Fingertip replantation: determinants of survival.

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Li, Jing; Guo, Zheng; Zhu, Qingsheng; Lei, Wei; Han, Yisheng; Li, Mingquan; Wang, Zhen

2008-09-01

The purpose of this study was to determine the risk factors for an unsuccessful replanted fingertip. Two hundred eleven complete fingertip amputations in 211 patients who underwent replantation surgery between August of 1990 and March of 2006 were included in this study. The patients' age, gender, smoking history, digit position, dominant hand, amputation level, injury mechanism, platelet count, ischemia time, preservation method of the amputated part, anesthesia, number of arteries repaired, venous drainage, use of vein grafting, neurorrhaphy, bone shortening, and smoking after operation were tested for their impact on fingertip survival. One hundred seventy-two of 211 patients (81.5 percent) had a successful replantation. Univariate analysis showed crush or avulsion injury, high platelet count, and inappropriate preservation of the amputated part in saline solution or ethanol to be associated with a high incidence of replantation failure. Twenty-two of 54 patients (41 percent) who had a crush or avulsion trauma had failed replantation. Logistic regression analysis identified injury mechanism, platelet count, smoking after operation, preservation method of the amputated part, and the use of vein grafting as statistically significant predictive factors for success or failure. Injury mechanism, platelet count, smoking after operation, preservation method of amputated part, and the use of vein grafting were found to be the main predictors for the survival of the replanted fingertip. Applying external bleeding in zone 1 and venous drainage through the medullary cavity in zone 2 or venous anastomosis combined with vein grafting rather than venous anastomosis alone were strongly recommended in the fingertip replantation of crush or avulsion injury.

Successful microsurgical replantation of an amputated penis

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Sanchit Garg

2016-01-01

Full Text Available Penile amputation is an uncommon injury for which immediate surgical replantation is warranted. Microsurgical replantation is the “standard” method for penile replantation. Early replantation yields a high success and low complication rate. We report a case of a 34-year-old male who presented with amputation at the proximal penile shaft which was successfully replanted using microsurgical techniques. Minor skin necrosis was noted post-operatively which was debrided and covered with skin graft. Follow-up at 6 months showed satisfactory cosmetic appearance, normal voiding, return of sensations and erectile function. The level of evidence was V.

Dermal pocketing following distal finger replantation.

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Puhaindran, Mark E; Paavilainen, Pasi; Tan, David M K; Peng, Yeong Pin; Lim, Aymeric Y T

2010-08-01

Replantation is an ideal technique for reconstruction following fingertip amputation as it provides 'like for like' total reconstruction of the nail complex, bone pulp tissue and skin with no donor-site morbidity. However, fingertips are often not replanted because veins cannot be found or are thought to be too small to repair. Attempts at 'cap-plasty' or pocketing of replanted tips with and without microvascular anastomosis have been done in the past with varying degrees of success. We prospectively followed up a group of patients who underwent digital replantation and dermal pocketing in the palm to evaluate the outcome of this procedure. There were 10 patients with 14 amputated digits (two thumbs, five index, four middle, two ring and one little) who underwent dermal pocketing of the amputated digit following replantation. Among the 14 digits that were treated with dermal pocketing, 11 survived completely, one had partial atrophy and two were completely lost. Complications encountered included finger stiffness (two patients) and infection of the replanted fingertip with osteomyelitis of the distal phalanx (one patient). We believe that this technique can help increase the chance of survival for distal replantation with an acceptable salvage rate of 85% in our series. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Standardized protocol for artery-only fingertip replantation.

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Buntic, Rudolf F; Brooks, Darrell

2010-09-01

Artery-only fingertip replantation can be reliable if low-resistance flow through the replant is maintained until venous outflow is restored naturally. Injuring the tip of the replant to promote ongoing bleeding augmented with anticoagulation usually accomplishes this; however, such management results in prolonged hospitalization. In this study, we analyzed the outcomes of artery-only fingertip replantation using a standardized postoperative protocol consisting of dextran-40, heparin, and leech therapy. Between 2001 and 2008, we performed 19 artery-only fingertip replants for 17 patients. All patients had the replanted nail plate removed and received intravenous dextran-40, heparin, and aspirin to promote fingertip bleeding and vascular outflow. Anticoagulation was titrated to promote a controlled bleed until physiologic venous outflow was restored by neovascularization. We used medicinal leeches and mechanical heparin scrubbing for acute decongestion. By postoperative day 6, bleeding was no longer promoted. We initiated fluorescent dye perfusion studies to assess circulatory competence and direct further anticoagulant intervention if necessary. The absence of bleeding associated with an initial rise followed by an appropriate fall in fluorescent dye concentration would trigger a weaning of anticoagulation. All of the 19 replants survived. The average length of hospital stay was 9 days (range, 7-17 d). Eleven patients received blood transfusions. The average transfusion was 1.8 units (range, 0-9 units). All patients were happy with the decision to replant, and the cosmetic result. A protocol that promotes temporary, controlled bleeding from the fingertip is protective of artery-only replants distal to the distal interphalangeal joint until physiologic venous outflow is restored. The protocol described is both safe and reliable. The patient should be informed that such replant attempts may result in the need for transfusions and extended hospital stays, factors that

Challenges in fingertip replantation.

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Kim, Jin-Soo; Yang, Jae-Won; Lee, Dong-Chul; Ki, Sae-Hwi; Roh, Si-Young

2013-11-01

Fingertip amputation is a challenging injury to manage. Among various reconstructive procedures, replantation results in superior outcome, but is seldom considered in many institutions. From the identification of vessel ends to reanastomosis of the submillimeter vessels, fingertip's highly specialized anatomy requires technical excellence. By addressing these anatomic challenges, fingertip replantation can be a routine reconstructive option for microvascular surgeons.

Challenges in Fingertip Replantation

OpenAIRE

Kim, Jin-Soo; Yang, Jae-Won; Lee, Dong-Chul; Ki, Sae-Hwi; Roh, Si-Young

2013-01-01

Fingertip amputation is a challenging injury to manage. Among various reconstructive procedures, replantation results in superior outcome, but is seldom considered in many institutions. From the identification of vessel ends to reanastomosis of the submillimeter vessels, fingertip's highly specialized anatomy requires technical excellence. By addressing these anatomic challenges, fingertip replantation can be a routine reconstructive option for microvascular surgeons.

Tooth replantation after use of Euro-Collins solution or bovine milk as storage medium: a histomorphometric analysis in dogs.

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Sottovia, André Dotto; Sottovia Filho, Dagoberto; Poi, Wilson Roberto; Panzarini, Sônia Regina; Luize, Danielle Shima; Sonoda, Celso Koogi

2010-01-01

Euro-Collins solution was developed for the preservation of organs for transplantation, whose characteristics have raised interest for its use as a storage medium for avulsed teeth before replantation. This study evaluated histologically and morphometrically the healing process of dog teeth replanted after storage in Euro-Collins solution or bovine milk. Eighty roots of 4 young adult mongrel dogs were randomly assigned to 4 groups (n = 20) and the root canals were instrumented and obturated with gutta-percha and a calcium hydroxide-based sealer. After 2 weeks, the teeth were extracted and subjected to the following protocols: GI (negative control), replantation immediately after extraction; GII (positive control), bench-drying for 2 hours before replantation; GIII and GIV, immersion in 10 mL of whole bovine milk and Euro-Collins solution at 4 degrees C, respectively, for 8 hours before replantation. The animals were sacrificed 90 days postoperatively. The pieces containing the replanted teeth were subjected to routine processing for histologic and histometric analyses under light microscopy and polarized light microscopy. Root resorption was observed in all groups. GII exhibited the greatest loss of dental structure (P < .01), and inflammatory resorption was predominant in this group. Storage in milk showed poorer results than immediate replantation and storage in Euro-Collins solution (P < .01). The teeth stored in Euro-Collins solution presented similar extension of root resorption and periodontal ligament reorganization to those of immediately replanted teeth. The findings of this study suggest that the Euro-Collins solution is an adequate storage medium for keeping avulsed teeth for up to 8 hours before replantation.

Mini replants: fingertip replant distal to the IP or DIP joint.

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Dautel, G; Barbary, S

2007-01-01

Amputations through the distal interphalangeal joint or distal to this joint are frequent and they represent probably one of the best indications for replantation. Details on the vascular anatomy of the fingertip have to be perfectly known by the surgeon who will have to deal with these replantations. Factors such as age, mechanism of amputation and type of anastomosis will influence the overall success rate of the procedure. Return of a true static two points discrimination can be observed in children even in the absence of any neural repair.

Fingertip replantation: Technical considerations and outcome analysis of 24 consecutive fingertip replantations

OpenAIRE

Venkatramani, H.; Sabapathy, S. Raja

2011-01-01

Fingertip amputations are one of the most common injuries faced in an emergency department. Finger tip replantation though technically possible, are not regularly done due to the presumed complexity of the procedure and doubts about the outcome. This article deals with our experience of 24 fingertip replantations in 24 patients done over a period of 8 years since the year 2000. Twenty-one fingertips survived. The most common affected digit in the series was thumb followed by index, middle, an...

[Fingertip replantation after amputation: report of 32 fingers].

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Ren, Gao-hong; Pei, Guo-xian; Gu, Li-qiang; Guo, Gang

2004-08-01

To describe the surgical techniques and our experiences in fingertip replantation after amputation. On the basis of examination of the anatomic features and the degree of fingertip vascular injury, 32 amputated fingertips in 26 cases were replanted, and flexible revascularization procedures of both artery and vein anastomoses, artery-only anastomosis, arterialized vein and arteriovenous anastomosis were adopted. All the replanted fingertips were trained with comprehensive rehabilitation program. Twenty-nine replanted fingertips survived but 3 failed, and the overall survival rate was 90.06%. During the follow-up lasting from 4 months to 5 years, the 29 replanted fingertips survived with excellent blood supply, good sensory functions, satisfactory shape and functions according to the criteria by Society of Hand Surgery of Chinese Medical Association. Fingertip replantation after amputation can achieve not only high survival rate but also satisfactory appearance and functions as long as appropriate operative procedures are adopted with comprehensive rehabilitation therapy.

Intramedullary Venous Drainage System for Distal Fingertip Replantations.

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Purisa, Husrev; Ozturk, Muhammed Besir; Kabakas, Fatih; Mersa, Berkan; Ozcelik, Ismail Bulent; Sezer, Ilker

2017-08-01

The number of venous anastomoses performed during fingertip replantation is one of the most important factors affecting the success of replantation. However, because vessel diameters decrease in the zone 1 level, vessel anastomoses, especially vein anastomoses, are technically difficult and, thus, cannot be performed in most cases. Alternative venous drainage methods are crucial when any reliable vein repair is not possible. In the literature, so many artery-only replantation techniques have been defined, such as arteriovenous anastomoses, forming an arteriovenous or venocutaneous fistula, manual milking and massage, puncturing, and external bleeding via a fishmouth incision and using a medical leech. It has been shown that, in distal fingertip replantations, the medullary cavity may also be a good way for venous return. In this study, we introduce an alternative intramedullary venous drainage system we developed to facilitate venous drainage in artery-only fingertip replantations. The results of 24 fingertip replantations distal to the nail fold by using this system are presented with a literature review.

Retention and Healing Outcomes after Intentional Replantation.

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Cho, Sin-Yeon; Lee, Yoon; Shin, Su-Jung; Kim, Euiseong; Jung, Il-Young; Friedman, Shimon; Lee, Seung-Jong

2016-06-01

Intentional replantation is an alternative to tooth extraction and prosthetic replacement when conventional endodontic treatment modalities are unfeasible or contraindicated. This study assessed tooth retention and healing after intentional replantation and explored predictors of these outcomes. Data of intentional replantation procedures performed between March 2000 and December 2010 were collected prospectively, excluding teeth with preoperative periodontal and root defects. A cohort of 159 teeth was followed up for 0.5-12 years. Retention and healed status without complications (periapical radiolucency, external root resorption, ankylosis, signs/symptoms, probing ≥6 mm) was recorded and analyzed with Kaplan-Meier survival analysis and Cox proportional hazard regression model (P regression identified extraoral time ≤15 minutes as predictor of complication-free healing (P < .04; hazard ratio, 2.767; 95% confidence interval, 1.053-7.272). This prospective cohort study of contemporary intentional replantation suggested a cumulative 12-year retention rate of 93% and healed rate of 77% after 3 years. Healing occurred 1.7 times more frequently in teeth replanted within 15 minutes. Although most complications occurred within 1 year after replantation, follow-up should extend for at least 3 years to capture late complications. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Unfavorable results in replantation

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Abraham G Thomas

2013-01-01

Full Text Available Reattachment of amputated parts of the body (Replantation has become a reality since the first arm replant was carried out six decades ago. Failures were not uncommon in the beginning, leading on to the analysis of the problem and refinements in technique. Improvements in sutures, instrumentation and better microscopes further helped the surgeons to do replantation with better finesse and functional results. Evaluation of results and particularly failure and long term results help the younger surgeons to learn from the difficulties faced earlier to do better in the future. An attempt is made to list various aspects of replantation experienced by the author during the past 30 years, particularly in reference to unfavorable results, which had been occasionally total failure, or a partial failure, with poor function and cosmesis due to infection. An insensate limb with poor function is the result of inadequate or improper nerve coaptation or infection destroying the whole repair. It is apt to mention that infection is mostly the result of poor vascularity due to devitalized tissue. Difficulties arise often in identifying the viable tissue, particularly while debriding in the distal amputated part since there is no bleeding. Experience counts in this, specifically to identify the viable muscle. The factors that may lead to complications are listed with remarks to avoid them.

Management of complications relating to finger amputation and replantation.

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Woo, Sang-Hyun; Kim, Young-Woo; Cheon, Ho-Jun; Nam, Hyun-Je; Kang, Dong-Ho; Kim, Jong-Min; Ahn, Hee-Chan

2015-05-01

There are many options in the management of fingertip or finger amputations. Injudicious revision amputation may cause complications. These complications can be prevented by tension-free closure of the amputation stump or primary coverage with appropriate flap. Replantation is the best way to keep the original length and maintain digital function. Patent vein repair or venous drainage with bleeding until neovascularization to the replanted part is the key to successful replantation. Prevention and management of complications in replantation and revision amputation increase patients' satisfaction and decrease costs. Research is needed to define new indications of replantation for digital amputation. Copyright © 2015 Elsevier Inc. All rights reserved.

[Partial replantation following proximal limb injury].

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Dubert, T; Malikov, S A; Dinh, A; Kupatadze, D D; Oberlin, C; Alnot, J Y; Nabokov, B B

2000-11-01

Proximal replantation is a technically feasible but life-threatening procedure. Indications must be restricted to patients in good condition with a good functional prognosis. The goal of replantation must be focused not only on reimplanting the amputated limb but also on achieving a good functional outcome. For the lower limb, simple terminalization remains the best choice in many cases. When a proximal amputation is not suitable for replantation, the main aim of the surgical procedure must be to reconstruct a stump long enough to permit fitting a prosthesis preserving the function of the adjacent joint. If the proximal stump beyond the last joint is very short, it may be possible to restore some length by partial replantation of spared tissues from the amputated part. We present here the results we obtained following this policy. This series included 16 cases of partial replantations, 14 involving the lower limb and 2 the upper limb. All were osteocutaneous microsurgical transfers. For the lower limb, all transfers recovered protective sensitivity following tibial nerve repair. The functional calcaeoplantar unit was used in 13 cases. The transfer of this specialized weight bearing tissue provided a stable distal surface making higher support unnecessary. In one case, we raised a 13-cm vascularized tibial segment covered with foot skin for additional length. For the upper limb, the osteocutaneous transfer, based on the radial artery, was not reinnervated, but this lack of sensitivity did not impair prosthesis fitting. One vascular failure was finally amputated. This was the only unsuccessful result. For all other patients, the surgical procedure facilitated prosthesis fitting and preserved the proximal joint function despite an initially very proximal amputation. The advantages of partial replantation are obvious compared with simple terminalization or secondary reconstruction. There is no secondary donor site and, because there is no major muscle mass in the

Fingertip Replantation Using Y-Shaped Vein Graft to Pulp Artery.

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Kim, Jun Hyuk; Lee, Young Man

2015-10-01

Re-establishing adequate venous outflow is the most important factor for success of fingertip replantation. However, in zone I level, replantation is very difficult, especially in repairing venous circulation. The authors have made an attempt to replantation using Y-shaped vein (YSV) graft to identify and repair veins easily in fingertip replantation. From January 2007 to December 2012, a total of 46 fingertip replantations in 44 consecutive patients with amputations in the Tamai zone I level were performed by using YSV graft. In all patients, arterial anastomosis was performed using YSV graft, and interpositional vein grafts were used for venous repair. The overall success rate of the YSV-grafted replantations was 91.3% (42/46). Postoperative vascular complications occurred in 6 YSV-grafted replantations (13%), and pulp atrophy in the YSV-grafted digits was 9.5% (4/42). Fingertip replantation in zone I level is a difficult territory to a microsurgeon, especially anastomosing veins. However, our YSV grafting technique has shown value in this setting, enabling better esthetic and functional results.

Nonsurgical factors of digital replantation and survival rate A metaanalysis

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Huawei Yu

2015-01-01

Full Text Available The aim of this metaanalysis was to evaluate the association between nonsurgical factors and survival rate of digital replantation. A computer search of MEDLINE, OVID, EMBASE and CNKI databases was conducted to identify literatures for digital replantation, with the keywords of "digit," "finger" and "replantation" from their inception to June 10, 2014. Based on the inclusion and exclusion criteria, data were extracted independently by two authors using piloted forms. Review Manager 5.2 software was used for data analysis. The effect of some nonsurgical factors (gender, age, amputated finger, injury mechanisms, ischemia time and the way of preservation on the survival rate of digital replantation was assessed. The metaanalysis result suggested that gender and ischemia time had no significant influence on the survival rate of amputation replantation. However, the survival rate of digital replantation of adults was significantly higher than that of children. The guillotine injury of a finger was easier to replant successfully than the crush and avulsion. The little finger was more difficult for replantation than thumb. Survival rate of fingers stored in low temperature was higher than that in common temperature. The present metaanalysis suggested that age, injury mechanism, amputated finger and the way of preservation were significantly associated with the survival rate of digital replantation.

Survival Rate of Limb Replantation in Different Age Groups.

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Tatebe, Masahiro; Urata, Shiro; Tanaka, Kenji; Kurahashi, Toshikazu; Takeda, Shinsuke; Hirata, Hitoshi

2017-08-01

Revascularization of damaged limbs/digits is technically feasible, but indications for surgical replantation remain controversial. The authors analyzed the survival rate of upper limb amputations and the associated factors in different age groups. They grouped 371 limb/digit amputees (average age, 44 years; range, 2-85 years) treated in their hospital during the past 10 years into three groups based on age (young, ≤ 15 years, n  = 12; adult, 16-64 years, n  = 302; elderly, ≥ 65 years, n  = 57) and analyzed their injury type (extent of injury and stump status), operation method, presence of medical complications (Charlson comorbidity index), and survival rate. There were 168 replantations, and the overall replantation survival rate was 93%. The Charlson comorbidity index of the replantation patients was 0 in 124 cases; 1 in 32; 2 in 9; and 3 in 3, but it did not show any significant difference in survival rate after replantation. Eight elderly patients (14%) did not opt for replantation. Younger patients tended to undergo replantation, but they had lower success rates due to their severe injury status. The results of this study show that the survival rate of replantation in elderly patients is equal to that in adults. Stump evaluation is important for survival, but the presence of medical complications is not associated with the overall survival rate.

The chicken foot digital replant training model.

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Athanassopoulos, Thanassi; Loh, Charles Yuen Yung

2015-01-01

A simple, readily available digital replantation model in the chicken foot is described. This high fidelity model will hopefully allow trainees in hand surgery to gain further experience in replant surgery prior to clinical application.

Long Term Follow-Up of a Successful Lower Limb Replantation in a 3-Year-Old Child

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Akbar Jaleel Zubairi

2015-01-01

Full Text Available Replantation of the lower extremity has controversial indications but nevertheless it may be considered in carefully selected patients who present early and are expected to show good functional recoveries. Here we present a successful replantation in a 3-year-old boy who has made excellent recovery with no functional deficit evident at 12 years of follow-up. He sustained a traumatic amputation at the level of distal tibia when he fell of a “Qing Qi” (motorcycle rickshaw. Replantation was attempted at 8 hours cold ischemia time with the tibia shortened 4 cm and all tendons, vessels, and nerves repaired. Patient required a second procedure during the same hospital stay for skin coverage. Patient made good recovery with ambulation without support at 6 months, less than 3 cm limb length discrepancy, plantar and dorsiflexion power 4/5, and recovery of sensation over the foot. Now at 12 years of follow-up patient has a normal gait and has integrated into society with no functional deficit. Considering the functional outcome of our case, replantation should be attempted whenever possible and feasible especially in children.

Successful replantation of a finger in an 8-month old child.

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Stewart, D A; Coombs, C J

2013-01-01

A successful replantation of an index fingertip in an 8-month old girl is reported. A literature review of replants in very young children suggests this is one of the youngest patients ever to undergo digital replantation and possibly the youngest finger replant performed.

Successful microsurgical lip replantation: Monitoring venous congestion by blood glucose measurements in the replanted lip

OpenAIRE

Kazufumi Tachi; Masanori Mori; Reiko Tsukuura; Rintaro Hirai

2018-01-01

Replantation of an amputated lip using microvascular anastomosis is the best option for restoration of the defect. However, the amputated region often lacks veins with appropriate diameters for microvascular anastomoses and typically necessitates both postoperative exsanguination using medicinal leeches and a blood transfusion. We present a case of the successful replantation of an avulsed lip in which postoperative congestion was evaluated objectively by measuring blood glucose levels in the...

DSA in digital replantations

International Nuclear Information System (INIS)

Wang Liuhong; Chao Ming; Jiang Dingyao; Zhang Guangqiang; Wu Jianjun; Chen Xianyi; Li Bin; Sun Jihong

2008-01-01

Objective: To assess revascularization and vessel anastomosis in digital replantations with DSA. Methods: Twelve cases of digital replantations underwent digital subtract angiography during 2 to 4 days after fingers reattachment. The vessel anastomosis, hemodynamics, stenosis and discontinuation were investigated. The unobstructed and smooth anastomosis was suggested as early stage survival of the reattached fingers, the spasm and stenosis of the reattached vessels were considered as mild vascular crisis, and the discontinuation of hemodynamics were indicated as severe vascular crisis. Results: The total 27 vessels were clearly displayed on DSA. Of these vessels, 23 vessels were unobstructed and smooth, all digits were survived. Diagnosis coincidence of early stage survival was 100% (23/23). Two vessels were obstructed, which were testified having thrombus by operation research. The other 2 vessels were spasm, the digits were also survived ultimately by expectant treatment. All 4 abnormal vessel anatomosis were found by DSA. Conclusion: DSA is important modality in assessing revascularization and blood circulation for digital replantations, guiding in dealing with the vascular crisis, and in predicting early stage survival of the reattached digits. (authors)

Fingertip replantation at or beyond the nail base in children.

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Shi, Dehai; Qi, Jian; Li, Donghui; Zhu, Lei; Jin, Wentao; Cai, Daozhang

2010-07-01

Although success of digital replantations in children has been reported by many authors, the very distal fingertip replantation remains technically demanding. The aim of this article is to review our experience with fingertip replantations at or distal to the nail base in pediatric patients and evaluate the clinical outcomes. From October 2000 to May 2007, 12 pediatric fingertips amputated at or distal to the nail base were replanted. Only one artery was anastomosed for revascularization with or without nerve repair; vein drainage was provided by the controlled bleeding technique. Eleven of the 12 replants (91%) survived; one replant of crushed digit failed. An average of 26 month (range, 6 to 36 months) follow-up revealed excellent restoration of finger motion and appearance. The regained static 2-point discrimination (S2PD) sensation was from 3.2 to 5.0 mm (mean, 4.2 mm). Both the parents and the children were satisfied with the final results. In conclusion, fingertip replantation in children allows good functional and esthetical recovery and should be attempted if technically feasible. (c) 2010 Wiley-Liss, Inc.

[Results After Distal Digital Replantation - Is It Worth The Effort?

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Braig, David; Thiele, Jan R; Penna, Vincenzo; Stark, G Björn; Eisenhardt, Steffen U

2017-02-01

There are only relative indications for distal digital replantation in zones 1 and 2 according to Tamai. In contrast to primary closure for fingertip amputations, replantation is a complex procedure that requires skills in supermicrosurgical techniques, as vessels with diameters between 0.3-0.8 mm are connected. In addition the time spent in hospital and the time off from work are longer. Distal digital replantation is thus only indicated, if the expected functional and aesthetic benefits surmount those of primary closure. We retrospectively analysed all fingertip amputations in zone 1 and 2 according to Tamai between 9/2009 and 7/2014 where we attempted distal digital replantation. The success of replantation, wound healing and functional results were evaluated according to Yamano. We performed 11 distal digital replantations in the study period. There were 6 total amputations, 4 subtotal amputations and 1 avulsion of the digital pulp. Revascularisation with long-term reattachment of the amputated tissues was possible in 8 cases (73%). In 3 cases (27%) secondary amputation closure was necessary. The mean operating time was 3 h 56 min. 6 patients, which had a successful replantation, were available for follow-up examinations after a mean period of 19 months. 5 patients were satisfied with the result and would again prefer replantation over primary amputation closure. 4 patients reported a good function of the replanted digits and did not complain about any limitations in their use. 2 patients complained about restricted function. All patients could return to their previous places of employment and were free of pain. Of the 12 affected digital nerves 11 nerves had a 2-point discrimination (2-PD) of ≤15 mm, 3 of them had a 2-PD between 7 and 10 mm and 4 of them of replanted digits and nail deformities in 2 patients. Distal digital replantation is complex and technically challenging. It leads to high patient satisfaction with only minimal functional

Timing of pulp extirpation for replanted avulsed teeth.

LENUS (Irish Health Repository)

Stewart, Chris

2009-01-01

A search was performed (April 2004) across four databases, namely Ovid Medline, Cochrane Library, PubMed and Web of Science, relevant to the proposed PICO ( Patient or problem, Intervention, Comparison, Outcome) question: (P) for a replanted avulsed permanent tooth, (I) is early pulp extirpation within 10-14 days of replantation, (C) compared with delayed pulp extirpation, (O) associated an increased likelihood of successful periodontal healing after tooth replantation. Only articles published in the English language were considered.

Intravascular stenting (IVaS) method for fingertip replantation.

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Narushima, Mitsunaga; Mihara, Makoto; Koshima, Isao; Gonda, Koichi; Takuya, Iida; Kato, Harunosuke; Nakanishi, Kenji; Yamamoto, Yusuke; Araki, Jun; Abe, Hiroaki; Mundinger, Gerhard S; Kikuchi, Kazuki; Uehara, Eri

2009-01-01

Remarkable progress has been made in microsurgery. However, fingertip replantation following amputation has not gained much popularity because of its technical difficulty. We have developed the intravascular stenting (IVaS) method, in which a nylon monofilament is placed inside the vessel lumen to act as a temporary stent, facilitating anastomosis completion. This report describes 7 fingertip replantations using the IVaS method. Intravascular stent size varied from 4-0 to 6-0 (0.199-0.07 mm diameter). There were no cases in which the back wall of a vessel became inadvertently caught in the anastomosis. The overall survival rate for distal digital replants was 85% (6/7 replants). It is very difficult to evenly anastomose vessels of differing diameter, especially on a supermicrosurgical scale. In this respect, the IVaS method plays a role in stably anchoring the 2 vessel ends, allowing for the even spacing of suture knots, even in vessels of different caliber. Because of its ease of use and exactitude, many surgeons may be able to use the IVaS method to reliably complete small anastomoses in fingertip replantations.

Replantation of digits

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... the surgery area. Outlook (Prognosis) Children are better candidates for replantation surgery because of their greater ability ... www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. ...

Validity of exploration for suitable vessels for replantation in the distal fingertip amputation in early childhood: replantation or composite graft.

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Imaizumi, Atsushi; Ishida, Kunihiro; Arashiro, Ken; Nishizeki, Osamu

2013-09-01

Composite grafting, grafting without microvascular anastomoses, has been widely performed for distal fingertip amputation in children with variable results, whereas successful replantation of these amputations using microsurgical technique has been reported. However, most of these reports included a wide age-range and a mix of different amputation levels. This study reviewed our cases of paediatric digital amputation, in order to verify the value of distal fingertip replantation over composite grafting, especially in early childhood. Seventeen young children (aged 3 years and 8 months on average), with single-digit fingertip amputations in Tamai zone I were reviewed from 1993-2008. Each amputation was subdivided into three types: distal, middle, and proximal. There were three distal, 13 middle, and one proximal type zone I amputations. All were crush or avulsion injuries. All three distal-type cases were reattached as primary composite grafts with one success. For middle-type cases, the survival rate of primary composite graft without exploration for possible vessels for anastomosis was 57%. On exploration, suitable vessels for anastomosis were found 50% of the time, in which all replantations were succeeded. The remaining cases were reattached as secondary composite grafts, with one success using the pocket method. Consequently, the success rate after exploration was 67%. The only one proximal-type amputation was failed in replantation. For the middle-type zone I amputation in early childhood, replantation has a high success rate if suitable vessels can be found. Therefore, exploration is recommended for amputations at this level with a view to replantation, irrespective of the mechanism of injury.

Retrospective Review of Air Transportation Use for Upper Extremity Amputations at a Level-1 Trauma Center.

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Grantham, W Jeffrey; To, Philip; Watson, Jeffry T; Brywczynski, Jeremy; Lee, Donald H

2016-08-01

Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations. Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed. The distance traveled was recorded, along with the times of the injury, referral, transportation duration, arrival, and start of the operation. The results of the transfer were defined as replantation or revision amputation. Overall, 47 patients were identified with 43 patients going to the operating room, but only 14 patients (30%) undergoing replantation. Patients arrived at the tertiary hand surgery center with a mean time of 182.3 minutes following the injury, which includes 105.2 minutes of transportation time. The average distance traveled was 105.4 miles (range, 22-353 miles). The time before surgery of those who underwent replantation was 154.6 minutes. The average cost of transportation was $20,482. Air transportation for isolated upper extremity amputations is costly and is not usually the determining factor for replantation. The type of injury and patients' expectations often dictate the outcome, and these may be better determined at the time of referral with use of telecommunication photos, discussion with a hand surgeon, and patient counseling. III.

Reverse Distal Transverse Palmar Arch in Distal Digital Replantation.

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Wei, Ching-Yueh; Orozco, Oscar; Vinagre, Gustavo; Shafarenko, Mark

2017-11-01

Refinements in microsurgery have made distal finger replantation an established technique with high success rates and good functional and aesthetic outcomes. However, it still represents a technically demanding procedure due to the small vessel caliber and frequent lack of vessel length, requiring the use of interpositional venous grafts in some instances. We describe a new technique for anastomosis in fingertip replantation, whereby the need for venous grafts is eliminated. Applying the reverse distal transverse palmar arch technique, 11 cases of distal digital replantation were performed between January 2011 and July 2016. The described procedure was used for arterial anastomosis in 10 cases and arteriovenous shunting for venous drainage in 1 case. A retrospective case review was conducted. The technical description and clinical outcome evaluations are presented. Ten of the 11 replanted digits survived, corresponding to an overall success rate of 91%. One replant failed due to venous insufficiency. Blood transfusions were not required for any of the patients. Follow-up (range, 1.5-5 months) revealed near-normal range of motion and good aesthetic results. All of the replanted digits developed protective sensation. The average length of hospital admission was 5 days. All patients were satisfied with the results and were able to return to their previous work. The use of the reverse distal transverse palmar arch is a novel and reliable technique in distal digital replantation when an increase in vessel length is required, allowing for a tension-free arterial repair without the need for vein grafts.

[Replantation of fingertip amputation in lack of availability of intravenous anastomosis].

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Wei, Jian-Min; Sun, Jun-Suo; Jiao, Xiao-Hu; Jing, Dou-Xing; He, Wei; Jin, Wen-Kuo; Chen, Shi-Gao

2012-08-01

To discuss the replantation of fingertip amputation in lack of availability of intravenous anastomosis. From November 2009 to November 2010, 86 patients (104 fingers) with fingertip amputation were treated with replantatioin, including 64 males and 22 females, with an average age of 26 years ranging from 2 to 64 years. The time from injury to therapy was from 30 min to 12 h, time of broken finger ischemia was from 2.5 to 12 h. Preoperative examination showed no obvious abnormalities. Four different replantation methods were selectively applied to these 104 amputated fingertips of 86 cases: (1) replantation with anastomosis of single or bilateral proper digital artery in 37 fingers; (2) replantation with arteriovenous bypass in 27 fingers; (3) replantation with exclusive anastomosis of digital artery in 24 fingers; (4) replantation with removing the palmar pocket method in 16 fingers. One hundred and two of 104 amputated fingertips were survived. Among these survived fingers,75 cases (92 fingers) were followed-up for 6 to 24 months. According to the assessment standard of Chinese Medical Association of Hand Surgery, the results were excellent in 52 cases, good in 19, poor in 4. It benefits to expand the indications and improve the survival rate of replantation of fingertip amputation with the correct choice of different replantation methods according to the injury situation of the broken fingertip artery after debridement under the microscope.

Replantation and revascularization vs. amputation in injured digits

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Mulders, Marjolein A. M.; Neuhaus, Valentin; Becker, Stéphanie J. E.; Lee, Sang-Gil; Ring, David C.

2013-01-01

The purpose of this study was to analyze factors associated with the decision to replant or revascularize rather than amputate an injured digit as well as factors associated with successful replantation or revascularization. We reviewed 315 complete and subtotal amputations at or proximal to the

Fingertip replantations: importance of venous anastomosis and the clinical results.

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Hasuo, Takaaki; Nishi, Genzaburo; Tsuchiya, Daiji; Otsuka, Takanobu

2009-01-01

Overall survival rate for 143 digits with complete amputation of the distal phalanx was 78%. Replanted digits that underwent venous anastomosis showed a very high survival rate of 93%. Loss of the distal interphalangeal joint function in subzone IV was significantly inferior to that in subzones II and III. Protective sensation was achieved in 96% of replanted digits. Sensory recovery in the absence of nerve repair was significantly worse for avulsion injury than for crush injury. Nail deformity tended to be increased for replanted digits in subzone III or with crush-type injury. Successful venous anastomosis appears to offer the best way to promote survival of replanted digits. If venous anastomosis is infeasible, a replanted digit can survive with any methods for venous drainage in subzones II and III, but does not survive in subzone IV. To minimise nail deformity, repair of the germinal matrix is necessary.

Fingertip replantation using the subdermal pocket procedure.

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Lin, Tsan-Shiun; Jeng, Seng-Feng; Chiang, Yuan-Cheng

2004-01-01

Restoration of finger length and function are the goals of replantation after fingertip amputation. Methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. To increase the survival rates for composite grafts, the subcutaneous pocket procedure has been used as a salvage procedure. The subdermal pocket procedure, which is a modification of the subcutaneous pocket procedure, was used for replantation of 17 fingertips in 16 consecutive patients. Eight fingertips experienced guillotine injuries and the other nine fingertips experienced crush injuries. Revascularization of one digital artery without available venous outflow was performed for six fingers, and composite graft techniques were used for the other 11 fingers. The success rate was 16 of 17 cases. The difference in success rates for guillotine versus crush injuries was statistically significant. Comparison of patients with arterial anastomoses and patients without arterial anastomoses also indicated a statistically significant difference. Thirteen fingertips survived completely. One finger, demonstrating complete loss and early termination of the pocketing procedure, was amputated on the eighth postoperative day. Two fingers were partially lost because of severe crushing injuries. One finger demonstrated partial loss of more than one quarter of the fingertip, which required secondary revision, because the patient was a heavy smoker. The pocketing period was 8 +/- 1 days (mean +/- SD, n = 6) for the fingers revascularized with one digital arterial anastomosis and 13.3 +/- 1.9 days (n = 10) for the fingers successfully replanted with composite graft techniques. The mean active range of motion of the interphalangeal joint of the three thumbs was 65 +/- 5 degrees, and that of the distal interphalangeal joint of the other 11 fingers was 51 +/- 11 degrees. The static two-point discrimination result was 6.4 +/- 1.0 mm (n = 14) after an average of 11 +/- 5 months

Fingertip Replantation With Palmar Venous Anastomoses in Children.

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Wen, Gen; Xu, Jia; Chai, Yi-Min

2017-06-01

Fingertip amputation in children is difficult to manage using microsurgical replantation techniques and many salvage procedures have failed owing to the nonavailability of suitable veins for anastomosis in the fingertip. This study reviewed our experience of pediatric fingertip replantation involving palmar venous anastomoses and evaluated the clinical outcomes. From October 2008 to May 2013, 21 pediatric fingertips that had been completely amputated at or distal to the distal interphalangeal joint of the finger, or at or distal to the interphalangeal joint of the thumb were managed using complete replantation. One artery was anastomosed for revascularization with or without nerve repair, and a palmar venous anastomosis was performed to reestablish the outflow system. Twenty (95.2%) of the 21 fingertips survived. One replant involving an avulsion amputation of the left little finger failed, and the patient underwent stump cap-plasty. Excellent restoration of finger motion, pinch strength, and appearance was observed during the mean 39.9-month (range, 18-65 months) follow-up. The mean regained static 2-point discrimination sensation was 3.8 mm (range, 3.2-4.2 mm). All of the children and their families were satisfied with the surgical outcomes. Successful palmar venous anastomosis appears to promote the survival of replanted fingertips in children. Given that the procedure may simplify postoperative care, minimize complications, and achieve a high survival rate, it should be attempted if the technical expertise is available.

A new device expanding operability of fingertip replantation: subzone 1 fingertip replantation assisted by non-enhanced angiography in a 2-year-old boy.

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Yoshimatsu, Hidehiko; Yamamoto, Takumi; Seki, Yukio; Narushima, Mitsunaga; Iida, Takuya; Koshima, Isao

2012-11-01

Fingertip replantation in young children is difficult, especially in cases with amputation at subzone 1. Replantation is preferred whenever possible, but the identification of vessels of operative size can be very challenging. Non-enhanced angiography (NEA; Genial Viewer; Genial Light, Shizuoka, Japan) emits infrared light with the wavelength of 850 nm, which is exclusively absorbed by haemoglobin. The light penetrates the bones and other soft tissues, effectively visualising vessels containing blood, and the image is shown in real time on the screen of a laptop computer. We present a case in which preoperative NEA visualised vessels in the amputated fingertip, allowing a successful replantation in a 2-year-old boy. By taking the guesswork out of vessel localisation, NEA can be useful in expanding operability of replantation surgery in fingertip amputations. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Crossover replantation after bilateral traumatic lower limb amputations: a case report

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Fang Jun

2012-07-01

Full Text Available Abstract Introduction Replantation of a limb to the contralateral stump after bilateral traumatic amputations is rare. To the best of our knowledge, there are only a few reports of crossover lower limb replantation in the literature. Case presentation We treated a 37-year-old Chinese woman with bilateral lower limb crush injuries sustained in a traffic accident. Her lower limb injuries were at different anatomic levels. We performed emergency bilateral amputations followed by crossover replantation. Five years later, the woman had recovered well, and had perfect movement and stability in her replanted leg. After reviewing the literature, we thought that presentation of our patient’s case might provide useful information for clinicians. Conclusions Crossover replantation should be considered when evaluating a patient with bilateral lower limb injuries, thus allowing the patient to touch the ground and stand using their own foot.

Analysis of bacterial and fungal community structure in replant ...

African Journals Online (AJOL)

High quality DNA is the basis of analyzing bacterial and fungal community structure in replant strawberry rhizosphere soil with the method of denaturing gradient gel electrophoresis (DGGE). DNA of soil microorganisms was extracted from the rhizosphere soil of strawberries planted in different replanted years (0, two, ...

Tetanus following replantation of an amputated finger: a case report.

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Hayashida, Kenji; Murakami, Chikako; Fujioka, Masaki

2012-10-08

Tetanus is an infectious disease caused by tetanus toxin produced by Clostridium tetani and induces severe neurological manifestations. We treated a patient who developed tetanus during hospitalization for replantation of an amputated finger. To the best of our knowledge, this is the first published case report of such an entity. A 49-year-old Japanese man had an amputation of his right middle finger at the distal interphalangeal joint region in an accident at work. His middle finger was successfully replanted, but his fingertip was partially necrotized because of crushing and so additional reconstruction with a reverse digital arterial flap was performed 15 days after the injury. Tetanus developed 21 days after replantation of the middle finger, but symptoms remitted via rapid diagnosis and treatment. In replantation after finger trauma with exposure of nerve and blood vessel bundles, concern over injuring nerves and blood vessels may prevent irrigation and debridement from being performed sufficiently; these treatments may have been insufficiently performed in this patient. It is likely that the replanted middle finger partially adhered, and Clostridium tetani colonized the partially necrotized region. Even when there is only limited soil contamination, administration of tetanus toxoid and anti-tetanus immunoglobulin is necessary when the fingers are injured outdoors and the finger nerves and blood vessels are exposed. The drugs should be administered just after replantation if the finger has been amputated. However, if clinicians pay attention to the possibility of tetanus development, treatment can be rapidly initiated.

Ultrastructural study of tissues surrounding replanted teeth and dental implants.

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Shioya, Kazuhiro; Sawada, Takashi; Miake, Yasuo; Inoue, Sadayuki; Yanagisawa, Takaaki

2009-03-01

The aim of this study was to describe the ultrastructure of the dentogingival border at replanted teeth and implants. Wistar rats (8 weeks old) were divided into groups for replantation and implantation experiments. In the former, the upper right first molars were extracted and then immediately replanted. In the latter, pure titanium implants were used. All tissues were fixed, demineralized and embedded in epoxy resin for ultrastructural observations. One week after replantation, the junctional epithelium was lost, and the oral sulcular epithelium covered the enamel surface. The amount of the epithelium increased in 2 weeks, and resembled the junctional epithelium, and the internal basal lamina and hemidesmosomes were formed in 4 weeks. One week after implantation, peri-implant epithelium was formed, and in 2 and 4 weeks, this epithelium with aggregated connective tissue cells were observed. In 8 weeks, the peri-implant epithelium receded, and aligned special cells with surrounding elongated fibroblasts and bundles of collagen fibers appeared to seal the implant interface. In replantation of the tooth, the internal basal lamina remained at the surface of the enamel of the replanted tooth, which is likely to be related to regeneration of the junctional epithelium and the attachment apparatus at the epithelium-tooth interface. Following implantation, a layer of cells with characteristics of connective tissue cells, but no junctional epithelium and attachment apparatus, was formed to seal the site of the implant.

Reconstruction of circulation in the fingertip without vein repair in zone I replantation.

