuous analysis of data from evaluation and monitoring has made it possible to check the plausibility of suspected causal relationships as well as to establish an overall perspective and assessment of effectiveness supported by a growing body of evidence.

  18. Communication training improves sense of performance expectancy of public health nurses engaged in long-term elderly prevention care program. (United States)

    Tanabe, Motoko; Suzukamo, Yoshimi; Tsuji, Ichiro; Izumi, Sin-Ichi


    This study examines the effectiveness of a communication skill training based on a coaching theory for public health nurses (PHNs) who are engaged in Japan's long-term care prevention program. The participants in this study included 112 PHNs and 266 service users who met with these PHNs in order to create a customized care plan within one month after the PHNs' training. The participants were divided into three groups: a supervised group in which the PHNs attended the 1-day training seminar and the follow-up supervision; a seminar group attended only the 1-day training seminar; a control group. The PHNs' sense of performance expectancy, and user's satisfaction, user's spontaneous behavior were evaluated at the baseline (T1), at one month (T2), and at three months (T3) after the PHNs' training. At T3, the PHNs performed a recalled evaluation (RE) of their communication skills before the training. The PHNs' sense of performance expectancy increased significantly over time in the supervised group and the control group (F = 11.28, P < 0.001; F = 4.03, P < 0.05, resp.). The difference score between T3-RE was significantly higher in the supervised group than the control group (P < 0.01). No significant differences in the users' outcomes were found.

  19. Long-Term Improvements in Knowledge and Psychosocial Factors of a Teen Pregnancy Prevention Intervention Implemented in Group Homes. (United States)

    Green, Jennifer; Oman, Roy F; Lu, Minggen; Clements-Nolle, Kristen D


    Youth in out-of-home care have higher rates of sexual risk behaviors and pregnancy than youth nationally. This study aimed to determine if Power Through Choices (PTC), a teen pregnancy prevention program developed for youth in out-of-home care, significantly improves knowledge and psychosocial outcomes regarding HIV and sexually transmitted infections (STIs), sexual activity and contraception methods, long term. A cluster randomized controlled trial was conducted with 1,036 ethnically diverse youths (aged 13-18 years) recruited from 44 residential group homes in three states. Intervention participants received the 10-session PTC intervention; control participants received usual care. Participants were administered self-report surveys at baseline, after intervention, 6 and 12 months after the intervention. Survey items assessed knowledge, attitudes, self-efficacy, and behavioral intentions regarding HIV and STIs, sexual activity and contraception methods. Random intercept logistic regression analyses were used to assess differences between the intervention and control groups. Compared with youth in the control group, youth in the PTC intervention demonstrated significant improvements in knowledge about anatomy and fertility (adjusted odds ratio [AOR] = 1.07, 95% confidence interval [CI] = 1.03-1.11), HIV and STIs (AOR = 1.03, 95% CI = 1.002-1.07), and methods of protection (AOR = 1.06, 95% CI = 1.03-1.09), as well as self-efficacy regarding self-efficacy to communicate with a partner (AOR = 1.14, 95% CI = 1.04-1.26), plan for protected sex and avoid unprotected sex (AOR = 1.16, 95% CI = 1.04-1.28), and where to get methods of birth control (AOR = 1.13, 95% CI = 1.01-1.26) 12 months after the intervention. Findings suggest that the PTC intervention can have positive long-term knowledge and psychosocial effects regarding contraception methods on youth in out-of-home care. Copyright © 2017 Society for Adolescent Health and Medicine. Published by

  20. Use of the Impella Device for Acute Coronary Syndrome Complicated by Cardiogenic Shock - Experience From a Single Heart Center With Analysis of Long-term Mortality. (United States)

    Schroeter, Marco Robin; Köhler, Herdis; Wachter, Astrid; Bleckmann, Annalen; Hasenfuß, Gerd; Schillinger, Wolfgang


    Impella is a microaxial rotary pump that is placed across the aortic valve to expel aspirated blood from the left ventricle into the ascending aorta; it can be used in cardiogenic shock. While previous studies have evaluated the efficacy and safety of the Impella device, more clinically relevant data are necessary, especially with regard to outcomes. We screened our database of Impella patients in our heart center and found 68 consecutive patients who underwent Impella implantation due to acute coronary syndrome (ACS) complicated by cardiogenic shock. Data were evaluated with regard to baseline and procedural characteristics and also included an assessment of the short-term and long-term outcomes. The majority of patients (74%) suffered from an ST-elevation myocardial infarction, and 59% of patients received the Impella device during the initial coronary angiography. In the remaining cases, Impella implantation was performed at a later time, most commonly after IABP implantation. Patient characteristics were not significantly different between both groups. The predominantly implanted device was an Impella 2.5. Mortality in the severely ill patient population remained high, but univariate/multivariate analyses identified significant risk factors. Interestingly, delayed initiation of Impella support was an independent predictor of higher long-term mortality (hazard ratio, 2.157; P=.04) within the Impella patient cohort. This large series of patients with ACS complicated by cardiogenic shock who underwent Impella implantation provides information on the relevant risk factors for mortality. Early (compared with delayed) initiation of Impella support was a predictor of improved survival in this population of patients.

  1. Complications of minimally invasive cosmetic procedures: Prevention and management

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    Lauren L Levy


    Full Text Available Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT, soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care.

  2. School-based prevention program associated with increased short- and long-term retention of safety knowledge. (United States)

    Klas, Karla S; Vlahos, Peter G; McCully, Michael J; Piche, David R; Wang, Stewart C


    Validation of program effectiveness is essential in justifying school-based injury prevention education. Although Risk Watch (RW) targets burn, fire, and life safety, its effectiveness has not been previously evaluated in the medical literature. Between 2007 and 2012, a trained fire service public educator (FSPE) taught RW to all second grade students in one public school district. The curriculum was delivered in 30-minute segments for 9 consecutive weeks via presentations, a safety smoke house trailer, a model-sized hazard house, a student workbook, and parent letters. A written pre-test (PT) was given before RW started, a post-test (PT#1) was given immediately after RW, and a second post-test (PT#2) was administered to the same students the following school year (ranging from 12 to 13 months after PT). Students who did not complete the PT or at least one post-test were excluded. Comparisons were made by paired t-test, analysis of variance, and regression analysis. After 183 (8.7%) were excluded for missing tests, 1,926 remaining students scored significantly higher (P = .0001) on PT#1 (mean 14.8) and PT#2 (mean 14.7) than the PT (mean 12.1). There was 1 FSPE and 36 school teachers with class size ranging from 10 to 27 (mean 21.4). Class size was not predictive of test score improvement (R = 0%), while analysis of variance showed that individual teachers trended toward some influence. This 6-year prospective study demonstrated that the RW program delivered by an FSPE effectively increased short-term knowledge and long-term retention of fire/life safety in early elementary students. Collaborative partnerships are critical to preserving community injury prevention education programs.

  3. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. (United States)

    Gao, Chang; Zong, Min; Wang, Wen-Tao; Xu, Lei; Cao, Da; Zou, Yue-Fen


    Background Percutaneous kyphoplasty (PKP) is a common treatment modality for painful osteoporotic vertebral compression fractures (OVCFs). Pre- and postoperative identification of risk factors for cement leakage and follow-up complications would therefore be helpful but has not been systematically investigated. Purpose To evaluate pre- and postoperative risk factors for the occurrence of short-term cement leakages and long-term complications after PKP for OVCFs. Material and Methods A total of 283 vertebrae with PKP in 239 patients were investigated. Possible risk factors causing cement leakage and complications during follow-up periods were retrospectively assessed using multivariate analysis. Cement leakage in general, three fundamental leakage types, and complications during follow-up period were directly identified through postoperative computed tomography (CT). Results Generally, the presence of cortical disruption ( P = 0.001), large volume of cement ( P = 0.012), and low bone mineral density (BMD) ( P = 0.002) were three strong predictors for cement leakage. While the presence of intravertebral cleft and Schmorl nodes ( P = 0.045 and 0.025, respectively) were respectively identified as additional risk factors for paravertebral and intradiscal subtype of cortical (C-type) leakages. In terms of follow-up complications, occurrence of cortical leakage was a strong risk factor both for new VCFs ( P = 0.043) and for recompression ( P = 0.004). Conclusion The presence of cortical disruption, large volume of cement, and low BMD of treated level are general but strong predictors for cement leakage. The presence of intravertebral cleft and Schmorl nodes are additional risk factors for cortical leakage. During follow-up, the occurrence of C-type leakage is a strong risk factor, for both new VCFs and recompression.

  4. Physical exercise prevents short and long-term deficits on aversive and recognition memory and attenuates brain oxidative damage induced by maternal deprivation. (United States)

    Neves, Ben-Hur; Menezes, Jefferson; Souza, Mauren Assis; Mello-Carpes, Pâmela B


    It is known from previous research that physical exercise prevents long-term memory deficits induced by maternal deprivation in rats. But we could not assume similar effects of physical exercise on short-term memory, as short- and long-term memories are known to result from some different memory consolidation processes. Here we demonstrated that, in addition to long-term memory deficit, the short-term memory deficit resultant from maternal deprivation in object recognition and aversive memory tasks is also prevented by physical exercise. Additionally, one of the mechanisms by which the physical exercise influences the memory processes involves its effects attenuating the oxidative damage in the maternal deprived rats' hippocampus and prefrontal cortex.

  5. Study protocol for the Flooring for Injury Prevention (FLIP) Study: a randomised controlled trial in long-term care. (United States)

    Lachance, Chantelle C; Feldman, Fabio; Laing, Andrew C; Leung, Pet Ming; Robinovitch, Stephen N; Mackey, Dawn C


    A promising strategy for reducing the incidence and severity of fall-related injuries in long-term care (LTC) is to decrease the ground surface stiffness, and the subsequent forces applied to the body parts at impact, through installation of compliant flooring that does not substantially affect balance or mobility. Definitive evidence of the effects of compliant flooring on fall-related injuries in LTC is lacking. The Flooring for Injury Prevention (FLIP) Study is designed to address this gap. The FLIP Study is a 4-year, parallel-group, 2-arm, randomised controlled superiority trial of flooring in 150 resident rooms at a LTC site. The primary objective is to determine whether compliant flooring reduces serious fall-related injuries relative to control flooring. Intervention (2.54 cm SmartCells compliant; 74 rooms) and control (2.54 cm plywood; 76 rooms) floorings were installed over the top of existing concrete floors and covered with identical 2.00 mm vinyl. The primary outcome is serious fall-related injury, defined as any impact-related injury due to a fall in a study room that results in Emergency Department visit or hospital admission. Secondary outcomes include minor fall-related injury, any fall-related injury, falls, number of fallers, fractures, and healthcare utilisation and costs for serious fall-related injuries. Randomisation of study rooms, and residents in rooms, was stratified by residential unit, and flooring assignments were concealed. Outcome ascertainment began September 2013. Results from the FLIP Study will provide evidence about the effects of compliant flooring on fall-related injuries in LTC and will guide development of safer environments for vulnerable older adults. NCT01618786. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  6. Identifying the gaps in infection prevention and control resources for long-term care facilities in British Columbia. (United States)

    Gamage, Bruce; Schall, Valerie; Grant, Jennifer


    Infection prevention and control (IPC) is a critical, although often neglected, part of long-term care (LTC) management. Little is known about what IPC resources are available for LTC and how that impacts patient care and safety. One hundred eighty-eight LTC facilities were randomly selected out of all British Columbia facilities and surveyed using a validated survey tool. The tool was used to collect data regarding IPC resources grouped within 6 indices: (1) leadership, (2) infection control professionals (ICP) coverage, (3) policies and procedures, (4) support through partnerships, (5) surveillance, and (6) control activities. All components measured have been identified as key for an effective IPC program. Survey responses were used to calculate scores for IPC programs as a whole and for each of the 6 indices. Of 188 randomly selected facilities, 86 institutions participated. Facilities were compared by region, funding source, and ICP coverage. Overall, LTC facilities lacked IPC leadership, especially physician support. Having no dedicated ICP was associated with poorer scores on all indices. Only 41% of practicing ICPs had more than 2 years experience, and only 14% were professionally certified. Twenty-two percent of ICPs had additional roles within the institution, and 44% had additional roles outside of the institution. Thirty-five percent of institutions had no IPC dedicated budget. LTC institutions-with bed numbers exceeding those in acute care-represent an important aspect of health services. These data show that many LTC facilities lack the necessary resources to provide quality infection control programs. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  7. [Primary prevention of cardiovascular diseases: long term results of five year long preventive intervention in 12-year old boys (ten year prospective study)]. (United States)

    Rozanov, V B; Aleksandov, A A; Shugaeva, E N; Perova, N V; Maslennikova, G Ia; Smirnova, S G; Olfer'ev, A M


    In a longitudinal cohort (prevention group, n=213, comparison group, n=163) of 10-year prospective follow-up we addressed efficacy of 5-year-long multifactor preventive intervention, conducted in a sample of population of 12 year old boys. Preventive intervention was carried out both at populational level and among persons with risk factors of development of cardiovascular diseases with the use of group, individual, and partly family approaches, and was directed at rationalization of nutrition, elevation of physical activity and prevention of harmful habits. During first 3 years of prevention we succeeded to achieve stable statistically significant lowering of mean levels of total cholesterol, low density lipoprotein cholesterol, triglycerides, and atherogeneity index, as well as to affect fatty component of body mass (skinfold thickness). Long term effect of 5-year long preventive intervention manifested as significantly lower level of systolic blood pressure, lower prevalence of low levels of high density lipoprotein cholesterol, smaller increment of low density lipoprotein cholesterol and index of atherogeneity in the prevention group. These results evidence that prevention of main factors of risk of development of cardiovascular diseases (obesity, arterial hypertension, disorders of lipid composition of the blood, and low physical activity) in child and adolescent age in the period of active growth and development is feasible, effective, safe and is able to lead to decrease of levels of these factors in adults, but should last uninterruptedly until formation of stable habits of healthy life style.

  8. Long-term results and quality of life of patients undergoing sequential surgical treatment for severe acute pancreatitis complicated by infected pancreatic necrosis. (United States)

    Cinquepalmi, Lorenza; Boni, Luigi; Dionigi, Gianlorenzo; Rovera, Francesca; Diurni, Mario; Benevento, Angelo; Dionigi, Renzo


    Infected pancreatic necrosis (IPN) is one of the most severe complications of acute pancreatitis (AP). Sequential surgical debridement represents one of the most effective treatments in terms of morbidity and mortality. The aim of this paper is to describe the quality of life and long-term results (e.g., nutritional, muscular, and pancreatic function) of patients treated by sequential necrosectomy at the Department of Surgery of the University of Insubria (Varese, Italy). Data were collected on patients undergoing sequential surgical debridement as treatment for IPN. The severity of AP was evaluated using the Ranson criteria, the Acute Physiology and Chronic Health Evaluation (APACHE II) Score, and the Sepsis Score, as well as the extent of necrosis. The surgical approach was through a midline or subcostal laparotomy, followed by exploration of the peritoneal cavity, wide debridement, and peritoneal lavage. The abdomen was either left open or closed partially with a surgical zipper, with multiple re-laparotomies scheduled until debridement of necrotic tissue was complete. The long-term evaluation focused on late morbidity, performance status, and abdominal wall function. In the majority of patients (68%), mixed flora were isolated. Pseudomonas aeruginosa was the microorganism identified most commonly (59%), often associated with Candida albicans or C. glabrata. The mean total hospital stay was 71+/-38 days (range 13-146 days), of which 24+/-19 days (range 0-66 days) were in the intensive care unit. Eight patients died, the deaths being caused by multiple organ dysfunction syndrome in seven patients and hemorrhage from the splenic artery in one. Normal exocrine and endocrine pancreatic function was observed in 28 patients (88%). At discharge, four patients had steatorrhea, which was temporary. Eight patients (23%) developed pancreatic pseudocysts, and in six, cystogastostomy was performed. Most patients (29/32, 91%) developed a post-operative hernia, but only five

  9. Epigenetic Studies Point to DNA Replication/Repair Genes as a Basis for the Heritable Nature of Long Term Complications in Diabetes

    Directory of Open Access Journals (Sweden)

    Alexey A. Leontovich


    Full Text Available Metabolic memory (MM is defined as the persistence of diabetic (DM complications even after glycemic control is pharmacologically achieved. Using a zebrafish diabetic model that induces a MM state, we previously reported that, in this model, tissue dysfunction was of a heritable nature based on cell proliferation studies in limb tissue and this correlated with epigenetic DNA methylation changes that paralleled alterations in gene expression. In the current study, control, DM, and MM excised fin tissues were further analyzed by MeDIP sequencing and microarray techniques. Bioinformatics analysis of the data found that genes of the DNA replication/DNA metabolism process group (with upregulation of the apex1, mcm2, mcm4, orc3, lig1, and dnmt1 genes were altered in the DM state and these molecular changes continued into MM. Interestingly, DNA methylation changes could be found as far as 6–13 kb upstream of the transcription start site for these genes suggesting potential higher levels of epigenetic control. In conclusion, DNA methylation changes in members of the DNA replication/repair process group best explain the heritable nature of cell proliferation impairment found in the zebrafish DM/MM model. These results are consistent with human diabetic epigenetic studies and provide one explanation for the persistence of long term tissue complications as seen in diabetes.

  10. [Gastroplasty: complications and their prevention]. (United States)

    Schlienger, J L; Meyer, L; Rohr, S; Pradignac, A; Perrin, A E; Meyer, C; Simon, C


    Bariatric surgery is now frequently proposed for the treatment of morbid or complicated obesity since the introduction of minimally invasive laparoscopic anti-obesity operations such as the adjustable silicone gastric binding gastroplasty. However this reversible procedure in not always as safe as presumed and the results in weight loss may be sometimes disappointing. Side effects are common and early or late complications occured in more than 20% out of the patients. They are favoured by post operative eating disorders. Nutritional consequences are probably underestimated and are not limited to uncomfortable digestive symptoms. Some deficiencies in micronutriments have been described. The worsening of previous eating disorders or psychosocial abnormalities are not seldom. Gastroplasty is not an harmless procedure. A good selection in patients, a regular follow up, nutritional advices and psychosocial management by a multidisciplinar team are required to reduce complications after gastroplasty.

  11. The Long-Term Effectiveness of a Selective, Personality-Targeted Prevention Program in Reducing Alcohol Use and Related Harms: A Cluster Randomized Controlled Trial (United States)

    Newton, Nicola C.; Conrod, Patricia J.; Slade, Tim; Carragher, Natacha; Champion, Katrina E.; Barrett, Emma L.; Kelly, Erin V.; Nair, Natasha K.; Stapinski, Lexine; Teesson, Maree


    Background: This study investigated the long-term effectiveness of Preventure, a selective personality-targeted prevention program, in reducing the uptake of alcohol, harmful use of alcohol, and alcohol-related harms over a 3-year period. Methods: A cluster randomized controlled trial was conducted to assess the effectiveness of Preventure.…

  12. Preventive Intervention for Preschoolers at High Risk for Antisocial Behavior: Long-Term Effects on Child Physical Aggression and Parenting Practices (United States)

    Brotman, Laurie Miller; Gouley, Kathleen Kiely; Huang, Keng-Yen; Rosenfelt, Amanda; O'Neal, Colleen; Klein, Rachel G.; Shrout, Patrick


    This article presents long-term effects of a preventive intervention for young children at high risk for antisocial behavior. Ninety-two children (M age = 4 years) were randomly assigned to an 8-month family intervention or no-intervention control condition and assessed 4 times over a 24-month period. Intent-to-treat analyses revealed significant…

  13. Centering Single Cells in Microgels via Delayed Crosslinking Supports Long-Term 3D Culture by Preventing Cell Escape

    NARCIS (Netherlands)

    Kamperman, Tom; Henke, Sieger; Visser, Claas Willem; Karperien, Marcel; Leijten, Jeroen


    Single-cell-laden microgels support physiological 3D culture conditions while enabling straightforward handling and high-resolution readouts of individual cells. However, their widespread adoption for long-term cultures is limited by cell escape. In this work, it is demonstrated that cell escape is

  14. [Cost-effectiveness research in elderly residents in long-term care: prevention is better than cure, but not always cheaper]. (United States)

    Achterberg, Wilco P; Gussekloo, Jacobijn; van den Hout, Wilbert B


    Cost-effectiveness research in elderly residents in long-term care facilities is based on general principals of cost-effectiveness research; these have been developed primarily from the perspective of relatively healthy adults in curative medicine. These principals are, however, inadequate when evaluating interventions for the fragile elderly in long-term care, both in terms of the value attached to the health of patients and to the specific decision-making context of the institution. Here we discuss the pitfalls of cost-effectiveness research in long-term care facilities, illustrated by two prevention interventions for prevalent conditions in nursing homes: pressure ulcers and urinary tract infections. These turned out to be effective, but not cost-effective.

  15. Long-term prisoner in prison isolation

    Directory of Open Access Journals (Sweden)

    Karolina Grudzińska


    Full Text Available Long-term prisoner belongs to a particular category of people who are imprisoned in prisons. On the one hand in this group are often heavily demoralized people who committed the most serious crimes, on the other hand it is a group of prisoners, who should be well thought out and programmed the impact of rehabilitation. The situation of man trapped for years poses in a complicated situation not only the prisoners, but also the entire prison staff. They have to take care of the fact that the prison isolation did not cause the state in which convicts form itself in learned helplessness and lack of skills for self-planning and decision-making. In addition, planning the rehabilitation impact of long-term prisoners should not be forgotten that these prisoners in the short or the long term will return to the libertarian environment therefore, should prevent any negative effects of long-term imprisonment. This article presents the main issues related to the execution of imprisonment against long-term prisoners. It is an attempt to systematize the knowledge of this category of people living in prison isolation.

  16. Current prevention and control of health care-associated infections in long-term care facilities for the elderly in Japan. (United States)

    Kariya, Naoko; Sakon, Naomi; Komano, Jun; Tomono, Kazunori; Iso, Hiroyasu


    Residents of long-term care facilities for the elderly are vulnerable to health care-associated infections. However, compared to medical institutions, long-term care facilities for the elderly lag behind in health care-associated infection control and prevention. We conducted a epidemiologic study to clarify the current status of infection control in long-term care facilities for the elderly in Japan. A questionnaire survey on the aspects of infection prevention and control was developed according to SHEA/APIC guidelines and was distributed to 617 long-term care facilities for the elderly in the province of Osaka during November 2016 and January 2017. The response rate was 16.9%. The incidence rates of health care-associated infection outbreaks and residents with health care-associated infections were 23.4 per 100 facility-years and 0.18 per 1,000 resident-days, respectively. Influenza and acute gastroenteritis were reported most frequently. Active surveillance to identify the carrier of multiple drug-resistant organisms was not common. The overall compliance with 21 items selected from the SHEA/APIC guidelines was approximately 79.2%. All facilities had infection control manuals and an assigned infection control professional. The economic burdens of infection control were approximately US$ 182.6 per resident-year during fiscal year 2015. Importantly, these data implied that physicians and nurses were actively contributed to higher SHEA/APIC guideline compliance rates and the advancement of infection control measures in long-term care facilities for the elderly. Key factors are discussed to further improve the infection control in long-term care facilities for the elderly, particularly from economic and social structural standpoints. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  17. Long-term fecal diverting device for the prevention of sepsis in case of colorectal anastomotic leakage: an animal experiment. (United States)

    Kim, Jae Hwang; Jung, Sang Hun; Kim, Yong-Jin; Park, Se-Ll; Kim, Dae-Hwan


    A new fecal diverting device (FDD) was fabricated for fecal diversion from the proximal colon above the anastomosis to outside the anus for protecting the rectal anastomosis. The aim of the study is to evaluate the safety and effectiveness of the FDD. After a pilot study, a prospective observational trial was performed in 34 mongrel dogs. The experiment comprised of segmental resection and anastomosis of the colon, fixation of the FDD, and observation for 3 weeks (n = 15) and more than 3 weeks (n = 19) without initiation of parenteral nutrition. Four cases of perioperative death unrelated to the FDD were excluded. Twenty-six (87 %) of the 30 dogs survived. Sixteen (53 %) dogs were able to retain the FDD for more than 3 weeks until 82 days. The autopsy findings revealed that four (15 %) dogs showed colonic wall erosions and mucosal scarring respectively at the band fixation area without evidence of serious septic complications. The surviving dogs retained the FDD for more than 6 days. Mortality occurred in four of the five dogs that expelled the FDD within three postoperative days. A closed abscess cavity as the evidence of anastomotic leakage was noted in seven (23 %) of the surviving dogs. The newly designed fecal diverting device can be retained for more than 3 weeks until 82 days without any serious complications. The FDD may prevent sepsis in case of anastomotic leakage if it is retained for more than 6 days.

  18. Air pollution and blood lipid markers levels: Estimating short and long-term effects on elderly hypertension inpatients complicated with or without type 2 diabetes. (United States)

    Xiao, Sanhua; Liu, Ranran; Wei, Youxiu; Feng, Lin; Lv, Xuemin; Tang, Fei


    With the development of society and the economy, many Chinese cities are shrouded in pollution haze for much of the year. Scientific studies have identified various adverse effects of air pollutants on human beings. However, the relationships between air pollution and blood lipid levels are still unclear. The objective of this study is to explore the short and long-term effects of air pollution on eight blood lipid markers among elderly hypertension inpatients complicated with or without type 2 diabetes (T2D). Blood lipid markers which met the pre-established inclusion criteria were exported from the medical record system. Air pollution data were acquired from the official environmental protection website. Associations between the air quality index and the blood lipid indexes were analyzed by one-way ANOVA and further Bonferroni correction. In an exposure time of 7 days or longer, blood lipid markers were somewhat affected by poor air quality. However, the results could not predict whether atherosclerosis would be promoted or inhibited by poorer air condition. Changes of blood lipid markers of hypertension inpatients with or without T2D were not completely the same, but no blood lipid markers had an opposite trend between the two populations. The air quality index was associated with changes to blood lipid markers to some extent in a population of hypertension inpatients with or without T2D. Further studies are needed to investigate the potential mechanism by which air pollutants induce blood lipids changes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Long-term visual acuity, retention and complications observed with the type-I and type-II Boston keratoprostheses in an Irish population. (United States)

    Duignan, E S; Ní Dhubhghaill, S; Malone, C; Power, W


    To evaluate the outcomes of the type-I and type-II Boston keratoprostheses in a single Irish centre. A retrospective chart review of keratoprosthesis implantations carried out in our institution from November 2002 to March 2014 was performed. All procedures were performed by a single surgeon (WP). Thirty-four keratoprosthesis implantations were carried out in 31 patients with a mean follow-up of 42±31 months (range 2-110 months). Seventeen patients were female (54.8%) and 14 were male (45.2%). The majority of keratoprostheses implanted were type-I (31/34, 91.2%), and three were type-II (3/34, 8.8%). Twenty-nine patients (85.3%) had an improvement in distance best-corrected visual acuity (BCVA) from baseline. Fifty per cent (17/34) of patients had a best-ever BCVA of at least 6/12. Eighteen patients (64.3%) retained a BCVA of at least 6/60 at 1 year. Over the course of follow-up, six keratoprostheses were explanted from six eyes of five patients, one of which was a type-II keratoprosthesis. Twenty-six patients (76.5%) developed postoperative complications. Complications included retroprosthetic membrane (18 patients, 52.9%), an exacerbation or new diagnosis of glaucoma (6 patients, 17.6%), endophthalmitis (5 patients, 14.7%) and retinal detachment (2 patients, 5.9%). These data demonstrate excellent visual acuity and retention outcomes in a cohort with a long follow-up period in a single centre. Complications remain a considerable source of morbidity. These outcomes provide further evidence for the long-term stability of type-I and type-II Boston keratoprostheses in the management of patients in whom a traditional graft is likely to fail. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  20. Evidence of glucuronidation of the glycation product LW-1: tentative structure and implications for the long-term complications of diabetes. (United States)

    Sell, David R; Nemet, Ina; Liang, Zhili; Monnier, Vincent M


    LW-1 is a collagen-linked blue fluorophore whose skin levels increase with age, diabetes and end-stage renal disease (ESRD), and correlate with the long-term progression of microvascular disease and indices of subclinical cardiovascular disease in type 1 diabetes. The chemical structure of LW-1 is still elusive, but earlier NMR analyses showed it has a lysine residue in an aromatic ring coupled to a sugar molecule reminiscent of advanced glycation end-products (AGEs). We hypothesized and demonstrate here that the unknown sugar is a N-linked glucuronic acid. LW-1 was extracted and highly purified from ~99 g insoluble skin collagen obtained at autopsy from patients with diabetes/ESRD using multiple rounds of proteolytic digestion and purification by liquid chromatography (LC). Advanced NMR techniques ( 1 H-NMR, 13 C-NMR, 1 H- 13 C HSQC, 1 H- 1 H TOCSY, 1 H- 13 C HMBC) together with LC-mass spectrometry (MS) revealed a loss of 176 amu (atomic mass unit) unequivocally point to the presence of a glucuronic acid moiety in LW-1. To confirm this data, LW-1 was incubated with β-glycosidases (glucosidase, galactosidase, glucuronidase) and products were analyzed by LC-MS. Only glucuronidase could cleave the sugar from the parent molecule. These results establish LW-1 as a glucuronide, now named glucuronidine, and for the first time raise the possible existence of a "glucuronidation pathway of diabetic complications". Future research is needed to rigorously probe this concept and elucidate the molecular origin and biological source of a circulating glucuronidine aglycone.

  1. Variations in status of preparation of personal protective equipment for preventing norovirus gastroenteritis in long-term care facilities for the elderly. (United States)

    Fujiki, Saori; Ishizaki, Tatsuro; Nakayama, Takeo


    Residents of long-term care facilities are highly susceptible to norovirus gastroenteritis, and each facility is concerned about the need to implement norovirus infection control. Among control measures, personal protective equipment (PPE), such as disposable gloves and masks, plays a major role in reducing infectious spread. However, the preparation status of PPE in facilities before infection outbreaks has not been reported. The aim was to clarify the implementation status of preventive measures for norovirus gastroenteritis and the cost of preparing the necessary PPE in long-term care facilities. A questionnaire survey of facilities affiliated with the Kyoto Prefecture and Osaka Prefecture branches of the Japan Association of Geriatric Health Services Facilities was conducted. The survey items were the characteristics of the facility, whether preventive measures had been implemented for norovirus gastroenteritis from October through the following March in both 2009 and 2010, and the quantities and unit prices of PPE prepared for preventive measures. Twenty-six (11.2%) of 232 surveyed facilities (as of August 2011) answered the survey. Among them, 24 (92.3%) in 2009 and 25 (96.2%) in 2010 reported having implemented preventive measures for norovirus gastroenteritis, while 21 facilities (80.8%) in 2009 and 22 facilities (84.6%) in 2010 had prepared PPE. The median total cost for preparing the PPE needed for the preventive measures was US $2601 (range US $221-9192) in 2009 and US $3904 (range US $305-6427) in 2010. Although the results need careful interpretation because of the low response rate, most of the surveyed long-term care facilities had implemented preventive measures for norovirus gastroenteritis. However, the cost of preparing the PPE needed for the preventive measures varied among the facilities. © 2017 John Wiley & Sons, Ltd.

  2. Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials. (United States)

    Ahmed, Haroon; Davies, Freya; Francis, Nick; Farewell, Daniel; Butler, Christoper; Paranjothy, Shantini


    To address clinical uncertainties about the effectiveness and safety of long-term antibiotic therapy for preventing recurrent urinary tract infections (UTIs) in older adults. Systematic review andmeta-analysis of randomised trials. We searched Medline, Embase, The Cumulative Index to Nursing and Allied Health Literature( CINAHL), and the Cochrane Register of Controlled Trials from inception to August 2016. Eligible studies compared long-term antibiotic therapy with non-antibiotic therapy or placebo in men or women aged over 65, or in postmenopausal women, with recurrent UTIs. We did not identify any studies that included older men. Three randomised controlled trials compared long-term antibiotics with vaginal oestrogens (n=150), oral lactobacilli (n=238) and D-mannose powder (n=94) in postmenopausal women. Long-term antibiotics reduced the risk of UTI recurrence by 24% (three trials, n=482; pooled risk ratio (RR) 0.76; 95% CI 0.61 to 0.95, number needed to treat=8.5). There was no statistically significant increase in risk of adverse events (mild adverse events: pooled RR 1.52; 95% CI 0.76 to 3.03; serious adverse events: pooled RR 0.90, 95% CI 0.31 to 2.66). One trial showed 90% of urinary and faecal Escherichia coli isolates were resistant to trimethoprim-sulfamethoxazole after 1 month of prophylaxis. Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance. © 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.

  3. Sucrose and naltrexone prevent increased pain sensitivity and impaired long-term memory induced by repetitive neonatal noxious stimulation: Role of BDNF and β-endorphin. (United States)

    Nuseir, Khawla Q; Alzoubi, Karem H; Alhusban, Ahmed; Bawaane, Areej; Al-Azzani, Mohammed; Khabour, Omar F


    Pain in neonates is associated with short and long-term adverse outcomes. Data demonstrated that long-term consequences of untreated pain are linked to the plasticity of the neonate's brain. Sucrose is effective and safe for reducing painful procedures from single events. However, the mechanism of sucrose-induced analgesia is not fully understood. The role of the opioid system in this analgesia using the opioid receptor antagonist Naltrexone was investigated, plus the long-term effects on learning and memory formation during adulthood. Pain was induced in rat pups via needle pricks of the paws. Sucrose solution and/or naltrexone were administered before the pricks. All treatments started on day one of birth and continued for two weeks. At the end of 8weeks, behavioral studies were conducted to test spatial learning and memory using radial arm water maze (RAWM), and pain threshold via foot-withdrawal response to a hot plate. The hippocampus was dissected; levels of brain derived neurotrophic factor (BDNF) and endorphins were assessed using ELISA. Acute repetitive neonatal pain increased pain sensitivity later in life, while naltrexone with sucrose decreased pain sensitivity. Naltrexone and/or sucrose prevented neonatal pain induced impairment of long-term memory, while neonatal pain decreased levels of BDNF in the hippocampus; this decrease was averted by sucrose and naltrexone. Sucrose with naltrexone significantly increased β-endorphin levels in noxiously stimulated rats. In conclusion, naltrexone and sucrose can reverse increased pain sensitivity and impaired long-term memory induced by acute repetitive neonatal pain probably by normalizing BDNF expression and increasing β-endorphin levels. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Long-term outcome of patients treated with prophylactic nesiritide for the prevention of acute kidney injury following cardiovascular surgery. (United States)

    Lingegowda, Vijaykumar; Van, Quoc C; Shimada, Michiko; Beaver, Thomas M; Dass, Bhagwan; Sood, Puneet; Ejaz, A Ahsan


    Previously, we reported that the prophylactic use of nesiritide did not reduce the incidence of dialysis or death following cardiovascular (CV) surgery despite reducing the incidence of acute kidney injury (AKI) in the immediate postoperative period. Therefore, we investigated whether the observed renal benefits of nesiritide had any long-term impact on cumulative patient survival and renal outcomes. Participants of the Nesiritide Study, a previously reported prospective, double-blind, placebo-controlled, randomized clinical trial investigating the effect of nesiritide on the incidence of dialysis or death at 21 days in adult patients undergoing high-risk CV surgery, were included in the study. Data of the participants' most recent health and renal function status were obtained using institutional review board-approved patient questionnaires, medical records, and the database of the Social Security Administration. Data on all 94 patients from the Nesiritide Study were obtained. The mean follow-up period was 20.8 +/- 10.4 months. No differences in cumulative survival between the groups were noted at follow-up (nesiritide 77.7% vs placebo 81.6%, P = 0.798). Patients with in-hospital incidence of AKI had a higher rate of mortality than those with no AKI (AKI 41.4% vs no AKI 10.7%, P = 0.002). However, differences in survival time were not significant between the groups when the analysis was restricted to patients with AKI (nesiritide 16.8 +/- 4 months vs placebo 18.5 +/- 2.3 months, P = 0.729). Renoprotection provided by nesiritide in the immediate postoperative period was not associated with improved long-term survival in patients undergoing high-risk CV surgery. Copyright 2010 Wiley Periodicals, Inc.


    Directory of Open Access Journals (Sweden)

    V. P. Pavlov


    a result of appropriate techniques of arthrodesis fixation. Positive long-term results (according to AOFAS questionnaire in 2.3 years after the operation were recorded in 97.8% of cases.

  6. Associations of rs3918242 and rs2285053 MMP-9 and MMP-2 polymorphisms with the risk, severity, and short- and long-term complications of degenerative mitral valve diseases: a 4.8-year prospective cohort study. (United States)

    Balistreri, Carmela Rita; Allegra, Alberto; Crapanzano, Floriana; Pisano, Calogera; Triolo, Oreste Fabio; Argano, Vincenzo; Candore, Giuseppina; Lio, Domenico; Ruvolo, Giovanni


    Degenerative forms of mitral valve diseases (MVDs) are very complex pathologies. Thus, it is difficult to make generalizations about the disease pathways or genetic risk factors contributing to these diseases. However, a key role of metalloproteinases (MMPs) in their pathophysiology is emerging. Thus, we performed for the first time a perspective study to assess eventual associations of some functional single nucleotide polymorphisms (SNPs) in MMP-2 and MMP-9 genes with the MVD risk, symptom severity, and short- and long-term (4.8 years) complications. For this purpose, 90 patients and two control groups were genotyped for rs3918242, rs243865, and rs2285053 MMP-2 and MMP-9 gene SNPs, and systemic levels of pro-atrial natriuretic peptide (pro-ANP) and two enzymes were quantified and correlated to genotypes of MMP-2 and MMP-9 SNPs studied. In addition, associations between these SNPs and symptom severity and short- and long-term (4.8 years) complications were evaluated. Interestingly, rs3918242 MMP-9 and rs2285053 MMP-2 SNPs were significantly represented in cases than two control groups and were associated with a higher MVD risk, as demonstrated using dominant/recessive models. Cases stratified for NYHA symptoms and particularly those NYHA III+IV with rs3918242 CT+TT MMP-9 and rs2285053CT+TT genotypes also showed higher severity related to significant higher systemic levels of MMP enzymes and pro-ANP at enrolment and 4.8 follow-up times. In addition, cases with these genotypes and particularly those NYHA III+IV had a very significant percentage of complications, particularly at the 4.8 follow-up. Surprisingly, 20% of patient controls developed MVD at 4.8-year follow-up and were carriers of these genotypes. Thus, the associations observed seem to suggest that the two SNPs might represent useful biomarkers and targets for preventing and monitoring MVDs and developing personalized treatments, consenting a more appropriate management and outcome. Copyright © 2016

  7. Pre-hospital thrombolytic therapy with either alteplase or streptokinase. : Practical applications, complications and long-term results in 529 patients.

    NARCIS (Netherlands)

    E.W.M. Grijseels (Els); M.J.M. Bouten; J.W. Deckers (Jaap); A.W. Hoes (Arno); J.A.M. Hartman; E. van der Does (Emiel); M.L. Simoons (Maarten); T. Lenderink (Timo)


    markdownabstractOBJECTIVE: To assess the practical application, safety and long-term outcome of pre-hospital thrombolytic intervention with either alteplase or streptokinase in patients with extensive myocardial infarction. DESIGN: Prospective study. SUBJECTS: Patients with chest pain of more

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

    NARCIS (Netherlands)

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


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

  9. Long term effects of prenatal X ray on human females: early fertility and frequency of operations to prevent pregnancy

    International Nuclear Information System (INIS)

    Meyer, M.B.; Tonascia, J.A.


    The subject of this paper is a long-term epidemiological study of human females who were exposed to radiation from maternal diagnostic x-ray procedures when they were in utero, compared with matched, unexposed controls. The study was designed to investigate possible effects of in-utero exposure, with particular interest being paid to reproductive capacity. In the human female and other mammals, because all mitotic divisions of germ cells occur during fetal life, the female baby is born with a finite supply of oocytes and future eggs. This supply is continuously depleted throughout life by ovulation and by cell degeneration, and there is no way for damaged or lost cells to be replaced. Experimental studies in a number of species have shown that female germ cells are extremely sensitive to radiation damage at two times during development. In humans the first of these probably occurs at around 4 to 5 months of gestation, and the second probably occurs around the time of birth. Radiation damage at these sensitive stages might show up at puberty ad during reproductive life, and might be detected by a well-designed study

  10. Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae in long-term acute-care hospitals. (United States)

    Hayden, Mary K; Lin, Michael Y; Lolans, Karen; Weiner, Shayna; Blom, Donald; Moore, Nicholas M; Fogg, Louis; Henry, David; Lyles, Rosie; Thurlow, Caroline; Sikka, Monica; Hines, David; Weinstein, Robert A


    Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (hereafter "KPC") are an increasing threat to healthcare institutions. Long-term acute-care hospitals (LTACHs) have especially high prevalence of KPC. Using a stepped-wedge design, we tested whether a bundled intervention (screening patients for KPC rectal colonization upon admission and every other week; contact isolation and geographic separation of KPC-positive patients in ward cohorts or single rooms; bathing all patients daily with chlorhexidine gluconate; and healthcare-worker education and adherence monitoring) would reduce colonization and infection due to KPC in 4 LTACHs with high endemic KPC prevalence. The study was conducted between 1 February 2010 and 30 June 2013; 3894 patients were enrolled during the preintervention period (lasting from 16 to 29 months), and 2951 patients were enrolled during the intervention period (lasting from 12 to 19 months). KPC colonization prevalence was stable during preintervention (average, 45.8%; 95% confidence interval [CI], 42.1%-49.5%), declined early during intervention, then reached a plateau (34.3%; 95% CI, 32.4%-36.2%; Pinfection, all-cause bacteremia, and blood culture contamination in a high-risk LTACH population. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail:

  11. HIV/AIDS status disclosure increases support, behavioural change and, HIV prevention in the long term: a case for an Urban Clinic, Kampala, Uganda. (United States)

    Atuyambe, Lynn Muhimbuura; Ssegujja, Eric; Ssali, Sarah; Tumwine, Christopher; Nekesa, Nicolate; Nannungi, Annette; Ryan, Gery; Wagner, Glenn


    Disclosure of HIV status supports risk reduction and facilitates access to prevention and care services, but can be inhibited by the fear of negative repercussions. We explored the short and long-term outcomes of disclosure among clients attending an urban HIV clinic in Uganda. Qualitative semi-structured interviews were administered to a purposeful sample of 40 adult HIV clients that was stratified by gender. The information elicited included their lived experiences and outcomes of disclosure in the short and long term. A text data management software (ATLAS.ti) was used for data analysis. Codes were exported to MS Excel and pivot tables, and code counts made to generate statistical data. Of the 134 short-term responses elicited during the interview regarding disclosure events, most responses were supportive including encouragement, advice and support regarding HIV care and treatment. The results show on-disclosing to spouse, there was more trust, and use of condoms for HIV prevention. Only one third were negative responses, like emotional shock and feeling of distress. The negative reactions to the spouses included rejection, shock and distress in the short term. Even then, none of these events led to drastic change such as divorce. Other responses reflected HIV prevention and call for behavioural change and advice to change sexual behaviour, recipient seeking HIV testing or care. Women reported more responses of encouragement compared to men. Men reported more preventive behaviour compared to women. Of the 137 long-term outcomes elicited during disclosure, three quarters were positive followed by behavioral change and prevention, and then negative responses. Men reported increased care and support when they disclosed to fellow men compared to when women disclosed to women. There was better or not change in relationship when women disclosed to women than when women disclosed to men. There is overwhelming support to individuals that disclose their HIV status

  12. Stroke Care 1 Medical treatment in acute and long-term secondary prevention after transient ischaemic attack and ischaemic stroke

    NARCIS (Netherlands)

    Rothwell, Peter M.; Algra, Ale; Amarenco, Pierre


    Stroke is a major cause of death and disability worldwide. Without improvements in prevention, the burden will increase during the next 20 years because of the ageing population, especially in developing countries. Major advances have occurred in secondary prevention during the past three decades,

  13. Long-term effect of intensive prevention on dental health of primary school children by socioeconomic status. (United States)

    Winter, Julia; Jablonski-Momeni, Anahita; Ladda, Annett; Pieper, Klaus


    Children in a German region took part in regular toothbrushing with fluoride gel during their time in primary school after having received a preventive program in kindergarten. The study aimed at determining the dental health of the students as a function of prevention in kindergarten and at school while taking into account their socioeconomic status and other confounders. The subjects were in six groups: groups 1 and 2, intensive prevention in kindergarten with and without fluoride gel at school; groups 3 and 4, basic prevention in kindergarten with and without fluoride gel at school; groups 5 and 6, no organized prevention in kindergarten with and without fluoride gel at school. Two dental examinations were performed for assessing caries experience and calculating caries increment from second grade (7-year-olds) to fourth grade (9-year-olds). A standardized questionnaire was used to record independent variables. To compare caries scores and preventive measures of various subgroups, non-parametric tests and a binary logistic regression analysis were performed. A significant difference was found in the mean decayed, missing, and filled tooth/teeth (DMFT) depending on socioeconomic status (no prevention in kindergarten, fluoride gel at school in children with low SES: DMFT = 0.47 vs. DMFT = 0.18 in children with high SES; p = 0.023). Class-specific differences were no longer visible among children who had taken part in an intensive preventive program combining daily supervised toothbrushing in kindergarten and application of fluoride gel in school. Early prevention, focusing on professionally supported training of toothbrushing in kindergarten and at school, has a positive effect on dental health and is able to reduce class-specific differences in caries distribution. Early training of toothbrushing and fissure sealing of first permanent molars are the most important factors for the dental health of primary school children.