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Zhang, Xu; Wen, Sumin; Wang, Baoshi; Wang, Qi; Li, Chenglin; Zhu, Hongwei

2008-11-01

In fingertip replantation, adequate venous drainage is important for success. As the level of amputation becomes more distal, anastomosis of veins becomes more technically difficult. External bleeding is a common solution to venous congestion, but the process is burdensome because of duration of bleeding for 3 or more days after surgery. We present a new technique for reconstructing circulation without vein anastomosis in zone I replantation and analyze the outcomes of this technique in terms of eliminating external bleeding and of a high survival rate of the replanted digits. Between 1997 and 2007, we performed 120 replantations in 112 patients (83 male and 29 female; mean age, 33 years; range, 3-54 years). All were zone I amputations, based on the Tamai classification. We surgically repaired both proper digital arteries, excluded the vein, and then ligated 1 of the arteries. Using this technique, circulation was restored. Included in the outcome evaluation were 91 digits in the 87 patients (mean age, 35 years; range, 14-54) who returned for outcome assessments 12 months after surgery. Of 120 digits replanted, 115 digits survived, corresponding to an overall success rate of 96%. No patients received alternative means to alleviate venous congestion, such as leeches or other means of external bleeding. Nearly all of the 87 patients (91 digits) were satisfied with the results of the replantations. Our technique reconstructs circulation without vein anastomosis in zone I replantation. This alternative to venous congestion involves a simple surgical procedure and straightforward postoperative care. Follow-up assessments of a series of 120 replantations show that the majority of zone I replantations led to satisfactory function. We therefore propose this technique as an effective method for zone I replantation. Therapeutic IV.

A novel technique for distal fingertip replantation: Polypropylene suture guided interpositional vein graft.

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Dadaci, Mehmet; Ince, Bilsev; Altuntas, Zeynep; Bitik, Ozan; Uzun, Hakan; Bilgen, Fatma

2015-05-04

Despite current advances in microsurgery, fingertip replantation is still controversial, mainly due to its difficulty and cost. The purpose of this study is to describe a new technique of interposition vein graft guided by polypropylene suture in distal fingertip replantation. A total of eight consecutive Tamai zone 1 fingertip replantations performed by the same author were included. All replantations were performed using interposition vein graft guided by polypropylene suture. This technique involved a vein graft of ∼ 2 cm, with appropriate calibration, obtained from the volar part of the forearm and a 2-0 polyprolene suture passed through the interposition vein graft. Then, a polypropylene suture guide carrying the vein graft was inserted into the artery. The anastomosis was easily performed with the aid of 10-0 or 11-0 nylon in a bloodless medium and without encountering the posterior wall problem. Average surgery time was 2.5 hours (range = 2-3 hours). Among eight Tamai zone 1 replantations, six were successful (75%). There were two replantations lost because of arterial failure. This technique may ease fingertip replantations and increase the success rate for Tamai zone 1 injuries.

Fingertip replantation in children.

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Dautel, G

2000-11-01

Despite common unfavorable mechanisms, fingertip replantation is a rewarding procedure in children. Cosmetic final results are usually better than those obtained by local or pedicled flaps. The success rate and the sensory reinnervation are also better than what can be expected in adult patients.

Tetanus following replantation of an amputated finger: a case report

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Hayashida Kenji

2012-10-01

Full Text Available Abstract Introduction Tetanus is an infectious disease caused by tetanus toxin produced by Clostridium tetani and induces severe neurological manifestations. We treated a patient who developed tetanus during hospitalization for replantation of an amputated finger. To the best of our knowledge, this is the first published case report of such an entity. Case presentation A 49-year-old Japanese man had an amputation of his right middle finger at the distal interphalangeal joint region in an accident at work. His middle finger was successfully replanted, but his fingertip was partially necrotized because of crushing and so additional reconstruction with a reverse digital arterial flap was performed 15 days after the injury. Tetanus developed 21 days after replantation of the middle finger, but symptoms remitted via rapid diagnosis and treatment. Conclusions In replantation after finger trauma with exposure of nerve and blood vessel bundles, concern over injuring nerves and blood vessels may prevent irrigation and debridement from being performed sufficiently; these treatments may have been insufficiently performed in this patient. It is likely that the replanted middle finger partially adhered, and Clostridium tetani colonized the partially necrotized region. Even when there is only limited soil contamination, administration of tetanus toxoid and anti-tetanus immunoglobulin is necessary when the fingers are injured outdoors and the finger nerves and blood vessels are exposed. The drugs should be administered just after replantation if the finger has been amputated. However, if clinicians pay attention to the possibility of tetanus development, treatment can be rapidly initiated.

Distal finger replantation.

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Scheker, Luis R; Becker, Giles W

2011-03-01

Reconstruction of the fingertip distal to the flexor tendon insertion by replantation remains controversial and technically challenging, but the anatomy of the fingertip has been well described and provides help in surgical planning. The open-book surgical technique is described with potential complications and is illustrated with clinical cases. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Sensory outcome of fingertip replantations without nerve repair.

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Ozcelik, Ismail Bulent; Tuncer, Serdar; Purisa, Husrev; Sezer, Ilker; Mersa, Berkan; Kabakas, Fatih; Celikdelen, Pinar

2008-01-01

The sensory recovery outcomes of fingertip replantations without nerve repair were retrospectively studied. Between 2000 and 2006, 112 fingertip replantations with only arterial repair were carried out in 98 patients. About 76 of the replants survived totally, with a success rate of 67.8%. Evaluation of sensory recovery was possible in 31 patients (38 replantations). Sensory evaluation was made with Semmes-Weinstein, static and dynamic two-point discrimination, and vibration sense tests. Fingertip atrophy, nail deformities, and return to work were also evaluated. According to the Semmes-Weinstein test, 29.0% (11/38) of the fingers had normal sense, 60.5% (23/38) had diminished light touch, 7.9% (3/38) had diminished protective sensation, and 2.6% (1/38) had loss of protective sensation. Mean static and dynamic two-point discriminations were 7.2 mm (3-11 mm), and 4.60 mm (3-6 mm), respectively. Vibratory testing revealed increased vibration in 42.1% of the fingers, decreased vibration in 36.8%, and equal vibration when compared with the non-injured fingers in 21.1%. Atrophy was present in 14 (36.8%) fingers and negatively affected the results. Nail deformities, cold intolerance, return to work, and the effect of sensory education were investigated. Comparison of crush and clean cut injuries did not yield any significant difference in any of the parameters. Patients who received sensory education had significantly better results in sensory testing. The results were classified as excellent, good, and poor based on results of two-point discrimination tests. The outcome was excellent in 18 fingers and good in 20 fingers. Overall, satisfactory sensory recovery was achieved in fingertip replantations without nerve repair. (c) 2008 Wiley-Liss, Inc.

Effects of non-surgical factors on digital replantation survival rate: a meta-analysis.

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Ma, Z; Guo, F; Qi, J; Xiang, W; Zhang, J

2016-02-01

This study aimed to evaluate the risk factors affecting survival rate of digital replantation by a meta-analysis. A computer retrieval of MEDLINE, OVID, EMBASE, and CNKI databases was conducted to identify citations for digital replantation with digit or finger or thumb or digital or fingertip and replantation as keywords. RevMan 5.2 software was used to calculate the pooled odds ratios. In total, there were 4678 amputated digits in 2641 patients. Gender and ischemia time had no significant influence on the survival rate of amputation replantation (P > 0.05). Age, injured hand, injury type, zone, and the method of preservation the amputated digit significantly influence the survival rate of digital replantation (P < 0.05). Children, right hand, crush, or avulsion and little finger are the risk factors that adversely affect the outcome. Level 5*. © The Author(s) 2015.

How to Plant Apple Trees to Reduce Replant Disease in Apple Orchard: A Study on the Phenolic Acid of the Replanted Apple Orchard.

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Chengmiao Yin

Full Text Available Apple replant disease (ARD is an important problem in the production of apple. The phenolic acid is one of the causes of ARD. How phenolic acid affects the ARD was not well known. In this study, we analyzed the type, concentration and annual dynamic variation of phenolic acid in soil from three replanted apple orchards using an accelerated solvent extraction system with high performance liquid chromatography (ASE-HPLC. We found that the type and concentration of phenolic acid were significantly differed among different seasons, different sampling positions and different soil layers. Major types of phenolic acid in three replanted apple orchards were phlorizin, benzoic acid and vanillic aldehyde. The concentration of phenolic acid was highest in the soil of the previous tree holes and it was increased from the spring to autumn. Moreover, phenolic acid was primarily distributed in 30-60 cm soil layer in the autumn, while it was most abundant in 0-30 cm soil layer in the spring. Our results suggest that phlorizin, benzoic acid and vanillic aldehyde may be the key phenolic acid that brought about ARD in the replanted apple orchard.

Evaluation of sensory function and recovery after replantation of fingertips at Zone I in children.

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Zhu, Zhao-Wei; Zou, Xiao-Yan; Huang, Yong-Jun; Liu, Jiang-Hui; Huang, Xi-Jun; He, Bo; Wang, Zeng-Tao

2017-11-01

Sensory function is the most significant criterion when evaluating the prognosis of replanted fingers. Current clinical research has focused on surgical techniques and indications for finger replantation; however, few studies have focused on recovery of finger sensory function after replantation. This study retrospectively assessed data of eight patients who had undergone nine Zone I replantations of the fingertips in the First Affiliated Hospital of Sun Yat-sen University of China from July 2014 to January 2016. Variations in the extent of damage, with the residual vessels or nerves in some fingers being too short or even missing, prevented tension-free suture repair in some patients. Thus, repair of four of the nine fingertips included arteriovenous anastomosis, the remaining five undergoing arterial anastomosis during replantation of the amputated fingers. Three patients underwent nerve repair, whereas the remaining six cases did not. Fingertip replantations were successful in all eight patients. Compared with the patients without vascular anastomosis, no obvious atrophy was visible in the fingertips of patients who did undergo vascular anastomosis during replantation and their sensory function did recover. Fingertip replantation provides good sensory function and cosmetic outcomes when good artery and vein anastomoses have been created, even when digital nerves have not been repaired.

Evaluation of sensory function and recovery after replantation of fingertips at Zone I in children

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Zhao-wei Zhu

2017-01-01

Full Text Available Sensory function is the most significant criterion when evaluating the prognosis of replanted fingers. Current clinical research has focused on surgical techniques and indications for finger replantation; however, few studies have focused on recovery of finger sensory function after replantation. This study retrospectively assessed data of eight patients who had undergone nine Zone I replantations of the fingertips in the First Affiliated Hospital of Sun Yat-sen University of China from July 2014 to January 2016. Variations in the extent of damage, with the residual vessels or nerves in some fingers being too short or even missing, prevented tension-free suture repair in some patients. Thus, repair of four of the nine fingertips included arteriovenous anastomosis, the remaining five undergoing arterial anastomosis during replantation of the amputated fingers. Three patients underwent nerve repair, whereas the remaining six cases did not. Fingertip replantations were successful in all eight patients. Compared with the patients without vascular anastomosis, no obvious atrophy was visible in the fingertips of patients who did undergo vascular anastomosis during replantation and their sensory function did recover. Fingertip replantation provides good sensory function and cosmetic outcomes when good artery and vein anastomoses have been created, even when digital nerves have not been repaired.

Microsurgical replantation of a small segment of thumb volar skin.

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Akyürek, Mustafa; Safak, Tunç

2004-06-01

This report presents a case of microsurgical replantation of a volar skin segment of the thumb. In a 24-year-old patient, a heavy object falling over the dominant thumb resulted in a crush-avulsion injury of a pure skin segment measuring 4 x 2 cm. Examination revealed that the distal fingertip as well as the bone-tendon structures remained intact. Exploration demonstrated that both neurovascular bundles were included in the avulsed skin segment. Microsurgical replantation was achieved successfully, repairing the radial digital artery at both ends with vein grafts as well as anastomosing a palmar vein. Both digital nerves were coapted proximally and distally. An excellent functional and cosmetic result was accomplished with a good sensory recovery. The authors conclude that microsurgical replantation should be attempted in cases of more proximal pure skin avulsions, even if the injury spares distal fingertip tissue or bone-tendon units. In such cases, replantation is superior to any other method of reconstruction. Liberal use of vein grafts is crucial to achieve success.

Evaluation of sensory function and recovery after replantation of fingertips at Zone I in children

OpenAIRE

Zhu, Zhao-wei; Zou, Xiao-yan; Huang, Yong-jun; Liu, Jiang-hui; Huang, Xi-jun; He, Bo; Wang, Zeng-tao

2017-01-01

Sensory function is the most significant criterion when evaluating the prognosis of replanted fingers. Current clinical research has focused on surgical techniques and indications for finger replantation; however, few studies have focused on recovery of finger sensory function after replantation. This study retrospectively assessed data of eight patients who had undergone nine Zone I replantations of the fingertips in the First Affiliated Hospital of Sun Yat-sen University of China from July ...

Allelochemicals and activities in a replanted Chinese fir (Cunninghamia lanceolata (Lamb.) Hook) tree ecosystem.

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Kong, C H; Chen, L C; Xu, X H; Wang, P; Wang, S L

2008-12-24

Autotoxicity is a major reason for replant problems in managed tree ecosystems. Studies have related phenolics-based allelochemicals to autotoxicity. We selected a 20-year-old replanted Chinese fir [Cunninghamia lancealata (Lamb.) Hook] tree ecosystem to isolate, identify, determine the biological activity of, and quantify soil phytotoxins. Eight common phenolics (coumarin, vanillin, isovanillin, and p-hydroxybenzoic, vanillic, benzoic, cinnamic, and ferulic acids), friedelin, and a novel cyclic dipeptide (6-hydroxy-1,3-dimethyl-8-nonadecyl-[1,4]-diazocane-2,5-diketone) were obtained by using the bioassay-guided isolation technique from toxic soil of the replanted Chinese fir tree ecosystem. Chemical structures were determined by spectroscopic means, including 2D-NMR (COSY, HMQC, HMBC, and NOESY) experiments. High concentrations of soil phenolics and friedelin were observed in the natural evergreen broadleaf forest (CK) rather than in the Chinese fir tree ecosystem. The phenolics and friedelin were not phytotoxic to Chinese fir trees. However, the cyclic dipeptide inhibited Chinese fir growth at soil concentrations determined in the replanted Chinese fir tree ecosystem. There was a significantly higher soil concentration of cyclic dipeptide in the replanted Chinese fir tree ecosystem than in a fresh Chinese fir tree ecosystem. The results suggest that phenolics and friedelin are not key allelochemicals since they are weakly phytotoxic and are detected in low concentrations in the replanted Chinese fir tree ecosystem, while cyclic dipeptide is a highly active allelochemical with a phytotoxic effect that limits offspring growth in the replanted Chinese fir tree ecosystem. The discovery of cyclic dipeptide, as well as a further understanding of its potential action mechanism in the replanted Chinese fir tree ecosystem, may contribute to solving the replant problems in managed tree ecosystems.

The use of arteriovenous anastomosis for venous drainage during Tamai zone I fingertip replantation.

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Wu, Fei; Shen, Xiaofang; Eberlin, Kyle R; Sun, Zhibo; Zhou, Xiao; Xue, Mingyu

2018-03-27

The purpose of this study was to evaluate outcomes for patients sustaining a distal fingertip amputation who underwent replantation witharteriovenous anastomosis for venous drainage over a one year period at our institution. This technique has been utilized when insufficient veins are identified in the amputated part for standard veno-venous anastomosis. A retrospective study was performed on patients presenting from 2013 to 2014. Guillotine, crush, and avulsion/degloving injuries were included if they underwent fingertip (Tamai Zone I) replantation with arterial anastomosis for vascular inflow and arteriovenous anastomosis for venous drainage. The cases were further classified as Ishikawa subzone I and subzone II. Arteriovenous anastomosis for venous drainage during replantation was used in 45 digits in 35 patients. 41 of the 45 digits underwent successful replantation using this technique (91%). The mean active ROM in the DIP joint of the fingers and in the IP joint of thumbs was 65° and 57°, respectively. Sensory evaluation demonstrated a mean of 6.9 mm s2PD in digits where the digital nerves could be repaired. 11 replanted digits without nerve repair regained some sensory recovery with a mean of 9.6 mm s2PD. 91% of patients were highly satisfied with the appearance of the replanted digits based on Tamai criteria. Arteriovenous anastomosis for venous outflow should be considered during zone I fingertip replantation if sufficient veins are not identified in the amputated part. This technique may allow for more routine and successful distal replantation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Functional and cosmetic results of fingertip replantation: anastomosing only the digital artery.

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Matsuzaki, Hironori; Yoshizu, Takae; Maki, Yutaka; Tsubokawa, Naoto

2004-10-01

In fingertip amputations, conventional stump plasty provides an almost acceptable functional result. However, replanting fingertips can preserve the nail and minimize loss of function. We investigated the functional and cosmetic results of fingertip replantation at the terminal branch of the digital artery. Outcomes were nailbed width and distal-segment length; sensory recovery; and range of motion (ROM) of thumb-interphalangeal (IP) or finger-distal interphalangeal (DIP) joints, and total active motion (TAM) of the replanted finger. Of 15 fingertips replanted after only arterial anastomosis, 13 were successful, and 12 were studied. After a median of 1.3 years, mean nailbed widths and distal-segment lengths were 95.4% and 93.0%, respectively, of the contralateral finger. Average TAM and ROM of the thumb-IP or finger-DIP joints were 92.0% and 83.0% of normal, respectively. Semmes-Weinstein results were blue (3.22 to 3.61) in 4 fingers and purple (3.84 to 4.31) in 8; the mean result from the 2-point discrimination test was 5.9 mm (range, 3 to 11 mm). Thus, amputated fingertips should be aggressively replanted.

[Replantation of amputated penis in Chinese men: a meta-analysis].

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Li, Gui-Zhong; Man, Li-Bo; He, Feng; Huang, Guang-Lin

2013-08-01

To evaluate the methods for the replantation of the amputated penis in Chinese men. We performed a meta-analysis on the domestic literature relating replantation of the amputated penis, particularly its successful methods published from 1964 to January 2012. We identified 109 reports on 111 cases of replantation of the amputated penis that met the inclusion criteria, including 103 adults and 8 children. The mean age, warm ischemia time and total ischemia time were 29 +/- 11 years (range 2 - 56 years), 5.2 +/- 5.7 hours (range 0 - 38 hours) and 6.3 +/- 5.7 hours (range 1 - 38 hours). Fifty-three of the cases were treated by microsurgery and 44 by non-microsurgery. Complications occurred in 81 (73%) of the cases, including ED in 14 cases, urethral stricture in 16, urinary fistula in 8, skin necrosis in 58 and skin sensory abnormality in 31. The incidences of ED, urethral stricture and urinary fistula exhibited significant differences between the microsurgery and non-microsurgery groups of the partial amputation patients (P penis and reduction of complications, and therefore can be regarded as a "standard" method for penile replantation in China.

Tractor-mounted, GPS-based spot fumigation system manages Prunus replant disease

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Our research goal was to use recent advances in global positioning system (GPS) and computer technology to apply just the right amount of fumigant where it is most needed (i.e., in a small target treatment zone in and around each tree replanting site) to control Prunus replant disease (PRD). We deve...

Nonarterialized Venous Replantation of Part of Amputated Thumb—A Case Report and Review of the Literature

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Kalimuthu, Ramasamy

2006-01-01

Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, thousands of severed digits and body parts have been successfully salvaged. Restoration of anatomic form and function are the goals of replantation after traumatic tissue amputation. Regardless of anatomic location, methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. Numerous techniques to maximize tissue survival after revascularization have been described, including “pocket procedures” to salvage composite grafts, interposition vein grafts, and medicinal leeches to name a few. Artery-to-venous anastomoses have been performed with successful “arterialization” of the distal venous system in fingertip replantation. Although there is documented survival of free venous cutaneous flaps, to our knowledge this is the first report of a replanted composite body part (bone, tendon, soft tissues, and skin) utilizing exclusively multiple, microvascular, nonarterialized venous–venous anastomoses. We present a patient with an isolated band saw fillet amputation to the back of the thumb at the metacarpal–phalangeal joint region, resulting in a composite graft composed of bone, tendon, soft tissue, and skin. The hand wound provided no viable regional arterial inflow source, but there were multiple good caliber superficial veins present. The amputated tissues were replanted and revascularized by using only venous blood flow. The replanted part survival was 100% with excellent function of the digit. We conclude that a hand composite body part involving bone, tendon, soft tissues, and skin can survive replantation with a strict venous blood supply if sufficient good caliber, microvascular, venous–venous anastomoses are performed, granted that arterial inflow options are not available. This is an isolated case, yet introduces a new way of thinking regarding tissue replantation. PMID:18780032

Assessment of survival rates compared according to the Tamai and Yamano classifications in fingertip replantations.

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Dadaci, Mehmet; Ince, Bilsev; Altuntas, Zeynep; Bitik, Ozan; Kamburoglu, Haldun Onuralp; Uzun, Hakan

2016-01-01

The fingertip is the most frequently injured and amputated segment of the hand. There are controversies about defining clear indications for microsurgical replantation. Many classification systems have been proposed to solve this problem. No previous study has simultaneously correlated different classification systems with replant survival rate. The aim of the study is to compare the outcomes of fingertip replantations according to Tamai and Yamano classifications. 34 consecutive patients who underwent fingertip replantation between 2007 and 2014 were retrospectively reviewed with respect to the Tamai and Yamano classifications. The medical charts from record room were reviewed. The mean age of the patients was 36.2 years. There were 30 men and 4 women. All the injuries were complete amputations. Of the 34 fingertip amputations, 19 were in Tamai zone 2 and 15 were in Tamai zone 1. When all the amputations were grouped in reference to the Yamano classification, 6 were type 1 guillotine, 8 were type 2 crush and 20 were type 3 crush avulsions. Of the 34 fingertips, 26 (76.4%) survived. Ten (66.6%) of 15 digits replanted in Tamai zone 1 and 16 (84.2%) of 19 digits replanted in Tamai zone 2 survived. There were no replantation failures in Yamano type 1 injuries (100%) and only two failed in Yamano type 2 (75%). Replantation was successful in 14 of 20 Yamano type 3 injuries, but six failed (70%). The percentage of success rates was the least in the hybridized groups of Tamai zone 1-Yamano type 2 and Tamai zone 1-Yamano type 3. Although clinically distinct, the survival rates between the groups were not statistically significantly different. The level and mechanism of injury play a decisive role in the success of fingertip replantation. Success rate increases in proximal fingertip amputations without crush injury.

Assessment of survival rates compared according to the Tamai and Yamano classifications in fingertip replantations

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Mehmet Dadaci

2016-01-01

Full Text Available Background: The fingertip is the most frequently injured and amputated segment of the hand. There are controversies about defining clear indications for microsurgical replantation. Many classification systems have been proposed to solve this problem. No previous study has simultaneously correlated different classification systems with replant survival rate. The aim of the study is to compare the outcomes of fingertip replantations according to Tamai and Yamano classifications. Materials and Methods: 34 consecutive patients who underwent fingertip replantation between 2007 and 2014 were retrospectively reviewed with respect to the Tamai and Yamano classifications. The medical charts from record room were reviewed. The mean age of the patients was 36.2 years. There were 30 men and 4 women. All the injuries were complete amputations. Of the 34 fingertip amputations, 19 were in Tamai zone 2 and 15 were in Tamai zone 1. When all the amputations were grouped in reference to the Yamano classification, 6 were type 1 guillotine, 8 were type 2 crush and 20 were type 3 crush avulsions. Results: Of the 34 fingertips, 26 (76.4% survived. Ten (66.6% of 15 digits replanted in Tamai zone 1 and 16 (84.2% of 19 digits replanted in Tamai zone 2 survived. There were no replantation failures in Yamano type 1 injuries (100% and only two failed in Yamano type 2 (75%. Replantation was successful in 14 of 20 Yamano type 3 injuries, but six failed (70%. The percentage of success rates was the least in the hybridized groups of Tamai zone 1-Yamano type 2 and Tamai zone 1-Yamano type 3. Although clinically distinct, the survival rates between the groups were not statistically significantly different. Conclusions: The level and mechanism of injury play a decisive role in the success of fingertip replantation. Success rate increases in proximal fingertip amputations without crush injury.

Fingertip replantation (zone I) without venous anastomosis: clinical experience and outcome analysis.

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Huan, An-Shi; Regmi, Subhash; Gu, Jia-Xiang; Liu, Hong-Jun; Zhang, Wen-Zhong

2016-01-01

The purpose of this study was to report our experience of fingertip replantation without venous anastomosis using alternate method to counter post-operative venous congestion. 30 Patients (18 men and 12 women) with 30 fingertip amputations (Tamai zone I) were treated with artery-only anastomosis fingertip replantation between March 2010 and July 2014. Postoperative venous outflow was maintained by allowing bleeding through wound gaps combined with topical (12500 u :250mlNS) and systemic (4000 IU SC once daily) heparin. The outcomes of replantation were evaluated using standard evaluating systems. The average duration of hospital stay was 10 days (range 7-14 days). Twenty-eight (93 %) replanted fingertips survived. Five replanted fingertip experienced postoperative vascular crisis. The estimated post-operative blood loss was about 200-450 ml (mean, 292 ml). Follow-up period ranged from 12 to 24 months (average, 18 months). At final follow-up examinations, the average value of static two point discrimination test was 5.6 mm (range 3-9 mm) and Semmes-Weinstein monofilament test was 3.35 g (range 2.83-4.56 g). The mean range of motion of distal interphalangeal joint was 65.2° (range 0-90°) and all patients returned to their work within 7-18 weeks (average, 11 weeks). Artery-only fingertip replantation can provide satisfactory cosmetic and functional results. Adequate venous outflow can be obtained by allowing minimal external bleeding through wound gaps combined with topical and systemic heparin.

Fingertip replantation at or distal to the nail base: use of the technique of artery-only anastomosis.

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Akyürek, M; Safak, T; Keçik, A

2001-06-01

The authors describe the functional and aesthetic results of microsurgical replantation of 21 fingertip amputations at or distal to the nail base-namely, zone I amputations. There were 15 male and 6 female patients, with an average age of 26 years (age range, 1-41 years). Replantations were performed using the anastomosis of the artery-only technique, with neither vein nor nerve repair. Venous drainage was provided by an external bleeding method with a fish-mouth incision in "distal" zone I amputations for approximately 7 days, and by the use of leeches in more "proximal" zone I amputations for 10 to 12 days. Results indicated that the overall survival rate was 76%, with 16 of 21 digits surviving. Sensory evaluation at an average follow-up of 12 months (range, 6-18 months) revealed an average static two-point discrimination of 6.1 mm (range, 2.0-8.0 mm). Considering the unfavorable results and the donor site morbidity of various fingertip reconstructions, a microsurgical fingertip replantation should always be considered except in extremely distal, clean-cut, pediatric cases, in which case a composite graft is a possibility. The results of this series indicate that an amputated fingertip in zone I can be salvaged successfully by microvascular anastomosis of the artery only, with a nonmicrosurgical method of venous drainage. Furthermore, acceptable sensory recovery can be expected without any nerve coaptation.

Treatment of Necrotic Calcified Tooth Using Intentional Replantation Procedure

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Nima Moradi Majd

2014-01-01

Full Text Available Introduction. If the teeth are impacted by a chronic irritant, the pulp space possibly will undergo calcific changes that may impede access opening during root canal treatment. In such cases that conventional endodontic treatment is impossible or impractical, intentional replantation may be considered as a last solution to preserve the tooth. Methods. After failing to perform conventional root canal therapy for a necrotic calcified right mandibular second premolar, the tooth was gently extracted. The root apex was resected and the root end cavity was prepared and filled with calcium enriched mixture (CEM cement. Then, the extracted tooth was replanted in its original position. Results. After a year the tooth was asymptomatic, and the size of periapical radiolucency was remarkably reduced and no clinical sign of ankylosis was observed. Conclusion. Intentional replantation of the necrotic calcified teeth could be considered as an alternative to teeth extraction, especially for the single-rooted teeth and when nonsurgical and surgical endodontic procedures seem impossible.

Intentional replantation: A viable alternative for management of palatogingival groove

OpenAIRE

Vijay Kumar; Ajay Logani; Naseem Shah

2013-01-01

Radicular groove is an anatomical malformation that often leads to combined endodontic-periodontic lesions. Treatment of complex groove presents a clinical challenge to the operator. A case of type III palatogingival groove is successfully treated with intentional replantation. With the understanding of the procedure and strict adherence to guidelines improves, practitioners can use intentional replantation as an easy and cost-effective alternative for the management of radicular groove. The ...

How to Plant Apple Trees to Reduce Replant Disease in Apple Orchard: A Study on the Phenolic Acid of the Replanted Apple Orchard

OpenAIRE

Yin, Chengmiao; Xiang, Li; Wang, Gongshuai; Wang, Yanfang; Shen, Xiang; Chen, Xuesen; Mao, Zhiquan

2016-01-01

Apple replant disease (ARD) is an important problem in the production of apple. The phenolic acid is one of the causes of ARD. How phenolic acid affects the ARD was not well known. In this study, we analyzed the type, concentration and annual dynamic variation of phenolic acid in soil from three replanted apple orchards using an accelerated solvent extraction system with high performance liquid chromatography (ASE-HPLC). We found that the type and concentration of phenolic acid were significa...

A retrospective study of the intentionally replanted mandibular second molars with C-shaped root canal configurations

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Objectives

2011-01-01

Full Text Available Objectives The purpose of this retrospective study was to evaluate the success rate of intentionally replanted mandibular second molar with C-shaped canal configurations and to access the impact of preoperative periapical lesion on the success of intentional replantation procedure. Materials and Methods This retrospective chart review study evaluated 52 intentionally replanted mandibular second molar teeth treated at Seoul National University Dental Hospital Department of Conservative Dentistry from January 2005 to December 2007. Seventeen teeth were lost for the follow-up, and another 6 teeth did not meet inclusion criteria of C-shaped root canal configurations. Healing outcome such as success, uncertain healing, and failure after follow-up was evaluated by clinical criteria and radiographs. Results The overall success rate was 72.4% for the 29 intentionally replanted C-shaped mandibular second molars. The success rate of replanted teeth with preoperative periapical lesions was similar to that of replanted teeth which have no periapical lesions. Conclusions Therefore, root canal treatment failure on C-shaped mandibular second molar can be predictably treated by intentional replantation regardless of the presence of periapical lesion.

The Effect of Re-Planting Trees on Soil Microbial Communities in a Wildfire-Induced Subalpine Grassland

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Ed-Haun Chang

2017-10-01

Full Text Available Wildfire often causes tremendous changes in ecosystems, particularly in subalpine and alpine areas, which are vulnerable due to severe climate conditions such as cold temperature and strong wind. This study aimed to clarify the effect of tree re-planting on ecosystem services such as the soil microbial community after several decades. We compared the re-planted forest and grassland with the mature forest as a reference in terms of soil microbial biomass C and N (Cmic and Nmic, enzyme activities, phospholipid fatty acids (PLFA composition, and denaturing gradient gel electrophoresis (DGGE. The Cmic and Nmic did not differ among the grassland, re-planted forest and mature forest soil; however, ratios of Cmic/Corg and Nmic/Ntot decreased from the grassland to re-planted forest and mature forest soil. The total PLFAs and those attributed to bacteria and Gram-positive and Gram-negative bacteria did not differ between the re-planted forest and grassland soil. Principle component analysis of the PLFA content separated the grassland from re-planted forest and mature forest soil. Similarly, DGGE analysis revealed changes in both bacterial and fungal community structures with changes in vegetation. Our results suggest that the microbial community structure changes with the re-planting of trees after a fire event in this subalpine area. Recovery of the soil microbial community to the original state in a fire-damaged site in a subalpine area may require decades, even under a re-planted forest.

Penile Replantation After Five Hours of Warm Ischemia

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Fernando N. Facio Jr.

2015-05-01

Full Text Available Although a rare occurrence, this event may occur as a result of self-mutilation among individuals with psychiatric disturbances or due to work-related accidents, iatrogenic injuries or the actions of individuals motivated by jealously, rage and feelings of betrayal. In western societies, most penile amputations are the result of self-aggression during a psychotic episode, the treatment of victims involves resuscitation, stabilization and immediate psychiatric support. The amputated tissue must be preserved under hypothermic conditions. Micro-surgery is currently the most widely employed method for penile replantation. This paper describes a successful case of penile replantation following 5 hours of warm ischemia.

Nonmicrosurgical replantation using a subcutaneous pocket for salvage of the amputated fingertip.

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Muneuchi, Gan; Kurokawa, Masato; Igawa, Kazuhiko; Hamamoto, Yusuke; Igawa, Hiroharu H

2005-05-01

The pocket principle suggested by Brent in 1979 is an alternative method for use when microsurgical replantation is not feasible. The application and the amputation level for which the method is available, however, have not been well examined. Between 1999 and 2003 we treated 6 patients (7 fingers) by nonmicrosurgical replantation using a subcutaneous pocket (the Brent technique). All patients had sustained complete fingertip amputations across or proximal to the lunula in digits other than the thumb. In every case the amputation was a crush or avulsion-type injury and microsurgical replantation was not feasible; however, cosmetic symmetry was desired strongly by the patient. Of the 7 fingers only one survived completely but became atrophic after 4 months. One finger developed necrosis involving less than half of the replant but a hooked nail deformity developed. Two fingers developed partial necrosis involving more than half of the replant but both fingers were missing the fingernail and the cosmetic results were not acceptable. Three fingers developed total necrosis. In addition a slight flexion contracture not improved with therapy in the digits was noted in 4 patients. The Brent technique should be performed scrupulously for fingertip amputation across or proximal to the lunula because of the poor survival rate and the possibility of contracture in the digits or other proximal joints.

Saving Natural Teeth: Intentional Replantation-Protocol and Case Series.

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Grzanich, Derek; Rizzo, Gabriella; Silva, Renato Menezes

2017-12-01

Intentional replantation is a reliable and predictable treatment for cases in which nonsurgical endodontic retreatment failed or is impractical and endodontic surgery is hampered because of anatomic limitations. This article presents a protocol for intentional replantation illustrated with some interesting cases. The cases presented here are from patients (average age, 61 years) with no contributing medical history. The cases are molars with previous failed endodontic treatment/retreatment and diagnosed with apical periodontitis. Treatment procedures included atraumatic extractions with minimal manipulations of the periodontal ligament, followed by root-end resection, root-end preparation with ultrasonic tips, root-end fill with bioceramic cement, and rapid tooth replacement into the socket. Granulomatous tissue was gently curetted when applicable. All procedures were performed under the microscope. Intentional replantation with careful case selection may be considered as a last option for preserving hopeless teeth. Atraumatic extraction by using state-of-the-art equipment, instruments, and materials, minimal extra-alveolar time, and maintaining an aseptic technique are key factors for success. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Microvascular transplantation and replantation of the dog submandibular gland.

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Su, Wan Fu; Jen, Yee Min; Chen, Shyi Gen; Nieh, Shin; Wang, Chih-Hung

2006-05-01

Transplantation and replantation of the submandibular gland with microvascular techniques were demonstrated in a previous study, with good gland survival. The application of radiation on the neck bed was attempted to address an actual clinical scenario in this study. Five canine submandibular glands were transplanted using microvascular techniques to the ipsilateral femoral system. Radiotherapy at a dosage level of 3,600 cGy using 600 cGy q.d was delivered to the nasopharyngeal and neck regions 2 weeks after transplantation. The transferred glands were then reintroduced into the original but radiated neck bed. The glands were harvested for histological examination 8 weeks later. Four of five canine submandibular glands can withstand microvascular transplantation and then replantation into a radiated neck bed for at least 8 weeks. However, the salivary function was depleted. The canine submandibular gland can survive the transplantation and replantation for at least 8 weeks in spite of precipitating radiation insult on the neck bed for 3 weeks. Neurorraphy is, however, essential to maintaining the glandular function.

Assessment of survival rates compared according to the Tamai and Yamano classifications in fingertip replantations

OpenAIRE

Mehmet Dadaci; Bilsev Ince; Zeynep Altuntas; Ozan Bitik; Haldun Onuralp Kamburoglu; Hakan Uzun

2016-01-01

Background: The fingertip is the most frequently injured and amputated segment of the hand. There are controversies about defining clear indications for microsurgical replantation. Many classification systems have been proposed to solve this problem. No previous study has simultaneously correlated different classification systems with replant survival rate. The aim of the study is to compare the outcomes of fingertip replantations according to Tamai and Yamano classifications. Materials a...

Treatment of fingertip amputation: comparison of results between microsurgical replantation and pocket principle.

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Yabe, Tetsuji; Tsuda, Tomoyuki; Hirose, Shunsuke; Ozawa, Toshiyuki

2012-05-01

In this article, a comparison of replantation using microsurgical replantation (replantation) and the Brent method and its modification (pocket principle) in the treatment of fingertip amputation is reported. As a classification of amputation level, we used Ishikawa's subzone classification of fingertip amputation, and the cases of amputations only in subzone 2 were included in this study. Between these two groups, there was no statistical difference in survival rate, postoperative atrophy, or postoperative range of motion. In terms of sensory recovery, some records were lost and exact study was difficult. But there was no obvious difference between these cases. In our comparison of microsurgical replantation versus the pocket principle in treatment of subzone 2 fingertip amputation, there was no difference in postoperative results. Each method has pros and cons, and the surgeon should choose which technique to use based on his or her understanding of the characteristics of both methods. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fingertip Replantation Without and With Palmar Venous Anastomosis: Analysis of the Survival Rates and Vein Distribution.

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Aksoy, Alper; Gungor, Melike; Sir, Emin

2017-01-01

The purpose of this study was to compare the results of fingertip replantations without (artery anastomosis only replantations) and with venous anastomosis (replantations in which both arterial and palmar venous anastomoses were performed). Also, distribution of the veins used for anastomosis was analyzed retrospectively. First 53 digits (47 patients) received only arterial anastomosis (group 1). For relieving venous congestion, external bleeding method was used. Last 41 digits (38 patients) received both arterial and palmar venous anastomoses without external bleeding (group 2). There was statistical significance of the survival rate between group 1 [77.3% (41/53)] and group 2 [92.6% (38/41)] (P = 0.039). Venous congestion was encountered at 10 digits in group 1 (all underwent necrosis totally) and at 3 digits in group 2 (both were moderate and could be salvaged partially) (P = 0.094, no statistical significance). There was statistical significance of the mean operation time for single-fingertip replantation between group 1 (80 ± 7.8 minutes) and group 2 (105 ± 14.5 minutes) (P replantations with palmar venous anastomosis have simpler postoperative care and lower drawbacks as compared with artery anastomosis-only replantations.

[Fingertip replantation with anastomosis of palm vein and retaining the nail].

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Wang, Xiang; Zhang, Wei-Kai; Yin, Shao-Meng; Wang, Hai-Bing; He, Tao; Gong, Yong-Qing; Zhu, Guo-Ming; Mao, Gen-Lian; Hu, Ming-Xing; Li, Jian

2013-08-01

To study the replantation methods and clinical results of amputated fingertip. From October 2007 to June 2011, 18 fingers of 13 cases were replanted with anastomosis of palm vein and retaining the nail, including 9 males and 4 females,with an average age of 26 years old ranging from 17 to 45 years old. The time from injury to therapy was from 30 min to 5 h, time of broken finger ischemia was from 1.5 to 7 h. All broken fingers were preservation under normal temperature. All fingers were survived, no vascular crisis happened. All cases were followed up from 3 to 24 months with an average of 14 months. The length and shape of replanted fingers were similar to that of the healthy side. The new nails were smooth, the function was perfect,the sense of pain and touched sensation had been recovered. Their two-piont discriminations ranged from 3 to 6 mm with an average of 5 mm. According to the assessment standard of Chinese Medical Association of Hand Surgery, the results were excellent in 14 cases, good in 3 cases, poor in 1 case. Fingertip replantation with anastomosis of palm vein and retaining the nail is regained satisfactory appearance and function of the digits with a high survival rate.

ANALYSIS OF OIL PALM SUSTAINABLE REPLANTING MODELS, A CASE AT PT. AGROWIYANA , TUNGGUL ULU, TANJUNG JABUNG BARAT, JAMBI

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Solikhin Solikhin

2012-09-01

Full Text Available The oil palm replanting program is becoming of importance for the next decade as some of oil palm plantations are reaching the productivity peak. This research was aimed to select the priority of oil palm replanting strategy with respect to the related factors and impacts to the share holders of PIR Trans and KPPA plantation of PT. AGROWIYANA , and to identify key success indicators of replanting model. A discriptive research methodoligy was carried out using Analytical Hierarchy Process (AHP and Focus Group Discussion (FGD involving multi stakeholders of PT. AGROWIYANA . Results of this research indicated that financial is considered as the most important factor for replanting implemention with the total cutting using standard technology as chosen replanting strategy. The funding scheme through intensive fund rising IDAPERTABUN needs to be well prepared to involve more farmer groups.Keywords: PT. AGROWIYANA , Replanting Strategy

Successful replantation in ten-digit amputation.

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Kantarci, Umit; Cepel, Selim; Buldu, Halil

2010-01-01

Amputations involving ten digits are very rare because of different lengths of the digits. A 34-year-old man working in a printing house presented one hour after guillotine amputation involving all ten digits. Surgery was initiated 80 minutes after admission and took seven hours. Under axillary anesthesia, the operation was performed by two teams each consisting of two microsurgeons and two assistants. Replantation was completed without the use of any skin graft or flap. Fingertip examination showed poor arterial circulation in the second, third, and fourth digits of the left hand after 24 hours of replantation and surgical exploration was performed, during which anastomosis of the ulnar digital artery of the second digit was re-established and a Y-shaped vein graft was placed at the level of the third web to restore revascularization of the third and fourth digits. However, these interventions did not prevent the development of necrosis in the distal segment of the fourth digit which resulted in dry gangrene that required amputation. After 38 months of replantation, radiographic examination showed complete union in all fingers without malunion or damage to the joint surface and about 8 degrees of medial angulation in the proximal phalanx of the fourth digit of the right hand. The patient did not have difficulty in performing daily activities and had a considerably good pinching. Losses of active range of motion of the metacarpophalangeal and interphalangeal joints were within the rage of 10 to 30 degrees in both hands. In the assessment of sensation, static and dynamic two-point discrimination test results were 6.1 mm and 4.0 mm, respectively.

Effect of periodontal ligament removal with gauze prior to delayed replantation in rabbit incisors on rate of replacement resorption.

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Maslamani, Manal; Joseph, Bobby; Gabato, Severino; Andersson, Lars

2018-03-23

Delayed (dry storage > 60 minutes) replantation results in ankylosis and replacement resorption. It has been suggested to remove the non-viable periodontal ligament before replantation to possibly reduce the rate of replacement resorption. However there has been no study on the rate of replacement resorption after such measures. The aim of this study was to investigate if there was any difference in the rate of replacement resorption by either removing the periodontal ligament (PDL) with gauze or not removing PDL in teeth subjected to delayed replantation followed by healing for 2 or 6 weeks. Maxillary central incisors were extracted in 8 rabbits. In the right central incisors, the necrotic PDL was removed by dry gauze over the root surface. In the left eight extracted teeth PDL was left on the root surface. All extracted teeth were left to dry for 60 minutes. Extra-oral root canal treatment was performed before replantation. The rabbits were sacrificed after 2 weeks and 6 weeks respectively. Histologic processing and evaluation was done. In the 2 weeks group, all teeth showed ankylosis. The cementum was intact, and fusion of the bone and root was generally seen without resorption of the root, whereas in the 6 weeks group regardless of whether PDL had been kept or not, ankylosis and osseous replacement of the dentin was seen. There was no evidence of inflammatory infiltrate in the sections examined. Removal of PDL prior to delayed replantation may result in some initial protection of the cementum during the first few weeks. However, over longer times there seems to be neither protection of the dentin from ankylosis and osseous replacement, nor any influence on the rate of replacement resorption. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A retrospective study of functional outcomes after successful replantation versus amputation closure for single fingertip amputations.

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Hattori, Yasunori; Doi, Kazuteru; Ikeda, Keisuke; Estrella, Emmanuel P

2006-01-01

To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations. Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed. Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer. Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump. Therapeutic, Level III.