  14. Physician visits and preventive care among Asian American and Pacific Islander long-term survivors of colorectal cancer, USA, 1996-2006. (United States)

    Steele, C Brooke; Townsend, Julie S; Tai, Eric; Thomas, Cheryll C


    Published literature on receipt of preventive healthcare services among Asian American and Pacific Islander (API) cancer survivors is scarce. We describe patterns in receipt of preventive services among API long-term colorectal cancer (CRC) survivors. Surveillance, Epidemiology, and End Results registry-Medicare data were used to identify 9,737 API and white patients who were diagnosed with CRC during 1996-2000 and who survived 5 or more years beyond their diagnoses. We examined receipt of vaccines, mammography (females), bone densitometry (females), and cholesterol screening among the survivors and how the physician specialties they visited for follow-up care correlated to services received. APIs were less likely than whites to receive mammography (52.0 vs. 69.3 %, respectively; P Women who visited both PCPs and oncologists compared with PCPs only were more likely to receive mammography (odds ratio = 1.40; 95 % confidence interval, 1.05-1.86). Visits to both PCPs and oncologists were associated with increased use of mammography. Although API survivors visited these specialties more frequently than white survivors, API women may need culturally appropriate outreach to increase their use of this test. Long-term cancer survivors need to be aware of recommended preventive healthcare services, as well as who will manage their primary care and cancer surveillance follow-up.

  15. Long-term analysis of health status and preventive behavior in music students across an entire university program. (United States)

    Spahn, Claudia; Nusseck, Manfred; Zander, Mark


    The aim of this investigation was to analyze longitudinal data concerning physical and psychological health, playing-related problems, and preventive behavior among music students across their complete 4- to 5-year study period. In a longitudinal, observational study, we followed students during their university training and measured their psychological and physical health status and preventive behavior using standardized questionnaires at four different times. The data were in accordance with previous findings. They demonstrated three groups of health characteristics observed in beginners of music study: healthy students (cluster 1), students with preclinical symptoms (cluster 2), and students who are clinically symptomatic (cluster 3). In total, 64% of all students remained in the same cluster group during their whole university training. About 10% of the students showed considerable health problems and belonged to the third cluster group. The three clusters of health characteristics found in this longitudinal study with music students necessitate that prevention programs for musicians must be adapted to the target audience.

  16. Prevention of Vascular Dysfunction after Preeclampsia: A Potential Long-Term Outcome Measure and an Emerging Goal for Treatment

    Directory of Open Access Journals (Sweden)

    Merzaka Lazdam


    Full Text Available Preeclampsia is increasingly being recognised as more than an isolated disease of pregnancy. In particular, preeclampsia has emerged as an independent risk factor for maternal cardiovascular disease and has recently been recognised as a risk factor for cardiovascular disease in children exposed in utero. Preeclampsia and cardiovascular disease may share important pathophysiological and molecular mechanisms and further investigation into these is likely to offer insight into the origins of both conditions. This paper considers the links between cardiovascular disease and preeclampsia and the implication of these findings for refinement of the management of patients whose care is complicated by preeclampsia.

  17. Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial. (United States)

    Cuzick, Jack; Sestak, Ivana; Cawthorn, Simon; Hamed, Hisham; Holli, Kaija; Howell, Anthony; Forbes, John F


    Four previously published randomised clinical trials have shown that tamoxifen can reduce the risk of breast cancer in healthy women at increased risk of breast cancer in the first 10 years of follow-up. We report the long-term follow-up of the IBIS-I trial, in which the participants and investigators remain largely masked to treatment allocation. In the IBIS-I randomised controlled trial, premenopausal and postmenopausal women 35-70 years of age deemed to be at an increased risk of developing breast cancer were randomly assigned (1:1) to receive oral tamoxifen 20 mg daily or matching placebo for 5 years. Patients were randomly assigned to the two treatment groups by telephone or fax according to a block randomisation schedule (permuted block sizes of six or ten). Patients and investigators were masked to treatment assignment by use of central randomisation and coded drug supply. The primary endpoint was the occurrence of breast cancer (invasive breast cancer and ductal carcinoma in situ), analysed by intention to treat. Cox proportional hazard models were used to assess breast cancer occurrence and mortality. The trial is closed to recruitment and active treatment is completed, but long-term follow-up is ongoing. This trial is registered with, number ISRCTN91879928. Between April 14, 1992, and March 30, 2001, 7154 eligible women recruited from genetics clinics and breast care clinics in eight countries were enrolled into the IBIS-I trial and were randomly allocated to the two treatment groups: 3579 to tamoxifen and 3575 to placebo. After a median follow up of 16.0 years (IQR 14.1-17.6), 601 breast cancers have been reported (251 [7.0%] in 3579 patients in the tamoxifen group vs 350 [9.8%] in 3575 women in the placebo group; hazard ratio [HR] 0.71 [95% CI 0.60-0.83], pbreast cancer was similar between years 0-10 (226 [6.3%] in 3575 women in the placebo group vs 163 [4.6%] in 3579 women in the tamoxifen group; hazard ratio [HR] 0.72 [95% CI 0

  18. Prevention of the Musculoskeletal Complications of Hemophilia

    Directory of Open Access Journals (Sweden)

    E. C. Rodriguez-Merchan


    Full Text Available Hemophilia is an inherited disorder of clotting factor deficiencies resulting in musculoskeletal bleeding, including hemarthroses, leading to musculoskeletal complications. The articular problems of hemophiliac patients begin in infancy. These include: recurrent hemarthroses, chronic synovitis, flexion deformities, hypertrophy of the growth epiphyses, damage to the articular cartilage, and hemophilic arthropathy. The most commonly affected joints are the ankle, the knee, and the elbow. Hematologic prophylactic treatment from ages 2 to 18 years could avoid the development of hemophilic arthropathy if the concentration of the patient's deficient factor is prevented from falling below 1% of normal. Hemarthroses can be prevented by the administration of clotting factor concentrates (prophylaxis. However, high costs and the need for venous access devices in younger children continue to complicate recommendations for universal prophylaxis. Prevention of joint arthropathy needs to focus on prevention of hemarthroses through prophylaxis, identifying early joint disease through the optimal use of cost-effective imaging modalities and the validation of serological markers of joint arthropathy. Screening for effects on bone health and optimal management of pain to improve quality of life are, likewise, important issues. Major hemarthrosis and chronic hemophilic synovitis should be treated aggressively to prevent hemophilic arthropathy.

  19. Tube shunt complications and their prevention. (United States)

    Sarkisian, Steven R


    Glaucoma drainage devices (GDDs) have been generally accepted as a treatment of refractory glaucoma. GDDs have their own unique set of complications that are important to evaluate to prevent them. Tube shunts are typically used in eyes with refractory glaucoma. There is increased interest in studying the efficacy of GDDs. Most of the attention has been focused on comparing trabeculectomy with the Baerveldt implant (Advanced Medical Optics, Inc., Santa Anna, California, USA). The other leading implant is the Ahmed Glaucoma Valve. There are several retrospective studies comparing these two devices and a prospective study is ongoing. There is great interest in the complication rate of tube shunts and these have been published both retrospectively and prospectively. Complications such as hypotony, diplopia, strabismus, proptosis, tube erosion, failure, corneal decompensation, endophthalmitis, and visual loss are all important and some have recently been reviewed in the literature. Moreover, the use of glaucoma drainage implants in the pediatric population has been evaluated. Glaucoma drainage implants have been a powerful tool in our surgical fight to prevent blindness; however, they are not without complications or controversy.

  20. Strengthening Effective Parenting Practices over the Long Term: Effects of a Preventive Intervention for Parentally Bereaved Families (United States)

    Hagan, Melissa J.; Tein, Jenn-Yun; Sandler, Irwin N.; Wolchik, Sharlene A.; Ayers, Tim S.; Luecken, Linda J.


    This study tested the effect of the Family Bereavement Program (FBP), a preventive intervention for bereaved families, on effective parenting (e.g., caregiver warmth, consistent discipline) 6 years after program completion. Families (n = 101; 69% female caregivers; 77% Caucasian, 11% Hispanic) with children between ages 8 and 16 who had…

  1. Coenzyme Q10 does not prevent oral dyskinesias induced by long-term haloperidol treatment of rats

    DEFF Research Database (Denmark)

    OA, Andreassen; Weber, Christine; HA, Jorgensen


    dyskinesias in rats, a putative analogue to human TD, could be prevented by the antioxidant coenzyme Q10 (CoQ10). Rats received 16 weeks of treatment with haloperidol decanoate (HAL) IM alone or together with orally administered CoQ10, and the behavior was recorded during and after treatment. HAL...

  2. Strengthening Effective Parenting Practices over the Long-Term: Effects of a Preventive Intervention for Parentally Bereaved Families


    Hagan, Melissa J.; Tein, Jenn-Yun; Sandler, Irwin N.; Wolchik, Sharlene A.; Ayers, Tim S.; Luecken, Linda J.


    This study tested the effect of the Family Bereavement Program (FBP), a preventive intervention for bereaved families, on effective parenting (e.g. caregiver warmth, consistent discipline) six years after program completion. Families (n=101; 69% female caregivers; 77% Caucasian, 11% Hispanic) with children between ages 8–16 who had experienced the death of one parent were randomized to the FBP (n=54) or a literature control condition (n=47). Multiple regression analyses conducted within a mul...

  3. Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review of RCTs. (United States)

    Neyens, Jacques C; van Haastregt, Jolanda C; Dijcks, Béatrice P; Martens, Mark; van den Heuvel, Wim J; de Witte, Luc P; Schols, Jos M


    There is extensive literature on interventions to prevent or reduce falls in elderly people. These findings, however, were based mainly on studies of community-living persons. The primary aim of the present study was to report the effectiveness and implementation aspects of interventions aimed at reducing falls in elderly residents in long-term care facilities: a systematic review of randomized controlled trials (RCTs). MEDLINE, EMBASE, CINAHL, and hand searching of reference lists of included RCTs. RCTs that assessed fall incidents (falls, fallers, recurrent fallers, fall-related injuries) among elderly residents in long-term care facilities were included in this narrative review. Two independent reviewers abstracted data: general program characteristics (setting, population, intervention program) and outcomes, detailed program characteristics (assessment, intervention content, individually tailored, multidisciplinary), and implementation aspects (feasibility, implications for practice). The CONSORT Statement 2001 Checklist was used regarding the quality of reporting RCTs. Twenty trials met the inclusion criteria. Seven trials, 4 multifactorial and 3 monofactorial, showed a significant reduction in the fall rate, the percentage of recurrent fallers, or both the fall rate and the percentage of persons sustaining femoral fractures. The positive effective programs were as follows: a comprehensive structured individual assessment with specific safety recommendations; a multidisciplinary program including general strategies tailored to the setting and strategies tailored specifically to residents; a multifaceted intervention including education, environmental adaptation, balance, resistance training, and hip protector; calcium plus vitamin D supplementation; vitamin D supplementation; a clinical medication review; and a multifactorial intervention (fall risk evaluation, specific and general interventions). In general, because of the limited number of included trials

  4. Introduction: Long term prediction

    International Nuclear Information System (INIS)

    Beranger, G.


    Making a decision upon the right choice of a material appropriate to a given application should be based on taking into account several parameters as follows: cost, standards, regulations, safety, recycling, chemical properties, supplying, transformation, forming, assembly, mechanical and physical properties as well as the behaviour in practical conditions. Data taken from a private communication (J.H.Davidson) are reproduced presenting the life time range of materials from a couple of minutes to half a million hours corresponding to applications from missile technology up to high-temperature nuclear reactors or steam turbines. In the case of deep storage of nuclear waste the time required is completely different from these values since we have to ensure the integrity of the storage system for several thousand years. The vitrified nuclear wastes should be stored in metallic canisters made of iron and carbon steels, stainless steels, copper and copper alloys, nickel alloys or titanium alloys. Some of these materials are passivating metals, i.e. they develop a thin protective film, 2 or 3 nm thick - the so-called passive films. These films prevent general corrosion of the metal in a large range of chemical condition of the environment. In some specific condition, localized corrosion such as the phenomenon of pitting, occurs. Consequently, it is absolutely necessary to determine these chemical condition and their stability in time to understand the behavior of a given material. In other words the corrosion system is constituted by the complex material/surface/medium. For high level nuclear wastes the main features for resolving problem are concerned with: geological disposal; deep storage in clay; waste metallic canister; backfill mixture (clay-gypsum) or concrete; long term behavior; data needed for modelling and for predicting; choice of appropriate solution among several metallic candidates. The analysis of the complex material/surface/medium is of great importance

  5. General surgical complications associated with the use of long-term mechanical circulatory support devices: are we 'under-reporting' problems? (United States)

    Tchantchaleishvili, Vakhtang; Umakanthan, Ramanan; Karp, Seth; Stulak, John M; Keebler, Mary E; Maltais, Simon


    Multiple complications are associated with use of ventricular assist devices (VADs). Cardiac-related complications and infections are most frequently reported. VADs, however, can also lead to a number of general surgical complications equally significant in terms of morbidity and mortality. The authors performed a systematic literature search to review current data that specifically relate general surgical complications to patients who undergo left VAD implantation. The review provides a relatively clear understanding of the spectrum of general surgical complications and shows that they contribute significantly to morbidity and mortality in these patients.

  6. Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infections in Vulnerable Older Persons: A Double-Blind Randomized Placebo-Controlled Trial in Long-Term Care Facilities (United States)

    Caljouw, Monique A A; van den Hout, Wilbert B; Putter, Hein; Achterberg, Wilco P; Cools, Herman J M; Gussekloo, Jacobijn


    Objectives To determine whether cranberry capsules prevent urinary tract infection (UTI) in long-term care facility (LTCF) residents. Design Double-blind randomized placebo-controlled multicenter trial. Setting Long-term care facilities (LTCFs). Participants LTCF residents (N = 928; 703 women, median age 84). Measurements Cranberry and placebo capsules were taken twice daily for 12 months. Participants were stratified according to UTI risk (risk factors included long-term catheterization, diabetes mellitus, ≥1 UTI in preceding year). Main outcomes were incidence of UTI according to a clinical definition and a strict definition. Results In participants with high UTI risk at baseline (n = 516), the incidence of clinically defined UTI was lower with cranberry capsules than with placebo (62.8 vs 84.8 per 100 person-years at risk, P = .04); the treatment effect was 0.74 (95% confidence interval (CI) = 0.57–0.97). For the strict definition, the treatment effect was 1.02 (95% CI = 0.68–1.55). No difference in UTI incidence between cranberry and placebo was found in participants with low UTI risk (n = 412). Conclusion In LTCF residents with high UTI risk at baseline, taking cranberry capsules twice daily reduces the incidence of clinically defined UTI, although it does not reduce the incidence of strictly defined UTI. No difference in incidence of UTI was found in residents with low UTI risk. PMID:25180378

  7. Long term effects of preventive activities of youth health care in The Netherlands: results of a four-part study

    Directory of Open Access Journals (Sweden)

    Pieter A. Wiegersma


    Full Text Available

    Background. In this article the results are presented of a four part study on the effect of screening for scoliosis and (repeated well-care visits and freely accessible consultation hours at secondary schools, on the incidence and prevalence of (parasuicide, mental health, adolescent health compromising behaviour and lastly obesity.

    Methods. An ecologic case-referent study design was used with data from the Netherlands Bureau of Statistics, the Ministry of Defence, the 1992 High-School Student Study, all of the youth health care departments in The Netherlands and relevant censuses.

    Results. Attention to mental and physical health and health compromising behaviour, either during screening, open consultation hours or during well-care visits seems to be ineffective and in some instances even detrimental to youth health.

    Of the 18 different outcome measurements, 5 were significantly negative and none were significantly positive.

    Conclusions. This four part study does not support the hypothesis that on a population level, the preventive activities of youth health care departments such as screening for scoliosis, (more frequent well-care visits or offering open consultation hours at secondary schools, have a beneficial effect on prevention of (parasuicide, poor mental health, health compromising behaviour or obesity.

  8. Long-term collections

    CERN Multimedia

    Collectes à long terme


    The Committee of the Long Term Collections (CLT) asks for your attention for the following message from a young Peruvian scientist, following the earthquake which devastated part of her country a month ago.

  9. Effect on caries experience of a long-term preventive program for mothers and children starting during pregnancy. (United States)

    Günay, H; Dmoch-Bockhorn, K; Günay, Y; Geurtsen, W


    The aim of this three-phase prospective study was to determine the effects of a primary-primary prevention program on the oral health of children. Eighty-six pregnant women from various social backgrounds participated in the first phase of this study. In the second phase (at 3 years of age) 54 of the mother-child couples and in the third phase (at 4 years of age) 47 of the mother-child couples remained. Participants were recalled every 6 months and received individual prophylactic care. The following clinical parameters were assessed at each examination period for mother and child: DMF-S or dmf-s, proximal plaque index, and the salivary level of Streptococcus mutans (Dentocult SM). The control group consisted of 65 (at 3 years of age) and 45 (at 4 years of age) children from various kindergartens. All children in the second phase of the study group revealed a naturally healthy dentition with an API of 0-25% and a salivary S. mutans score of 0 (0-10(3) cfu/ml). In the third phase, only four of the 47 children of the study group showed caries, with a mean dmf-s of 1.5. No S. mutans could be detected in 20 (42.6%) children. Ten (21.3%) children of the study group showed a S. mutans score of > or = 2 (> 10(5) cfu/ml). In contrast, only 53 of the 65 children of the control group (second phase) and 26 of the 45 control children (third phase) revealed a naturally healthy dentition. The remaining 19 children of the control group revealed a mean dmf-s of 7.0 at 4 years of age. In the control group, no S. mutans could be detected in 25 (38.5%) children at 3 years of age whereas 21 (32.3%) children showed a S. mutans score of > or = 2. In the third phase, a salivary S. mutans score of > or = 2 was found in 27 (60%) children of the control group. The statistical comparison between the study and the control groups revealed significant differences for all results determined (P mutans colonization. From our data we conclude that a pre- and postnatal prevention program (primary

  10. Long-term antagonism of κ opioid receptors prevents escalation of and increased motivation for heroin intake. (United States)

    Schlosburg, Joel E; Whitfield, Timothy W; Park, Paula E; Crawford, Elena F; George, Olivier; Vendruscolo, Leandro F; Koob, George F


    The abuse of opioid drugs, both illicit and prescription, is a persistent problem in the United States, accounting for >1.2 million users who require treatment each year. Current treatments rely on suppressing immediate withdrawal symptoms and replacing illicit drug use with long-acting opiate drugs. However, the mechanisms that lead to preventing opiate dependence are still poorly understood. We hypothesized that κ opioid receptor (KOR) activation during chronic opioid intake contributes to negative affective states associated with withdrawal and the motivation to take increasing amounts of heroin. Using a 12 h long-access model of heroin self-administration, rats showed escalation of heroin intake over several weeks. This was prevented by a single high dose (30 mg/kg) of the long-acting KOR antagonist norbinaltorphimine (nor-BNI), paralleled by reduced motivation to respond for heroin on a progressive-ratio schedule of reinforcement, a measure of compulsive-like responding. Systemic nor-BNI also significantly decreased heroin withdrawal-associated anxiety-like behavior. Immunohistochemical analysis showed prodynorphin content increased in the nucleus accumbens core in all heroin-exposed rats, but selectively increased in the nucleus accumbens shell in long-access rats. Local infusion of nor-BNI (4 μg/side) into accumbens core altered the initial intake of heroin but not the rate of escalation, while local injection into accumbens shell selectively suppressed increases in heroin intake over time without altering initial intake. These data suggest that dynorphin activity in the nucleus accumbens mediates the increasing motivation for heroin taking and compulsive-like responding for heroin, suggesting that KOR antagonists may be promising targets for the treatment of opioid addiction.

  11. Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program. (United States)

    Hewitt, Jennifer; Goodall, Stephen; Clemson, Lindy; Henwood, Timothy; Refshauge, Kathryn


    Falls prevention is an international priority, and residents of long-term aged care fall approximately 3 times more often than community dwellers. There is a relative scarcity of published trials in this setting. Our objective was to undertake a randomized controlled trial to test the effect of published best practice exercise in long-term residential aged care. The trial was designed to determine if combined high level balance and moderate intensity progressive resistance training (the Sunbeam Program) is effective in reducing the rate of falls in residents of aged care facilities. A cluster randomized controlled trial of 16 residential aged care facilities and 221 participants was conducted. The broad inclusion criterion was permanent residents of aged care. Exclusions were diagnosed terminal illness, no medical clearance, permanent bed- or wheelchair-bound status, advanced Parkinson's disease, or insufficient cognition to participate in group exercise. Assessments were taken at baseline, after intervention, and at 12 months. Randomization was performed by computer-generated sequence to receive either the Sunbeam program or usual care. A cluster refers to an aged care facility. The program consisted of individually prescribed progressive resistance training plus balance exercise performed in a group setting for 50 hours over a 25-week period, followed by a maintenance period for 6 months. The primary outcome measure was the rate of falls (number of falls and days followed up). Secondary outcomes included physical performance (Short Physical Performance Battery), quality of life (36-item Short-Form Health Survey), functional mobility (University of Alabama Life Space Assessment), fear of falling (Falls Efficacy Scale International), and cognition (Addenbrooke's Cognitive Evaluation-revised). The rate of falls was reduced by 55% in the exercise group (incidence rate ratio = 0.45, 95% confidence interval 0.17-0.74); an improvement was also seen in physical

  12. Textured saline-filled breast implants for augmentation mammaplasty: does overfilling prevent deflation? A long-term follow-up. (United States)

    Al-Sabounchi, Shareef; De Mey, Albert M G; Eder, Helga


    Augmentation mammaplasty is the second most commonly performed aesthetic operation. Since the moratorium on gel-filled devices in 1992, saline-filled devices have become the prosthesis of choice in the United States. Although inflatable breast implants have been available since 1965, high rates of complete implant deflation have been reported. In this retrospective study, the authors highlight the effect of filling volume on the incidence of implant deflation, other implant-related trade-offs, and implant survival. Forty-nine women who had undergone aesthetic augmentation mammaplasty were followed up for up to 139 months. Twelve implants were underfilled (group 1), 47 devices were filled within the recommended volume (group 2), and 37 implants were overfilled beyond the manufacturer's maximum recommended volume (group 3). All the implants used were of the same type and from the same manufacturer (Siltex by Mentor, 2600). Through an inframammary approach, subpectoral placement of the device was used exclusively. Nineteen women experienced complete deflation of their implants, with an overall implant complete deflation rate of 19.79 percent. This complication occurred in 16.6 percent of group 1 patients, 21.2 percent of group 2, and 18.9 percent of group 3. Skin wrinkling and rippling were encountered in 50 percent of group 1, 29.78 percent of group 2, and 43.2 percent of group 3, with an overall incidence of 37.5 percent. In this series, the authors could not find a protective effect of overfilling on complete deflation (p = 0.925) nor on the avoidance of rippling and wrinkling (p = 0.285). Moreover, overfilling by more than 25 ml beyond the maximum recommended dose showed no statistical significance for the frequency of complete deflation (p = 0.982) or for the incidence of wrinkling and rippling (p = 0.828). However, Kaplan-Meier survival analysis revealed that overfilling the implants prolonged their longevity and had a statistically significant effect on the

  13. New strategies for the prevention of radiation injury. Possible implications for countering radiation hazards of long-term space travel

    International Nuclear Information System (INIS)

    Seed, T.; Kumar, S.; Whitnall, M.


    New strategies for the prevention of radiation injuries are currently being explored with the ultimate aim of developing globally radioprotective, nontoxic pharmacologics. The prophylactic treatments under review encompass such diverse pharmacologic classes as novel immunomodulators, nutritional antioxidants, and cytokines. An immunomodulator that shows promise is 5-androstenediol (AED), a well-tolerated, long-acting and rostene steroid with broad-spectrum radioprotective attributes that include not only protection against acute tissue injury, but also reduced susceptibility to infectious agents, as well as reduced rates of neoplastic transformation. Other potentially useful radioprotectants currently under study include the nutraceutical vitamin E and analogs, a chemically-engineered cytokine, interleukin-1β, and a sustained-release formulation of an aminothiol, amifostine. Results suggest that a new paradigm is evolving for the prophylaxes of radiation injuries, based on use of newly identified, nontoxic, broad-spectrum prophylactic agents whose protective action may be leveraged by subsequent postexposure use of cytokines with organ-specific reparative functions. (author)

  14. New strategies for the prevention of radiation injury. Possible implications for countering radiation hazards of long-term space travel

    Energy Technology Data Exchange (ETDEWEB)

    Seed, T.; Kumar, S.; Whitnall, M. [Armed Forces Radiobiology Research Inst., Bethesda, MD (United States). Radiation Casualty Management] [and others


    New strategies for the prevention of radiation injuries are currently being explored with the ultimate aim of developing globally radioprotective, nontoxic pharmacologics. The prophylactic treatments under review encompass such diverse pharmacologic classes as novel immunomodulators, nutritional antioxidants, and cytokines. An immunomodulator that shows promise is 5-androstenediol (AED), a well-tolerated, long-acting and rostene steroid with broad-spectrum radioprotective attributes that include not only protection against acute tissue injury, but also reduced susceptibility to infectious agents, as well as reduced rates of neoplastic transformation. Other potentially useful radioprotectants currently under study include the nutraceutical vitamin E and analogs, a chemically-engineered cytokine, interleukin-1{beta}, and a sustained-release formulation of an aminothiol, amifostine. Results suggest that a new paradigm is evolving for the prophylaxes of radiation injuries, based on use of newly identified, nontoxic, broad-spectrum prophylactic agents whose protective action may be leveraged by subsequent postexposure use of cytokines with organ-specific reparative functions. (author)

  15. Skin fluorescence as a clinical tool for non-invasive assessment of advanced glycation and long-term complications of diabetes

    NARCIS (Netherlands)

    Fokkens, Bernardina T.; Smit, Andries J.

    Glycation is important in the development of complications of diabetes mellitus and may have a central role in the well-described glycaemic memory effect in developing these complications. Skin fluorescence has emerged over the last decade as a non-invasive method for assessing accumulation of

  16. Individual Risk and Prevention of Complications

    DEFF Research Database (Denmark)

    Serup, Jørgen


    Doctors who are consulted about health and tattoo risks have an important role in the prevention of an individual's tattoo complications. Tattooing is a tremendous exposure of the human body to needle operation, particles, and chemicals. The risk is related to a person's health condition, level o...... about tattoos, tattoo problems, how to reduce risk, and a checklist for the tattoo customer before decision-making. The sheets with keynote information are useful aids for doctors giving advice to persons curious about acquiring a tattoo....

  17. Long-term health-related quality of life after pancreatic resection for malignancy in patients with and without severe postoperative complications. (United States)

    Heerkens, Hanne D; van Berkel, Lisanne; Tseng, Dorine S J; Monninkhof, Evelyn M; van Santvoort, Hjalmar C; Hagendoorn, Jeroen; Borel Rinkes, Inne H M; Lips, Irene M; Intven, Martijn; Molenaar, I Quintus


    Surgery for pancreatic cancer yields significant morbidity and mortality risks and survival is limited. Therefore, the influence of complications on quality of life (QoL) after pancreatic surgery is important. This study compares QoL in patients with and without severe complications after surgery for pancreatic (pre-)malignancy. This prospective cohort study scored complications after pancreatic surgery according to the Clavien-Dindo system and the definitions of the International Study Group of Pancreatic Surgery. QoL was measured by the RAND36 questionnaire, the European Organization for Research and Treatment of Cancer core questionnaire (QLQ-C30) and the pancreas specific QLQ-PAN26. QoL in patients with severe complications was compared with QoL in patients with no or mild complications over a period of 12 months. Analysis was performed with linear mixed models for repeated measurements. Between March 2012 and July 2016, 137 patients were included. Sixty-eight patients (50%) had at least 1 severe complication. There were no statistically significant and clinically relevant differences between both groups in QoL up to 12 months after surgery. In this study, no differences in QoL between patients with and without severe postoperative complications were encountered during the first 12 months after surgery for pancreatic (pre-)malignancy. Identifier: NCT02175992. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

  18. Anti-Urokinase Receptor Antisense Oligonucleotide (uPAR-aODN) to Prevent and Cure Long-Term Space Exploration-Related Retinal Pathological Angiogenesis (United States)

    Lazzarano, Stefano; Lulli, Matteo; Fibbi, Gabriella; Margheri, Francesca; Papucci, Laura; Serrati, Simona; Witort, Ewa; Chilla, Anastasia; Lapucci, Andrea; Donnini, Martino; Quaglierini, Paolo; Romiti, Alice; Specogna, Rebecca; Del Rosso, Mario; Capaccioli, Sergio


    Angiogenesis underlies a variety of physiological processes and its possible deregulation during long term space exploration needs to be investigated. Angiogenesis is a multistep process of new blood capillary formation, where degradation of the extracellular matrix (ECM) by proteolytic enzymes, including uPA (urokinase plasminogen activator) and opening the way to migration of endothelial cells (EC), is critical. Plasminogen activation system regulates angiogenesis by both uPA-driven ECM degradation and uPA receptor (uPAR). Microgravity and low dose irradiations promote tissue neoangiogeenesis and neovascularization is often common occurence in ophthalmologic pathologies. We have designed and patented the uPAR antisense oligonucleotide (aODN) and evaluated its antiangiogenetic activity by EC cellular migration and capillary morphogenesis assays. The uPAR aODN treatment caused a 75% inhibition of human microvascular EC migration and a complete inhibition of capillary morphogenesis, suggesting its therapeutic application to prevent neoangiogenesis-related ophthalmologic pathologies during space exploration.

  19. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. (United States)

    Kraaijenga, Sophie A C; van der Molen, Lisette; Jacobi, Irene; Hamming-Vrieze, Olga; Hilgers, Frans J M; van den Brekel, Michiel W M


    Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.

  20. Selegiline prevents long-term changes in dopamine efflux and stress immobility during the second and third weeks of abstinence following opiate withdrawal. (United States)

    Grasing, K; Ghosh, S


    Selegiline is an irreversible inhibitor of monoamine oxidase B with trophic and neuroprotective effects. Because of evidence for decreased dopaminergic function during the withdrawal syndromes associated with opiates and other medications with potential for abuse, we investigated effects of treatment with selegiline on in vitro measures of dopamine efflux following opiate withdrawal. Treatment with 2.0 mg/kg/day of selegiline did not modify the severity of opiate withdrawal, as assessed by weight loss over the first 3 days of abstinence. Opiate withdrawal increased immobility in response to a forced warm water swim test performed during the second and third weeks of abstinence following the onset of withdrawal. Brain slices obtained from the nucleus accumbens of opiate-withdrawn animals immediately following swim stress testing displayed diminished efflux of tritiated dopamine after two in vitro exposures to cocaine or amphetamine. Cocaine increases neurotransmitter efflux through blockade of dopamine reuptake, while amphetamine augments efflux by stimulating release of dopamine from intracellular storage vesicles. Although slices from opiate withdrawal subjects showed decreases in efflux after in vitro treatment with these agents, no differences were observed after exposure to 4-aminopyridine, which increases neurotransmitter release by prolonging action potential duration. These findings indicate mechanisms of action that are specific for catecholamine neurotransmitter systems are important for demonstrating long-term changes in dopaminergic function following opiate withdrawal. Selegiline prevented decreases in the efflux of tritiated dopamine in slices obtained from opiate-withdrawn subjects. In addition, selegiline decreased withdrawal-induced immobility during warm water swim testing. In conclusion, treatment with selegiline can prevent long-term changes in stress-induced immobility and deficits in presynaptic dopaminergic function that occur following the

  1. Hepatobiliary scintigraphy in the assessment of long-term complication after biliary-enteric anastomosis: role in the diagnosis of post-operative segmental or total biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Seung; Moon, Dae Hyuk; Lee, Sung Gyu; Lee, Yung Joo; Park, Kwang Min; Shin, Jung Woo; Ryu, Jin Sook; Lee, Hee Kyung [Asan Medicial Center, Seoul (Korea, Republic of)


    The purpose of this study was to investigate the accuracy of hepatobiliary scintigraphy (HBS) in the diagnosis of segmental or total biliary obstruction during long-term follow-up period after curative radical surgery with biliary-enteric anastomosis. The study population included 80 patients who underwent biliary-enteric anastomoses for benign (n=33) or malignant (n=47) biliary disease. Fifty-six of these 80 patients also underwent curative hepatic resection. Ninety eight hepatobiliary scintigrams using {sup 99m}Tc-DISIDA were performed at least 1 month after surgery (median 9 month). The scintigraphic criteria of total biliary obstruction we used were intestinal excretion beyond one hour or delayed hepatobiliary washout despite the presence of intestinal excretion. Segmental biliary obstruction was defined as delayed segmental excretion. The accuracy for biliary obstruction was evaluated according to different clinical situations. There were 9 instances with total biliary obstruction and 23 with segmental bile duct obstruction. Diagnosis of biliary obstruction was confirmed by percutaneous transhepatic cholangiography or surgery in 13, and follow-up clinical data for at least 6 months in 19 instances. Among the 32 instances with biliary symptoms and abnormal liver function, HBS allowed correct diagnosis in all 32(9 total, 14 segmental obstruction and 9 non-obstruction). Of the 40 with nonspecific symptom or isolated elevation of serum alkaline phosphatase, HBS diagnosed 8 of the 9 segmental biliary obstruction and 30 of the 31 non-obstruction. There were no biliary obstruction and no false positive result of scintigraphy in 26 instances which had no clinical symptom or signs of biliary obstruction. Diagnostic sensitivity of HBS was 100% (9/9) for total biliary obstruction, and 96%(22/23) for segmental bile obstruction. Specificity was 98%(39/40) in patients who had abnormal symptom or sign. Hepatobiliary scintigraphy is a highly accurate modality in the

  2. Hepatobiliary scintigraphy in the assessment of long-term complication after biliary-enteric anastomosis: role in the diagnosis of post-operative segmental or total biliary obstruction

    International Nuclear Information System (INIS)

    Kim, Jae Seung; Moon, Dae Hyuk; Lee, Sung Gyu; Lee, Yung Joo; Park, Kwang Min; Shin, Jung Woo; Ryu, Jin Sook; Lee, Hee Kyung


    The purpose of this study was to investigate the accuracy of hepatobiliary scintigraphy (HBS) in the diagnosis of segmental or total biliary obstruction during long-term follow-up period after curative radical surgery with biliary-enteric anastomosis. The study population included 80 patients who underwent biliary-enteric anastomoses for benign (n=33) or malignant (n=47) biliary disease. Fifty-six of these 80 patients also underwent curative hepatic resection. Ninety eight hepatobiliary scintigrams using 99m Tc-DISIDA were performed at least 1 month after surgery (median 9 month). The scintigraphic criteria of total biliary obstruction we used were intestinal excretion beyond one hour or delayed hepatobiliary washout despite the presence of intestinal excretion. Segmental biliary obstruction was defined as delayed segmental excretion. The accuracy for biliary obstruction was evaluated according to different clinical situations. There were 9 instances with total biliary obstruction and 23 with segmental bile duct obstruction. Diagnosis of biliary obstruction was confirmed by percutaneous transhepatic cholangiography or surgery in 13, and follow-up clinical data for at least 6 months in 19 instances. Among the 32 instances with biliary symptoms and abnormal liver function, HBS allowed correct diagnosis in all 32(9 total, 14 segmental obstruction and 9 non-obstruction). Of the 40 with nonspecific symptom or isolated elevation of serum alkaline phosphatase, HBS diagnosed 8 of the 9 segmental biliary obstruction and 30 of the 31 non-obstruction. There were no biliary obstruction and no false positive result of scintigraphy in 26 instances which had no clinical symptom or signs of biliary obstruction. Diagnostic sensitivity of HBS was 100% (9/9) for total biliary obstruction, and 96%(22/23) for segmental bile obstruction. Specificity was 98%(39/40) in patients who had abnormal symptom or sign. Hepatobiliary scintigraphy is a highly accurate modality in the evaluation of

  3. Complications after the placement of domestic ZQL filter and imported inferior vena caval filter: a mid-and long-term comparative study

    International Nuclear Information System (INIS)

    Huang Kun; Zhao Yi; Xu Ke; Feng Bo; Liang Songnian


    Objective: To investigate the clinical value of domestic ZQL-type inferior vena caval filter through comparing its complications with that of imported inferior vena caval filter. Methods: Domestic ZQL-type inferior vena caval filter was placed in 62 patients (study group) and imported inferior vena caval filter in 58 patients (control group) for the treatment of deep venous thrombosis of the lower limb. Abdominal plain film, lower limb phlebography and/or pulmonary arteriography, color Doppler ultrasonography were performed after the procedure. 3D-CT scanning was carried out when pulmonary embolism was suspected. The complications were documented and analyzed. Results In all patients the inferior vena caval filter was successfully implanted in planned site. In study group, the complications included filter migration over 10 cm (n = 1), thrombus in the filter (n = 1), inferior vena cava obstruction (n = 2) and pulmonary embolism (n = 1). In control group, the complications included thrombus in the filter (n = 2), deep venous thrombus of the lower extremities (n = 2), inferior vena cava obstruction (n = 9), venous perforation by filter (n = 1) and pulmonary embolism (n = 1). The data were compared between two groups and statistic analysis showed no significant difference between two groups (P > 0.05). Conclusion: No significant difference in the occurrence of complications exists between domestic ZQL-type inferior vena caval filter and imported inferior vena caval filter, therefore, domestic ZQL-type inferior vena caval filter can safely substitute for the imported filter. (authors)

  4. Long-term outcome of a randomized controlled universal prevention trial through a positive parenting program: is it worth the effort? (United States)

    Hahlweg, Kurt; Heinrichs, Nina; Kuschel, Annett; Bertram, Heike; Naumann, Sebastian


    Approximately 20% of children experience internalizing or externalizing DSM-IV-TR disorders. This prevalence rate cannot be reduced through treatment only. Effective preventive interventions are therefore urgently needed. The aim of the current investigation is to evaluate the two-year efficacy of the group Triple P parenting program administered universally for the prevention of child behavior problems. Based on their respective preschool, N = 280 families were randomly assigned either to the parent training or to the control group. The efficacy was analyzed using multi-source assessments, including questionnaires by mother and father, behavioral observation of mother-child interaction, and teacher evaluations. At the 2-year follow-up, both parents in the Triple P intervention reported significant reductions in dysfunctional parenting behavior, and mothers also an increase in positive parenting behavior. In addition, mothers reported significant reductions in internalizing and externalizing child behavior. Single-parent mothers in the Triple P intervention did not report significant changes in parenting or child problem behavior which is primarily due to inexplicable high positive effects in single parent mothers of the control group. Neither mother-child interactions nor teacher ratings yielded significant results. The results support the long-term efficacy of the Triple P - group program as a universal prevention intervention for changing parenting behavior in two-parent households, but not necessarily in single-parent mothers.

  5. Anti-factor IXa/X bispecific antibody ACE910 prevents joint bleeds in a long-term primate model of acquired hemophilia A (United States)

    Yoshihashi, Kazutaka; Takeda, Minako; Kitazawa, Takehisa; Soeda, Tetsuhiro; Igawa, Tomoyuki; Sampei, Zenjiro; Kuramochi, Taichi; Sakamoto, Akihisa; Haraya, Kenta; Adachi, Kenji; Kawabe, Yoshiki; Nogami, Keiji; Shima, Midori; Hattori, Kunihiro


    ACE910 is a humanized anti-factor IXa/X bispecific antibody mimicking the function of factor VIII (FVIII). We previously demonstrated in nonhuman primates that a single IV dose of ACE910 exerted hemostatic activity against hemophilic bleeds artificially induced in muscles and subcutis, and that a subcutaneous (SC) dose of ACE910 showed a 3-week half-life and nearly 100% bioavailability, offering support for effective prophylaxis for hemophilia A by user-friendly SC dosing. However, there was no direct evidence that such SC dosing of ACE910 would prevent spontaneous bleeds occurring in daily life. In this study, we newly established a long-term primate model of acquired hemophilia A by multiple IV injections of an anti-primate FVIII neutralizing antibody engineered in mouse-monkey chimeric form to reduce its antigenicity. The monkeys in the control group exhibited various spontaneous bleeding symptoms as well as continuous prolongation of activated partial thromboplastin time; notably, all exhibited joint bleeds, which are a hallmark of hemophilia. Weekly SC doses of ACE910 (initial 3.97 mg/kg followed by 1 mg/kg) significantly prevented these bleeding symptoms; notably, no joint bleeding symptoms were observed. ACE910 is expected to prevent spontaneous bleeds and joint damage in hemophilia A patients even with weekly SC dosing, although appropriate clinical investigation is required. PMID:25274508

  6. Long-term outcome of a randomized controlled universal prevention trial through a positive parenting program: is it worth the effort?

    Directory of Open Access Journals (Sweden)

    Bertram Heike


    Full Text Available Abstract Background Approximately 20% of children experience internalizing or externalizing DSM-IV-TR disorders. This prevalence rate cannot be reduced through treatment only. Effective preventive interventions are therefore urgently needed. The aim of the current investigation is to evaluate the two-year efficacy of the group Triple P parenting program administered universally for the prevention of child behavior problems. Methods Based on their respective preschool, N = 280 families were randomly assigned either to the parent training or to the control group. The efficacy was analyzed using multi-source assessments, including questionnaires by mother and father, behavioral observation of mother-child interaction, and teacher evaluations. Results At the 2-year follow-up, both parents in the Triple P intervention reported significant reductions in dysfunctional parenting behavior, and mothers also an increase in positive parenting behavior. In addition, mothers reported significant reductions in internalizing and externalizing child behavior. Single-parent mothers in the Triple P intervention did not report significant changes in parenting or child problem behavior which is primarily due to inexplicable high positive effects in single parent mothers of the control group. Neither mother-child interactions nor teacher ratings yielded significant results. Conclusions The results support the long-term efficacy of the Triple P - group program as a universal prevention intervention for changing parenting behavior in two-parent households, but not necessarily in single-parent mothers.

  7. Cannabinoids prevent the differential long-term effects of exposure to severe stress on hippocampal- and amygdala-dependent memory and plasticity. (United States)

    Shoshan, Noa; Segev, Amir; Abush, Hila; Mizrachi Zer-Aviv, Tomer; Akirav, Irit


    Exposure to excessive or uncontrolled stress is a major factor associated with various diseases including posttraumatic stress disorder (PTSD). The consequences of exposure to trauma are affected not only by aspects of the event itself, but also by the frequency and severity of trauma reminders. It was suggested that in PTSD, hippocampal-dependent memory is compromised while amygdala-dependent memory is strengthened. Several lines of evidence support the role of the endocannabinoid (eCB) system as a modulator of the stress response. In this study we aimed to examine cannabinoids modulation of the long-term effects (i.e., 1 month) of exposure to a traumatic event on memory and plasticity in the hippocampus and amygdala. Following exposure to the shock and reminders model of PTSD in an inhibitory avoidance light-dark apparatus rats demonstrated: (i) enhanced fear retrieval and impaired inhibitory extinction (Ext), (ii) no long-term potentiation (LTP) in the CA1, (iii) impaired hippocampal-dependent short-term memory in the object location task, (iv) enhanced LTP in the amygdala, and (v) enhanced amygdala-dependent conditioned taste aversion memory. The cannabinoid CB1/2 receptor agonist WIN55-212,2 (0.5mg/kg, i.p.) and the fatty acid amide hydrolase (FAAH) inhibitor URB597 (0.3mg/kg, i.p.), administered 2 hr after shock exposure prevented these opposing effects on hippocampal- and amygdala-dependent processes. Moreover, the effects of WIN55-212,2 and URB597 on Ext and acoustic startle were prevented by co-administration of a low dose of the CB1 receptor antagonist AM251 (0.5mg/kg, i.p.), suggesting that the preventing effects of both drugs are mediated by CB1 receptors. Exposure to shock and reminders increased CB1 receptor levels in the CA1 and basolateral amygdala 1 month after shock exposure and this increase was also prevented by administering WIN55-212,2 or URB597. Taken together, these findings suggest the involvement of the eCB system, and specifically CB1

  8. Long-Term Collections

    CERN Multimedia

    Comité des collectes à long terme


    It is the time of the year when our fireman colleagues go around the laboratory for their traditional calendars sale. A part of the money of the sales will be donated in favour of the long-term collections. We hope that you will welcome them warmly.

  9. Leukemia prevention and long-term survival of AKR mice transplanted with MHC-matched or MHC-mismatched bone marrow

    International Nuclear Information System (INIS)

    Longley, R.E.; Good, R.A.