Intentional replantation: A viable alternative for management of palatogingival groove

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Vijay Kumar

2013-01-01

Full Text Available Radicular groove is an anatomical malformation that often leads to combined endodontic-periodontic lesions. Treatment of complex groove presents a clinical challenge to the operator. A case of type III palatogingival groove is successfully treated with intentional replantation. With the understanding of the procedure and strict adherence to guidelines improves, practitioners can use intentional replantation as an easy and cost-effective alternative for the management of radicular groove. The paper presents a brief review of palatogingival groove and highlights an easy and predictable alternative for its management.

Artery-only fingertip replantations using a controlled nailbed bleeding protocol.

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Erken, H Yener; Takka, Semih; Akmaz, Ibrahim

2013-11-01

We report our experience, treatment protocol, and 2-year follow-up results of 24 fingertip replantations treated using the artery-only technique without vein or nerve repair. We performed a retrospective review of 24 patients who had undergone fingertip replantation at the same center between 2005 and 2011. All patients in this study had complete fingertip amputation at or distal to the distal interphalangeal joint of the fingers or interphalangeal joint of the thumb. Patients with incomplete and complete amputations who had undergone vein and/or nerve repair along with artery repair were excluded. All patients received the same protocol including removal of the nail at the surgery and intravenous heparin 70 U/kg administered at the time of arterial anastomosis. After surgery, the nailbed was mechanically made to bleed with a sterile needle and mechanically scrubbed with a heparin-saline gauze. All patients received the same postoperative medical treatment protocol until physiological outflow was restored. Successful replantation was confirmed with clinical observation. Twenty-one of the 24 fingertip replantations (88%) were successful. The mean length of hospital stay was 7 days (range, 4-9 d). Fifteen of 22 patients required blood transfusion. The average amount of blood transfusion was 1.2 U (range, 0-3 U). This study shows that the described technique and protocol reconstructed circulation without vein anastomosis and with a high success rate. Furthermore, adequate sensory recovery without any nerve repair had occurred by the 2-year follow-up. Therapeutic IV. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Classification of distal fingertip amputation based on the arterial system for replantation.

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Park, Hyun Chul; Bahar-Moni, Ahmed Suparno; Cho, Sang Hyun; Kim, Sang Soo; Park, Hyun Sik; Ahn, Sang Cheon

2013-06-01

During replantation of distal fingertip amputation, identification of the artery is the most important but time consuming procedure. Depending on the damaged arterial structure, we classified distal fingertip amputations into 4 zones, on the basis of three dimensional concept. Zone 1 injury was defined as damage to the proximal central pulp artery; zone 2 injury, damage to the branch of the central pulp artery; zone 3 injury, damage to the distal central pulp artery; and zone 4 injury, no injury to the central pulp artery, injury only to the lateral pulp artery. From April 2010 to June 2011, 27 patients were evaluated. Successful replantation was observed in 21 patients. Skin necrosis occurred in six patients. For distal fingertip amputation classification based on the damaged arterial system is an easy method to find out the appropriate artery which should be anastomosed during replantation.

Fingertip replantation (zone I) without venous anastomosis: clinical experience and outcome analysis

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Huan, An-shi; Regmi, Subhash; Gu, Jia-xiang; Liu, Hong-jun; Zhang, Wen-zhong

2016-01-01

Purpose The purpose of this study was to report our experience of fingertip replantation without venous anastomosis using alternate method to counter post-operative venous congestion. Methods 30 Patients (18 men and 12 women) with 30 fingertip amputations (Tamai zone I) were treated with artery-only anastomosis fingertip replantation between March 2010 and July 2014. Postoperative venous outflow was maintained by allowing bleeding through wound gaps combined with topical (12500u:250mlNS) and ...

[Face replantation using labial artery for revascularization. Case report].

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de la Parra-Márquez, Miguel; Mondragón-González, Sergio; López-Palazuelos, Jaime; Naal-Mendoza, Norberto; Rangel-Flores, Jesús María

2013-01-01

Restoration of the face function and cosmetic appearance after a traumatic complex wound is a challenge for the plastic surgeon. Worldwide, few cases have been reported about face replantation. To present the case of the first partial face replantation reported in the national bibliography, using the labial artery for revascularization. On June 19th 2011, a 7 years old male presented to the emergency room of the Mexican Institute of Social Security at Monterrey, Mexico, 4 hours after a partial face amputation secondary to a dog bite. The amputated segment was composed of 75% of the upper lip, 33% of the lower lip, oral commissure and 75% of the left cheek. The labial coronary artery and vein were anastomosed with 11-0 nylon sutures and the miorraphy of the orbicularis oris, the depressor anguli oris and the depressor labii inferioris with 4-0 vycril sutures. Six months after the surgery, the functional and aesthetic outcomes were excellent with reestablishment of total labial continence and total recovery of articulation of words. amputations of any facial component should be initially managed with replantation. The function and cosmetics are better than any other technique of reconstruction. The labial coronary artery is an excellent choice for revascularization up to 25% of the face (lips and cheek).

Multiple venous anastomoses decrease the need for intensive postoperative management in tamai zone I replantations

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Deok Hyeon Ryu

2018-01-01

Full Text Available Background Venous anastomosis is an important component of digital replantation, but is not always feasible, as some cases require external bleeding to treat venous congestion in the replanted tissue. In the present study, we evaluated the relationship between the number of vein anastomoses and the survival rate of Tamai zone I replantations. Methods A retrospective review was performed of all patients who underwent replantation of a fingertip amputation between 2014 and 2016. Patient charts were reviewed for demographic information, the mechanism of injury, the number of venous anastomoses, and the use of anticoagulation, external bleeding, and/or leeches. The cohort was divided into 3 groups depending on the number of venous anastomoses: no veins (group 1, a single vein (group 2, and 2 or more veins (group 3. Survival rates and external bleeding rates were analyzed across the groups. Results The review identified 143 fingertip replantations among 134 patients. The overall survival rate was 94% (135 of 143. Failures were due equally to venous complications (n=4, 50% and to arterial complications (n=4, 50%. Our analysis did not identify any correlation between the number of veins anastomosed and the replant survival rate (P=0.689. However, a greater number of anastomoses was associated with a significantly lower frequency of external bleeding (P=0.017. Conclusions The number of venous anastomoses was not correlated with the survival rate. However, a greater number of venous anastomoses was associated with a decreased need for external bleeding, corresponding to a significant decrease in the need for postoperative monitoring and leech therapy.

Multiple venous anastomoses decrease the need for intensive postoperative management in tamai zone I replantations

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Ryu, Deok Hyeon; Roh, Si Young; Kim, Jin Soo; Lee, Dong Chul; Lee, Kyung Jin

2018-01-01

Background Venous anastomosis is an important component of digital replantation, but is not always feasible, as some cases require external bleeding to treat venous congestion in the replanted tissue. In the present study, we evaluated the relationship between the number of vein anastomoses and the survival rate of Tamai zone I replantations. Methods A retrospective review was performed of all patients who underwent replantation of a fingertip amputation between 2014 and 2016. Patient charts were reviewed for demographic information, the mechanism of injury, the number of venous anastomoses, and the use of anticoagulation, external bleeding, and/or leeches. The cohort was divided into 3 groups depending on the number of venous anastomoses: no veins (group 1), a single vein (group 2), and 2 or more veins (group 3). Survival rates and external bleeding rates were analyzed across the groups. Results The review identified 143 fingertip replantations among 134 patients. The overall survival rate was 94% (135 of 143). Failures were due equally to venous complications (n=4, 50%) and to arterial complications (n=4, 50%). Our analysis did not identify any correlation between the number of veins anastomosed and the replant survival rate (P=0.689). However, a greater number of anastomoses was associated with a significantly lower frequency of external bleeding (P=0.017). Conclusions The number of venous anastomoses was not correlated with the survival rate. However, a greater number of venous anastomoses was associated with a decreased need for external bleeding, corresponding to a significant decrease in the need for postoperative monitoring and leech therapy. PMID:29076329

Fingertip replantation using a single volar arteriovenous anastomosis and drainage with a transverse tip incision.

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Yabe, T; Muraoka, M; Motomura, H; Ozawa, T

2001-11-01

Four cases of fingertip replantation using a single volar arteriovenous anastomosis and drainage with a transverse tip incision are reported. Because of lack of suitable arteries for anastomosis in the amputated finger, in each case a volar radial vein was anastomosed to the proximal digital artery and external drainage was performed through a transverse tip incision. In 3 cases the replanted fingertip survived completely; partial necrosis occurred in 1 case. Because veins are more superficial and larger than arteries, they are more available for anastomosis. The results indicate that this method is a useful alternative in fingertip replantation.

Healing process of incisor teeth of diabetic rats replanted after storage in milk.

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Ricieri, Camila Benez; Sonoda, Celso Koogi; Aranega, Alessandra Marcondes; Panzarini, Sônia Regina; Poi, Wilson Roberto; Sundefeld, Maria Lúcia Marçal Mazza; Okamoto, Tetuo

2009-06-01

Several local factors that influence the healing process of replanted teeth have been investigated. However, it remains unclear how systemic alterations, such as diabetes mellitus, affect the prognosis of these cases. The purpose of this study was to evaluate the healing process of incisors of non-controlled diabetic rats replanted after storage in bovine long shelf-life (UHT) whole milk. Thirty-two rats were randomly assigned to receive an endovenous injection of either citrate buffer solution (group I - control; n = 16) or streptozotocin dissolved in citrate buffer solution to induce diabetes (group II; n = 16). After confirmation of the diabetic status by analysis of the glycemic levels, the maxillary right incisor of each animal was extracted and immersed in milk for 60 min. The root canals of teeth were then instrumented, and were filled with a calcium hydroxide-based dressing and replanted into their sockets. All animals received systemic antibiotic and were killed by anesthetic overdose 10 and 60 days after replantation. The specimens containing the replanted teeth were removed, fixed, decalcified, and embedded in paraffin. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histologic and histometric analyses. The results showed that the connective tissue adjacent to the root surface was less organized in the diabetic animals than in the control animals in both periods; the root dentin was less severely affected by root resorption in the diabetic rats; there were no significant differences between the control and diabetic groups regarding the occurrence of replacement resorption and inflammatory resorption.

Delayed replantation of rat teeth after use of reconstituted powdered milk as a storage medium.

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dos Santos, Cláudia Letícia Vendrame; Sonoda, Celso Koogi; Poi, Wilson Roberto; Panzarini, Sônia Regina; Sundefeld, Maria Lúcia Marçal Mazza; Negri, Márcia Regina

2009-02-01

Minimal extraoral dry storage period and moist storage for the avulsed tooth are identified as key steps for the treatment protocol of tooth replantation. Among the possible moist storage media, bovine milk has stood out because of its capacity of preserving the integrity of the periodontal ligament (PDL) fibers. This condition has attracted the attention to investigate the use of powdered milk, which is one of the presentation forms of bovine milk, as a feasible storage medium in cases of delayed tooth replantation. The aim of this study was to evaluate the healing process after delayed replantation of rat teeth stored in reconstituted powdered milk and long shelf-life (ultra high temperature) whole milk. Forty maxillary right rat incisors were assigned to four groups (n = 10): group I--the teeth were extracted and immediately replanted into theirs sockets; group II--the teeth were stored for 60 min in 200 ml of freshly reconstituted powdered milk; group III--the teeth were stored for 60 min in 200 ml of long shelf-life whole milk; group IV--the teeth were kept dry for the same time. All procedures were performed at room temperature. Next, the root canals of teeth in groups II, III, and IV were instrumented, filled with a calcium hydroxide-based paste, and replanted into their sockets. All animals received systemic antibiotic therapy and were killed by anesthetic overdose 60 days after replantation. The pieces containing the replanted teeth were removed, fixed, decalcified, and paraffin-embedded. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histomorphological analysis. There was statistically significant difference (P < 0.05) between groups I and IV regarding the presence of replacement resorption and PDL remnants on root surface. The powdered milk and long shelf-life whole milk presented similar results to each other and may be indicated as storage media for avulsed teeth.

Delayed replantation of avulsed teeth

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Adil N

2007-05-01

Full Text Available Dental injuries are very common and their extent has been classified by Ellis. Avulsion of tooth is a grievous injury and ranges from 1-16% among the traumatic injuries, of which maxillary anterior are commonest. Reimplantation of avulsed teeth is a standard procedure. However, it has certain limitations. Most often their management is very challenging. In this case report we are presenting the management of maxillary incisors by replantation after 36 hrs in a 12 year old girl.

Contralateral Abdominal Pocketing in Salvation of Replanted Fingertips with Compromised Circulation

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Hyung-Sup Shim

2014-01-01

Full Text Available Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications.

Contralateral Abdominal Pocketing in Salvation of Replanted Fingertips with Compromised Circulation

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Shim, Hyung-Sup; Kim, Dong-Hwi; Kwon, Ho; Jung, Sung-No

2014-01-01

Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM) before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications. PMID:25379539

Simple replantation protocol to avoid ankylosis in teeth intended for orthodontic treatment

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Yuli Nugraeni

2009-03-01

Full Text Available Background: Dento-alveolar trauma resulted from accidents involving the oral regions mostly affect the upper central incisors. Overjet that is beyond 5 mm and incompetent lip also contribute to increase the risk. Several literatures had already discussed different methods of replantation of avulsed teeth. However, it was not meant for further orthodontic treatment. Purpose: The objective of this review is to propose a simple replantation protocol of avulsed teeth which also prevent from ankylosis. Reviews: Protruded teeth usually need orthodontic treatment; therefore, an appropriate management should be done to avoid the development of ankylosis. Ankylosis of the periodontal ligament (PDL becomes a problem in orthodontic tooth movement in repositioned or replanted teeth. In addition, ankylosed teeth also more susceptible to root resorption. Actually, it was caused by the endodontic treatment. In particular, severely protruded or unoccluded teeth are hypofunctional, therefore have narrow PDL, thus it may facilitate to ankylosis development. Ideal management protocol such as the use of root canal sealer i.e. mineral trioxide aggregate (MTA; the using of Emdogain, and resilient wiring or semi-rigid fixation with brackets has become a solution in avulsed teeth arranged for orthodontic treatment. Nevertheless, the presence of oral surgeon, endodontist and orthodontist in the same time, and also ideal preparations after an accident was difficult to achieve. Conclusion: Considering that reducing the ongoing PDL inflammation with intracanal medicaments and maintaining the functional force during mastication is possible; it is concluded that this simple replantation protocol is likely.

The use of medicinal leeches in fingertip replantation without venous anastomosis - case report of a 4-year-old patient.

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Streit, L; Dvořák, Z; Novák, O; Stiborová, S; Veselý, J

2014-01-01

Replantation of amputated fingertip is a technical challenge to the microsurgeons. The success rate depends directly on the availability and the size of preserved vessels and on the degree of their damage. In distal digital amputations, veins are usually not easily recovered or even absent, and thus high number of replantation procedures fails because of the venous congestion. The use of medicinal leeches is a treatment option for venous congestion of replanted fingers. A case report of a 4-year-old patient after fingertip replantation without venous anastomosis when temporary venous drainage was provided by an application of medicinal leeches is reported together with literature review. We observed an unusually short duration of venous congestion (48 hours) and there was no need of blood transfusion.

The effect of Emdogain and 24% EDTA root conditioning on periodontal healing of replanted dog's teeth.

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Guzmán-Martínez, Nayelli; Silva-Herzog, Flores Daniel; Méndez, González Verónica; Martín-Pérez, Silvia; Cerda-Cristerna, Bernardino Isaac; Cohenca, Nestor

2009-02-01

Controversies still exist as for the regenerative role of enamel matrix derivatives and the need for removal of the periodontal ligament in replanted teeth. The purpose of this study was to evaluate the effect of Emdogain and 24% ethylenediamine tetraacetic acid (EDTA) root conditioning on periodontal healing of replanted dog's teeth. Teeth were extracted, endodontically treated and preconditioned as follows: group 1, Emdogain; group 2, Emdogain + EDTA and group 3, EDTA. Teeth were replanted after 30 min extraoral time, splinted for 15 days and animals sacrificed after 8 weeks of observation. Histological evaluation was performed using hematoxylin/eosin and Masson trichrome and results scored based on previously reported criteria for histological evaluation. Replacement root resorption was histologically diagnosed in all groups except in the negative control. A parametric analysis showed no statistically significant differences between experimental groups. Root preconditioning with Emdogain alone or in combination with 24% EDTA showed no evidence of regeneration of collagen fibers and consequently did not prevent the development of replacement root resorption on replanted dog's teeth.

Lateral Nail Fold Incision Technique for Venous Anastomosis in Fingertip Replantation.

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Jeon, Byung-Joon; Yang, Jae-Won; Roh, Si Young; Ki, Sae Hwi; Lee, Dong Chul; Kim, Jin Soo

2016-01-01

Successful venous anastomosis is one of the most important factors in fingertip replantation. Volar veins in the fingertip course proximally in a random pattern, which makes it difficult to find out the exact locations. Although dorsal veins in the lateral nail fold have constant location and adequate diameter for anastomosis, they have been known as hard to dissect from the immobile subcutaneous tissue. The authors present a new lateral nail fold incision technique for venous anastomosis in the fingertip amputations. From February 2010 to October 2010, 9 replantations using the new incision and venous anastomosis technique were performed in 9 patients. The levels of amputations were from the nail base to half of the nail bed. After repairing the proper digital arteries, a skin incision was made along the junction between the lateral nail fold and nail bed. Careful dissection was performed to isolate the veins in the lateral nail fold. After evaluation of the suitability of the vessel, venous anastomosis was performed. Seven male and 2 female patients were enrolled in this study. Appropriate dorsal veins for anastomosis could be found in 8 of 9 patients. All the replanted stumps survived without venous congestion and following additional procedures. A sizable volar or dorsal vein could not be found in 1 patient. The salvage technique was required in this patient. Dorsal veins in the lateral nail fold can be found easily because of the constant anatomical location. The new incision on the lateral nail fold provides not only sufficient operative field for anastomosis but also additional opportunity of successful venous anastomosis in the selected cases. The authors, therefore, propose this technique as an effective method for an alternative venous anastomosis in the zone I replantation.

Arterial and venous revascularization with bifurcation of a single central artery: a reliable strategy for Tamai Zone I replantation.

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Hsu, Chung-Chen; Lin, Yu-Te; Moran, Steven L; Lin, Cheng-Hung; Wei, Fu-Chan; Lin, Chih-Hung

2010-12-01

Replantation of the distal phalanx and pulp can be performed to improve finger function and finger aesthetics; however, establishing adequate venous drainage is a challenge. Slattery et al. reported microsurgical reattachment of a partial distal phalanx with the use of a bifurcated terminal digital artery. The bifurcation was divided into two pedicles, one of which was used for venous drainage. In this article, the authors report their experience with a similar technique and propose a new algorithm for distal finger replantation. From January of 2008 to February of 2009, five replantations were performed using a single central artery. The replanted levels were pulp, avulsed fingertip of the thumb, and distal phalanges. There was no volar vein, dorsal vein, or second artery available in the amputated part for standard venous drainage. Venous drainage in all cases was established by creating an anastomosis from a branch of the solitary terminal artery to a recipient vein. All digits were replanted successfully without evidence of arterial insufficiency or venous congestion. Partial necrosis was not identified postoperatively in any of the five fingers. There were no cases of wound infection. A branch of the central solitary artery may be used successfully to reestablish venous outflow in cases of distal finger tip replantation. This technique allowed for the salvage of all fingers in this study without the use of leeches or other techniques used in cases of venous insufficiency.

Short-term vs long-term calcium hydroxide therapy after immediate tooth replantation: a histomorphometric study in monkey's teeth.

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Panzarini, Sônia Regina; Gulinelli, Jéssica Lemos; Saito, Célia T M H; Poi, Wilson Roberto; Sonoda, Celso Koogi; Américo de Oliveira, José; Melo, Moriel Evangelista; de Souza Gomes, Weglis Dyanne

2012-06-01

Endodontic treatment is an important step of tooth replantation protocols, but the ideal moment for definitive obturation of replanted teeth has not yet been established. In this study, a histomorphometric analysis was undertaken to evaluate the repair process on immediate replantation of monkey's teeth after calcium hydroxide (CH) therapy for 1 and 6 months followed by root canal filling with a CH-based sealer (Sealapex(®) ). The maxillary and mandibular lateral incisors of five female Cebus apella monkeys were extracted, kept in sterile saline for 15 min, replanted and splinted with stainless steel orthodontic wire and composite resin for 10 days. In Group I (control), definitive root canal filling was performed before tooth extraction. In Groups II and III, CH therapy started after removal of splint, and definitive root canal filling was performed 1 and 6 months later, respectively. The animals were euthanized 9 months after replantation, and specimens were processed for histomorphometric analysis. In all groups, epithelial attachment occurred at the cementoenamel junction or very close to this region; the areas of resorption on root surface had small extension and depth and were repaired by newly formed cementum; and the periodontal ligament was organized. Statistical analysis of the scores obtained for the histomorphometric parameters did not show any statistically significant difference (P = 0.1221) among the groups. The results suggests that when endodontic treatment is initiated 10 days after immediate replantation and an antibiotic regimen is associated, definitive root canal filling can be performed after a short-term CH therapy. © 2011 John Wiley & Sons A/S.

Correlation of volumetric flow rate and skin blood flow with cold intolerance in digital replantation.

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Zhao, Gang; Mi, Jingyi; Rui, Yongjun; Pan, Xiaoyun; Yao, Qun; Qiu, Yang

2017-12-01

Cold intolerance is a common complication of digital replantation. The exact etiology is unclear, but it is considered to be multifactorial, including nonsurgical characteristics, vascular, and neurologic conditions. Blood flow may play a significant role in cold intolerance. This study was designed to evaluate the correlation of digital blood flow, including volumetric flow rate (VFR) and skin blood flow (SkBF), with cold intolerance in replanted fingers.A retrospective study was conducted among patients who underwent digital replantation between 2010 and 2013. Patients were selected into study cohort based on the inclusion criteria. Surgical data was collected on each patient, including age, sex, injury mechanism, amputation level, ischemia time, number of arteries repaired, and whether or not vascular crisis occurred. Patients were included as study cohort with both nerves repaired and without chronic disease. Cold intolerance was defined as a Cold Intolerance Symptom Severity (CISS) score over 30. The arterial flow velocity and caliber were measured by Color Doppler Ultrasound and the digital VFR was calculated. The SkBF was measured by Laser Speckle Imager. Both VFR and SkBF were calculated as a percentage of the contralateral fingers. Comparative study of surgical data and blood flow was performed between the patient with and without cold intolerance. Correlation between VFR and SkBF was also analyzed.A total of 93 patients met inclusion criteria for the study. Approximately, 42 patients were identified as having cold intolerance. Fingers that survived vascular crisis had a higher incidence of cold intolerance with a lower VFR and SkBF. The VFR was higher in 2-artery replantation, but the SkBF and incidence of cold intolerance did not differ significantly. No differences were found in age, sex, injury mechanism, amputation level, or ischemia time. Furthermore, no correlation was found between VFR and SkBF.Cold intolerance of digital replantation is associated

Les difficultés de la replantation. Quel avenir pour le cacao en Côte d’Ivoire ?

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Ruf François

2001-11-01

Full Text Available La conférence internationale sur le thème « Quel avenir pour les cultures pérennes ? » est née de deux préoccupations. La première recouvre le champ des difficultés de la replantation, difficultés techniques, économiques mais aussi environnementales, sociales et politiques : comment replanter 1 ? La seconde est la baisse des cours, probablement structurelle, de la plupart des matières premières agricoles, notamment de celles produites par des cultures pérennes. Si les prix restent aussi bas de façon aussi durable, pourquoi replanter ? De même qu’il est toujours de bon aloi d’acheter des actions quand la bourse s’écroule, les économistes recommandent de planter quand les cours des matières premières sont à leur plancher. Toutefois, si des centaines de milliers d’hectares sont plantés par des producteurs qui anticipent une remontée des cours, celle-ci peut alors être fort retardée. Cette capacité à anticiper un retour à des prix élevés est ainsi une des causes du prolongement de la phase des très bas prix du cacao jusqu’en 2001, ce qui semble bien relever d’un échec du marché 2. Le pourquoi et le comment de la replantation sont bien indissociables. Face aux enjeux, de nombreux pays détenteurs du patrimoine « cultures pérennes tropicales » ne manquent-ils pas d’une véritable politique de replantation prenant acte des changements nécessaires dans les conditions de production, se remettant en cause, tout en faisant face aux difficultés à interpréter les marchés ? Les problèmes de replantation ne peuvent se surmonter qu’à partir d’une compréhension des processus en œuvre, sur le terrain, en commençant par les décisions des producteurs. Les exemples, les études de cas, par village, par région, restent donc des fondamentaux pour une réflexion globale, pour une anticipation des problèmes, une action nationale, voire internationale, sur la replantation. En même temps, la question de

Replantation of fingertip amputation by using the pocket principle in adults.

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Lee, P K; Ahn, S T; Lim, P

1999-04-01

There are several treatment modalities for zone 1 or zone 2 fingertip amputations that cannot be replanted by using microsurgical techniques, such as delayed secondary healing, stump revision, skin graft, local flaps, distant flaps, and composite graft. Among these, composite graft of the amputated digit tip is the only possible means of achieving a full-length digit with a normal nail complex. The pocket principle can provide an extra blood supply for survival of the composite graft of the amputated finger by enlarging the area of vascular contact. The surgery was performed in two stages. The amputated digit was debrided, deepithelialized, and reattached to the proximal stump. The reattached finger was inserted into the abdominal pocket. About 3 weeks later, the finger was removed from the pocket and covered with a skin graft. We have consecutively replanted 29 fingers in 25 adult patients with fingertip amputations by using the pocket principle. All were complete amputations with crushing or avulsion injuries. Average age was 33.64 years, and men were predominant. The right hand, the dominant one, was more frequently injured, with the middle finger being the most commonly injured. Of the 29 fingers, 16 (55.2 percent) survived completely and 10 (34.5 percent) had partial necrosis less than one-quarter of the length of the amputated part. The results of the above 26 fingers were satisfactory from both functional and cosmetic aspects. Twenty of the 29 fingers, which had been followed up for more than 6 months (an average of 16 months), were included in a sensory evaluation. Fifteen of these 20 fingers (75 percent) were classified as "good" (static two-point discrimination of less than 8 mm and normal use). From the overall results and our experience, we suggest that the pocket principle is a safe and valuable method in replantation of zone 1 or zone 2 fingertip amputation, an alternative to microvascular replantation, even in adults.

Management of complicated crown-root fracture in central incisors using intentional replantation with 180° rotation: A case report

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Reyhaneh Faghihian

2017-01-01

Full Text Available Introduction: Complicated crown-root fractures are rare and their treatment is complex. Numerous methods such as crown lengthening and orthodontic or surgical extrusion have been described for the treatment of crown-root fracture. The aim of this study was to report managing complicated crown-root fracture using intentional replantation with 180° rotation. Case report: This case report demonstrates successful management of complicated crown-root fracture in central incisor of a 10-year-old boy using intentional replantation with 180° rotation. Discussion: At 18-month follow-up, the replanted tooth revealed normal function with no obvious resorption.

Apical Revascularization after Delayed Tooth Replantation: An Unusual Case

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Marília Pacífico Lucisano

2016-01-01

Full Text Available The aim of this paper is to present the clinical and radiological outcome of the treatment involving a delayed tooth replantation after an avulsed immature permanent incisor, with a follow-up of 1 year and 6 months. An 8-year-old boy was referred after dental trauma that occurred on the previous day. The permanent maxillary right central incisor (tooth 11 had been avulsed. The tooth was hand-held during endodontic therapy and an intracanal medication application with calcium hydroxide-based paste was performed. An apical plug with mineral trioxide aggregate (MTA was introduced into the apical portion of the canal. When the avulsed tooth was replanted with digital pressure, a blood clot had formed within the socket, which moved the MTA apical plug about 2 mm inside of the root canal. These procedures developed apical revascularization, which promoted a successful endodontic outcome, evidenced by apical closure, slight increase in root length, and absence of signs of external root resorption, during a follow-up of 1 year and 6 months.

Cross-finger dermal pocketing to augment venous outflow for distal fingertip replantation.

Science.gov (United States)

Tan, Valerie H; Murugan, Arul; Foo, Tun-Lin; Puhaindran, Mark E

2014-09-01

Venous anastomosis in distal fingertip replantations is not always possible, and venous congestion is recognized as a potential cause of failure. Methods previously described to address this problem include amputate deepithelization and dermal pocketing postarterial anastomosis to augment venous outflow. However, attachment of the digit to the palm or abdomen resulted in finger stiffness. We describe a modification of the previous methods by utilizing dermal flaps raised from the adjacent digit in the form of a cross-finger flap. The key differences are the partial deepithelization of the replanted fingertip and subsequent replacement of the dermal flap to the donor digit to minimize donor site morbidity. During the period where the 2 digits are attached, interphalangeal joint mobilization is permitted to maintain joint mobility.

Use of the mechanical leech for successful zone I replantation.

Science.gov (United States)

Kim, Sang Wha; Han, Hyun Ho; Jung, Sung-No

2014-01-01

Replantation of zone I finger injuries remains a challenge, particularly if the fingertip was previously scarred or atrophied, which makes it difficult to secure a suitable vein at the amputation site. In cases of artery-only anastomosis, we propose using a mechanical leech technique to maintain sufficient venous outflow until the internal circulation regenerates. We applied this procedure to eight patients who had zone 1 amputations without veins that were suitable for anastomosis. Emergent surgery was performed and an artery-only anastomosis was created. As there were no veins available, we cut a branch of the central artery and anastomosed it with a 24-gauge angioneedle, which served as a conduit for venous drainage. The overall survival rate for zone I replantation using mechanical leech was 87.5% and the average time to maintain the mechanical leech was 5 days. The mechanical leech technique may serve as an alternative option for the management of venous congestion when no viable veins are available.

Use of the Mechanical Leech for Successful Zone I Replantation

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Sang Wha Kim

2014-01-01

Full Text Available Replantation of zone I finger injuries remains a challenge, particularly if the fingertip was previously scarred or atrophied, which makes it difficult to secure a suitable vein at the amputation site. In cases of artery-only anastomosis, we propose using a mechanical leech technique to maintain sufficient venous outflow until the internal circulation regenerates. We applied this procedure to eight patients who had zone 1 amputations without veins that were suitable for anastomosis. Emergent surgery was performed and an artery-only anastomosis was created. As there were no veins available, we cut a branch of the central artery and anastomosed it with a 24-gauge angioneedle, which served as a conduit for venous drainage. The overall survival rate for zone I replantation using mechanical leech was 87.5% and the average time to maintain the mechanical leech was 5 days. The mechanical leech technique may serve as an alternative option for the management of venous congestion when no viable veins are available.

Successful Replantation of Amputated Penile Shaft following Industrial Injury

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M Salehipour

2010-09-01

Full Text Available Penile amputation is an uncommon urological emergency. Although rare, traumatic amputation of penis is a challenging injury to treat. However, modern microsurgical reconstruction techniques have improved success rate of penile replantation and become the procedure of choice for managing these patients. Herein, we report on a case of penile amputation following an industrial accident.

The timing of neovascularization in fingertip replantation by external bleeding.

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Han, Seung-Kyu; Chung, Heung-Soo; Kim, Woo-Kyung

2002-09-15

To overcome venous congestion in fingertip replantation with no venous anastomosis, the authors have used a salvage procedure that consists of continuous external bleeding through a stab incision on the paraungual area and dripping a heparinized saline solution at the incision site to maintain external bleeding. Because this method requires continuous bleeding for a certain period of time, it may be a great burden on the patient; therefore, it is most important to minimize the duration of bleeding. Many authors have studied the timing of the new venous channel formation of the flap. However, to our knowledge, a study on fingertip replantations has not yet been performed. From June of 1985 to November of 1999, the authors performed fingertip replantations on 144 fingers of 137 patients using our salvage procedure at Korea University Guro Hospital. Among the 144 fingers, 101 fingers of 96 patients were successfully transplanted, including those with partial necrosis. The authors reviewed the medical records of these 101 fingers retrospectively; they compared and analyzed the necessary duration of external bleeding according to sex, age, level of injury, cause of amputation, and the type of injury. The average period of the salvage procedure was 7.6 days. Regarding age, the shortest period (5.5 days) was required for patients younger than 10 years. On the basis of the types of injuries, the duration of bleeding was shortest for the guillotine injury group (5.9 days) compared with crush (8.2 days) or avulsion (8.0 days) injuries. Sex and level of injury did not make much difference in the duration of the procedure.

Distal fingertip replantation without skeletal fixation.

Science.gov (United States)

Sabapathy, S Raja; Venkatramani, Hari; Bharathi, R Ravindra; Sebastin, Sandeep J

2005-01-01

The replantation of fingertip amputation (through the nail bed) requires repair of the artery and vein on the palmar side. These structures are present in different planes, with the artery being deeper and the veins superficial. The authors believe that vascular repair in such cases is facilitated by stabilization of the amputated part by nail-bed repair alone. This provides a certain degree of flexibility, which allows for easier placement of clamps in the limited space available. Although Kirschner wires were not used for bony fixation, bony union was achieved in all five cases in which this technique was used.

Effect of topical alendronate on root resorption of dried replanted dog teeth.

Science.gov (United States)

Levin, L; Bryson, E C; Caplan, D; Trope, M

2001-06-01

Alendronate (ALN) is a third generation bisphosphonate with demonstrated osteoclast inhibitory activity that may slow down the resorptive process after severe traumatic injuries. Eighty-two premolar roots of five mongrel dogs were endodontically treated and restored, extracted and treated as follows: 70 roots were bench dried for either 40 or 60 min. Thirty-eight of these roots were then soaked for 5 min in a 1 mM solution of ALN in Hanks' Balanced Salt Solution (HBSS) and replanted. Thirty-two roots were soaked for 5 min in HBSS and replanted. In the remaining 12 roots which were not exposed to the bench drying procedure, a 0.5 mM deep lingual mid-root cemental defect was made. Six of these roots were soaked in a 1 mM solution of ALN in HBSS for 5 min and replanted. The other six roots were soaked for 5 min in HBSS and replanted. Historical negative and positive controls were used from similarly treated teeth in our previous studies. After 4 months the dogs were killed and the roots prepared for histological evaluation. Five-microm-thick cross-sections of the root and surrounding tissue taken every 70 microm were evaluated for healing according to the criteria of Andreasen. In the 12 roots with cemental defects, healing with cementum of the damaged root surface was evaluated. In addition, residual root mass was also measured to determine the extent of root structure loss for each soaking method. Cemental healing took place in all 12 artificially damaged roots, indicating that these soaking media did not inhibit cementogenesis. The alendronate-soaked roots had statistically significantly more healing than the roots soaked in HBSS without alendronate. This improvement in healing was seen in all dogs except one and in all teeth except the first premolar. Soaking in alendronate also resulted in significantly less loss in root mass due to resorption compared to those teeth soaked in HBSS without alendronate.

Replanting/underplanting strategy for old coconut plantations in Papua New Guinea

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Ollivier Jean

2001-11-01

Full Text Available In most producing countries, the population of coconut palms is growing old, and ways of replacing them are rarely implemented to ensure that production is maintained and the future of the industry and its profitability are safeguarded. Rehabilitating/replanting coconut plantations and adopting appropriate intercropping systems is one of the main challenges to be taken up for the future of coconut in the Asia-Pacific region. The example of Papua New Guinea (PNG reveals one of the lowest yields per hectare among the countries in the Asia-Pacific zone. Almost 106,000 ha were planted between 1910 and 1940, amounting to around 40% of the current coconut plantings, hence 80 to 100,000 ha can be expected to disappear in the next twenty years. Faced with this forecast, the PNG Cocoa and Coconut Research Institute (PNG CCRI launched several operations, beginning with the creation of a coconut research centre on the PNG mainland: examination of a replanting strategy for old coconut plantings, based on hybrid planting material, distribution of improved planting material through the creation of a seed garden, and development of a system for controlling pest populations in high-risk zones. The experiments set up at the station are designed to optimize the felling date for old coconut palms, by measuring the effects of competition with the underplanted hybrids, and to determine from an economic point of view the best strategy to be applied for implementing rehabilitation and/or replanting programmes in old coconut plantings. This paper describes the results of these operations.

An evidence-based assessment of the clinical guidelines for replanted avulsed teeth. Part II: prescription of systemic antibiotics.

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Hinckfuss, Susan Elisabeth; Messer, Louise Brearley

2009-04-01

Current clinical guidelines recommend prescribing systemic antibiotic therapy (SAT) for patients having an avulsed permanent tooth replanted. The principles of evidence-based dentistry can be used to assess whether this is the best approach based on currently-available evidence. The objective of this study was to use the principles of evidence-based dentistry to answer the PICO question: (P) for a replanted avulsed permanent tooth, (I) is prescribing SAT, (C) compared with not prescribing SAT, (O) associated with an increased likelihood of successful periodontal healing after tooth replantation? A literature search was performed across four internet databases (Ovid Medline, Cochrane Library, PubMed, ISI Web of Science), for relevant citations (n = 35 702). Limiting citations to those in English and removing duplicates produced a set of titles (n = 14 742) that were sieved according to evidence-based dentistry principles. Relevant titles were selected for abstract assessment (n = 782), identifying papers for examination (n = 74). Inclusion criteria were applied and three papers (326 total teeth) met the final criteria for meta-analysis. Meta-analyses found no statistically significant difference between prescribing or not prescribing antibiotics for acceptable periodontal healing without progressive root resorption (common odds ratio = 0.90, SE = 0.29, 95% confidence intervals = 0.51-1.58). The evidence for an association between prescribing SAT and an increased likelihood of acceptable periodontal healing outcome is inconclusive. This investigation of antibiotic use as defined in the clinical guidelines indicates there is inconclusive clinical evidence from studies of replanted avulsed human teeth to either contradict or support the guideline. Pending future research to the contrary, dentists are recommended to follow current guidelines in prescribing SAT when replanting avulsed teeth.

Rhizospheric microbial communities are driven by Panax ginseng at different growth stages and biocontrol bacteria alleviates replanting mortality

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Linlin Dong

2018-03-01

Full Text Available The cultivation of Panax plants is hindered by replanting problems, which may be caused by plant-driven changes in the soil microbial community. Inoculation with microbial antagonists may efficiently alleviate replanting issues. Through high-throughput sequencing, this study revealed that bacterial diversity decreased, whereas fungal diversity increased, in the rhizosphere soils of adult ginseng plants at the root growth stage under different ages. Few microbial community, such as Luteolibacter, Cytophagaceae, Luteibacter, Sphingomonas, Sphingomonadaceae, and Zygomycota, were observed; the relative abundance of microorganisms, namely, Brevundimonas, Enterobacteriaceae, Pandoraea, Cantharellales, Dendryphion, Fusarium, and Chytridiomycota, increased in the soils of adult ginseng plants compared with those in the soils of 2-year-old seedlings. Bacillus subtilis 50-1, a microbial antagonist against the pathogenic Fusarium oxysporum, was isolated through a dual culture technique. These bacteria acted with a biocontrol efficacy of 67.8%. The ginseng death rate and Fusarium abundance decreased by 63.3% and 46.1%, respectively, after inoculation with B. subtilis 50-1. Data revealed that microecological degradation could result from ginseng-driven changes in rhizospheric microbial communities; these changes are associated with the different ages and developmental stages of ginseng plants. Biocontrol using microbial antagonists alleviated the replanting problem. KEY WORDS: Panax ginseng, Microbial communities, Replanting problem, High-throughput sequencing, Different ages, Bioremediation

Apple replant disease: role of microbial ecology in cause and control.

Science.gov (United States)

Mazzola, Mark; Manici, Luisa M

2012-01-01

Replant disease of apple is common to all major apple growing regions of the world. Difficulties in defining disease etiology, which can be exacerbated by abiotic factors, have limited progress toward developing alternatives to soil fumigation for disease control. However, the preponderance of data derived from studies of orchard soil biology employing multidisciplinary approaches has defined a complex of pathogens/parasites as causal agents of the disease. Approaches to manipulate microbial resources endemic to the orchard soil system have been proposed to induce a state of general soil suppressiveness to replant disease. Such a long-term strategy may benefit the existing orchard through extending the period of economic viability and reduce overall disease pressure to which young trees are exposed during establishment of successive plantings on the site. Alternatively, more near-term methods have been devised to achieve specific quantitative and qualitative changes in soil biology during the period of orchard renovation that may lead to effective disease suppression.

Apple Replant Disease: Role of microbial ecology in cause and control

Science.gov (United States)

1. Apple replant disease (ARD) has been reported from all major fruit-growing regions of the world, and is often caused by a consortium of biological agents. Development of non-fumigant alternatives for the control of this disease has been hindered by the absence of consensus concerning the etiology...

Illumina amplicon sequencing of 16S rRNA tag reveals bacterial community development in the rhizosphere of apple nurseries at a replant disease site and a new planting site.

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Jian Sun

Full Text Available We used a next-generation, Illumina-based sequencing approach to characterize the bacterial community development of apple rhizosphere soil in a replant site (RePlant and a new planting site (NewPlant in Beijing. Dwarfing apple nurseries of 'Fuji'/SH6/Pingyitiancha trees were planted in the spring of 2013. Before planting, soil from the apple rhizosphere of the replant site (ReSoil and from the new planting site (NewSoil was sampled for analysis on the Illumina MiSeq platform. In late September, the rhizosphere soil from both sites was resampled (RePlant and NewPlant. More than 16,000 valid reads were obtained for each replicate, and the community was composed of five dominant groups (Proteobacteria, Acidobacteria, Bacteroidetes, Gemmatimonadetes and Actinobacteria. The bacterial diversity decreased after apple planting. Principal component analyses revealed that the rhizosphere samples were significantly different among treatments. Apple nursery planting showed a large impact on the soil bacterial community, and the community development was significantly different between the replanted and newly planted soils. Verrucomicrobia were less abundant in RePlant soil, while Pseudomonas and Lysobacter were increased in RePlant compared with ReSoil and NewPlant. Both RePlant and ReSoil showed relatively higher invertase and cellulase activities than NewPlant and NewSoil, but only NewPlant soil showed higher urease activity, and this soil also had the higher plant growth. Our experimental results suggest that planting apple nurseries has a significant impact on soil bacterial community development at both replant and new planting sites, and planting on new site resulted in significantly higher soil urease activity and a different bacterial community composition.

Microvascular replantation of avulsed tissue after a dog bite of the face

African Journals Online (AJOL)

Various authors have described successful microsurgical replantation of totally avulsed facial tissue. In a significant nwnber of cases difficulties were experienced with the venous anastomoses and/or venous drainage of the tissue. Many different methods were used to overcome the problem. Despite these difficulties, good ...

Tractor-mounted, GPS-based spot fumigation system manages Prunus replant disease

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V. Udompetaikul

2013-10-01

Full Text Available Our research goal was to use recent advances in global positioning system (GPS and computer technology to apply just the right amount of fumigant where it is most needed (i.e., in a small target treatment zone in and around each tree replanting site to control Prunus replant disease (PRD. We developed and confirmed the function of (1 GPS-based software that can be used on cleared orchard land to flexibly plan and map all of an orchard's future tree sites and associated spot fumigation treatment zones and 2 a tractor-based GPS-controlled spot fumigation system to quickly and safely treat the targeted tree site treatment zones. In trials in two almond orchards and one peach orchard, our evaluations of the composite mapping and application system, which examined spatial accuracy of the spot treatments, delivery rate accuracy of the spot treatments, and tree growth responses to the spot treatments, all indicated that GPS spot fumigation has excellent potential to greatly reduce fumigant usage while adequately managing the PRD complex.

Atypical arteriole anastomoses for fingertip replantations under digital block.

Science.gov (United States)

Koshima, Isao

2008-01-01

Reconstructive microsurgery is now in a new stage of supermicrosurgery. With this technique, very tiny (0.3mm) vascular anastomoses are possible. In this paper, we describe two cases of successful fingertip replantations employing arteriole (terminal branch of digital artery) anastomoses, the arteriole graft being obtained from the same fingertip defect, reverse arteriole flow to subdermal venule, and delayed venular drainage for venous congestion. These atypical tiny vascular anastomoses were successfully carried out under digital block.

Multidisciplinary approach in the immediate replantation of a maxillary central incisor - A six and a half year follow-up

OpenAIRE

Cristina Braga Xavier; Beatriz Farias Vogt; Giselle Daer Faria; Leandro Calcagno Reinhardt; Elaini Sickert Hosni; Josué Martos

2015-01-01

This report proposes a discussion of the various peculiarities of a tooth 21 replantation in a 9-year-old patient and describes different treatment facets and a 6-year follow-up of the case. The splint was maintained for a 3-month period. After a 1΍ year therapy with calcium hydroxide to control inflammatory resorption, the final canal obturation was performed 18 months after trauma with mineral trioxide aggregate. Two years after replantation, the orthodontic treatment had been initiated and...

Composite grafting with pulp adipofascial advancement flaps for treating non-replantable fingertip amputations.

Science.gov (United States)

Lai, Hsin-Ti; Wu, Sheng-Hua; Lai, Ya-Wei; Hsieh, Tung-Ying; Lee, Su-Shin; David Wang, Hui-Min; Chang, Kao-Ping; Lin, Sin-Daw; Lai, Chung-Sheng; Huang, Shu-Hung

2016-11-01

Non-replantable fingertip amputation is still a clinical challenge. We performed modified composite grafting with pulp adipofascial advancement flap for Hirase IIA fingertip amputations. Results from a series of patients are presented and achieved better outcome than traditional composite grafting. From September 2012 to April 2014, fourteen patients with sixteen digits were included in our study. Mean age of patients was 43.9 years (20-71 years). All of our patients underwent this procedure under digital block anesthesia. We performed pulp adipofascial advancement flap for better soft tissue coverage of bone exposure stump first. The amputated parts were defatted, trimming, and reattached as composite graft. Age and gender of patients, injured finger, Hirase classification, mechanism of trauma, overall graft survival area, two-point discrimination (2PD) (mm) at six-month, length of shortening of digit, The average disabilities of the arm, shoulder, and hand (DASH) score and subjective self-evaluation questionnaire at 6 month were recorded. Average graft survival area was 89% (75-100%). Average length of shortening was 2.2 mm (1.8-3.5 mm). 2PD at six-month after surgery was 6.3 mm in average (5-8 mm). Average DASH score at 6 month was 1.45 (0.83-2.5). The self-evaluated aesthetic results showed twelve patients (85.7%) were very satisfied, and no patient was completely unsatisfied. In Hirase zone IIA traumatic fingertip amputation where replantation is difficult, our modified technique of composite grafting with pulp adipofascial advancement flap provided an alternative choice with high successful rate, acceptable functional and aesthetic outcomes. © 2016 Wiley Periodicals, Inc. Microsurgery, 2016. © 2015 Wiley Periodicals, Inc. Microsurgery 36:651-657, 2016. © 2016 Wiley Periodicals, Inc.

Delayed tooth replantation after root surface treatment with sodium hypochlorite and sodium fluoride: histomorphometric analysis in rats.

Science.gov (United States)

Sottovia, André Dotto; Sonoda, Celso Koogi; Poi, Wilson Roberto; Panzarini, Sônia Regina; Lauris, José Roberto Pereira

2006-04-01

In cases of delayed tooth replantation, non-vital periodontal ligament remnants have been removed with sodium hypochlorite in an attempt to control root resorption. Nevertheless, reports of its irritating potential in contact with the alveolar connective tissue have been described. Therefore, this study evaluated the healing process on delayed replantation of rat teeth, after periodontal ligament removal by different treatment modalities. Twenty-four rats, assigned to 3 groups (n=8), had their upper right incisor extracted and left on the workbench for desiccation during 60 min. Afterwards, the teeth in group I were immersed in saline for 2 min. In group II, root surfaces were scrubbed with gauze soaked in saline for 2 min; and in group III, scrubbing was done with gauze soaked in 1% sodium hypochlorite solution. Thereafter, root surfaces were etched with 37% phosphoric acid and immersed in 2% acidulate-phosphate sodium fluoride solution, at pH 5.5. Root canals were filled with a calcium hydroxide-based paste and the teeth were replanted. The animals were sacrificed 60 days postoperatively and the pieces containing the replanted teeth were processed and paraffin- embedded. Semi-serial transversally sections were obtained from the middle third of the root and stained with hematoxylin and eosin for histomorphometric analysis. Data were analyzed statistically using Kruskal-Wallis and Dunn's tests. The results showed that root structure and cementum extension were more affected by resorption in group III (p<0.05). All groups were affected by root resorption but the treatment performed in group III was the least effective for its control. The treatment accomplished in groups I and II yielded similar results to each other.

Six years follow-up of a penis replantation in a child.

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de Lagausie, Pascal; Jehanno, Pascal

2008-03-01

Total amputation of the penis is very rare in a child. This article presents a case of a traumatic penile amputation at the base of the perineum, with scissors, in a 4-year-old child. Six hours after the aggression, the penis was replanted. Three weeks after the intervention, except for skin necrosis, the results were excellent. Six years afterward, this child has done very well from pediatric, psychological, urological, and plastic surgery points of view. Sensibility and erections are present and normal. Longer follow-ups particularly during puberty are necessary. Total amputation of the penis is a very rare accident in a child. Partial lesions are more common, particularly during circumcision. As in adult cases, replantation of the penis in a child needs a clean section by scissors or a knife, a correct conservation of the penis (in ice but without direct contact), and a short period between the lesion and the surgical procedure. All these conditions explain that very few cases are reported in the literature. We present a case of amputation of the penis in a 4-year-old child, with good results 6 years afterward.

[Clinico-electromyographic evaluation of the state of motor units of the hand muscles replanted after traumatic amputation].

Science.gov (United States)

Rezkov, G I

1991-01-01

Needle electromyography was used to study motor units of the muscles leading away the thumb and little finger, replanted after traumatic amputation of the large segment of the upper limb in 34 patients. A direct relationship was discovered between the time of the appearance of action potentials of motor units (PMU), recovery of the movements, and trauma level. The appearance of clear PMU associated with movement recovery was recorded not earlier than 6-7 months after trauma. Analysis of PMU is a reliable criterion for the recovery of the own movements of the muscles and function of the neuromotor apparatus in patients with the replanted upper limb segment.

Replantation of multi-level fingertip amputation using the pocket principle (palmar pocket method).

Science.gov (United States)

Arata, J; Ishikawa, K; Soeda, H; Kitayama, T

2003-07-01

Two cases of multi-level fingertip amputation are presented. In each case, replantation was achieved in a two-stage procedure, involving reattachment, de-epithelialisation and insertion into a palmar pocket in stage 1, followed by removal from the palmar pocket 16 days later. The cases are described and the technique is discussed.

Fingertip replantation at the eponychial level with venous anastomosis: an anatomic study and clinical application.

Science.gov (United States)

Cheng, L; Chen, K; Chai, Y-M; Wen, G; Wang, C-Y

2013-11-01

We present an anatomic study of the vein distribution at the eponychial level, in order to standardize outpatient fingertip replantation. The cross sectional anatomy of 100 fingers was studied by dissection following dye injection. The distribution of the veins >0.3 mm was recorded on a pie-chart. Thirty fingers in 27 patients with fingertip amputations at the eponychial level were replanted by anastomosis of the palmar subcutaneous veins, to reconstruct the venous reflux of the amputated digits. The operations were aided by the anatomical study and confirmed that the palmar area is the preferred site for venous anastomosis Following a distal finger amputation at the level of the eponychial fold we propose starting the search for veins between the 3 to 5 o'clock or 7 to 9 o'clock positions, as these are the areas where there are most likely to be suitable veins.

The replanting campaign has begun

CERN Multimedia

GS-SEM Group - General Infrastructure and Services Department

2010-01-01

The poplars on the border of CERN's Prévessin site were felled, according to plan, on Friday, 26 February. The work was essential as the trees were showing signs of serious ageing problems (broken and dead branches, weakened trunks and root systems, etc.) and needed to be felled to ensure the safety of drivers on the D35 The trees that have been cut will be transformed into renewable energy wood chips and used to heat local schools and crèches. They will be replaced by a hedge of hornbeams, a native fast-growing tree, which will be planted in the spring.     The felling operation was entrusted to the French national forestry authorities, with the support of the Bellegarde-Pays de Gex Agence Routière et Technique. It marks the start of a vast poplar-felling and replanting campaign, which will be extended to CERN's Meyrin site.  The work is part of CERN's general renovation and site planning scheme for the future.    

[Experiment study on ultrashort wave for treating vascular crisis after rat tail replantation].

Science.gov (United States)

Tan, Long; Gao, Wenshan; Xi, Ali; Wang, Cong; Chen, Shouying; Zhao, Yanyan; Di, Keqian; Yang, Xincai; Weng, Shengbin

2012-10-01

To explore the effect and mechanism of ultrashort wave (USW) for prevention and treatment of vascular crisis after rat tail replantation. Eighty 3-month old female Sprague Dawley rats (weighing 232.8-289.6 g) were randomly divided into 5 groups. In each group, based on the caudal vein and the coccyx was retained, the tail was cut off. The tail artery was ligated in group A; the tail artery was anastomosed in groups B, C, D, and E to establish the tail replantation model. After surgery, the rats of group B were given normal management; the rats of group C were immediately given intraperitoneal injection (3.125 mL/kg) of diluted papaverine hydrochloride injection (1 mg/mL); the rats of groups D and E were immediately given the local USW treatment (once a day) at anastomotic site for 5 days at the dosage of 3 files and 50 mA for 20 minutes (group D) and 2 files and 28 mA for 20 minutes (group E). The survival rate of the rat tails was observed for 10 days after the tail replantation. The tail skin temperature difference between proximal and distal anastomosis was measured at pre- and post-operation; the change between postoperative and preoperative temperature difference was calculated. The blood plasma specimens were collected from the inner canthus before operation and from the tip of the tail at 8 hours after operation to measure the content of nitric oxide (NO). The survival rates of the rat tails were 0 (0/14), 36.4% (8/22), 57.1% (8/14), 22.2% (4/18), and 75.0% (9/12) in groups A, B, C, D, and E, respectively, showing significant overall differences among 5 groups (chi2 = 19.935, P = 0.001); the survival rate of group E was significantly higher than that of group B at 7 days (P 0.05). At preoperation, there was no significant difference in tail skin temperature difference among 5 groups (P > 0.05); at 8 hours, 5 days, 6 days, and 7 days after operation, significant overall difference was found in the change of the skin temperature difference among groups (P

The use of CT for evaluate to healing of segmental replantation in rabbits' tibia

International Nuclear Information System (INIS)

Liu Yifan; Hong Tianlu

2000-01-01

Objective: To study the value of CT in the bone healing. Methods: The rabbit's tibia segments were resected and replanted X-ray and CT photograph were taken after operation at 2,4,8,12 week. Results: CT is more clear than X-ray. Conclusion: CT is superior to X-ray photography in observed bone healing

Apple replant disease and the –omics: interaction of apple rootstock metabolome and the soil microbiome

Science.gov (United States)

Apple replant disease (ARD) negatively impacts tree health and reduces crop yield in new orchard plantings. Use of tolerant rootstock cultivars can diminish the growth limiting effects of ARD; however specific rootstock attributes enabling ARD tolerance are not understood. Systems biology tools were...

Transcriptomic analysis of molecular responses in Malus domestica 'M26' roots affected by apple replant disease.

Science.gov (United States)

Weiß, Stefan; Bartsch, Melanie; Winkelmann, Traud

2017-06-01

Gene expression studies in roots of apple replant disease affected plants suggested defense reactions towards biotic stress to occur which did not lead to adequate responses to the biotic stressors. Apple replant disease (ARD) leads to growth inhibition and fruit yield reduction in replanted populations and results in economic losses for tree nurseries and fruit producers. The etiology is not well understood on a molecular level and causal agents show a great diversity indicating that no definitive cause, which applies to the majority of cases, has been found out yet. Hence, it is pivotal to gain a better understanding of the molecular and physiological reactions of the plant when affected by ARD and later to overcome the disease, for example by developing tolerant rootstocks. For the first time, gene expression was investigated in roots of ARD affected plants employing massive analysis of cDNA ends (MACE) and RT-qPCR. In reaction to ARD, genes in secondary metabolite production as well as plant defense, regulatory and signaling genes were upregulated whereas for several genes involved in primary metabolism lower expression was detected. For internal verification of MACE data, candidate genes were tested via RT-qPCR and a strong positive correlation between both datasets was observed. Comparison of apple 'M26' roots cultivated in ARD soil or γ-irradiated ARD soil suggests that typical defense reactions towards biotic stress take place in ARD affected plants but they did not allow responding to the biotic stressors attack adequately, leading to the observed growth depressions in ARD variants.

Foster replantation of fingertip using neighbouring digital artery in a young child.

Science.gov (United States)

Xu, Jing-Hong; Gao, Zheng-Jun; Yao, Jing-Ming; Tan, Wei-Qiang; Dawreeawo, Javed

2010-06-01

Reconstruction of an amputated fingertip in a young child demands special techniques for success. We report a 2.5-year-old female patient with an amputated left index fingertip with the vascular defect being too severe to perform the usual replantation. Comparing several methods, we used the neighbouring digital artery as the feeding artery to perform foster replantation. Finally, the patient was satisfied with the appearance and function of her fingers. The clinical case, techniques, results are described and discussed. We consider it a useful technique, especially for those with a rather severe vascular defect. A 2.5-year-old girl suffered a crush amputation of the left index fingertip. Only the flexor tendon of the amputated fingertip was connected to the proximal finger tissue and the blood supply was completely lost (Figure 1). The distal amputated fingertip was fixed using Kirschner wire under general anaesthesia. Then, microsurgery operation was carried out immediately to replant this amputated fingertip. Both ulnar and radial digital arteries were avulsed, while the dorsal vein was intact and the digital nerve was also surviving. The integrity of blood vessels was too traumatised to connect to the proximal part. In the case of the distal part of the ulnar artery of the injured index finger, the blood supply was established by anastomosing the distal end of the amputated tip and the radial artery of the middle finger, which was the feeding artery (Figure 2). A 11/0 nylon suture was used. The dorsal vein and digital nerve were repaired by means of microsurgical anastomosis. The wound was covered with the dorsal skin of the middle finger and the palmar skin of the index finger to form a skin pedicle, and then, immobility of the two fingers was maintained to prevent avulsion. The index tip obtained good blood supply and survived completely (Figure 3). Detachment of the index and middle finger was performed after 3 weeks, and both of the fingers showed good

Leech Therapy For The Treatment Of Venous Congestion In Flaps, Digital Re-Plants And Revascularizations - A Two-Year Review From A Regional Centre.

Science.gov (United States)

Butt, Ahsan Masood; Ismail, Amir; Lawson-Smith, Matthew; Shahid, Muhammad; Webb, Jill; Chester, Darren L

2016-01-01

Leeches are a well-recognized treatment for congested tissue. This study reviewed the efficacy of leech therapy for salvage of venous congested flaps and congested replanted or revascularized hand digits over a 2-year period. All patients treated with leeches between 1 Oct 2010 and 30 Sep 2012 (two years) at Queen Elizabeth Hospital, Birmingham, UK were included in the study. Details regarding mode of injury requiring reconstruction, surgical procedure, leech therapy duration, subsequent surgery requirement and tissue salvage rates were recorded. Twenty tissues in 18 patients required leeches for tissue congestion over 2 years: 13 men and 5 women. The mean patient age was 41 years (range 17-79). The defect requiring reconstruction was trauma in 16 cases, following tumour resection in two, and two miscellaneous causes. Thirteen cases had flap reconstruction and seven digits in six patients had hand digit replantations or revascularisation. Thirteen of 20 cases (65%) had successful tissue salvage following leech therapy for congestion (77% in 10 out of 13 flaps, and 43% in 3 of 7 digits). The rate of tissue salvage in pedicled flaps was good 6/6 (100%) and so was in digital revascularizations 2/3 (67%), but poor in digital re-plants 1/4 (25%) and free flaps 0/2 (0%). Leeches are a helpful tool for congested tissue salvage and in this study, showed a greater survival benefit for pedicled flaps than for free flaps or digital replantations.

Mastication in subjects with extremely shortened dental arches rehabilitated with removable partial dentures.

Science.gov (United States)

Arce-Tumbay, Jackelyn; Sanchez-Ayala, Alfonso; Sotto-Maior, Bruno Salles; Senna, Plinio Mendes; Campanha, Nara Hellen

2011-01-01

Mastication was evaluated in subjects presenting extremely shortened dental arches (ESDAs) rehabilitated with mandibular free-end removable partial dentures (RPDs). Subjects were divided into four groups (n = 10): those with a complete dentition, those with ESDAs, and those with ESDAs who were rehabilitated with an RPD, who were evaluated both with and without their prostheses. Mastication was measured through masticatory performance, time, and ability. RPD wearers showed higher masticatory performance (P mastication in ESDA subjects but without achieving normal mastication levels.

Classification of Distal Fingertip Amputation Based on the Arterial System for Replantation

OpenAIRE

Park, Hyun Chul; Bahar-Moni, Ahmed Suparno; Cho, Sang Hyun; Kim, Sang Soo; Park, Hyun Sik; Ahn, Sang Cheon

2012-01-01

During replantation of distal fingertip amputation, identification of the artery is the most important but time consuming procedure. Depending on the damaged arterial structure, we classified distal fingertip amputations into 4 zones, on the basis of three dimensional concept. Zone 1 injury was defined as damage to the proximal central pulp artery; zone 2 injury, damage to the branch of the central pulp artery; zone 3 injury, damage to the distal central pulp artery; and zone 4 injury, no inj...

Plasticity of Select Primary Afferent Projections to the Dorsal Horn after a Lumbosacral Ventral Root Avulsion Injury and Root Replantation in Rats

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Allison J. Bigbee

2017-07-01

Full Text Available Injuries to the conus medullaris and cauda equina portions of the spinal cord result in neurological impairments, including paralysis, autonomic dysfunction, and pain. In experimental studies, earlier investigations have shown that a lumbosacral ventral root avulsion (VRA injury results in allodynia, which may be ameliorated by surgical replantation of the avulsed ventral roots. Here, we investigated the long-term effects of an L6 + S1 VRA injury on the plasticity of three populations of afferent projections to the dorsal horn in rats. At 8 weeks after a unilateral L6 + S1 VRA injury, quantitative morphological studies of the adjacent L5 dorsal horn showed reduced immunoreactivity (IR for the vesicular glutamate transporter, VGLUT1 and isolectin B4 (IB4 binding, whereas IR for calcitonin gene-related peptide (CGRP was unchanged. The IR for VGLUT1 and CGRP as well as IB4 binding was at control levels in the L5 dorsal horn at 8 weeks following an acute surgical replantation of the avulsed L6 + S1 ventral roots. Quantitative morphological studies of the L5 dorsal root ganglia (DRGs showed unchanged neuronal numbers for both the VRA and replanted series compared to shams. The portions of L5 DRG neurons expressing IR for VGLUT1 and CGRP, and IB4 binding were also the same between the VRA, replanted, and sham-operated groups. We conclude that the L5 dorsal horn shows selective plasticity for VGLUT1 and IB4 primary afferent projections after an L6 + S1 VRA injury and surgical repair.

Use of a halo frame for optimum intra- and post-operative management after scalp replantation/revascularization.

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Koul, Ashok R; Nahar, Sushil; Valandi, Beena; Praveen, Kumar H P

2012-09-01

We present a new technique for stabilizing an avulsed scalp during and after replantation/revascularization. We used an aluminium "halo" frame with 4 screws. This technique can rigidly stabilize an avulsed scalp and eliminate the possibility of shearing/pressure necrosis. This device can make perioperative management easier and more comfortable for the patient and caregivers.

Stress distribution in delayed replanted teeth splinted with different orthodontic wires: a three-dimensional finite element analysis.

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de Souza, Fernando Isquierdo; Poi, Wilson Roberto; da Silva, Vanessa Ferreira; Martini, Ana Paula; Melo, Regis Alexandre da Cunha; Panzarini, Sonia Regina; Rocha, Eduardo Passos

2015-06-01

The aim was to evaluate the biomechanical behavior of the supporting bony structures of replanted teeth and the periodontal ligament (PDL) of adjacent teeth when orthodontic wires with different mechanical properties are applied, with three-dimensional finite element analysis. Based on tomographic and microtomographic data, a three-dimensional model of the anterior maxilla with the corresponding teeth (tooth 13-tooth 23) was generated to simulate avulsion and replantation of the tooth 21. The teeth were splinted with orthodontic wire (Ø 0.8 mm) and composite resin. The elastic modulus of the three orthodontic wires used, that is, steel wire (FA), titanium-molybdenum wire (FTM), and nitinol wire (FN) were 200 GPa, 84 GPa, and 52 GPa, respectively. An oblique load (100 N) was applied at an angle of 45° on the incisal edge of the replanted tooth and was analyzed using Ansys Workbench software. The maximum (σmax) and minimum (σmin) principal stresses generated in the PDL, cortical and alveolar bones, and the modified von Mises (σvM) values for the orthodontic wires were obtained. With regard to the cortical bone and PDL, the highest σmin and σmax values for FTM, FN, and FA were checked. With regard to the alveolar bone, σmax and σmin values were highest for FA, followed by FTM and FN. The σvM values of the orthodontic wires followed the order of rigidity of the alloys, that is, FA > FTM > FN. The biomechanical behavior of the analyzed structures with regard to all the three patterns of flexibility was similar. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Microsurgical replantation and postoperative leech treatment of a large severed nasal segment

DEFF Research Database (Denmark)

Stemann Andersen, Peter; Elberg, Jens Jørgen

2012-01-01

The survival of a microsurgically replanted segment of nose in a 41-year-old woman was facilitated by the assistance of the medicinal leech Hirudo medicinalis. An arterial microanastomosis was made to a severed partial segment of nose with no possibility of recreating a venous anastomosis. The re....... The resulting venous congestion was treated with nine days of treatment with a medical leech until venous neovascularisation had been achieved. At follow-up six months after discharge there was a well-heeled nasal segment and a satisfying functional - as well as cosmetic - result....

Déterminants sociaux et économiques de la replantation

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Ruf François

2000-03-01

Full Text Available Sur les bourses européennes, la notion de durabilité des investissements dans les valeurs est explicite « Développement durable rime avec investissement rentable » (La Tribune, 11 mars 2000. La maxime émerge avec le développement des fonds éthiques. Selon leurs promoteurs, plus une société commerciale aura le souci de son environnement, plus elle sera boursièrement performante. D’une certaine façon, ce raisonnement reprend des courants de l’écologie humaine et de l’économie rurale, s’appliquant fort bien aux cultures pérennes. En l’absence de pensions et de retraites, les planteurs voient dans les cultures pérennes un moyen efficace pour accumuler des richesses, épargner, et éventuellement pour les transmettre à la génération suivante [1, 2]. Les cultures pérennes représentent bien un patrimoine, et leur propriétaire est à la fois un entrepreneur qui investit et un épargnant soucieux de la valeur de son patrimoine, donc de l’environnement garantissant sa durabilité. Cette notion de durabilité peut signifier une stratégie de prolongement de vie économique de l’actif épargné, la plantation, mais peut aussi passer par des stratégies de vente, de rachat, de reconversion, replantation, diversification. Pour un planteur, tout à la fois chef de famille, entrepreneur, épargnant et consommateur, la notion de durabilité s’applique d’abord à celle des revenus disponibles pour la famille. Par rapport à un objectif de durabilité des revenus, comment, pourquoi et quand un planteur prend-il la décision de replanter ? Nous essayerons ici de répondre à cette question sous forme de réflexion et d’exemples pris dans différents pays pour diverses cultures pérennes.

Age and timing of pulp extirpation as major factors associated with inflammatory root resorption in replanted permanent teeth.

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Bastos, Juliana Vilela; Ilma de Souza Côrtes, Maria; Andrade Goulart, Eugenio Marcos; Colosimo, Enrico Antonio; Gomez, Ricardo Santiago; Dutra, Walderez Ornelas

2014-03-01

External root resorption (ERR) is a serious complication after replantation, and its progressive inflammatory and replacement forms are significant causes of tooth loss. This retrospective study aimed to evaluate the factors related to the occurrence of inflammatory ERR (IERR) and replacement ERR (RERR) shortly after permanent tooth replantation in patients treated at the Dental Trauma Clinic at the School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil. Case records and radiographs of 165 patients were evaluated for the presence, type, and extension of ERR and its association with age and factors related to the management and acute treatment of the avulsed tooth by using the logistic regression model. The patient's age at the moment of trauma had a marked effect on the ERR prevalence and extension. The patients older than 16 years at the moment of trauma had less chance of developing IERR and RERR (77% and 87%, respectively) before the pulp extirpation, regardless of the extension of the resorption. The patients older than 11 years of age at the moment of trauma showed the lowest indices of IERR (P = .02). Each day that elapsed between the replantation and the pulp extirpation increased the risk of developing IERR and RERR by 1.2% and 1.1%, respectively, and also raised the risk of severe IERR by 0.5% per day. The risk of mature teeth developing severe IERR before the onset of endodontic therapy was directly affected by the timing of the pulpectomy and was inversely proportional to age. Systemic antibiotic therapy use had no effect on the occurrence and severity of IERR in mature teeth. The occurrence of RERR before the onset of endodontic treatment stimulates further investigations of the early human host response to trauma and subsequent infection. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Experiencing Extended Point-of-View Shots : A Film-Phenomenological Perspective on Extreme Character Subjectivity

NARCIS (Netherlands)

Hanich, Julian; Reinerth, Maike Sarah; Thon, Jan-Noel

2017-01-01

The wish to accurately represent the subjective perceptual experience of a filmic character and to intimately connect these character perceptions with the viewer’s experience has a long history. However, this history of extreme first-person perspectives in film—from the inside out, so to speak—is a

Use of an Intra-Arterial Catheter as a Provisional Conduit for Regulated Outflow Management in the Setting of Artery-Only Digital Replantation.

Science.gov (United States)

DeFazio, Michael V; Han, Kevin D; Paryavi, Ebrahim

2017-12-01

Successful replantation of distal digital segments necessitates the establishment of sufficient outflow to minimize congestion and progressive tissue necrosis. In cases where only arterial anastomosis is feasible, an artificial outlet must be provided to maintain physiological requirements until microvenous circulation regenerates. This can be accomplished using any number of "exsanguination techniques" designed to facilitate egress through ongoing passive blood loss. Although reportedly effective, these measures are imprecise and carry a substantial risk of infection, scarring, and/or uncontrolled hemorrhage. Herein, we describe a preemptive alternative for provisional venous drainage, whereby direct catheterization of a distal arterial branch is used to enhance the precision of outflow management following artery-only digital replantation. The establishment of intravascular access, using the technique described, permits remote manipulation of the microcirculatory environment through timed administration of heparinized saline and regulated removal of controlled volumes of blood.

Surgical management with intentional replantation on a tooth with palato-radicular groove

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Jorge Forero-López

2015-05-01

Full Text Available A palato-radicular groove (PRG is a developmental anomaly primarily found in the maxillary lateral incisors. It is a potential communication path between the root canal and the periodontium that decreases the survival prognosis of the affected tooth, therefore compromising the stability of the dental structure in the oral cavity. The aim of this case report is to present an original technique where a PRG was treated by means of intracanal disinfection, PRG sealing with glass ionomer, replantation with intentional horizontal 180 degree rotation of the tooth, and an aesthetic veneer placed to provide adequate tooth morphology. The clinical and biological benefits of this novel technique are presented and discussed.

Sistemas de tutoramento e épocas de transplante de physalis Periods replanting and training systems of cape-gooseberry

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Cláudia Simone Madruga Lima

2010-12-01

Full Text Available A physalis (Physalis peruviana é uma pequena fruta com grandes potencialidades, que, associadas ao seu ciclo curto e às propriedades nutracêuticas, apresenta possibilidade de alto retorno econômico. O objetivo deste trabalho foi avaliar o sistema de tutoramento e a época de transplante mais adequados para o crescimento e a produção de frutos de P. peruviana nas condições edafoclimáticas do sul do Rio Grande do Sul. O trabalho foi desenvolvido em Pelotas, RS, na safra de 2007/2008. O transplante de mudas de physalis foi realizado em duas épocas (época 1, 21/11/2007 e época 2 15/01/2008, sendo as plantas tutoradas em quatro sistemas de condução (sistema "V" invertido, sistema triangular, sistema vertical com bambu e sistema vertical com fitilho, semelhantes aos utilizados na cultura do tomateiro. O delineamento experimental adotado foi de blocos casualizados, com três repetições, sendo cada um representado por dez plantas. Os tratamentos formaram um fatorial 2x4 (épocas de transplante x sistemas de tutoramento. As variáveis analisadas foram: incremento do comprimento e da área da seção do ramo principal, área da seção do ramo principal, produtividade e eficiência produtiva. Foi evidenciado que a primeira época de transplante associada aos sistemas de tutoramento "V" invertido e triangular proporciona melhor desempenho agronômico das plantas de physalis.The cape-gooseberry (Physalis peruviana is a small fruit with great potentialities that whether associated to its short cycle and nutraceutical properties it shows high economical return. The work aimed to evaluate the best training system and replant period to plant growth, production and fruit quality of P. peruviana under edaphoclimatic at conditions of southern Rio Grande do Sul. The trial was carried out in Pelotas, RS, in 2007/2008 crop. Transplanting seedlings cape-gooseberry was conducted in two seasons Plant replanting was done in two periods (period 1, 21

Soil pH in fruit trees in relation to specific replant disorder of apple. I. Introduction and review of literature

NARCIS (Netherlands)

Jonkers, H.; Hoestra, H.

1978-01-01

A low pH of the soil prevents the specific apple replant disorder (SARD). Not much is known about the effect of a low pH on the growth of fruit trees. Most authors accept a pH of between 5.5 and 6.5 as optimum for apples but this assumption is not based on experimental research. It is feasible that

Ectopic banking of amputated great toe for delayed thumb reconstruction: case report.

Science.gov (United States)

Valerio, Ian L; Hui-Chou, Helen G; Zelken, Jonathan; Basile, Patrick L; Ipsen, Derek; Higgins, James P

2014-07-01

Ectopic banking of amputated parts is a recognized technique for delayed replantation of an amputated part when the amputation stump will not permit immediate replantation. This is conventionally performed with the intent of transferring the injured part back to its anatomic position when the amputation stump is more appropriate for replantation. Current warfare conditions have led to a commonly encountered military trauma injury pattern of multiple extremity amputations with protected trunk and core structures. This pattern poses many challenges, including the limit or absence of donor sites for immediate or delayed flap reconstructive procedures. We describe a case in which we ectopically banked the great toe of an amputated lower extremity for delayed thumb reconstruction. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

A histological and micro-CT investigation in to the effect of NGF and EGF on the periodontal, alveolar bone, root and pulpal healing of replanted molars in a rat model - a pilot study.

Science.gov (United States)

Furfaro, Francesco; Ang, Estabelle S M; Lareu, Ricky R; Murray, Kevin; Goonewardene, Mithran

2014-01-06

This study aims to investigate, utilising micro-computed tomography (micro-CT) and histology, whether the topical application of nerve growth factor (NGF) and/or epidermal growth factor (EGF) can enhance periodontal, alveolar bone, root and pulpal tissue regeneration while minimising the risk of pulpal necrosis, root resorption and ankylosis of replanted molars in a rat model. Twelve four-week-old male Sprague-Dawley rats were divided into four groups: sham, collagen, EGF and NGF. The maxillary right first molar was elevated and replanted with or without a collagen membrane impregnated with either the growth factors EGF or NGF, or a saline solution. Four weeks after replantation, the animals were sacrificed and the posterior maxilla was assessed using histological and micro-CT analysis. The maxillary left first molar served as the control for the corresponding right first molar. Micro-CT analysis revealed a tendency for all replanted molars to have reduced root length, root volume, alveolar bone height and inter-radicular alveolar bone volume. It appears that the use of the collagen membrane had a negative effect while no positive effect was noted with the incorporation of EGF or NGF. Histologically, the incorporation of the collagen membrane was found to negatively affect pulpal, root, periodontal and alveolar bone healing with pulpal inflammation and hard tissue formation, extensive root resorption and alveolar bone fragmentation. The incorporation of EGF and NGF did not improve root, periodontal or alveolar bone healing. However, EGF was found to improve pulp vascularisation while NGF-improved pulpal architecture and cell organisation, although not to the level of the control group. Results indicate a possible benefit on pulpal vascularisation and pulpal cell organisation following the incorporation of EGF and NGF, respectively, into the alveolar socket of replanted molars in the rat model. No potential benefit of EGF and NGF was detected in periodontal or root

Ethanol and lactic acid production using sap squeezed from old oil palm trunks felled for replanting.

Science.gov (United States)

Kosugi, Akihiko; Tanaka, Ryohei; Magara, Kengo; Murata, Yoshinori; Arai, Takamitsu; Sulaiman, Othman; Hashim, Rokiah; Hamid, Zubaidah Aimi Abdul; Yahya, Mohd Khairul Azri; Yusof, Mohd Nor Mohd; Ibrahim, Wan Asma; Mori, Yutaka

2010-09-01

Old oil palm trunks that had been felled for replanting were found to contain large quantities of high glucose content sap. Notably, the sap in the inner part of the trunk accounted for more than 80% of the whole trunk weight. The glucose concentration of the sap from the inner part was 85.2g/L and decreased towards the outer part. Other sugars found in relatively low concentrations were sucrose, fructose, galactose, xylose, and rhamnose. In addition, oil palm sap was found to be rich in various kinds of amino acids, organic acids, minerals and vitamins. Based on these findings, we fermented the sap to produce ethanol using the sake brewing yeast strain, Saccharomyces cerevisiae Kyokai no.7. Ethanol was produced from the sap without the addition of nutrients, at a comparable rate and yield to the reference fermentation on YPD medium with glucose as a carbon source. Likewise, we produced lactic acid, a promising material for bio-plastics, poly-lactate, from the sap using the homolactic acid bacterium Lactobacillus lactis ATCC19435. We confirmed that sugars contained in the sap were readily converted to lactic acid with almost the same efficiency as the reference fermentation on MSR medium with glucose as a substrate. These results indicate that oil palm trunks felled for replanting are a significant resource for the production of fuel ethanol and lactic acid in palm oil-producing countries such as Malaysia and Indonesia. Copyright 2010 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

Soil pH in fruit trees in relation to specific apple replant disorder (SARD). II. The first five years at Wageningen research plot

NARCIS (Netherlands)

Jonkers, H.; Hoestra, H.; Borsboom, O.; Pouwer, A.

1980-01-01

Field plots were established with 4 target pH values, viz. 4, 5, 6 and 7, to study the effect of pH on specific apple replant disorder (SARD). The target pH levels were not stable and frequently showed fluctuations. Although no significant differences have been found on tree performance, the

Initial experience with hand replantation after traumatic amputation in a nonspecialized center Experiência inicial com reimplante de mão após amputação traumática em um centro não-especializado

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Cleinaldo de Almeida Costa

2006-12-01

Full Text Available Traumatic amputation of the hand is an incapacitating injury, requiring skilled surgical care. Achieving functional recovery in addition to salvage of the amputated extremity should be the goal of the patient care team, after the life of the patient is secured. This is a report of the first five cases of hand replantation after complete traumatic amputation in Manaus (Amazonas, Brazil, carried out at Hospital Pronto-Socorro Dr. João Lúcio Pereira Machado. The patients were all young males, mean age of 22.8 years, presenting at the emergency room with complete sharp amputation of the hand. After initial procedures according to the ATLS® protocol, the following surgical actions were taken: heparinization of the blood vessels of the amputated extremity, fixation of the bones, wide opening of the carpal tunnel, primary vascular anastomoses and repair of nerves and tendons. In four cases, viability and partial functional recovery of the replanted hands were achieved. The unsuccessful case was due to extensive venous thrombosis.Through this preliminary experience, we can state that hand replantation can be performed successfully in a nonspecialized hospital and that optimal results depend on adequate prehospital care, multidisciplinary surgical treatment and careful postoperative assistance.A amputação traumática de mão é uma lesão incapacitante, requerendo tratamento cirúrgico hábil. Alcançar recuperação funcional além de salvar a extremidade amputada deve ser o objetivo da equipe médica, depois de resguardada a vida do paciente. Este é o relato dos cinco primeiros casos de reimplante de mão após amputações traumáticas completas na cidade de Manaus (AM, realizados no Hospital Pronto-Socorro Dr. João Lúcio Pereira Machado. Todos os pacientes eram homens jovens, média das idades de 22,8 anos, sendo admitidos na sala de emergência com amputação completa da mão por trauma inciso. Após medidas iniciais de acordo com o

Using cone-beam CT as a low-dose 3D imaging technique for the extremities: initial experience in 50 subjects

International Nuclear Information System (INIS)

Huang, Ambrose J.; Chang, Connie Y.; Palmer, William E.; Thomas, Bijoy J.; MacMahon, Peter J.

2015-01-01

To prospectively evaluate a dedicated extremity cone-beam CT (CBCT) scanner in cases with and without orthopedic hardware by (1) comparing its imaging duration and image quality to those of radiography and multidetector CT (MDCT) and (2) comparing its radiation dose to that of MDCT. Written informed consent was obtained for all subjects for this IRB-approved, HIPAA-compliant study. Fifty subjects with (1) fracture of small bones, (2) suspected intraarticular fracture, (3) fracture at the site of complex anatomy, or (4) a surgical site difficult to assess with radiography alone were recruited and scanned on an extremity CBCT scanner prior to FDA approval. Same-day radiographs were performed in all subjects. Some subjects also underwent MDCT within 1 month of CBCT. Imaging duration and image quality were compared between CBCT and radiographs. Imaging duration, effective radiation dose, and image quality were compared between CBCT and MDCT. Fifty-one CBCT scans were performed in 50 subjects. Average imaging duration was shorter for CBCT than radiographs (4.5 min vs. 6.6 min, P = 0.001, n = 51) and MDCT (7.6 min vs. 10.9 min, P = 0.01, n = 7). Average estimated effective radiation dose was less for CBCT than MDCT (0.04 mSv vs. 0.13 mSv, P = 0.02, n = 7). CBCT images yielded more diagnostic information than radiographs in 23/51 cases and more diagnostic information than MDCT in 1/7 cases, although radiographs were superior for detecting hardware complications. CBCT performs high-resolution imaging of the extremities using less imaging time than radiographs and MDCT and lower radiation dose than MDCT. (orig.)

Using cone-beam CT as a low-dose 3D imaging technique for the extremities: initial experience in 50 subjects

Energy Technology Data Exchange (ETDEWEB)

Huang, Ambrose J.; Chang, Connie Y.; Palmer, William E. [Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States); Thomas, Bijoy J. [Universal College of Medical Sciences, Department of Radiology, Bhairahawa (Nepal); MacMahon, Peter J. [Mater Misericordiae University Hospital, Department of Radiology, Dublin 7 (Ireland)

2015-06-01

To prospectively evaluate a dedicated extremity cone-beam CT (CBCT) scanner in cases with and without orthopedic hardware by (1) comparing its imaging duration and image quality to those of radiography and multidetector CT (MDCT) and (2) comparing its radiation dose to that of MDCT. Written informed consent was obtained for all subjects for this IRB-approved, HIPAA-compliant study. Fifty subjects with (1) fracture of small bones, (2) suspected intraarticular fracture, (3) fracture at the site of complex anatomy, or (4) a surgical site difficult to assess with radiography alone were recruited and scanned on an extremity CBCT scanner prior to FDA approval. Same-day radiographs were performed in all subjects. Some subjects also underwent MDCT within 1 month of CBCT. Imaging duration and image quality were compared between CBCT and radiographs. Imaging duration, effective radiation dose, and image quality were compared between CBCT and MDCT. Fifty-one CBCT scans were performed in 50 subjects. Average imaging duration was shorter for CBCT than radiographs (4.5 min vs. 6.6 min, P = 0.001, n = 51) and MDCT (7.6 min vs. 10.9 min, P = 0.01, n = 7). Average estimated effective radiation dose was less for CBCT than MDCT (0.04 mSv vs. 0.13 mSv, P = 0.02, n = 7). CBCT images yielded more diagnostic information than radiographs in 23/51 cases and more diagnostic information than MDCT in 1/7 cases, although radiographs were superior for detecting hardware complications. CBCT performs high-resolution imaging of the extremities using less imaging time than radiographs and MDCT and lower radiation dose than MDCT. (orig.)

[Decoronation management of the replacement resorption after delayed replantation of avulsed teeth-case report with 4-year follow-up].

Science.gov (United States)

Ruizhen, Fang; Siyi, Li; Lei, Gao; Li'an, Wu

2017-12-01

Replacement resorption is the most frequent complication after delayed replantation of avulsed teeth. The resorption can interfere with the development of the alveolar ridge and lead to tilt of the adjacent teeth in growing patients. However, there is no means of arresting or reversing the process. Recently decoronation is recommended by International Assocaition of Dental Traumatology as the optimal choice to manage it. This paper demonstrates the procedure and effectiveness of the decoronation by literature review and a case report with 4-year follow-up.

Classification and evaluation of the functional results of replanted parts of the hand at the Prince of Wales Hospital and the Prince of Wales Children's Hospital: 1984 to 1988.

Science.gov (United States)

Milroy, B C; Sackelariou, R P; Lendvay, P G; Baldwin, M R; McGlynn, M

1991-01-01

This paper describes a simple method of classification and evaluation of the functional results of replanted and revascularized parts in the hand. The results are presented in graphic form and have been analyzed to correlate various factors: injured part, cause, and zone (level) of injury. The type of injury, ischemic time and age have been studied in more detail to determine their influence of the final functional result. The series contains 187 amputated and devascularized parts of the hand in 119 patients who have undergone surgery at the Prince of Wales Hospital from 1984 through 1988. The length of cold or warm ischemic times, up to 16 hours in this series, while not affecting survival of the amputated part, does adversely affect the functional result. The survival rate of replanted parts in children was significantly less favorable than in adults, but the functional results were uniformly superior.

Ronald Malt or Chen Zhongwei: Who performed the first surgical replantation?

Science.gov (United States)

Fan, Ka-Wai

2018-01-01

This article discusses the contributions of the two pioneers of the surgical procedure of replantation-Ronald Malt in the US and Chen Zhongwei in China. Ronald Malt performed the reattachment surgery on a boy who had an accident in 1962, but he published his case report two years later in 1964. Chen Zhongwei performed a similar surgery on a worker who cut off his forearm in 1963, but he published his case report the same year. There is some debate about which one of these reputed surgeons should be given credit for being the first one to perform this breakthrough surgery, because although Malt was the first to perform the procedure, Zhongwei was the first to report it. To shed light on this controversy, criteria for scientific priority suggested by Ronald Vale and Anthony Hyman were applied. Although the criteria mainly favored Zhongwei as the pioneer of this procedure, he did not entirely fulfill one of the criteria. Therefore, the article could not present a definitive answer to the question, and it concludes by pointing out the highly commendable achievements and contributions of both Ronald Malt and Chen Zhongwei.