    The current studies were designed to evaluate the effectiveness of marrow transplantation within and outside the major histocompatibility complex (MHC) on the long-term survival and occurrence of spontaneous leukemia in AKR mice. AKR mice, which were lethally irradiated and received MHC-matched marrow from CBA/J mice (CBA----AKR), never developed leukemia and were alive and remained healthy for up to 280 days post-transplant. These long-term surviving chimeras possessed substantial immune vigor when both cell-mediated and humoral responses were tested. Lethally irradiated AKR mice, which had received MHC-mismatched marrow (anti-Thy-1.2 treated or nontreated) from C57BL/6J mice (B6----AKR), never developed leukemia and survived up to 170 days post-transplant. However, both groups of these chimeras began dying 180 to 270 days post-transplant due to a disease process which could not be readily identified. Histological analysis of B6----AKR chimeras revealed severe lymphoid cell depletion in thymus and spleen; however, none of these chimeras exhibited classical features of acute graft versus host disease. Concanavalin A mitogenesis, primary antibody responses to sheep red blood cells and the production of interleukin 2 (IL-2) were suppressed in B6----AKR chimeras. IL-2 treatment of B6----AKR chimeras was shown to partially correct these deficiencies without stimulating mixed lymphocyte responsiveness to donor or host lymphocytes. These studies indicate that the use of MHC-mismatched marrow for the prevention of spontaneous AKR leukemia may rely on augmentative IL-2 therapy for complete immune reconstitution of leukemia-free chimeras

  10. Association between microfibrillar-associated protein 4 (MFAP4) and micro- and macrovascular complications in long-term type 1 diabetes mellitus

    DEFF Research Database (Denmark)

    Blindbæk, S L; Schlosser, A; Green, A


    in the former Funen County, Denmark. Detection of plasma-MFAP4 (pMFAP4) was performed by the AlphaLISA Technique. Diabetic retinopathy (DR) was graded in accordance with the Early Treatment Diabetic Retinopathy Study adaptation of the modified Airlie House classification. A monofilament test was used to test...... diabetic retinopathy, nephropathy or macrovascular disease. CONCLUSIONS: No association between pMFAP4 and macrovascular vascular complications was found. However, high levels of pMFAP4 correlated independently with diabetic neuropathy. Further studies on the predictive value of increased circulating MFAP4......AIMS: To evaluate microfibrillar-associated protein 4 (MFAP4) as a marker of micro- and macrovascular complications in patients with type 1 diabetes. METHODS: This cross-sectional study included 203 persons with a long duration of type 1 diabetes from a population-based cohort ascertained...

  11. Radiological management of patients with urinary obstruction following urinary diversion procedures: technical factors, complications, long-term management and outcome. Experience with 378 procedures.

    LENUS (Irish Health Repository)

    Maher, M M


    We aimed to assess management by interventional radiology techniques of patients with urinary diversion procedures (UD) complicated by urinary obstruction (UO). A 12-year electronic database of interventional cases was searched for urinary access in patients with UD. Patients\\' records were assessed for aetiology of obstruction, indication for procedure, types of interventional radiology, complications and outcome. Management issues included frequency of visits for catheter care, type of catheter placement and technical problems associated with catheter maintenance. Three hundred and seventy eight procedures were carried out in 25 patients (mean age 70 years; Male : Female ratio 13:12). Indications for UD were malignancy (n = 22) and neuropathic bladder (n = 3). UD included ileal conduits (n = 17), cutaneous ureterostomy (n = 3 (2 patients)) and sigmoid colon urinary conduit (n = 6). In most patients, catheters were placed antegradely through nephrostomy tract, but subsequent access was through the UD. Twenty of 25 patients had unilateral stents where as 5 had bilateral stents (8-10- Fr pigtail catheters (20-45 cm in length)). The mean number of procedures including catheter changes was 15 +\\/- 4 per patient and 331 of 378 procedures (87 %) were carried out as outpatients. Since catheter placement, 11 patients required hospital admission on 22 occasions for catheter-related complications. Ureteric strictures in patients with UD can be successfully managed by interventional radiology.

  12. Single fluoxetine treatment before but not after stress prevents stress-induced hippocampal long-term depression and spatial memory retrieval impairment in rats (United States)

    Han, Huili; Dai, Chunfang; Dong, Zhifang


    A growing body of evidence has shown that chronic treatment with fluoxetine, a widely prescribed medication for treatment of depression, can affect synaptic plasticity in the adult central nervous system. However, it is not well understood whether acute fluoxetine influences synaptic plasticity, especially on hippocampal CA1 long-term depression (LTD), and if so, whether it subsequently impacts hippocampal-dependent spatial memory. Here, we reported that LTD facilitated by elevated-platform stress in hippocampal slices was completely prevented by fluoxetine administration (10 mg/kg, i.p.) 30 min before stress. The LTD was not, however, significantly inhibited by fluoxetine administration immediately after stress. Similarly, fluoxetine incubation (10 μM) during electrophysiological recordings also displayed no influence on the stress-facilitated LTD. In addition, behavioral results showed that a single fluoxetine treatment 30 min before but not after acute stress fully reversed the impairment of spatial memory retrieval in the Morris water maze paradigm. Taken together, these results suggest that acute fluoxetine treatment only before, but not after stress, can prevent hippocampal CA1 LTD and spatial memory retrieval impairment caused by behavioral stress in adult animals. PMID:26218751

  13. Chronic and acute adenosine A2A receptor blockade prevents long-term episodic memory disruption caused by acute cannabinoid CB1 receptor activation. (United States)

    Mouro, Francisco M; Batalha, Vânia L; Ferreira, Diana G; Coelho, Joana E; Baqi, Younis; Müller, Christa E; Lopes, Luísa V; Ribeiro, Joaquim A; Sebastião, Ana M


    Cannabinoid-mediated memory impairment is a concern in cannabinoid-based therapies. Caffeine exacerbates cannabinoid CB 1 receptor (CB 1 R)-induced memory deficits through an adenosine A 1 receptor-mediated mechanism. We now evaluated how chronic or acute blockade of adenosine A 2A receptors (A 2A Rs) affects long-term episodic memory deficits induced by a single injection of a selective CB 1 R agonist. Long-term episodic memory was assessed by the novel object recognition (NOR) test. Mice received an intraperitoneal (i.p.) injection of the CB 1 /CB 2 receptor agonist WIN 55,212-2 (1 mg/kg) immediately after the NOR training, being tested for novelty recognition 24 h later. Anxiety levels were assessed by the Elevated Plus Maze test, immediately after the NOR. Mice were also tested for exploratory behaviour at the Open Field. For chronic A 2A R blockade, KW-6002 (istradefylline) (3 mg/kg/day) was administered orally for 30 days; acute blockade of A 2A Rs was assessed by i.p. injection of SCH 58261 (1 mg/kg) administered either together with WIN 55,212-2 or only 30 min before the NOR test phase. The involvement of CB 1 Rs was assessed by using the CB 1 R antagonist, AM251 (3 mg/kg, i.p.). WIN 55,212-2 caused a disruption in NOR, an action absent in mice also receiving AM251, KW-6002 or SCH 58261 during the encoding/consolidation phase; SCH 58251 was ineffective if present during retrieval only. No effects were detected in the Elevated Plus maze or Open Field Test. The finding that CB 1 R-mediated memory disruption is prevented by antagonism of adenosine A 2A Rs, highlights a possibility to prevent cognitive side effects when therapeutic application of CB 1 R drugs is desired. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Early prevention of antisocial personality: long-term follow-up of two randomized controlled trials comparing indicated and selective approaches. (United States)

    Scott, Stephen; Briskman, Jackie; O'Connor, Thomas G


    Antisocial personality is a common adult problem that imposes a major public health burden, but for which there is no effective treatment. Affected individuals exhibit persistent antisocial behavior and pervasive antisocial character traits, such as irritability, manipulativeness, and lack of remorse. Prevention of antisocial personality in childhood has been advocated, but evidence for effective interventions is lacking. The authors conducted two follow-up studies of randomized trials of group parent training. One involved 120 clinic-referred 3- to 7-year-olds with severe antisocial behavior for whom treatment was indicated, 93 of whom were reassessed between ages 10 and 17. The other involved 109 high-risk 4- to 6-year-olds with elevated antisocial behavior who were selectively screened from the community, 90 of whom were reassessed between ages 9 and 13. The primary psychiatric outcome measures were the two elements of antisocial personality, namely, antisocial behavior (assessed by a diagnostic interview) and antisocial character traits (assessed by a questionnaire). Also assessed were reading achievement (an important domain of youth functioning at work) and parent-adolescent relationship quality. In the indicated sample, both elements of antisocial personality were improved in the early intervention group at long-term follow-up compared with the control group (antisocial behavior: odds ratio of oppositional defiant disorder=0.20, 95% CI=0.06, 0.69; antisocial character traits: B=-4.41, 95% CI=-1.12, -8.64). Additionally, reading ability improved (B=9.18, 95% CI=0.58, 18.0). Parental expressed emotion was warmer (B=0.86, 95% CI=0.20, 1.41) and supervision was closer (B=-0.43, 95% CI=-0.11, -0.75), but direct observation of parenting showed no differences. Teacher-rated and self-rated antisocial behavior were unchanged. In contrast, in the selective high-risk sample, early intervention was not associated with improved long-term outcomes. Early intervention with

  15. Association between microfibrillar-associated protein 4 (MFAP4) and micro- and macrovascular complications in long-term type 1 diabetes mellitus. (United States)

    Blindbæk, S L; Schlosser, A; Green, A; Holmskov, U; Sorensen, G L; Grauslund, J


    To evaluate microfibrillar-associated protein 4 (MFAP4) as a marker of micro- and macrovascular complications in patients with type 1 diabetes. This cross-sectional study included 203 persons with a long duration of type 1 diabetes from a population-based cohort ascertained in the former Funen County, Denmark. Detection of plasma-MFAP4 (pMFAP4) was performed by the AlphaLISA Technique. Diabetic retinopathy (DR) was graded in accordance with the Early Treatment Diabetic Retinopathy Study adaptation of the modified Airlie House classification. A monofilament test was used to test for neuropathy, and nephropathy was evaluated in a single spot urine sample. Data describing macrovascular disease were obtained from the Danish National Patient Register. Median age and duration of diabetes were 58.7 and 43 years, respectively, and 61% were males. High levels of pMFAP4 were found in participants of old age, in women and in non-smokers (p diabetic neuropathy (OR 2.47 for quartile 4 versus quartile 1, 95% CI 1.01-6.03). No association was found between pMFAP4 and proliferative diabetic retinopathy, nephropathy or macrovascular disease. No association between pMFAP4 and macrovascular vascular complications was found. However, high levels of pMFAP4 correlated independently with diabetic neuropathy. Further studies on the predictive value of increased circulating MFAP4 in diabetic neuropathy are warranted.

  16. Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium. (United States)

    Goldberg, Ronald B; Aroda, Vanita R; Bluemke, David A; Barrett-Connor, Elizabeth; Budoff, Matthew; Crandall, Jill P; Dabelea, Dana; Horton, Edward S; Mather, Kieren J; Orchard, Trevor J; Schade, David; Watson, Karol; Temprosa, Marinella


    Despite the reduced incidence of coronary heart disease with intensive risk factor management, people with diabetes mellitus and prediabetes remain at increased coronary heart disease risk. Diabetes prevention interventions may be needed to reduce coronary heart disease risk. This approach was examined in the DPP (Diabetes Prevention Program) and the DPPOS (Diabetes Prevention Program Outcome Study), a long-term intervention study in 3234 subjects with prediabetes (mean±SD age, 64±10 years) that showed reduced diabetes risk with lifestyle and metformin compared with placebo over 3.2 years. The DPPOS offered periodic group lifestyle sessions to all participants and continued metformin in the originally randomized metformin group. Subclinical atherosclerosis was assessed in 2029 participants with coronary artery calcium (CAC) measurements after an average of 14 years of follow-up. The CAC scores were analyzed continuously as CAC severity and categorically as CAC presence (CAC score >0) and reported separately in men and women. There were no CAC differences between lifestyle and placebo intervention groups in either sex. CAC severity and presence were significantly lower among men in the metformin versus the placebo group (age-adjusted mean CAC severity, 39.5 versus 66.9 Agatston units, P =0.04; CAC presence, 75% versus 84%, P =0.02), but no metformin effect was seen in women. In multivariate analysis, the metformin effect in men was not influenced by demographic, anthropometric, or metabolic factors; by the development of diabetes mellitus; or by use/nonuse of statin therapy. Metformin may protect against coronary atherosclerosis in prediabetes and early diabetes mellitus among men. URL: Unique identifier: NCT00038727. © 2017 American Heart Association, Inc.

  17. Estradiol-induced increase in the magnitude of long-term potentiation is prevented by blocking NR2B-containing receptors. (United States)

    Smith, Caroline C; McMahon, Lori L


    Estradiol, through activation of genomic estrogen receptors, induces changes in synaptic morphology and function in hippocampus, a brain region important for memory acquisition. Specifically, this hormone increases CA1 pyramidal cell dendritic spine density, NMDA receptor (NMDAR)-mediated transmission, and the magnitude of long-term potentiation (LTP) at CA3-CA1 synapses. We recently reported that the estradiol-induced increase in LTP magnitude occurs only when there is a simultaneous increase in the fractional contribution of NMDAR-mediated transmission relative to AMPA receptor transmission, suggesting a direct role for the increase in NMDAR transmission to the heightened LTP magnitude. Estradiol has been shown to increase expression of the NMDAR subunit NR2B, but whether this translates into an increase in function of NR2B-containing receptors remains to be determined. Here we show that not only is the estradiol-induced increase in NMDAR transmission mediated by NR2B-containing receptors, but blocking these receptors using RO25-6981 [R-(R,S)-alpha-(4-hydroxyphenyl)-beta-methyl-4-(phenylmethyl)-1-piperidine propranol] (0.5 microM), an NR2B selective antagonist, prevents the estradiol-induced increase in LTP magnitude. Thus, our data show a causal link between the estradiol-induced increase in transmission mediated by NR2B-containing NMDARs and the increase in LTP magnitude.

  18. Do prophylactic antibiotics in gynecologic surgery prevent postoperative inflammatory complications? A systematic review. (United States)

    Boesch, Cedric Emanuel; Pronk, Roderick Franziskus; Medved, Fabian; Hentschel, Pascal; Schaller, Hans-Eberhard; Umek, Wolfgang


    The aim of this study was to systematically review the literature on antibiotic prophylaxis in gynaecologic surgeries to prevent inflammatory complications after gynaecological operations. The study was carried out as a systematic review. Only randomised controlled trials of women undergoing gynaecological surgery were included. The Medline and the Cochrane library databases were searched from 1966 to 2016. The trials must have investigated an antibiotic intervention to prevent an inflammatory complication after gynaecological surgery. Trials were excluded if they were not randomised, uncontrolled or included obstetrical surgery. Prophylactic antibiotics prevent inflammatory complications after gynaecological surgery. Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina. Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin. No benefit has been shown for the combination of antibiotics as prophylaxis. No difference has been shown between the long-term and short-term use of antibiotics. There is no need for the primary use of an anaerobic antibacterial agent. Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries.

  19. Dual- vs. single-chamber defibrillators for primary prevention of sudden cardiac death: long-term follow-up of the Défibrillateur Automatique Implantable-Prévention Primaire registry. (United States)

    Defaye, Pascal; Boveda, Serge; Klug, Didier; Beganton, Frankie; Piot, Olivier; Narayanan, Kumar; Périer, Marie-Cécile; Gras, Daniel; Fauchier, Laurent; Bordachar, Pierre; Algalarrondo, Vincent; Babuty, Dominique; Deharo, Jean-Claude; Leclercq, Christophe; Marijon, Eloi; Sadoul, Nicolas


    Implantable cardioverter defibrillators (ICDs) are an effective primary prevention of sudden cardiac death. We examined whether dual-chamber (DC) ICDs confer a greater benefit than single-chamber (SC) ICDs, and compared the long-term outcomes of recipients of each type of device implanted for primary prevention. Between 2002 and 2012, the DAI-PP registry consecutively enrolled 1258 SC- and 1280 DC-ICD recipients at 12 French medical centres. The devices were interrogated at 4- to 6-month intervals during outpatient visits, with a focus on the therapies delivered. The study endpoints were incidence of appropriate therapies, ICD-related morbidity, and deaths from all and from specific causes. The mean age of the SC- and DC-ICD recipients was 59 ± 12 and 62 ± 11 years, respectively (PDC- vs. 8.8% in the SC-ICD groups (P= 0.008). Over a mean follow-up of 3.1 ± 2.2 years, pulse generators were replaced in 21.9% of the DC- vs. 13.6% of the SC-ICD group (PDC-ICDs were associated with higher rates of peri-implant complications and generator replacements, whereas the survival and rates of inappropriate shocks were similar in both groups. NCT#01992458. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions please email:

  20. Antibiotics to prevent complications following tooth extractions. (United States)

    Lodi, Giovanni; Figini, Lara; Sardella, Andrea; Carrassi, Antonio; Del Fabbro, Massimo; Furness, Susan


    The most frequent indications for tooth extractions are dental caries and periodontal infections, and these extractions are generally done by general dental practitioners. Antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection. To determine the effect of antibiotic prophylaxis on the development of infectious complications following tooth extractions. The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 25 January 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1948 to 25 January 2012), EMBASE via OVID (1980 to 25 January 2012) and LILACS via BIREME (1982 to 25 January 2012). There were no restrictions regarding language or date of publication. We included randomised double-blind placebo-controlled trials of antibiotic prophylaxis in patients undergoing tooth extraction(s) for any indication. Two review authors independently assessed risk of bias for the included studies and extracted data. We contacted trial authors for further details where these were unclear. For dichotomous outcomes we calculated risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. For continuous outcomes we used mean differences (MD) with 95% CI using random-effects models. We examined potential sources of heterogeneity. The quality of the body of evidence has been assessed using the GRADE tool. This review included 18 double-blind placebo-controlled trials with a total of 2456 participants. Five trials were assessed at unclear risk of bias, thirteen at high risk, and none at low risk of bias. Compared to placebo, antibiotics probably reduce the risk of infection in patients undergoing third molar extraction(s) by approximately 70% (RR 0.29 (95% CI 0.16 to 0.50) P antibiotics to prevent one infection following extraction of impacted wisdom teeth. There is evidence that antibiotics may reduce

  1. Long-term follow-up study and long-term care of childhood cancer survivors

    Directory of Open Access Journals (Sweden)

    Hyeon Jin Park


    Full Text Available The number of long-term survivors is increasing in the western countries due to remarkable improvements in the treatment of childhood cancer. The long-term complications of childhood cancer survivors in these countries were brought to light by the childhood cancer survivor studies. In Korea, the 5-year survival rate of childhood cancer patients is approaching 70%; therefore, it is extremely important to undertake similar long-term follow-up studies and comprehensive long-term care for our population. On the basis of the experiences of childhood cancer survivorship care of the western countries and the current Korean status of childhood cancer survivors, long-term follow-up study and long-term care systems need to be established in Korea in the near future. This system might contribute to the improvement of the quality of life of childhood cancer survivors through effective intervention strategies.

  2. Preventing microvascular complications in type 1 diabetes mellitus


    Viswanathan, Vijay


    Patients with complications of diabetes such as retinopathy, nephropathy, and cardiovascular complications have increased hospital stay with greater economic burden. Prevention of complications should be started before the onset of type 1 diabetes mellitus (T1DM) by working on risk factors and thereafter by intervention upon confirmatory diagnosis which can prevent further damage to β-cells. The actual risk of getting microvascular complications like microalbuminuria and retinopathy progressi...

  3. Long-Term Collections

    CERN Multimedia

    Staff Association


    45 years helping in developing countries! CERN personnel have been helping the least fortunate people on the planet since 1971. How? With the Long-Term Collections! Dear Colleagues, The Staff Association’s Long-Term Collections (LTC) Committee is delighted to share this important milestone in the life of our Laboratory with you. Indeed, whilst the name of CERN is known worldwide for scientific discoveries, it also shines in the many humanitarian projects which have been supported by the LTC since 1971. Several schools and clinics, far and wide, carry its logo... Over the past 45 years, 74 projects have been supported (9 of which are still ongoing). This all came from a group of colleagues who wanted to share a little of what life offered them here at CERN, in this haven of mutual understanding, peace and security, with those who were less fortunate elsewhere. Thus, the LTC were born... Since then, we have worked as a team to maintain the dream of these visionaries, with the help of regular donat...

  4. Long-Term Collection

    CERN Multimedia

    Staff Association


    Dear Colleagues, As previously announced in Echo (No. 254), your delegates took action to draw attention to the projects of the Long-Term Collections (LTC), the humanitarian body of the CERN Staff Association. On Tuesday, 11 October, at noon, small Z-Cards were widely distributed at the entrances of CERN restaurants and we thank you all for your interest. We hope to have achieved an important part of our goal, which was to inform you, convince you and find new supporters among you. We will find out in the next few days! An exhibition of the LTC was also set up in the Main Building for the entire week. The Staff Association wants to celebrate the occasion of the Long-Term Collection’s 45th anniversary at CERN because, ever since 1971, CERN personnel have showed great support in helping the least fortunate people on the planet in a variety of ways according to their needs. On a regular basis, joint fundraising appeals are made with the Directorate to help the victims of natural disasters around th...

  5. Collectes à long terme

    CERN Multimedia

    Collectes à long terme


    En cette fin d’année 2014 qui approche à grands pas, le Comité des Collectes à Long Terme remercie chaleureusement ses fidèles donatrices et donateurs réguliers pour leurs contributions à nos actions en faveur des plus démunis de notre planète. C’est très important, pour notre Comité, de pouvoir compter sur l’appui assidu que vous nous apportez. Depuis plus de 40 ans maintenant, le modèle des CLT est basé principalement sur des actions à long terme (soit une aide pendant 4-5 ans par projet, mais plus parfois selon les circonstances), et sa planification demande une grande régularité de ses soutiens financiers. Grand MERCI à vous ! D’autres dons nous parviennent au cours de l’année, et ils sont aussi les bienvenus. En particulier, nous tenons à remercier...

  6. Complications of an implantable venous access port: Prevention and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Tae Seok; Song, Myung Gyu [Dept. of Radiology, Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Cha, In Ho [Dept. Radiology, Chungang University Hospital, Chungang University College of Medicine, Seoul (Korea, Republic of)


    Placement of an implantable venous access port (IVAP) is a popular procedure for repeated and intermittent chemotherapy in patients with malignancy. In this article, we present various IVAP related complications. In addition, we review the technical tips to prevent and manage the complications. It is important that the operator should keep the mechanism of the complications in mind, perform a careful procedure for prevention, and manage the complication properly and immediately in case of its development for safety and satisfaction of the patients Complications of an implantable venous access port: Prevention and treatment.

  7. The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. (United States)

    Anderson, Deverick J; Miller, Becky A; Chen, Luke F; Adcock, Linda H; Cook, Evelyn; Cromer, A Lynn; Louis, Susan; Thacker, Paul A; Sexton, Daniel J


    To describe the rates of several key outcomes and healthcare-associated infections (HAIs) among hospitals that participated in the Duke Infection Control Outreach Network (DICON). Prospective, observational cohort study of patients admitted to 24 community hospitals from 2003 through 2009. The following data were collected and analyzed: incidence of central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTIs), and HAIs caused by methicillin-resistant Staphylococcus aureus (MRSA); employee exposures to bloodborne pathogens (EBBPs); physician EBBPs; patient-days; central line-days; ventilator-days; and urinary catheter-days. Poisson regression was used to determine whether incidence rates of these HAIs and exposures changed during the first 5 and 7 years of participation in DICON; nonrandom clustering of each outcome was controlled for. Cost saved and lives saved were calculated on the basis of published estimates. In total, we analyzed 6.5 million patient-days, 4,783 EBPPs, 2,948 HAIs due to MRSA, and 2,076 device-related infections. Rates of employee EBBPs, HAIs due to MRSA, and device-related infections decreased significantly during the first 5 years of participation in DICON (Pprevented. Each hospital saved approximately $100,000 per year of participation, and collectively the hospitals may have prevented 52-105 deaths from CLABSI or VAP. The 7-year analysis demonstrated that these trends continued with further participation. Hospitals with long-term participation in an infection control network decreased rates of significant HAIs by approximately 50%, decreased costs, and saved lives.

  8. [Prognostic prediction of the functional capacity and effectiveness of functional improvement program of the musculoskeletal system among users of preventive care service under long-term care insurance]. (United States)

    Sone, Toshimasa; Nakaya, Naoki; Tomata, Yasutake; Aida, Jun; Okubo, Ichiro; Ohara, Satoko; Obuchi, Shuichi; Sugiyama, Michiko; Yasumura, Seiji; Suzuki, Takao; Tsuji, Ichiro


    The purpose of this study was to examine the effectiveness of the Functional Improvement Program of the Musculoskeletal System among users of Preventive Care Service under Long-Term Care Insurance. A total of 3,073 subjects were analyzed. We used the prediction formula to estimate the predicted value of the Kihon Checklist after one year, and calculated the measured value minus the predicted value. The subjects were divided into two groups according to the measured value minus predicted value tertiles: the lowest and middle tertile (good-to-fair measured value) and the highest tertile (poor measured value). We used a multiple logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) of the good-to-fair measured values of the Kihon Checklist after one year, according to the Functional Improvement Program of the Musculoskeletal System. In potentially dependent elderly, the multivariate adjusted ORs (95% CI) of the good-to-fair measured values were 2.4 (1.3-4.4) for those who attended the program eight times or more in a month (vs those who attended it three times or less in a month), 1.3 (1.0-1.8) for those who engaged in strength training using machines (vs those who did not train), and 1.4 (1.0-1.9) for those who engaged in endurance training. In this study, among potentially dependent elderly, those who attended the program eight times or more in a month and those who engaged in strength training using machines or endurance training showed a significant improvement of their functional capacity.

  9. [Antibiotic treatment for prevention of infectious complications in joint replacement]. (United States)

    Jahoda, D; Nyc, O; Pokorný, D; Landor, I; Sosna, A


    used only in indicated cases when deep infection is suspected and no assessment of the causative agent is available. Otherwise this approach carries a high risk of infectious complications in aseptic revision arthroplasty. Long-term, unjustified administration of antibiotics leads to an increase in resistance to the antibiotic involved. Some studies show that a day's course is as effective as a seven-day one. A shorter antibiotic course decreases the costs, reduces side-effects and minimizes the development of resistance. An optimal duration of antibiotic treatment has not been defined yet, and is still a hot issue for discussion. Many authors recommend one pre-operative antibiotic dose and, according to the kind of antibiotic, agree to its 24-hour administration in order to lower the toxic effect of antibiotic and to prevent selection of resistant microorganisms. The choice of suitable antibiotics for prophylactic treatment should be based on the range of agents causing joint replacement infections and the pharmacological properties of the drug. This should have minimal toxicity, should be well tolerated by the patient and, from the epidemiological point of view, should have a low risk of inducing resistance because of frequent use. Naturally, it is not possible to include all antibiotics against all causative agents and therefore attention should be paid, in the first place, to Gram-positive bacteria, i. e., staphylococci and streptococci, which are the most common causes of infectious complications associated with joint replacement. Because of difficulties related to the right choice of antibiotic, it is recommended to keep a record of complications in each patient in order to provide feedback and to facilitate the establishment of reliable antibiotic-based prevention. The prevention of infection in orthopedics is a comprehensive issue. It cannot be expected that prophylactic antibiotic treatment will compensate for mistakes made in operative protocols, for

  10. A Novel Study Paradigm for Long-term Prevention Trials in Alzheimer Disease: The Placebo Group Simulation Approach (PGSA): Application to MCI data from the NACC database. (United States)

    Berres, M; Kukull, W A; Miserez, A R; Monsch, A U; Monsell, S E; Spiegel, R


    as determined for the original NTB score. An algorithm comprising a small number of baseline variables, notably cognitive performance at baseline, forecasts the group trajectory of cognitive decline in subsequent years with high accuracy. The current analysis of 3 independent subgroups of aMCI patients from the NACC database supports the validity of the PGSA longitudinal algorithm for a NTB. Use of the PGSA in long-term secondary AD prevention trials deserves consideration.

  11. Prevention and treatment of complications following percutaneous nephrolithotomy

    NARCIS (Netherlands)

    Skolarikos, Andreas; de la Rosette, Jean


    PURPOSE OF REVIEW: The aim of this article is to identify classification and grading systems of percutaneous nephrolithotomy-related complications and evidence for the prevention and treatment of these complications. RECENT FINDINGS: A total complication rate of up to 83% following percutaneous

  12. Long-Term Symbolic Learning

    National Research Council Canada - National Science Library

    Kennedy, William G; Trafton, J. G


    What are the characteristics of long-term learning? We investigated the characteristics of long-term, symbolic learning using the Soar and ACT-R cognitive architectures running cognitive models of two simple tasks...

  13. Implementing long-term EAP follow-up with clients and family members to help prevent relapse-With implications for primary prevention. (United States)

    Foote, A; Googins, B; Moriarty, M; Sandonato, C; Nadolski, J; Jefferson, C


    This paper reports on a study in progress which involves (a) regular post-treatment contact by employee assistance program (EAP) staff with employees who seek help through the EAP, and (b) contact with a family member or other support person designated by the employee. The contacts are designed to provide support for maintenance of therapeutic gains, assistance in adjusting to current life situations, and early identification and prevention of relapse. The study will evaluate the process of initiating these contacts and will examine their effectiveness at reducing relapse. Factors associated with implementing these services in an EAP context are discussed.

  14. Long-term biodosimetry Redux

    International Nuclear Information System (INIS)

    Simon, Steven L.; Bouville, Andre


    This paper revisits and reiterates the needs, purposes and requirements of bio-dosimetric assays for long-term dose and health risk assessments. While the most crucial need for bio-dosimetric assays is to guide medical response for radiation accidents, the value of such techniques for improving our understanding of radiation health risk by supporting epidemiological (long-term health risk) studies is significant. As new cohorts of exposed persons are identified and new health risk studies are undertaken with the hopes that studying the exposed will result in a deeper understanding of radiation risk, the value of reliable dose reconstruction is underscored. The ultimate application of biodosimetry in long-term health risk studies would be to completely replace model-based dose reconstruction-a complex suite of methods for retrospectively estimating dose that is commonly fraught with large uncertainties due to the absence of important exposure-related information, as well as imperfect models. While biodosimetry could potentially supplant model-based doses, there are numerous limitations of presently available techniques that constrain their widespread application in health risk research, including limited ability to assess doses received far in the past, high cost, great inter-individual variability, invasiveness, higher than preferred detection limits and the inability to assess internal dose (for the most part). These limitations prevent the extensive application of biodosimetry to large cohorts and should be considered a challenge to researchers to develop new and more flexible techniques that meet the demands of long-term health risk research. Events in recent years, e.g. the Fukushima reactor accident and the increased threat of nuclear terrorism, underscore that any event that results in significant radiation exposures of a group of people will also produce a much larger population, exposed at lower levels, but that likewise needs (or demands) an exposure


    CERN Multimedia



    ACKNOWLEDGMENTS The Long-Term Collections (CLT) committee would like to warmly thank its faithful donors who, year after year, support our actions all over the world. Without you, all this would not be possible. We would like to thank, in particular, the CERN Firemen’s Association who donated 5000 CHF in the spring thanks to the sale of their traditional calendar, and the generosity of the CERN community. A huge thank you to the firemen for their devotion to our cause. And thank you to all those who have opened their door, their heart, and their purses! Similarly, we warmly thank the CERN Yoga Club once again for its wonderful donation of 2000 CHF we recently received. We would also like to tell you that all our projects are running well. Just to remind you, we are currently supporting the activities of the «Réflexe-Partage» Association in Mali; the training centre of «Education et Développement» in Abomey, Benin; and the orphanage and ...

  16. Study design: two long-term observational studies of the biosimilar filgrastim Nivestim™ (Hospira filgrastim) in the treatment and prevention of chemotherapy-induced neutropenia

    International Nuclear Information System (INIS)

    Kamioner, Didier; Fruehauf, Stefan; Maloisel, Fréderic; Cals, Laurent; Lepretre, Stéphane; Berthou, Christian


    407 patients, and NEXT in September 2013 with 2123 patients. Last patient, last visit for each study will be December 2013 and March 2014 respectively. The NEXT and VENICE studies will provide long-term safety, efficacy and practice pattern data in patients receiving Nivestim™ to support myelosuppressive chemotherapy in real world clinical practice. These data will improve our understanding of the performance of Nivestim™ in patients encountered in the general patient population. NEXT, VENICE

  17. Evaluating long term forecasts

    Energy Technology Data Exchange (ETDEWEB)

    Lady, George M. [Department of Economics, College of Liberal Arts, Temple University, Philadelphia, PA 19122 (United States)


    The U.S. Department of Energy's Energy Information Administration (EIA), and its predecessor organizations, has published projections of U.S. energy production, consumption, distribution and prices annually for over 30 years. A natural issue to raise in evaluating the projections is an assessment of their accuracy compared to eventual outcomes. A related issue is the determination of the sources of 'error' in the projections that are due to differences between the actual versus realized values of the associated assumptions. One way to do this would be to run the computer-based model from which the projections are derived at the time the projected values are realized, using actual rather than assumed values for model assumptions; and, compare these results to the original projections. For long term forecasts, this approach would require that the model's software and hardware configuration be archived and available for many years, possibly decades, into the future. Such archival creates many practical problems; and, in general, it is not being done. This paper reports on an alternative approach for evaluating the projections. In the alternative approach, the model is run many times for cases in which important assumptions are changed individually and in combinations. A database is assembled from the solutions and a regression analysis is conducted for each important projected variable with the associated assumptions chosen as exogenous variables. When actual data are eventually available, the regression results are then used to estimate the sources of the differences in the projections of the endogenous variables compared to their eventual outcomes. The results presented here are for residential and commercial sector natural gas and electricity consumption. (author)

  18. Navigating Long-Term Care

    Directory of Open Access Journals (Sweden)

    James D. Holt MD


    Full Text Available Americans over age 65 constitute a larger percentage of the population each year: from 14% in 2010 (40 million elderly to possibly 20% in 2030 (70 million elderly. In 2015, an estimated 66 million people provided care to the ill, disabled, and elderly in the United States. In 2000, according to the Centers for Disease Control and Prevention (CDC, 15 million Americans used some form of long-term care: adult day care, home health, nursing home, or hospice. In all, 13% of people over 85 years old, compared with 1% of those ages 65 to 74, live in nursing homes in the United States. Transitions of care, among these various levels of care, are common: Nursing home to hospital transfer, one of the best-studied transitions, occurs in more than 25% of nursing home residents per year. This article follows one patient through several levels of care.

  19. Long-term effects of a preoperative smoking cessation programme

    DEFF Research Database (Denmark)

    Villebro, Nete Munk; Pedersen, Tom; Møller, Ann M


    Preoperative smoking intervention programmes reduce post-operative complications in smokers. Little is known about the long-term effect upon smoking cessation.......Preoperative smoking intervention programmes reduce post-operative complications in smokers. Little is known about the long-term effect upon smoking cessation....

  20. Long Term Financing of Infrastructure


    Sinha, Sidharth


    Infrastructure projects, given their long life, require long term financing. The main sources of long term financings are insurance and pension funds who seek long term investments with low credit risk. However, in India household financial savings are mainly invested in bank deposits. Insurance and pension funds account for only a small percentage of household financial savings. In addition most infrastructure projects do not qualify for investment by insurance and pension funds because of t...

  1. Handling and prevention of complications in stone basketing

    NARCIS (Netherlands)

    de La Rosette, Jean J. M. C. H.; Skrekas, Thomas; Segura, Joseph W.


    OBJECTIVE: To review the incidence, risk factors, and treatment options of intraoperative and postoperative complications of stone basketing in urology with emphasis on certain principles that must be upheld to prevent those complications. METHODS: A literature search was performed using the MEDLINE

  2. Evaluation of high myopia complications prevention program in university freshmen


    Tseng, Gow-Lieng; Chen, Cheng-Yu


    Abstract High myopia is a global eye health problem because of its high incidence of sight-threatening complications. Due to the role of awareness, self-examination, and preventive behavior in prevention of morbidity of high myopia complications, promoting knowledge, capabilities, and attitude of high myopic personnel are required in this regard. In this quasi-experiment study, 31 freshmen with high myopia in a national university were enrolled in 2014. The data were collected by validated an...

  3. Long term effect of curcumin in regulation of glycolytic pathway and angiogenesis via modulation of stress activated genes in prevention of cancer.

    Directory of Open Access Journals (Sweden)

    Laxmidhar Das

    Full Text Available Oxidative stress, an important factor in modulation of glycolytic pathway and induction of stress activated genes, is further augmented due to reduced antioxidant defense system, which promotes cancer progression via inducing angiogenesis. Curcumin, a naturally occurring chemopreventive phytochemical, is reported to inhibit carcinogenesis in various experimental animal models. However, the underlying mechanism involved in anticarcinogenic action of curcumin due to its long term effect is still to be reported because of its rapid metabolism, although metabolites are accumulated in tissues and remain for a longer time. Therefore, the long term effect of curcumin needs thorough investigation. The present study aimed to analyze the anticarcinogenic action of curcumin in liver, even after withdrawal of treatment in Dalton's lymphoma bearing mice. Oxidative stress observed during lymphoma progression reduced antioxidant enzyme activities, and induced angiogenesis as well as activation of early stress activated genes and glycolytic pathway. Curcumin treatment resulted in activation of antioxidant enzyme super oxide dismutase and down regulation of ROS level as well as activity of ROS producing enzyme NADPH:oxidase, expression of stress activated genes HIF-1α, cMyc and LDH activity towards normal level. Further, it lead to significant inhibition of angiogenesis, observed via MMPs activity, PKCα and VEGF level, as well as by matrigel plug assay. Thus findings of this study conclude that the long term effect of curcumin shows anticarcinogenic potential via induction of antioxidant defense system and inhibition of angiogenesis via down regulation of stress activated genes and glycolytic pathway in liver of lymphoma bearing mice.

  4. Long-term urethral catheterisation. (United States)

    Turner, Bruce; Dickens, Nicola

    This article discusses long-term urethral catheterisation, focusing on the relevant anatomy and physiology, indications for the procedure, catheter selection and catheter care. It is important that nurses have a good working knowledge of long-term catheterisation as the need for this intervention will increase with the rise in chronic health conditions and the ageing population.

  5. Prevention and treatment of complications for thyroid-arterial embolization

    International Nuclear Information System (INIS)

    Yang Jijin; Yuan Min; Tian Jianming; Chen Wei; Yang Chaoai; Hao Qiang; Zou Dajing; Wang Yongchun


    Objective: To investigate the complications of thyroid-arterial embolization and their prevention and treatment. Methods: 61 cases of thyroid disorders received the therapy of thyroid-arterial embolization were retrospectively studied. The complications of arterial embolization during or after the procedure were analyzed. How to prevent and deal with these complications were discussed. Results: Sensitivity to contrast media occurred in 1 case and surgical arterial injury in 2. After embolization thyroid storm occurred in 1 patient and all other complications including headache (23 cases), toothache (11 cases), neckache (13 cases), hoarseness (37 cases) were caused by non-target arterial embolization with the most serious one of cerebral infarction (1 case) and another eyelid ptosis (1 case). The cerebral infarct one was treated with some vasodilating drugs and anti-coagulant, all others were given anti-symptomatics or no special treatment. Conclusions: Proper treatment should be ready during thyroid arterial embolization and given in time with occurrence of complications

  6. Do preoperative antibiotics prevent dental implant complications? (United States)

    Balevi, Ben


    The Cochrane Oral Health Group's Trials Registry, the Cochrane Central Register of Controlled Trials, Medline and Embase were consulted to find relevant work. Searches were made by hand of numerous journals pertinent to oral implantology. There were no language restrictions. Randomised controlled clinical trials (RCT) with a followup of at least 3 months were chosen. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.). Two reviewers independently assessed the quality and extracted relevant data from included studies. The estimated effect of the intervention was expressed as a risk ratio together with its 95% confidence interval (CI). Numbers-needed-to-treat (NNT) were calculated from numbers of patients affected by implant failures. Meta-analysis was done only if there were studies with similar comparisons that reported the same outcome measure. Significance of any discrepancies between studies was assessed by means of the Cochran's test for heterogeneity and the I2 statistic. Only two RCT met the inclusion criteria. Meta-analysis of these two trials showed a statistically significantly higher number of patients experiencing implant failures in the group not receiving antibiotics (relative risk, 0.22; 95% CI, 0.06-0.86). The NNT to prevent one patient having an implant failure is 25 (95%CI, 13-100), based on a patient implant failure rate of 6% in people not receiving antibiotics. The following outcomes were not statistically significantly linked with implant failure: prosthesis failure, postoperative infection and adverse events (eg, gastrointestinal effects, hypersensitivity). There is some evidence suggesting that 2 g of amoxicillin given orally 1 h preoperatively significantly reduces failures of dental implants placed in ordinary conditions. It remains unclear whether postoperative antibiotics are beneficial, and which is the most effective antibiotic. One dose of

  7. Evaluation of high myopia complications prevention program in university freshmen. (United States)

    Tseng, Gow-Lieng; Chen, Cheng-Yu


    High myopia is a global eye health problem because of its high incidence of sight-threatening complications. Due to the role of awareness, self-examination, and preventive behavior in prevention of morbidity of high myopia complications, promoting knowledge, capabilities, and attitude of high myopic personnel are required in this regard.In this quasi-experiment study, 31 freshmen with high myopia in a national university were enrolled in 2014. The data were collected by validated and reliable questionnaire based on health belief model (HBM) and self-efficacy theory. The intervention program consisted of 1 educational session lasting 150 minutes by lecturing of high myopia complications, virtual reality experiencing, similarity modeling, and quibbling a film made on high myopia complications preventive concepts.Implementing the educational program showed immediate effect in knowledge, perceived susceptibility, perceived severity, self-efficacy, and preventive behavior intention. While 6 weeks after the educational program, significant increases were observed in cues to action, self-efficacy, and preventive behavior intention.This article provided that, after a single session, there was positive improvement in high myopia complication prevention behavior intention among participants. These positive effects confirmed the efficacy of the education program and will probably induce behavior change.

  8. The Prevention of Child Maltreatment Through the Nurse Family Partnership Program: Mediating Effects in a Long-Term Follow-Up Study. (United States)

    Eckenrode, John; Campa, Mary I; Morris, Pamela A; Henderson, Charles R; Bolger, Kerry E; Kitzman, Harriet; Olds, David L


    We examine maternal life-course mediators of the impact of a nurse home visitation program on reducing child maltreatment among participants in the Elmira trial of the Nurse Family Partnership program from the first child's birth through age 15. For women having experienced low to moderate levels of domestic violence, program effects on the number of confirmed maltreatment reports were mediated by reductions in numbers of subsequent children born to mothers and their reported use of public assistance. Together, the two mediators explained nearly one half of the total effect of nurse home visiting on child maltreatment. The long-term success of this program on reducing child maltreatment can be explained, at least in part, by its positive effect on pregnancy planning and economic self-sufficiency.

  9. Long term effect of curcumin in restoration of tumour suppressor p53 and phase-II antioxidant enzymes via activation of Nrf2 signalling and modulation of inflammation in prevention of cancer.

    Directory of Open Access Journals (Sweden)

    Laxmidhar Das

    Full Text Available Inhibition of carcinogenesis may be a consequence of attenuation of oxidative stress via activation of antioxidant defence system, restoration and stabilization of tumour suppressor proteins along with modulation of inflammatory mediators. Previously we have delineated significant role of curcumin during its long term effect in regulation of glycolytic pathway and angiogenesis, which in turn results in prevention of cancer via modulation of stress activated genes. Present study was designed to investigate long term effect of curcumin in regulation of Nrf2 mediated phase-II antioxidant enzymes, tumour suppressor p53 and inflammation under oxidative tumour microenvironment in liver of T-cell lymphoma bearing mice. Inhibition of Nrf2 signalling observed during lymphoma progression, resulted in down regulation of phase II antioxidant enzymes, p53 as well as activation of inflammatory signals. Curcumin potentiated significant increase in Nrf2 activation. It restored activity of phase-II antioxidant enzymes like GST, GR, NQO1, and tumour suppressor p53 level. In addition, curcumin modulated inflammation via upregulation of TGF-β and reciprocal regulation of iNOS and COX2. The study suggests that during long term effect, curcumin leads to prevention of cancer by inducing phase-II antioxidant enzymes via activation of Nrf2 signalling, restoration of tumour suppressor p53 and modulation of inflammatory mediators like iNOS and COX2 in liver of lymphoma bearing mice.

  10. [Interventions based on exercise and physical environment for preventing falls in cognitively impaired older people living in long-term care facilities: A systematic review and meta-analysis]. (United States)

    González-Román, Loreto; Bagur-Calafat, Caritat; Urrútia-Cuchí, Gerard; Garrido-Pedrosa, Jèssica


    This systematic review aims to report the effectiveness of interventions based on exercise and/or physical environment for reducing falls in cognitively impaired older adults living in long-term care facilities. In July 2014, a literature search was conducted using main databases and specialised sources. Randomised controlled trials assessing the effectiveness of fall prevention interventions, which used exercise or physical environment among elderly people with cognitive impairment living in long-term care facilities, were selected. Two independent reviewers checked the eligibility of the studies, and evaluated their methodological quality. If it was adequate, data were gathered. Fourteen studies with 3,539 participants using exercise and/or physical environment by a single or combined approach were included. The data gathered from studies that used both interventions showed a significant reduction in fall rate. Further research is needed to demonstrate the effectiveness of those interventions for preventing falls in the elderly with cognitive impairment living in long-term care establishments. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

  11. Salt brickwork as long-term sealing in salt formations

    International Nuclear Information System (INIS)

    Walter, F.; Yaramanci, U.