Type 2 diabetes and pre-diabetes are associated with obstructive sleep apnea in extremely obese subjects: A cross-sectional study

Directory of Open Access Journals (Sweden)

Røislien Jo

2011-09-01

Full Text Available Abstract Background Obstructive sleep apnea (OSA is a common yet underdiagnosed condition. The aim of our study is to test whether prediabetes and type 2 diabetes are associated with obstructive sleep apnea (OSA in extremely obese (BMI ≥ 40 kg/m2 subjects. Methods One hundred and thirty seven consecutive extremely obese patients (99 females from a controlled clinical trial [MOBIL-study (Morbid Obesity treatment, Bariatric surgery versus Intensive Lifestyle intervention Study (ClinicalTrials.gov number NCT00273104] underwent somnography with Embletta® and a 2-hour oral glucose tolerance test (OGTT. OSA was defined by an apnea-hypopnea index (AHI ≥ 5 events/hour. Patients were categorized into three groups according to criteria from the American Diabetes Association: normal glucose tolerance, pre-diabetes and type 2 diabetes. Multiple logistic regression analysis was used to identify possible determinants of OSA. Results The patients had a mean (SD age of 43 (11 years and a body mass index (BMI of 46.9 (5.7 kg/m2. Males had significantly higher AHI than females, 29 (25 vs 12 (17 events/hour, p Conclusions Type 2 diabetes and pre-diabetes are associated with OSA in extremely obese subjects. Trial registration MOBIL-study (Morbid Obesity treatment, Bariatric surgery versus Intensive Lifestyle intervention Study (ClinicalTrials.gov number NCT00273104

The Relationship Between Early-Stage Knee Osteoarthritis and Lower-Extremity Alignment, Joint Laxity, and Subjective Scores of Pain, Stiffness, and Function.

Science.gov (United States)

Hicks-Little, Charlie A; Peindl, Richard D; Hubbard-Turner, Tricia J; Cordova, Mitchell L

2016-08-01

Knee osteoarthritis (OA) is a debilitating disease that affects an estimated 27 million Americans. Changes in lower-extremity alignment and joint laxity have been found to redistribute the medial and/or lateral loads at the joint. However, the effect that changes in anteroposterior knee-joint laxity have on lower-extremity alignment and function in individuals with knee OA remains unclear. To examine anteroposterior knee-joint laxity, lower-extremity alignment, and subjective pain, stiffness, and function scores in individuals with early-stage knee OA and matched controls and to determine if a relationship exists among these measures. Case control. Sports-medicine research laboratory. 18 participants with knee OA and 18 healthy matched controls. Participants completed the Western Ontario McMaster (WOMAC) osteoarthritis questionnaire and were tested for total anteroposterior knee-joint laxity (A-P) and knee-joint alignment (ALIGN). WOMAC scores, A-P (mm), and ALIGN (°). A significant multivariate main effect for group (Wilks' Λ = 0.30, F7,26 = 8.58, P Knee-OA participants differed in WOMAC scores (P knee OA had worse pain, stiffness, and functional outcome scores than the matched controls; however, ALIGN and A-P were no different. There was no association identified among participants' subjective scores, ALIGN, or A-P measures in this study.

Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial.

Science.gov (United States)

Page, Stephen J; Hill, Valerie; White, Susan

2013-06-01

To compare the efficacy of a repetitive task-specific practice regimen integrating a portable, electromyography-controlled brace called the 'Myomo' versus usual care repetitive task-specific practice in subjects with chronic, moderate upper extremity impairment. Sixteen subjects (7 males; mean age 57.0 ± 11.02 years; mean time post stroke 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment. Subjects were administered repetitive task-specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30 minutes in duration, occurring 3 days/week for eight weeks. One group participated in repetitive task-specific practice entirely while wearing the portable robotic, while the other performed the same activity regimen manually. The upper extremity Fugl-Meyer, Canadian Occupational Performance Measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention. After intervention, groups exhibited nearly identical Fugl-Meyer score increases of ≈2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian Occupational Performance Measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale. Findings suggest that therapist-supervised repetitive task-specific practice integrating robotics is as efficacious as manual practice in subjects with moderate upper extremity impairment.

Comparison of the Effects of Walking with and without Nordic Pole on Upper Extremity and Lower Extremity Muscle Activation.

Science.gov (United States)

Shim, Je-Myung; Kwon, Hae-Yeon; Kim, Ha-Roo; Kim, Bo-In; Jung, Ju-Hyeon

2013-12-01

[Purpose] The aim of this study was to assess the effect of Nordic pole walking on the electromyographic activities of upper extremity and lower extremity muscles. [Subjects and Methods] The subjects were randomly divided into two groups as follows: without Nordic pole walking group (n=13) and with Nordic pole walking group (n=13). The EMG data were collected by measurement while the subjects walking on a treadmill for 30 minutes by measuring from one heel strike to the next. [Results] Both the average values and maximum values of the muscle activity of the upper extremity increased in both the group that used Nordic poles and the group that did not use Nordic poles, and the values showed statistically significant differences. There was an increase in the average value for muscle activity of the latissimus dorsi, but the difference was not statistically significant, although there was a statistically significant increase in its maximum value. The average and maximum values for muscle activity of the lower extremity did not show large differences in either group, and the values did not show any statistically significant differences. [Conclusion] The use of Nordic poles by increased muscle activity of the upper extremity compared with regular walking but did not affect the lower extremity.

The greenhouse effect and extreme weather

International Nuclear Information System (INIS)

Groenaas, Sigbjoern; Kvamstoe, Nils Gunnar

2002-01-01

The article asserts that an anthropogenic global warming is occurring. This greenhouse effect is expected to cause more occurrences of extreme weather. It is extremely difficult, however, to relate specific weather catastrophes to global warming with certainty, since such extreme weather conditions are rare historically. The subject is controversial. The article also discusses the public debate and the risk of floods

Christian Extremism as a Domestic Terror Threat

Science.gov (United States)

2011-05-19

extremism with cultural relativism to universally deem extremist actions as justified.8 Religious extremism and conflict are not new. Conceivably, as...legitimized this practice, they forfeited their legitimacy and moral authority to govern.” Rudolph went on to state that his actions were to “embarrass and...funerals?7 Religion remains a significantly complex and controversial subject within any social culture . Like any social construct, religion is subject

Sexuality in persons with lower extremity amputations.

Science.gov (United States)

Bodenheimer, C; Kerrigan, A J; Garber, S L; Monga, T N

2000-06-15

There is a paucity of information regarding sexual functioning in persons with lower extremity amputations. The purpose of this study was to describe sexual and psychological functioning and health status in persons with lower extremity amputation. Self-report surveys assessed sexual functioning (Derogatis Inventory), depression (Beck Depression Inventory, anxiety (State-Trait Anxiety Inventory), and health status (Health Status Questionnaire) in a convenience sample of 30 men with lower extremity amputations. Mean age of the participants was 57 years (range 32-79). Mean duration since amputation was 23 months (range 3-634 months). Twenty one subjects (70%) had trans-tibial and seven subjects (23%) had trans-femoral amputations. A majority of subjects were experiencing problems in several domains of sexual functioning. Fifty three percent (n = 16) of the subjects were engaged in sexual intercourse or oral sex at least once a month. Twenty seven percent (n = 8) were masturbating at least once a month. Nineteen subjects (63%) reported orgasmic problems and 67% were experiencing erectile difficulties. Despite these problems, interest in sex was high in over 90% of the subjects. There was no evidence of increased prevalence of depression or anxiety in these subjects when compared to other outpatient adult populations. Sexual problems were common in the subjects studied. Despite these problems, interest in sex remained high. Few investigations have been directed toward identifying the psychological and social factors that may contribute to these problems and more research with a larger population is needed in this area.

Extreme meteorological conditions

International Nuclear Information System (INIS)

Altinger de Schwarzkopf, M.L.

1983-01-01

Different meteorological variables which may reach significant extreme values, such as the windspeed and, in particular, its occurrence through tornadoes and hurricanes that necesarily incide and wich must be taken into account at the time of nuclear power plants' installation, are analyzed. For this kind of study, it is necessary to determine the basic phenomenum of design. Two criteria are applied to define the basic values of design for extreme meteorological variables. The first one determines the expected extreme value: it is obtained from analyzing the recurence of the phenomenum in a convened period of time, wich may be generally of 50 years. The second one determines the extreme value of low probability, taking into account the nuclear power plant's operating life -f.ex. 25 years- and considering, during said lapse, the occurrence probabilities of extreme meteorological phenomena. The values may be determined either by the deterministic method, which is based on the acknowledgement of the fundamental physical characteristics of the phenomena or by the probabilistic method, that aims to the analysis of historical statistical data. Brief comments are made on the subject in relation to the Argentine Republic area. (R.J.S.) [es

Event-adjusted evaluation of weather and climate extremes

Czech Academy of Sciences Publication Activity Database

Müller, Miloslav; Kašpar, Marek

2014-01-01

Roč. 14, č. 2 (2014), s. 473-483 ISSN 1561-8633 R&D Projects: GA ČR(CZ) GAP209/11/1990 Institutional support: RVO:68378289 Keywords : weather extreme * climate extreme * extremity evaluation * return period * generalized extreme value distribution * region of influence Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 1.735, year: 2014 http://www.nat-hazards- earth -syst-sci.net/14/473/2014/nhess-14-473-2014.pdf

Saphenous vein grafts for perforator flap salvage in autologous breast reconstruction.

Science.gov (United States)

Flores, Jaime I; Rad, Ariel N; Shridharani, Sachin M; Stapleton, Sahael M; Rosson, Gedge D

2009-01-01

Although the use of saphenous vein grafts in free-flap salvage and extremity replantation is relatively common, their use in breast reconstruction is rare. These two case reports represent extreme alternatives for breast reconstruction flap salvage. In our normal daily practice, the overwhelming majority of elective breast reconstructions proceed smoothly. However, the occasional patient may require saphenous vein graft flap rescue for completion of the reconstruction. (c) 2008 Wiley-Liss, Inc.

Upper extremity sensorimotor control among collegiate football players.

Science.gov (United States)

Laudner, Kevin G

2012-03-01

Injuries stemming from shoulder instability are very common among athletes participating in contact sports, such as football. Previous research has shown that increased laxity negatively affects the function of the sensorimotor system potentially leading to a pathological cycle of shoulder dysfunction. Currently, there are no data detailing such effects among football players. Therefore, the purpose of this study was to examine the differences in upper extremity sensorimotor control among football players compared with that of a control group. Forty-five collegiate football players and 70 male control subjects with no previous experience in contact sports participated. All the subjects had no recent history of upper extremity injury. Each subject performed three 30-second upper extremity balance trials on each arm. The balance trials were conducted in a single-arm push-up position with the test arm in the center of a force platform and the subjects' feet on a labile device. The trials were averaged, and the differences in radial area deviation between groups were analyzed using separate 1-way analyses of variance (p football players showed significantly more radial area deviation of the dominant (0.41 ± 1.23 cm2, p = 0.02) and nondominant arms (0.47 ± 1.63 cm2, p = 0.03) when compared with the control group. These results suggest that football players may have decreased sensorimotor control of the upper extremity compared with individuals with no contact sport experience. The decreased upper extremity sensorimotor control among the football players may be because of the frequent impacts accumulated during football participation. Football players may benefit from exercises that target the sensorimotor system. These findings may also be beneficial in the evaluation and treatment of various upper extremity injuries among football players.

Extremism from the perspective of a system approach

Directory of Open Access Journals (Sweden)

Zinchenko, Yury P.

2014-03-01

Full Text Available Extremism is seen as a complex, multilevel, and multicomponent phenomenon. The problems of modern science in understanding extremism are revealed. The following bases of extremism as a system phenomenon are singled out: social factors, latent extremism, and extremist acts. It is demonstrated that a system approach makes it possible to shape a notion of a subject as a system, to identify patterns of the manifestations of the given phenomenon, and to translate them into concrete practices.

Extremely deformable structures

CERN Document Server

2015-01-01

Recently, a new research stimulus has derived from the observation that soft structures, such as biological systems, but also rubber and gel, may work in a post critical regime, where elastic elements are subject to extreme deformations, though still exhibiting excellent mechanical performances. This is the realm of ‘extreme mechanics’, to which this book is addressed. The possibility of exploiting highly deformable structures opens new and unexpected technological possibilities. In particular, the challenge is the design of deformable and bi-stable mechanisms which can reach superior mechanical performances and can have a strong impact on several high-tech applications, including stretchable electronics, nanotube serpentines, deployable structures for aerospace engineering, cable deployment in the ocean, but also sensors and flexible actuators and vibration absorbers. Readers are introduced to a variety of interrelated topics involving the mechanics of extremely deformable structures, with emphasis on ...

The Future of Coral Reefs Subject to Rapid Climate Change: Lessons from Natural Extreme Environments

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Emma F. Camp

2018-02-01

Full Text Available Global climate change and localized anthropogenic stressors are driving rapid declines in coral reef health. In vitro experiments have been fundamental in providing insight into how reef organisms will potentially respond to future climates. However, such experiments are inevitably limited in their ability to reproduce the complex interactions that govern reef systems. Studies examining coral communities that already persist under naturally-occurring extreme and marginal physicochemical conditions have therefore become increasingly popular to advance ecosystem scale predictions of future reef form and function, although no single site provides a perfect analog to future reefs. Here we review the current state of knowledge that exists on the distribution of corals in marginal and extreme environments, and geographic sites at the latitudinal extremes of reef growth, as well as a variety of shallow reef systems and reef-neighboring environments (including upwelling and CO2 vent sites. We also conduct a synthesis of the abiotic data that have been collected at these systems, to provide the first collective assessment on the range of extreme conditions under which corals currently persist. We use the review and data synthesis to increase our understanding of the biological and ecological mechanisms that facilitate survival and success under sub-optimal physicochemical conditions. This comprehensive assessment can begin to: (i highlight the extent of extreme abiotic scenarios under which corals can persist, (ii explore whether there are commonalities in coral taxa able to persist in such extremes, (iii provide evidence for key mechanisms required to support survival and/or persistence under sub-optimal environmental conditions, and (iv evaluate the potential of current sub-optimal coral environments to act as potential refugia under changing environmental conditions. Such a collective approach is critical to better understand the future survival of

Book review: Extreme ocean waves

Science.gov (United States)

Geist, Eric L.

2011-01-01

‘‘Extreme Ocean Waves’’ is a collection of ten papers edited by Efim Pelinovsky and Christian Kharif that followed the April 2007 meeting of the General Assembly of the European Geosciences Union. A note on terminology: extreme waves in this volume broadly encompass different types of waves, includ- ing deep-water and shallow-water rogue waves (alternatively termed freak waves), storm surges from cyclones, and internal waves. Other types of waves such as tsunamis or rissaga (meteotsunamis) are not discussed in this volume. It is generally implied that ‘‘extreme’’ has a statistical connotation relative to the average or significant wave height specific to each type of wave. Throughout the book, in fact, the reader will find a combination of theoretical and statistical/ empirical treatment necessary for the complete examination of this subject. In the introduction, the editors underscore the importance of studying extreme waves, documenting several dramatic instances of damaging extreme waves that occurred in 2007. 

The personal dispositions of violent extremism

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Davydov D.G.

2017-04-01

Full Text Available The paper presents the differences in the nature of extremism and radicalism, and the necessity of introducing the concept of "violent extremism." It is shown that the ideology is the explanation of extremist behavior, rather than its cause. The ideology of extremism often eclectic, contradictory and can easily be transformed by changing the object of hostility, depending on the situation. For the description of the psychological causes of extremism it is proposed to use the concept of personal disposition. Disposition is the preferred way to subjective interpretation of reality and reflects both the specific needs of a person as well the typical social situations where it realized and personal experience. Considered the following dispositions of violent extremism: the Cult of force and aggression, Intolerance, Out-group hostility Conventional coercion, Social pessimism and destructiveness, Mystical, Fighting and overcoming, Nihilism to law, Anti-subjectivism. It is proposed to use these dispositions as diagnostic criteria and for preventing and correcting.

[Lower extremity amputation rates in diabetic patients].

Science.gov (United States)

Cisneros-González, Nelly; Ascencio-Montiel, Iván Jesús; Libreros-Bango, Vita Norma; Rodríguez-Vázquez, Héctor; Campos-Hernández, Ángel; Dávila-Torres, Javier; Kumate-Rodríguez, Jesús; Borja-Aburto, Víctor Hugo

2016-01-01

The lower extremity amputations diminish the quality of life of patients with Diabetes Mellitus (DM). The aim of this study was to describe the lower extremity amputation rates in subjects with DM in the Mexican Social Security Institute (IMSS), comparing 2004 and 2013. A comparative cross-sectional study was done. Amputations were identified from the hospital records of System of Medical Statistics (DataMart). The DM patient census was obtained from the System of Integral Attention to Health. Major and minor amputations rates were expressed per 100,000 DM patients. We observed 2 334 340 and 3 416 643 DM patients during 2004 and 2013, respectively. The average age at the time of the amputation was similar in 2004 and 2013 (61.7 and 65.6 years old for minor and major amputations respectively). The major amputations rates were 100.9 and 111.1 per 100 000 subjects with DM in during 2004 and 2013 (p = 0.001); while minor amputations rates were 168.8 and 162.5 per 100 000 subjects with DM in during 2004 and 2013 respectively (p = 0.069). The lower extremity amputations rates at IMSS are very high compared with that reported in developed countries. The major amputations rate increased in 2013 compared with 2004.

Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive-regenerative therapy.

Science.gov (United States)

Pohl, Yango; Filippi, Andreas; Kirschner, Horst

2005-04-01

The status of the periodontal ligament (PDL) and of the pulp are decisive for the healing of avulsed and replanted teeth. A tooth rescue box was developed and distributed to offer optimal storage conditions for avulsed teeth. The therapy comprised extraoral endodontic treatment and applications of medicaments to enhance periodontal healing. In this long-term clinical study the healing results following avulsion and replantation were investigated. Twenty-eight permanent teeth in 24 patients were evaluated. The extraoral storage media and periods varied considerably. Soon after avulsion six teeth were stored in a cell culture medium (tooth rescue box Dentosafe) for 1-53 h; the PDL was defined as not compromised. Sixteen teeth were stored in a non-physiologic situation temporarily, the PDL was considered as compromised. Six teeth were stored in non-physiologic conditions for longer periods; the condition of the PDL was defined as hopeless. On 14 teeth antiresorptive-regenerative therapy (ART) with the local application of glucocorticoids and enamel matrix derivative and the systemic administration of doxycyclin was used. In all teeth extraoral endodontic treatment by retrograde insertion of posts was performed. The mean observation period was 31.2 months (+/-24.1; 5.1-100.2; median: 23.8). All six teeth rescued physiologically healed with a functional PDL (functional healing, FH) irrespective of the storage period. Of eight teeth with a compromised PDL on which ART was used, three teeth healed with a functional PDL. All other teeth showed replacement resorption, in three teeth additionally infection-related resorption was recorded. The predominant influence on the healing results was the immediate physiologic rescue of avulsed teeth (chi-square, P = 0.0001). The use of ART seemed to support FH (chi-square, P = 0.0547) in teeth with a compromised PDL. No other factors (maturity of roots, crown fractures, gender, age, antibiotics) were related to healing. In a linear

Rhizobial characterization in revegetated areas after bauxite mining

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Wardsson Lustrino Borges

2016-06-01

Full Text Available Abstract Little is known regarding how the increased diversity of nitrogen-fixing bacteria contributes to the productivity and diversity of plants in complex communities. However, some authors have shown that the presence of a diverse group of nodulating bacteria is required for different plant species to coexist. A better understanding of the plant symbiotic organism diversity role in natural ecosystems can be extremely useful to define recovery strategies of environments that were degraded by human activities. This study used ARDRA, BOX-PCR fingerprinting and sequencing of the 16S rDNA gene to assess the diversity of root nodule nitrogen-fixing bacteria in former bauxite mining areas that were replanted in 1981, 1985, 1993, 1998, 2004 and 2006 and in a native forest. Among the 12 isolates for which the 16S rDNA gene was partially sequenced, eight, three and one isolate(s presented similarity with sequences of the genera Bradyrhizobium, Rhizobium and Mesorhizobium, respectively. The richness, Shannon and evenness indices were the highest in the area that was replanted the earliest (1981 and the lowest in the area that was replanted most recently (2006.

TECHNIQUE OF EXTRACORPOREAL PARTIAL NEPHRECTOMY IN TERMS OF PHARMACO-COLD ISCHEMIA WITHOUT CROSSING THE URETER WITH RENAL VESSELS ORTHOTOPIC REPLANTATION IN PATIENTS WITH RENAL CELL CARCINOMA

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Alexander Gritskevitch

2015-01-01

Full Text Available Background. The most difficult is to determine medical tactics in patients with renal cell carcinoma (RCC with intraparenchimal and central localization in the single, the only functioning kidney, as well as with a combination of tumor and other illnesses in contralateral kidney. Partial nephrectomy leading to renal replacement therapy results in life-threatening complications and poor prognosis. The priority is to develop organ-preserving treatment: from minimally invasive endoscopic surgery to ex vivo kidney resection. Aim: to develop a technique of extracorporeal partial nephrectomy in terms of pharmaco-cold ischemia without crossing the ureter with renal vessels orthotopic replantation in patients with RCC. Materials and methods. The study included 37 patients with pT1a-T3vN0M0-1G1-3 RCC with intraparenchymal and central tumor location. The average age of the patients was 55.32 ± 13.1 years. The ratio of men and women - 2.7:1. Bilateral renal tumors were observed in 3 (8.1% patients, and the RCC of the single functioning kidney in 6 (16.2% patients. One patient (2.7% was diagnosed RCC of a single kidney with intraluminal invasion (cava-renal form. Results. The mean operation time was 413.97 ± 89.14 minutes. The mean warm ischemia time – 8.39 ± 4.75 minutes. Cold ischemia lasted from 70 to 240 minutes, on the average 151.41 ± 41.29 min. The amount of blood loss made up 729.03 ± 481.4 ml. Perioperative complications were detected in 3 (8.1% patients. In two cases after starting the renal blood flow the kidney was found to be nonviable and had to be removed. And in one case the recurrent prosthetic thrombosis of the renal artery resulted in a renal scarring. Postoperative complications were observed in 18 (48.6% patients. According to Clavien-Dindo classification there were 8 low grade (I-II degree complications (44.4%, 8 other of III degree, and one IV degree complication, and there was one lethal case (V degree. Conclusion

Problèmes entomologiques en replantation des palmeraies et des cocoteraies

Directory of Open Access Journals (Sweden)

Mariau Dominique

2000-03-01

Full Text Available C’est aux alentours de la vingt-cinquième année que l’on envisage de replanter une palmeraie. C’est en effet vers cet âge que commencent à se poser des problèmes de récolte en raison de la taille des palmiers. En un quart de siècle, l’amélioration génétique aura suffisamment fait de progrès pour escompter un gain de production de l’ordre de 20%. Enfin, dans certaines situations, plusieurs maladies ont pu affecter les vieilles palmeraies. Avec de 15 à 25% d’arbres manquants, principalement lorsque ceux-ci se présentent sous la forme de taches, une diminution de la production se fait nettement sentir. Cela peut, par exemple, être le cas avec les maladies de la fusariose en Afrique de l’Ouest, lorsque la palmeraie n’a pas été plantée avec du matériel végétal tolérant, ou du ganoderma en Malaisie. Le renouvellement des cocoteraies se fait avec un espace de temps beaucoup plus long. En effet, la récolte des noix peut se faire au sol et la hauteur des cocotiers n’est donc pas un facteur limitant. Par ailleurs, la majorité des cocoteraies étant sous la forme de petites plantations villageoises, les agriculteurs rechignent toujours à abattre leurs cocotiers, même si des semences potentiellement plus productives leurs sont proposées. Ce sont les raisons pour lesquelles les cocoteraies de 50 ans et plus représentent la règle. L’abattage d’une plantation de palmiers à huile ou de cocotiers constitue naturellement un changement brutal de l’environnement, ce qui a des conséquences importantes notamment sur l’entomofaune, parmi laquelle des ravageurs majeurs ainsi que leurs ennemis naturels.

Near-horizon symmetries of extremal black holes

International Nuclear Information System (INIS)

Kunduri, Hari K; Lucietti, James; Reall, Harvey S

2007-01-01

Recent work has demonstrated an attractor mechanism for extremal rotating black holes subject to the assumption of a near-horizon SO(2, 1) symmetry. We prove the existence of this symmetry for any extremal black hole with the same number of rotational symmetries as known four- and five-dimensional solutions (including black rings). The result is valid for a general two-derivative theory of gravity coupled to Abelian vectors and uncharged scalars, allowing for a non-trivial scalar potential. We prove that it remains valid in the presence of higher-derivative corrections. We show that SO(2, 1)-symmetric near-horizon solutions can be analytically continued to give SU(2)-symmetric black hole solutions. For example, the near-horizon limit of an extremal 5D Myers-Perry black hole is related by analytic continuation to a non-extremal cohomogeneity-1 Myers-Perry solution

The influence of extreme traumatization on body, mind and social relations

DEFF Research Database (Denmark)

Rosenbaum, Bent; Varvin, Sverre

2007-01-01

Extreme traumatization affects the individual's relation to others in several social and psychological ways. The post-traumatic experiences are characterized by helplessness, insecurity, anxiety, loss of basic trust, and fragmentation of perspectives on one's own life. Special considerations should......, the subject-group dimension, and the subject-discourse dimension. All three dimensions have specific structural characteristics that are expressed in the analytic relation. Extreme trauma causes disturbances in each of these dimensions. The authors present clinical material from a traumatized refugee...

Extremal solutions of measure differential equations

Czech Academy of Sciences Publication Activity Database

Monteiro, Giselle Antunes; Slavík, A.

2016-01-01

Roč. 444, č. 1 (2016), s. 568-597 ISSN 0022-247X Institutional support: RVO:67985840 Keywords : measure differential equations * extremal solution * lower solution Subject RIV: BA - General Mathematics Impact factor: 1.064, year: 2016 http://www.sciencedirect.com/science/article/pii/S0022247X16302724

Extreme Weather and Climate: Workshop Report

Science.gov (United States)

Sobel, Adam; Camargo, Suzana; Debucquoy, Wim; Deodatis, George; Gerrard, Michael; Hall, Timothy; Hallman, Robert; Keenan, Jesse; Lall, Upmanu; Levy, Marc;

Enemies within: Christian Extremism, a Threat to the Homeland

Science.gov (United States)

2016-06-10

promotes fear of Muslim radical groups that perpetuate violence in the name of religion , while ignoring the threat Christian extremism poses on...those within the homeland that threaten the very liberty and freedom intended by the founding fathers for all Americans. This thesis and many more...the safety and freedom of Americans are protected. 15. SUBJECT TERMS Christian Extremism 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF

Standardized voluntary force measurement in a lower extremity rehabilitation robot

Directory of Open Access Journals (Sweden)

Bolliger Marc

2008-10-01

Full Text Available Abstract Background Isometric force measurements in the lower extremity are widely used in rehabilitation of subjects with neurological movement disorders (NMD because walking ability has been shown to be related to muscle strength. Therefore muscle strength measurements can be used to monitor and control the effects of training programs. A new method to assess isometric muscle force was implemented in the driven gait orthosis (DGO Lokomat. To evaluate the capabilities of this new measurement method, inter- and intra-rater reliability were assessed. Methods Reliability was assessed in subjects with and without NMD. Subjects were tested twice on the same day by two different therapists to test inter-rater reliability and on two separate days by the same therapist to test intra-rater reliability. Results Results showed fair to good reliability for the new measurement method to assess isometric muscle force of lower extremities. In subjects without NMD, intraclass correlation coefficients (ICC for inter-rater reliability ranged from 0.72 to 0.97 and intra-rater reliability from 0.71 to 0.90. In subjects with NMD, ICC ranged from 0.66 to 0.97 for inter-rater and from 0.50 to 0.96 for intra-rater reliability. Conclusion Inter- and intra- rater reliability of an assessment method for measuring maximal voluntary isometric muscle force of lower extremities was demonstrated. We suggest that this method is a valuable tool for documentation and controlling of the rehabilitation process in patients using a DGO.

Extreme Conditions Modeling Workshop Report

Energy Technology Data Exchange (ETDEWEB)

Coe, Ryan Geoffrey [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Neary, Vincent Sinclair [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Lawon, Michael J. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Yu, Yi-Hsiang [National Renewable Energy Lab. (NREL), Golden, CO (United States); Weber, Jochem [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2014-07-01

Sandia National Laboratories (SNL) and the National Renewable Energy Laboratory (NREL) hosted the Wave Energy Converter (WEC) Extreme Conditions Modeling (ECM) Workshop in Albuquerque, New Mexico on May 13–14, 2014. The objective of the workshop was to review the current state of knowledge on how to numerically and experimentally model WECs in extreme conditions (e.g. large ocean storms) and to suggest how national laboratory resources could be used to improve ECM methods for the benefit of the wave energy industry. More than 30 U.S. and European WEC experts from industry, academia, and national research institutes attended the workshop, which consisted of presentations from W EC developers, invited keynote presentations from subject matter experts, breakout sessions, and a final plenary session .

The effects of hip external rotator exercises and toe-spread exercises on lower extremity muscle activities during stair-walking in subjects with pronated foot.

Science.gov (United States)

Goo, Young-Mi; Kim, Da-Yeon; Kim, Tae-Ho

2016-03-01

[Purpose] The purpose of the present study was to examine the effects of toe-spread (TS) exercises and hip external rotator strengthening exercises for pronated feet on lower extremity muscle activities during stair-walking. [Subjects and Methods] The participants were 20 healthy adults with no present or previous pain, no past history of surgery on the foot or the ankle, and no foot deformities. Ten subjects performed hip external rotator strengthening exercises and TS exercises and the remaining ten subjects performed only TS exercises five times per week for four weeks. [Results] Less change in navicular drop height occurred in the group that performed hip external rotator exercises than in the group that performed only TS exercises. The group that performed only TS exercises showed increased abductor hallucis muscle activity during both stair-climbing and -descending, and the group that performed hip external rotator exercises showed increased muscle activities of the vastus medialis and abductor hallucis during stair-climbing and increased muscle activity of only the abductor hallucis during stair-descending after exercise. [Conclusion] Stair-walking can be more effectively performed if the hip external rotator muscle is strengthened when TS exercises are performed for the pronated foot.

Results of a prospective randomized controlled trial of early ambulation for patients with lower extremity autografts.

Science.gov (United States)

Lorello, David John; Peck, Michael; Albrecht, Marlene; Richey, Karen J; Pressman, Melissa A

2014-01-01

It is common practice to keep those patients with lower extremity autografts immobile until post-operative day (POD) 5. There is however inherent risks associated with even short periods of immobility. As of now there are no randomized controlled trials looking at early ambulation of patients with lower extremity autografts in the burn community.The objective of this study was to show that patients who begin ambulation within 24 hours of lower extremity autografting will have no increased risk of graft failure than those patients who remain immobile until POD 5. Thirty-one subjects who received autografts to the lower extremity were randomized after surgery into either the early ambulation group (EAG;17 subjects) or the standard treatment group (STG;14 subjects). Those subjects randomized to the EAG began ambulating with physical therapy on POD 1. Subjects in the STG maintained bed rest until POD 5. There was no difference in the number of patients with graft loss in either the EAG or STG on POD 5, and during any of the follow-up visits. No subjects required regrafting. There was a significant difference in the mean minutes of ambulation, with the EAG ambulating longer than the STG (EAG 23.4 minutes [SD 12.03], STG 14.1 [SD 9.00], P=.0235) on POD 5. Burn patients with lower extremity autografts can safely ambulate on POD 1 without fear of graft failure compared with those patients that remain on bed rest for 5 days.

Rhizobial characterization in revegetated areas after bauxite mining.

Science.gov (United States)

Borges, Wardsson Lustrino; Prin, Yves; Ducousso, Marc; Le Roux, Christine; de Faria, Sergio Miana

2016-01-01

Little is known regarding how the increased diversity of nitrogen-fixing bacteria contributes to the productivity and diversity of plants in complex communities. However, some authors have shown that the presence of a diverse group of nodulating bacteria is required for different plant species to coexist. A better understanding of the plant symbiotic organism diversity role in natural ecosystems can be extremely useful to define recovery strategies of environments that were degraded by human activities. This study used ARDRA, BOX-PCR fingerprinting and sequencing of the 16S rDNA gene to assess the diversity of root nodule nitrogen-fixing bacteria in former bauxite mining areas that were replanted in 1981, 1985, 1993, 1998, 2004 and 2006 and in a native forest. Among the 12 isolates for which the 16S rDNA gene was partially sequenced, eight, three and one isolate(s) presented similarity with sequences of the genera Bradyrhizobium, Rhizobium and Mesorhizobium, respectively. The richness, Shannon and evenness indices were the highest in the area that was replanted the earliest (1981) and the lowest in the area that was replanted most recently (2006). Copyright © 2016 Sociedade Brasileira de Microbiologia. Published by Elsevier Editora Ltda. All rights reserved.

Assessing functional mobility in survivors of lower-extremity sarcoma: reliability and validity of a new assessment tool.

Science.gov (United States)

Marchese, Victoria G; Rai, Shesh N; Carlson, Claire A; Hinds, Pamela S; Spearing, Elena M; Zhang, Lijun; Callaway, Lulie; Neel, Michael D; Rao, Bhaskar N; Ginsberg, Jill P

2007-08-01

Reliability and validity of a new tool, Functional Mobility Assessment (FMA), were examined in patients with lower-extremity sarcoma. FMA requires the patients to physically perform the functional mobility measures, unlike patient self-report or clinician administered measures. A sample of 114 subjects participated, 20 healthy volunteers and 94 patients with lower-extremity sarcoma after amputation, limb-sparing, or rotationplasty surgery. Reliability of the FMA was examined by three raters testing 20 healthy volunteers and 23 subjects with lower-extremity sarcoma. Concurrent validity was examined using data from 94 subjects with lower-extremity sarcoma who completed the FMA, Musculoskeletal Tumor Society (MSTS), Short-Form 36 (SF-36v2), and Toronto Extremity Salvage Scale (TESS) scores. Construct validity was measured by the ability of the FMA to discriminate between subjects with and without functional mobility deficits. FMA demonstrated excellent reliability (ICC [2,1] >or=0.97). Moderate correlations were found between FMA and SF-36v2 (r = 0.60, P < 0.01), FMA and MSTS (r = 0.68, P < 0.01), and FMA and TESS (r = 0.62, P < 0.01). The patients with lower-extremity sarcoma scored lower on the FMA as compared to healthy controls (P < 0.01). The FMA is a reliable and valid functional outcome measure for patients with lower-extremity sarcoma. This study supports the ability of the FMA to discriminate between patients with varying functional abilities and supports the need to include measures of objective functional mobility in examination of patients with lower-extremity sarcoma.

Stereology of extremes; bivariate models and computation

Czech Academy of Sciences Publication Activity Database

Beneš, Viktor; Bodlák, M.; Hlubinka, D.

2003-01-01

Roč. 5, č. 3 (2003), s. 289-308 ISSN 1387-5841 R&D Projects: GA AV ČR IAA1075201; GA ČR GA201/03/0946 Institutional research plan: CEZ:AV0Z1075907 Keywords : sample extremes * domain of attraction * normalizing constants Subject RIV: BA - General Mathematics

The Relation Between Visual Impairment and Extremity Fractures

Directory of Open Access Journals (Sweden)

Berrak Şekeryapan

2013-08-01

Full Text Available Purpose: To evaluate the association between the development of extremity fracture and visual impairment in adults. Material and Method: This study included 56 patients (patient group aged 18 years or older who had extremity fractures due to a fall. The control group (n=42 was selected from visitors who had regular medical check-ups at our hospital. Each participant underwent a full ophthalmologic examination. Mean age was compared by Student’s t test. The other variables were compared by chi-square test. Results: The prevalence of subjects with visual impairment was significantly higher in the patients group (78.6% than in the control group (38.1% (p<0.05. The prevalence of treatable eye diseases such as cataract and refractive errors were significantly higher in the patient group than in the control group (p<0.05 for both. Twenty-eight patients (50% in the patient group and 8 subjects in the control group had visual acuities lower than 0.5 (p<0.05. Discussion: We have found that the prevalence of visual impairment was significantly higher in adults with extremity fractures due to falls than in the control group. Hence, we believe that regular ophthalmological examination in adults, providing regular use of eyeglasses in patients with refractive errors, and timely treatment of treatable eye diseases such as cataract could decrease the extremity fractures from falls in adults. (Turk J Ophthalmol 2013; 43: 250-2

Thermodynamic extremal principles for irreversible processes in materials science

Czech Academy of Sciences Publication Activity Database

Fischer, F. D.; Svoboda, Jiří; Petryk, H.

2014-01-01

Roč. 67, APR (2014), s. 1-20 ISSN 1359-6454 Institutional support: RVO:68081723 Keywords : Non- equilibrium * Thermodynamics * Entropy * Onsager's principle * Thermodynamic extremal principles Subject RIV: BJ - Thermodynamics Impact factor: 4.465, year: 2014

Wind simulation for extreme and fatigue loads

Energy Technology Data Exchange (ETDEWEB)

Nielsen, M.; Larsen, G.C.; Mann, J.; Ott, S.; Hansen, K.S.; Pedersen, B.J.

2004-01-01

Measurements of atmospheric turbulence have been studied and found to deviate from a Gaussian process, in particular regarding the velocity increments over small time steps, where the tails of the pdf are exponential rather than Gaussian. Principles for extreme event counting and the occurrence of cascading events are presented. Empirical extreme statistics agree with Rices exceedence theory, when it is assumed that the velocity and its time derivative are independent. Prediction based on the assumption that the velocity is a Gaussian process underpredicts the rate of occurrence of extreme events by many orders of magnitude, mainly because the measured pdf is non-Gaussian. Methods for simulation of turbulent signals have been developed and their computational efficiency are considered. The methods are applicable for multiple processes with individual spectra and probability distributions. Non-Gaussian processes are simulated by the correlation-distortion method. Non-stationary processes are obtained by Bezier interpolation between a set of stationary simulations with identical random seeds. Simulation of systems with some signals available is enabled by conditional statistics. A versatile method for simulation of extreme events has been developed. This will generate gusts, velocity jumps, extreme velocity shears, and sudden changes of wind direction. Gusts may be prescribed with a specified ensemble average shape, and it is possible to detect the critical gust shape for a given construction. The problem is formulated as the variational problem of finding the most probable adjustment of a standard simulation of a stationary Gaussian process subject to relevant event conditions, which are formulated as linear combination of points in the realization. The method is generalized for multiple correlated series, multiple simultaneous conditions, and 3D fields of all velocity components. Generalization are presented for a single non-Gaussian process subject to relatively

Workshop on extremely high energy density plasmas and their diagnostics

Energy Technology Data Exchange (ETDEWEB)

Ishii, Shozo (ed.)

2001-09-01

Compiled are the papers presented at the workshop on 'Extremely High Energy Density Plasmas and Their Diagnostics' held at National Institute for Fusion Science. The papers cover physics and applications of extremely high-energy density plasmas such as dense z-pinch, plasma focus, and intense pulsed charged beams. Separate abstracts were presented for 7 of the papers in this report. The remaining 25 were considered outside the subject scope of INIS. (author)

Workshop on extremely high energy density plasmas and their diagnostics

International Nuclear Information System (INIS)

Ishii, Shozo

2001-09-01

Compiled are the papers presented at the workshop on 'Extremely High Energy Density Plasmas and Their Diagnostics' held at National Institute for Fusion Science. The papers cover physics and applications of extremely high-energy density plasmas such as dense z-pinch, plasma focus, and intense pulsed charged beams. Separate abstracts were presented for 7 of the papers in this report. The remaining 25 were considered outside the subject scope of INIS. (author)

Upper extremity golf injuries.

Science.gov (United States)

Cohn, Michael A; Lee, Steven K; Strauss, Eric J

2013-01-01

Golf is a global sport enjoyed by an estimated 60 million people around the world. Despite the common misconception that the risk of injury during the play of golf is minimal, golfers are subject to a myriad of potential pathologies. While the majority of injuries in golf are attributable to overuse, acute traumatic injuries can also occur. As the body's direct link to the golf club, the upper extremities are especially prone to injury. A thorough appreciation of the risk factors and patterns of injury will afford accurate diagnosis, treatment, and prevention of further injury.

A two-component generalized extreme value distribution for precipitation frequency analysis

Czech Academy of Sciences Publication Activity Database

Rulfová, Zuzana; Buishand, A.; Roth, M.; Kyselý, Jan

2016-01-01

Roč. 534, March (2016), s. 659-668 ISSN 0022-1694 R&D Projects: GA ČR(CZ) GA14-18675S Institutional support: RVO:68378289 Keywords : precipitation extremes * two-component extreme value distribution * regional frequency analysis * convective precipitation * stratiform precipitation * Central Europe Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 3.483, year: 2016 http://www.sciencedirect.com/science/article/pii/S0022169416000500

Ear replanatation: a case report and literature review

Directory of Open Access Journals (Sweden)

Krešimir Božikov

2013-10-01

Full Text Available Background: Total ear amputation is a rare accident. The most common causes are traffic accidents (33 %, followed by fights (28 %. In 1980, Pennington et al. reported the first successful microsurgical ear replantation in a 29-year old man.Methods: An English literature review of trauma cases of total ear amputation showed only 13 successful replantations with arterial and venous microanastomoses. We present a case report of successful total ear replantation with arterial and vein microanastomoses in a 17-year old boy.Results: Our ear replantation with both arterial and venous anastomoses performed was successful and we achieved an excellent aesthetic outcome.Conclusion: The reason for such a low number of successful ear replantations is technical challenge due to small vessel diameter, difficult vessel identification, vessel approach and concomitant avulsion injury. The best aesthetic result in ear reconstruction is achieved by microsurgical replantation. The surgical technique depends on the intraoperative findings. Since ear replantation is a very challenging procedure, a microsurgeon needs to discuss with the patient the risk of partial/total necrosis of the replanted ear and the possibilities of other reconstructive options.

Effects of long-term continuous cropping on soil nematode community and soil condition associated with replant problem in strawberry habitat

Science.gov (United States)

Li, Xingyue; Lewis, Edwin E.; Liu, Qizhi; Li, Heqin; Bai, Chunqi; Wang, Yuzhu

2016-08-01

Continuous cropping changes soil physiochemical parameters, enzymes and microorganism communities, causing “replant problem” in strawberry cultivation. We hypothesized that soil nematode community would reflect the changes in soil conditions caused by long-term continuous cropping, in ways that are consistent and predictable. To test this hypothesis, we studied the soil nematode communities and several soil parameters, including the concentration of soil phenolic acids, organic matter and nitrogen levels, in strawberry greenhouse under continuous-cropping for five different durations. Soil pH significantly decreased, and four phenolic acids, i.e., p-hydroxybenzoic acid, ferulic acid, cinnamic acid and p-coumaric acid, accumulated with time under continuous cropping. The four phenolic acids were highly toxic to Acrobeloides spp., the eudominant genus in non-continuous cropping, causing it to reduce to a resident genus after seven-years of continuous cropping. Decreased nematode diversity indicated loss of ecosystem stability and sustainability because of continuous-cropping practice. Moreover, the dominant decomposition pathway was altered from bacterial to fungal under continuous cropping. Our results suggest that along with the continuous-cropping time in strawberry habitat, the soil food web is disturbed, and the available plant nutrition as well as the general health of the soil deteriorates; these changes can be indicated by soil nematode community.