    Radioactive wastes can be disposed of in deep salt formations. Rock salt is a suitable geologic medium because of its unique characteristics. Open boreholes, shafts and drifts are created to provide physical access to the repository. Long-term seals must be emplaced in these potential pathways to prevent radioactive release into the biosphere. The sealing materials must be mechanically and, most important, geochemically stable within the host rock. Salt bricks made from compressed salt-powder are understood to be the first choice long-term sealing material. Seals built of salt bricks will be ductile. Large sealing systems are built by combining the individual bricks with mortar. Raw materials for mortar are fine-grained halite powder and ground saliferous clay. This provides for the good adhesive strength of the mortar to the bricks and the high shear-strength of the mortar itself. To test the interaction of rock salt with an emplaced long-term seal, experiments will be carried out in situ, in the Asse salt mine in Germany. Simple borehole sealing experiments will be performed in horizontal holes and a complicated drift sealing experiment is planned, to demonstrate the technology of sealing a standard size drift or shaft inside a disturbed rock mass. Especially, the mechanical stability of the sealing system has to be demonstrated

  12. Does a more extensive mucosal excision prevent haemorrhoidal recurrence after stapled haemorrhoidopexy? Long-term outcome of a randomized controlled trial. (United States)

    Altomare, D F; Pecorella, G; Tegon, G; Aquilino, F; Pennisi, D; De Fazio, M


    The study aimed in a multicentric randomized controlled trial to define the role of a more extensive mucosal resection on recurrence of mucosal prolapse in patients with Stage III haemorrhoids undergoing stapled haemorrhoidopexy. In all, 135 patients were randomized to treatment with a PPH-01/03 (Ethicon EndoSurgery) or an EEA (Covidien) stapler. They were reviewed after a minimum follow-up of 4 years to determine the rate of recurrent mucosal prolapse and general condition (wellness evaluation score). Postoperative bowel dysfunction was assessed using the Rome III criteria. Eighty-seven (65%) of the 135 patients (48 in the EEA stapler group and 37 in the PPH group) were available for long-term follow-up. The two groups were comparable for age, gender and duration of follow-up (mean 49.3 ± 5.4 months and 49.0 ± 5.3 months respectively). In the EEA group, 11 (23%) patients had some degree of recurrent prolapse compared with 12 (32%) in the PPH group (P = 0.409). Persistence of anal bleeding was significantly higher in the PPH group (P = 0.04) while the postoperative Haemorrhoid Symptom Score was significantly better in the EEA group (1.73 ± 1.65 vs 3.17 ± 1.94, P < 0.001). The wellness evaluation score was significantly better in the EEA group (1.2 ± 1.27 vs 0.6 ± 1.0, P = 0.028). Furthermore, 7 (15%) of the patients in the EEA group complained of some evacuation disturbance compared with 13 (36%) in the PPH group (P = 0.021). The study failed to demonstrate any significant difference in the long-term recurrence rate of Stage III haemorrhoids using EEA or PPH. Nevertheless, use of the larger volume EEA provides better symptom resolution compared with PPH. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  13. Non-alcoholic fatty liver disease and impaired proinsulin conversion as newly identified predictors of the long-term non-response to a lifestyle intervention for diabetes prevention: results from the TULIP study. (United States)

    Schmid, Vera; Wagner, Robert; Sailer, Corinna; Fritsche, Louise; Kantartzis, Konstantinos; Peter, Andreas; Heni, Martin; Häring, Hans-Ulrich; Stefan, Norbert; Fritsche, Andreas


    Lifestyle intervention is effective to prevent type 2 diabetes. However, a considerable long-term non-response occurs to a standard lifestyle intervention. We investigated which risk phenotypes at baseline and their changes during the lifestyle intervention predict long-term glycaemic non-response to the intervention. Of 300 participants at high risk for type 2 diabetes who participated in a 24 month lifestyle intervention with diet modification and increased physical activity, 190 participants could be re-examined after 8.7 ± 1.6 years. All individuals underwent a five-point 75 g OGTT and measurements of body fat compartments and liver fat content with MRI and spectroscopy at baseline, 9 and 24 months during the lifestyle intervention, and at long-term follow-up. Fasting proinsulin to insulin conversion (PI/I ratio) and insulin sensitivity and secretion were calculated from the OGTT. Non-response to lifestyle intervention was defined as no decrease in glycaemia, i.e. no decrease in AUC for glucose at 0-120 min during OGTT (AUCglucose 0-120 min ). Before the lifestyle intervention, 56% of participants had normal glucose regulation and 44% individuals had impaired fasting glucose and/or impaired glucose tolerance. At long-term follow-up, 11% had developed diabetes. Multivariable regression analysis with adjustment for age, sex, BMI and change in BMI during the lifestyle intervention revealed that baseline insulin secretion and insulin sensitivity, as well as change in insulin sensitivity during the lifestyle intervention, predicted long-term glycaemic control after 9 years. In addition, increased hepatic lipid content as well as impaired fasting proinsulin conversion at baseline were newly detected phenotypes that independently predicted long-term glycaemic control. Increased hepatic lipid content and impaired proinsulin conversion are new predictors, independent of change in body weight, for non-response to lifestyle intervention in addition to the

  14. Factors affecting nursing staff use of a communication tool to reduce potentially preventable acute care transfers in long-term care. (United States)

    Ballard, Stephanie A; Peretti, Matteo; Lungu, Ovidiu; Voyer, Philippe; Tabamo, Fruan; Alfonso, Linda; Cetin-Sahin, Deniz; Johnson, Sarasa M A; Wilchesky, Machelle

    Although specialized communication tools can effectively reduce acute care transfers, few studies have assessed the factors that may influence the use of such tools by nursing staff at the individual level. We evaluated the associations between years of experience, tool-related training, nursing attitudes, and intensity of use of a communication tool developed to reduce transfers in a long-term care facility. We employed a mixed methods design using data from medical charts, electronic records, and semi-structured interviews. Experienced nurses used the tool significantly less than inexperienced nurses, and training had a significant positive impact on tool use. Nurses found the purpose of the tool to be confusing. No significant differences in attitude were observed based on years of experience or intensity of use. Project findings indicate that focused efforts to enrich training may increase intervention adherence. Experienced nurses in particular should be made aware of the benefits of utilizing communication tools. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. A burn prevention program as a long-term investment: trends in burn injuries among Jews and Bedouin children in Israel. (United States)

    Shani, E; Bahar-Fuchs, S A; Abu-Hammad, I; Friger, M; Rosenberg, L


    In order to broaden our long-term intervention efforts in elementary schools in Israel (underway since 1988) and to set priorities for further population-specific actions, we compared the pattern of burn injuries among two age groups (0-4; 5-14) of two ethnic groups of Jews and Bedouins admitted to a regional hospital between 1986 and 1995 (n = 1050). The findings indicated a significant downward trend, though somewhat nonlinear, in burn admissions among the older age groups. A relatively less favorable trend was observed for the younger age groups. Consistently across years, burn rates in the younger group of Bedouin children were the highest. For the 10-year period, a significant season by ethnic group variation in burn admissions was observed, with a peak in the spring and in the wintertime for the Jews and Bedouins, respectively. A significant trend of decrease, mostly among older children, in average lengths of hospital stay, was also evident. Yet, regardless of age group and across years, Bedouin children stayed longer in the hospital than Jewish children. The overall leading causes of injury (for 1992-1995) were hot liquids (69%), fire (17%), chemicals (9.5%) and contact (2%). In our view, there is a need to address at-risk populations through environmental, community and family-oriented interventions and to venture beyond the pathogenic factors to the investigation of the salutary factors of health under diverse life conditions.

  16. Combined effect of blood pressure and total cholesterol levels on long-term risks of subtypes of cardiovascular death: Evidence for Cardiovascular Prevention from Observational Cohorts in Japan. (United States)

    Satoh, Michihiro; Ohkubo, Takayoshi; Asayama, Kei; Murakami, Yoshitaka; Sakurai, Masaru; Nakagawa, Hideaki; Iso, Hiroyasu; Okayama, Akira; Miura, Katsuyuki; Imai, Yutaka; Ueshima, Hirotsugu; Okamura, Tomonori


    No large-scale, longitudinal studies have examined the combined effects of blood pressure (BP) and total cholesterol levels on long-term risks for subtypes of cardiovascular death in an Asian population. To investigate these relationships, a meta-analysis of individual participant data, which included 73 916 Japanese subjects (age, 57.7 years; men, 41.1%) from 11 cohorts, was conducted. During a mean follow-up of 15.0 years, deaths from coronary heart disease, ischemic stroke, and intraparenchymal hemorrhage occurred in 770, 724, and 345 cases, respectively. Cohort-stratified Cox proportional hazard models were used. After stratifying the participants by 4 systolic BP ×4 total cholesterol categories, the group with systolic BP ≥160 mm Hg with total cholesterol ≥5.7 mmol/L had the greatest risk for coronary heart disease death (adjusted hazard ratio, 4.39; Pdeath, and total cholesterol was inversely associated with intraparenchymal hemorrhage, but no significant interactions between BP and total cholesterol were observed for stroke. High BP and high total cholesterol can synergistically increase the risk for coronary heart disease death but not for stroke in the Asian population. © 2015 American Heart Association, Inc.

  17. [Long-term psychiatric hospitalizations]. (United States)

    Plancke, L; Amariei, A


    Long-term hospitalizations in psychiatry raise the question of desocialisation of the patients and the inherent costs. Individual indicators were extracted from a medical administrative database containing full-time psychiatric hospitalizations for the period 2011-2013 of people over 16 years old living in the French region of Nord-Pas-de-Calais. We calculated the proportion of people who had experienced a hospitalization with a duration of 292 days or more during the study period. A bivariate analysis was conducted, then ecological data (level of health-care offer, the deprivation index and the size of the municipalities of residence) were included into a multilevel regression model in order to identify the factors significantly related to variability of long-term hospitalization rates. Among hospitalized individuals in psychiatry, 2.6% had had at least one hospitalization of 292 days or more during the observation period; the number of days in long-term hospitalization represented 22.5% of the total of days of full-time hospitalization in psychiatry. The bivariate analysis revealed that seniority in the psychiatric system was strongly correlated with long hospitalization rates. In the multivariate analysis, the individual indicators the most related to an increased risk of long-term hospitalization were: total lack of autonomy (OR=9.0; 95% CI: 6.7-12.2; P<001); diagnoses of psychological development disorders (OR=9.7; CI95%: 4.5-20.6; P<.001); mental retardation (OR=4.5; CI95%: 2.5-8.2; P<.001): schizophrenia (OR=3.0; CI95%: 1.7-5.2; P<.001); compulsory hospitalization (OR=1.7; CI95%: 1.4-2.1; P<.001); having experienced therapeutic isolation (OR=1.8; CI95%: 1.5-2.1; P<.001). Variations of long-term hospitalization rates depending on the type of establishment were very high, but the density of hospital beds or intensity of ambulatory activity services were not significantly linked to long-term hospitalization. The inhabitants of small urban units had

  18. Lansoprazole for secondary prevention of gastric or duodenal ulcers associated with long-term non-steroidal anti-inflammatory drug (NSAID) therapy: results of a prospective, multicenter, double-blind, randomized, double-dummy, active-controlled trial. (United States)

    Sugano, Kentaro; Kontani, Teiji; Katsuo, Shinichi; Takei, Yoshinori; Sakaki, Nobuhiro; Ashida, Kiyoshi; Mizokami, Yuji; Asaka, Masahiro; Matsui, Shigeyuki; Kanto, Tatsuya; Soen, Satoshi; Takeuchi, Tsutomu; Hiraishi, Hideyuki; Hiramatsu, Naoki


    Low-dose lansoprazole has not been intensively evaluated for its efficacy in the prevention of recurrent gastric or duodenal ulcers in patients receiving long-term non-steroidal anti-inflammatory drug (NSAID) therapy for pain relief in such diseases as rheumatoid arthritis, osteoarthritis, and low back pain. This multi-center, prospective, double-blind, randomized, active-controlled study involving 99 sites in Japan was designed to compare the efficacy of lansoprazole (15 mg daily) with gefarnate (50 mg twice daily). Patients with a history of gastric or duodenal ulcers who required long-term NSAID therapy were randomized to receive lansoprazole 15 mg daily (n = 185) or gefarnate 50 mg twice daily (n = 181) and followed up for 12 months or longer prospectively. The cumulative incidence of gastric or duodenal ulcer at days 91, 181, and 361 from the start of the study was calculated by the Kaplan-Meier method as 3.3, 5.9, and 12.7%, respectively, in the lansoprazole group versus 18.7, 28.5, and 36.9%, respectively, in the gefarnate group. The risk for ulcer development was significantly (log-rank test, P lansoprazole group than in the gefarnate group, with the hazard ratio being 0.2510 (95% CI 0.1400-0.4499). A long-term follow-up study showed an acceptable safety profile for low-dose lansoprazole therapy, with diarrhea as the most frequent adverse event. Lansoprazole was superior to gefarnate in reducing the risk of gastric or duodenal ulcer recurrence in patients with a definite history of gastric or duodenal ulcers who required long-term NSAID therapy.

  19. Maternal complication prevention: evidence from a case-control study in southwest Nigeria

    Directory of Open Access Journals (Sweden)

    Kayode O. Osungbade


    Full Text Available Background: The importance of strengthening maternal health services as a preventive intervention for morbidities and complications during pregnancy and delivery in developing countries cannot be over-emphasised, since use of prenatal health services improves maternal health outcomes. Aim: This study investigated differences in risk factors for maternal complications in booked and unbooked pregnant women in Nigeria, and provided evidence for their prevention. Setting: The study was carried out in a postnatal ward in a secondary health facility. Methods: This was a case-control study involving booked and unbooked pregnant women who had delivered. Consecutive enrolment of all unbooked pregnant women (cases was done, and one booked pregnant woman (control was enrolled and matched for age with each of these. Both groups were interviewed using a questionnaire, whilst records of delivery were extracted from the hospital files. Findings were subjected to logistical regression at a significance level of p < 0.05. Results: Booked women had a lower median length of labour (10 hours compared to unbooked women (13 hours. More women in the booked control group (139; 35.1% than in the unbooked case group (96; 23.6% reported at least one type of morbidity during the index pregnancy (p = 0.0004. Booking status was associated with a likelihood of spontaneous vaginal delivery. Young maternal age, low education, rural residence and low socio-economic status were associated with less likelihood of using prenatal services. Young maternal age, low education and intervention in the delivery were associated with a likelihood of experiencing a complication of delivery. Conclusion: Strengthening antenatal and secondary healthcare services as short- and mediumterm measures might be cost-effective as a preventive strategy in complications of pregnancy,whilst socio-economic dimensions of health are accorded priority in the long term.

  20. A Multi-institutional Prospective Observational Study of Stereotactic Radiosurgery for Patients With Multiple Brain Metastases (JLGK0901 Study Update): Irradiation-related Complications and Long-term Maintenance of Mini-Mental State Examination Scores. (United States)

    Yamamoto, Masaaki; Serizawa, Toru; Higuchi, Yoshinori; Sato, Yasunori; Kawagishi, Jun; Yamanaka, Kazuhiro; Shuto, Takashi; Akabane, Atsuya; Jokura, Hidefumi; Yomo, Shoji; Nagano, Osamu; Aoyama, Hidefumi


    The JLGK0901 study showed the noninferiority of stereotactic radiosurgery (SRS) alone as initial treatment of 5 to 10 brain metastases (BMs) compared with 2 to 4 BMs in terms of overall survival and most secondary endpoints (Lancet Oncol 2014;15:387-95). However, observation periods were not long enough to allow confirmation of the long-term safety of SRS alone in patients with 5 to 10 BMs. This was a prospective observational study of Gamma Knife SRS-treated patients with 1 to 10 newly diagnosed BMs enrolled at 23 facilities between March 1, 2009, and February 15, 2012. The 1194 eligible patients were categorized into the following groups: group A, 1 tumor (n=455); group B, 2 to 4 tumors (n=531); and group C, 5 to 10 tumors (n=208). Cumulative rates of Mini-Mental State Examination (MMSE) score maintenance (MMSE score decrease <3 from baseline) determined with a competing risk analysis of groups A, B, and C were 93%, 91%, and 92%, respectively, at the 12th month after SRS; 91%, 89%, and 91%, respectively, at the 24th month; 89%, 88%, and 89%, respectively, at the 36th month; and 87%, 86%, and 89%, respectively, at the 48th month (hazard ratio [HR] of group A vs group B, 0.719; 95% confidence interval [CI], 0.437-1.172; P=.18; HR of group B vs group C, 1.280; 95% CI, 0.696-2.508; P=.43). During observations ranging from 0.3 to 67.5 months (median, 12.0 months; interquartile range, 5.8-26.5 months), as of December 2014, 145 patients (12.1%) had SRS-induced complications. Cumulative complication incidences by competing risk analysis for groups A, B, and C were 7%, 8%, and 6%, respectively, at the 12th month after SRS; 10%, 11%, and 11%, respectively, at the 24th month; 11%, 11%, and 12%, respectively, at the 36th month; and 12%, 12%, and 13%, respectively, at the 48th month (HR of group A vs group B, 0.850; 95% CI, 0.592-1.220; P=.38; HR of group B vs group C, 1.052; 95% CI, 0.666-1.662, P=.83). Leukoencephalopathy occurred in 12 of the 1074 patients (1.1%) with

  1. Long-Term Visual Prognosis of Peripheral Multifocal Chorioretinitis

    NARCIS (Netherlands)

    Ossewaarde-van Norel, J; ten Dam-van Loon, NH; de Boer, JH; Rothova, A.


    Purpose To report on the clinical manifestations, complications, and long-term visual prognosis of patients with peripheral multifocal chorioretinitis and to search for predictors for a lower visual outcome. Design Retrospective consecutive observational case series. Methods setting: Institutional.

  2. Prevention and treatment of the orofacial complications of radiotherapy

    International Nuclear Information System (INIS)

    Rothwell, B.R.


    Radiotherapy of malignant head and neck tumors often causes extensive, permanent changes in salivary glands, peridental alveolar bone, and mucosal structures. Dental neglect and inappropriate dental management can cause complications. The potential orofacial side effects of radiotherapy are reviewed, as are preventive strategies for the dental treatment of patients scheduled to undergo radiotherapy

  3. Long-term outcome of a randomized controlled universal prevention trial through a positive parenting program: is it worth the effort?


    Hahlweg, Kurt; Heinrichs, Nina; Kuschel, Annett; Bertram, Heike; Naumann, Sebastian


    Abstract Background Approximately 20% of children experience internalizing or externalizing DSM-IV-TR disorders. This prevalence rate cannot be reduced through treatment only. Effective preventive interventions are therefore urgently needed. The aim of the current investigation is to evaluate the two-year efficacy of the group Triple P parenting program administered universally for the prevention of child behavior problems. Methods Based on their respective preschool, N = 280 families were ra...

  4. Endovascular gamma-irradiation for prevention of restenosis after angioplasty of femoropopliteal de-novo-stenoses. Long-term results of a feasibility study

    International Nuclear Information System (INIS)

    Krueger, K.; Zaehringer, M.; Schulte, O.; Lackner, K.; Bendel, M.; Bongartz, R.; Nolte, M.


    Objectives: To evaluate the performance and efficacy of endovascular irradiation after percutaneous transluminal angioplasty (PTA) of de-novo femoropopliteal stenoses in a pilot study. Methods: 6 patients received non-centered endovascular irradiation (12 Gray at surface of the vessel wall) immediately after angioplasty of de-novo femoropopliteal stenosis, 1 patient was given centered endovascular irradiation using 192-iridium (12 Gray at surface of the vessel wall) Centered irradiation was considered for two other patients. Duplex sonographies and interviews were performed the day before and after PTA and after 1, 3, 6, 9, 12, 18, 24 months up to 4 years. Intraarterial angiography was performed in symptomatic patients. Results: Non-centered endovascular irradiation was possible in all patiens without problems or complications. Centered irradiation was not possible in two patients with the cross-over approach. One thromboembolic complication occurred during centered irradiation. Both restenosis and new stenosis at the edge of irradiated distance occurred in 1/7 patiens. No other side effects were observed during follow-up. Conclusions: In our pilot study endovascular irradiation after angioplasty of de-novo femoropopliteal stenosis was possible with low rates of complications and restenosis and taking vessel anatomy into account. (orig.) [de

  5. Influenza in long-term care facilities. (United States)

    Lansbury, Louise E; Brown, Caroline S; Nguyen-Van-Tam, Jonathan S


    Long-term care facility environments and the vulnerability of their residents provide a setting conducive to the rapid spread of influenza virus and other respiratory pathogens. Infections may be introduced by staff, visitors or new or transferred residents, and outbreaks of influenza in such settings can have devastating consequences for individuals, as well as placing extra strain on health services. As the population ages over the coming decades, increased provision of such facilities seems likely. The need for robust infection prevention and control practices will therefore remain of paramount importance if the impact of outbreaks is to be minimised. In this review, we discuss the nature of the problem of influenza in long-term care facilities, and approaches to preventive and control measures, including vaccination of residents and staff, and the use of antiviral drugs for treatment and prophylaxis, based on currently available evidence. © 2017 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

  6. Trajectories of change and long-term outcomes in a randomised controlled trial of internet-based insomnia treatment to prevent depression. (United States)

    Batterham, Philip J; Christensen, Helen; Mackinnon, Andrew J; Gosling, John A; Thorndike, Frances P; Ritterband, Lee M; Glozier, Nick; Griffiths, Kathleen M


    Insomnia treatment using an internet-based cognitive-behavioural therapy for insomnia (CBT-I) program reduces depression symptoms, anxiety symptoms and suicidal ideation. However, the speed, longevity and consistency of these effects are unknown. To test the following: whether the efficacy of online CBT-I was sustained over 18 months; how rapidly the effects of CBT-I emerged; evidence for distinct trajectories of change in depressive symptoms; and predictors of these trajectories. A randomised controlled trial compared the 6-week Sleep Healthy Using the Internet (SHUTi) CBT-I program to an attention control program. Adults ( N =1149) with clinical insomnia and subclinical depression symptoms were recruited online from the Australian community. Depression, anxiety and insomnia decreased significantly by week 4 of the intervention period and remained significantly lower relative to control for >18 months (between-group Cohen's d =0.63, 0.47, 0.55, respectively, at 18 months). Effects on suicidal ideation were only short term. Two depression trajectories were identified using growth mixture models: improving (95%) and stable/deteriorating (5%) symptoms. More severe baseline depression, younger age and limited comfort with the internet were associated with reduced odds of improvement. Online CBT-I produced rapid and long-term symptom reduction in people with subclinical depressive symptoms, although the initial effect on suicidal ideation was not sustained. P.J.B. has received grants from the National Health and Medical Research Council (NHMRC) during the conduct of the study. H.C. has received grants from the NHMRC and the Australian Research Council during the conduct of the study. L.M.R. receives research funding from the National Institutes of Health (NIH) that, in part, focuses on insomnia. F.P.T. and L.M.R. have equity ownership in BeHealth Solutions (Charlottesville, VA, USA), a company that develops and makes available products related to the research reported

  7. Lansoprazole for secondary prevention of gastric or duodenal ulcers associated with long-term low-dose aspirin therapy: results of a prospective, multicenter, double-blind, randomized, double-dummy, active-controlled trial. (United States)

    Sugano, Kentaro; Matsumoto, Yasushi; Itabashi, Tsukasa; Abe, Sumihisa; Sakaki, Nobuhiro; Ashida, Kiyoshi; Mizokami, Yuji; Chiba, Tsutomu; Matsui, Shigeyuki; Kanto, Tatsuya; Shimada, Kazuyuki; Uchiyama, Shinichiro; Uemura, Naomi; Hiramatsu, Naoki


    The efficacy of low-dose lansoprazole has not been established for the prevention of recurrent gastric or duodenal ulcers in those receiving long-term low-dose aspirin (LDA) for cardiovascular and cerebrovascular protection. This study sought to examine the efficacy of low-dose lansoprazole (15 mg once daily) for the secondary prevention of LDA-associated gastric or duodenal ulcers. Patients were randomized to receive lansoprazole 15 mg daily (n = 226) or gefarnate 50 mg twice daily (n = 235) for 12 months or longer in a prospective, multicenter, double-blind, randomized active-controlled trial, followed by a 6-month follow-up study with open-label lansoprazole treatment. The study utilized 94 sites in Japan and 461 Japanese patients with a history of gastric or duodenal ulcers who required long-term LDA therapy for cardiovascular and cerebrovascular disease. The primary endpoint was the development of gastric or duodenal ulcers. The cumulative incidence of gastric or duodenal ulcers on days 91, 181, and 361 from the start of the study was calculated by the Kaplan-Meier method as 1.5, 2.1, and 3.7%, respectively, in the lansoprazole group versus 15.2, 24.0, and 31.7%, respectively, in the gefarnate group. The risk of ulcer development was significantly (log-rank test, P lansoprazole group than in the gefarnate group, with the hazard ratio being 0.099 (95% confidence interval [CI] 0.042-0.230). Lansoprazole was superior to gefarnate in reducing the risk of gastric or duodenal ulcer recurrence in patients with a definite history of gastric or duodenal ulcers who required long-term LDA therapy.

  8. Body piercing: complications and prevention of health risks. (United States)

    Holbrook, Jaimee; Minocha, Julia; Laumann, Anne


    Body and earlobe piercing are common practices in the USA today. Minor complications including infection and bleeding occur frequently and, although rare, major complications have been reported. Healthcare professionals should be cognizant of the medical consequences of body piercing. Complications vary depending on the body-piercing site, materials used, experience of the practitioner, hygiene regimens, and aftercare by the recipient. Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation. Site-specific complications have been reported. Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal. Piercing tracts in the ear, nipple, and navel are prone to tearing. Galactorrhea may be caused by stimulation from a nipple piercing. Genital piercings may lead to infertility secondary to infection, and obstruction of the urethra secondary to scar formation. In men, priapism and fistula formation may occur. Women who are pregnant or breastfeeding and have a piercing or are considering obtaining one need to be aware of the rare complications that may affect them or their child. Though not a 'complication' per se, many studies have reported body piercing as a marker for high-risk behavior, psychopathologic symptoms, and anti-social personality traits. When it comes to piercing complications, prevention is the key. Body piercers should take a complete medical and social history to identify conditions that may predispose an individual to complications, and candidates should choose a

  9. Reducing potentially preventable complications at the multi hospital level

    Directory of Open Access Journals (Sweden)

    Czyz Anne


    Full Text Available Abstract Background This study describes the continuation of a program to constrain health care costs by limiting inpatient hospital programs among the hospitals of Syracuse, New York. Through a community demonstration project, it identified components of individual hospital programs for reduction of complications and their impact on the frequency and rates of these outcomes. Findings This study involved the implementation of interventions by three hospitals using the Potentially Preventable Complications System developed by 3M™ Health Information Systems. The program is noteworthy because it included competing hospitals in the same community working together to reduce adverse patient outcomes and related costs. The study data identified statistically significant reductions in the frequency of high and low volume complications during the three year period at two of the hospitals. At both of these hospitals, aggregate complication rates also declined. At these hospitals, the differences between actual complication rates and severity adjusted complication rates were also reduced. At the third hospital, specific and aggregate complication rates remained the same or increased slightly. Differences between these rates and those of severity adjusted comparison population also remained the same or increased. Conclusions Results of the study suggested that, in one community health care system, the progress of reducing complications involved different experiences. At two hospitals with relatively higher rates at the beginning of the study, management by administrative and clinical staff outside quality assurance produced significant reductions in complication rates, while at a hospital with lower rates, management by quality assurance staff had little effect on reducing the rate of PPCs.

  10. Skin collagen glycation, glycoxidation, and crosslinking are lower in subjects with long-term intensive versus conventional therapy of type 1 diabetes - Relevance of glycated collagen products versus HbA(1c) as markers of diabetic complications

    NARCIS (Netherlands)

    Monnier, VM; Bautista, O; Kenny, D; Sell, DR; Fogarty, J; Dahms, W; Cleary, PA; Lachin, J; Genuth, S

    The relationships between long-term intensive control of glycemia and indicators of skin collagen glycation (furosine), glycoxidation (pentosidine and N-epsilon-[carboxymethyl]-lysine [CML]), and crosslinking (acid and pepsin solubility) were examined in 216 patients with type 1 diabetes from the

  11. An Effectiveness Trial of a Selected Dissonance-Based Eating Disorder Prevention Program for Female High School Students: Long-Term Effects (United States)

    Stice, Eric; Rohde, Paul; Shaw, Heather; Gau, Jeff


    Objective: Efficacy trials found that a dissonance-based eating disorder prevention program in which female high school and college students with body image concerns critique the thin ideal reduced eating disorder risk factors, eating disorder symptoms, and future eating disorder onset. The present effectiveness trial tested whether this program…

  12. Prevention and treatment of complications after transjugular intrahepatic portosystemic shunt

    Directory of Open Access Journals (Sweden)

    XUE Hui


    Full Text Available The application of transjugular intrahepatic portosystemic shunt (TIPS in the treatment of cirrhotic portal hypertension has been widely accepted both at home and abroad. This article focuses on the fatal complications of TIPS (including intraperitoneal bleeding and acute pulmonary embolism, shunt failure, and recurrent portosystemic hepatic encephalopathy, and elaborates on the reasons for such conditions and related preventive measures, in order to improve the accuracy and safety of intraoperative puncture, reduce common complications such as shunt failure and hepatic encephalopathy, and improve the clinical effect of TIPS in the treatment of cirrhotic portal hypertension.

  13. Impact of protein supplementation and exercise in preventing changes in gene expression profiling in woman muscles after long-term bedrest as revealed by microarray analysis. (United States)

    Chopard, Angele; Lecunff, Martine; Danger, Richard; Teusan, Raluca; Jasmin, Bernard J.; Marini, Jean-Francois; Leger, Jean

    Long duration space flights have a dramatic impact on human physiology and under such a condition, skeletal muscles are known to be one of the most affected systems. A thorough understanding of the basic mechanisms leading to muscle impairment under microgravity, which causes significant loss of muscle mass as well as structural disorders, is necessary for the development of efficient space flight countermeasures. This study was conducted under the aegis of the European Space Agency (ESA), the National Aeronautics and Space Administration of the USA (NASA), the Canadian Space Agency (CSA), and the French "Centre National d'Etudes Spatiales" (CNES). It gave us the opportunity to investigate for the first time the effects of prolonged disuse (long-term bedrest, LTBR) on the transcriptome of different muscle types in healthy women (control, n=8), as well as the potential beneficial impact of protein supplementation (nutrition, n=8) and a combined resistance and aerobic exercise training program (exercise, n=8). Pre- (LTBR -8) and post- (LTBR +59) biopsies were obtained from vastus lateralis (VL) and soleus (SOL) muscles from each subject. Skeletal muscle gene expression profiles were obtained using a custom made microarray containing 6681 muscle-relevant genes. 555 differentiallyexpressed and statistically-significant genes were identified in control group following 60 days of LTBR, including 348 specific for SOL, 83 specific for VL, and 124 common for the two types of muscle (p<0.05). After LTBR, both muscle types exhibited a consistent decrease in pathways involved in fatty acid oxidation, ATP synthesis, and oxidative phosphorylation (p<0.05). However, the postural SOL muscle exhibited a higher level of changes with mRNA encoding proteins involved in protein synthesis and activation of protein degradation (mainly ubiquitinproteasome components) (p<0.05). Major changes in muscle function, such as those involved in calcium signaling and muscle structure including

  14. A national strategy for a long-term monitoring of permafrost and periglacial processes and their relationship to natural hazard prevention in Austria (United States)

    Kellerer-Pirklbauer, Andreas; Bartsch, Annett; Gitschthaler, Christoph; Reisenhofer, Stefan; Weyss, Gernot; Riedl, Claudia; Avian, Michael


    About 2.5% (~2000 km²) of the national territory of Austria is influenced by permafrost conditions. A slightly smaller area of Austria is additionally affected by deep seasonal frost which is, however, similarly exposed to intensive physical weathering and related geomorphic processes. Currently, 23 skiing resorts, 31 water reservoirs and 42 mountain huts are either directly or indirectly influenced by permafrost and associated processes in Austria as determined from regional permafrost models. Ground thermal changes most likely affect the ground stability and infrastructure in those areas. Therefore, changes in the distribution and characteristics of permafrost and seasonal frost are of high economic and ecological importance. A range of Austrian institutions are interested in systematic permafrost monitoring (several universities, geological surveys, the Austrian torrent and avalanche control agency or several different alpine clubs). However, to date no coordinated monitoring network has been established on a national scale and a strategy for long-term permafrost/periglacial observation did not exist so far. Such a national strategy has been developed in 2015 within the permAT project funded through the StartClim2014-program. During permAT an extensive literature review and data search as well as a workshop with 40 participants (scientists, stakeholder and policy maker) were accomplished. The workshop allowed the integration of national as well as international colleagues into the strategy development. Results of permAT clearly demonstrate that the number of present permafrost/periglacial monitoring sites is far too little in Austria. Only few alpine areas of Austria are well represented by the existing monitoring activities but large areas lack such instrumentations. Furthermore, permafrost boreholes exist at only three sites in central Austria (all contribution to the GTN-P network) and there is a lack of knowledge about thermal conditions and recent changes

  15. Setting the stage for long-term reproductive health. (United States)

    Payne, Craig A; Vander Ley, Brian; Poock, Scott E


    This article discusses some of the aspects of heifer development that contribute to long-term health and productivity, such as disease prevention and control. Nutrition is also an important component of long-term health, and body condition score is discussed as a way to determine whether the nutrient demands of heifers are being met. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Long-Term Sustainability of Evidence-Based Prevention Interventions and Community Coalitions Survival: a Five and One-Half Year Follow-up Study. (United States)

    Johnson, Knowlton; Collins, David; Shamblen, Steve; Kenworthy, Tara; Wandersman, Abraham


    This study examines (1) coalition survival, (2) prevalence of evidence-based prevention interventions (EBPIs) to reduce substance abuse implemented as part of the Tennessee Strategic Prevention Framework (SPF) State Incentive Grant (SIG), (3) EBPI sustainability, and (4) factors that predict EBPI sustainability. Secondary data were collected on 27 SPF SIG-funded coalitions and 88 EBPI and non-EBPI implementations. Primary data were collected by a telephone interview/web survey five and one-half years after the SPF SIG ended. Results from secondary data show that 25 of the 27 coalitions survived beyond the SPF SIG for one to five and one-half years; 19 coalitions (70%) were still active five and one-half years later. Further, 88 EBPIs and non-EBPIs were implemented by 27 county SPF SIG coalitions. Twenty-one (21) of 27 coalitions (78%) implemented one to three EBPIs, totaling 37 EBPI implementations. Based on primary survey data on 29 of the 37 EBPI implementations, 28 EBPIs (97%) were sustained between two and five and one-half years while 22 EBPI implementations (76%) were sustained for five and one-half years. When controlling for variability among coalitions (nesting of EBPIs in coalitions), increases in data resources (availability of five types of prevention data) was a strong predictor of length of EBPI sustainability. Positive change in extramural funding resources and level of expertise during SPF SIG implementation, as well as level of coalition formalization at the end of the SPF SIG predicted EBPI sustainability length. One intervention attribute (trialability) also predicted length of sustainability. Implications are discussed.

  17. Embolis cutis medicamentosa, a rare preventable iatrogenic complication

    Directory of Open Access Journals (Sweden)

    Manjunath Kavya,


    Full Text Available Embolis cutis medicamentosa is an uncommon iatrogenic complication characterised by variable degree of skin and tissue necrosis, likely to follow intramuscular injection. Intense pain and purplish discoloration of overlying skin, with or without reticulate pattern subsequently followed by tissue necrosis and scarring is highly specific for this syndrome. It has also been reported following intravenous, intra-articular and subcutaneous injections. Herein we are reporting two cases of this rare preventable entity.

  18. Treatment and Prevention of Common Complications of Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Sheikh Salahuddin Ahmed


    Full Text Available Chronic kidney disease (CKD is a worldwide public health problem with an increasing incidence and prevalence. Outcomes of CKD include not only complications of decreased kidney function and cardiovascular disease but also kidney failure causing increased morbidity and mortality. Unfortunately, CKD is often undetected and undertreated because of its insidious onset, variable progression, and length of time to overt kidney failure. Diabetes is now the leading cause of CKD requiring renal replacement therapy in many parts of the world, and its prevalence is increasing disproportionately in the developing countries. This review article outlines the current recommendations from various clinical guidelines and research studies for treatment, prevention and delaying the progression of both CKD and its common complications such as hypertension, anemia, renal osteodystrophy, electrolyte and acid-base imbalance, and hyperlipidemia. Recommendations for nutrition in CKD and measures adopted for early diabetic kidney disease to prevent further progression have also been reviewed. There is strong evidence that early detection and management of CKD can prevent or reduce disease progression, decrease complications and improve outcomes. Evidence supports that achieving optimal glucose control, blood pressure, reduction in albuminuria with a multifactorial intervention slows the progression of CKD. Angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists are most effective because of their unique ability to decrease proteinuria, a factor important for the progression of CKD.

  19. Complications of thoracentesis: incidence, risk factors, and strategies for prevention. (United States)

    Cantey, Eric P; Walter, James M; Corbridge, Thomas; Barsuk, Jeffrey H


    Although thoracentesis is generally considered safe, procedural complications are associated with increased morbidity, mortality, and healthcare costs. In this article, we review the risk factors and prevention of the most common complications of thoracentesis including pneumothorax, bleeding (chest wall hematoma and hemothorax), and re-expansion pulmonary edema. Recent data support the importance of operator expertise and the use of ultrasound in reducing the risk of iatrogenic pneumothorax. Although coagulopathy or thrombocytopenia and the use of anticoagulant or antiplatelet medications have traditionally been viewed as contraindications to thoracentesis, new evidence suggests that patients may be able to safely undergo thoracentesis without treating their bleeding risk. Re-expansion pulmonary edema, a rare complication of thoracentesis, is felt to result in part from the generation of excessively negative pleural pressure. When and how to monitor changes in pleural pressure during thoracentesis remains a focus of ongoing study. Major complications of thoracentesis are uncommon. Clinician awareness of risk factors for procedural complications and familiarity with strategies that improve outcomes are essential components for safely performing thoracentesis.

  20. Nuclear Energy, Long Term Requirements

    International Nuclear Information System (INIS)

    Knapp, V.


    There are serious warnings about depletion of oil and gas and even more serious warnings about dangers of climate change caused by emission of carbon dioxide. Should developed countries be called to replace CO2 emitting energy sources as soon as possible, and the time available may not be longer then few decades, can nuclear energy answer the call and what are the requirements? Assuming optimistic contribution of renewable energy sources, can nuclear energy expand to several times present level in order to replace large part of fossil fuels use? Paper considers intermediate and long-term requirements. Future of nuclear power depends on satisfactory answers on several questions. First group of questions are those important for near and intermediate future. They deal with economics and safety of nuclear power stations in the first place. On the same time scale a generally accepted concept for radioactive waste disposal is also required. All these issues are in the focus of present research and development. Safer and more economical reactors are targets of international efforts in Generation IV and INPRO projects, but aiming further ahead these innovative projects are also addressing issues such as waste reduction and proliferation resistance. However, even assuming successful technical development of these projects, and there is no reason to doubt it, long term and large-scale nuclear power use is thereby not yet secured. If nuclear power is to play an essential role in the long-term future energy production and in reduction of CO2 emission, than several additional questions must be replied. These questions will deal with long-term nuclear fuel sufficiency, with necessary contribution of nuclear power in sectors of transport and industrial processes and with nuclear proliferation safety. This last issue is more political then technical, thus sometimes neglected by nuclear engineers, yet it will have essential role for the long-term prospects of nuclear power. The

  1. A randomized multifactorial intervention study for prevention of ischaemic heart disease (Inter99): the long-term effect on physical activity

    DEFF Research Database (Denmark)

    von Huth Smith, Lisa; Ladelund, Steen; Borch-Johnsen, Knut


    , group B, n=1,308) were invited for a health examination, an assessment of absolute risk of developing IHD, and an individualized lifestyle intervention. The participation rate was 52.5%. High-risk persons in group A were also offered diet/physical activity and/or smoking cessation group counselling....... High-risk persons in group B were referred to their GP. High-risk persons were re-counselled after 12 and 36 months. The control group (group C, n=5,264, response rate=61.3%) answered a mailed questionnaire. Data were analysed using longitudinal linear regression models with random effects. MAIN......AIM: To examine the effect of a randomized multiple risk factor intervention study for prevention of ischaemic heart disease (IHD) on the development in physical activity over a 36-month period. METHODS: Two random samples (high intensity intervention, group A, n=11,708; low intensity intervention...

  2. A randomized multifactorial intervention study for prevention of ischaemic heart disease (Inter99): The long-term effect on physical activity

    DEFF Research Database (Denmark)

    Smith, L.V.H.; Ladelund, S.; Borch-Johnsen, K.


    , group B, n=1,308) were invited for a health examination, an assessment of absolute risk of developing IHD, and an individualized lifestyle intervention. The participation rate was 52.5%. High-risk persons in group A were also offered diet/physical activity and/or smoking cessation group counselling....... High-risk persons in group B were referred to their GP. High-risk persons were re-counselled after 12 and 36 months. The control group (group C, n=5,264, response rate=61.3%) answered a mailed questionnaire. Data were analysed using longitudinal linear regression models with random effects. MAIN......AIM: To examine the effect of a randomized multiple risk factor intervention study for prevention of ischaemic heart disease (IHD) on the development in physical activity over a 36-month period. METHODS: Two random samples (high intensity intervention, group A, n=11,708; low intensity intervention...

  3. Can long-term antibiotic treatment prevent progression of peripheral arterial occlusive disease? A large, randomized, double-blinded, placebo-controlled trial

    DEFF Research Database (Denmark)

    Joensen, J B; Juul, Svend; Henneberg, E


    PURPOSE: The purpose was to investigate in a large, randomized, double-blinded, placebo-controlled trial, whether antibiotic treatment can prevent progression of peripheral arterial disease (PAD). MATERIAL AND METHODS: Five hundred and seven patients were included; all patients had an established...... analyzed mainly by Cox regression and linear regression. RESULTS: Included patients with PAD were randomized. Two patients withdrew. Of the remaining, 248 received roxithromycin and 257 placebo. In the treatment group 55% were seropositive and 53% in the placebo group. Mean follow-up was 2.1 years (range 0.......06-5.1 years). In the placebo group, 26 died and 80 primary events occurred in total. In the treatment group, 28 died and 74 primary events were observed. The hazard ratio of death was 1.13 (95% CI: 0.68; 1.90), and of primary events 0.92 (95% CI: 0.67; 1.26). Also on secondary events and ABPI changes...

  4. An analysis methodology of degradation by corrosion mechanisms and preventive actions of the negative effects in the NPP circuits with direct impact in the long-term development

    International Nuclear Information System (INIS)

    Dinu, A.


    The corrosion mechanisms, implied in the degradation processes of several alloys, preoccupied the scientific world, producers and users of metallic materials, as well. Due to permanent presence of a potential danger, a great importance was given to corrosion evaluation and prevention in power domain, also including the nuclear power. The main activities have as aim the development of techniques and methods of investigation of structural materials corrosion. Also, there were developed methods of chemical investigation of the environment as well as data bases that allow the simulation of several corrosion types, characteristic of different materials systems and/or media. This made possible the prediction of safe operation life of several structural components. In this context, the paper presents the most important results of project with acronym 'PERFORMCOR' developed in the framework of PNCDI II, 'Capacities' Programme, Modulus I, with the aim of ensuring a R and D infrastructure upgrade of 'LADICON' laboratory of INR - Pitesti. (author)

  5. Analysing long term discursive processes

    DEFF Research Database (Denmark)

    Horsbøl, Anders

    which extend beyond the single interaction, for instance negotiations or planning processes, seems to have played a less important role, with studies such as Iedema 2001 and Wodak 2000 as exceptions. These long term processes, however, are central to the constitution and workings of organizations......What do timescales - the notion that processes take place or can be viewed within a shorter or longer temporal range (Lemke 2005) - mean for the analysis of discourse? What are the methodological consequences of analyzing discourse at different timescales? It may be argued that discourse analysis...... in general has favored either the analysis of short term processes such as interviews, discussions, and lessons, or the analysis of non-processual entities such as (multimodal) texts, arguments, discursive repertoires, and discourses (in a Foucaultian sense). In contrast, analysis of long term processes...