Sensitivity of European wheat to extreme weather

Czech Academy of Sciences Publication Activity Database

Mäkinen, H.; Kaseva, J.; Trnka, Miroslav; Balek, Jan; Kersebaum, K. C.; Nendel, C.; Gobin, A.; Olesen, J. E.; Bindi, M.; Ferrise, R.; Moriondo, M.; Rodríguez, A.; Ruiz-Ramos, M.; Takáč, J.; Bezák, P.; Ventrella, D.; Ruget, F.; Capellades, G.; Kahiluoto, H.

2018-01-01

Roč. 222, jun (2018), s. 209-217 ISSN 0378-4290 R&D Projects: GA MŠk(CZ) LO1415; GA MZe(CZ) QJ1610072 Institutional support: RVO:86652079 Keywords : Climate change * Cultivar * European wheat * Extreme * Weather * Yield response Subject RIV: DG - Athmosphere Sciences, Meteorology OBOR OECD: Meteorology and atmospheric sciences Impact factor: 3.048, year: 2016

Effects of aquatic PNF lower extremity patterns on balance and ADL of stroke patients

OpenAIRE

Kim, Eun-Kyung; Lee, Dong-Kyu; Kim, Young-Mi

2015-01-01

[Purpose] This study investigated the effect of aquatic proprioceptive neuromuscular facilitation (PNF) patterns in the lower extremity on balance and activities of daily living (ADL) in stroke patients. [Subjects] Twenty poststroke participants were randomly assigned to an experimental group (n = 10) or a control group (n = 10). The experimental group performed lower extremity patterns in an aquatic environment, and the control group performed lower extremity patterns on the ground. Both exe...

Medical and psychosocial implications of adolescent extreme obesity - acceptance and effects of structured care, short: Youth with Extreme Obesity Study (YES).

Science.gov (United States)

Wabitsch, Martin; Moss, Anja; Reinehr, Thomas; Wiegand, Susanna; Kiess, Wieland; Scherag, André; Holl, Reinhard; Holle, Rolf; Hebebrand, Johannes

2013-08-29

Prevalence rates of overweight and obesity have increased in German children and adolescents in the last three decades. Adolescents with extreme obesity represent a distinct risk group. On the basis of data obtained by the German Child and Youth Survey (KiGGS) and the German district military offices we estimate that the group of extremely obese adolescents (BMI ≥ 35 kg/m2) currently encompasses approximately 200.000 adolescents aged 14 to 21 yrs. Conventional approaches focusing on weight reduction have largely proven futile for them. In addition, only a small percentage of adolescents with extreme obesity seek actively treatment for obesity while contributing disproportionately strong to health care costs. Because of somatic and psychiatric co-morbidities and social problems adolescents with extreme obesity require special attention within the medical care system. We have initiated the project "Medical and psychosocial implications of adolescents with extreme obesity--acceptance and effects of structured care, short: 'Youths with Extreme Obesity Study (YES)'", which aims at improving the medical care and social support structures for youths with extreme obesity in Germany. We focus on identification of these subjects (baseline examination) and their acceptance of diagnostic and subsequent treatment procedures. In a randomized controlled trial (RCT) we will investigate the effectiveness of a low key group intervention not focusing on weight loss but aimed at the provision of obesity related information, alleviation of social isolation, school and vocational integration and improvement of self-esteem in comparison to a control group treated in a conventional way with focus on weight loss. Interested individuals who fulfill current recommended criteria for weight loss surgery will be provided with a structured preparation and follow-up programs. All subjects will be monitored within a long-term observational study to elucidate medical and psychosocial outcomes

Thermal discomfort with cold extremities in relation to age, gender, and body mass index in a random sample of a Swiss urban population

Directory of Open Access Journals (Sweden)

Orgül Selim

2010-06-01

Full Text Available Abstract Background The aim of this epidemiological study was to investigate the relationship of thermal discomfort with cold extremities (TDCE to age, gender, and body mass index (BMI in a Swiss urban population. Methods In a random population sample of Basel city, 2,800 subjects aged 20-40 years were asked to complete a questionnaire evaluating the extent of cold extremities. Values of cold extremities were based on questionnaire-derived scores. The correlation of age, gender, and BMI to TDCE was analyzed using multiple regression analysis. Results A total of 1,001 women (72.3% response rate and 809 men (60% response rate returned a completed questionnaire. Statistical analyses revealed the following findings: Younger subjects suffered more intensely from cold extremities than the elderly, and women suffered more than men (particularly younger women. Slimmer subjects suffered significantly more often from cold extremities than subjects with higher BMIs. Conclusions Thermal discomfort with cold extremities (a relevant symptom of primary vascular dysregulation occurs at highest intensity in younger, slimmer women and at lowest intensity in elderly, stouter men.

Adaptive Control of a Wearable Exoskeleton for Upper-Extremity Neurorehabilitation

Directory of Open Access Journals (Sweden)

Sivakumar Balasubramanian

2012-01-01

Full Text Available The paper describes the implementation and testing of two adaptive controllers developed for a wearable, underactuated upper extremity therapy robot – RUPERT (Robotic Upper Extremity Repetitive Trainer. The controllers developed in this study were used to implement two adaptive robotic therapy modes – the adaptive co-operative mode and the adaptive active-assist mode – that are based on two different approaches for providing robotic assistance for task practice. The adaptive active-assist mode completes therapy tasks when a subject is unable to do so voluntarily. This robotic therapy mode is a novel implementation of the idea of an active-assist therapy mode; it utilizes the measure of a subject’s motor ability, along with their real-time movement kinematics to initiate robotic assistance at the appropriate time during a movement trial. The adaptive co-operative mode, on the other hand, is based on the idea of enabling task completion instead of completing the task for the subject. Both these therapy modes were designed to adapt to a stroke subject's motor ability, and thus encourage voluntary participation from the stroke subject. The two controllers were tested on three stroke subjects practicing robot-assisted reaching movements. The results from this testing demonstrate that an underactuated wearable exoskeleton, such as RUPERT, can be used for administering robot-assisted therapy, in a manner that encourages voluntary participation from the subject undergoing therapy.

Choice-Based Evaluation for the Improvement of Upper-Extremity Function Compared With Other Impairments in Tetraplegia

NARCIS (Netherlands)

Snoek, Govert J.; IJzerman, Maarten Joost; Post, Marcel W.; Stiggelbout, Anne M.; Roach, Mary J.; Zilvold, Gerrit

2005-01-01

Objectives To assess preference of reconstructive treatment of upper extremities in subjects with tetraplegia compared with preference of treatment of 3 other impairments and to determine the effect of subjects’ characteristics on preference of upper-extremity reconstruction. Design Survey. Setting

Towards constraining extreme temperature projections of the CMIP5 ensemble

Science.gov (United States)

Vogel, Martha-Marie; Orth, René; Isabelle Seneviratne, Sonia

2016-04-01

The frequency and intensity of heat waves is expected to change in future in response to global warming. Given the severe impacts of heat waves on ecosystems and society it is important to understand how and where they will intensify. Projections of extreme hot temperatures in the IPCC AR5 model ensemble show large uncertainties for projected changes of extreme temperatures in particular in Central Europe. In this region land-atmosphere coupling can contribute substantially to the development of heat waves. This coupling is also subject to change in future, while model projections display considerable spread. In this work we link projections of changes in extreme temperatures and of changes in land-atmosphere interactions with a particular focus on Central Europe. Uncertainties in projected extreme temperatures can be partly explained by different projected changes of the interplay between latent heat and temperature as well as soil moisture. Given the considerable uncertainty in land-atmosphere coupling representation already in the current climate, we furthermore employ observational data sets to constrain the model ensemble, and consequently the extreme temperature projections.

Extremal Overall Elastic Response of Polycrystalline Materials

DEFF Research Database (Denmark)

Bendsøe, Martin P; Lipton, Robert

1996-01-01

Polycrystalline materials comprised of grains obtained froma single anisotropic material are considered in the frameworkof linear elasticity. No assumptions on the symmetry of thepolycrystal are made. We subject the material to independentexternal strain and stress fields with prescribed mean...... values.We show that the extremal overall elastic response is alwaysachieved by a configuration consisting of a single properlyoriented crystal. This result is compared to results for isotropicpolycrystals....

Alteration of a human intestinal microbiota under extreme life environment in the Antarctica.

Science.gov (United States)

Jin, Jong-Sik; Touyama, Mutsumi; Yamada, Shin; Yamazaki, Takashi; Benno, Yoshimi

2014-01-01

The human intestinal microbiota (HIM) settles from birth and continues to change phenotype by some factors (e.g. host's diet) throughout life. However, the effect of extreme life environment on human HIM composition is not well known. To understand HIM fluctuation under extreme life environment in humans, fecal samples were collected from six Japanese men on a long Antarctic expedition. They explored Antarctica for 3 months and collected their fecal samples at once-monthly intervals. Using terminal restriction fragment length polymorphism (T-RFLP) and real time polymerase chain reaction (PCR) analysis, the composition of HIM in six subjects was investigated. Three subjects presented restoration of HIM after the expedition compared versus before and during the expedition. Two thirds samples collected during the expedition belonged to the same cluster in dendrogram. However, all through the expedition, T-RFLP patterns showed interindividual variability. Especially, Bifidobacterium spp. showed a tendency to decrease during and restore after the expedition. A reduction of Bifidobacterium spp. was observed in five subjects the first 1 month of the expedition. Bacteroides thetaiotaomicron, which is thought to proliferate during emotional stress, significantly decreased in one subject, indicating that other factors in addition to emotional stress may affect the composition of HIM in this study. These findings could be helpful to understand the effect of extreme life environment on HIM.

Investigating NARCCAP Precipitation Extremes via Bivariate Extreme Value Theory (Invited)

Science.gov (United States)

Weller, G. B.; Cooley, D. S.; Sain, S. R.; Bukovsky, M. S.; Mearns, L. O.

2013-12-01

We introduce methodology from statistical extreme value theory to examine the ability of reanalysis-drive regional climate models to simulate past daily precipitation extremes. Going beyond a comparison of summary statistics such as 20-year return values, we study whether the most extreme precipitation events produced by climate model simulations exhibit correspondence to the most extreme events seen in observational records. The extent of this correspondence is formulated via the statistical concept of tail dependence. We examine several case studies of extreme precipitation events simulated by the six models of the North American Regional Climate Change Assessment Program (NARCCAP) driven by NCEP reanalysis. It is found that the NARCCAP models generally reproduce daily winter precipitation extremes along the Pacific coast quite well; in contrast, simulation of past daily summer precipitation extremes in a central US region is poor. Some differences in the strength of extremal correspondence are seen in the central region between models which employ spectral nudging and those which do not. We demonstrate how these techniques may be used to draw a link between extreme precipitation events and large-scale atmospheric drivers, as well as to downscale extreme precipitation simulated by a future run of a regional climate model. Specifically, we examine potential future changes in the nature of extreme precipitation along the Pacific coast produced by the pineapple express (PE) phenomenon. A link between extreme precipitation events and a "PE Index" derived from North Pacific sea-surface pressure fields is found. This link is used to study PE-influenced extreme precipitation produced by a future-scenario climate model run.

Therapeutic riding followed by rhythmic auditory stimulation to improve balance and gait in a subject with orthopedic pathologies.

Science.gov (United States)

Ungermann, Cathryn M; Gras, Laura Z

2011-12-01

The study objectives were to investigate the effect of therapeutic riding with a subject who had an orthopedic diagnosis. This is a single-subject case report. The study was conducted at an equestrian facility with an indoor riding arena. The subject was a 59-year-old woman with grade I spondylolisthesis at L4/L5 and multilevel lumbar spinal stenosis in central and foraminal canals. The subject had an anterior cervical fusion of C3-C7. The subject has been ambulating with a straight cane due to her history of frequent falls. Gait, agility, strength, range of motion, and balance testing were performed. The subject had impairments of bilateral lower extremities with an ataxic gait pattern and was at risk for continued falls according to the balance measures. The intervention comprised therapeutic riding sessions 3 times a week for 20 minutes for 4 weeks. Each riding session was immediately followed by a 10-minute independent walking program with a metronome for rhythmic auditory stimulation. The outcome measures were as follows: Manual muscle testing and range of motion of the lower extremities, Gait Speed Test, Dynamic Gait Index, Four-Square Step Test, Chair Stand Test, Single Leg Stance. Improvements were seen in lower extremity strength and range of motion and balance. The subject improved on balance scores, placing her out of the risk for falls category. Therapeutic riding followed by rhythmic auditory stimulation improved lower extremity range of motion, strength, and balance with this subject.

Does trampoline or hard surface jumping influence lower extremity alignment?

Science.gov (United States)

Akasaka, Kiyokazu; Tamura, Akihiro; Katsuta, Aoi; Sagawa, Ayako; Otsudo, Takahiro; Okubo, Yu; Sawada, Yutaka; Hall, Toby

2017-12-01

[Purpose] To determine whether repetitive trampoline or hard surface jumping affects lower extremity alignment on jump landing. [Subjects and Methods] Twenty healthy females participated in this study. All subjects performed a drop vertical jump before and after repeated maximum effort trampoline or hard surface jumping. A three-dimensional motion analysis system and two force plates were used to record lower extremity angles, moments, and vertical ground reaction force during drop vertical jumps. [Results] Knee extensor moment after trampoline jumping was greater than that after hard surface jumping. There were no significant differences between trials in vertical ground reaction force and lower extremity joint angles following each form of exercise. Repeated jumping on a trampoline increased peak vertical ground reaction force, hip extensor, knee extensor moments, and hip adduction angle, while decreasing hip flexion angle during drop vertical jumps. In contrast, repeated jumping on a hard surface increased peak vertical ground reaction force, ankle dorsiflexion angle, and hip extensor moment during drop vertical jumps. [Conclusion] Repeated jumping on the trampoline compared to jumping on a hard surface has different effects on lower limb kinetics and kinematics. Knowledge of these effects may be useful in designing exercise programs for different clinical presentations.

Association of plasma fetuin-a levels with peripheral arterial disease and lower extremity arterial calcification in subjects with type 2 diabetes mellitus.

Science.gov (United States)

Eleftheriadou, Ioanna; Grigoropoulou, Pinelopi; Kokkinos, Alexander; Mourouzis, Iordanis; Perrea, Despoina; Katsilambros, Nicholas; Sfikakis, Petros P; Tentolouris, Nikolaos

2017-03-01

Fetuin-A is a hepatic glycoprotein that is involved in insulin resistance and atherosclerosis. Herein we examined the association of plasma fetuin-A levels with peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (T2DM). A total of 71 patients with T2DM and 57 non-diabetic individuals were recruited. Diagnosis of PAD was based on the absence of triphasic waveform at pedal arteries, while ankle-brachial index (ABI) was calculated. Radiographs of both feet and ankles were taken for the assessment of lower extremity arterial calcification (LEAC). Plasma fetuin-A levels were measured using ELISA. Patients with T2DM had higher fetuin-A levels than non-diabetic participants. Participants with diabetes and PAD had lower fetuin-A levels than non-PAD diabetic patients. In subjects with T2DM fetuin-A levels were associated with ABI. Multivariate analysis demonstrated that in patients with T2DM the odds of PAD increased with long diabetes duration, smoking, presence of arterial hypertension and dyslipidemia, as well as with lower fetuin-A levels. A trend towards higher fetuin-A levels in subjects with less severe LEAC was found. Plasma fetuin-A levels are lower in patients with T2DM and PAD and are associated with PAD, irrespective of traditional cardiovascular risk factors. Moreover, fetuin-A may be involved in arterial calcification. Copyright © 2016 Elsevier Inc. All rights reserved.

Example of a Non-standard Extreme Value Law

Czech Academy of Sciences Publication Activity Database

Haydn, N.; Kupsa, Michal

2015-01-01

Roč. 35, č. 6 (2015), s. 1902-1912 ISSN 0143-3857 Institutional support: RVO:67985556 Keywords : extreme-value law * rotations of unit circle * non-mixing systems * discrete law * Gumbel distribution * Weibull distribution * Frechet distribution * return times Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 0.983, year: 2015 http://library.utia.cas.cz/separaty/2014/SI/kupsa-0434480.pdf

Medical and psychosocial implications of adolescent extreme obesity – acceptance and effects of structured care, short: Youth with Extreme Obesity Study (YES)

Science.gov (United States)

2013-01-01

Background Prevalence rates of overweight and obesity have increased in German children and adolescents in the last three decades. Adolescents with extreme obesity represent a distinct risk group. On the basis of data obtained by the German Child and Youth Survey (KiGGS) and the German district military offices we estimate that the group of extremely obese adolescents (BMI ≥ 35 kg/m2) currently encompasses approximately 200.000 adolescents aged 14 to 21 yrs. Conventional approaches focusing on weight reduction have largely proven futile for them. In addition, only a small percentage of adolescents with extreme obesity seek actively treatment for obesity while contributing disproportionately strong to health care costs. Because of somatic and psychiatric co-morbidities and social problems adolescents with extreme obesity require special attention within the medical care system. We have initiated the project “Medical and psychosocial implications of adolescents with extreme obesity - acceptance and effects of structured care, short: ‘Youths with Extreme Obesity Study (YES)’”, which aims at improving the medical care and social support structures for youths with extreme obesity in Germany. Methods/Design We focus on identification of these subjects (baseline examination) and their acceptance of diagnostic and subsequent treatment procedures. In a randomized controlled trial (RCT) we will investigate the effectiveness of a low key group intervention not focusing on weight loss but aimed at the provision of obesity related information, alleviation of social isolation, school and vocational integration and improvement of self-esteem in comparison to a control group treated in a conventional way with focus on weight loss. Interested individuals who fulfill current recommended criteria for weight loss surgery will be provided with a structured preparation and follow-up programs. All subjects will be monitored within a long-term observational study to

Mandelbrot's Extremism

NARCIS (Netherlands)

Beirlant, J.; Schoutens, W.; Segers, J.J.J.

2004-01-01

In the sixties Mandelbrot already showed that extreme price swings are more likely than some of us think or incorporate in our models.A modern toolbox for analyzing such rare events can be found in the field of extreme value theory.At the core of extreme value theory lies the modelling of maxima

Rotational profile of the lower extremity in achondroplasia: computed tomographic examination of 25 patients

Energy Technology Data Exchange (ETDEWEB)

Song, Hae-Ryong; Suh, Seung-Woo [Korea University Guro Hospital, Department of Orthopaedic Surgery, Rare Diseases Institute, Seoul (Korea); Choonia, Abi-Turab [Laud Clinic, Department of Orthopaedic Surgery, Mumbai (India); Hong, Suk Joo; Cha, In Ho [Korea University Guro Hospital, Department of Radiology, Seoul (Korea); Lee, Seok-Hyun [Dongguk University Ilsan Buddist Hospital, Department of Orthopaedic Surgery, Goyang (Korea); Park, Jong-Tae [Korea University Ansan Hospital, Department of Occupational and Enviornmental Medicine, Ansan (Korea)

2006-12-15

To evaluate lower-extremity rotational abnormalities in subjects with achondroplasia using computed tomography (CT) scans. CT scans were performed in 25 subjects with achondroplasia (13 skeletally immature, mean age 8.7 years; 12 skeletally mature, mean age 17.6 years). In a total of 50 bilateral limbs, CT images were used to measure the angles of acetabular anteversion, femoral anteversion, and tibial external torion. Measurement was performed by three examiners and then repeated by one examiner. Inter- and intraobserver agreements were analyzed, and results were compared with previously reported normal values. Mean values for skeletally immature and skeletally mature subjects were 13.6{+-}7.5 and 21.5{+-}6.4 respectively for acetabular anteversion, 27.1{+-}20.8 and 30.5{+-}20.1 for femoral torsion, and 21.6{+-}10.6 and 22.5{+-}10.8 for tibial torsion. Intra- and interobserver agreements were good to excellent. Acetabular anteversion and femoral anteversion in skeletally mature subjects were greater than normal values in previous studies. Both skeletally immature and mature subjects with achondroplasia had decreased tibial torsion compared to normal skeletally immature and mature subjects. Lower-extremity rotational abnormalities in subjects with achondroplasia include decreased tibial external torsion in both skeletally immature and mature subjects, as well as increased femoral and acetabular anteversion in skeletally mature subjects. (orig.)

Rotational profile of the lower extremity in achondroplasia: computed tomographic examination of 25 patients

International Nuclear Information System (INIS)

Song, Hae-Ryong; Suh, Seung-Woo; Choonia, Abi-Turab; Hong, Suk Joo; Cha, In Ho; Lee, Seok-Hyun; Park, Jong-Tae

2006-01-01

To evaluate lower-extremity rotational abnormalities in subjects with achondroplasia using computed tomography (CT) scans. CT scans were performed in 25 subjects with achondroplasia (13 skeletally immature, mean age 8.7 years; 12 skeletally mature, mean age 17.6 years). In a total of 50 bilateral limbs, CT images were used to measure the angles of acetabular anteversion, femoral anteversion, and tibial external torion. Measurement was performed by three examiners and then repeated by one examiner. Inter- and intraobserver agreements were analyzed, and results were compared with previously reported normal values. Mean values for skeletally immature and skeletally mature subjects were 13.6±7.5 and 21.5±6.4 respectively for acetabular anteversion, 27.1±20.8 and 30.5±20.1 for femoral torsion, and 21.6±10.6 and 22.5±10.8 for tibial torsion. Intra- and interobserver agreements were good to excellent. Acetabular anteversion and femoral anteversion in skeletally mature subjects were greater than normal values in previous studies. Both skeletally immature and mature subjects with achondroplasia had decreased tibial torsion compared to normal skeletally immature and mature subjects. Lower-extremity rotational abnormalities in subjects with achondroplasia include decreased tibial external torsion in both skeletally immature and mature subjects, as well as increased femoral and acetabular anteversion in skeletally mature subjects. (orig.)

Arterial trauma of the extremities. An Ivorian surgical experience ...

African Journals Online (AJOL)

... clinical and surgical experience of the arterial injuries of extremities for 23 years(1977 to ... Their case files have been reviewed and forms the subject of this study ... due to reperfusion injury (1 case) and biliary peritonitis(1 case). Conclusion Arterial injury is a true surgical emergencies and repair should be urgent to avoid ...

Evaluation of the Plastic Surgery In-Service Training Exam: Lower Extremity Questions.

Science.gov (United States)

Silvestre, Jason; Basta, Marten N; Serletti, Joseph M; Chang, Benjamin

2015-01-01

To facilitate the training of plastic surgery residents, we analyzed a knowledge-based curriculum for plastic and reconstructive surgery of the lower extremity. The Plastic Surgery In-Service Training Exam (PSITE) is a commonly used tool to assess medical knowledge in plastic surgery. We reviewed the lower extremity content on 6 consecutive score keys (2008-2013). Questions were classified by taxonomy, anatomy, and subject. Answer references were quantified by source and relative year of publication. Totally, 107 questions related to the lower extremity (9.1% of all questions) and 14 questions had an associated image (13.1%). Questions required decision making (49%) over interpretation (36%) and direct recall (15%) skills (p < 0.001). Conditions of the leg (42.1%) and thigh (24.3%) constituted most of the questions. Subject matter focused on flap reconstruction (38.3%), nerve injury (8.4%), and congenital deformity (6.5%). Analysis of 263 citations to 66 unique journals showed that Plastic and Reconstructive Surgery (54.9%) was the highest yield primary source. The median year of publication relative to PSITE administration was 6 (range: 1-58) with a mode of 2 years. Plastic Surgery by Mathes et al. was the most referenced textbook (21.9%). These data establish a benchmark for lower extremity training during plastic surgery residency. Study efforts focused on the most common topics and references will enhance trainee preparation for lower extremity PSITE questions. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

How extreme is extreme hourly precipitation?

Science.gov (United States)

Papalexiou, Simon Michael; Dialynas, Yannis G.; Pappas, Christoforos

2016-04-01

The importance of accurate representation of precipitation at fine time scales (e.g., hourly), directly associated with flash flood events, is crucial in hydrological design and prediction. The upper part of a probability distribution, known as the distribution tail, determines the behavior of extreme events. In general, and loosely speaking, tails can be categorized in two families: the subexponential and the hyperexponential family, with the first generating more intense and more frequent extremes compared to the latter. In past studies, the focus has been mainly on daily precipitation, with the Gamma distribution being the most popular model. Here, we investigate the behaviour of tails of hourly precipitation by comparing the upper part of empirical distributions of thousands of records with three general types of tails corresponding to the Pareto, Lognormal, and Weibull distributions. Specifically, we use thousands of hourly rainfall records from all over the USA. The analysis indicates that heavier-tailed distributions describe better the observed hourly rainfall extremes in comparison to lighter tails. Traditional representations of the marginal distribution of hourly rainfall may significantly deviate from observed behaviours of extremes, with direct implications on hydroclimatic variables modelling and engineering design.

Calibration of windowless photodiode for extreme ultraviolet pulse energy measurement

Czech Academy of Sciences Publication Activity Database

Koláček, Karel; Schmidt, Jiří; Štraus, Jaroslav; Frolov, Oleksandr

2015-01-01

Roč. 54, č. 35 (2015), s. 10454-10459 ISSN 1559-128X R&D Projects: GA MŠk(CZ) LG13029 Institutional support: RVO:61389021 Keywords : Photodetectors * Soft-X-ray * Extreme ultraviolet * Detection * Filters * Metrology Subject RIV: BH - Optics , Masers, Lasers Impact factor: 1.598, year: 2015

Heavy rains and extreme rainfall-runoff events in Central Europe from 1951 to 2002

Czech Academy of Sciences Publication Activity Database

Müller, Miloslav; Kašpar, Marek; Matschullat, J.

2009-01-01

Roč. 9, č. 2 (2009), s. 441-450 ISSN 1561-8633 R&D Projects: GA AV ČR KJB300420701; GA AV ČR KJB300420802 Institutional research plan: CEZ:AV0Z30420517 Keywords : weather extreme * extreme precipitation * rain flood Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 1.357, year: 2009 http://www.nat-hazards-earth-syst-sci.net/9/451/2009/

Clinical application of lower extremity CTA and lower extremity perfusion CT as a method of diagnostic for lower extremity atherosclerotic obliterans

Energy Technology Data Exchange (ETDEWEB)

Moon, Il Bong; Dong, Kyung Rae [Dept. Radiological Technology, Gwangju Health University, Gwangju (Korea, Republic of); Goo, Eun Hoe [Dept. Radiological Science, Cheongju University, Cheongju (Korea, Republic of)

2016-11-15

The purpose of this study was to assess clinical application of lower extremity CTA and lower extremity perfusion CT as a method of diagnostic for lower extremity atherosclerotic obliterans. From January to July 2016, 30 patients (mean age, 68) were studied with lower extremity CTA and lower extremity perfusion CT. 128 channel multi-detector row CT scans were acquired with a CT scanner (SOMATOM Definition Flash, Siemens medical solution, Germany) of lower extremity perfusion CT and lower extremity CTA. Acquired images were reconstructed with 3D workstation (Leonardo, Siemens, Germany). Site of lower extremity arterial occlusive and stenosis lesions were detected superficial femoral artery 36.6%, popliteal artery 23.4%, external iliac artery 16.7%, common femoral artery 13.3%, peroneal artery 10%. The mean total DLP comparison of lower extremity perfusion CT and lower extremity CTA, 650 mGy-cm and 675 mGy-cm, respectively. Lower extremity perfusion CT and lower extremity CTA were realized that were never be two examination that were exactly the same legions. Future through the development of lower extremity perfusion CT soft ware programs suggest possible clinical applications.

Thermodynamics of extremal rotating thin shells in an extremal BTZ spacetime and the extremal black hole entropy

Science.gov (United States)

Lemos, José P. S.; Minamitsuji, Masato; Zaslavskii, Oleg B.

2017-02-01

In a (2 +1 )-dimensional spacetime with a negative cosmological constant, the thermodynamics and the entropy of an extremal rotating thin shell, i.e., an extremal rotating ring, are investigated. The outer and inner regions with respect to the shell are taken to be the Bañados-Teitelbom-Zanelli (BTZ) spacetime and the vacuum ground state anti-de Sitter spacetime, respectively. By applying the first law of thermodynamics to the extremal thin shell, one shows that the entropy of the shell is an arbitrary well-behaved function of the gravitational area A+ alone, S =S (A+). When the thin shell approaches its own gravitational radius r+ and turns into an extremal rotating BTZ black hole, it is found that the entropy of the spacetime remains such a function of A+, both when the local temperature of the shell at the gravitational radius is zero and nonzero. It is thus vindicated by this analysis that extremal black holes, here extremal BTZ black holes, have different properties from the corresponding nonextremal black holes, which have a definite entropy, the Bekenstein-Hawking entropy S (A+)=A/+4G , where G is the gravitational constant. It is argued that for extremal black holes, in particular for extremal BTZ black holes, one should set 0 ≤S (A+)≤A/+4G;i.e., the extremal black hole entropy has values in between zero and the maximum Bekenstein-Hawking entropy A/+4 G . Thus, rather than having just two entropies for extremal black holes, as previous results have debated, namely, 0 and A/+4 G , it is shown here that extremal black holes, in particular extremal BTZ black holes, may have a continuous range of entropies, limited by precisely those two entropies. Surely, the entropy that a particular extremal black hole picks must depend on past processes, notably on how it was formed. A remarkable relation between the third law of thermodynamics and the impossibility for a massive body to reach the velocity of light is also found. In addition, in the procedure, it

The effect of enhanced trunk control on balance and falls through bilateral upper extremity exercises among chronic stroke patients in a standing position

OpenAIRE

Shin, Ji Won; Don Kim, Kyoung

2016-01-01

[Purpose] This study examined the effects of bilateral upper extremity exercises on trunk control, balance, and risk of falls in stroke patients. [Subjects and Methods] A total of 30 study subjects were selected and randomly divided into experimental and control groups containing 15 subjects each, who received bilateral upper extremity activities and conventional rehabilitation treatment, respectively. [Results] There were statistically significant differences between groups in all sub-items ...

Ectopic major transplantation for salvage of upper and lower extremity amputations

Directory of Open Access Journals (Sweden)

Nazerani Shahram

2013-12-01

Full Text Available 【Abstract】Objective: Ectopic tissue transplanta- tion is not a new idea. Godina and his colleagues pioneered this method in the 1980s. This method is a last resort method of preserving an amputated body part, which consists of banking the amputated segment in an ectopic area and re- turning it to its native place at a later date. In this article we present our experience with this demanding procedure. Methods: Debridement was the mainstay of this procedure. The stump and amputated part are carefully de- brided and the stump was either closed primarily or covered by a flap. The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting. Results: Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study. The over- all success rate was about 70%, lower than expected but these are cases of severe crush injury. Although the func- tional recovery of these patients are very low, all of the successful cases except one could find a job as a janitor or light manual worker. No patient could return to his previous job. Conclusion: Ectopic transplantation of body parts is an accepted method of treatment of severely crushed ex- tremity or finger injuries. In our country an amputee has very little chance of finding a job instead a disabled person can. In addition in Iran cultures amputation is seen as pu- nishment of either the God or the society, so it is not well accepted and many patients persist on saving the limb even with no functional recovery. None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers. Key words: Replantation; Transplantation; Extremities; Amputation, traumatic

Extreme value distributions

CERN Document Server

Ahsanullah, Mohammad

2016-01-01

The aim of the book is to give a through account of the basic theory of extreme value distributions. The book cover a wide range of materials available to date. The central ideas and results of extreme value distributions are presented. The book rwill be useful o applied statisticians as well statisticians interrested to work in the area of extreme value distributions.vmonograph presents the central ideas and results of extreme value distributions.The monograph gives self-contained of theory and applications of extreme value distributions.

Identification and characterization of a Bacillus subtilis strain TS06 ...

African Journals Online (AJOL)

Replant disease is a major limitation for strawberry production in greenhouse. Bio-control may be a good way to cope with the replant diseases. Here, we report identification and characterization of a bacterial strain TS06 that may be used as a bio-control agent against the replant diseases in strawberry. TS06 was identified ...

Diagnostic accuracy of self-report and subjective history in the diagnosis of low back pain with non-specific lower extremity symptoms: A systematic review.

Science.gov (United States)

Shultz, Susan; Averell, Kristina; Eickelman, Angela; Sanker, Holly; Donaldson, Megan Burrowbridge

2015-02-01

Subjective history questions/self-report items are commonly used to triage the patient with low back pain and related leg symptoms. However the value of the history taking process for decision-making to identify common classifications/diagnosis for patients presenting with low back related leg pain (LBRLP) have not been considered. The purpose of this study was to investigate the diagnostic accuracy of self-report items/history-taking questions used to identify patients with LBRLP. Eligible studies included: 1)subjects with low back pain AND related lower extremity pain, 2)details of subjective examination/self-report items, 3)cohort, prospective/longitudinal studies, and randomized control trials, 4)use of statistical reporting, 5)an acceptable reference standard. Quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2. A synthesis of history items that met the threshold for at least a small shift in the likelihood of the condition with a +LR ≥ 2 or -LR ≤ 0.5 were reported. Conditions commonly reported in the literature: lumbar spinal stenosis, lumbosacral nerve root compression/radiculopathy, disc herniation and neurophysiological low back pain ± leg pain. Eleven studies met the inclusion criteria. This is the first systematic review of diagnostic accuracy studies that examined only the history-taking items for their ability to identify LBRLP conditions. Clustering key items may provide a more precise clinical picture necessary to detect and treat a patient's presentation. History questions formed within the interview and their contributing value for decision-making remain understudied. There is a need for better designs to determine a more accurate diagnostic power to identify conditions with LBRLP. Copyright © 2014 Elsevier Ltd. All rights reserved.

Magnetic-Field-Assisted Assembly of Ordered Multifunctional Ceramic Nanocomposites for Extreme Environments

Science.gov (United States)

2016-04-01

SUBJECT TERMS carbon nanotubes, composite, electromagnetic shielding , extreme environments, magnetism, fibers, woven composite, boron nitride...The samples were sealed in glass vial and exposed to the magnetic field immediately after deposition prior to crystallization of PEG that allowed

Fatigue influences lower extremity angular velocities during a single-leg drop vertical jump

OpenAIRE

Tamura, Akihiro; Akasaka, Kiyokazu; Otsudo, Takahiro; Shiozawa, Junya; Toda, Yuka; Yamada, Kaori

2017-01-01

[Purpose] Fatigue alters lower extremity landing strategies and decreases the ability to attenuate impact during landing. The purpose of this study was to reveal the influence of fatigue on dynamic alignment and joint angular velocities in the lower extremities during a single leg landing. [Subjects and Methods] The 34 female college students were randomly assigned to either the fatigue or control group. The fatigue group performed single-leg drop vertical jumps before, and after, the fatigue...

Frequent extreme cold exposure and brown fat and cold-induced thermogenesis: a study in a monozygotic twin.

Directory of Open Access Journals (Sweden)

Maarten J Vosselman

Full Text Available INTRODUCTION: Mild cold acclimation is known to increase brown adipose tissue (BAT activity and cold-induced thermogenesis (CIT in humans. We here tested the effect of a lifestyle with frequent exposure to extreme cold on BAT and CIT in a Dutch man known as 'the Iceman', who has multiple world records in withstanding extreme cold challenges. Furthermore, his monozygotic twin brother who has a 'normal' sedentary lifestyle without extreme cold exposures was measured. METHODS: The Iceman (subject A and his brother (subject B were studied during mild cold (13°C and thermoneutral conditions (31°C. Measurements included BAT activity and respiratory muscle activity by [18F]FDG-PET/CT imaging and energy expenditure through indirect calorimetry. In addition, body temperatures, cardiovascular parameters, skin perfusion, and thermal sensation and comfort were measured. Finally, we determined polymorphisms for uncoupling protein-1 and β3-adrenergic receptor. RESULTS: Subjects had comparable BAT activity (A: 1144 SUVtotal and B: 1325 SUVtotal, within the range previously observed in young adult men. They were genotyped with the polymorphism for uncoupling protein-1 (G/G. CIT was relatively high (A: 40.1% and B: 41.9%, but unlike during our previous cold exposure tests in young adult men, here both subjects practiced a g-Tummo like breathing technique, which involves vigorous respiratory muscle activity. This was confirmed by high [18F]FDG-uptake in respiratory muscle. CONCLUSION: No significant differences were found between the two subjects, indicating that a lifestyle with frequent exposures to extreme cold does not seem to affect BAT activity and CIT. In both subjects, BAT was not higher compared to earlier observations, whereas CIT was very high, suggesting that g-Tummo like breathing during cold exposure may cause additional heat production by vigorous isometric respiratory muscle contraction. The results must be interpreted with caution given the

Critical care at extremes of temperature: effects on patients, staff and equipment.

Science.gov (United States)

Hindle, Elise M; Henning, J D

2014-12-01

Modern travel and military operations have led to a significant increase in the need to provide medical care in extreme climates. Presently, there are few data on what happens to the doctor, their drugs and equipment when exposed to these extremes. A review was undertaken to find out the effects of 'extreme heat or cold' on anaesthesia and critical care; in addition, subject matter experts were contacted directly. Both extreme heat and extreme cold can cause a marked physiological response in a critically ill patient and the doctor treating these patients may also suffer a decrement in both physical and mental functioning. Equipment can malfunction when exposed to extremes of temperature and should ideally be stored and operated in a climatically controlled environment. Many drugs have a narrow range of temperatures in which they remain useable though some have been shown to remain effective if exposed to extremes of temperature for a short period of time. All personnel embarking on an expedition to an extreme temperature zone should be of sufficient physical robustness and ideally should have a period of acclimatisation which may help mitigate against some of the physiological effects of exposure to extreme heat or extreme cold. Expedition planners should aim to provide climatic control for drugs and equipment and should have logistical plans for replenishment of drugs and medical evacuation of casualties. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Extremely Preterm Birth

Science.gov (United States)

... Events Advocacy For Patients About ACOG Extremely Preterm Birth Home For Patients Search FAQs Extremely Preterm Birth ... Spanish FAQ173, June 2016 PDF Format Extremely Preterm Birth Pregnancy When is a baby considered “preterm” or “ ...

[Clinical application of ultrasound guided Fogarty balloon catheter in arterial crisis].

Science.gov (United States)

Li, Xiaodong; Wang, Pei; Yu, Changyu; Yan, Xiaowei; Yin, Jing

2017-10-01

To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter. Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years (mean, 32 years). The limb mutilation position was at knee joint in 3 cases, lower limb in 9 cases, ankle joint in 6 cases, elbow joint in 2 cases, forearm in 4 cases, and wrist joint in 3 cases. The arterial crisis happened at 2.5-18 hours (mean, 7.5 hours) after limb replantation surgery. Color doppler ultrasonography was used to diagnose the arterial thrombosis, finally the anastomotic thrombosis were found in 16 cases, non-anastomotic thrombosis in 7 cases, and combined thrombosis in 4 cases. All the thrombosis were deteced in the arteries with the length of 0.8-3.9 cm. No complication such as vascular perforation, rupture, air embolism, thromboembolism, wound infection, or sepsis happened after operation. Arterial crisis occurred again in 3 cases at 1.5-13.5 hours after limb replantation and treated by arterial exploration, 1 case was treated successfully; 2 cases had arterial occlusion and partial necrosis of limb, and got amputation treatment at last. The rest 24 cases survived with the incision healing by first stage. In the 24 cases, 1 case suffered from acute myonephropathic metabolic syndrome and corrected after hemodialysis; 1 case suffered from acute liver functional damage and corrected by comprehensive treatment of internal medicine. The 24 patients were followed up 7-38 months (mean, 11 months). At last follow-up, blood supply of the limb was good with normal skin temperature and improved sense of feeling, activity, and swelling. According to Chinese Medical Association of hand surgery to the upper extremity function assessment standard, the results were

Extreme environment electronics

CERN Document Server

Cressler, John D

2012-01-01

Unfriendly to conventional electronic devices, circuits, and systems, extreme environments represent a serious challenge to designers and mission architects. The first truly comprehensive guide to this specialized field, Extreme Environment Electronics explains the essential aspects of designing and using devices, circuits, and electronic systems intended to operate in extreme environments, including across wide temperature ranges and in radiation-intense scenarios such as space. The Definitive Guide to Extreme Environment Electronics Featuring contributions by some of the world's foremost exp

Novel indices for the comparison of precipitation extremes and floods: an example from the Czech territory

Czech Academy of Sciences Publication Activity Database

Müller, Miloslav; Kašpar, Marek; Valeriánová, A.; Crhová, L.; Holtanová, E.; Gvoždíková, B.

2015-01-01

Roč. 19, č. 11 (2015), s. 4641-4652 ISSN 1027-5606 R&D Projects: GA ČR(CZ) GAP209/11/1990 Institutional support: RVO:68378289 Keywords : precipitation extreme * flood * extremity index * Czech Republic Subject RIV: DG - Athmosphere Sci ences, Meteorology Impact factor: 3.990, year: 2015 http://www.hydrol-earth-syst- sci .net/19/4641/2015/hess-19-4641-2015.html

INCORRECT PRESERVATION OF AMPUTATED DIGITS

Directory of Open Access Journals (Sweden)

Uroš Ahčan

2004-09-01

completely amputated finger or fingers; the occurence was at its highest in 1998 (28 cases and at its lowest (23 in the years 2000 and 2002 (at an average of 24.8 annually. The number of attempted replantations has been demonstrated to be on the rise (28.8% of all severed fingers replanted in 1998; and 47.9% in 2002. The success rate throughout the 5 year period was 81%. The type of injury under investigation is most frequent in population of the age group 30 to 50.The presented cases clearly indicate that the incorrect, hypothermic treatment of the amputated extremity has a demonstrable negative effect on the result of the replantation.Conclusions. It is obvious that the knowledge on the treatment of severed digits is lacking in both lay and professional public. The most common error in the preservation of the severed digit is dangerously low temperature during transport. Optimal conditions of hypothermic preservation are, however, difficult to maintain in the field. A more engaged education would greatly improve the conditions of transport, and increase the success rate of replantations. Adequate educational programmes; instructions to both lay persons and professionals; and devising a transport bag for hypothermic preservation of severed digits are urgently called for.

Validity of the lower extremity functional movement screen in patients with chronic ankle instability

OpenAIRE

Choi, Ho-Suk; Shin, Won-Seob

2015-01-01

[Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen includ...

Effects of virtual reality-based bilateral upper-extremity training on brain activity in post-stroke patients.

Science.gov (United States)

Lee, Su-Hyun; Kim, Yu-Mi; Lee, Byoung-Hee

2015-07-01

[Purpose] This study investigated the therapeutic effects of virtual reality-based bilateral upper-extremity training on brain activity in patients with stroke. [Subjects and Methods] Eighteen chronic stroke patients were divided into two groups: the virtual reality-based bilateral upper-extremity training group (n = 10) and the bilateral upper-limb training group (n = 8). The virtual reality-based bilateral upper-extremity training group performed bilateral upper-extremity exercises in a virtual reality environment, while the bilateral upper-limb training group performed only bilateral upper-extremity exercise. All training was conducted 30 minutes per day, three times per week for six weeks, followed by brain activity evaluation. [Results] Electroencephalography showed significant increases in concentration in the frontopolar 2 and frontal 4 areas, and significant increases in brain activity in the frontopolar 1 and frontal 3 areas in the virtual reality-based bilateral upper-extremity training group. [Conclusion] Virtual reality-based bilateral upper-extremity training can improve the brain activity of stroke patients. Thus, virtual reality-based bilateral upper-extremity training is feasible and beneficial for improving brain activation in stroke patients.