  6. Menopause as a long-term risk to health: implications of general practitioner accounts of prevention for women's choice and decision-making. (United States)

    Murtagh, Madeleine J; Hepworth, Julie


    Over the past two decades medical researchers and modernist feminist researchers have contested the meaning of menopause. In this article we examine various meanings of menopause in major medical and feminist literature and the construction of menopause in a semi-structured interview study of general practitioners in rural South Australia. Three discursive themes are identified in these interviews; (i) .the hormonal menopause - symptoms, risk, prevention; (ii). the informed menopausal woman; and (iii). decision-making and hormone replacement therapy. By using the discourse of prevention, general practitioners construct menopause in relation to women's health care choices, empowerment and autonomy. We argue that the ways in which these concepts are deployed by general practitioners in this study produces and constrains the options available to women. The implications of these general practitioner accounts are discussed in relation to the proposition that medical and feminist descriptions of menopause posit alternative but equally-fixed truths about menopause and their relationship with the range of responses available to women at menopause. Social and cultural explanations of disease causality (c.f. Germov 1998, Hardey 1998) are absent from the new menopause despite their being an integral part of the framework of the women's health movement and health promotion drawn on by these general practitioners. Further, the shift of responsibility for health to the individual woman reinforces practice claims to empower women, but oversimplifies power relations and constructs menopause as a site of self-surveillance. The use of concepts from the women's health movement and health promotion have nevertheless created change in both the positioning of women as having 'choices' and the positioning of some general practitioners in terms of greater information provision to women and an attention to the woman's autonomy. In conclusion, we propose that a new menopause has evolved

  7. Comparing long term energy scenarios

    International Nuclear Information System (INIS)

    Cumo, M.; Simbolotti, G.


    Major projection studies by international organizations and senior analysts have been compared with reference to individual key parameters (population, energy demand/supply, resources, technology, emissions and global warming) to understand trends and implications of the different scenarios. Then, looking at the long term (i.e., 2050 and beyond), parameters and trends have been compared together to understand and quantify whether and when possible crisis or market turbulence might occur due to shortage of resources or environmental problems [it

  8. Establishment of the operating procedure to prevent boron precipitation during Post-LOCA long term cooling for Korean Westinghouse 3-loop NPPs

    International Nuclear Information System (INIS)

    Choi, Han Rim; Kwon, Tae Soon; Ban, Chang Hwan; Jeong, Jae Hoon; Lee, Young Jin.


    During post-LOCA LTC the increase of the excess reactivity for the extended fuel cycle should require increasing the RWST boron concentration in order to ensure core subcritical state. To quantify the concentration increment, the calculation methods was developed for the post-LOCA RCS/Sump mixed mean boron concentration, which applied for Kori 3 and 4 and Ulchin 1 and 2 of the Westinghouse 3-loop nuclear power plants in Korean. From the calculation results, the minimum boric acid concentrations increased of the RWST and accumulator were determined consideration of the convenient operation for operator on reloading. Boric acid concentrations of the RWST and the accumulators for Westinghouse 3-loop type plants were increased to meet the post-LOCA shutdown requirement for the long life cycles from 12 months to 18 months. To maintain LTC capability following a LOCA, the switchover time is examined using boron code of prevent the boron precipitation in the reactor core with the increased boron concentrations. The analysis results showed that hot leg recirculation switchover times were shortened to 7.5 hours from 24 hours after the initiation of LOCA for Kori 3 and 4 and 8 hours from 18 hours for Ulchin 1 and 2, respectively. The flow path in the mode J for Kori 3 and 4 was recommended to realign to the simultaneous recirculation of both hot and cold legs from the cold leg recirculation, as done by Ulchin 1 and 2. (author). 2 tabs., 12 figs., 13 refs

  9. Long-Term Monitoring of Fresco Paintings in the Cathedral of Valencia (Spain) Through Humidity and Temperature Sensors in Various Locations for Preventive Conservation (United States)

    Zarzo, Manuel; Fernández-Navajas, Angel; García-Diego, Fernando-Juan


    We describe the performance of a microclimate monitoring system that was implemented for the preventive conservation of the Renaissance frescoes in the apse vault of the Cathedral of Valencia, that were restored in 2006. This system comprises 29 relative humidity (RH) and temperature sensors: 10 of them inserted into the plaster layer supporting the fresco paintings, 10 sensors in the walls close to the frescoes and nine sensors measuring the indoor microclimate at different points of the vault. Principal component analysis was applied to RH data recorded in 2007. The analysis was repeated with data collected in 2008 and 2010. The resulting loading plots revealed that the similarities and dissimilarities among sensors were approximately maintained along the three years. A physical interpretation was provided for the first and second principal components. Interestingly, sensors recording the highest RH values correspond to zones where humidity problems are causing formation of efflorescence. Recorded data of RH and temperature are discussed according to Italian Standard UNI 10829 (1999). PMID:22164100

  10. Long-Term Monitoring of Fresco Paintings in the Cathedral of Valencia (Spain Through Humidity and Temperature Sensors in Various Locations for Preventive Conservation

    Directory of Open Access Journals (Sweden)

    Angel Fernández-Navajas


    Full Text Available We describe the performance of a microclimate monitoring system that was implemented for the preventive conservation of the Renaissance frescoes in the apse vault of the Cathedral of Valencia, that were restored in 2006. This system comprises 29 relative humidity (RH and temperature sensors: 10 of them inserted into the plaster layer supporting the fresco paintings, 10 sensors in the walls close to the frescoes and nine sensors measuring the indoor microclimate at different points of the vault. Principal component analysis was applied to RH data recorded in 2007. The analysis was repeated with data collected in 2008 and 2010. The resulting loading plots revealed that the similarities and dissimilarities among sensors were approximately maintained along the three years. A physical interpretation was provided for the first and second principal components. Interestingly, sensors recording the highest RH values correspond to zones where humidity problems are causing formation of efflorescence. Recorded data of RH and temperature are discussed according to Italian Standard UNI 10829 (1999.

  11. Long term radioactive waste management

    International Nuclear Information System (INIS)

    Lavie, J.M.


    In France, waste management, a sensitive issue in term of public opinion, is developing quickly, and due to twenty years of experience, is now reaching maturity. With the launching of the French nuclear programme, the use of radioactive sources in radiotherapy and industry, waste management has become an industrial activity. Waste management is an integrated system dealing with the wastes from their production to the long term disposal, including their identification, sortage, treatment, packaging, collection and transport. This system aims at guaranteing the protection of present and future populations with an available technology. In regard to their long term management, and the design of disposals, radioactive wastes are divided in three categories. This classification takes into account the different radioisotopes contained, their half life and their total activity. Presently short-lived wastes are stored in the shallowland disposal of the ''Centre de la Manche''. Set up within the French Atomic Energy Commission (CEA), the National Agency for waste management (ANDRA) is responsible within the framework of legislative and regulatory provisions for long term waste management in France [fr

  12. Long-term prediction of prostate cancer diagnosis and death using PSA and obesity related anthropometrics at early middle age: data from the malmö preventive project. (United States)

    Assel, Melissa J; Gerdtsson, Axel; Thorek, Daniel L J; Carlsson, Sigrid V; Malm, Johan; Scardino, Peter T; Vickers, Andrew; Lilja, Hans; Ulmert, David


    To evaluate whether anthropometric parameters add to PSA measurements in middle-aged men for risk assessment of prostate cancer (PCa) diagnosis and death. After adjusting for PSA, both BMI and weight were significantly associated with an increased risk of PCa death with the odds of a death corresponding to a 10 kg/m2 or 10 kg increase being 1.58 (95% CI 1.10, 2.28; p = 0.013) and 1.14 (95% CI 1.02, 1.26; p = 0.016) times greater, respectively. AUCs did not meaningfully increase with the addition of weight or BMI to prediction models including PSA. In 1974 to 1986, 22,444 Swedish men aged 44 to 50 enrolled in Malmö Preventive Project, Sweden, and provided blood samples and anthropometric data. Rates of PSA screening in the cohort were very low. Documentation of PCa diagnosis and disease-specific death up to 2014 was retrieved through national registries. Among men with anthropometric measurements available at baseline, a total of 1692 men diagnosed with PCa were matched to 4190 controls, and 464 men who died of disease were matched to 1390 controls. Multivariable conditional logistic regression was used to determine whether diagnosis or death from PCa were associated with weight and body mass index (BMI) at adulthood after adjusting for PSA. Men with higher BMI and weight at early middle age have an increased risk of PCa diagnosis and death after adjusting for PSA. However, in a multi-variable numerical statistical model, BMI and weight do not importantly improve the predictive accuracy of PSA. Risk-stratification of screening should be based on PSA without reference to anthropometrics.

  13. Emerging Risk Factors and Prevention of Perioperative Pulmonary Complications

    Directory of Open Access Journals (Sweden)

    Priyanka Bhateja


    Full Text Available Modern surgery is faced with the emergence of newer “risk factors” and the challenges associated with identifying and managing these risks in the perioperative period. Obstructive sleep apnea and obesity hypoventilation syndrome pose unique challenges in the perioperative setting. Recent studies have identified some of the specific risks arising from caring for such patients in the surgical setting. While all possible postoperative complications are not yet fully established or understood, the prevention and management of these complications pose even greater challenges. Pulmonary hypertension with its changing epidemiology and novel management strategies is another new disease for the surgeon and the anesthesiologist in the noncardiac surgical setting. Traditionally most such patients were not considered surgical candidates for any required elective surgery. Our review discusses these disease entities which are often undiagnosed before elective noncardiac surgery.

  14. Long-Term Effectiveness of a Lifestyle Intervention for the Primary Prevention of Type 2 Diabetes in a Low Socio-Economic Community--An Intervention Follow-Up Study on Reunion Island. (United States)

    Fianu, Adrian; Bourse, Léa; Naty, Nadège; Le Moullec, Nathalie; Lepage, Benoît; Lang, Thierry; Favier, François


    In type 2 diabetes (T2D) prevention research, evidence for maintenance of risk factor reduction after three years of follow-up is needed. The objective of this study was to evaluate the long-term effectiveness of a combined lifestyle intervention aiming at controlling body weight (BW) and waist circumference (WC) in non-diabetic, overweight/obese adults living in a low socio-economic community. On Reunion Island, 445 adults living in deprived areas, aged 18-40 and at high-risk for T2D, were included in an intervention versus control trial for primary prevention (2001-2002). The intervention promoted a healthy diet and moderate regular physical activity, through actions strengthening individuals or community and improving living conditions. The control group received a one-shot medical information and nutritional advices. After the end of the trial (2003), 259 of the subjects participated in a follow-up study (2010-2011). The outcomes were the nine-year changes from baseline in BW, body mass index (BMI) and WC measurements, separately. Statistical analyses were performed on an intention-to-treat basis, using available and imputed datasets. At inclusion, T2D risk factors were prevalent: family history of diabetes in first-degree relatives (42%), women with a personal history of gestational diabetes (11%), total obesity (43%, median BMI 29.1 kg/m²) and central obesity (71%). At follow-up, the adjusted effect on imputed dataset was significant for WC -2.4 cm (95% confidence interval: -4.7 to -0.0 cm, p = 0.046), non-significant for BW -2.2 kg (-4.6 to +0.2 kg, p = 0.073) and BMI -0.81 kg/m² (-1.69 to +0.08 kg/m², p = 0.074). A specific long-term effect was the increased likelihood of reduction in adiposity: BW loss, BMI reduction, and WC reduction were more frequent in the intervention group. In the context of low socio-economic communities, our data support the assumption of long-term effect of lifestyle interventions targeting total obesity and central obesity two

  15. Long term stability of power systems

    Energy Technology Data Exchange (ETDEWEB)

    Kundur, P; Gao, B [Powertech Labs. Inc., Surrey, BC (Canada)


    Power system long term stability is still a developing subject. In this paper we provide our perspectives and experiences related to long term stability. The paper begins with the description of the nature of the long term stability problem, followed by the discussion of issues related to the modeling and solution techniques of tools for long term stability analysis. Cases studies are presented to illustrate the voltage stability aspect and plant dynamics aspect of long term stability. (author) 20 refs., 11 figs.

  16. Strategies to overcome barriers to implementing osteoporosis and fracture prevention guidelines in long-term care: a qualitative analysis of action plans suggested by front line staff in Ontario, Canada. (United States)

    Alamri, Sultan H; Kennedy, Courtney C; Marr, Sharon; Lohfeld, Lynne; Skidmore, Carly J; Papaioannou, Alexandra


    Osteoporosis is a major global health problem, especially among long-term care (LTC) facilities. Despite the availability of effective clinical guidelines to prevent osteoporosis and bone fractures, few LTC homes actually adhere to these practical recommendations. The purpose of this study was to identify barriers to the implementation of evidence-based practices for osteoporosis and fracture prevention in LTC facilities and elicit practical strategies to address these barriers. We performed a qualitative analysis of action plans formulated by Professional Advisory Committee (PAC) teams at 12 LTC homes in the intervention arm of the Vitamin D and Osteoporosis Study (ViDOS) in Ontario, Canada. PAC teams were comprised of medical directors, administrators, directors of care, pharmacists, dietitians, and other staff. Thematic content analysis was performed to identify the key themes emerging from the action plans. LTC teams identified several barriers, including lack of educational information and resources prior to the ViDOS intervention, difficulty obtaining required patient information for fracture risk assessment, and inconsistent prescribing of vitamin D and calcium at the time of admission. The most frequently suggested recommendations was to establish and adhere to standard admission orders regarding vitamin D, calcium, and osteoporosis therapies, improve the use of electronic medical records for osteoporosis and fracture risk assessment, and require bone health as a topic at quarterly reviews and multidisciplinary conferences. This qualitative study identified several important barriers and practical recommendations for improving the implementation of osteoporosis and fracture prevention guidelines in LTC settings.

  17. Risk factors and prevention of vascular complications in polycythemia vera. (United States)

    Barbui, T; Finazzi, G


    Risk factors for vascular complications in polycythemia vera (PV) include laboratory and clinical findings. Among laboratory values, the hematocrit has been clearly associated with thrombosis, particularly in the cerebral circulation. Platelet count is a possible but not yet clearly established predictor of vascular complications. Platelet function tests are of little help in prognostic evaluation because most attempts to correlate these abnormalities with clinical events have been disappointing. Clinical predictors of thrombosis include increasing age and a previous history of vascular events. Identifying risk factors for thrombosis is important to initiate therapy. Phlebotomy is associated with an increased incidence of thrombosis in the first 3 to 5 years, whereas chemotherapy may induce a higher risk of secondary malignancies after 7 to 10 years of follow-up. New cytoreductive drugs virtually devoid of mutagenic risk include interferon-alpha and anagrelide, but their role in reducing thrombotic complications remains to be demonstrated. Antithrombotic drugs, such as aspirin, are frequently used in PV, despite doubts regarding safety and efficacy. Two recent studies from the Gruppo Italiano Studio Policitemia Vera (GISP) assessed the rate of major thrombosis as well as the tolerability of low-dose aspirin in PV patients. These investigations created a favorable scenario for launching a European collaborative clinical trial (ECLAP study) aimed at testing the efficacy of low-dose aspirin in preventing thrombosis and prolonging survival in patients with PV.

  18. An assessment of the long-term health outcome of renal transplant recipients in Ireland.

    LENUS (Irish Health Repository)

    Al-Aradi, A


    BACKGROUND: Renal transplantation remains the preferred method of renal replacement therapy in terms of patient survival, quality of life and cost. However, patients have a high risk of complications ranging from rejection episodes, infection and cancer, amongst others. AIMS AND METHODS: In this study, we sought to determine the long-term health outcomes and preventive health measures undertaken for the 1,536 living renal transplant patients in Ireland using a self-reported questionnaire. Outcomes were divided into categories, namely, general health information, allograft-related information, immunosuppression-related complications and preventive health measures. RESULTS: The results demonstrate a high rate of cardiovascular, neoplastic and infectious complications in our transplant patients. Moreover, preventive health measures are often not undertaken by patients and lifestyle choices can be poor. CONCLUSIONS: This study highlights the work needed by the transplantation community to improve patient education, adjust immunosuppression where necessary and aggressively manage patient risk factors.

  19. Prophylactic Subacute Administration of Zinc Increases CCL2, CCR2, FGF2, and IGF-1 Expression and Prevents the Long-Term Memory Loss in a Rat Model of Cerebral Hypoxia-Ischemia

    Directory of Open Access Journals (Sweden)

    Victor Manuel Blanco-Alvarez


    Full Text Available Prophylactic subacute administration of zinc decreases lipoperoxidation and cell death following a transient cerebral hypoxia-ischemia, thus suggesting neuroprotective and preconditioning effects. Chemokines and growth factors are also involved in the neuroprotective effect in hypoxia-ischemia. We explored whether zinc prevents the cerebral cortex-hippocampus injury through regulation of CCL2, CCR2, FGF2, and IGF-1 expression following a 10 min of common carotid artery occlusion (CCAO. Male rats were grouped as follows: (1 Zn96h, rats injected with ZnCl2 (one dose every 24 h during four days; (2 Zn96h + CCAO, rats treated with ZnCl2 before CCAO; (3 CCAO, rats with CCAO only; (4 Sham group, rats with mock CCAO; and (5 untreated rats. The cerebral cortex-hippocampus was dissected at different times before and after CCAO. CCL2/CCR2, FGF2, and IGF-1 expression was assessed by RT-PCR and ELISA. Learning in Morris Water Maze was achieved by daily training during 5 days. Long-term memory was evaluated on day 7 after learning. Subacute administration of zinc increased expression of CCL2, CCR2, FGF2, and IGF-1 in the early and late phases of postreperfusion and prevented the CCAO-induced memory loss in the rat. These results might be explained by the induction of neural plasticity because of the expression of CCL2 and growth factors.

  20. 3. Management and prevention of obesity and its complications in children and adolescents. (United States)

    Batch, Jennifer A; Baur, Louise A


    Obesity in children and adolescents has reached alarming levels--20%-25% of children and adolescents are overweight or obese, and 4.9% of boys and 5.4% of girls are obese. Rates of obesity have increased significantly in Australia from 1985 to 1995, with the prevalence of overweight doubling and obesity trebling. Body mass index (related to reference standards for age and sex) is recommended as a practical measure of overweight and obesity in children, and is used in monitoring individual progress in clinical practice. Obesity in childhood and adolescence may be associated with a range of medical and psychological complications, and can predispose individuals to serious health problems in adult life, including type 2 diabetes, hypertension, dyslipidaemia and non-alcoholic steatohepatitis. Obesity interventions for which there is some evidence include family support, a developmentally appropriate approach, long-term behaviour modification, dietary change, and increased physical activity and decreased sedentary behaviour. Prevention of obesity in children and adolescents requires a range of strategies involving changes in both the microenvironment (eg, housing, neighbourhoods, recreational opportunities) and the macroenvironment (eg, food marketing, transport systems, urban planning).

  1. Long-term Morbidity of Testicular Cancer Treatment. (United States)

    Fung, Chunkit; Fossa, Sophie D; Williams, Annalynn; Travis, Lois B


    Second malignant neoplasms, cardiovascular disease, neurotoxicity and ototoxicity, pulmonary complications, hypogonadism, and nephrotoxicity are potentially life-threatening long-term complications of testicular cancer and its therapy. This article describes the pathogenesis, risks, and management of these late effects experienced by long-term testicular cancer survivors, who are defined as individuals who are disease free 5 years or more after primary treatment. Testicular cancer survivors should follow applicable national guidelines for cancer screening and management of cardiovascular disease risk factors. In addition, health care providers should capitalize on the time of cancer diagnosis as a teachable moment to introduce and promote lifestyle changes. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Long-term control of root growth (United States)

    Burton, Frederick G.; Cataldo, Dominic A.; Cline, John F.; Skiens, W. Eugene


    A method and system for long-term control of root growth without killing the plants bearing those roots involves incorporating a 2,6-dinitroaniline in a polymer and disposing the polymer in an area in which root control is desired. This results in controlled release of the substituted aniline herbicide over a period of many years. Herbicides of this class have the property of preventing root elongation without translocating into other parts of the plant. The herbicide may be encapsulated in the polymer or mixed with it. The polymer-herbicide mixture may be formed into pellets, sheets, pipe gaskets, pipes for carrying water, or various other forms. The invention may be applied to other protection of buried hazardous wastes, protection of underground pipes, prevention of root intrusion beneath slabs, the dwarfing of trees or shrubs and other applications. The preferred herbicide is 4-difluoromethyl-N,N-dipropyl-2,6-dinitro-aniline, commonly known as trifluralin.

  3. Long-Term Prognosis of Ischemic Stroke in Young Adults


    Varona, Jose F.


    There is limited information about long-term prognosis of ischemic stroke in young adults. Giving the potentially negative impact in physical, social, and emotional aspects of an ischemic stroke in young people, providing early accurate long-term prognostic information is very important in this clinical setting. Moreover, detection of factors associated with bad outcomes (death, recurrence, moderate-to-severe disability) help physicians in optimizing secondary prevention strategies. The prese...

  4. Long term study of mechanical

    Directory of Open Access Journals (Sweden)

    Ahmed M. Diab


    Full Text Available In this study, properties of limestone cement concrete containing different replacement levels of limestone powder were examined. It includes 0%, 5%, 10%, 15%, 20% and 25% of limestone powder as a partial replacement of cement. Silica fume was added incorporated with limestone powder in some mixes to enhance the concrete properties. Compressive strength, splitting tensile strength and modulus of elasticity were determined. Also, durability of limestone cement concrete with different C3A contents was examined. The weight loss, length change and cube compressive strength loss were measured for concrete attacked by 5% sodium sulfate using an accelerated test up to 525 days age. The corrosion resistance was measured through accelerated corrosion test using first crack time, cracking width and steel reinforcement weight loss. Consequently, for short and long term, the use of limestone up to 10% had not a significant reduction in concrete properties. It is not recommended to use blended limestone cement in case of sulfate attack. The use of limestone cement containing up to 25% limestone has insignificant effect on corrosion resistance before cracking.

  5. Long-term competence restoration. (United States)

    Morris, Douglas R; DeYoung, Nathaniel J


    While the United States Supreme Court's Jackson v. Indiana decision and most state statutes mandate determinations of incompetent defendants' restoration probabilities, courts and forensic clinicians continue to lack empirical evidence to guide these determinations and do not yet have a consensus regarding whether and under what circumstances incompetent defendants are restorable. The evidence base concerning the restoration likelihood of those defendants who fail initial restoration efforts is even further diminished and has largely gone unstudied. In this study, we examined the disposition of a cohort of defendants who underwent long-term competence restoration efforts (greater than six months) and identified factors related to whether these defendants were able to attain restoration and adjudicative success. Approximately two-thirds (n = 52) of the 81 individuals undergoing extended restoration efforts were eventually deemed restored to competence. Lengths of hospitalization until successful restoration are presented with implications for the reasonable length of time that restoration efforts should persist. Older individuals were less likely to be restored and successfully adjudicated, and individuals with more severe charges and greater factual legal understanding were more likely to be restored and adjudicated. The significance of these findings for courts and forensic clinicians is discussed.

  6. Uranium ... long-term confidence

    International Nuclear Information System (INIS)



    Half way through 1983 the outlook for the world's uranium producers was far from bright if one takes a short term view. The readily accessible facts present a gloomy picture. The spot prices of uranium over the past few years decreased from a high of $42-$43/lb to a low of $17 in 1982. It now hovers between $23 and $24. the contract prices negotiated between producers and consumers are not so accessible but they do not reflect the spot price. The reasons why contractual uranium prices do not follow the usual dictates of supply and demand are related to the position in which uranium and associated power industries find themselves. There is public reaction with strong emotional overtones as well as much reduced expectations about the electric power needs of the world. Furthermore the supply of uranium is not guaranteed despite present over production. However the people in the industry, taking the medium- and long-term view, are not despondent

  7. Long-term corrosion studies

    International Nuclear Information System (INIS)

    Gdowski, G.


    The scope of this activity is to assess the long-term corrosion properties of metallic materials under consideration for fabricating waste package containers. Three classes of metals are to be assessed: corrosion resistant, intermediate corrosion resistant, and corrosion allowance. Corrosion properties to be evaluated are general, pitting and crevice corrosion, stress-corrosion cracking, and galvanic corrosion. The performance of these materials will be investigated under conditions that are considered relevant to the potential emplacement site. Testing in four aqueous solutions, and vapor phases above them, and at two temperatures are planned for this activity. (The environmental conditions, test metals, and matrix are described in detail in Section 3.0.) The purpose and objective of this activity is to obtain the kinetic and mechanistic information on degradation of metallic alloys currently being considered for waste package containers. This information will be used to provide assistance to (1) waste package design (metal barrier selection) (E-20-90 to E-20-92), (2) waste package performance assessment activities (SIP-PA-2), (3) model development (E-20-75 to E-20-89). and (4) repository license application

  8. Sleep facilitates long-term face adaptation. (United States)

    Ditye, Thomas; Javadi, Amir Homayoun; Carbon, Claus-Christian; Walsh, Vincent


    Adaptation is an automatic neural mechanism supporting the optimization of visual processing on the basis of previous experiences. While the short-term effects of adaptation on behaviour and physiology have been studied extensively, perceptual long-term changes associated with adaptation are still poorly understood. Here, we show that the integration of adaptation-dependent long-term shifts in neural function is facilitated by sleep. Perceptual shifts induced by adaptation to a distorted image of a famous person were larger in a group of participants who had slept (experiment 1) or merely napped for 90 min (experiment 2) during the interval between adaptation and test compared with controls who stayed awake. Participants' individual rapid eye movement sleep duration predicted the size of post-sleep behavioural adaptation effects. Our data suggest that sleep prevented decay of adaptation in a way that is qualitatively different from the effects of reduced visual interference known as 'storage'. In the light of the well-established link between sleep and memory consolidation, our findings link the perceptual mechanisms of sensory adaptation--which are usually not considered to play a relevant role in mnemonic processes--with learning and memory, and at the same time reveal a new function of sleep in cognition.

  9. Vitamin D and the Promotion of Long-Term Metabolic Health from a Programming Perspective

    Directory of Open Access Journals (Sweden)

    Saranya Palaniswamy


    Full Text Available Studies linking vitamin D and long-term metabolic health have generated much debate. Recommendations for the intake of vitamin D by the general public and by the health care professionals have been complicated by a number of inconsistencies in the literature. These caveats relate to the methodological approaches, differences in the populations (and the species of study, and the definitions used for thresholds of vitamin D status. This review addresses current evidence available for assessing the potential programming of long-term metabolic health of offspring by maternal vitamin D status in pregnancy. It summarizes knowledge on the early origins of metabolic health and analyzes evidence for an association between the vitamin D status in pregnancy and maternal and fetal health status. In addition, we analyze the link between the regulation of inflammation and the vitamin D status in the general population to inform on the general mechanisms through which early vitamin D might affect the programming of long-term health. The evidence suggests an association between the vitamin D status in early life and the programming of long-term health. However, to the best of our knowledge, the current finding is insufficient to draw a final conclusion for evidence-based preventive actions. The data warrant replication in prospective studies and additional research substantiating the causal factors and pathways.

  10. The long-term consequences of anaesthetic management | Sessler ...

    African Journals Online (AJOL)

    Thus, it is reasonable to ask to what extent anaesthetic management might influence long-term outcomes. The distinction being made here is between the classical definition of anaesthetic complications, which is restricted to the immediate perioperative period, perhaps extending to a few days after surgery, and the ...

  11. Differences in health status between long-term and short-term benzodiazepine users.

    NARCIS (Netherlands)

    Zandstra, S.M.; Furer, J.W.; Lisdonk, E.H. van de; Bor, J.H.J.; Zitman, F.G.; Weel, C. van


    BACKGROUND: Despite generally accepted advice to keep treatment short, benzodiazepines are often prescibed for more than six months. Prevention of long-term benzodiazepine use could be facilitated by the utilisation of risk indicators for long-term use. However, the characteristics of long-term

  12. Toxicities Associated with Cisplatin-Based Chemotherapy and Radiotherapy in Long-Term Testicular Cancer Survivors

    Directory of Open Access Journals (Sweden)

    Chunkit Fung


    Full Text Available Testicular cancer has become the paradigm of adult-onset cancer survivorship, due to the young age at diagnosis and 10-year relative survival of 95%. This clinical review presents the current status of various treatment-related complications experienced by long-term testicular cancer survivors (TCS free of disease for 5 or more years after primary treatment. Cardiovascular disease and second malignant neoplasms represent the most common potentially life-threatening late effects. Other long-term adverse outcomes include neuro- and ototoxicity, pulmonary complications, nephrotoxicity, hypogonadism, infertility, and avascular necrosis. Future research efforts should focus on delineation of the genetic underpinning of these long-term toxicities to understand their biologic basis and etiopathogenetic pathways, with the goal of developing targeted prevention and intervention strategies to optimize risk-based care and minimize chronic morbidities. In the interim, health care providers should advise TCS to adhere to national guidelines for the management of cardiovascular disease risk factors, as well as to adopt behaviors consistent with a healthy lifestyle, including smoking cessation, a balanced diet, and a moderate to vigorous intensity exercise program. TCS should also follow national guidelines for cancer screening as currently applied to the general population.

  13. Toxicities Associated with Cisplatin-Based Chemotherapy and Radiotherapy in Long-Term Testicular Cancer Survivors (United States)

    Dinh, Paul; Ardeshir-Rouhani-Fard, Shirin; Fossa, Sophie D.; Travis, Lois B.


    Testicular cancer has become the paradigm of adult-onset cancer survivorship, due to the young age at diagnosis and 10-year relative survival of 95%. This clinical review presents the current status of various treatment-related complications experienced by long-term testicular cancer survivors (TCS) free of disease for 5 or more years after primary treatment. Cardiovascular disease and second malignant neoplasms represent the most common potentially life-threatening late effects. Other long-term adverse outcomes include neuro- and ototoxicity, pulmonary complications, nephrotoxicity, hypogonadism, infertility, and avascular necrosis. Future research efforts should focus on delineation of the genetic underpinning of these long-term toxicities to understand their biologic basis and etiopathogenetic pathways, with the goal of developing targeted prevention and intervention strategies to optimize risk-based care and minimize chronic morbidities. In the interim, health care providers should advise TCS to adhere to national guidelines for the management of cardiovascular disease risk factors, as well as to adopt behaviors consistent with a healthy lifestyle, including smoking cessation, a balanced diet, and a moderate to vigorous intensity exercise program. TCS should also follow national guidelines for cancer screening as currently applied to the general population. PMID:29670654

  14. A joint prevention and control mechanism for air pollution in the Beijing-Tianjin-Hebei region in china based on long-term and massive data mining of pollutant concentration (United States)

    Wang, Hongbo; Zhao, Laijun


    China's Beijing-Tianjin-Hebei (BTH) region suffers from the country's worst air pollution. The problem has caused widespread concern both at home and abroad. Based on long-term and massive data mining of PM2.5 and PM10 concentration, we found that these pollutants showed similar variations in four seasons, but the most severe pollution was in winter. Through cluster analysis of the winter daily average concentration (DAC) of the two pollutants, we defined regions with similar variations in pollutant concentrations in winter. For the most polluted cities in BTH, the relationship between correlation coefficients for winter DAC and the distance between cities revealed that PM2.5 has regional, large-scale characteristics, with concentrated outbreaks, whereas PM10 has local, small-scale characteristics, with outbreaks at multiple locations. By selecting the key cities with the strongest linear relationship between the pollutant's DAC of each city and the daily individual air quality index values of the BTH region and through cluster analysis on the correlations between the pollutant DACs of the key cities, we defined regional divisions suitable for Joint Prevention and Control of Atmospheric Pollution (JPCAP) program to control PM2.5 and PM10. Comprehensively considering the degree of influence of regional atmospheric pollution control (RAPC) on air quality in BTH, as well as the elasticity and urgency of RAPC, we defined the control grades of the JPCAP regions. We found both the regions and corresponding control grades were consistent for PM2.5 and PM10. The thinking and methods of atmospheric pollution control we proposed will have broad significance for implementation of RAPC in other regions around the world.

  15. Adverse event reporting in Czech long-term care facilities. (United States)

    Hěib, Zdenřk; Vychytil, Pavel; Marx, David


    To describe adverse event reporting processes in long-term care facilities in the Czech Republic. Prospective cohort study involving a written questionnaire followed by in-person structured interviews with selected respondents. Long-term care facilities located in the Czech Republic. Staff of 111 long-term care facilities (87% of long-term care facilities in the Czech Republic). None. Sixty-three percent of long-term health-care facilities in the Czech Republic have adverse event-reporting processes already established, but these were frequently very immature programs sometimes consisting only of paper recording of incidents. Compared to questionnaire responses, in-person interview responses only partially tended to confirm the results of the written survey. Twenty-one facilities (33%) had at most 1 unconfirmed response, 31 facilities (49%) had 2 or 3 unconfirmed responses and the remaining 11 facilities (17%) had 4 or more unconfirmed responses. In-person interviews suggest that use of a written questionnaire to assess the adverse event-reporting process may have limited validity. Staff of the facilities we studied expressed an understanding of the importance of adverse event reporting and prevention, but interviews also suggested a lack of knowledge necessary for establishing a good institutional reporting system in long-term care.

  16. Changing incentives for long-term gas contracts

    International Nuclear Information System (INIS)

    Bohi, D.R.


    There is much concern about the absence of long-term gas contracts with fixed price and quantity conditions, which until recent years was the standard way of doing business in the gas industry. These types of contracts performed a valuable service in the development of the gas industry, and there comparative absence today is sometimes thought to be one reason for the current malaise in the industry. One hears the argument that there must be some kind of 'market failure' that prevents buyers and sellers from entering into these long term arrangements, and recent changes in state and federal regulations are often cited as the cause of the problem. The purpose of the author's remarks is to argue that what is taken as a breakdown in the market may be simply a reaction to a decline in economic incentives to enter into long-term contracts with rigid price and quantity terms. This is, in other words, simply one more aspect of change in the gas business that Frank Heintz referred to in his opening remarks this morning. The author starts by giving a brief description of the motives for engaging in long-term contracts, and then describes how incentives to use long-term contracts have declined for both gas buyers and gas sellers. He concludes that the decline in the use of long-term contracts is not cause for regulatory concern, but a result of the continuing transformation of the gas business to one that more closely resembles other commodity markets

  17. Characteristics of choroidal neovascularization in the complications of age-related macular degeneration prevention trial. (United States)

    Maguire, Maureen G; Alexander, Judith; Fine, Stuart L


    To describe the characteristics of incident choroidal neovascularization (CNV) in observed and treated eyes in the Complications of Age-related Macular Degeneration Prevention Trial (CAPT). Cross-sectional descriptive study within a multicenter, randomized clinical trial. Patients who developed CNV during CAPT follow-up. Inclusion criteria for CAPT specified bilateral large drusen (>or=10 drusen at least 125 micro), visual acuity >or=20/40 in each eye, and age >or=50. Exclusion criteria included CNV and geographic atrophy >1 Macular Photocoagulation Study (MPS) disc area or within 500 micro of the foveal center. One eye of each person was selected randomly for low-intensity laser treatment and the contralateral eye was observed. Fluorescein angiography was performed at baseline, annually for >or=5 years, and whenever there were symptoms of CNV. Trained readers at the CAPT Photograph Reading Center assessed color stereo photographs and angiogram negatives to identify CNV. Choroidal neovascularization was classified by type (predominantly classic CNV, minimally classic CNV, occult only CNV, or scar), location, and area. Visual acuity was measured by certified examiners. Symmetry of characteristics between eyes of bilaterally affected patients was examined. Choroidal neovascularization developed in 282 eyes of 225 patients. At the time of detection, 192 (68%) of the lesions were occult only, 153 (54%) were subfoveal, and 157 (56%) were or=20/40 in 123 (69%) of 179 eyes with visual acuity measured at the time of detection. Choroidal neovascularization developed in both eyes in 57 patients (25%) during CAPT follow-up. Lesions in eyes of bilaterally affected patients were no more similar to each other than affected eyes in 2 different patients. When patients are monitored closely, many CNV lesions can be detected outside of the fovea and when they are relatively small. Early detection may lead to improved long-term visual acuity.

  18. Financing long term liabilities (Germany)

    International Nuclear Information System (INIS)


    charges and fees levied from the waste producers. Altogether, financial resources for decommissioning are needed for the following steps: the post-operational phase in which the facility is prepared for dismantling after its final shut-down, dismantling of the radioactive part of the facility, management, storage and disposal of the radioactive waste, restoration of the site, licensing and regulatory supervision of all these steps. Additional means are necessary for the management, storage and disposal of the spent fuel. The way in which the availability of financial resources is secured differs between public owned installations and installations of the private power utilities. In Germany, past practices has resulted in singular contaminated sites of limited extent, mainly during the first half of the 20. century. Those contaminated sites have been or are being cleaned up and redeveloped. In large areas of Saxony and Thuringia, the geological formations permitted the surface and underground mining of Uranium ore. Facilities of the former Soviet-German WISMUT Ltd. where ore was mined and processed from 1946 until the early 1990's can be found at numerous sites. In the course of the re-unification of Germany, the soviet shares of the WISMUT were taken over by the Federal Republic of Germany and the closure of the WISMUT facilities was initiated. In that phase the extent of the damages to the environment and of the necessary remediation work became clear. All mining and milling sites are now closed and are under decommissioning. A comprehensive remediation concept covers all WISMUT sites. Heaps and mill-tailing ponds are transferred into a long-term stable condition. The area of the facilities to be remediated amounts to more than 30 km 2 . Heaps cover a total area of ca. 15,5 km 2 , tailing ponds in which the tailings resulting from the Uranium production are stored as sludges cover 6,3 km 2 ). In total, the remediation issues are very complex and without precedent. The

  19. Child maltreatment: pathway to chronic and long-term conditions? (United States)

    Taylor, Julie; Bradbury-Jones, Caroline; Lazenbatt, Anne; Soliman, Francesca


    The manifesto Start Well, Live Better by the UK Faculty of Public Health (Start Well, Live Better-A Manifesto for the Public's Health. London: UK Faculty of Public Health, 2014) sets out 12 compelling priorities for the protection of people's health. The focus of this document is preventative, calling for a comprehensive strategy to target a wide-ranging set of challenges to public health; however, it fails to mention child maltreatment and its negative impact on long-term health outcomes. In this article, we explore the long-term negative consequences of child maltreatment and how these can be conceptually aligned with four different characteristics of long-term health conditions. We suggest that situating child maltreatment within a long-term conditions framework could have significant advantages and implications for practice, policy and research, by strengthening a commitment across disciplines to apply evidence-based principles linked with policy and evaluation and recognizing the chronic effects of maltreatment to concentrate public, professional and government awareness of the extent and impact of the issue. We argue that a public health approach is the most effective way of focusing preventative efforts on the long-term sequelae of child maltreatment and to foster cooperation in promoting children's rights to grow and develop in a safe and caring environment free from violence and abuse. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail:

  20. [Perioperative management of long-term medication]. (United States)

    Vogel Kahmann, I; Ruppen, W; Lurati Buse, G; Tsakiris, D A; Bruggisser, M


    Anesthesiologists and surgeons are increasingly faced with patients who are under long-term medication. Some of these drugs can interact with anaesthetics or anaesthesia and/or surgical interventions. As a result, patients may experience complications such as bleeding, ischemia, infection or severe circulatory reactions. On the other hand, perioperative discontinuation of medication is often more dangerous. The proportion of outpatient operations has increased dramatically in recent years and will probably continue to increase. Since the implementation of DRGs (pending in Switzerland, introduced in Germany for some time), the patient enters the hospital the day before operation. This means that the referring physician as well as anesthesiologists and surgeons at an early stage must deal with issues of perioperative pharmacotherapy. This review article is about the management of the major drug classes during the perioperative period. In addition to cardiac and centrally acting drugs and drugs that act on hemostasis and the endocrine system, special cases such as immunosuppressants and herbal remedies are mentioned.

  1. Long term results of compression sclerotherapy. (United States)

    Labas, P; Ohradka, B; Cambal, M; Reis, R; Fillo, J


    To compare the short and long term results of different techniques of compression sclerotherapy. In the past 10 years the authors treated 1622 pts due to chronic venous insufficiency. There were 3 groups of patients: 1) Pts treated by Sigg's technique using Aethoxysclerol, 2) Pts treated by Fegan's technique with Fibrovein, and 3) Pts treated by Fegan's procedure, but using a combination of both sclerosants. In all cases, the techniques of empty vein, bubble air, uninterrupted 6-week compression and forced mobilisation were used. In the group of pats. treated by Sigg's procedure, the average cure rate was 67.47% after 6 months, 60.3% after 5 years of follow-up. In Fegan's group this rate was 83.6% after 6 months and 78.54% after 5 year assessment. Statistically, significant differences were found only by the disappearance of varices and reduction of pain in favour of Fegan's technique. In the group of pts treated by Fegan's (Aethoxysclerol + Fibrovein) this rate after 5 years was 86%. The only statistically significant difference was found by the disappearance of varices in favour of Fegan's technique using a combination of 2 detergent sclerosants. Sclerotherapy is effective when properly executed in any length of vein no matter how dilated it has become. The recurrences are attributed more to inadequate technique than to the shortcoming of the procedure. Sclerotherapy is miniinvasive, with few complications, and can be repeated on out-patient basis. (Tab. 1, Ref. 22.).

  2. A Long-term Plan for Kalk

    DEFF Research Database (Denmark)


    In this case, the author demonstrates together with the owner-manager of KALK A/S, Mr Rasmus Jorgensen, how to use the Family Business Map to frame a constructive discussion about long-term planning. The Family Business Map is a tool for long-term planning in family firms developed by Professor...

  3. Virtual Models of Long-Term Care (United States)

    Phenice, Lillian A.; Griffore, Robert J.


    Nursing homes, assisted living facilities and home-care organizations, use web sites to describe their services to potential consumers. This virtual ethnographic study developed models representing how potential consumers may understand this information using data from web sites of 69 long-term-care providers. The content of long-term-care web…

  4. [Hypertensive disorders during pregnancy: Cardiovascular long-term outcomes]. (United States)

    Alvarez-Alvarez, B; Martell-Claros, N; Abad-Cardiel, M; García-Donaire, J A

    Pregnancy-induced hypertension (PIH) induces maternal and fetal damage, but it can also be the beginning of future metabolic and vascular disorders. The relative risk of chronic hypertension after PIH is between 2.3 and 11, and the likelihood of subsequent development of type 2 diabetes is multiplied by 1.8. Women with prior preeclampsia/eclampsia have a twofold risk of stroke and a higher frequency of arrhythmias and hospitalization due to heart failure. Furthermore, a tenfold greater risk for long-term chronic kidney disease is observed as well. The relative risk of cardiovascular death is 2.1 times higher compared to the group without pregnancy-induced hypertension problems, although the risk is between 4 and 7 times higher in preterm birth associated with gestational hypertension or pre-existing hypertension The postpartum period is a great opportunity to intervene on lifestyle, obesity, make an early diagnosis of chronic hypertension and DM and provide the necessary treatments to prevent cardiovascular complications in women. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Aetiology, complications, and preventive measures of liver cirrhosis ...

    African Journals Online (AJOL)

    Common complications included ascites (92%), hepatic encephalopathy (19%), portal hypertension (8%), hepatocellular carcinoma (5%), and spontaneous bacterial peritonitis (3%). In the majority of patients, management was based on diuretics (furosemide and spironolactone) and dietary sodium restriction. Few patients ...

  6. Efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on risk and health-related quality of life in a low-education cohort: a randomized controlled study. (United States)

    Mayer-Berger, Wolfgang; Simic, Dusan; Mahmoodzad, Jawad; Burtscher, Ralph; Kohlmeyer, Martin; Schwitalla, Birgitta; Redaèlli, Marcus


    The aim of this study was to evaluate the efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on cardiovascular risk and health-related quality of life in a cohort of middle-aged (≤58 years) coronary artery disease (CAD) patients of low educational level compared to usual care. The study included 600 patients with CAD, with 271 in the intervention group (IG) and 329 in the control group (CG). The average age was nearly 50 years in both groups, nearly 90% were male, and 77% had less than 10 years of school education. No significant differences existed between the groups at baseline. Both groups had a 3-week comprehensive cardiovascular inpatient rehabilitation programme at the beginning, the intervention consisted of one further rehabilitation session in hospital after 6 months and regular telephone reminders over a period of 36 months. Analyses were conducted on an intention-to-treat basis. To evaluate the individual risk level, we used the PROCAM score and intima-media thickness (IMT) was measured at the common carotid artery on both sides following international standards. Health-related quality of life was assessed with the EUROQOL and HADS. Patients in the IG showed better 3-year risk profile outcomes. The PROCAM score increased by 3.0 (IG) and by 3.7 (CG) from the beginning to after 3 years (p > 0.05 intention-to-treat). The average IMT increased by 0.04 mm in the CG and was reduced by 0.03 mm in the IG (p = 0.014 for the difference). The IG had a significant improvement in health-related quality of life. Mortality, myocardial infarction, and stroke were not different although 'other cardiac events' (cardiac surgery or intervention) were significantly lower in the IG than the CG patients (p quality of life between the IG and CG, despite the relatively positive outcomes in the CG. In this low-education (predominantly male), middle-aged cohort, the positive impact on cardiovascular risk was

  7. Long term results of childhood dysphonia treatment. (United States)

    Mackiewicz-Nartowicz, Hanna; Sinkiewicz, Anna; Bielecka, Arleta; Owczarzak, Hanna; Mackiewicz-Milewska, Magdalena; Winiarski, Piotr


    The aim of this study was to assess the long term results of treatment and rehabilitation of childhood dysphonia. This study included a group of adolescents (n=29) aged from 15 to 20 who were treated due to pediatric hyperfunctional dysphonia and soft vocal fold nodules during their pre-mutational period (i.e. between 5 and 12 years of age). The pre-mutational therapy was comprised of proper breathing pattern training, voice exercises and psychological counseling. Laryngostroboscopic examination and perceptual analysis of voice were performed in each patient before treatment and one to four years after mutation was complete. The laryngostroboscopic findings, i.e. symmetry, amplitude, mucosal wave and vocal fold closure, were graded with NAPZ scale, and the GRBAS scale was used for the perceptual voice analysis. Complete regression of the childhood dysphonia was observed in all male patients (n=14). Voice disorders regressed completely also in 8 out of 15 girls, but symptoms of dysphonia documented on perceptual scale persisted in the remaining seven patients. Complex voice therapy implemented in adolescence should be considered as either the treatment or preventive measure of persistent voice strain, especially in girls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Long-term effects of islet transplantation. (United States)

    Holmes-Walker, D Jane; Kay, Thomas W H


    Islet transplantation has made great progress in recent years. This is a remarkable technical feat but raises the question of what the long-term benefits and risks are for type I diabetes recipients. Graft survival continues to improve, and recent multicenter studies show that islet transplantation is particularly effective to prevent hypoglycemic events even in those who do not become insulin-independent and to achieve excellent glycemic control. Concerns include histocompatability leucocyte antigen (HLA) sensitization and other risks including from immunosuppression that islet transplantation shares with other forms of allotransplantation. Reversal of hypoglycemia unawareness and protection from severe hypoglycemia events are two of the main benefits of islet transplantation and they persist for the duration of graft function. Islet transplantation compares favorably with other therapies for those with hypoglycemia unawareness, although new technologies have not been tested head-to-head with transplantation. HLA sensitization increases with time after transplantation especially if immunosuppression is ceased and is a risk for those who may require future transplantation as well as being associated with loss of graft function.