Risk Factor, Job Stress and Quality of Life in Workers With Lower Extremity Pain Who Use Video Display Terminals.

Science.gov (United States)

Choi, Sehoon; Jang, Seong Ho; Lee, Kyu Hoon; Kim, Mi Jung; Park, Si-Bog; Han, Seung Hoon

2018-02-01

To investigate the general characteristics of video display terminal (VDT) workers with lower extremity pain, to identify the risk factors of work-related lower extremity pain, and to examine the relationship between work stress and health-related quality of life. A questionnaire about the general characteristics of the survey group and the musculoskeletal symptom was used. A questionnaire about job stress used the Korean Occupational Stress Scale and medical outcome study 36-item Short Form Health Survey (SF-36) to assess health-related quality of life. There were 1,711 subjects in the lower extremity group and 2,208 subjects in the control group. Age, sex, hobbies, and feeling of loading affected lower extremity pain as determined in a crossover analysis of all variables with and without lower extremity pain. There were no statistically significant difference between the two groups in terms of job stress and SF-36 values of the pain and control groups. Job stress in VDT workers was higher than average, and the quality of life decreased as the stress increased. Factors such as younger age, women, hobbies other than exercise, and feeling of loading influenced lower extremity pain of workers. Further long-term follow-up and supplementary studies are needed to identify risk factors for future lower extremity pain, taking into account ergonomic factors such as worker's posture.

Progression of disease preceding lower extremity amputation in Denmark

DEFF Research Database (Denmark)

Jensen, Pia Søe; Petersen, Janne; Kirketerp-Møller, Klaus

2017-01-01

OBJECTIVES: Patients with non-traumatic lower extremity amputation are characterised by high age, multi-morbidity and polypharmacy and long-term complications of atherosclerosis and diabetes. To ensure early identification of patients at risk of amputation, we need to gain knowledge about...... the progression of diseases related to lower extremity amputations during the years preceding the amputation. DESIGN: A retrospective population-based national registry study. SETTING: The study includes data on demographics, diagnoses, surgery, medications and healthcare services from five national registries....... Data were retrieved from 14 years before until 1 year after the amputation. Descriptive statistics were used to describe the progression of diseases and use of medication and healthcare services. PARTICIPANTS: An unselected cohort of patients (≥50 years; n=2883) subjected to a primary non...

High Energy Ion Acceleration by Extreme Laser Radiation Pressure

Science.gov (United States)

2017-03-14

published in the internationally leading journal Physical Review Letters. We continued to progress this pionee 15.  SUBJECT TERMS ion therapy, heavy ion ...Thomson parabola spectrometer: To separate and provide a measurement of the charge -to-mass ratio and energy spectrum of the different ion species...AFRL-AFOSR-UK-TR-2017-0015 High energy ion acceleration by extreme laser radiation pressure Paul McKenna UNIVERSITY OF STRATHCLYDE VIZ ROYAL COLLEGE

Extreme cosmos

CERN Document Server

Gaensler, Bryan

2011-01-01

The universe is all about extremes. Space has a temperature 270°C below freezing. Stars die in catastrophic supernova explosions a billion times brighter than the Sun. A black hole can generate 10 million trillion volts of electricity. And hypergiants are stars 2 billion kilometres across, larger than the orbit of Jupiter. Extreme Cosmos provides a stunning new view of the way the Universe works, seen through the lens of extremes: the fastest, hottest, heaviest, brightest, oldest, densest and even the loudest. This is an astronomy book that not only offers amazing facts and figures but also re

Experimental studies on the treatment of traumatic dental avulsion in dogs

International Nuclear Information System (INIS)

Borissov, I.; Lazarova, L.

2001-01-01

The experiments were performed on 7 dogs aged between 2 and 4 years weighing 12-16 kg in the period October 1998- January 2000. After anaesthesia, the following dental procedures were accomplished; performance of a dental avulsion, endodontic treatment, apical dentotomy, tooth replantation and fixation with an orthodontic splint, figure-of-eight wire ligature and photopolymer. The treatment was effective in 71.4% of experimental replantations of incisors and the replanted teeth persisted for more than 8-9 months. The radiological survey showed that the regeneration began as early as the first post replantation days. In the period between days 30-45, a bone bridging was observed and the regeneration was complete by the end of the second month

Physics of condensed matter at extreme conditions

International Nuclear Information System (INIS)

Ross, M.

1988-01-01

The study of matter under extreme conditions is a highly interdisciplinary subject with broad applications to materials science, geophysics and astrophysics. High-pressure properties are studied in the laboratory using static and dynamic techniques. The two differ drastically in the methods of generating and measuring pressure and in the fundamentally different nature of the final compressed state. This article covers a very broad range of conditions, intended to present an overview of important recent developments and to emphasize the behavior of materials and the kinds of properties now being studied

An Exit for the Human Product: A Comparative Study of Extreme Literature

Directory of Open Access Journals (Sweden)

Amelia Ying Qin

2014-04-01

Full Text Available This paper examines from a comparative perspective six novels telling stories of extreme life experiences set in both Western and oriental cultures. The paper argues that in these extreme cases, the characters, subjected to absolute power domination, lose their individual identities and are transformed into “human products.” Their struggles for power will always remain futile unless they find a way to reverse the power relationships they are trapped in. Such a reversal allows the hope of an exit for the “human products” to escape the hopeless situation of perpetuated social, sexual, and mental enslavement.

Further outlooks: extremely uncomfortable; Die weiteren Aussichten: extrem ungemuetlich

Energy Technology Data Exchange (ETDEWEB)

Resenhoeft, T.

2006-07-01

Climate is changing extremely in the last decades. Scientists dealing with extreme weather, should not only stare at computer simulations. They have also to turn towards psyche, seriously personal experiences, knowing statistics, relativise supposed sensational reports and last not least collecting more data. (GL)

Climate change scenarios of precipitation extremes in Central Europe from ENSEMBLES regional climate models

Czech Academy of Sciences Publication Activity Database

Gaál, Ľ.; Beranová, R.; Hlavčová, K.; Kyselý, Jan

2014-01-01

Roč. 2014, č. 943487 (2014), s. 1-14 ISSN 1687-9309 Institutional support: RVO:67179843 ; RVO:68378289 Keywords : precipitation extremes * regional climate models * climate change Subject RIV: EH - Ecology, Behaviour Impact factor: 0.946, year: 2014

Visual memory and learning in extremely low-birth-weight/extremely preterm adolescents compared with controls: a geographic study.

Science.gov (United States)

Molloy, Carly S; Wilson-Ching, Michelle; Doyle, Lex W; Anderson, Vicki A; Anderson, Peter J

2014-04-01

Contemporary data on visual memory and learning in survivors born extremely preterm (EP; Visual learning and memory data were available for 221 (74.2%) EP/ELBW subjects and 159 (60.7%) controls. EP/ELBW adolescents exhibited significantly poorer performance across visual memory and learning variables compared with controls. Visual learning and delayed visual memory were particularly problematic and remained so after controlling for visual-motor integration and visual perception and excluding adolescents with neurosensory disability, and/or IQ visual memory and learning outcomes compared with controls, which cannot be entirely explained by poor visual perceptual or visual constructional skills or intellectual impairment.

Legacies from extreme drought increase ecosystem sensitivity to future extremes

Science.gov (United States)

Smith, M. D.; Knapp, A.; Hoover, D. L.; Avolio, M. L.; Felton, A. J.; Wilcox, K. R.

2016-12-01

Climate extremes, such as drought, are increasing in frequency and intensity, and the ecological consequences of these extreme events can be substantial and widespread. Although there is still much to be learned about how ecosystems will respond to an intensification of drought, even less is known about the factors that determine post-drought recovery of ecosystem function. Such knowledge is particularly important because post-drought recovery periods can be protracted depending on the extent to which key plant populations, community structure and biogeochemical processes are affected. These drought legacies may alter ecosystem function for many years post-drought and may impact future sensitivity to climate extremes. We experimentally imposed two extreme growing season droughts in a central US grassland to assess the impacts of repeated droughts on ecosystem resistance (response) and resilience (recovery). We found that this grassland was not resistant to the first extreme drought due to reduced productivity and differential sensitivity of the co-dominant C4 grass (Andropogon gerardii) and C3 forb (Solidago canadensis) species. This differential sensitivity led to a reordering of species abundances within the plant community. Yet, despite this large shift in plant community composition, which persisted post-drought, the grassland was highly resilient post-drought, due to increased abundance of the dominant C4 grass. Because of this shift to increased C4 grass dominance, we expected that previously-droughted grassland would be more resistant to a second extreme drought. However, contrary to these expectations, previously droughted grassland was more sensitive to drought than grassland that had not experienced drought. Thus, our result suggest that legacies of drought (shift in community composition) may increase ecosystem sensitivity to future extreme events.

Weekly Versus Fortnightly Cryotherapy For Warts On Extremities - A Pilot Study

Directory of Open Access Journals (Sweden)

Eapen Annamma

1997-01-01

Full Text Available Forty two patients with verruca vulgaris on the extremities who attended the Government Wenlock Hospital and KMC, Attavar, were subjected to weekly and fortnightly cryotherapy. At the end of 8 weeks, it was found that of the 37 patients who were followed up, 94% in weekly group and 84% in fortnightly group responded to treatment.

Physiology and microbial community structure in soil at extreme water content

Czech Academy of Sciences Publication Activity Database

Uhlířová, Eva; Elhottová, Dana; Tříska, Jan; Šantrůčková, Hana

2005-01-01

Roč. 50, č. 2 (2005), s. 161-166 ISSN 0015-5632 R&D Projects: GA ČR(CZ) GA206/99/1410; GA ČR(CZ) GA526/99/P033 Institutional research plan: CEZ:AV0Z6066911 Keywords : microbial community structure * soils * extreme water content Subject RIV: EH - Ecology, Behaviour Impact factor: 0.918, year: 2005

The problem of defining contemporary right-wing extremism in political theory

Directory of Open Access Journals (Sweden)

Đorić Marija

2016-01-01

Full Text Available The subject matter of research in this paper is theoretical controversy related to the definition of right-wing extremism. Given the fact that extremism is a variable, amorphous and insufficiently researched phenomenon, largely conditioned by time, space, political and cultural differences, there is a great confusion in the field of political science when defining right-wing extremism. The problem of researching right-wing extremism is additionally complicated by various terms that are being used in the contemporary literature as its synonyms, such as right-wing radicalism, neo-Fascism, ultra-radicalism, etc. In order to provide the most valid theoretical determination of right-wing extremism, the author provides a detailed analysis of all the components constituting this phenomenon and examines their causality. In the political praxis, the term extremism is extensively abused, which additionally complicates its determination. Videlicet, politicians often use term 'extremist' in order to discredit their political opponents. While during the French revolution aristocracy saw the bourgeoisie as extremists, the members of the working class later stated that the bourgeoisie were extremists. The problem lies in the fact that, in politics, extremists are not only the ones who use violence as modus operandi; indeed, it is also used by political opponents who do not belong to the extreme political option. Another aggravating factor in defining right-wing extremism is that many administrative and academic definitions do not make a clear distinction between extremism and related phenomena, such as terrorism, radicalism and populism. Extremism is most often equaled with terrorism, which gives rise to another problem in defining this phenomenon. The relation between extremism and terrorism is the relation of general and specific. Namely, every act of terrorism is concurrently considered to be an act of extremism, but not vice versa, given the fact that

Extreme events in the Dudetes Mountains - Their long-term geomorphic impact and possible controlling factors

Czech Academy of Sciences Publication Activity Database

Migon, P.; Hrádek, Mojmír; Parzoch, K.

2002-01-01

Roč. 36, č. 36 (2002), s. 29-49 ISSN 0081-6434 Institutional research plan: CEZ:AV0Z3086906 Keywords : extreme events * debris flow * landslide-floods Subject RIV: DE - Earth Magnetism, Geodesy, Geography

Sensitivity of subject-specific models to errors in musculo-skeletal geometry

NARCIS (Netherlands)

Carbone, V.; van der Krogt, M.M.; Koopman, H.F.J.M.; Verdonschot, N.

2012-01-01

Subject-specific musculo-skeletal models of the lower extremity are an important tool for investigating various biomechanical problems, for instance the results of surgery such as joint replacements and tendon transfers. The aim of this study was to assess the potential effects of errors in

Resilience of coastal wetlands to extreme hydrologicevents in Apalachicola Bay

Science.gov (United States)

Medeiros, S. C.; Singh, A.; Tahsin, S.

2017-12-01

Extreme hydrologic events such as hurricanes and droughts continuously threaten wetlands which provide key ecosystem services in coastal areas. The recovery time for vegetation after impact fromthese extreme events can be highly variable depending on the hazard type and intensity. Apalachicola Bay in Florida is home to a rich variety of saltwater and freshwater wetlands and is subject to a wide rangeof hydrologic hazards. Using spatiotemporal changes in Landsat-based empirical vegetation indices, we investigate the impact of hurricane and drought on both freshwater and saltwater wetlands from year 2000to 2015 in Apalachicola Bay. Our results indicate that saltwater wetlands are more resilient than freshwater wetlands and suggest that in response to hurricanes, the coastal wetlands took almost a year to recover,while recovery following a drought period was observed after only a month.

Global patterns of NDVI-indicated vegetation extremes and their sensitivity to climate extremes

International Nuclear Information System (INIS)

Liu Guo; Liu Hongyan; Yin Yi

2013-01-01

Extremes in climate have significant impacts on ecosystems and are expected to increase under future climate change. Extremes in vegetation could capture such impacts and indicate the vulnerability of ecosystems, but currently have not received a global long-term assessment. In this study, a robust method has been developed to detect significant extremes (low values) in biweekly time series of global normalized difference vegetation index (NDVI) from 1982 to 2006 and thus to acquire a global pattern of vegetation extreme frequency. This pattern coincides with vegetation vulnerability patterns suggested by earlier studies using different methods over different time spans, indicating a consistent mechanism of regulation. Vegetation extremes were found to aggregate in Amazonia and in the semi-arid and semi-humid regions in low and middle latitudes, while they seldom occurred in high latitudes. Among the environmental variables studied, extreme low precipitation has the highest slope against extreme vegetation. For the eight biomes analyzed, these slopes are highest in temperate broadleaf forest and temperate grassland, suggesting a higher sensitivity in these environments. The results presented here contradict the hypothesis that vegetation in water-limited semi-arid and semi-humid regions might be adapted to drought and suggest that vegetation in these regions (especially temperate broadleaf forest and temperate grassland) is highly prone to vegetation extreme events under more severe precipitation extremes. It is also suggested here that more attention be paid to precipitation-induced vegetation changes than to temperature-induced events. (letter)

Early warnings of extreme winds using the ECMWF Extreme Forecast Index

OpenAIRE

Petroliagis, Thomas I.; Pinson, Pierre

2014-01-01

The European FP7 SafeWind Project aims at developing research towards a European vision of wind power forecasting, which requires advanced meteorological support concerning extreme wind events. This study is focused mainly on early warnings of extreme winds in the early medium-range. Three synoptic stations (airports) of North Germany (Bremen, Hamburg and Hannover) were considered for the construction of time series of daily maximum wind speeds. All daily wind extremes were found to be linked...

Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm

Directory of Open Access Journals (Sweden)

Kang Youn

2012-10-01

Full Text Available Abstract Background Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation. However, the underlying mechanisms for these therapeutic effects have not been previously described. Objectives We attempted to delineate the changes in corticospinal excitability when individuals were asked to exercise their upper extremity using a real mirror and virtual mirror. Moreover, we attempted to delineate the role of visual modulation within the virtual environment that affected corticospinal excitability in healthy subjects and stroke patients. Methods A total of 18 healthy subjects and 18 hemiplegic patients were enrolled into the study. Motor evoked potential (MEPs from transcranial magnetic stimulation were recorded in the flexor carpi radialis of the non-dominant or affected upper extremity using three different conditions: (A relaxation; (B real mirror; and (C virtual mirror. Moreover, we compared the MEPs from the virtual mirror paradigm using continuous visual feedback or intermittent visual feedback. Results The rates of amplitude increment and latency decrement of MEPs in both groups were higher during the virtual mirror task than during the real mirror. In healthy subjects and stroke patients, the virtual mirror task with intermittent visual feedback significantly facilitated corticospinal excitability of MEPs compared with continuous visual feedback. Conclusion Corticospinal excitability was facilitated to a greater extent in the virtual mirror paradigm than in the real mirror and in intermittent visual feedback than in the continuous visual feedback, in both groups. This provides neurophysiological evidence supporting the application of the virtual mirror paradigm using various visual modulation technologies to upper extremity rehabilitation in stroke patients.

Chaos synchronization communication using extremely unsymmetrical bidirectional injections.

Science.gov (United States)

Zhang, Wei Li; Pan, Wei; Luo, Bin; Zou, Xi Hua; Wang, Meng Yao; Zhou, Zhi

2008-02-01

Chaos synchronization and message transmission between two semiconductor lasers with extremely unsymmetrical bidirectional injections (EUBIs) are discussed. By using EUBIs, synchronization is realized through injection locking. Numerical results show that if the laser subjected to strong injection serves as the receiver, chaos pass filtering (CPF) of the system is similar to that of unidirectional coupled systems. Moreover, if the other laser serves as the receiver, a stronger CPF can be obtained. Finally, we demonstrate that messages can be extracted successfully from either of the two transmission directions of the system.

Feasibility of an Exoskeleton-Based Interactive Video Game System for Upper Extremity Burn Contractures.

Science.gov (United States)

Schneider, Jeffrey C; Ozsecen, Muzaffer Y; Muraoka, Nicholas K; Mancinelli, Chiara; Della Croce, Ugo; Ryan, Colleen M; Bonato, Paolo

2016-05-01

Burn contractures are common and difficult to treat. Measuring continuous joint motion would inform the assessment of contracture interventions; however, it is not standard clinical practice. This study examines use of an interactive gaming system to measure continuous joint motion data. To assess the usability of an exoskeleton-based interactive gaming system in the rehabilitation of upper extremity burn contractures. Feasibility study. Eight subjects with a history of burn injury and upper extremity contractures were recruited from the outpatient clinic of a regional inpatient rehabilitation facility. Subjects used an exoskeleton-based interactive gaming system to play 4 different video games. Continuous joint motion data were collected at the shoulder and elbow during game play. Visual analog scale for engagement, difficulty and comfort. Angular range of motion by subject, joint, and game. The study population had an age of 43 ± 16 (mean ± standard deviation) years and total body surface area burned range of 10%-90%. Subjects reported satisfactory levels of enjoyment, comfort, and difficulty. Continuous joint motion data demonstrated variable characteristics by subject, plane of motion, and game. This study demonstrates the feasibility of use of an exoskeleton-based interactive gaming system in the burn population. Future studies are needed that examine the efficacy of tailoring interactive video games to the specific joint impairments of burn survivors. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

FDG-PET imaging of lower extremity muscular activity during level walking

International Nuclear Information System (INIS)

Oi, Naoyuki; Iwaya, Tsutomu; Tobimatsu, Yoshiko; Fujimoto, Toshihiko; Itoh, Masatoshi; Yamaguchi, Keiichiro

2003-01-01

We analyzed muscular activity of the lower extremities during level walking using positron emission tomography (PET) with 18 F-fluorodeoxyglucose ( 18 F-FDG). We examined 17 healthy male subjects; 11 were assigned to a walking group and 6 to a resting group. After 18 F-FDG injection, the walking group subjects walked at a free speed for 15 min. A whole-body image was then obtained by a PET camera, and the standardized uptake ratio (SUR) was computed for each muscle. The SUR for each muscle of the walking group was compared with that for the corresponding muscles in the resting group. The level of muscular activity of all the muscles we examined were higher during level walking than when resting. The activity of the lower leg muscles was higher than that of the thigh muscles during level walking. The muscular activity of the soleus was highest among all the muscles examined. Among the gluteal muscles, the muscular activity of the gluteus minimus was higher than that of the gluteus maximus and gluteus medius. The concurrent validity of measuring muscular activity of the lower extremity during level walking by the PET method using 18 F-FDG was demonstrated. (author)

Reliability of Ceramic Column Grid Array Interconnect Packages Under Extreme Temperatures

Science.gov (United States)

Ramesham, Rajeshuni

2011-01-01

A paper describes advanced ceramic column grid array (CCGA) packaging interconnects technology test objects that were subjected to extreme temperature thermal cycles. CCGA interconnect electronic package printed wiring boards (PWBs) of polyimide were assembled, inspected nondestructively, and, subsequently, subjected to ex - treme-temperature thermal cycling to assess reliability for future deep-space, short- and long-term, extreme-temperature missions. The test hardware consisted of two CCGA717 packages with each package divided into four daisy-chained sections, for a total of eight daisy chains to be monitored. The package is 33 33 mm with a 27 27 array of 80%/20% Pb/Sn columns on a 1.27-mm pitch. The change in resistance of the daisy-chained CCGA interconnects was measured as a function of the increasing number of thermal cycles. Several catastrophic failures were observed after 137 extreme-temperature thermal cycles, as per electrical resistance measurements, and then the tests were continued through 1,058 thermal cycles to corroborate and understand the test results. X-ray and optical inspection have been made after thermal cycling. Optical inspections were also conducted on the CCGA vs. thermal cycles. The optical inspections were conclusive; the x-ray images were not. Process qualification and assembly is required to optimize the CCGA assembly, which is very clear from the x-rays. Six daisy chains were open out of seven daisy chains, as per experimental test data reported. The daisy chains are open during the cold cycle, and then recover during the hot cycle, though some of them also opened during the hot thermal cycle..

Characteristics of extreme precipitation in the Vosges Mountains region (north-eastern France)

Czech Academy of Sciences Publication Activity Database

Minářová, Jana; Müller, Miloslav; Clappier, A.; Kašpar, Marek

2017-01-01

Roč. 37, č. 13 (2017), s. 4529-4542 ISSN 0899-8418 Institutional support: RVO:68378289 Keywords : Vosges Mountains * extreme precipitation * heavy rainfall * WEI * synoptic conditions * precipitation * Grosswetterlagen * trend analysis Subject RIV: DG - Athmosphere Sciences, Meteorology OBOR OECD: Meteorology and atmospheric sciences Impact factor: 3.760, year: 2016 http://onlinelibrary.wiley.com/doi/10.1002/joc.5102/abstract

Early warnings of extreme winds using the ECMWF Extreme Forecast Index

DEFF Research Database (Denmark)

Petroliagis, Thomas I.; Pinson, Pierre

2014-01-01

The European FP7 SafeWind Project aims at developing research towards a European vision of wind power forecasting, which requires advanced meteorological support concerning extreme wind events. This study is focused mainly on early warnings of extreme winds in the early medium-range. Three synoptic...... regimes. Overall, it becomes clear that the first indications of an extreme wind event might come from the ECMWF deterministic and/or probabilistic components capturing very intense weather systems (possible windstorms) in the medium term. For early warnings, all available EPS Extreme Forecast Index (EFI......) formulations were used, by linking daily maximum wind speeds to EFI values for different forecast horizons. From all possible EFI schemes deployed for issuing early warnings, the highest skill was found for the Gust Factor formulation (EFI-10FGI). Using EFI-10FGI, the corresponding 99% threshold could provide...

Analysis of students’ nervous system’s typological properties, in aspect of response to extreme situation, with the help of multi-dimensional analysis

Directory of Open Access Journals (Sweden)

Z.L. Kozina

2015-06-01

Full Text Available Purpose: determination of objective and subjective characteristics of students’ with different properties of nervous system fear of heights. Material: In the research 10 students of 18-19 years old age, who did not practice sports, participated. The students fulfilled one exercises: passing suspended ferriage in hiking. This exercise gives subjective perception of height and creates artificial conditions for appearing of fear. He exercise was fulfilled under all required safety measures and supervised by experienced instructor. Cluster and discriminant analysis were used. Results: we have shown that is possible to divide people into groups by indicators of functional changes in extreme situation in combination with indicators of psycho-physiological potentials and properties of nervous system. We have found that the most significant indicators for distribution of students into groups by individual typological properties are speed and accuracy of passing of psycho-physiological tests with different modes of signals’ supply as well as functional changes before exercise of extreme character. Conclusions: It was determined that students with strong type of nervous system had confidently less heart beats rate before fulfillment of extreme exercise than the students with weak type of nervous system. Subjective feeling of fear before fulfillment of extreme exercise was also confidently less in representatives of strong type of nervous system.

A Baseline Measure of Tree and Gastropod Biodiversity in Replanted and Natural Mangrove Stands in Malaysia: Langkawi Island and Sungai Merbok

Science.gov (United States)

Hookham, Brenda; Shau-Hwai, Aileen Tan; Dayrat, Benoit; Hintz, William

2014-01-01

The diversities of mangrove trees and of their associated gastropods were assessed for two mangrove regions on the west coast of Peninsular Malaysia: Langkawi Island and Sungai Merbok. The mangrove area sampled on Langkawi Island was recently logged and replanted, whereas the area sampled in Sungai Merbok was part of a protected nature reserve. Mangrove and gastropod diversity were assessed in four 50 m2 (10 × 5 m) sites per region. The species richness (S), Shannon Index (H’) and Evenness Index (J’) were calculated for each site, and the mean S, H’ and J’ values were calculated for each region. We report low tree and gastropod S, H’ and J’ values in all sites from both regions. For Langkawi Island, the mean S, H’ and J’ values for mangrove trees were S = 2.00±0, H’ = 0.44±0.17 and J’ = 0.44±0.17; the mean S, H’ and J’ values for gastropods were S = 4.00±1.63, H’ = 0.96±0.41 and J’ = 0.49±0.06. In Sungai Merbok, the mean S, H’ and J’ values for mangrove trees were S = 1.33±0.58, H’ = 0.22±0.39 and J’ = 0.22 ±0.39; the mean S, H’ and J’ values for gastropods were S = 4.75±2.22, H’ = 1.23±0.63 and J’ = 0.55±0.12. This study emphasises the need for baseline biodiversity measures to be established in mangrove ecosystems to track the impacts of anthropogenic disturbances and to inform management and restoration efforts. PMID:25210584

Optimization with Extremal Dynamics

International Nuclear Information System (INIS)

Boettcher, Stefan; Percus, Allon G.

2001-01-01

We explore a new general-purpose heuristic for finding high-quality solutions to hard discrete optimization problems. The method, called extremal optimization, is inspired by self-organized criticality, a concept introduced to describe emergent complexity in physical systems. Extremal optimization successively updates extremely undesirable variables of a single suboptimal solution, assigning them new, random values. Large fluctuations ensue, efficiently exploring many local optima. We use extremal optimization to elucidate the phase transition in the 3-coloring problem, and we provide independent confirmation of previously reported extrapolations for the ground-state energy of ±J spin glasses in d=3 and 4

Arsenic-rich acid mine water with extreme arsenic concentration: mineralogy, geochemistry, microbiology, and environmental implications

Czech Academy of Sciences Publication Activity Database

Majzlan, J.; Plášil, Jakub; Škoda, R.; Gescher, J.; Kögler, F.; Rusznyak, A.; Küsel, K.; Neu, T.R.; Mangold, S.; Rothe, J.

2014-01-01

Roč. 48, č. 23 (2014), s. 13685-13693 ISSN 0013-936X R&D Projects: GA ČR GP13-31276P Institutional support: RVO:68378271 Keywords : extreme arsenic concentration Subject RIV: DB - Geology ; Mineralogy Impact factor: 5.330, year: 2014

Thermal extremes mortality risk assessment in urban areas

Directory of Open Access Journals (Sweden)

Paulo Canário

2010-06-01

Full Text Available The impact of heat waves on mortality has been the subject of numerous studies and the focus of attention of various national and international governmental bodies. In the summer of 2003 alone, which was exceptionally hot, the number of deaths in 12 European countries increased by 70,000. The overall trend of warming will lead to an increase in frequency, duration and intensity of heat waves and to an increase in heat related mortality. The need to assess the risk of death due to extreme heat, at a detailed spatial scale, has determined the implementation of a research project based on a general model of risk for potentially destructive natural phenomena; the model uses the relationship between hazard and vulnerability and was designed primarily for urban areas. The major hazardous meteorological variables are those that determine the thermal complex (air temperature, radiative temperature, wind and humidity and the variables related to air quality (mainly ozone and Particulate matter. Vulnerability takes into account the population sensitivity (at various spatial scales and their exposure to thermal extremes.

Evaluation of precipitation extremes and floods and comparison between their temporal distributions

Czech Academy of Sciences Publication Activity Database

Müller, Miloslav; Kašpar, Marek; Valeriánová, A.; Crhová, L.; Holtanová, E.

2015-01-01

Roč. 12, č. 1 (2015), s. 281-310 ISSN 1812-2108 R&D Projects: GA ČR(CZ) GAP209/11/1990 Institutional support: RVO:68378289 Keywords : precipitation extremes * floods Subject RIV: DG - Athmosphere Sci ences, Meteorology OBOR OECD: Meteorology and atmospheric sci ences https://www.hydrol-earth-syst- sci .net/19/4641/2015/hessd-12-281-2015.pdf

INDIRECT EFFECT OF EXTREME FLOODING: DISAPPEARANCE OF WADING BIRDS ROOST CAUSED BY VEGETATION TURN

Czech Academy of Sciences Publication Activity Database

Rajchard, J.; Balounová, Z.; Novák, R.; Kindlmann, Pavel

2007-01-01

Roč. 26, č. 1 (2007), s. 64-67 ISSN 1335-342X R&D Projects: GA AV ČR IAA6093105; GA AV ČR(CZ) KSK6005114 Keywords : extreme flooding * night heron * spoonbill * little egret * shrubs Subject RIV: EH - Ecology, Behaviour Impact factor: 0.085, year: 2005

Ideologies and Discourses: Extreme Narratives in Extreme Metal Music

Directory of Open Access Journals (Sweden)

Bojana Radovanović

2016-10-01

Full Text Available Historically speaking, metal music has always been about provoking a strong reaction. Depending on the characteristics of different sub-genres, one can focus on the sound, technique, visual appearance, and furthermore, the ideologies and ideas that are the foundation for each of the sub-genres. Although the majority of the metal community rejects accusations of being racially intolerant, some ideologies of extreme sub-genres (such as black metal are in fact formed around the ideas of self-conscious elitism expressed through interest in pagan mythology, racism, Nazism and fascism. There has been much interest in the Nazi era within the extreme metal scene thus influencing other sub-genres and artists. The aim of this paper is to examine various appearances of extreme narratives such as Nazism and racism in  different sub-genres of metal, bearing in mind variations dependent on geographical, political, and other factors.

Extremal surface barriers

International Nuclear Information System (INIS)

Engelhardt, Netta; Wall, Aron C.

2014-01-01

We present a generic condition for Lorentzian manifolds to have a barrier that limits the reach of boundary-anchored extremal surfaces of arbitrary dimension. We show that any surface with nonpositive extrinsic curvature is a barrier, in the sense that extremal surfaces cannot be continuously deformed past it. Furthermore, the outermost barrier surface has nonnegative extrinsic curvature. Under certain conditions, we show that the existence of trapped surfaces implies a barrier, and conversely. In the context of AdS/CFT, these barriers imply that it is impossible to reconstruct the entire bulk using extremal surfaces. We comment on the implications for the firewall controversy

Hydrometeorological extremes derived from taxation records for south-eastern Moravia, Czech Republic, 1751–1900 AD

Czech Academy of Sciences Publication Activity Database

Brázdil, Rudolf; Chromá, Kateřina; Valášek, H.; Dolák, L.

2012-01-01

Roč. 8, č. 2 (2012), s. 467-481 ISSN 1814-9324 Institutional support: RVO:67179843 Keywords : documentary evidence * hydrometeorological extremes * tax alleviation * flood * hailstorm * torrential rain Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 3.556, year: 2012

Evaluation of a morphing based method to estimate muscle attachment sites of the lower extremity

NARCIS (Netherlands)

Pellikaan, P.; van der Krogt, Marjolein; Carbone, Vincenzo; Fluit, René; Vigneron, L.M.; van Deun, J.; Verdonschot, Nicolaas Jacobus Joseph; Koopman, Hubertus F.J.M.

2014-01-01

To generate subject-specific musculoskeletal models for clinical use, the location of muscle attachment sites needs to be estimated with accurate, fast and preferably automated tools. For this purpose, an automatic method was used to estimate the muscle attachment sites of the lower extremity, based

DETERMINATION OF THE TIME LIMITS OF ELIGIBILITY IN A STATE OF EXTREME NECESSITY

Directory of Open Access Journals (Sweden)

Vyacheslav Victorovich Naumov

2015-12-01

Full Text Available Up to now the limits of eligibility of extreme necessity were not the subject of independent research.The problems of definition of the time limits of p eligibility are considered in this article based on the scientific and monographic literature analysis. Relevance of the considered matter is defined by the fact that the correct establishment of time limits of eligibility of act is of great importance in the law enforcement activity in order to establish the non-delinquency of act in state of extreme necessity. The purpose of this research is the analysis of definition of time limits of extreme necessity eligibility and drawing proposals on this basis for improvement of legislative regulations and existing laws enforcement efficiency with regards to extreme necessity. Research methods: dialectic, formal-logical, system. The author empha-sizes the eligibility limits of admissible harm and the temporary limits. When determining the time limits the author emphasizes the following criteria: the value of danger, intensity of actions, and also identifies an "initial" and "final" moments in the defense of legally protected interests. The improvement of the existing legisla-tion was proposed based on the carried-out analysis.

Estimating extremes in climate change simulations using the peaks-over-threshold method with a non-stationary threshold

Czech Academy of Sciences Publication Activity Database

Kyselý, Jan; Picek, J.; Beranová, Romana

2010-01-01

Roč. 72, 1-2 (2010), s. 55-68 ISSN 0921-8181 R&D Projects: GA ČR GA205/06/1535; GA ČR GAP209/10/2045 Grant - others:GA MŠk(CZ) LC06024 Institutional research plan: CEZ:AV0Z30420517 Keywords : climate change * extreme value analysis * global climate models * peaks-over-threshold method * peaks-over-quantile regression * quantile regression * Poisson process * extreme temperatures Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 3.351, year: 2010

Web Based Information System for Job Training Activities Using Personal Extreme Programming (PXP)

Science.gov (United States)

Asri, S. A.; Sunaya, I. G. A. M.; Rudiastari, E.; Setiawan, W.

2018-01-01

Job training is one of the subjects in university or polytechnic that involves many users and reporting activities. Time and distance became problems for users to reporting and to do obligations tasks during job training due to the location where the job training took place. This research tried to develop a web based information system of job training to overcome the problems. This system was developed using Personal Extreme Programming (PXP). PXP is one of the agile methods is combination of Extreme Programming (XP) and Personal Software Process (PSP). The information system that has developed and tested which are 24% of users are strongly agree, 74% are agree, 1% disagree and 0% strongly disagree about system functionality.

[Optimising care structures for severe hand trauma and replantation and chances of launching a national network].

Science.gov (United States)

Haas, E M; Volkmer, E; Holzbach, T; Wallmichrath, J; Engelhardt, T O; Giunta, R E

2013-12-01

Severe hand traumata have a significant impact on our health system and on insurance companies, respectively. It is estimated that 33% of all occupational injuries and 9% of all invalidity pensions are due to severe hand trauma. Unfortunately, these high numbers are not only due to the severity of the trauma but to organisational deficiencies. Usually, the patient is treated at the general surgical emergency in the first place and only then forwarded to a microsurgeon. This redirection increases the time that is required for the patient to finally arrive at an expert for hand surgery. On the one hand, this problem can be explained by the population's lack of awareness for distinguished experts for hand and microsurgery, on the other hand, the emergency network, or emergency doctors in particular are not well informed about where to take a patient with a severe hand trauma - clearly a problem of communication between the hospitals and the ambulance. It is possible to tackle this problem, but put participating hand trauma centres have to work hand in hand as a network and thus exploit synergy effects. The French system "FESUM" is a good example for such a network and even comprises centres in Belgium and Switzerland. To improve the treatment of severe hand trauma, a similar alliance was initiated in Germany just recently. The pilot project "Hand Trauma Alliance" (www.handverletzung.com) was started in April 2013 and currently comprises two hospitals within the region of upper Bavaria. The network provides hand trauma replantation service on a 24/7 basis and aims at shortening the way from the accident site to the fully qualified hand surgeon, to improve the therapy of severe hand injuries and to optimise acute patient care in general. In order to further increase the alliance's impact it is intended to extend the project's scope from regional to national coverage - nevertheless, such an endeavour can only be done in collaboration with the German Society for Hand

Distal phalanx amputation with delayed presentation and successful reconstruction with reposition and flap after 2 weeks

Directory of Open Access Journals (Sweden)

Jefferson Braga-Silva

2016-01-01

Full Text Available Traumatic finger amputations are common, causing significant functional and cosmetic deficits. Microsurgical replantation techniques are the mainstay of treatment for most such injuries although they require adequate conservation of the amputated segment for a successful result. In distal finger amputations, replantation is the procedure of choice, as long as the amputated fragment is viable. If replantation is not an option, reposition + flap using a neurovascular flap can be an efficient option, as this offers improved skin coverage. To the best of our knowledge, this case illustrates the longest cold ischaemic time with a successful outcome.

Continuous Infraclavicular Block for Forearm Amputation After Being Bitten by a Saltwater Crocodile (Crocodylus Porosus: A Case Report

Directory of Open Access Journals (Sweden)

Chin-Hsi Chiu

2009-08-01

Full Text Available Two important issues after a complete right forearm amputation are replantation and ongoing pain management. There are no reports of successful forearm replantation as a consequence of a crocodile bite. Here, we discuss our pain management in a case of complete forearm amputation after a bite from a saltwater crocodile (Crocodylus porosus, which necessitated six further operations to achieve successful replantation. Continuous infraclavicular brachial plexus block was effective for acute pain control in this case. We strongly recommend performing the block with an indwelling catheter under ultrasound guidance for higher accuracy and safety.

Statistics of Extremes

KAUST Repository

Davison, Anthony C.

2015-04-10

Statistics of extremes concerns inference for rare events. Often the events have never yet been observed, and their probabilities must therefore be estimated by extrapolation of tail models fitted to available data. Because data concerning the event of interest may be very limited, efficient methods of inference play an important role. This article reviews this domain, emphasizing current research topics. We first sketch the classical theory of extremes for maxima and threshold exceedances of stationary series. We then review multivariate theory, distinguishing asymptotic independence and dependence models, followed by a description of models for spatial and spatiotemporal extreme events. Finally, we discuss inference and describe two applications. Animations illustrate some of the main ideas. © 2015 by Annual Reviews. All rights reserved.

Moving in extreme environments: what's extreme and who decides?

Science.gov (United States)

Cotter, James David; Tipton, Michael J

2014-01-01

Humans work, rest and play in immensely varied extreme environments. The term 'extreme' typically refers to insufficiency or excess of one or more stressors, such as thermal energy or gravity. Individuals' behavioural and physiological capacity to endure and enjoy such environments varies immensely. Adverse effects of acute exposure to these environments are readily identifiable (e.g. heat stroke or bone fracture), whereas adverse effects of chronic exposure (e.g. stress fractures or osteoporosis) may be as important but much less discernable. Modern societies have increasingly sought to protect people from such stressors and, in that way, minimise their adverse effects. Regulations are thus established, and advice is provided on what is 'acceptable' exposure. Examples include work/rest cycles in the heat, hydration regimes, rates of ascent to and duration of stay at altitude and diving depth. While usually valuable and well intentioned, it is important to realise the breadth and importance of limitations associated with such guidelines. Regulations and advisories leave less room for self-determination, learning and perhaps adaptation. Regulations based on stress (e.g. work/rest cycles relative to WBGT) are more practical but less direct than those based on strain (e.g. core temperature), but even the latter can be substantively limited (e.g. by lack of criterion validation and allowance for behavioural regulation in the research on which they are based). Extreme Physiology & Medicine is publishing a series of reviews aimed at critically examining the issues involved with self- versus regulation-controlled human movement acutely and chronically in extreme environments. These papers, arising from a research symposium in 2013, are about the impact of people engaging in such environments and the effect of rules and guidelines on their safety, enjoyment, autonomy and productivity. The reviews will cover occupational heat stress, sporting heat stress, hydration, diving

Evolution caused by extreme events.

Science.gov (United States)

Grant, Peter R; Grant, B Rosemary; Huey, Raymond B; Johnson, Marc T J; Knoll, Andrew H; Schmitt, Johanna

2017-06-19

Extreme events can be a major driver of evolutionary change over geological and contemporary timescales. Outstanding examples are evolutionary diversification following mass extinctions caused by extreme volcanism or asteroid impact. The evolution of organisms in contemporary time is typically viewed as a gradual and incremental process that results from genetic change, environmental perturbation or both. However, contemporary environments occasionally experience strong perturbations such as heat waves, floods, hurricanes, droughts and pest outbreaks. These extreme events set up strong selection pressures on organisms, and are small-scale analogues of the dramatic changes documented in the fossil record. Because extreme events are rare, almost by definition, they are difficult to study. So far most attention has been given to their ecological rather than to their evolutionary consequences. We review several case studies of contemporary evolution in response to two types of extreme environmental perturbations, episodic (pulse) or prolonged (press). Evolution is most likely to occur when extreme events alter community composition. We encourage investigators to be prepared for evolutionary change in response to rare events during long-term field studies.This article is part of the themed issue 'Behavioural, ecological and evolutionary responses to extreme climatic events'. © 2017 The Author(s).

Delayed tooth replantation after root surface treatment with sodium hypochlorite and sodium fluoride: histomorphometric analysis in rats Reimplante dentário tardio após o tratamento da superfície radicular com hipoclorito de sódio e fluoreto de sódio: análise histomorfométrica em ratos

Directory of Open Access Journals (Sweden)

André Dotto Sottovia

2006-04-01

Full Text Available In cases of delayed tooth replantation, non-vital periodontal ligament remnants have been removed with sodium hypochlorite in an attempt to control root resorption. Nevertheless, reports of its irritating potential in contact with the alveolar connective tissue have been described. Therefore, this study evaluated the healing process on delayed replantation of rat teeth, after periodontal ligament removal by different treatment modalities. Twenty-four rats, assigned to 3 groups (n=8, had their upper right incisor extracted and left on the workbench for desiccation during 60 min. Afterwards, the teeth in group I were immersed in saline for 2 min. In group II, root surfaces were scrubbed with gauze soaked in saline for 2 min; and in group III, scrubbing was done with gauze soaked in 1% sodium hypochlorite solution. Thereafter, root surfaces were etched with 37% phosphoric acid and immersed in 2% acidulate-phosphate sodium fluoride solution, at pH 5.5. Root canals were filled with a calcium hydroxide-based paste and the teeth were replanted. The animals were sacrificed 60 days postoperatively and the pieces containing the replanted teeth were processed and paraffin- embedded. Semi-serial transversally sections were obtained from the middle third of the root and stained with hematoxylin and eosin for histomorphometric analysis. Data were analyzed statistically using Kruskal-Wallis and Dunn's tests. The results showed that root structure and cementum extension were more affected by resorption in group III (pEm reimplante dentário tardio, o ligamento periodontal desvitalizado tem sido removido empregando-se o hipoclorito de sódio, buscando o controle da reabsorção radicular. Relatos de efeito irritante no tecido conjuntivo alveolar após o seu uso, têm sido descritos. Isso justificou a realização deste trabalho buscando minimizar esse inconveniente. Para isso 24 ratos, divididos em 3 grupos de 8 animais, tiveram o incisivo superior direito extra

Effects of aquatic PNF lower extremity patterns on balance and ADL of stroke patients.