  9. Radiation therapy for the prevention of postoperative and traumatic complications

    Energy Technology Data Exchange (ETDEWEB)

    Kishkovskij, A.N.; DudareV, A.L. (Voenno-Meditsinskaya Akademiya, Leningrad (USSR))


    An analysis of the results of radiation therapy of 587 patients with postoperative and traumatic complications has shown that special ..gamma..-therapy used at early time following trauma or surgical intervention, with the first clinical signs of an incipient inflammatory process (the so-called ''anticipating'' irradiation), makes it possible to avoid the development of serious postoperative, post-traumatic complications: wound suppuration, fistulas, secondary parotitis, postamputation pain syndrome, ''needle'' osteomyelitis, keloid cicatrix, skin graft rejection, etc. In the author opinion, this promising trend in radiotherapy of nontumorous diseases is worth a wider using in clinical practice.

  10. Fourteen-Year Long-Term Results after Gastric Banding

    Directory of Open Access Journals (Sweden)

    Christine Stroh


    Full Text Available Background. Gastric banding (GB is a common bariatric procedure that is performed worldwide. Weight loss can be substantial after this procedure, but it is not sufficient in a significant portion of patients. Long-term rates for associated complications increase with every year of follow up, and only a few long-term studies have been published that examine these rates. We present our results after 14 years of postoperative follow up. Methods. Two hundred patients were operated upon form 01.02.1995 to 31.01.2009. Data collection was performed prospectively. In retrospective analysis, we analyzed weight loss, short- and long-term complications, amelioration of comorbidities and long-term outcome. Results. The mean postoperative follow up time was 94.4 months (range 2–144. The follow up rate was 83.5%. The incidence of postoperative complications for slippage was 2.5%, for pouch dilatation was 9.5%, for band migration was 5.5% and 12.0% for overall band removal. After 14 years, the reoperation rate was 30.5% with a reoperation rate of 2.2% for every year of follow up. Excess weight loss was 40.2% after 1 year, 46.3% after 2 years, 45.9% after 3 years, 41.9% after five years, 33.3% after 8 years, 30.8% after 10 years, 33.3% after 12 years and 15.6% after 14 years of follow up. Conclusion. The complication and reoperation rate after GB is high. Nevertheless, GB is still a therapeutic option in morbid obese patients, but the criteria for patient selection should be carefully evaluated.

  11. Type 2 diabetes mellitus : prevention of macrovascular complications

    NARCIS (Netherlands)

    Meeuwisse-Pasterkamp, Susanne H; van der Klauw, Melanie M.; Wolffenbuttel, Bruce HR


    Type 2 diabetes mellitus is a disease that affects a rapidly increasing number of patients. Most patients with Type 2 diabetes will develop vascular complications. This may be microvascular disease, such as nephropathy, retinopathy or polyneuropathy, and also macrovascular disease, such as coronary

  12. Long-Term Complications of Diabetes (For Parents) (United States)

    ... child keeps all appointments with them. Having a child with diabetes may seem overwhelming at times, but you're ... It's Important Monitoring Blood Sugar Talking to Your Child About Diabetes When Blood Sugar Is Too High Keeping Track ...

  13. Long term neurological complications of bacterial meningitis in ...

    African Journals Online (AJOL)



    Mar 11, 2013 ... seizures, cognitive delay, speech/language disorders, behavioral ... occupation of parents, and educational levels of parents were all obtained. ... Behavioral problem 2. 3. 5.32. ADHD ... tiation of appropriate antibiotic therapy.

  14. Bronchopulmonary Dysplasia: Chronic Lung Disease of Infancy and Long-Term Pulmonary Outcomes

    Directory of Open Access Journals (Sweden)

    Lauren M. Davidson


    Full Text Available Bronchopulmonary dysplasia (BPD is a chronic lung disease most commonly seen in premature infants who required mechanical ventilation and oxygen therapy for acute respiratory distress. While advances in neonatal care have resulted in improved survival rates of premature infants, limited progress has been made in reducing rates of BPD. Lack of progress may in part be attributed to the limited therapeutic options available for prevention and treatment of BPD. Several lung-protective strategies have been shown to reduce risks, including use of non-invasive support, as well as early extubation and volume ventilation when intubation is required. These approaches, along with optimal nutrition and medical therapy, decrease risk of BPD; however, impacts on long-term outcomes are poorly defined. Characterization of late outcomes remain a challenge as rapid advances in medical management result in current adult BPD survivors representing outdated neonatal care. While pulmonary disease improves with growth, long-term follow-up studies raise concerns for persistent pulmonary dysfunction; asthma-like symptoms and exercise intolerance in young adults after BPD. Abnormal ventilatory responses and pulmonary hypertension can further complicate disease. These pulmonary morbidities, combined with environmental and infectious exposures, may result in significant long-term pulmonary sequalae and represent a growing burden on health systems. Additional longitudinal studies are needed to determine outcomes beyond the second decade, and define risk factors and optimal treatment for late sequalae of disease.

  15. Long-Term Prediction of Severe Hypoglycemia in Type 1 Diabetes

    DEFF Research Database (Denmark)

    Henriksen, Marie Moth; Færch, Louise; Thorsteinsson, Birger


    BACKGROUND: Prediction of risk of severe hypoglycemia (SH) in patients with type 1 diabetes is important to prevent future episodes, but it is unknown if it is possible to predict the long-term risk of SH. The aim of the study is to assess if long-term prediction of SH is possible in type 1...... diabetes. METHODS: A follow-up study was performed with 98 patients with type 1 diabetes. At baseline and at follow-up, the patients filled in a questionnaire about diabetes history and complications, number of SH in the preceding year and state of awareness, and HbA1c and C-peptide levels were measured......-up. CONCLUSIONS: Long-term prediction of severe hypoglycemia in type 1 diabetes was not possible, although baseline hypoglycemia unawareness tended to remain a predictor for risk of SH at follow-up. Therefore, it is important repeatedly to assess the different risk factors of SH to determine the actual risk....

  16. Esophageal replacement in children: Challenges and long-term outcomes

    Directory of Open Access Journals (Sweden)

    Giampiero Soccorso


    Full Text Available Replacement of a nonexistent or damaged esophagus continues to pose a significant challenge to pediatric surgeons. Various esophageal replacement grafts and techniques have not produced consistently good outcomes to emulate normal esophagus. Therefore, many techniques are still being practiced and recommended with no clear consensus. We present a concise literature review of the currently used techniques and with discussions on the advantages and anticipated morbidity. There are no randomized controlled pediatric studies to compare different types of esophageal replacements. Management and graft choice are based on geographical and personal predilections rather than on any discernible objective data. The biggest series with long-term outcome are reported for gastric transposition and colonic replacement. Comparison of different studies shows no significant difference in early (graft necrosis and anastomotic leaks or late complications (strictures, poor feeding, gastro-esophageal reflux, tortuosity of the graft, and Barrett′s esophagus. The biggest series seem to have lower complications than small series reflecting the decennials experience in their respective centers. Long-term follow-up is recommended following esophageal replacement for the development of late strictures, excessive tortuosity, and Barrett′s changes within the graft. Once child overcomes initial morbidity and establishes oral feeding, long-term consequences and complications of pediatric esophageal replacement should be monitored and managed in adult life.

  17. Long-Term Retrievability of IVC Filters: Should We Abandon Permanent Devices?

    International Nuclear Information System (INIS)

    Berczi, V.; Bottomley, J. R.; Thomas, S. M.; Taneja, S.; Gaines, P. A.; Cleveland, T. J.


    Thromboembolic disease produces a considerable disease burden, with death from pulmonary embolism in the UK alone estimated at 30,000-40,000 per year. Whilst it is unproven whether filters actually improve longevity, the morbidity and mortality associated with thromboembolic disease in the presence of contraindications to anticoagulation is high. Thus complications associated with filter insertion, and whilst they remain in situ, must be balanced against the alternatives. Permanent filters remain in situ for the remainder of the patient's life and any complications from the filters are of significant concern. Filters that are not permanent are therefore attractive in these circumstances. Retrievable filters, to avoid or decrease long-term filter complications, appear to be a significant advance in the prevention of pulmonary embolism. In this review, we discuss the safety and effectiveness of both permanent and retrievable filters as well as the retrievability of retrievable inferior vena cava (IVC) filters, to explore whether the use of permanent IVC filters can be abandoned in favor of retrievable filters. Currently four types of retrievable filters are available: the Recovery filter (Bard Peripheral Vascular, Tempe, AZ, USA), the Guenther Tulip filter (Cook, Bloomington, IN, USA), the OptEase Filter (Cordis, Roden, The Netherlands), and the ALN filter (ALN Implants Chirurgicaux, Ghisonaccia, France). Efficacy and safety data for retrievable filters are as yet based on small series, with a total number of fewer than 1,000 insertions, and follow-up is mostly short term. Current long-term data are poor and insufficient to warrant the long-term implantation of these devices into humans. The case of fractured wire from a Recovery filter that migrated to the heart causing pericardial tamponade requiring open heart surgery is a reminder that any new endovascular device remaining in situ in the long term may produce unexpected problems. We should also bear in mind that

  18. Long term results of pyeloplasty in adults

    International Nuclear Information System (INIS)

    Tayib, Abdul Malik


    To determine the presenting systems, complications, stone coincidence in adult patients with primary ureteropelvic junction (UPJ) obstruction seen at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia. We are also reporting the success rate and long term results of adult pyeloplasty. We reviewed the records of 34 patients who underwent 37 pyeloplasty operations during the period January 1992 through to June 2002. The preoperative radiological diagnosis made by intravenous urogram or renal isotopes scan. We excluded from our study patients with previous history of passage of stones, renal or ureteral surgeries, large renal pelvis stone that may cause UPJ obstruction or abnormalities that may lead to secondry UPJ obstruction such as vesicoureteral reflux. There were 28 male patients and 8 females, their age varied between 16 and 51-years, the mean age was 36.1 years, and 18 (52.9%) patients had concomitant renal stones. Ispsilateral split renal function improved by 3-7% post pyeloplasty in 23 patients, while in one patient the function stayed the same, and in another patient the split function reduced by 4%. T1/2 renal isotopes washout time became less than 15 minutes in 19 patients and less than 20 minutes in 6 patients. Intravenous urogram revealed disappearence of the obstruction at UPJ in 7 patients while in 2 patients it became poorly functioning. Anderson Hynes pyeloplasty is an excellent procedure for treating UPJ obstruction in adults. Our success rate is comparable to the international repoted rates, while our study revealed a higher incidence of concomitant renal stones than the international studies. (author)

  19. Long term wet spent nuclear fuel storage

    International Nuclear Information System (INIS)


    The meeting showed that there is continuing confidence in the use of wet storage for spent nuclear fuel and that long-term wet storage of fuel clad in zirconium alloys can be readily achieved. The importance of maintaining good water chemistry has been identified. The long-term wet storage behaviour of sensitized stainless steel clad fuel involves, as yet, some uncertainties. However, great reliance will be placed on long-term wet storage of spent fuel into the future. The following topics were treated to some extent: Oxidation of the external surface of fuel clad, rod consolidation, radiation protection, optimum methods of treating spent fuel storage water, physical radiation effects, and the behaviour of spent fuel assemblies of long-term wet storage conditions. A number of papers on national experience are included

  20. Industrial Foundations as Long-Term Owners

    DEFF Research Database (Denmark)

    Thomsen, Steen; Poulsen, Thomas; Børsting, Christa Winther

    Short-termism has become a serious concern for corporate governance, and this has inspired a search for institutional arrangements to promote long-term decision-making. In this paper, we call attention to long-term ownership by industrial foundations, which is common in Northern Europe but little...... known in the rest of the world. We use a unique Danish data set to document that industrial foundations are long-term owners that practice long-term governance. We show that foundation ownership is highly stable compared to other ownership structures. Foundation-owned companies replace managers less...... frequently. They have conservative capital structures with low financial leverage. They score higher on an index of long-termism in finance, investment, and employment. They survive longer. Overall, our paper supports the hypothesis that corporate time horizons are influenced by ownership structures...

  1. Coping with PH over the Long Term (United States)

    ... a job, a volunteer commitment, or even a hobby can take a toll on long-term survivors ... people find solace in meditation, faith, humor, writing, hobbies and more. Find an outlet that you enjoy ...

  2. Long term effects of radiation in man

    International Nuclear Information System (INIS)

    Tso Chih Ping; Idris Besar


    An overview of the long term effects of radiation in man is presented, categorizing into somatic effects, genetic effects and teratogenic effects, and including an indication of the problems that arise in their determination. (author)

  3. Long term liquidity analysis of the firm

    Directory of Open Access Journals (Sweden)

    Jaroslav Gonos


    Full Text Available Liquidity control is a very difficult and important function. If the business is not liquid in the long term, it is under threatof bankruptcy, and on the other hand surplus of the cash in hand threaten its future efficiency, because the cash in hand is a sourceof only limited profitability. Long term liquidity is related to the ability of the short term and long term liabilities payment. Articleis trying to point out to the monitoring and analyzing of the long term liquidity in the concrete business, in this case the printing industrycompany. Hereby at the end of the article mentioned monitored and analyzed liquidity is evaluated in the five years time period.

  4. Long Term Care Minimum Data Set (MDS) (United States)

    U.S. Department of Health & Human Services — The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive...

  5. Sleep facilitates long-term face adaptation


    Ditye, Thomas; Javadi, Amir Homayoun; Carbon, Claus-Christian; Walsh, Vincent


    Adaptation is an automatic neural mechanism supporting the optimization of visual processing on the basis of previous experiences. While the short-term effects of adaptation on behaviour and physiology have been studied extensively, perceptual long-term changes associated with adaptation are still poorly understood. Here, we show that the integration of adaptation-dependent long-term shifts in neural function is facilitated by sleep. Perceptual shifts induced by adaptation to a distorted imag...

  6. Team Training and Institutional Protocols to Prevent Shoulder Dystocia Complications. (United States)

    Smith, Samuel


    Shoulder dystocia is an obstetrical emergency that may result in significant neonatal complications. It requires rapid recognition and a coordinated response. Standardization of care, teamwork and communication, and clinical simulation are the key components of patient safety programs in obstetrics. Simulation-based team training and institutional protocols for the management of shoulder dystocia are emerging as integral components of many labor and delivery safety initiatives because of their impact on technical skills and team performance.

  7. Prevention of cardiac complications in peripheral vascular surgery

    International Nuclear Information System (INIS)

    Cutler, B.S.


    The prevalence of severe coronary artery disease in peripheral vascular patients exceeds 50 per cent. Complications of coronary artery disease are the most common causes of mortality following peripheral vascular operations. To reduce the incidence of cardiac complications, it is first necessary to identify patients at risk through screening tests. Screening methods in current use include risk factor analysis, exercise testing, routine coronary angiography, and dipyridamole thallium-201 scintigraphy. The risk factor approach has the advantage of being widely applicable since it makes use of historical, physical, and electrocardiographic findings that are already familiar to surgeons and anesthesiologists. It is also inexpensive. However, it may overlook the patient who has no symptoms of coronary artery disease, possibly as a result of the sedentary lifestyle imposed by complications of peripheral vascular disease. The electrocardiographically monitored stress test will identify the asymptomatic patient with occult coronary disease and is helpful in predicting operative risk. However, a meaningful test is dependent on the patient's ability to exercise--an activity that is frequently limited by claudication, amputation, or arthritis. Exercise testing also suffers from a lack of sensitivity and specificity when compared with coronary arteriography. Routine preoperative coronary angiography overcomes the exercise limitation of treadmill testing but is not widely applicable as a screening test for reasons of cost and inherent risk. Dipyridamole thallium-201 scanning, on the other hand, is safe and of relatively low cost and does not require exercise

  8. Prevention of Infectious Complications in Patients With Chronic Granulomatous Disease. (United States)

    Slack, Maria A; Thomsen, Isaac P


    Chronic granulomatous disease (CGD) is a primary immunodeficiency that confers a markedly increased risk of bacterial and fungal infections caused by certain opportunistic pathogens. Current evidence supports the use of prophylactic antibacterial, antifungal, and immunomodulatory therapies designed to prevent serious or life-threatening infections in patients with CGD. In this review, we discuss current strategies for the prevention of infections in children and adults with CGD and the evidence that supports those strategies. In addition, we address current challenges and opportunities for future research in this important area.

  9. Very long-term sequelae of craniopharyngioma. (United States)

    Wijnen, Mark; van den Heuvel-Eibrink, Marry M; Janssen, Joseph A M J L; Catsman-Berrevoets, Coriene E; Michiels, Erna M C; van Veelen-Vincent, Marie-Lise C; Dallenga, Alof H G; van den Berge, J Herbert; van Rij, Carolien M; van der Lely, Aart-Jan; Neggers, Sebastian J C M M


    Studies investigating long-term health conditions in patients with craniopharyngioma are limited by short follow-up durations and generally do not compare long-term health effects according to initial craniopharyngioma treatment approach. In addition, studies comparing long-term health conditions between patients with childhood- and adult-onset craniopharyngioma report conflicting results. The objective of this study was to analyse a full spectrum of long-term health effects in patients with craniopharyngioma according to initial treatment approach and age group at craniopharyngioma presentation. Cross-sectional study based on retrospective data. We studied a single-centre cohort of 128 patients with craniopharyngioma treated from 1980 onwards (63 patients with childhood-onset disease). Median follow-up since craniopharyngioma presentation was 13 years (interquartile range: 5-23 years). Initial craniopharyngioma treatment approaches included gross total resection ( n  = 25), subtotal resection without radiotherapy ( n  = 44), subtotal resection with radiotherapy ( n  = 25), cyst aspiration without radiotherapy ( n  = 8), and 90 Yttrium brachytherapy ( n  = 21). Pituitary hormone deficiencies (98%), visual disturbances (75%) and obesity (56%) were the most common long-term health conditions observed. Different initial craniopharyngioma treatment approaches resulted in similar long-term health effects. Patients with childhood-onset craniopharyngioma experienced significantly more growth hormone deficiency, diabetes insipidus, panhypopituitarism, morbid obesity, epilepsy and psychiatric conditions compared with patients with adult-onset disease. Recurrence-/progression-free survival was significantly lower after initial craniopharyngioma treatment with cyst aspiration compared with other therapeutic approaches. Survival was similar between patients with childhood- and adult-onset craniopharyngioma. Long-term health conditions were comparable after

  10. Perinatal respiratory infections and long term consequences

    Directory of Open Access Journals (Sweden)

    Luciana Indinnimeo


    Full Text Available Respiratory syncytial virus (RSV is the most important pathogen in the etiology of respiratory infections in early life. 50% of children are affected by RSV within the first year of age, and almost all children become infected within two years. Numerous retrospective and prospective studies linking RSV and chronic respiratory morbidity show that RSV bronchiolitis in infancy is followed by recurrent wheezing after the acute episod. According to some authors a greater risk of wheezing in children with a history of RSV bronchiolitis would be limited to childhood, while according to others this risk would be extended into adolescence and adulthood. To explain the relationship between RSV infection and the development of bronchial asthma or the clinical pathogenetic patterns related to a state of bronchial hyperreactivity, it has been suggested that RSV may cause alterations in the response of the immune system (immunogenic hypothesis, activating directly mast cells and basophils and changing the pattern of differentiation of immune cells present in the bronchial tree as receptors and inflammatory cytokines. It was also suggested that RSV infection can cause bronchial hyperreactivity altering nervous airway modulation, acting on nerve fibers present in the airways (neurogenic hypothesis.The benefits of passive immunoprophylaxis with palivizumab, which seems to represent an effective approach in reducing the sequelae of RSV infection in the short- and long-term period, strengthen the implementation of prevention programs with this drug, as recommended by the national guidelines of the Italian Society of Neonatology. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the

  11. Preventive effects of benfotiamine in chronic diabetic complications. (United States)

    Chakrabarti, Rana; Chen, Megan; Liu, Weihua; Chen, Shali


    Aims/Introduction:  In diabetes, increased oxidative stress as a result of damage to the electron transport chain can lead to tissue injury through upregulation of multiple vasoactive factors and extracellular matrix proteins. Benfotiamine, a lipid soluble thiamine derivative, through reducing mitochondrial superoxide production, blocks multiple pathways leading to tissue damage in hyperglycemia. We investigated if treatment with benfotiamine can prevent diabetes-induced production of vasoactive factors and extracellular matrix proteins, and whether such effects are tissue-specific. We also examined whether effects of benfotiamine are mediated through a nuclear mechanism.   Retinal, renal and cardiac tissues from the streptozotocin-induced diabetic rats were examined after 4 months of follow up. mRNA levels were quantified using real-time RT-PCR. Protein levels were quantified using western blot and ELISA. Cellular expressions of 8-Hydroxy-2'-deoxyguanosine, a marker of nuclear DNA damage and Phospho-H2AX were also examined.   Diabetic animals showed hyperglycemia, glucosuria, increased urinary albumin/creatine ratio and loss of bodyweight. In the kidneys, heart and retina, diabetes caused increased production of endothelin-1, transforming growth factor-β1, vascular endothelial growth factor and augmented extracellular matrix proteins (collagen, fibronectin [FN] and its splice variant extradomain B containing FN), along with evidence of structural alterations, characteristic of diabetes-induced tissue damage. Such changes were prevented by benfotiamine. Furthermore, benfotiamine prevented diabetes-induced oxidative DNA damage and upregulation of p300, a histone acetylator and a transcription coactivator.   Data from the present study suggest that benfotiamine is effective in preventing tissue damage in diabetes and at the transcriptional level such effects are mediated through prevention of p300 upregulation. (J Diabetes Invest, doi: 10.1111/j.2040

  12. Effect of long-term calcitonin administration on steroid-induced osteoporosis after cardiac transplantation. (United States)

    Kapetanakis, Emmanouil I; Antonopoulos, Athanassios S; Antoniou, Theofani A; Theodoraki, Kassiani A; Zarkalis, Dimitrios A; Sfirakis, Peter D; Chilidou, Despina A; Alivizatos, Peter A


    Early, rapid bone loss and fractures after cardiac transplantation are well-documented complications of steroid administration; therefore, we undertook this study on the effects of long-term calcitonin on steroid-induced osteoporosis. Twenty-three heart transplant recipients on maintenance immunosuppression with cyclosporine, mycophenolate mofetil and prednisone were retrospectively studied. All patients received long-term prophylactic treatment with elemental calcium and vitamin D. Twelve (52.2%) patients also received long-term intranasal salmon calcitonin, whereas 11 (47.8%) received none. Bone mineral density and vertebral fractures were assessed at yearly intervals. Statistical comparisons between each group's bone loss during the first year and in the early (1 to 3 years), intermediate (4 to 6 years) and late (7+ years) post-transplantation periods were done. Lumbar spine bone loss was significant during the early follow-up period in the group not receiving calcitonin (0.744 +/- 0.114 g/cm(2) vs 0.978 +/- 0.094 g/cm(2) [p = 0.002]). The calcitonin group showed bone mineral density (BMD) levels within normal average values throughout the study period. BMD increased in the no-calcitonin group during the intermediate (4 to 6 years) and late (7+ years) follow-up periods, with values approaching normal average and no significant difference between the 2 groups (0.988 +/- 0.184 g/cm(2) vs 0.982 +/- 0.088 g/cm(2) [p = 0.944] and 0.89 +/- 0.09 g/cm(2) vs 1.048 +/- 0.239 g/cm(2) [p = 0.474], respectively). Prophylactic treatment with intranasal salmon calcitonin prevents rapid bone loss associated with high-dose steroids early after cardiac transplantation. Long-term administration does not seem warranted in re-establishing BMD.

  13. The preoperative evaluation prevent the postoperative complications of thyroidectomy

    Directory of Open Access Journals (Sweden)

    Chien-Feng Huang


    Conclusions: The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention.


    Fedorkiv, M B


    Increased of proinflammatory cytokines levels, including interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) on severe acute pancreatitis causes vasodilatation, increased permeability of the wall, accumulation of fluid in lung tissue and pleural sinuses. Transudate from acute parapancreatyc clusters of hot liquid and abdomen falls into the chest cavity through microscopic defects in the diaphragm due to the formation of pathological pleural-peritoneal connections or the relevant pressure gradient between the abdominal and pleural cavities. Remediation and removal of acute parapancreatyc clusters combined with the use of a multicomponent drug infusion therapy Cytoflavin provide a reduction in the frequency of pulmonary complications of acute pancreatitis from 48.3 to 31.0%. Use of the drug Cytoflavin reduces the severity of endogenous intoxication and mortality from acute lung injury from 12.9 to 6.1%.

  15. [A clinical study of gelatamp colloidal silver gelatin sponge on preventing the complication of teeth extraction]. (United States)

    Cai, Yong-hai; Lu, Chang-shou


    To study the clinical effect of Gelatamp colloidal silver gelatin sponge on preventing the complication of teeth extraction. 672 teeth were divided into experimental group and control group semi-randomly. All teeth were extracted after local anesthesia and sockets were cleaned. Gelatamp colloidal silver gelatin sponge was implanted into socket in experimental group and nothing was implanted into alveolar socket in control group. The complication of teeth extraction was observed on 0.5 h, 2 d and 7 d after extraction. The incidence rate of complication was calculated. The incidence rate of complication of teeth extraction in experimental group was 7.72%, which was lower than that of control group (24.43%). There was significant difference in the incidence rates of complication between experimental group and control group (P colloidal silver gelatin sponge can prevent the occurrence of complication of teeth extraction, this can be used in clinic.

  16. Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention

    NARCIS (Netherlands)

    Skolarikos, Andreas; Alivizatos, Gerasimos; de la Rosette, Jean


    OBJECTIVE: We review the pathophysiology and possible prevention measures of complications after extracorporeal shock wave lithotripsy (ESWL). METHODS: A literature search was performed with the Medline database on ESWL between 1980 and 2004. RESULTS: ESWL application has been intuitively connected

  17. Long-Term Prognosis of Plantar Fasciitis

    DEFF Research Database (Denmark)

    Hansen, Liselotte; Krogh, Thøger Persson; Ellingsen, Torkell


    , exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad. Study....... The risk was significantly greater for women (P heel...... regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us...

  18. Long-term dependence in exchange rates

    Directory of Open Access Journals (Sweden)

    A. Karytinos


    Full Text Available The extent to which exchange rates of four major currencies against the Greek Drachma exhibit long-term dependence is investigated using a R/S analysis testing framework. We show that both classic R/S analysis and the modified R/S statistic if enhanced by bootstrapping techniques can be proven very reliable tools to this end. Our findings support persistence and long-term dependence with non-periodic cycles for the Deutsche Mark and the French Franc series. In addition a noisy chaos explanation is favored over fractional Brownian motion. On the contrary, the US Dollar and British Pound were found to exhibit a much more random behavior and lack of any long-term structure.

  19. Long-term assessments after pancreaticoduodenectomy with pancreatic duct invagination anastomosis

    International Nuclear Information System (INIS)

    Fujino, Yasuhiro; Matsumoto, Ippei; Sakai, Tetsuya; Ajiki, Tetsuo; Ueda, Takashi; Kuroda, Yoshikazu; Suzuki, Yasuyuki


    The purpose of this cohort was to evaluate the long-term patency of the anastomosis and the remnant pancreatic functions. Fifty-six consecutive patients undergoing a pancreaticoduodenectomy with pancreatic duct invagination anastomosis were enrolled in this study. During the follow-up, changes in the remnant pancreatic duct size, pancreatic exocrine and endocrine functions, and nutritional status were monitored. No seriously activated pancreatic fistula, no hemorrhagic complications, no reoperations, and no in-hospital deaths were observed after surgery. A dilatation of remnant pancreatic duct was detected a total of 37 times (51%) during annual computed tomography (CT) evaluations. Pancreatic dysfunctions were observed in a considerable number of patients (exocrine 4/12, 9/14, and 8/16, endocrine 9/35, 8/27, and 4/16 at 1, 2, and 3 postoperative years, respectively). Functional declines in the remnant pancreas, duct dilatation, and a decrease in the body mass index were observed from the first year. However, these data did not progressively deteriorate thereafter, at least during the first 3 postoperative years. This study demonstrated a significant correlation between the duct dilatation and endocrine dysfunction. Our pancreatic duct invagination anastomosis resulted in somewhat limited long-term outcomes, although it did prevent serious complications in the short-term. (author)

  20. Long-term following-up of viability of spleen autotransplants in the Beagle canine model. (United States)

    Sajtos, Erika; Balint, Anita; Brath, Endre; Nemeth, Norbert; Peto, Katalin; Kovacs, Judit; Galuska, Laszlo; Varga, Jozsef; Fodor, Zoltan; Furka, Istvan; Miko, Iren


    To examine the possible late complications of splenectomy or spleen autotransplantation in large laboratory animal model, in which we need non-invasive or minimal-invasive methods for long-term monitoring of the experimental animals. Experimental groups of beagle dogs were: non-operated control, sham-operated control, splenectomy, spleen autotransplantation with 5 or 10 spleen-chips taken into the greater omentum (Furka's technique). Prior to operations, on the 1(st) postoperative week, monthly till the 6(th) as well as in the 9(th) and 12(th) month, hemorheological examinations were performed. In postoperative 12(th) month colloid scintigraphy and diagnostic laparoscopy were carried out. At the end of the investigation comparative morphological examinations were performed, too. From the 4(th)-5(th) postoperative month filtration function of spleen-autotransplants showed particular restoration compared to splenectomy group. However, the functional results did not reach the values of the control or sham-operated groups. Sham-operated control's scintigraphy nicely showed activity in the spleen. In spleen autotransplantation-groups scintigraphy indicated well the activity of spleen-chips. During diagnostic laparoscopy spleen-chips with their blood supply were found. Histologically, the structure of spleen-autotransplants was similar to normal splenic tissue. The autotransplants are regenerated, their functions have been partly restored, and thus spleen autotransplantation may prevent the possible complications of splenectomy. These parameters and the presented investigative protocol are suitable for long-term following-up of viability of the spleen-autotransplants.

  1. Characteristics of asthma attack with long-term management for bronchial asthma. (United States)

    Kawahara, Noriko; Hasegawa, Shunji; Hashimoto, Kunio; Matsubara, Tomoyo; Ichiyama, Takashi; Furukawa, Susumu


    There have been no reports on the evaluation of the usefulness of long-term asthma management based on the Japanese Pediatric Guideline for the Treatment and Management of Bronchial Asthma 2005 (JPGL 2005). The purpose of the present study was to retrospectively investigate the records of 350 patients admitted to Yamaguchi University Hospital who had asthma attacks from January 2006 to June 2008. There were 149 patients who were treated for more than 3 months in accordance with the guideline (long-term management group) and 201 who were not (non-long-term management group). The patients were divided into three age groups: 100 infants, 159 toddlers, and 91 schoolchildren. The onset age of asthma in the long-term management group was earlier than that in the non-long-term management group in toddlers and schoolchildren. The white blood cell counts and C-reactive protein levels were higher in the non-long-term management group in schoolchildren, suggesting the complication of some infections. The severity of asthma in the long-term management group was greater than that in the non-long-term management group among all three age groups. There were no significant differences, however, in the severity of asthma attack at admission between the long-term and non-long-term management groups in the three age groups. Patients who had severe asthma tended to be treated with long-term management, which suggests that long-term asthma management according to JPGL 2005 may reduce the severity of asthma attack at that admission, because the severity of asthma in patients undergoing long-term management correlates with the severity of asthma attack.

  2. Long-term outcomes of children undergoing video-assisted gastrostomy


    Sal?, Martin; Santimano, Ana; Helmroth, Sofia; Stenstr?m, Pernilla; Arnbjornsson, Einar ?lafur


    Purpose The aims of this study were to assess the short- and long-term complication rates after video-assisted gastrostomy (VAG), the effects of age and gender on long-term complications and the effect of duration of gastrostomy tube retention on the need for gastroraphy when the gastrostomy device was removed. Methods This was a retrospective study of children undergoing VAG at a single institution. Children who died or moved from the area were excluded. The rates of short- and long-term com...

  3. Colloidon baby – Rare case with preventable complications

    Directory of Open Access Journals (Sweden)

    Janardhan Bommakanti


    Full Text Available Colloidon baby is a rare congenital disorder characterized clinical-ly by parchment like taught membrane covering the whole body at the time of birth, which subsequently develops Non bullous ichthyosiform erythroderma or Lamellar ichthyiosis in most cases and in few cases other ichthyosiform disorders. The colloidon membrane spontaneously desquamates within 2 weeks or up to 3 months in few cases. Herein, we present 2 cases of colloidon babies born to consanguineously married couples of which the first baby was born at term by normal vaginal delivery and second baby born prematurely by caesarean section. Both 1st & 2nd baby were delivered in different private hospitals in villages of Nizamabad district, Telangana state and reported to tertiary level children’s hospital in Hyderabad city on 4nd and 6th day of life respectively with complaints of colloidon membrane and macera-tion of skin in diaper area, was admitted in Neonatal intensive care unit (NICU in humidified incubator, treated with emollients, intra-venous fluids and prophylactic antibiotics to avoid complications. Nursing care is of prime importance. This presentation was aimed at stressing not only the importance of early recognition by pedia-trician & timely referral to dermatologist and ophthalmologist for saving life of affected baby but also equal importance to proper nursing care.

  4. Long term planning for wind energy development

    International Nuclear Information System (INIS)

    Trinick, M.


    In a planning system intended to be governed primarily by policies in statutory plans a reasonable horizon for long term planning is 10 years or longer. Because of statutory requirements, developers have no option but to pay due regard to, and take a full part in, long term planning. The paper examines the type of policies which have emerged in the last few years to cater for wind energy development. It canvasses the merits of different types of policies. Finally, it discusses the policy framework which may emerge to cater for development outside NFFO. (Author)

  5. Long-term characteristics of nuclear emulsion

    International Nuclear Information System (INIS)

    Naganawa, N; Kuwabara, K


    Long-term characteristics of the nuclear emulsion so called 'OPERA film' used in the neutrino oscillation experiment, OPERA, has been studied for 8 years since its production or refreshing after it. In the results, it turned out to be excellent in sensitivity, amount of random noise, and refreshing characteristics. The retention capacity of latent image of tracks was also studied. The result will open the way to the recycling of 7,000,000 emulsion films which will remain not developed after 5 years of OPERA's run, and other long-term experiments with emulsion.

  6. Long-term characteristics of nuclear emulsion (United States)

    Naganawa, N.; Kuwabara, K.


    Long-term characteristics of the nuclear emulsion so called ``OPERA film'' used in the neutrino oscillation experiment, OPERA, has been studied for 8 years since its production or refreshing after it. In the results, it turned out to be excellent in sensitivity, amount of random noise, and refreshing characteristics. The retention capacity of latent image of tracks was also studied. The result will open the way to the recycling of 7,000,000 emulsion films which will remain not developed after 5 years of OPERA's run, and other long-term experiments with emulsion.

  7. Long-term home care scheduling

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr

    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans spanning several days such that a high quality of service is maintained and the overall cost is kept as low as possible. A solution to the problem...... provides detailed information on visits and visit times for each employee on each of the covered days. We propose a branch-and-price algorithm for the long-term home care scheduling problem. The pricing problem generates one-day plans for an employee, and the master problem merges the plans with respect...

  8. Long term storage techniques for 85Kr

    International Nuclear Information System (INIS)

    Foster, B.A.; Pence, D.T.; Staples, B.A.


    As new nuclear fuel reprocessing plants go on stream, the collection of fission product 85 Kr will be required to avoid potential local release problems and long-term atmospheric buildup. Storage of the collected 85 Kr for a period of at least 100 years will be necessary to allow approximately 99.9 percent decay before it is released. A program designed to develop and evaluate proposed methods for long-term storage of 85 Kr is discussed, and the results of a preliminary evaluation of three methods, high pressure steel cylinders, zeolite encapsulation, and clathrate inclusion are presented. (U.S.)

  9. Long-term results after endoscopic drainage and necrosectomy of symptomatic pancreatic fluid collections. (United States)

    Seewald, Stefan; Ang, Tiing Leong; Richter, Hugo; Teng, Karl Yu Kim; Zhong, Yan; Groth, Stefan; Omar, Salem; Soehendra, Nib


    To determine the immediate and long-term results of endoscopic drainage and necrosectomy for symptomatic pancreatic fluid collections. The data of 80 patients with symptomatic pancreatic fluid collections (mean diameter: 11.7 cm, range 3-20; pseudocysts: 24/80, abscess: 20/80, infected walled-off necrosis: 36/80) referred for endoscopic management from October 1997 to March 2008 were analyzed retrospectively. Endoscopic drainage techniques included endoscopic ultrasound (EUS)-guided aspiration (2/80), EUS-guided transenteric drainage (70/80) and non-EUS-guided drainage across a spontaneous transenteric fistula (8/80). Endoscopic necrosectomy was carried out in 49/80 (abscesses: 14/20; infected necrosis: 35/36). Procedural complications were bleeding (12/80), perforation (7/80), portal air embolism (1/80) and Ogilvie Syndrome (1/80). Initial technical success was achieved in 78/80 (97.5%) and clinical resolution of the collections was achieved endoscopically in 67/80 (83.8%), with surgery required in 13/80 (perforation: four; endoscopically inaccessible areas: two; inadequate drainage: seven). Within 6 months five patients required surgery due to recurrent fluid collections; over a mean follow up of 31 months, surgery was required in four more patients due to recurrent collections as a consequence of underlying pancreatic duct abnormalities that could not be treated endoscopically. The long-term success of endoscopic treatment was 58/80 (72.5%). Endoscopic drainage of symptomatic pancreatic fluid collections is safe and effective, with excellent immediate and long-term results. Endoscopic necrosectomy has a risk of serious complications. The underlying pancreatic duct abnormalities must be addressed to prevent recurrence of fluid collections. © 2011 The Authors. Digestive Endoscopy © 2011 Japan Gastroenterological Endoscopy Society.

  10. Experiences of long-term tranquillizer use

    DEFF Research Database (Denmark)

    Skinhoj, K T; Larsson, S; Helweg-Joergensen, S


    , the psychodynamic perspective is integrated within a multi-dimensional model that considers biological, cognitive, identity, gender and social learning factors. The analysis reveals the possibility of achieving a detailed understanding of the dynamic processes involved in the development of long-term tranquillizer...

  11. Long-Term Orientation in Trade

    NARCIS (Netherlands)

    Hofstede, G.J.; Jonker, C.M.; Verwaart, D.


    Trust does not work in the same way across cultures. This paper presents an agent model of behavior in trade across Hofstedes cultural dimension of long-term vs. short-term orientation. The situation is based on a gaming simulation, the Trust and Tracing game. The paper investigates the

  12. Safety of long-term PPI therapy

    DEFF Research Database (Denmark)

    Reimer, Christina


    Proton pump inhibitors have become the mainstay of medical treatment of acid-related disorders. Long-term use is becoming increasingly common, in some cases without a proper indication. A large number of mainly observational studies on a very wide range of possible associations have been publishe...... to a careful evaluation of the indication for PPI treatment....

  13. Long term consequences of early childhood malnutrition

    NARCIS (Netherlands)

    Kinsey, B.H.; Hoddinott, J; Alderman, H.


    This paper examines the impact of pre-school malnutrition on subsequent human capital formation in rural Zimbabwe using a maternal fixed effects - instrumental variables (MFE-IV) estimator with a long term panel data set. Representations of civil war and drought shocks are used to identify

  14. Financial Incentives in Long-Term Care

    NARCIS (Netherlands)

    P.L.H. Bakx (Pieter)


    markdownabstract__Abstract__ Long-term care (ltc) aims to help individuals to cope with their impairments. In my thesis, I describe ltc financing alternatives and their consequences for the allocation of ltc. This thesis consists of two parts. In the first part, I investigate how alternative ways

  15. Long-term outcomes of patellofemoral arthroplasty.

    NARCIS (Netherlands)

    Jonbergen, J.P.W. van; Werkman, D.M.; Barnaart, L.F.; Kampen, A. van


    The purpose of this study was to correlate the long-term survival of patellofemoral arthroplasty with primary diagnosis, age, sex, and body mass index. One hundred eighty-five consecutive Richards type II patellofemoral arthroplasties were performed in 161 patients with isolated patellofemoral

  16. Long-Term Memory and Learning (United States)

    Crossland, John


    The English National Curriculum Programmes of Study emphasise the importance of knowledge, understanding and skills, and teachers are well versed in structuring learning in those terms. Research outcomes into how long-term memory is stored and retrieved provide support for structuring learning in this way. Four further messages are added to the…

  17. The 2013 Long-Term Budget Outlook (United States)


    number of years, leading to substantial additional federal spending. For example, the nation could experience a massive earthquake, a nuclear meltdown...budget surpluses remaining after paying down publicly held debt available for redemption . a. For comparison with the current long-term projections, CBO

  18. Long-term effects of ionizing radiation

    International Nuclear Information System (INIS)

    Kaul, Alexander; Burkart, Werner; Grosche, Bernd; Jung, Thomas; Martignoni, Klaus; Stephan, Guenther


    This paper approaches the long-term effects of ionizing radiation considering the common thought that killing of cells is the basis for deterministic effects and that the subtle changes in genetic information are important in the development of radiation-induced cancer, or genetic effects if these changes are induced in germ cells

  19. Pituitary diseases : long-term psychological consequences

    NARCIS (Netherlands)

    Tiemensma, Jitske


    Nowadays, pituitary adenomas can be appropriately treated, but patients continue to report impaired quality of life (QoL) despite long-term remission or cure. In patients with Cushing’s disease, Cushing’s syndrome or acromegaly, doctors should be aware of subtle cognitive impairments and the

  20. The long term stability of lidar calibrations

    DEFF Research Database (Denmark)

    Courtney, Michael; Gayle Nygaard, Nicolai

    Wind lidars are now used extensively for wind resource measurements. One of the requirements for the data to be accepted in support of project financing (so-called ‘banka-bility’) is to demonstrate the long-term stability of lidar cali-brations. Calibration results for six Leosphere WindCube li...

  1. Rebalancing for Long-Term Investors

    NARCIS (Netherlands)

    Driessen, Joost; Kuiper, Ivo


    In this study we show that the rebalance frequency of a multi-asset portfolio has only limited impact on the utility of a long-term passive investor. Although continuous rebalancing is optimal, the loss of a suboptimal strategy corresponds to up to only 30 basis points of the initial wealth of the

  2. Long-term sealing of openings in salt formations

    International Nuclear Information System (INIS)

    Walter, F.; Stockmann, N.; Yaramanci, U.; Laurens, J.F.


    Radioactive wastes can be disposed of in deep salt formations. Rock salt is a suitable geologic medium because of its unique characteristics. Open boreholes, shafts and drifts are created to provide physical access to the repository. Long-term seals must be emplaced in those potential pathways to prevent radioactive release to the biosphere. The sealing materials must be mechanically and, most important, geochemically stable within the host rock. Salt bricks made of compressed salt-powder are understood to be the first choice long-term sealing material. Seals built from salt bricks will be ductile. The permeability of the salt bricks is assumed to be in the order of 2*10 -15 m 2 . Large sealing systems are built by combining the individual bricks with mortar. Raw materials for mortar are fine-grained halite powder and ground saliferous clay. The permeability of the mortar decreases with its salt content to approx. 2*10 -14 m 2 . Moistened saliferous clay may show temporary swelling. Sealing experiments will be carried out in the Asse salt mine. Long-term seals will be built into holes of 1 m diameter. The contact and merging of the brick-wall with the surrounding rock salt will be investigated in long-term tests. Within the in situ sealing program a number of geophysical methods are applied. Acoustic emission measurements are used to study the effects of high pressure gas injection and a geoelectrical observation program is aiming to estimate the permeability in and around the long-term seal. High frequency electromagnetic methods contribute to the knowledge of the petrophysical rock properties. 11 refs., 12 figs

  3. Long-term studies of the natural history of asthma in childhood

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Bønnelykke, Klaus


    secondary prevention through the use of inhaled corticosteroids can effectively halt the long-term disease progression in childhood. In conclusion, the natural history of asthma and the associated airway changes is still poorly understood, and we have not managed to translate findings from long-term studies...

  4. [Laparoscopic management of ureteroileal stenosis: Long term follow up. (United States)

    Emiliani, Esteban; Gavrilov, Pavel; Mayordomo, Olga; Salvador, Josep; Palou, Joan; Rosales, Antonio; Villavicencio, Humberto


    To describe the laparoscopic approach for uretero-ileal anastomosis strictures and to analyse our long term series. A retrospective review was performed evaluating our series of patients with benign ureteroileal anastomosis strictures treated laparoscopically from 2011 to 2017. Demographics and perioperative data were obtained and analyzed. Complications were described with the Clavien-Dindo classification. The surgical technique was described and a literature review was performed. Eleven procedures were performed in ten patients. Mean blood loss was 180 ml. All the operations were performed laparoscopically without conversion. Mean hospital stay was 10 days (4-23). Early complications were Clavien-Dindo I y II: Two cases of limited anastomosis leakage, one lymphorrea, one paralitic ileum and one accidental descent of the ureteral catheter. Mean follow-up was 56 months (12-179) No late complications have been described. Based on our series with 5 year follow up, the laparoscopic approach for uretero-ileal anastomosis strictures is feasible and safe.

  5. Radiotherapy in early-stage Dupuytren's contracture. Long-term results after 13 years

    International Nuclear Information System (INIS)

    Betz, Nicolas; Ott, Oliver J.; Sauer, Rolf; Fietkau, Rainer; Adamietz, Boris; Keilholz, Ludwig


    Background and Purpose: In early-stage Dupuytren's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis. Patients and Methods: Between 12/1982 and 02/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in two courses with five daily fractions of 3.0 Gy to a total dose of 30 Gy; separated by a 6- to 8-week interval. The extent of disease was described according to a modified classification of Tubiana et al. Long-term outcome was analyzed at last follow-up between 02/2008 and 05/2008 with a median follow-up of 13 years (range, 2-25 years). Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response. Results: According to the individual stages, 123 cases (59%) remained stable, 20 (10%) improved, and 65 (31%) progressed. In stage N 87% and in stage N/I 70% remained stable or even regressed. In more advanced stages, the rate of disease progression increased to 62% (stage I) or 86% (stage II). 66% of the patients showed a long-term relief of symptoms (i.e., burning sensations, itching and scratching, pressure and tension). Radiotherapy did not increase the complication rate after surgery in case of disease progression and only minor late toxicity (skin atrophy, dry desquamation) could be observed in 32% of the patients. There was no evidence for a second malignancy induced by radiotherapy. Conclusion: After a mean follow-up of 13 years radiotherapy is effective in prevention of disease progression and improves patients' symptoms in early-stage Dupuytren's contracture (stage N, N/I). In case of disease progression after radiotherapy, a ''salvage'' operation is still feasible. (orig.)

  6. Efficiency of various preventive methods of perinatal mother and child complications

    Directory of Open Access Journals (Sweden)

    Sadretdinova T.L.


    Full Text Available Purpose: to study efficiency of various methods of prevention of perinatal complications in mother and child. Material and methods. In three risk groups preventive treatment of intrauterine infected fetus (IUIF, gestosis, noncarrying of pregnancy and fetoplacental insufficiency has been carried out. In group I consisted of 71 pregnant women preventive treatment has included medication with application of antioxidants; stimulators of processes of carboxylation in cycle Krebs; endogenic synthesis prostaglandins, prostacyclin; drugs improving processes of microcirculation, stabilizing function of endothelium ofvessels, an exchange of homocysteine. In group II consisted of 67 pregnant women prevention of IUIF and complications has been carried out by means of physical exercises in combination with aqua aerobics. In group III consisted of 100 women prevention of IUIF has been standard. In the control group IV consisted of 70 women pregnancy has not been complicated. Parameters of oxidant and antioxidant systems, central hemodynamics, determined in this group have been determined as normal for comparison. Results. In relation to group III medicamen-tous treatment in group I, regular aqua aerobics in group II have allowed to lower frequency of IUIF, perinatal mother complications, perinatal diseases, death rates in newborns and morbidity in children of early age. Conclusion. For the prevention of IUIF, mother and child perinatal complications, morbidity in children of early age it has been proposed to use medication and regular aqua aerobics which provides nonmedicamentous pregnancy course

  7. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation Práticas recomendadas para triagem e prevenção de complicações em sobreviventes de longo prazo após transplante de células hematopoéticas

    Directory of Open Access Journals (Sweden)

    Navneet Singh Majhail


    Full Text Available Advances in hematopoietic cell transplantation (HCT technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (e.g. umbilical cord blood and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, periand post-transplant exposures and risk-factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplant experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.Os avanços na tecnologia do transplante de células hematopoéticas (TCH e do tratamento de suporte levaram a melhoria na sobrevida a longo prazo após os TCH. Indicações emergentes de transplante, introdução de novas fontes de células (p.ex. sangue de cordão umbilical e transplante de pacientes mais velhos utilizando regimes de condicionamento menos intensos também contribuíram para o aumento no número de sobreviventes após TCH. Estes sobreviventes estão sob risco de desenvolver complicações tardias devido a exposições e fatores de risco pré, peri e pós-transplante. Práticas recomendadas para a triagem e a prevenção de complicações em sobreviventes de TCH foram publicadas em 2006. Um grupo internacional de especialistas foi formado em 2011 para rever a literatura contemporânea e atualizar as recomendações, considerando as mudanças nas práticas de transplante e a aplicabilidade internacional destas recomenda

  8. Long-term hearing result using Kurz titanium ossicular implants. (United States)

    Hess-Erga, Jeanette; Møller, Per; Vassbotn, Flemming Slinning


    Titanium implants in middle ear surgery were introduced in the late 90s and are now frequently used in middle ear surgery. However, long-term studies of patient outcome are few and have only been published in subgroups of patients. We report the long-term effect of titanium middle ear implants for ossicular reconstruction in chronic ear disease investigated in a Norwegian tertiary otological referral centre. Retrospective chart reviews were performed for procedures involving 76 titanium implants between 2000 and 2007. All patients who underwent surgery using the Kurz Vario titanium implant were included in the study. Audiological parameters using four frequencies, 0.5, 1, 2, and 3 kHz, according to AAO-HNS guidelines, was assessed pre and postoperatively. Otosurgical procedures, complications, revisions, and extrusion rates were analyzed. The study had no dropouts. The partial ossicular replacement prosthesis (PORP) was used in 44 procedures and the total ossicular replacement prosthesis (TORP) in 32 procedures, respectively. Mean follow-up was 5.2 years (62 months). The ossiculoplasties were performed as staging procedures or in combination with other chronic ear surgery. The same surgeon performed all the procedures. A postoperative air-bone gap of ≤ 20 dB was obtained in 74 % of the patients, 82 % for the Bell (PORP) prosthesis, and 63 % for the Arial (TORP) prosthesis. The extrusion rate was 5 %. We conclude that titanium ossicular implants give stable and excellent long-term hearing results.

  9. Defining a communication system for the long term

    International Nuclear Information System (INIS)

    Mitropoulou, Eleni


    Prof. Eleni Mitropoulou presented an ongoing study, undertaken on behalf of Andra, on long-term communication. The speaker highlighted that it is not so much the marking that needs to be sustainable, but above all what the marking communicates. She highlighted the importance of sustainable human action to produce memory and, thus, the need to reconcile the passive character of geological disposal and the active character of memory keeping. Focusing on semiotics, the interaction between the short, medium and long term was pointed out, highlighting the need to create a relay system. A multidimensional message was proposed, for the purposes of information ('storage site here'), interpellation (to warn, prevent or alert) and integration (with regard to the surrounding environment). This corresponds to the systemic approach of the RK and M initiative, which is based on a variety of RK and M transmission mechanisms that are integrated with and/or complement one another

  10. Efficacy of lifestyle modification for long-term weight control. (United States)

    Wadden, Thomas A; Butryn, Meghan L; Byrne, Kirstin J


    A comprehensive program of lifestyle modification induces loss of approximately 10% of initial weight in 16 to 26 weeks, as revealed by a review of recent randomized controlled trials, including the Diabetes Prevention Program. Long-term weight control is facilitated by continued patient-therapist contact, whether provided in person or by telephone, mail, or e-mail. High levels of physical activity and the consumption of low-calorie, portion-controlled meals, including liquid meal replacements, can also help maintain weight loss. Additional studies are needed of the effects of macronutrient content (e.g., low-fat vs. low-carbohydrate diets) on long-term changes in weight and health. Research also is needed on effective methods of providing comprehensive weight loss control to the millions of Americans who need it.

  11. [Effect of anemia on child development: long-term consequences]. (United States)

    Zavaleta, Nelly; Astete-Robilliard, Laura


    Anemia in children younger than 3 years is a public health problem in Peru and worldwide. It is believed that one of the primary causes of anemia is iron deficiency. Numerous studies and reviews have reported that iron deficiency limited psychomotor development in children and that, despite the correction of anemia, children with iron deficiency experienced poorer long-term performance in cognitive, social, and emotional functioning. These outcomes were reported in observational studies, follow-up studies, and experimental studies with a control group. Anemia can decrease school performance, productivity in adult life, quality of life, and the general income of affected individuals. Here we describe possible mechanisms underlying the effect of iron deficiency, with or without anemia, on childhood development. The high rate of anemia in this age group is a cause for concern. Moreover, anemia should be prevented in the first year of life to avoid long-term negative effects on individual development.

  12. Long-term health benefits of appetite suppressants remain unproven

    Directory of Open Access Journals (Sweden)

    Francisco José Roma Paumgartten


    Full Text Available Because of the increasing prevalence of obesity, prevention and treatment of overweight has become a major public health concern. In addition to diet and exercise, drugs are needed for patients who failed to lose weight with behavioral treatment. The current article aimed to summarize recent concerns on the safety and efficacy of appetite suppressants. Several appetite suppressants have been banned for safety reasons. In 2010, sibutramine was withdrawn from the market because a long-term study showed it increased the risks of cardiovascular events. So far no study with a sufficiently large sample size has demonstrated that appetite suppressants can reduce morbidity and mortality associated with overweight. The withdrawal of sibutramine highlights that guidelines for the evaluation of weight control drugs must be more stringent, and studies on their long-term health benefits are needed prior to their marketing.

  13. Long-term selenium status in humans

    International Nuclear Information System (INIS)

    Baskett, C.K.; Spate, V.L.; Mason, M.M.; Nichols, T.A.; Williams, A.; Dubman, I.M.; Gudino, A.; Denison, J.; Morris, J.S.


    The association of sub-optimal selenium status with increased risk factors for some cancers has been reported in two recent epidemiological studies. In both studies the same threshold in selenium status was observed, below which, cancer incidence increased. To assess the use of nails as a biologic monitor to measure the long-term selenium status, an eight-year longitudinal study was undertaken with a group of 11 adult subjects, 5 women and 6 men. Selenium has been measured by instrumental neutron activation analysis. Differences between fingernails and toenails with be discussed. In addition, the results will be discussed in the context of the long-term stability of the nail monitor to measure selenium status during those periods when selenium determinants are static; and the changes that occur as a result of selenium supplementation. (author)

  14. Long-Term Ownership by Industrial Foundations

    DEFF Research Database (Denmark)

    Børsting, Christa Winther; Kuhn, Johan Moritz; Poulsen, Thomas


    in Denmark. Industrial foundations are independent legal entities without owners or members typically with the dual objective of preserving the company and using excess profits for charity. We use a unique Danish data set to examine the governance of foundation-owned companies. We show that they are long......-term in several respects. Foundations hold on to their shares for longer. Foundation-owned companies replace managers less frequently. They have more conservative capital structures with less leverage. Their companies survive longer. Their business decisions appear to be more long term. This paper supports...... the hypothesis that time horizons are influenced by ownership structures and particularly that industrial foundations promote longtermism. Policymakers which are interested in promoting longtermism should allow and perhaps even encourage the creation of industrial foundations. More generally they should consider...

  15. Analysis of long-term energy scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Lemming, J.; Morthorst, P.E.


    When addressing the role of fusion energy in the 21. century, the evaluation of possible future structures in the electricity market and the energy sector as a whole, can be a useful tool. Because fusion energy still needs demonstration, commercialized fusion energy is not likely to be a reality within the next few decades. Therefore long-term scenarios are needed describing the energy markets, which fusion energy eventually will be part of. This report performs an analysis of two of the most detailed existing long-term scenarios describing possible futures of the energy system. The aim is to clarify the frames in which the future development of the global energy demand, as well as the structure of the energy system can be expected to develop towards the year 2100. (au) 19 refs.

  16. Long-term effects of radiation

    International Nuclear Information System (INIS)

    Smith, J.; Smith, T.


    It is pointed out that sources of long-term damage from radiation are two-fold. People who have been exposed to doses of radiation from initial early fallout but have recovered from the acute effects may still suffer long-term damage from their exposure. Those who have not been exposed to early fallout may be exposed to delayed fallout, the hazards from which are almost exclusively from ingesting strontium, caesium and carbon isotopes present in food; the damage caused is relatively unimportant compared with that caused by the brief doses from initial radiation and early fallout. A brief discussion is presented of the distribution of delayed long-lived isotope fallout, and an outline is sketched of late biological effects, such as malignant disease, cataracts, retarded development, infertility and genetic effects. (U.K.)

  17. Long term economic relationships from cointegration maps (United States)

    Vicente, Renato; Pereira, Carlos de B.; Leite, Vitor B. P.; Caticha, Nestor


    We employ the Bayesian framework to define a cointegration measure aimed to represent long term relationships between time series. For visualization of these relationships we introduce a dissimilarity matrix and a map based on the sorting points into neighborhoods (SPIN) technique, which has been previously used to analyze large data sets from DNA arrays. We exemplify the technique in three data sets: US interest rates (USIR), monthly inflation rates and gross domestic product (GDP) growth rates.

  18. Murine model of long term obstructive jaundice (United States)

    Aoki, Hiroaki; Aoki, Masayo; Yang, Jing; Katsuta, Eriko; Mukhopadhyay, Partha; Ramanathan, Rajesh; Woelfel, Ingrid A.; Wang, Xuan; Spiegel, Sarah; Zhou, Huiping; Takabe, Kazuaki


    Background With the recent emergence of conjugated bile acids as signaling molecules in cancer, a murine model of obstructive jaundice by cholestasis with long-term survival is in need. Here, we investigated the characteristics of 3 murine models of obstructive jaundice. Methods C57BL/6J mice were used for total ligation of the common bile duct (tCL), partial common bile duct ligation (pCL), and ligation of left and median hepatic bile duct with gallbladder removal (LMHL) models. Survival was assessed by Kaplan-Meier method. Fibrotic change was determined by Masson-Trichrome staining and Collagen expression. Results 70% (7/10) of tCL mice died by Day 7, whereas majority 67% (10/15) of pCL mice survived with loss of jaundice. 19% (3/16) of LMHL mice died; however, jaundice continued beyond Day 14, with survival of more than a month. Compensatory enlargement of the right lobe was observed in both pCL and LMHL models. The pCL model demonstrated acute inflammation due to obstructive jaundice 3 days after ligation but jaundice rapidly decreased by Day 7. The LHML group developed portal hypertension as well as severe fibrosis by Day 14 in addition to prolonged jaundice. Conclusion The standard tCL model is too unstable with high mortality for long-term studies. pCL may be an appropriate model for acute inflammation with obstructive jaundice but long term survivors are no longer jaundiced. The LHML model was identified to be the most feasible model to study the effect of long-term obstructive jaundice. PMID:27916350

  19. Long-term course of opioid addiction. (United States)

    Hser, Yih-Ing; Evans, Elizabeth; Grella, Christine; Ling, Walter; Anglin, Douglas


    Opioid addiction is associated with excess mortality, morbidities, and other adverse conditions. Guided by a life-course framework, we review the literature on the long-term course of opioid addiction in terms of use trajectories, transitions, and turning points, as well as other factors that facilitate recovery from addiction. Most long-term follow-up studies are based on heroin addicts recruited from treatment settings (mostly methadone maintenance treatment), many of whom are referred by the criminal justice system. Cumulative evidence indicates that opioid addiction is a chronic disorder with frequent relapses. Longer treatment retention is associated with a greater likelihood of abstinence, whereas incarceration is negatively related to subsequent abstinence. Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids. Histories of sexual or physical abuse and comorbid mental disorders are associated with the persistence of opioid use, whereas family and social support, as well as employment, facilitates recovery. Maintaining opioid abstinence for at least five years substantially increases the likelihood of future stable abstinence. Recent advances in pharmacological treatment options (buprenorphine and naltrexone) include depot formulations offering longer duration of medication; their impact on the long-term course of opioid addiction remains to be assessed.

  20. Long-term economic outlook. Annual review

    Energy Technology Data Exchange (ETDEWEB)


    This review provides economic growth forecast tables for Ontario, Canada, the US, Western Europe, and Japan. Economic growth, government policy, the long-term prospects for inflation, interest rates and foreign exchange rates, trends in the Canadian dollar, and energy markets and prices are also reviewed. Data generally cover 1965-2025. Appendices give a summary of historical and forecast data. 18 figs., 16 tabs.

  1. Long-term data storage in diamond


    Dhomkar, Siddharth; Henshaw, Jacob; Jayakumar, Harishankar; Meriles, Carlos A.


    The negatively charged nitrogen vacancy (NV?) center in diamond is the focus of widespread attention for applications ranging from quantum information processing to nanoscale metrology. Although most work so far has focused on the NV? optical and spin properties, control of the charge state promises complementary opportunities. One intriguing possibility is the long-term storage of information, a notion we hereby introduce using NV-rich, type 1b diamond. As a proof of principle, we use multic...

  2. French Approach for Long Term Storage Safety

    International Nuclear Information System (INIS)

    Marciano, Jacob; Carreton, Jean-Pierre; Lizot, Marie Therese; Lhomme, Veronique


    IRSN presents its statement regarding long-term storage facilities; in France, the regulatory documents do not define the long term duration. The storage facility lifetime can only be appreciated according to the needs and materials stored therein. However, the magnitude of the long-term can be estimated at a few hundred years compared to a few decades for current storage. Usually, in France, construction of storage facilities is driven from the necessity various necessities, linked to the management of radioactive material (eg spent fuel) and to the management of radioactive waste. Because of the variety of 'stored materials and objects' (fission product solutions, plutonium oxide powders, activated solids, drums containing technological waste, spent fuel...), a great number of storage facility design solutions have been developed (surface, subsurface areas, dry or wet conditions...) in the World. After describing the main functions of a storage facility, IRSN displays the safety principles and the associated design principles. The specific design principles applied to particular storage (dry or wet spent fuel storage, depleted uranium or reprocessed uranium storage, plutonium storage, waste containing tritium storage, HLW and ILLW storage...) are also presented. Finally, the concerns due to the long-term duration storage and related safety assessment are developed. After discussing these issues, IRSN displays its statement. The authorization procedures governing the facility lifetime are similar to those of any basic nuclear installation, the continuation of the facility operation remaining subject to periodic safety reviews (in France, every 10 years). The applicant safety cases have to show, that the safety requirements are always met; this requires, at minimum, to take into account at the design stage, comfortable design margins. (author)

  3. Accounting of Long-Term Biological Assets


    Valeriy Mossakovskyy; Vasyl Korytnyy


    The article is devoted to generalization of experience in valuation of long-term biological assets of plant-growing and animal-breeding, and preparation of suggestions concerning improvement of accounting in this field. Recommendations concerning accounting of such assets are given based on the study of accounting practice at specific agricultural company during long period of time. Authors believe that fair value is applicable only if price level for agricultural products is fixed by the gov...

  4. Optimal long-term contracting with learning


    He, Zhiguo; Wei, Bin; Yu, Jianfeng; Gao, Feng


    We introduce uncertainty into Holmstrom and Milgrom (1987) to study optimal long-term contracting with learning. In a dynamic relationship, the agent's shirking not only reduces current performance but also increases the agent's information rent due to the persistent belief manipulation effect. We characterize the optimal contract using the dynamic programming technique in which information rent is the unique state variable. In the optimal contract, the optimal effort is front-loaded and decr...

  5. Timber joints under long-term loading

    DEFF Research Database (Denmark)

    Feldborg, T.; Johansen, M.

    This report describes tests and results from stiffness and strength testing of splice joints under long-term loading. During two years of loading the spicimens were exposed to cyclically changing relative humidity. After the loading period the specimens were short-term tested. The connectors were...... integral nail-plates and nailed steel and plywood gussets. The report is intended for designers and researchers in timber engineering....

  6. Inflation Hedging for Long-Term Investors


    Shaun K. Roache; Alexander P. Attie


    Long-term investors face a common problem-how to maintain the purchasing power of their assets over time and achieve a level of real returns consistent with their investment objectives. While inflation-linked bonds and derivatives have been developed to hedge the effects of inflation, their limited supply and liquidity lead many investors to continue to rely on the indirect hedging properties of traditional asset classes. In this paper, we assess these properties over different time horizons,...

  7. Long term evolution 4G and beyond

    CERN Document Server

    Yacoub, Michel; Figueiredo, Fabrício; Tronco, Tania


    This book focus on Long Term Evolution (LTE) and beyond. The chapters describe different aspects of research and development in LTE, LTE-Advanced (4G systems) and LTE-450 MHz such as telecommunications regulatory framework, voice over LTE, link adaptation, power control, interference mitigation mechanisms, performance evaluation for different types of antennas, cognitive mesh network, integration of LTE network and satellite, test environment, power amplifiers and so on. It is useful for researchers in the field of mobile communications.

  8. Long-Term Care Services for Veterans (United States)


    includes but is not limited to home physical , occupational, or speech therapy ; wound care; and intravenous (IV) care. A VA physician determines that a...restoring/rehabilitating the veteran’s health, such as skilled nursing care, physical therapy , occupational therapy , and IV therapy Same as HBPC... geriatric evaluation,  palliative care,  adult day health care,  homemaker/home health aide care,  respite care, Long-Term Care Services for

  9. Long term adequacy of uranium resources

    International Nuclear Information System (INIS)

    Steyn, J.


    This paper examines the adequacy of world economic uranium resources to meet requirements in the very long term, that is until at least 2025 and beyond. It does so by analysing current requirements forecasts, existing and potential production centre supply capability schedules and national resource estimates. It takes into account lead times from resource discovery to production and production rate limitations. The institutional and political issues surrounding the question of adequacy are reviewed. (author)

  10. New strategies to prevent fetal and neonatal complications in Rhesus D immunization


    Tiblad, Eleonor


    The general purpose of this thesis was to investigate if fetal and neonatal complications due to RhD immunization in the mother could be prevented by 1) reducing procedurerelated complications in intrauterine blood transfusions and by 2) reducing the incidence of RhD immunization by providing routine antenatal anti-D prophylaxis during pregnancy selectively to non-immunized RhD negative women with RhD positive fetuses. Paper I was a retrospective study including 284 intra...

  11. Long-term follow-up of low-dose external pituitary irradiation for Cushing's disease

    International Nuclear Information System (INIS)

    Littley, M.D.; Shalet, S.M.; Beardwell, C.G.; Ahmed, S.R.; Sutton, M.L.


    Twenty-four patients (three male) with Cushing's disease, aged between 11 and 67 years, were treated with low-dose external pituitary irradiation (20 Gy in eight fractions over 10-12 days) and followed for between 13 and 171 months (median 93 months). Eleven patients (46%) went into remission 4-36 months after irradiation, but five subsequently relapsed. In this series, the low incidence of radiation-induced hypopituitarism and absence of other complications attributable to radiotherapy suggest that low-dose pituitary irradiation may be a useful treatment option in selected patients. However, long-term follow-up has demonstrated a high relapse rate and failure to prevent Nelson's syndrome in adrenalectomized patients, indicating that it should not be used as primary treatment in preference to selective adenomectomy. (author)

  12. Asthma Medicines: Long-Term Control (United States)

    ... Healthy Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & Prevention Safety & Prevention Safety and Prevention Immunizations ...

  13. Malnutrition in the elderly residing in long-term care facilities: a cross ...

    African Journals Online (AJOL)

    Keywords: care facility, elderly, malnutrition, mini nutritional Assessment, nutrition screening, South Africa ..... hip fractures, confusion and preventable hospitalisation.29 .... in elderly patients in Dutch residential long-term care (LTC): a.

  14. Sexuality and Physical Intimacy in Long Term Care: Sexuality, long term care, capacity assessment


    Lichtenberg, Peter A.


    Sexuality and sexual needs in older adults remains a neglected area of clinical intervention, particularly so in long term care settings. Because older adults in medical rehabilitation and long term care beds present with significant frailties, and often significant neurocognitive disorders it makes it difficult for occupational therapists and other staff to evaluate the capacity of an older adult resident to participate in sexual relationships. The current paper reviews the current literatur...

  15. Predictors and long-term health outcomes of eating disorders.

    Directory of Open Access Journals (Sweden)

    Katie M O'Brien

    Full Text Available Anorexia and bulimia nervosa may have long-term effects on overall and reproductive health. We studied predictors of self-reported eating disorders and associations with later health events. We estimated odds ratios (ORs for these associations in 47,759 participants from the Sister Study. Two percent (n = 967 of participants reported a history of an eating disorder. Risk factors included being non-Hispanic white, having well-educated parents, recent birth cohort (OR = 2.16, 95% confidence interval [CI]: 2.01-2.32 per decade, and having a sister with an eating disorder (OR = 3.68, CI: 1.92-7.02. As adults, women who had experienced eating disorders were more likely to smoke, to be underweight, to have had depression, to have had a later first birth, to have experienced bleeding or nausea during pregnancy, or to have had a miscarriage or induced abortion. In this descriptive analysis, we identified predictors of and possible long-term health consequences of eating disorders. Eating disorders may have become more common over time. Interventions should focus on prevention and mitigation of long-term adverse health effects.

  16. Esophageal variceal ligation in the secondary prevention of variceal ...

    African Journals Online (AJOL)

    Pan African Medical Journal ... Introduction: Long-term outcome of patients after band ligation have been poorly defined. ... endoscopic band ligation, liver cirrhosis, complication of band ligation, esophageal varices, secondary prevention ...

  17. Long Term Sequelae of Pediatric Craniopharyngioma – Literature Review and 20 Years of Experience (United States)

    Cohen, Michal; Guger, Sharon; Hamilton, Jill


    Craniopharyngioma are rare histologically benign brain tumors that develop in the pituitary–hypothalamic area. They may invade nearby anatomical structures causing significant rates of neurological, neurocognitive, and endocrinological complications including remarkable hypothalamic damage. Information regarding long term implications of the tumors and treatment in the pediatric population is accumulating, and treatment goals appear to be changing accordingly. In this review we aim to present data regarding long term complications of craniopharyngioma in children and adolescents and our experience from a large tertiary center. Hypothalamic dysfunction was noted to be the most significant complication, adversely affecting quality of life in survivors. Obesity, fatigue, and sleep disorders are the most notable manifestations of this dysfunction, and treatment is extremely difficult. Changes in management in recent years show a potential for improved long term outcomes; we found a trend toward less aggressive surgical management and increasing use of adjuvant treatment, accompanied by a decrease in complication rates. PMID:22645511

  18. Long term sequelae of pediatric craniopharyngioma - literature review and 20 years of experience

    Directory of Open Access Journals (Sweden)

    Michal eCohen


    Full Text Available Craniopharyngioma are rare histologically benign brain tumors that develop in the pituitary- hypothalamic area. They may invade nearby anatomical structures causing significant rates of neurological, neurocognitive and endocrinological complications including remarkable hypothalamic damage. Information regarding long term implications of the tumors and treatment in the pediatric population is accumulating, and treatment goals appear to be changing accordingly. In this review we aim to present data regarding long term complications of craniopharyngioma in children and adolescents and our experience from a large tertiary center. Hypothalamic dysfunction was noted to be the most significant complication, adversely affecting quality of life in survivors. Obesity, fatigue and sleep disorders are the most notable manifestations of this dysfunction, and treatment is extremely difficult. Changes in management in recent years show a potential for improved long term outcomes; we found a trend towards less aggressive surgical management and increasing use of adjuvant treatment, accompanied by a decrease in complication rates.

  19. Long-term outcome after mastectomy with immediate breast reconstruction

    DEFF Research Database (Denmark)

    Stralman, K.; Mollerup, C.L.; Kristoffersen, U.S.


    INTRODUCTION: The purpose of this study was to investigate long term outcome for women who had undergone mastectomy and immediate breast reconstruction. MATERIAL AND METHODS: Patient files of 167 immediately reconstructed breast cancer patients were reviewed for late surgical complications....... Furthermore, information of local recurrence rate, radiotherapy and death was obtained from the Danish Breast Cancer Cooperative Group register. Histopatological high and low risk patients were compared with respect to locoregional recurrence rate, recurrence free survival and death. Unpaired t...... found no increase in the occurrence of capsular contracture in our study group in patients who received radiotherapy. CONCLUSION: Immediate breast reconstruction seems to be oncologically safe. Breast reconstruction performed with implants was associated with a higher risk of late complications...

  20. Factors influencing long-term adherence to pelvic floor exercises in women with urinary incontinence. (United States)

    Venegas, Mónica; Carrasco, Bernardita; Casas-Cordero, Romina


    To ensure the effectiveness of Physical Therapy for urinary incontinence (UI), it is crucial that patients adhere to treatment in both the long and the short term. Treatment adherence may prevent symptom progression and the need for surgery, which is associated with higher costs and potential complications. Adherence is defined as carrying out a recommended behavioral modification or change. The World Health Organization (WHO) has established that adherence is a multifactorial phenomenon determined by the interaction of five dimensions, which include diverse factors that affect long-term adherence on many levels. To identify the factors that influence long-term adherence to pelvic floor exercises in women with UI. Observational, descriptive, cross-sectional study. The sample was recruited from the "Centro Integral de Reeducación de Piso Pélvico" (CIREP), and included 61 women treated for UI at the center in 2014 and 2015. Participants completed a self-administered, 28-item questionnaire developed for this study based on the WHO five dimensions. Data analysis was performed using STATA 13.0 software. Having performed pelvic floor home exercises after discharge from Physical Therapy was significantly associated with self-rated treatment adherence (P pelvic floor exercise program (P pelvic floor exercises in women with UI; forgetting to do the exercises and boredom with the exercises were the factors most strongly related to low treatment adherence, while motivation and commitment were associated with high adherence in this population. © 2017 Wiley Periodicals, Inc.

  1. Effects of long-term intake of a yogurt fermented with Lactobacillus delbrueckii subsp. bulgaricus 2038 and Streptococcus thermophilus 1131 on mice. (United States)

    Usui, Yuki; Kimura, Yasumasa; Satoh, Takeshi; Takemura, Naoki; Ouchi, Yasuo; Ohmiya, Hiroko; Kobayashi, Kyosuke; Suzuki, Hiromi; Koyama, Satomi; Hagiwara, Satoko; Tanaka, Hirotoshi; Imoto, Seiya; Eberl, Gérard; Asami, Yukio; Fujimoto, Kosuke; Uematsu, Satoshi


    The gut is an extremely complicated ecosystem where microorganisms, nutrients and host cells interact vigorously. Although the function of the intestine and its barrier system weakens with age, some probiotics can potentially prevent age-related intestinal dysfunction. Lactobacillus delbrueckii subsp. bulgaricus 2038 and Streptococcus thermophilus 1131, which are the constituents of LB81 yogurt, are representative probiotics. However, it is unclear whether their long-term intake has a beneficial influence on systemic function. Here, we examined the gut microbiome, fecal metabolites and gene expression profiles of various organs in mice. Although age-related alterations were apparent in them, long-term LB81 yogurt intake led to an increased Bacteroidetes to Firmicutes ratio and elevated abundance of the bacterial family S24-7 (Bacteroidetes), which is known to be associated with butyrate and propanoate production. According to our fecal metabolite analysis to detect enrichment, long-term LB81 yogurt intake altered the intestinal metabolic pathways associated with propanoate and butanoate in the mice. Gene ontology analysis also revealed that long-term LB81 yogurt intake influenced many physiological functions related to the defense response. The profiles of various genes associated with antimicrobial peptides-, tight junctions-, adherens junctions- and mucus-associated intestinal barrier functions were also drastically altered in the LB81 yogurt-fed mice. Thus, long-term intake of LB81 yogurt has the potential to maintain systemic homeostasis, such as the gut barrier function, by controlling the intestinal microbiome and its metabolites.

  2. Prevention and treatment of long-term social disability amongst young people with emerging severe mental illness with social recovery therapy (The PRODIGY Trial): study protocol for a randomised controlled trial. (United States)

    Fowler, David; French, Paul; Banerjee, Robin; Barton, Garry; Berry, Clio; Byrne, Rory; Clarke, Timothy; Fraser, Rick; Gee, Brioney; Greenwood, Kathryn; Notley, Caitlin; Parker, Sophie; Shepstone, Lee; Wilson, Jon; Yung, Alison R; Hodgekins, Joanne


    Young people who have social disability associated with severe and complex mental health problems are an important group in need of early intervention. Their problems often date back to childhood and become chronic at an early age. Without intervention, the long-term prognosis is often poor and the economic costs very large. There is a major gap in the provision of evidence-based interventions for this group, and therefore new approaches to detection and intervention are needed. This trial provides a definitive evaluation of a new approach to early intervention with young people with social disability and severe and complex mental health problems using social recovery therapy (SRT) over a period of 9 months to improve mental health and social recovery outcomes. This is a pragmatic, multi-centre, single blind, superiority randomised controlled trial. It is conducted in three sites in the UK: Sussex, Manchester and East Anglia. Participants are aged 16 to 25 and have both persistent and severe social disability (defined as engaged in less than 30 hours per week of structured activity) and severe and complex mental health problems. The target sample size is 270 participants, providing 135 participants in each trial arm. Participants are randomised 1:1 using a web-based randomisation system and allocated to either SRT plus optimised treatment as usual (enhanced standard care) or enhanced standard care alone. The primary outcome is time use, namely hours spent in structured activity per week at 15 months post-randomisation. Secondary outcomes assess typical mental health problems of the group, including subthreshold psychotic symptoms, negative symptoms, depression and anxiety. Time use, secondary outcomes and health economic measures are assessed at 9, 15 and 24 months post-randomisation. This definitive trial will be the first to evaluate a novel psychological treatment for social disability and mental health problems in young people presenting with social


    Schumer, Maya C; Panza, Kaitlyn E; Mulqueen, Jilian M; Jakubovski, Ewgeni; Bloch, Michael H


    To examine long-term outcome in children with trichotillomania. We conducted follow-up clinical assessments an average of 2.8 ± 0.8 years after baseline evaluation in 30 of 39 children who previously participated in a randomized, double-blind, placebo-controlled trial of N-acetylcysteine (NAC) for pediatric trichotillomania. Our primary outcome was change in hairpulling severity on the Massachusetts General Hospital Hairpulling Hospital Hairpulling Scale (MGH-HPS) between the end of the acute phase and follow-up evaluation. We also obtained secondary measures examining styles of hairpulling, comorbid anxiety and depressive symptoms, as well as continued treatment utilization. We examined both correlates and predictors of outcome (change in MGH-HPS score) using linear regression. None of the participants continued to take NAC at the time of follow-up assessment. No significant changes in hairpulling severity were reported over the follow-up period. Subjects reported significantly increased anxiety and depressive symptoms but improvement in automatic pulling symptoms. Increased hairpulling symptoms during the follow-up period were associated with increased depression and anxiety symptoms and increased focused pulling. Older age and greater focused pulling at baseline assessment were associated with poor long-term prognosis. Our findings suggest that few children with trichotillomania experience a significant improvement in trichotillomania symptoms if behavioral treatments are inaccessible or have failed to produce adequate symptom relief. Our findings also confirm results of previous cross-sectional studies that suggest an increased risk of depression and anxiety symptoms with age in pediatric trichotillomania. Increased focused pulling and older age among children with trichotillomania symptoms may be associated with poorer long-term prognosis. © 2015 Wiley Periodicals, Inc.

  4. Long-term EEG in children. (United States)

    Montavont, A; Kaminska, A; Soufflet, C; Taussig, D


    Long-term video-EEG corresponds to a recording ranging from 1 to 24 h or even longer. It is indicated in the following situations: diagnosis of epileptic syndromes or unclassified epilepsy, pre-surgical evaluation for drug-resistant epilepsy, follow-up of epilepsy or in cases of paroxysmal symptoms whose etiology remains uncertain. There are some specificities related to paediatric care: a dedicated pediatric unit; continuous monitoring covering at least a full 24-hour period, especially in the context of pre-surgical evaluation; the requirement of presence by the parents, technician or nurse; and stronger attachment of electrodes (cup electrodes), the number of which is adapted to the age of the child. The chosen duration of the monitoring also depends on the frequency of seizures or paroxysmal events. The polygraphy must be adapted to the type and topography of movements. It is essential to have at least an electrocardiography (ECG) channel, respiratory sensor and electromyography (EMG) on both deltoids. There is no age limit for performing long-term video-EEG even in newborns and infants; nevertheless because of scalp fragility, strict surveillance of the baby's skin condition is required. In the specific context of pre-surgical evaluation, long-term video-EEG must record all types of seizures observed in the child. This monitoring is essential in order to develop hypotheses regarding the seizure onset zone, based on electroclinical correlations, which should be adapted to the child's age and the psychomotor development. Copyright © 2015. Published by Elsevier SAS.

  5. Long-term governance for sustainability

    International Nuclear Information System (INIS)

    Martell, M.


    Meritxell Martell spoke of the long-term aspects of radioactive waste management. She pointed out that decision-making processes need to be framed within the context of sustainability, which means that a balance should be sought between scientific considerations, economic aspects and structural conditions. Focusing on structural aspects, Working Group 3 of COWAM-Spain came to the conclusion that the activity of the regulator is a key factor of long-term management. Another finding is that from a sustainability perspective multi-level governance is more effective for coping with the challenges of radioactive waste management than one tier of government-making decisions. The working group also felt that the current Local Information Committees need to evolve towards more institutionalized and legitimized mechanisms for long-term involvement. Ms. Martell introduced a study comparing the efficiency of economic instruments to advance sustainable development in nuclear communities vs. municipalities in mining areas. The study found that funds transferred to nuclear zones had become a means to facilitate local acceptance of nuclear facilities rather than a means to promote socio-economic development. Another finding is that economic instruments are not sufficient guarantees of sustainable development by themselves; additional preconditions include leadership, vision and entrepreneur-ship on the part of community leaders, private or public investments, among others. Finally, Ms. Martell summarised the challenges faced by the Spanish radioactive waste management programme, which include the need for strategic thinking, designing the future in a participatory fashion, and working with local and regional governments and citizens to devise mechanisms for social learning, economic development and environmental protection. (author)

  6. Long term aspects of uranium tailings management

    International Nuclear Information System (INIS)

    Bragg, K.


    This paper sets out the background issues which lead to the development of interim close-out criteria for uranium mill tailings. It places the current state-of-the-art for tailings management into both a national and international perspective and shows why such interim criteria are needed now. There are seven specific criteria proposed dealing with the need to have: passive barriers, limits on surface water recharge, durable systems, long term performance guarantees, limits to access, controls on water and airborne releases and finally to have a knowledge of exposure pathways. This paper is intended to serve as a focus for subsequent discussions with all concerned parties. (auth)

  7. Human Behaviour in Long-Term Missions (United States)


    In this session, Session WP1, the discussion focuses on the following topics: Psychological Support for International Space Station Mission; Psycho-social Training for Man in Space; Study of the Physiological Adaptation of the Crew During A 135-Day Space Simulation; Interpersonal Relationships in Space Simulation, The Long-Term Bed Rest in Head-Down Tilt Position; Psychological Adaptation in Groups of Varying Sizes and Environments; Deviance Among Expeditioners, Defining the Off-Nominal Act in Space and Polar Field Analogs; Getting Effective Sleep in the Space-Station Environment; Human Sleep and Circadian Rhythms are Altered During Spaceflight; and Methodological Approach to Study of Cosmonauts Errors and Its Instrumental Support.

  8. Optimal Long-Term Financial Contracting


    Peter M. DeMarzo; Michael J. Fishman


    We develop an agency model of financial contracting. We derive long-term debt, a line of credit, and equity as optimal securities, capturing the debt coupon and maturity; the interest rate and limits on the credit line; inside versus outside equity; dividend policy; and capital structure dynamics. The optimal debt-equity ratio is history dependent, but debt and credit line terms are independent of the amount financed and, in some cases, the severity of the agency problem. In our model, the ag...

  9. Modeling flood events for long-term stability

    International Nuclear Information System (INIS)

    Schruben, T.; Portillo, R.


    The primary objective for the disposal of uranium mill tailings in the Uranium Mill Tailings Remedial Action (UMTRA) Project is isolation and stabilization to prevent their misuse by man and dispersal by natural forces such as wind, rain, and flood waters (40 CFR-192). Stabilization of sites that are located in or near flood plains presents unique problems in design for long-term performance. This paper discusses the process involved with the selection and hydrologic modeling of the design flood event; and hydraulic modeling with geomorphic considerations of the design flood event. The Gunnison, Colorado, and Riverton, Wyoming, sites will be used as examples in describing the process

  10. Rotational bed therapy to prevent and treat respiratory complications: a review and meta-analysis. (United States)

    Goldhill, David R; Imhoff, Michael; McLean, Barbara; Waldmann, Carl


    Immobility is associated with complications involving many body systems. To review the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients. Published articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses. A literature search yielded 15 nonrandomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intrapulmonary shunt, hemodynamic effects, urine output, and intracranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (eg, degree, pause time, and amount of time per day). Meta-analysis suggests that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality. Rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.

  11. [Prevention of cardiovascular complications associated with diabetes mellitus: hospital emergency department involvement]. (United States)

    Agudo Villa, Teresa; Álvarez-Rodríguez, Esther; Caurel Sastre, Zaida; Martín Martínez, Alfonso; Merinero Palomares, Raúl; Alvarez Rodríguez, Virginia; Portero Sánchez, Isabel


    To analyze the risk profile of patients with diabetes who seek care from hospital emergency departments and emergency department involvement in preventing cardiovascular complications in these patients. Cross-sectional analysis of case series from 2 Spanish hospital emergency departments. We included all patients with a history or final diagnosis of diabetes mellitus who were treated in the emergency department between November 1, 2010, and June 30, 2011. Each patient's cardiovascular risk profile was analyzed. The main outcome was the appropriate of prescribed treatment to prevent cardiovascular complications according to the 2012 guidelines of the American Diabetes Association on the patient's discharge from emergency care. A total of 298 patients were included; 275 (92%) had type II diabetes. Ninety percent of the series (269 patients) had at least 1 cardiovascular risk factor and 147 (49%) had prior target organ damage; target organ damage was newly diagnosed in 41 (14%). Fifty-eight percent (172 patients) were discharged home from the emergency department. Although 215 patients (72%) were not adhering to at least 1 previously prescribed preventive treatment and 30 (10%) were not adhering to any prescribed treatment, drug prescriptions were modified only in 1.1% to 3.3% of patients and no follow-up was recommended in 42 cases (24%). Although diabetic patients treated in emergency departments are at high risk for cardiovascular complications, their visit is not used to optimize preventive treatment for these complications or ensure appropriate follow-up.

  12. Femoral artery pseudoaneurysm as a complication of angioplasty. How can it be prevented? (United States)

    Gupta, Prabha Nini; Salam Basheer, Abdul; Sukumaran, Gireesh Gomaty; Padmajan, Sabin; Praveen, Satheesan; Velappan, Praveen; Nair, Bigesh Unnikrishnan; Nair, Sandeep Govindan; Kunjuraman, Usha Kumari; Madthipat, Unnikrishnan; R, Jayadevan


    Femoral pseudoaneurysm is a common complication of repeated femoral puncture during cardiac catheterisation. We describe here the development of femoral pseudoaneurysms in a patient with Takayasu's arteritis, which healed in response to conservative treatment, and review the literature on the prevention and treatment of femoral pseudoaneurysm. PMID:27326111

  13. Impact of Nursing Educational Program on Reducing or Preventing Postoperative Complications for Patients after Intracranial Surgery (United States)

    Elmowla, Rasha Ali Ahmed Abd; El-Lateef, Zienab Abd; El-khayat, Roshdy


    Intracranial surgery means any surgery performed inside the skull to treat problems in the brain and surrounding structures. Aim: Evaluate the impact of nursing educational program on reducing or preventing postoperative complications for patients after intracranial surgery. Subjects and methods: Sixty adult patients had intracranial surgery (burr…

  14. Long-term environmental behaviour of radionuclides

    International Nuclear Information System (INIS)

    Brechignac, F.; Moberg, L.; Suomela, M.


    The radioactive pollution of the environment results from the atmospheric nuclear weapons testing (during the mid-years of twentieth century), from the development of the civilian nuclear industry and from accidents such as Chernobyl. Assessing the resulting radiation that humans might receive requires a good understanding of the long-term behaviour of radionuclides in the environment. This document reports on a joint European effort to advance this understanding, 3 multinational projects have been coordinated: PEACE, EPORA and LANDSCAPE. This report proposes an overview of the results obtained and they are presented in 6 different themes: i) redistribution in the soil-plant system, ii) modelling, iii) countermeasures, iv) runoff v) spatial variations, and vi) dose assessment. The long term behaviour of the radionuclides 137 Cs, 90 Sr and 239-240 Pu is studied through various approaches, these approaches range from in-situ experiments designed to exploit past contamination events to laboratory simulations. A broad scope of different ecosystems ranging from arctic and boreal regions down to mediterranean ones has been considered. (A.C.)

  15. Craniopharyngioma in Children: Long-term Outcomes (United States)

    STEINBOK, Paul


    The survival rate for childhood craniopharyngioma has been improving, with more long-term survivors. Unfortunately it is rare for the patient to be normal, either from the disease itself or from the effects of treatment. Long-term survivors of childhood craniopharyngioma suffer a number of impairments, which include visual loss, endocrinopathy, hypothalamic dysfunction, cerebrovascular problems, neurologic and neurocognitive dysfunction. Pituitary insufficiency is present in almost 100%. Visual and hypothalamic dysfunction is common. There is a high risk of metabolic syndrome and increased risk of cerebrovascular disease, including stroke and Moyamoya syndrome. Cognitive, psychosocial, and emotional problems are prevalent. Finally, there is a higher risk of premature death among survivors of craniopharyngioma, and often this is not from tumor recurrence. It is important to consider craniopharyngioma as a chronic disease. There is no perfect treatment. The treatment has to be tailored to the individual patient to minimize dysfunction caused by tumor and treatments. So “cure” of the tumor does not mean a normal patient. The management of the patient and family needs multidisciplinary evaluation and should involve ophthalmology, endocrinology, neurosurgery, oncology, and psychology. Furthermore, it is also important to address emotional issues and social integration. PMID:26345668

  16. Institutionalization and Organizational Long-term Success

    Directory of Open Access Journals (Sweden)

    Denise L. Fleck


    Full Text Available Institutionalization processes have an ambivalent effect on organizational long-term success. Even though they foster organizational stability and permanence, they also bring about rigidity and resistance to change. As a result, successful organizations are likely to lose their competitive advantage over time. The paper addresses this issue through the investigation of the institutionalization processes of two long-lived companies: General Electric, a firm that has been a long-term success and its rival, Westinghouse, which was broken up after eleven decades of existence. The longitudinal, multilevel analysis of firms and industry has identified two different modes of organizational institutionalization. The reactive mode gives rise to rigidity and change resistance, much like institutional theory predicts; the proactive mode, on the other hand, neutralizes those negative effects of institutionalization processes. In the reactive mode, structure predominates. In the proactive mode, agency plays a major role in organizational institutionalization, and in managing the organization’s relations with the environment, clearly contributing to environmental institutionalization.

  17. Long term testing of PSI-membranes

    Energy Technology Data Exchange (ETDEWEB)

    Huslage, J; Brack, H P; Geiger, F; Buechi, F N; Tsukada, A; Scherer, G G [Paul Scherrer Inst. (PSI), Villigen (Switzerland)


    Long term tests of PSI membranes based on radiation-grafted FEP and ETFE films were carried out and FEP-based membranes were evaluated by monitoring the in-situ membrane area resistance measured by a current pulse method. By modifying our irradiation procedure and using the double crosslinking concept we obtain reproducible membrane cell lifetimes (in term of in-situ membrane resistance) of greater than 5000 hours at 60-65{sup o}C. Preliminary tests at 80-85{sup o}C with lifetimes of greater than 2500 demonstrate the potential long term stability of PSI proton exchange membranes based on FEP over the whole operating temperature range of low-temperature polymer electrolyte fuel cells. Radiation grafted PSI membranes based on ETFE have better mechanical properties than those of the FEP membranes. Mechanical properties are particularly important in large area cells and fuel cell stacks. ETFE membranes have been tested successfully for approximately 1000 h in a 2-cell stack (100 cm{sup 2} active area each cell). (author) 4 figs., 4 refs.

  18. Neo bladder long term follow-up

    International Nuclear Information System (INIS)

    Fakhr, I.; Mohamed, A. M.; Moustafa, A.; Al-Sherbiny, M.; Salama, M.


    One of the commonest forms of orthotopic bladder substitution for bladder cancer surivors, used in our institute, is the use of ileocecal segment. Sometimes, the need for Indiana pouch heterotropic continent diversion arises. Aim: To compare the long-term effect of orthotopic ileocecal bladder and heterotropic Indiana pouch following radical cystectomy in bladder cancer patients. Patients and methods: Between January 2008 and December 2011, 91 patients underwent radical cystectomy/anterior pelvic exentration and ortho topic ileocecal bladder reconstruction (61 patients) and Indiana pouch (30 patients), when orthotopic diversion could not be technically or oncologically feasible. Results: Convalescence was uneventful in most patients. All minor and major urinary leakage cases, in both diversions groups, where successfully conservatively treated. Only one patient in the ileocecal group with major urinary leak required re-exploration with successful revision of uretro-colonic anastomosis. Only one patient in the Indiana pouch group had accidentally discovered sub-centimetric stone, which was simply expelled. The overall survival proportion of ileocecal group was 100% compared to 80% in the Indiana pouch group (p < 0.001). The disease free survival proportion of ileocecal group was 90.8% compared to 80% in the Indiana pouch group (p = 0.076). Effective comparative daytime and nighttime urinary continence as well as renal function deterioration were not statistically significant between both reconstruction types. Conclusion: Both ileocecal bladder and Indiana pouch are safe procedures in regard to long-term effects over kidney function following radical cystectomy

  19. Toward a comprehensive long term nicotine policy. (United States)

    Gray, N; Henningfield, J E; Benowitz, N L; Connolly, G N; Dresler, C; Fagerstrom, K; Jarvis, M J; Boyle, P


    Global tobacco deaths are high and rising. Tobacco use is primarily driven by nicotine addiction. Overall tobacco control policy is relatively well agreed upon but a long term nicotine policy has been less well considered and requires further debate. Reaching consensus is important because a nicotine policy is integral to the target of reducing tobacco caused disease, and the contentious issues need to be resolved before the necessary political changes can be sought. A long term and comprehensive nicotine policy is proposed here. It envisages both reducing the attractiveness and addictiveness of existing tobacco based nicotine delivery systems as well as providing alternative sources of acceptable clean nicotine as competition for tobacco. Clean nicotine is defined as nicotine free enough of tobacco toxicants to pass regulatory approval. A three phase policy is proposed. The initial phase requires regulatory capture of cigarette and smoke constituents liberalising the market for clean nicotine; regulating all nicotine sources from the same agency; and research into nicotine absorption and the role of tobacco additives in this process. The second phase anticipates clean nicotine overtaking tobacco as the primary source of the drug (facilitated by use of regulatory and taxation measures); simplification of tobacco products by limitation of additives which make tobacco attractive and easier to smoke (but tobacco would still be able to provide a satisfying dose of nicotine). The third phase includes a progressive reduction in the nicotine content of cigarettes, with clean nicotine freely available to take the place of tobacco as society's main nicotine source.

  20. Long term ground movement of TRISTAN synchrotron

    International Nuclear Information System (INIS)

    Endo, K.; Ohsawa, Y.; Miyahara, M.


    The long term ground movement is estimated through the geological survey before a big accelerator is planned. For the case of TRISTAN-MR (main ring), its site was surveyed to reflect the underground information to the building prior to the construction. The movement of the synchrotron magnet mainly results from the structure of the tunnel. If an individual movement of the magnet exceeds a certain threshold limit, it gives a significant effect on the particle behavior in a synchrotron. Height of the quadrupole magnets were observed periodically during past two years at the TRISTAN-MR and their height differences along the 3 km circumference of the accelerator ring were decomposed into the Fourier components depicting the causes of the movements. Results shows the movement of the tunnel foundation which was also observed by the simultaneous measurement of both magnets and fiducial marks on the tunnel wall. The long term movement of the magnets is summarized with the geological survey prior to construction. 1 ref., 6 figs., 1 tab

  1. Long-term environmental behaviour of radionuclides

    Energy Technology Data Exchange (ETDEWEB)

    Brechignac, F.; Moberg, L.; Suomela, M


    The radioactive pollution of the environment results from the atmospheric nuclear weapons testing (during the mid-years of twentieth century), from the development of the civilian nuclear industry and from accidents such as Chernobyl. Assessing the resulting radiation that humans might receive requires a good understanding of the long-term behaviour of radionuclides in the environment. This document reports on a joint European effort to advance this understanding, 3 multinational projects have been coordinated: PEACE, EPORA and LANDSCAPE. This report proposes an overview of the results obtained and they are presented in 6 different themes: (i) redistribution in the soil-plant system, (ii) modelling, (iii) countermeasures, (iv) runoff (v) spatial variations, and (vi) dose assessment. The long term behaviour of the radionuclides {sup 137}Cs, {sup 90}Sr and {sup 239-240}Pu is studied through various approaches, these approaches range from in-situ experiments designed to exploit past contamination events to laboratory simulations. A broad scope of different ecosystems ranging from arctic and boreal regions down to mediterranean ones has been considered. (A.C.)

  2. Long-term preservation of anammox bacteria. (United States)

    Rothrock, Michael J; Vanotti, Matias B; Szögi, Ariel A; Gonzalez, Maria Cruz Garcia; Fujii, Takao


    Deposit of useful microorganisms in culture collections requires long-term preservation and successful reactivation techniques. The goal of this study was to develop a simple preservation protocol for the long-term storage and reactivation of the anammox biomass. To achieve this, anammox biomass was frozen or lyophilized at two different freezing temperatures (-60°C and in liquid nitrogen (-200°C)) in skim milk media (with and without glycerol), and the reactivation of anammox activity was monitored after a 4-month storage period. Of the different preservation treatments tested, only anammox biomass preserved via freezing in liquid nitrogen followed by lyophilization in skim milk media without glycerol achieved stoichiometric ratios for the anammox reaction similar to the biomass in both the parent bioreactor and in the freshly harvested control treatment. A freezing temperature of -60°C alone, or in conjunction with lyophilization, resulted in the partial recovery of the anammox bacteria, with an equal mixture of anammox and nitrifying bacteria in the reactivated biomass. To our knowledge, this is the first report of the successful reactivation of anammox biomass preserved via sub-zero freezing and/or lyophilization. The simple preservation protocol developed from this study could be beneficial to accelerate the integration of anammox-based processes into current treatment systems through a highly efficient starting anammox biomass.

  3. Andra long term memory project - 59277

    International Nuclear Information System (INIS)

    Charton, Patrick; Boissier, Fabrice; Martin, Guillaume


    Document available in abstract form only. Full text of publication follows: Long term memory of repositories is required by safety, reversibility and social expectations. Thus Andra has implemented since 2010 a long-term memory project to reinforce and diversify its current arrangements in this field, as well as to explore opportunities to extend memory keeping over thousands years. The project includes opportunity studies of dedicated facilities. The 'Ecotheque' and 'Geotheque' projects contribute to memory respectively through environmental and geological samples preservation. The options of creating (i) an archive centre for Andra's interim and permanent archives, (ii) an artist center to study the contribution of arts to memory preservation, (iii) a museum of radioactive waste disposal history and technology (radium industry..., sea disposal, current solutions...) are considered. Other studies provided by the project examine our heritage. This includes the continuity of languages and symbolic systems, the continuity of writing and engraving methods, the archaeology of landscapes (memory of the earths evolution, multi-century memory of industrial and agricultural landscapes), the archaeology practices (how might a future archaeologist be interested in our current activity?), the preservation of historical sites and industrial memory, the continuity of institutional organizations, the memory and history of science evolution as well as broad history

  4. Long term creep behavior of concrete

    International Nuclear Information System (INIS)

    Kennedy, T.W.


    This report presents the findings of an experimental investigation to evaluate the long term creep behavior of concrete subjected to sustained uniaxial loads for an extended period of time at 75 0 F. The factors investigated were (1) curing time (90, 183, and 365 days); (2) curing history (as-cast and air-dried); and (3) uniaxial stress (600 and 2400 psi). The experimental investigation applied uniaxial compressive loads to cylindrical concrete specimens and measured strains with vibrating wire strain gages that were cast in the concrete specimen along the axial and radial axes. Specimens cured for 90 days prior to loading were subjected to a sustained load for a period of one year, at which time the loads were removed; the specimens which were cured for 183 or 365 days, however, were not unloaded and have been under load for 5 and 4.5 years, respectively. The effect of each of the above factors on the instantaneous and creep behavior is discussed and the long term creep behavior of the specimens cured for 183 or 365 days is evaluated. The findings of these evaluations are summarized. (17 figures, 10 tables) (U.S.)

  5. Vaccination for the expatriate and long-term traveler. (United States)

    Shepherd, Suzanne M; Shoff, William H


    Duration of travel is an important factor in addressing travel health safety due to cumulative risk of exposure to illness and injury. The diverse group of expatriate and long-term business and leisure travelers present a different spectrum of issues for the travel medicine practitioner to address during consultation than does the short-term traveler, due to changes in travel patterns and activities, lifestyle alterations, and increased interaction with local populations. Immunization provides one safe and reliable method of preventing infectious illness in this group. We review travel patterns and available data on illnesses that they may be exposed to, including the increased risk of certain vaccine-preventable illnesses. We review the pre-travel management of these travelers, particularly the increased risk of certain vaccine-preventable illnesses as it applies to routine vaccines, recommended travel vaccines and required travel vaccines.

  6. [Current status of the prevention and treatment of stoma complications. A narrative review]. (United States)

    de Miguel Velasco, Mario; Jiménez Escovar, Fernando; Parajó Calvo, Alberto


    The aim of our study was to perform a review of the literature to assess the results of prevention and treatment of stoma complications. Medline, EMBASE medical database and the Cochrane Library were searched up to December 2012. Stomal complications are prevalent and associated with a worse quality of life and increased health-economic burdens. The most common complications are attributed to stoma construction. Attention to the finer technical points performed by experienced surgeons reduces morbidity. The use of mesh reduces the risk of parastomal hernia and recurrence rates in hernia repair. Preoperative stoma site marking and postoperative care by a stomatherapist are crucial for the patients' successful adaption, improving quality of life, promoting their independence and reducing the rates of complications. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  7. Extracts of Magnolia Species-Induced Prevention of Diabetic Complications: A Brief Review

    Directory of Open Access Journals (Sweden)

    Xuezhong Zhao


    Full Text Available Diabetic complications are the major cause of mortality for the patients with diabetes. Oxidative stress and inflammation have been recognized as important contributors for the development of many diabetic complications, such as diabetic nephropathy, hepatopathy, cardiomyopathy, and other cardiovascular diseases. Several studies have established the anti-inflammatory and oxidative roles of bioactive constituents in Magnolia bark, which has been widely used in the traditional herbal medicines in Chinese society. These findings have attracted various scientists to investigate the effect of bioactive constituents in Magnolia bark on diabetic complications. The aim of this review is to present a systematic overview of bioactive constituents in Magnolia bark that induce the prevention of obesity, hyperglycemia, hyperlipidemia, and diabetic complications, including cardiovascular, liver, and kidney.

  8. Complications of HIV Disease and Antiretroviral Therapy


    Luetkemeyer, Anne F.; Havlir, Diane V.; Currier, Judith S.


    There is growing interest in the pathogenesis, treatment, and prevention of long-term complications of HIV disease and its therapies. Specifically, studies focused on cardiovascular, renal, bone, and fat abnormalities were prominent at the 17th Conference on Retroviruses and Opportunistic Infections. Although enthusiasm about the effectiveness of current antiretroviral therapy remains strong, collectively, the ongoing work in the area of HIV disease and treatment complications appears to refl...

  9. Long term surgical treatment outcome of talar body fracture

    Directory of Open Access Journals (Sweden)

    Sen Ramesh Kumar


    Full Text Available 【Abstract】Objective: Talar body fractures are rare and have poor treatment outcome. The purpose of this study is to report the long term surgical treatment outcome of closed talar dome fractures. Methods: Eight closed talar body fractures, treated by open reduction and internal fixation with small fragment cancellous screws and/or Herbert screws in our level I trauma centre were retrospectively analyzed. Preoperative and postoperative radiographs of the foot (antero-posterior, lateral and oblique views and ankle (antero-posterior, lateral and mortise views were obtained. The patients were followed up both radiologically and functionally (foot function index, FFI after 3 weeks, 6 weeks, 3 months, 6 months and then annually. Results: There were five crush fractures and three shear fractures (two sagittal shear and one coronal shear, with average follow-up of 5 years. No early complications were noticed in these patients. Late complications included osteoarthrosis of subtalar/ankle joints in six patients and osteonecrosis of talar body in four patients. On functional assessment, mean FFI after 5 years was 104.63 points and worse outcome was noticed in crush injury and coronal shear fractures. Sagittal shear fractures had a good functional and radiological outcome. Conclusions: Late complications subsequent to surgically treated talar body fractures are inevitable, even though exact reduction and rigid fixation are achieved, thus patients are supposed to be counseled about the adverse outcome. Although crush and coronal shear fractures have poor outcome, sagittal injuries have good prognosis on long term evaluation. Key words: Fractures, bone; Talus; Fracture fixation, internal

  10. Maternal creatine supplementation during pregnancy prevents acute and long-term deficits in skeletal muscle after birth asphyxia: a study of structure and function of hind limb muscle in the spiny mouse. (United States)

    LaRosa, Domenic A; Ellery, Stacey J; Snow, Rod J; Walker, David W; Dickinson, Hayley


    Maternal antenatal creatine supplementation protects the brain, kidney, and diaphragm against the effects of birth asphyxia in the spiny mouse. In this study, we examined creatine's potential to prevent damage to axial skeletal muscles. Pregnant spiny mice were fed a control or creatine-supplemented diet from mid-pregnancy, and 1 d before term (39 d), fetuses were delivered by c-section with or without 7.5 min of birth asphyxia. At 24 h or 33 ± 2 d after birth, gastrocnemius muscles were obtained for ex-vivo study of twitch-tension, muscle fatigue, and structural and histochemical analysis. Birth asphyxia significantly reduced cross-sectional area of all muscle fiber types (P creatine treatment prevented all asphyxia-induced changes in the gastrocnemius, improved motor performance. This study demonstrates that creatine loading before birth protects the muscle from asphyxia-induced damage at birth.

  11. Long-term results after fibroid embolization; Langzeitergebnisse nach Myomembolisation

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Huelsbeck, S. [Medizinischer Klinikverbund Flensburg, Akademisches Lehrkrankenhaus des Universitaetsklinikums Schleswig-Holstein, Abt. Diagnostische und interventionelle Radiologie/Neuroradiologie, Ev.-Luth. Diakonissenanstalt zu Flensburg, Flensburg (Germany)


    Fibroids (leiomyoma) are the most frequent benign tumors of the uterus during female reproductive age. In the case of clinical symptoms, uterine artery embolization (UAE) is a well established treatment option for symptomatic fibroids, resulting in promising long-term results. In order to estimate long-term success after UAE, reduction of fibroids and uterus volume is less important than complete improvement and disappearance of fibroid-related symptoms. In addition to a high technical success rate and a low perioperative complication rate, UAE results in high short-term and long-term patient satisfaction (>87%) and improvement of symptoms (>81%). Candidates for UAE should be informed about potential reinterventions in terms of repeated UAE (up to 18% of cases) or surgical treatment options. (orig.) [German] Myome sind die haeufigsten gutartigen soliden Tumoren des weiblichen Genitaltrakts im reproduktiven Alter. Bei klinischen Beschwerden stellt die Uterusarterienembolisation (UAE) zur Therapie des symptomatischen Uterus myomatosus einen fest etabliertes Verfahren dar, das mit viel versprechenden Langzeitergebnissen aufwarten kann. Im Vordergrund der Abschaetzung eines lang andauernden Therapieerfolgs nach UAE stehen weniger die Volumenreduktion eines dominanten Myoms bzw. des gesamten Uterus nach der Behandlung, sondern vielmehr die Besserung oder das voellige Verschwinden der von der Patientin initial vor der UAE angegebenen (myombedingten) Beschwerden. Neben einer hohen technischen Erfolgsrate und geringen perioperativen Komplikationsrate fuehrt die fachkundig durchgefuehrte UAE sowohl im Kurz- als auch Langzeitverlauf zu einem hohen Mass an Patientenzufriedenheit (>87%), verbunden mit einer deutlichen Symptombesserung (>81%). Ueber eine Reintervention (in bis zu ca. 18% der Faelle) im Sinne einer erneuten UAE oder einer operativen Massnahme sollten die Patientinnen allerdings im Vorfeld aufgeklaert werden. (orig.)

  12. Long-term survivorship of stemless anatomical shoulder replacement. (United States)

    Beck, Sascha; Beck, Verena; Wegner, Alexander; Dudda, Marcel; Patsalis, Theodor; Jäger, Marcus


    Like in many other joints, current shoulder replacement designs aim at bone preservation. According to the literature available, stemless total shoulder arthroplasty (TSA) compares favourably with stemmed designs in terms of function and survivorship of the implant. However, long-term results of stemless shoulder arthroplasty are still missing. Therefore, the aim of the present study was to evaluate long-term results of stemless anatomical TSA. Between 2006 and 2009, 51 shoulders in 46 patients were resurfaced using the Biomet Total Evolutive Shoulder System (TESS). Thirty-one shoulders in 26 patients who were aged 66.7 ± 10.0 (range 34-82) years were available for review at a mean follow-up of 94.7 ± 11.3 (76-124) months. The implant survival rate was 93.5% at eight years. The overall revision rate of the TESS implant was 9.7%. Radiolucent lines were found on the glenoid side of the TESS arthroplasty in 90.9% of the cases. All stemless humeral corolla implants showed solid fixation at follow-up. Clinical scores significantly improved at long-term follow-up (VAS from 8.1 ± 0.9 to 1.0 ± 1.2, p < 0.001; Quick-DASH from 67.9 ± 13.5 to 18.7 ± 16.5, p < 0.001 and Constant score from 14.7 ± 6.1 to 68.8 ± 13.2, p < 0.001). Stemless TSA has stood the test of time at eight years in terms of clinical scores, radiographic loosening, complication rates and implant survivorship.

  13. Diabetes technology: improving care, improving patient-reported outcomes and preventing complications in young people with Type 1 diabetes. (United States)

    Prahalad, P; Tanenbaum, M; Hood, K; Maahs, D M


    With the evolution of diabetes technology, those living with Type 1 diabetes are given a wider arsenal of tools with which to achieve glycaemic control and improve patient-reported outcomes. Furthermore, the use of these technologies may help reduce the risk of acute complications, such as severe hypoglycaemia and diabetic ketoacidosis, as well as long-term macro- and microvascular complications. In addition, diabetes technology can have a beneficial impact on psychosocial health by reducing the burden of diabetes. Unfortunately, diabetes goals are often unmet and people with Type 1 diabetes too frequently experience acute and long-term complications of this condition, in addition to often having less than ideal psychosocial outcomes. Increasing realization of the importance of patient-reported outcomes is leading to diabetes care delivery becoming more patient-centred. Diabetes technology in the form of medical devices, digital health and big data analytics have the potential to improve clinical care and psychosocial support, resulting in lower rates of acute and chronic complications, decreased burden of diabetes care, and improved quality of life. © 2018 Diabetes UK.

  14. Long-term stability of salivary cortisol

    DEFF Research Database (Denmark)

    Garde, A H; Hansen, Åse Marie


    either stored in small vials or spiked to polyester Salivette tampons before analysis for cortisol using Spectria RIA kits. The effects of storage were evaluated by a linear regression model (mixed procedure) on a logarithmic scale. No effects on cortisol concentrations were found after storage of saliva......The measurement of salivary cortisol provides a simple, non-invasive, and stress-free measure frequently used in studies of the hypothalamic-pituitary-adrenal axis activity. In research projects, samples are often required to be stored for longer periods of time either because of the protocol...... of the project or because of lack of funding for analysis. The aim of the present study was to explore the effects of long-term storage of samples on the amounts of measurable cortisol. Ten pools of saliva were collected on polyester Salivette tampons from five subjects. After centrifugation the samples were...

  15. Long-term cryogenic space storage system (United States)

    Hopkins, R. A.; Chronic, W. L.


    Discussion of the design, fabrication and testing of a 225-cu ft spherical cryogenic storage system for long-term subcritical applications under zero-g conditions in storing subcritical cryogens for space vehicle propulsion systems. The insulation system design, the analytical methods used, and the correlation between the performance test results and analytical predictions are described. The best available multilayer insulation materials and state-of-the-art thermal protection concepts were applied in the design, providing a boiloff rate of 0.152 lb/hr, or 0.032% per day, and an overall heat flux of 0.066 Btu/sq ft hr based on a 200 sq ft surface area. A six to eighteen month cryogenic storage is provided by this system for space applications.

  16. Long term performance of radon mitigation systems

    International Nuclear Information System (INIS)

    Prill, R.; Fisk, W.J.


    Researchers installed radon mitigation systems in 12 houses in Spokane, Washington and Coeur d'Alene, Idaho during the heating season 1985--1986 and continued to monitor indoor radon quarterly and annually for ten years. The mitigation systems included active sub-slab ventilation, basement over-pressurization, and crawlspace isolation and ventilation. The occupants reported various operational problems with these early mitigation systems. The long-term radon measurements were essential to track the effectiveness of the mitigation systems over time. All 12 homes were visited during the second year of the study, while a second set 5 homes was visited during the fifth year to determine the cause(s) of increased radon in the homes. During these visits, the mitigation systems were inspected and measurements of system performance were made. Maintenance and modifications were performed to improve system performance in these homes

  17. Rising Long-term Interest Rates

    DEFF Research Database (Denmark)

    Hallett, Andrew Hughes

    Rather than chronicle recent developments in European long-term interest rates as such, this paper assesses the impact of increases in those interest rates on economic performance and inflation. That puts us in a position to evaluate the economic pressures for further rises in those rates......, the first question posed in this assignment, and the scope for overshooting (the second question), and then make some illustrative predictions of future interest rates in the euro area. We find a wide range of effects from rising interest rates, mostly small and mostly negative, focused on investment...... till the emerging European recovery is on a firmer basis and capable of overcoming increases in the cost of borrowing and shrinking fiscal space. There is also an implication that worries about rising/overshooting interest rates often reflect the fact that inflation risks are unequally distributed...

  18. Prediction of long-term creep curves

    International Nuclear Information System (INIS)

    Oikawa, Hiroshi; Maruyama, Kouichi


    This paper aims at discussing how to predict long-term irradiation enhanced creep properties from short-term tests. The predictive method based on the θ concept was examined by using creep data of ferritic steels. The method was successful in predicting creep curves including the tertiary creep stage as well as rupture lifetimes. Some material constants involved in the method are insensitive to the irradiation environment, and their values obtained in thermal creep are applicable to irradiation enhanced creep. The creep mechanisms of most engineering materials definitely change at the athermal yield stress in the non-creep regime. One should be aware that short-term tests must be carried out at stresses lower than the athermal yield stress in order to predict the creep behavior of structural components correctly. (orig.)

  19. Hanford grout: predicting long-term performance

    International Nuclear Information System (INIS)

    Sewart, G.H.; Mitchell, D.H.; Treat, R.L.; McMakin, A.H.


    Grouted disposal is being planned for the low-level portion of liquid radioactive wastes at the Hanford site in Washington state. The performance of the disposal system must be such that it will protect people and the environment for thousands of years after disposal. To predict whether a specific grout disposal system will comply with existing and foreseen regulations, a performance assessment (PA) is performed. Long-term PAs are conducted for a range of performance conditions. Performance assessment is an inexact science. Quantifying projected impacts is especially difficult when only scant data exist on the behavior of certain components of the disposal system over thousands of years. To develop defensible results, we are honing the models and obtaining experimental data. The combination of engineered features and PA refinements is being used to ensure that Hanford grout will meet its principal goal: to protect people and the environment in the future

  20. The discovery of long-term potentiation. (United States)

    Lømo, Terje


    This paper describes circumstances around the discovery of long-term potentiation (LTP). In 1966, I had just begun independent work for the degree of Dr medicinae (PhD) in Per Andersen's laboratory in Oslo after an eighteen-month apprenticeship with him. Studying the effects of activating the perforant path to dentate granule cells in the hippocampus of anaesthetized rabbits, I observed that brief trains of stimuli resulted in increased efficiency of transmission at the perforant path-granule cell synapses that could last for hours. In 1968, Tim Bliss came to Per Andersen's laboratory to learn about the hippocampus and field potential recording for studies of possible memory mechanisms. The two of us then followed up my preliminary results from 1966 and did the experiments that resulted in a paper that is now properly considered to be the basic reference for the discovery of LTP.

  1. Long-term opioid therapy in Denmark

    DEFF Research Database (Denmark)

    Birke, H; Ekholm, Ola; Sjøgren, P


    significantly associated with initiation of L-TOT in individuals with CNCP at baseline. During follow-up, L-TOT in CNCP patients increased the likelihood of negative changes in pain interference with work (OR 9.2; 95% CI 1.9-43.6) and in moderate activities (OR 3.7; 95% CI 1.1-12.6). The analysis of all......,145). A nationally representative subsample of individuals (n = 2015) completed the self-administered questionnaire in both 2000 and 2013. Collected information included chronic pain (≥6 months), health behaviour, self-rated health, pain interference with work activities and physical activities. Long-term users were...... individuals indicated a dose-response relationship between longer treatment duration and the risk of experiencing negative changes. CONCLUSIONS: Individuals on L-TOT seemed not to achieve the key goals of opioid therapy: pain relief, improved quality of life and functional capacity. SIGNIFICANCE: Long...

  2. Long Term Planning at IQ Metal

    DEFF Research Database (Denmark)


    This is a Danish version. This case about long term planning at the owner-managed manufacturing firm IQ Metal shows how the future management and ownership may be organized to utilize owner assets and minimize roadblocks. Initially, the owner-manager Bo Fischer Larsen explains how he acquired...... a stake in 2007 in the company which at that time was named Braendstrup Maskinfabrik. He furthermore expalins how he has developed the company based on a strategic plan focusing on professionalization and outsourcing. Next, the video shows how to type Bo Fischer Larsen's replies to the questions...... in The Owner Strategy Map into the questionnaire available on Lastly, the Owner Strategy Map's recommendation of how to organize the future management and ownership of IQ Metal is explained....

  3. Long-term Consequences of Early Parenthood

    DEFF Research Database (Denmark)

    Johansen, Eva Rye; Nielsen, Helena Skyt; Verner, Mette

    (and to lesser extent employment), as fathers appear to support the family, especially when early parenthood is combined with cohabitation with the mother and the child. Heterogeneous effects reveal that individuals with a more favorable socioeconomic background are affected more severely than......Having children at an early age is known to be associated with unfavorable economic outcomes, such as lower education, employment and earnings. In this paper, we study the long-term consequences of early parenthood for mothers and fathers. Our study is based on rich register-based data that......, importantly, merges all childbirths to the children’s mothers and fathers, allowing us to study the consequences of early parenthood for both parents. We perform a sibling fixed effects analysis in order to account for unobserved family attributes that are possibly correlated with early parenthood...

  4. [Bilateral pathological sub-trochanteric fracture in a long-term biphosphonate user]. (United States)

    Kľoc, P; Tomčovčík, L; Kľoc, J


    The number of papers reporting the occurrence of specific pathological fractures in long-term biphosphonate users has recently increased. They refer to the forms of stress fracture probably resulting from an extreme decrease in bone turnover, which may involve sub-trochanteric or isolated transverse fractures, or short transverse fractures with a unicortical beak in an area of cortical hypertrophy. At the time of prodromal signs and symptoms, cortical bone at the site of impeding fracture appears rougher on radiographs. Gradually, an incomplete fracture develops, with a subsequent complete fracture often sustained without any mechanism of injury noted. The occurrence of such fractures is reported in the range of 2 to 8 years from the start of biphosphonate use. The fractures are often bilateral and, at the time the first occurs, it is often possible to diagnose contralateral pathological changes similar to those before the first fracture. The paper presents the case of a female patient who sustained a bilateral pathological sub-trochanteric fracture; the first fracture occurred after 5 and the other after 9 years of Rizendronat use. She was followed up for unilateral incomplete sub-trochanteric fracture from the fourth year of its use. In that period, magnetic resonance imaging showed a pathological finding in the contralateral extremity. She had already had prodromal signs manifested as lasting hip pain before the first fracture. Both fractures were surgically treated. Thirty-three months later she had to undergo repeat surgery for pseudoarthrosis at the site of the first fracture. The pseudoarthrosis healed without complications. However, in the second fracture non-union was still present at 7 months after surgery. The patient took Rizendronat during the whole treatment period and thereafter. In the discussion, certain aspects of long-term biphosphonate use are addressed, as well as some preventive, diagnostic and therapeutic procedures related to this rare

  5. Sudden Death Due to Coronary Artery Lesions Long-term After the Arterial Switch Operation: A Systematic Review.

    NARCIS (Netherlands)

    van Wijk, Sebastiaan W.H.; van der Stelt, Femke; ter Heide, Henriëtte; Schoof, Paul H.; Doevendans, Pieter A.F.M.; Meijboom, Folkert J.; Breur, Johannes M.P.J.


    Background The arterial switch operation (ASO) is the preferred procedure for children with dextrotransposition of the great arteries or Taussig-Bing anomaly. Short- as well as long-term outcome of ASO are excellent, but coronary artery stenoses are reported as a common long-term complication. It

  6. Critical neural networks with short- and long-term plasticity (United States)

    Michiels van Kessenich, L.; Luković, M.; de Arcangelis, L.; Herrmann, H. J.


    In recent years self organized critical neuronal models have provided insights regarding the origin of the experimentally observed avalanching behavior of neuronal systems. It has been shown that dynamical synapses, as a form of short-term plasticity, can cause critical neuronal dynamics. Whereas long-term plasticity, such as Hebbian or activity dependent plasticity, have a crucial role in shaping the network structure and endowing neural systems with learning abilities. In this work we provide a model which combines both plasticity mechanisms, acting on two different time scales. The measured avalanche statistics are compatible with experimental results for both the avalanche size and duration distribution with biologically observed percentages of inhibitory neurons. The time series of neuronal activity exhibits temporal bursts leading to 1 /f decay in the power spectrum. The presence of long-term plasticity gives the system the ability to learn binary rules such as xor, providing the foundation of future research on more complicated tasks such as pattern recognition.

  7. Dissolution rates of DWPF glasses from long-term PCT

    International Nuclear Information System (INIS)

    Ebert, W.L.; Tam, S.W.


    We have characterized the corrosion behavior of several Defense Waste Processing Facility (DWPF) reference waste glasses by conducting static dissolution tests with crushed glasses. Glass dissolution rates were calculated from measured B concentrations in tests conducted for up to five years. The dissolution rates of all glasses increased significantly after certain alteration phases precipitated. Calculation of the dissolution rates was complicated by the decrease in the available surface area as the glass dissolves. We took the loss of surface area into account by modeling the particles to be spheres, then extracting from the short-term test results the dissolution rate corresponding to a linear decrease in the radius of spherical particles. The measured extent of dissolution in tests conducted for longer times was less than predicted with this linear dissolution model. This indicates that advanced stages of corrosion are affected by another process besides dissolution, which we believe to be associated with a decrease in the precipitation rate of the alteration phases. These results show that the dissolution rate measured soon after the formation of certain alteration phases provides an upper limit for the long-term dissolution rate, and can be used to determine a bounding value for the source term for radionuclide release from waste glasses. The long-term dissolution rates measured in tests at 20,000 per m at 90 degrees C in tuff groundwater at pH values near 12 for the Environmental Assessment glass and glasses made with SRL 131 and SRL 202 frits, respectively

  8. Long-term outcomes of nasopharyngectomy using partial maxillectomy approach. (United States)

    Ng, Li Shia; Lim, Chwee Ming; Loh, Kwok Seng


    To determine the long-term outcomes of a prospective cohort of 20 patients who had nasopharyngectomy using an open partial-maxillectomy approach. A prospective cohort study of the surgical outcomes of patients with recurrent T1 (rT1) and rT2 nasopharyngeal carcinoma recurrence. There were 14 male and six female patients. The mean age was 49 years. The mean duration of follow-up was 60.4 months. All of the surgical margins were free of malignancy. Ten patients (50%) developed recurrences. The 5-year local control rate, disease-free, disease-specific, and overall survivals were 70%, 48.9%, 70.2%, and 66.7%, respectively. There were no major intraoperative complications. The most common morbidity was pain. The median length of hospitalization was 4 days. Early local recurrence of nasopharyngeal carcinoma can be treated surgically using a partial maxillectomy approach. The long-term outcomes are similar to nasopharyngectomy performed using the more common approaches. 4. Laryngoscope, 126:1103-1107, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  9. Preeclampsia: long-term consequences for vascular health

    Directory of Open Access Journals (Sweden)

    Amaral LM


    Full Text Available Lorena M Amaral, Mark W Cunningham Jr, Denise C Cornelius, Babbette LaMarca Department of Pharmacology, University of Mississippi Medical Center, Jackson, MS, USA Abstract: Preeclampsia (PE is a pregnancy-specific syndrome and one of the leading causes of preterm birth, neonatal and maternal morbidity and mortality. This disease is characterized by new onset hypertension usually in the third trimester of pregnancy and is sometimes associated with proteinuria, although proteinuria is not a requirement for the diagnosis of PE. In developing countries, women have a higher risk of death due to PE than more affluent countries and one of the most frequent causes of death is high blood pressure and stroke. Although PE only affects approximately 2%–8% of pregnancies worldwide it is associated with severe complications such as eclampsia, hemorrhagic stroke, hemolysis, elevated liver enzymes and low platelets (HELLP syndrome, renal failure and pulmonary edema. Importantly, there is no “cure” for the disease except for early delivery of the baby and placenta, leaving PE a health care risk for babies born from PE moms. In addition, PE is linked to the development of cardiovascular disease and stroke in women after reproductive age, leaving PE a risk factor for long-term health in women. This review will highlight factors implicated in the pathophysiology of PE that may contribute to long-term effects in women with preeclamptic pregnancies. Keywords: preeclampsia, endothelial dysfunction, AT1-AA, CD4+ T helper cells

  10. Long term radiological impact of thorium extraction

    International Nuclear Information System (INIS)

    Menard, S.; Schapira, J.P.


    Thorium extraction produces a certain amount of radioactive wastes. Potential long term radiological impact of these residues has been calculated using the recent ICRP-68 ingestion dose factors in connection with the computing code DECAY, developed at Orsay and described in this work. This code solves the well known Bateman's equations which govern the time dependence of a set of coupled radioactive nuclei. Monazites will be very likely the minerals to be exploited first, in case of an extensive use of thorium as nuclear fuel. Because monazites contain uranium as well, mining residues will contain not only the descendants of 232 Th and a certain proportion of non-extracted thorium (taken here to be 5%), but also this uranium, if left in the wastes for economical reasons. If no uranium would be present at all in the mineral, the potential radiotoxicity would strongly decrease in approximately 60 years, at the pace of the 5.8 years period of 228 Ra, which becomes the longest-lived radionuclide of the 4n radioactive family in the residues. Moreover, there is no risk due to radon exhalation, because of the very short period of 220 Rn. These significant differences between uranium and thorium mining have to be considered in view of some estimated long term real radiological impacts due to uranium residues, which could reach a value of the order of 1 mSv/year, the dose limit recommended for the public by the recent ICRP-60. (authors). 15 refs., 4 figs., 3 tabs., 43 appendices

  11. Managing Records for the Long Term - 12363

    Energy Technology Data Exchange (ETDEWEB)

    Montgomery, John V. [U.S. Department of Energy, Office of Legacy Management, Morgantown, West Virginia (United States); Gueretta, Jeanie [U.S. Department of Energy, Office of Legacy Management, Grand Junction, Colorado (United States)


    The U.S. Department of Energy (DOE) is responsible for managing vast amounts of information documenting historical and current operations. This information is critical to the operations of the DOE Office of Legacy Management. Managing legacy records and information is challenging in terms of accessibility and changing technology. The Office of Legacy Management is meeting these challenges by making records and information management an organizational priority. The Office of Legacy Management mission is to manage DOE post-closure responsibilities at former Cold War weapons sites to ensure the future protection of human health and the environment. These responsibilities include environmental stewardship and long-term preservation and management of operational and environmental cleanup records associated with each site. A primary organizational goal for the Office of Legacy Management is to 'Preserve, Protect, and Share Records and Information'. Managing records for long-term preservation is an important responsibility. Adequate and dedicated resources and management support are required to perform this responsibility successfully. Records tell the story of an organization and may be required to defend an organization in court, provide historical information, identify lessons learned, or provide valuable information for researchers. Loss of records or the inability to retrieve records because of poor records management processes can have serious consequences and even lead to an organisation's downfall. Organizations must invest time and resources to establish a good records management program because of its significance to the organization as a whole. The Office of Legacy Management will continue to research and apply innovative ways of doing business to ensure that the organization stays at the forefront of effective records and information management. DOE is committed to preserving records that document our nation's Cold War legacy, and the

  12. Long-term potentiation and long-term depression: a clinical perspective

    Directory of Open Access Journals (Sweden)

    Timothy V.P. Bliss


    Full Text Available Long-term potentiation and long-term depression are enduring changes in synaptic strength, induced by specific patterns of synaptic activity, that have received much attention as cellular models of information storage in the central nervous system. Work in a number of brain regions, from the spinal cord to the cerebral cortex, and in many animal species, ranging from invertebrates to humans, has demonstrated a reliable capacity for chemical synapses to undergo lasting changes in efficacy in response to a variety of induction protocols. In addition to their physiological relevance, long-term potentiation and depression may have important clinical applications. A growing insight into the molecular mechanisms underlying these processes, and technological advances in non-invasive manipulation of brain activity, now puts us at the threshold of harnessing long-term potentiation and depression and other forms of synaptic, cellular and circuit plasticity to manipulate synaptic strength in the human nervous system. Drugs may be used to erase or treat pathological synaptic states and non-invasive stimulation devices may be used to artificially induce synaptic plasticity to ameliorate conditions arising from disrupted synaptic drive. These approaches hold promise for the treatment of a variety of neurological conditions, including neuropathic pain, epilepsy, depression, amblyopia, tinnitus and stroke.

  13. 2003 Long-Term Surveillance and Maintenance Program Report

    International Nuclear Information System (INIS)


    Radioactive waste was created by the Federal Government and private industry at locations around the country in support of national defense, research, and civilian power-generation programs. If not controlled, much of this legacy waste would remain hazardous to human health and the environment indefinitely. Current technology does not allow us to render this waste harmless, so the available methods to control risk rely on consolidation, isolation, and long-term management of the waste. The U.S. Department of Energy (DOE) has an obligation to safely control the radioactive waste and to inform and train future generations to maintain and, perhaps, improve established protections. DOE is custodian for much of the radioactive and other hazardous waste under control of the Federal Government. DOE established the Formerly Utilized Sites Remedial Action Program (FUSRAP) in 1974 and the Defense Decontamination and Decommissioning (D&D) Program and the Surplus Facilities Management Program in the 1980s. Congress passed the Uranium Mill Tailings Radiation Control Act (UMTRCA) in 1978. These federal programs and legislation were established to identify, remediate, and manage legacy waste. Remedial action is considered complete at a radioactive waste site when the identified hazardous material is isolated and the selected remedial action remedy is in place and functioning. Radioactive or other hazardous materials remain in place as part of the remedy at many DOE sites. Long-term management of radioactive waste sites incorporates a set of actions necessary to maintain protection of human health and the environment. These actions include maintaining physical impoundment structures in good repair to ensure that they perform as designed, preventing exposure to the wastes by maintaining access restrictions and warnings, and recording site conditions and activities for future custodians. Any actions, therefore, that will prevent exposure to the radioactive waste now or in the future

  14. 2003 Long-Term Surveillance and Maintenance Program Report

    Energy Technology Data Exchange (ETDEWEB)



    Radioactive waste was created by the Federal Government and private industry at locations around the country in support of national defense, research, and civilian power-generation programs. If not controlled, much of this legacy waste would remain hazardous to human health and the environment indefinitely. Current technology does not allow us to render this waste harmless, so the available methods to control risk rely on consolidation, isolation, and long-term management of the waste. The U.S. Department of Energy (DOE) has an obligation to safely control the radioactive waste and to inform and train future generations to maintain and, perhaps, improve established protections. DOE is custodian for much of the radioactive and other hazardous waste under control of the Federal Government. DOE established the Formerly Utilize