Science.gov (United States)

Kim, Eun-Kyung; Lee, Dong-Kyu; Kim, Young-Mi

2015-01-01

[Purpose] This study investigated the effect of aquatic proprioceptive neuromuscular facilitation (PNF) patterns in the lower extremity on balance and activities of daily living (ADL) in stroke patients. [Subjects] Twenty poststroke participants were randomly assigned to an experimental group (n = 10) or a control group (n = 10). The experimental group performed lower extremity patterns in an aquatic environment, and the control group performed lower extremity patterns on the ground. Both exercises were conducted for 30 minutes/day, 5 days/week for 6 weeks. Balance was measured with the Berg Balance Scale (BBS), Timed Up and Go Test (TUGT), Functional Reach Test (FRT), and One Leg Stand Test (OLST). Activities of daily living were measured with the Functional Independence Measure (FIM). A paired t-test was used to measure pre- and post-experiment differences, and an independent t-test was used to measure between-group differences. [Results] The experimental and control groups showed significant differences for all pre- and post-experiment variables. In the between-group comparison, the experimental group was significantly difference from the control group. [Conclusion] These results indicate that performing aquatic proprioceptive neuromuscular facilitation patterns in the lower extremity enhances balance and ADL in stroke patients.

Combinations of large-scale circulation anomalies conducive to precipitation extremes in the Czech Republic

Czech Academy of Sciences Publication Activity Database

Kašpar, Marek; Müller, Miloslav

2014-01-01

Roč. 138, March 2014 (2014), s. 205-212 ISSN 0169-8095 R&D Projects: GA ČR(CZ) GAP209/11/1990 Institutional support: RVO:68378289 Keywords : precipitation extreme * synoptic-scale cause * re-analysis * circulation anomaly Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 2.844, year: 2014 http://www.sciencedirect.com/science/article/pii/S0169809513003372

Adaptive statistical iterative reconstruction use for radiation dose reduction in pediatric lower-extremity CT: impact on diagnostic image quality.

Science.gov (United States)

Shah, Amisha; Rees, Mitchell; Kar, Erica; Bolton, Kimberly; Lee, Vincent; Panigrahy, Ashok

2018-06-01

For the past several years, increased levels of imaging radiation and cumulative radiation to children has been a significant concern. Although several measures have been taken to reduce radiation dose during computed tomography (CT) scan, the newer dose reduction software adaptive statistical iterative reconstruction (ASIR) has been an effective technique in reducing radiation dose. To our knowledge, no studies are published that assess the effect of ASIR on extremity CT scans in children. To compare radiation dose, image noise, and subjective image quality in pediatric lower extremity CT scans acquired with and without ASIR. The study group consisted of 53 patients imaged on a CT scanner equipped with ASIR software. The control group consisted of 37 patients whose CT images were acquired without ASIR. Image noise, Computed Tomography Dose Index (CTDI) and dose length product (DLP) were measured. Two pediatric radiologists rated the studies in subjective categories: image sharpness, noise, diagnostic acceptability, and artifacts. The CTDI (p value = 0.0184) and DLP (p value ASIR compared with non-ASIR studies. However, the subjective ratings for sharpness (p ASIR images (p ASIR CT studies. Adaptive statistical iterative reconstruction reduces radiation dose for lower extremity CTs in children, but at the expense of diagnostic imaging quality. Further studies are warranted to determine the specific utility of ASIR for pediatric musculoskeletal CT imaging.

A case of dorsal oblique fingertip amputation.

Science.gov (United States)

Takeda, Shinsuke; Tatebe, Masahiro; Morita, Akimasa; Yoneda, Hidemasa; Iwatsuki, Katsuyuki; Hirata, Hitoshi

2017-01-01

This study reports successful finger replantation in a patient with a dorsal oblique fingertip amputation. When repairing this unique type of injury, an evaluation of the remaining vessels is more useful for successful replantation than the anatomical zone classification. We propose that Kasai's classification is appropriate for guiding treatment.

A modified technique for application of tissue expanders for extremities in burn scars patients

International Nuclear Information System (INIS)

Ghalambor, A.

2007-01-01

Tissue expansion is considered a major advancement in reconstructive surgery. However, there are limitations to their application in the extremities and carries relatively higher rates of complications. The aim of this study was to propose a modification to this technique and assess the rate of complications with slower rate of expansion. Thirty females (age range 14 to 40) with burn scars in the upper or lower extremity (15 cases in each) were the subjects of this investigation. Various sized rectangular expanders were used and expanded at a rate of 5% of the maximum inflatable size over 20 weeks. All of the cases of expansion completed the procedure uneventfully. In one case that developed necrosis at the edge of the flap, one week after removal of the expander, which was debrided and repaired successfully completed the treatment. Slow expansion method is a useful method which can safely be applied for burn scars in the extremities. (author)

Effect of Robot-Assisted Game Training on Upper Extremity Function in Stroke Patients

Science.gov (United States)

2017-01-01

Objective To determine the effects of combining robot-assisted game training with conventional upper extremity rehabilitation training (RCT) on motor and daily functions in comparison with conventional upper extremity rehabilitation training (OCT) in stroke patients. Methods Subjects were eligible if they were able to perform the robot-assisted game training and were divided randomly into a RCT and an OCT group. The RCT group performed one daily session of 30 minutes of robot-assisted game training with a rehabilitation robot, plus one daily session of 30 minutes of conventional rehabilitation training, 5 days a week for 2 weeks. The OCT group performed two daily sessions of 30 minutes of conventional rehabilitation training. The effects of training were measured by a Manual Function Test (MFT), Manual Muscle Test (MMT), Korean version of the Modified Barthel Index (K-MBI) and a questionnaire about satisfaction with training. These measurements were taken before and after the 2-week training. Results Both groups contained 25 subjects. After training, both groups showed significant improvements in motor and daily functions measured by MFT, MMT, and K-MBI compared to the baseline. Both groups demonstrated similar training effects, except motor power of wrist flexion. Patients in the RCT group were more satisfied than those in the OCT group. Conclusion There were no significant differences in changes in most of the motor and daily functions between the two types of training. However, patients in the RCT group were more satisfied than those in the OCT group. Therefore, RCT could be a useful upper extremity rehabilitation training method. PMID:28971037

Effect of Robot-Assisted Game Training on Upper Extremity Function in Stroke Patients.

Science.gov (United States)

Lee, Kyeong Woo; Kim, Sang Beom; Lee, Jong Hwa; Lee, Sook Joung; Kim, Jin Wan

2017-08-01

To determine the effects of combining robot-assisted game training with conventional upper extremity rehabilitation training (RCT) on motor and daily functions in comparison with conventional upper extremity rehabilitation training (OCT) in stroke patients. Subjects were eligible if they were able to perform the robot-assisted game training and were divided randomly into a RCT and an OCT group. The RCT group performed one daily session of 30 minutes of robot-assisted game training with a rehabilitation robot, plus one daily session of 30 minutes of conventional rehabilitation training, 5 days a week for 2 weeks. The OCT group performed two daily sessions of 30 minutes of conventional rehabilitation training. The effects of training were measured by a Manual Function Test (MFT), Manual Muscle Test (MMT), Korean version of the Modified Barthel Index (K-MBI) and a questionnaire about satisfaction with training. These measurements were taken before and after the 2-week training. Both groups contained 25 subjects. After training, both groups showed significant improvements in motor and daily functions measured by MFT, MMT, and K-MBI compared to the baseline. Both groups demonstrated similar training effects, except motor power of wrist flexion. Patients in the RCT group were more satisfied than those in the OCT group. There were no significant differences in changes in most of the motor and daily functions between the two types of training. However, patients in the RCT group were more satisfied than those in the OCT group. Therefore, RCT could be a useful upper extremity rehabilitation training method.

Qualification of Fiber Optic Cables for Martian Extreme Temperature Environments

Science.gov (United States)

Ramesham, Rajeshuni; Lindensmith, Christian A.; Roberts, William T.; Rainen, Richard A.

2011-01-01

Means have been developed for enabling fiber optic cables of the Laser Induced Breakdown Spectrometer instrument to survive ground operations plus the nominal 670 Martian conditions that include Martian summer and winter seasons. The purpose of this development was to validate the use of the rover external fiber optic cabling of ChemCam for space applications under the extreme thermal environments to be encountered during the Mars Science Laboratory (MSL) mission. Flight-representative fiber optic cables were subjected to extreme temperature thermal cycling of the same diurnal depth (or delta T) as expected in flight, but for three times the expected number of in-flight thermal cycles. The survivability of fiber optic cables was tested for 600 cumulative thermal cycles from -130 to +15 C to cover the winter season, and another 1,410 cumulative cycles from -105 to +40 C to cover the summer season. This test satisfies the required 3 times the design margin that is a total of 2,010 thermal cycles (670 x 3). This development test included functional optical transmission tests during the course of the test. Transmission of the fiber optic cables was performed prior to and after 1,288 thermal cycles and 2,010 thermal cycles. No significant changes in transmission were observed on either of the two representative fiber cables subject through the 3X MSL mission life that is 2,010 thermal cycles.

Likelihood estimators for multivariate extremes

KAUST Repository

Huser, Raphaë l; Davison, Anthony C.; Genton, Marc G.

2015-01-01

The main approach to inference for multivariate extremes consists in approximating the joint upper tail of the observations by a parametric family arising in the limit for extreme events. The latter may be expressed in terms of componentwise maxima, high threshold exceedances or point processes, yielding different but related asymptotic characterizations and estimators. The present paper clarifies the connections between the main likelihood estimators, and assesses their practical performance. We investigate their ability to estimate the extremal dependence structure and to predict future extremes, using exact calculations and simulation, in the case of the logistic model.

Likelihood estimators for multivariate extremes

KAUST Repository

Huser, Raphaël

2015-11-17

The main approach to inference for multivariate extremes consists in approximating the joint upper tail of the observations by a parametric family arising in the limit for extreme events. The latter may be expressed in terms of componentwise maxima, high threshold exceedances or point processes, yielding different but related asymptotic characterizations and estimators. The present paper clarifies the connections between the main likelihood estimators, and assesses their practical performance. We investigate their ability to estimate the extremal dependence structure and to predict future extremes, using exact calculations and simulation, in the case of the logistic model.

Effects of interactive metronome training on postural stability and upper extremity function in Parkinson's disease: a case study.

Science.gov (United States)

Kim, Arim; Lee, Hye-Sun; Song, Chiang-Soon

2017-01-01

[Purpose] The purpose of this study was to examine the effects of interactive metronome training on the postural stability and upper extremity function of an individual with Parkinson's disease. [Subject and Methods] The participant of this case study was a 75-year-old female with Parkinson's disease diagnosed 7 years prior. This study was a single-subject research with an A-B-A design. She received IM training during the treatment phase (B phase) for 40 minutes per session. She was assessed pretest and posttest using the Berg balance scale and Wolf motor function test, and at baseline and the treatment phase using the measured box-and-block test and a Tetrax system. [Results] After training, the patient's static and dynamic balance, functional activity, and performance time of the upper extremity improved. Interactive metronome therapy improved the manual dexterity of both hands. Interactive metronome therapy also improved the limit of stability of the Parkinson's disease. [Conclusion] Though a case study, the results of this study suggest that IM therapy is effective at restoring the postural stability and upper extremity function of patients with Parkinson's disease.

Classifying Returns as Extreme

DEFF Research Database (Denmark)

Christiansen, Charlotte

2014-01-01

I consider extreme returns for the stock and bond markets of 14 EU countries using two classification schemes: One, the univariate classification scheme from the previous literature that classifies extreme returns for each market separately, and two, a novel multivariate classification scheme tha...

Association between anomalies of moisture flux and extreme runoff events in the south-eastern Alps

Czech Academy of Sciences Publication Activity Database

Müller, Miloslav; Kašpar, Marek

2011-01-01

Roč. 11, č. 3 (2011), s. 915-920 ISSN 1561-8633 Institutional research plan: CEZ:AV0Z30420517 Keywords : moisture flux * extreme precipitation * seasonality of heavy rains Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 1.983, year: 2011 http://www.nat-hazards-earth-syst-sci.net/11/915/2011/

Probabilistic analysis of extreme wind events

Energy Technology Data Exchange (ETDEWEB)

Chaviaropoulos, P.K. [Center for Renewable Energy Sources (CRES), Pikermi Attikis (Greece)

1997-12-31

A vital task in wind engineering and meterology is to understand, measure, analyse and forecast extreme wind conditions, due to their significant effects on human activities and installations like buildings, bridges or wind turbines. The latest version of the IEC standard (1996) pays particular attention to the extreme wind events that have to be taken into account when designing or certifying a wind generator. Actually, the extreme wind events within a 50 year period are those which determine the ``static`` design of most of the wind turbine components. The extremes which are important for the safety of wind generators are those associated with the so-called ``survival wind speed``, the extreme operating gusts and the extreme wind direction changes. A probabilistic approach for the analysis of these events is proposed in this paper. Emphasis is put on establishing the relation between extreme values and physically meaningful ``site calibration`` parameters, like probability distribution of the annual wind speed, turbulence intensity and power spectra properties. (Author)

Extremism among young people and its prevention in educational organization

Directory of Open Access Journals (Sweden)

A.I. Kirsanov,

2014-08-01

Full Text Available We describe the results of a survey of 50 experts – representatives of educational institutions of Moscow, district education authorities and the staff of the juvenile justice system. We note that the researchers often miss the opinion of the subjects of preventive work. Expert survey allowed to specify the conditions and behavioral manifestations of contemporary youth extremism, rank his psychological reasons, summarize the available methods and forms of prevention. We show the basic extremist ideas that are common among young people, and extremists speech features. The study revealed the understanding by the subjects of the preventive work of the “extremism” concept content, of goals and mechanisms of prevention, shows the typical difficulties in this work. The results can be used to search for new and more effective forms of prevention and improving the organization of preventive work in general.

A case of dorsal oblique fingertip amputation

OpenAIRE

Takeda, Shinsuke; Tatebe, Masahiro; Morita, Akimasa; Yoneda, Hidemasa; Iwatsuki, Katsuyuki; Hirata, Hitoshi

2017-01-01

Abstract This study reports successful finger replantation in a patient with a dorsal oblique fingertip amputation. When repairing this unique type of injury, an evaluation of the remaining vessels is more useful for successful replantation than the anatomical zone classification. We propose that Kasai?s classification is appropriate for guiding treatment.

Are recent severe floods in Xiang River basin of China linked with the increase extreme precipitation?

Science.gov (United States)

Cheng, L.; Du, J.

2015-12-01

The Xiang River, a main tributary of the Yangtze River, is subjected to high floods frequently in recent twenty years. Climate change, including abrupt shifts and fluctuations in precipitation is an important factor influencing hydrological extreme conditions. In addition, human activities are widely recognized as another reasons leading to high flood risk. With the effects of climate change and human interventions on hydrological cycle, there are several questions that need to be addressed. Are floods in the Xiang River basin getting worse? Whether the extreme streamflow shows an increasing tendency? If so, is it because the extreme rainfall events have predominant effect on floods? To answer these questions, the article detected existing trends in extreme precipitation and discharge using Mann-Kendall test. Continuous wavelet transform method was employed to identify the consistency of changes in extreme precipitation and discharge. The Pearson correlation analysis was applied to investigate how much degree of variations in extreme discharge can be explained by climate change. The results indicate that slightly upward trends can be detected in both extreme rainfalls and discharge in the upper region of Xiang River basin. For the most area of middle and lower river basin, the extreme rainfalls show significant positive trends, but the extreme discharge displays slightly upward trends with no significance at 90% confidence level. Wavelet transform analysis results illustrate that highly similar patterns of signal changes can be seen between extreme precipitation and discharge in upper section of the basin, while the changes in extreme precipitation for the middle and lower reaches do not always coincide with the extreme streamflow. The correlation coefficients of the wavelet transforms for the precipitation and discharge signals in most area of the basin pass the significance test. The conclusion may be drawn that floods in recent years are not getting worse in

Stationary and non-stationary extreme value modeling of extreme temperature in Malaysia

Science.gov (United States)

Hasan, Husna; Salleh, Nur Hanim Mohd; Kassim, Suraiya

2014-09-01

Extreme annual temperature of eighteen stations in Malaysia is fitted to the Generalized Extreme Value distribution. Stationary and non-stationary models with trend are considered for each station and the Likelihood Ratio test is used to determine the best-fitting model. Results show that three out of eighteen stations i.e. Bayan Lepas, Labuan and Subang favor a model which is linear in the location parameter. A hierarchical cluster analysis is employed to investigate the existence of similar behavior among the stations. Three distinct clusters are found in which one of them consists of the stations that favor the non-stationary model. T-year estimated return levels of the extreme temperature are provided based on the chosen models.

The dynamic response of human subjects while seated in car seats.

Science.gov (United States)

Pope, M H; Magnusson, M; Broman, N H; Hasson, T

1998-01-01

A pendulum impact method was used to establish the dynamic response of the seated subject. Threaded K wires were placed in the L3 spinous process. The gain and phase angle between the platform and the vertebra were established. The response of the subject was observed while seated on a platform and a variety of other seats. The seats were found to be very important in the attenuation of the impulse, leading to a higher transmissibility. Clinical Relevance Skeletal impact through the lower extremity is quite common in many occupations. The importance of posture and seat design in attenuation of impulses has been established.

RESEARCH ON THE DEVELOPMENT OF ALTERNATIVE TECHNOLOGIES FOR THE PRODUCTION OF TOMATO SEEDLINGS IN DRĂGANU ARGEŞ

OpenAIRE

Florina Uleanu; Adriana Bădulescu

2017-01-01

This paper aims to find the most efficient techniques for the production of seedlings because it represents one of the greatest concerns of the vegetable growers, being a subject of great interest. A special attention shows determining influence of different pots, plastic or biodegradable, on the growth and development of tomato seedlings. The replanting of the seedlings was carried out in various pots (of polyethylene film, from peat, Jiffy pots, small and big alveolar pallets ) filled wi...

A note on extreme sets

Directory of Open Access Journals (Sweden)

Radosław Cymer

2017-10-01

Full Text Available In decomposition theory, extreme sets have been studied extensively due to its connection to perfect matchings in a graph. In this paper, we first define extreme sets with respect to degree-matchings and next investigate some of their properties. In particular, we prove the generalized Decomposition Theorem and give a characterization for the set of all extreme vertices in a graph.

Accuracy and consequences of 3D-fluoroscopy in upper and lower extremity fracture treatment: A systematic review

NARCIS (Netherlands)

Beerekamp, M. S. H. Suzan; Sulkers, George S. I.; Ubbink, Dirk T.; Maas, Mario; Schep, Niels W. L.; Goslings, J. Carel

2012-01-01

Objectives: The aim of this systematic review was to compare the diagnostic accuracy, subjective image quality and clinical consequences of 3D-fluoroscopy with standard imaging modalities (2D-fluoroscopy, X-ray or CT) during reduction and fixation of intra-articular upper and lower extremity

Extreme Programming: Maestro Style

Science.gov (United States)

Norris, Jeffrey; Fox, Jason; Rabe, Kenneth; Shu, I-Hsiang; Powell, Mark

2009-01-01

"Extreme Programming: Maestro Style" is the name of a computer programming methodology that has evolved as a custom version of a methodology, called extreme programming that has been practiced in the software industry since the late 1990s. The name of this version reflects its origin in the work of the Maestro team at NASA's Jet Propulsion Laboratory that develops software for Mars exploration missions. Extreme programming is oriented toward agile development of software resting on values of simplicity, communication, testing, and aggressiveness. Extreme programming involves use of methods of rapidly building and disseminating institutional knowledge among members of a computer-programming team to give all the members a shared view that matches the view of the customers for whom the software system is to be developed. Extreme programming includes frequent planning by programmers in collaboration with customers, continually examining and rewriting code in striving for the simplest workable software designs, a system metaphor (basically, an abstraction of the system that provides easy-to-remember software-naming conventions and insight into the architecture of the system), programmers working in pairs, adherence to a set of coding standards, collaboration of customers and programmers, frequent verbal communication, frequent releases of software in small increments of development, repeated testing of the developmental software by both programmers and customers, and continuous interaction between the team and the customers. The environment in which the Maestro team works requires the team to quickly adapt to changing needs of its customers. In addition, the team cannot afford to accept unnecessary development risk. Extreme programming enables the Maestro team to remain agile and provide high-quality software and service to its customers. However, several factors in the Maestro environment have made it necessary to modify some of the conventional extreme

Tolerances of microorganisms to extreme environmental conditions

International Nuclear Information System (INIS)

West, J.M.; Arme, S.C.

1985-03-01

Microbial isolates from sites relevant to the disposal of radioactive wastes have been subjected to extreme environmental conditions in order to ascertain their tolerance ability. Two groups were chosen, sulphate reducing bacteria and sulphur oxidising bacteria, because of their potential effects on waste containment. They have been subjected to high temperatures, pressures and radiation (delta-emissions) in optimal media conditions and their ability to tolerate the conditions has been ascertained by epifluorescence microscopy and adenosine tri-phosphate (ATP) analysis followed by 'culture-on' to assess post experimental viability. Results indicate that the sulphate reducers in general, are more tolerant to these conditions than the sulphur oxidisers, some proving to be thermophilic. The sulphate reducer showed increased growth rates, as determined by population numbers, at 50 0 C and survived at 80 0 C, 4,500 psig (310 bar) with no subsequent loss in viability. Gamma irradiation of this group and an isolate of 10 5 rad over 4 hours had no effect on population numbers or viability. Such resistances are not apparent with the sulphur oxidisers whose numbers decreased with increasing radiation dose and are destroyed with pressure. (author)

Hydrological and meteorological extremes derived from taxation records: the estates of Brtnice, Třebíč and Velké Meziříčí, 1706–1849

Czech Academy of Sciences Publication Activity Database

Dolák, L.; Brázdil, Rudolf; Valášek, H.

2013-01-01

Roč. 58, č. 8 (2013), s. 1620-1634 ISSN 0262-6667 Institutional support: RVO:67179843 Keywords : taxation system * tax remission * hydrological extremes * meteorological extreme * fluctuation * hailstrom * torrential rain * flash flood * human impact Subject RIV: EH - Ecology, Behaviour Impact factor: 1.252, year: 2013

High temperature extremes in the Czech Republic 1961–2010 and their synoptic variants

Czech Academy of Sciences Publication Activity Database

Valeriánová, A.; Crhová, L.; Holtanová, E.; Kašpar, Marek; Müller, Miloslav; Pecho, Jozef

2016-01-01

Roč. 127, 1-2 (2016), s. 17-29 ISSN 0177-798X R&D Projects: GA ČR(CZ) GAP209/11/1990 Institutional support: RVO:68378289 Keywords : weather extreme * heat waves * Central Europe * atmospheric circulation Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 2.640, year: 2016 http://link.springer.com/article/10.1007/s00704-015-1614-8/fulltext.html

Spatial dependence of extreme rainfall

Science.gov (United States)

Radi, Noor Fadhilah Ahmad; Zakaria, Roslinazairimah; Satari, Siti Zanariah; Azman, Muhammad Az-zuhri

2017-05-01

This study aims to model the spatial extreme daily rainfall process using the max-stable model. The max-stable model is used to capture the dependence structure of spatial properties of extreme rainfall. Three models from max-stable are considered namely Smith, Schlather and Brown-Resnick models. The methods are applied on 12 selected rainfall stations in Kelantan, Malaysia. Most of the extreme rainfall data occur during wet season from October to December of 1971 to 2012. This period is chosen to assure the available data is enough to satisfy the assumption of stationarity. The dependence parameters including the range and smoothness, are estimated using composite likelihood approach. Then, the bootstrap approach is applied to generate synthetic extreme rainfall data for all models using the estimated dependence parameters. The goodness of fit between the observed extreme rainfall and the synthetic data is assessed using the composite likelihood information criterion (CLIC). Results show that Schlather model is the best followed by Brown-Resnick and Smith models based on the smallest CLIC's value. Thus, the max-stable model is suitable to be used to model extreme rainfall in Kelantan. The study on spatial dependence in extreme rainfall modelling is important to reduce the uncertainties of the point estimates for the tail index. If the spatial dependency is estimated individually, the uncertainties will be large. Furthermore, in the case of joint return level is of interest, taking into accounts the spatial dependence properties will improve the estimation process.

Assessing Climate Variability using Extreme Rainfall and ...

African Journals Online (AJOL)

user1

extreme frequency); the average intensity of rainfall from extreme events ... frequency and extreme intensity indices, suggesting that extreme events are more frequent and intense during years with high rainfall. The proportion of total rainfall from ...

How Heart Valves Evolve to Adapt to an Extreme-Pressure System

DEFF Research Database (Denmark)

Amstrup Funder, Jonas; Christian Danielsen, Carl; Baandrup, Ulrik

2017-01-01

BACKGROUND: Heart valves which exist naturally in an extreme-pressure system must have evolved in a way to resist the stresses of high pressure. Giraffes are interesting as they naturally have a blood pressure twice that of humans. Thus, knowledge regarding giraffe heart valves may aid...... in developing techniques to design improved pressure-resistant biological heart valves. METHODS: Heart valves from 12 giraffes and 10 calves were explanted and subjected to either biomechanical or morphological examinations. Strips from the heart valves were subjected to cyclic loading tests, followed...... in giraffes than in calves, which would make giraffe valves more resistant to the high-pressure forces. However, collagen also stiffens and thickens the valves. The mitral leaflets showed similar (but mostly insignificant) trends in strength, stiffness, and collagen content....

Infection in the ischemic lower extremity.

Science.gov (United States)

Fry, D E; Marek, J M; Langsfeld, M

1998-06-01

Infections in the lower extremity of the patient with ischemia can cover a broad spectrum of different diseases. An understanding of the particular pathophysiologic circumstances in the ischemic extremity can be of great value in understanding the natural history of the disease and the potential complications that may occur. Optimizing blood flow to the extremity by using revascularization techniques is important for any patient with an ischemic lower extremity complicated by infection or ulceration. Infections in the ischemic lower extremity require local débridement and systemic antibiotics. For severe infections, such as necrotizing fasciitis or the fetid foot, more extensive local débridement and even amputation may be required. Fundamentals of managing prosthetic graft infection require removing the infected prosthesis, local wound débridement, and systemic antibiotics while attempting to preserve viability of the lower extremity using autogenous graft reconstruction.

Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running.

Science.gov (United States)

Snyder, Kelli R; Earl, Jennifer E; O'Connor, Kristian M; Ebersole, Kyle T

2009-01-01

Movement and muscle activity of the hip have been shown to affect movement of the lower extremity, and been related to injury. The purpose of this study was to determine if increased hip strength affects lower extremity mechanics during running. Within subject, repeated measures design. Fifteen healthy women volunteered. Hip abduction and external rotation strength were measured using a hand-held dynamometer. Three-dimensional biomechanical data of the lower extremity were collected during running using a high-speed motion capture system. Measurements were made before, at the mid-point, and after a 6-week strengthening program using closed-chain hip rotation exercises. Joint range of motion (rearfoot eversion, knee abduction, hip adduction, and internal rotation), eversion velocity, eversion angle at heel strike, and peak joint moments (rearfoot inversion, knee abduction, hip abduction, and external rotation) were analyzed using repeated measures analysis of variance (P knee abduction moment (P=0.05) decreased by 57% and 10%, respectively. The hip abductors and external rotators were strengthened, leading to an alteration of lower extremity joint loading which may reduce injury risk. These exercises could be used in the rehabilitation, or prevention, of lower extremity injuries.

Sensitivity of subject-specific models to Hill muscle-tendon model parameters in simulations of gait

NARCIS (Netherlands)

Carbone, V.; Krogt, M.M. van der; Koopman, H.F.J.M.; Verdonschot, N.J.

2016-01-01

Subject-specific musculoskeletal (MS) models of the lower extremity are essential for applications such as predicting the effects of orthopedic surgery. We performed an extensive sensitivity analysis to assess the effects of potential errors in Hill muscle-tendon (MT) model parameters for each of

Sensitivity of subject-specific models to Hill muscle-tendon model parameters in simulations of gait

NARCIS (Netherlands)

Carbone, Vincenzo; van der Krogt, Marjolein; Koopman, Hubertus F.J.M.; Verdonschot, Nicolaas Jacobus Joseph

2016-01-01

Subject-specific musculoskeletal (MS) models of the lower extremity are essential for applications such as predicting the effects of orthopedic surgery. We performed an extensive sensitivity analysis to assess the effects of potential errors in Hill muscle–tendon (MT) model parameters for each of

Effects of interactive metronome training on postural stability and upper extremity function in Parkinson’s disease: a case study

Science.gov (United States)

Kim, Arim; Lee, Hye-Sun; Song, Chiang-Soon

2017-01-01

[Purpose] The purpose of this study was to examine the effects of interactive metronome training on the postural stability and upper extremity function of an individual with Parkinson’s disease. [Subject and Methods] The participant of this case study was a 75-year-old female with Parkinson’s disease diagnosed 7 years prior. This study was a single-subject research with an A-B-A design. She received IM training during the treatment phase (B phase) for 40 minutes per session. She was assessed pretest and posttest using the Berg balance scale and Wolf motor function test, and at baseline and the treatment phase using the measured box-and-block test and a Tetrax system. [Results] After training, the patient’s static and dynamic balance, functional activity, and performance time of the upper extremity improved. Interactive metronome therapy improved the manual dexterity of both hands. Interactive metronome therapy also improved the limit of stability of the Parkinson’s disease. [Conclusion] Though a case study, the results of this study suggest that IM therapy is effective at restoring the postural stability and upper extremity function of patients with Parkinson’s disease. PMID:28210066

Extreme events in total ozone over Arosa – Part 1: Application of extreme value theory

Directory of Open Access Journals (Sweden)

H. E. Rieder

2010-10-01

Full Text Available In this study ideas from extreme value theory are for the first time applied in the field of stratospheric ozone research, because statistical analysis showed that previously used concepts assuming a Gaussian distribution (e.g. fixed deviations from mean values of total ozone data do not adequately address the structure of the extremes. We show that statistical extreme value methods are appropriate to identify ozone extremes and to describe the tails of the Arosa (Switzerland total ozone time series. In order to accommodate the seasonal cycle in total ozone, a daily moving threshold was determined and used, with tools from extreme value theory, to analyse the frequency of days with extreme low (termed ELOs and high (termed EHOs total ozone at Arosa. The analysis shows that the Generalized Pareto Distribution (GPD provides an appropriate model for the frequency distribution of total ozone above or below a mathematically well-defined threshold, thus providing a statistical description of ELOs and EHOs. The results show an increase in ELOs and a decrease in EHOs during the last decades. The fitted model represents the tails of the total ozone data set with high accuracy over the entire range (including absolute monthly minima and maxima, and enables a precise computation of the frequency distribution of ozone mini-holes (using constant thresholds. Analyzing the tails instead of a small fraction of days below constant thresholds provides deeper insight into the time series properties. Fingerprints of dynamical (e.g. ENSO, NAO and chemical features (e.g. strong polar vortex ozone loss, and major volcanic eruptions, can be identified in the observed frequency of extreme events throughout the time series. Overall the new approach to analysis of extremes provides more information on time series properties and variability than previous approaches that use only monthly averages and/or mini-holes and mini-highs.

Subject-Specific Carpal Ligament Elongation in Extreme Positions, Grip, and the Dart Thrower's Motion

Science.gov (United States)

Rainbow, Michael J.; Kamal, Robin N.; Moore, Douglas C.; Akelman, Edward; Wolfe, Scott W.; Crisco, Joseph J.

2015-01-01

This study examined whether the radiocarpal and dorsal capsular ligaments limit end-range wrist motion or remain strained during midrange wrist motion. Fibers of these ligaments were modeled in the wrists of 12 subjects over multiple wrist positions that reflect high demand tasks and the dart thrower's motion. We found that many of the volar and dorsal ligaments were within 5% of their maximum length throughout the range of wrist motion. Our finding of wrist ligament recruitment during midrange and end-range wrist motion helps to explain the complex but remarkably similar intersubject patterns of carpal motion. PMID:26367853

7 CFR 457.140 - Dry pea crop insurance provisions.

Science.gov (United States)

2010-01-01

... of the Basic Provisions that limit the amount of a replant payment to the actual cost of replanting... present that are identified by the Food and Drug Administration or other public health organizations of... feasible. We may obtain prices from any buyer of our choice. If we obtain prices from one or more buyers...

Treatment of fingertip amputation in adults by palmar pocketing of the amputated part.

Science.gov (United States)

Jung, Mi Sun; Lim, Young Kook; Hong, Yong Taek; Kim, Hoon Nam

2012-07-01

First suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults. Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm. Of a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results. A composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.

Management of avulsed permanent maxillary central incisors during endotracheal intubation

Directory of Open Access Journals (Sweden)

Ritesh R Kalaskar

2016-01-01

Full Text Available Avulsion is serious injury that may encounter during endotracheal intubation and its management often presents a challenge. Replantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. The present article describes the management of air-dried maxillary permanent incisors that have been avulsed due to direct laryngoscopy during the induction of general anesthesia for tonsillectomy procedure. The replanted maxillary central incisors had maintained its function and esthetic for 1 year after replantation. Children in a mixed dentition phase are high-risk group children for traumatic dental injury during laryngoscopy; therefore, Anesthetic Departments should have local protocols to refer patients for dental treatment postoperatively in the event of trauma.

Identification of discrete vascular lesions in the extremities using post-mortem computed tomography angiography – Case reports

NARCIS (Netherlands)

Haakma, Wieke; Rohde, Marianne; Uhrenholt, Lars; Pedersen, Michael; Boel, Lene Warner Thorup

2017-01-01

In this case report, we introduced post-mortem computed tomography angiography (PMCTA) in three cases suffering from vascular lesions in the upper extremities. In each subject, the third part of the axillary arteries and veins were used to catheterize the arms. The vessels were filled with a barium

Rural livelihoods and household adaptation to extreme flooding in the Okavango Delta, Botswana

Science.gov (United States)

Motsholapheko, M. R.; Kgathi, D. L.; Vanderpost, C.

Adaptation to flooding is now widely adopted as an appropriate policy option since flood mitigation measures largely exceed the capability of most developing countries. In wetlands, such as the Okavango Delta, adaptation is more appropriate as these systems serve as natural flood control mechanisms. The Okavango Delta system is subject to annual variability in flooding with extreme floods resulting in adverse impacts on rural livelihoods. This study therefore seeks to improve the general understanding of rural household livelihood adaptation to extreme flooding in the Okavango Delta. Specific objectives are: (1) to assess household access to forms of capital necessary for enhanced capacity to adapt, (2) to assess the impacts of extreme flooding on household livelihoods, and (3) to identify and assess household livelihood responses to extreme flooding. The study uses the sustainable livelihood and the socio-ecological frameworks to analyse the livelihood patterns and resilience to extreme flooding. Results from a survey of 623 households in five villages, key informant interviews, focus group discussions and review of literature, indicate that access to natural capital was generally high, but low for financial, physical, human and social capital. Households mainly relied on farm-based livelihood activities, some non-farm activities, limited rural trade and public transfers. In 2004 and 2009, extreme flooding resulted in livelihood disruptions in the study areas. The main impacts included crop damage, household displacement, destruction of household property, livestock drowning and mud-trapping, the destruction of public infrastructure and disruption of services. The main household coping strategies were labour switching to other livelihood activities, temporary relocation to less affected areas, use of canoes for early harvesting or evacuation and government assistance, particularly for the most vulnerable households. Household adaptive strategies included

Global predictability of temperature extremes

Science.gov (United States)

Coughlan de Perez, Erin; van Aalst, Maarten; Bischiniotis, Konstantinos; Mason, Simon; Nissan, Hannah; Pappenberger, Florian; Stephens, Elisabeth; Zsoter, Ervin; van den Hurk, Bart

2018-05-01

Extreme temperatures are one of the leading causes of death and disease in both developed and developing countries, and heat extremes are projected to rise in many regions. To reduce risk, heatwave plans and cold weather plans have been effectively implemented around the world. However, much of the world’s population is not yet protected by such systems, including many data-scarce but also highly vulnerable regions. In this study, we assess at a global level where such systems have the potential to be effective at reducing risk from temperature extremes, characterizing (1) long-term average occurrence of heatwaves and coldwaves, (2) seasonality of these extremes, and (3) short-term predictability of these extreme events three to ten days in advance. Using both the NOAA and ECMWF weather forecast models, we develop global maps indicating a first approximation of the locations that are likely to benefit from the development of seasonal preparedness plans and/or short-term early warning systems for extreme temperature. The extratropics generally show both short-term skill as well as strong seasonality; in the tropics, most locations do also demonstrate one or both. In fact, almost 5 billion people live in regions that have seasonality and predictability of heatwaves and/or coldwaves. Climate adaptation investments in these regions can take advantage of seasonality and predictability to reduce risks to vulnerable populations.

Extremal graph theory

CERN Document Server

Bollobas, Bela

2004-01-01

The ever-expanding field of extremal graph theory encompasses a diverse array of problem-solving methods, including applications to economics, computer science, and optimization theory. This volume, based on a series of lectures delivered to graduate students at the University of Cambridge, presents a concise yet comprehensive treatment of extremal graph theory.Unlike most graph theory treatises, this text features complete proofs for almost all of its results. Further insights into theory are provided by the numerous exercises of varying degrees of difficulty that accompany each chapter. A

Statistical Model of Extreme Shear

DEFF Research Database (Denmark)

Larsen, Gunner Chr.; Hansen, Kurt Schaldemose

2004-01-01

In order to continue cost-optimisation of modern large wind turbines, it is important to continously increase the knowledge on wind field parameters relevant to design loads. This paper presents a general statistical model that offers site-specific prediction of the probability density function...... by a model that, on a statistically consistent basis, describe the most likely spatial shape of an extreme wind shear event. Predictions from the model have been compared with results from an extreme value data analysis, based on a large number of high-sampled full-scale time series measurements...... are consistent, given the inevitabel uncertainties associated with model as well as with the extreme value data analysis. Keywords: Statistical model, extreme wind conditions, statistical analysis, turbulence, wind loading, statistical analysis, turbulence, wind loading, wind shear, wind turbines....

An Evaluation of the Correlation between the Free Moments Applied on the Lower Extremity and the Knee Extensor Mechanism Force in Pronated Foot Subjects during the Stance Phase of Gait

Directory of Open Access Journals (Sweden)

Farzaneh Yazdani

2016-12-01

Full Text Available Background: Due to the rotatory nature of the excessive subtalar pronation and the possible impairment of the tibial rotation-knee flexion mechanism, changes of the free moment (FM and changes of the extensor mechanism force are expected in hyper-pronated foot subjects. The purpose of this study was to evaluate the correlation between the FM applied on the lower extremity and the knee extensor mechanism force in subjects with flexible pronated feet. Methods: Fifteen asymptomatic female subjects (21.32±1.66 y, 56.30±6.08 kg, 159±6.3 cm participated in the study. Excessive subtalar pronation was determined by measuring the resting calcaneal stance position (RCSP in the frontal plane during weight bearing. A neutrally aligned foot was defined as having an RCSP between 2° of inversion and 2° of eversion. On the other hand, a flat foot had an RCSP of more than or equal to 4° of eversion. Both kinetic and kinematic data were collected using a six-camera motion analysis system and a single force plate. Three successful barefoot walking trials were recorded at selfselected speeds. The extensor mechanism force and the adductory component of the free moment (ADD FM were calculated. The correlation between the ADD FM and the knee extensor mechanism force was examined using the Pearson correlation test. Results: The Pearson correlation analysis showed a high positive correlation between the ADD FM and the extensor mechanism force (r=0.917, P<0.001. Conclusion: Excessive subtalar pronation, along with a possible impairment of the tibial rotation-knee flexion mechanism, may affect the extensor mechanism force at the knee joint. From a clinical perspective, the possible biomechanical linkage between the knee and the foot complex in the physical examination and treatment of patients should be considered.

Wearing a safety harness during treadmill walking influences lower extremity kinematics mainly through changes in ankle regularity and local stability

Directory of Open Access Journals (Sweden)

Decker Leslie M

2012-02-01

Full Text Available Abstract Background Wearing a harness during treadmill walking ensures the subject's safety and is common practice in biomedical engineering research. However, the extent to which such practice influences gait is unknown. This study investigated harness-related changes in gait patterns, as evaluated from lower extremity kinematics during treadmill walking. Findings Healthy subjects (n = 10 walked on a treadmill at their preferred speed for 3 minutes with and without wearing a harness (LiteGait®, Mobility Research, Inc.. In the former condition, no weight support was provided to the subjects. Lower extremity kinematics was assessed in the sagittal plane from the mean (meanRoM, standard deviation (SDRoM and coefficient of variation (CoVRoM of the hip, knee, and ankle ranges of motion (RoM, as well as from the sample entropy (SampEn and the largest Lyapunov exponent (LyE of the joints' angles. Wearing the harness increased the meanRoM of the hip, the SDRoM and the CoVRoM of the knee, and the SampEn and the LyE of the ankle. In particular, the harness effect sizes for both the SampEn and the LyE of the ankle were large, likely reflecting a meaningful decline in the neuromuscular stabilizing control of this joint. Conclusions Wearing a harness during treadmill walking marginally influences lower extremity kinematics, resulting in more or less subtle changes in certain kinematic variables. However, in cases where differences in gait patterns would be expressed through modifications in these variables, having subjects walk with a harness may mask or reinforce such differences.

Functional studies in 79-year-olds. II. Upper extremity function.

Science.gov (United States)

Lundgren-Lindquist, B; Sperling, L

1983-01-01

As part of the Gerontological and Geriatric Population Study of 79-year-old people in Göteborg, a representative subsample comprising 112 women and 93 men took part in a study of upper extremity function. Thirty-eight per cent of the women and 37% of the men had disorders in the upper extremities. The investigation included tests of co-ordination, static strength in the key-grip and the transversal volar grip, power capacity in opening jars and a bottle, basal movements in the upper extremities in personal hygiene and dressing activities, function in the kitchen e.g. reaching shelves, manual tasks including tests of pronation and supination of the forearm. In the key-grip as well as in the transversal volar grip men showed a generally larger decrease in strength with age than women compared to 70-year-olds in a previous population study. Significant correlations were found between strength in the key-grip and the performance time in the test of co-ordination. Women produced about 66% of the muscular force of the men when opening jars. Significant correlations were found between strength in the transversal volar grip and the maximal torque for opening the jars. Female and male subjects who were not capable of handling the electric plug in the manual ability test had significantly weaker strength in the key-grip. The importance of designing products and adapting the environment so as to correspond to the functional capacity of the elderly, is emphasized.

Spontaneous and artificial direct nanostructuring of solid surface by extreme ultraviolet laser with nanosecond pulses

Czech Academy of Sciences Publication Activity Database

Koláček, Karel; Schmidt, Jiří; Štraus, Jaroslav; Frolov, Oleksandr; Prukner, Václav; Melich, Radek; Psota, Pavel

2016-01-01

Roč. 34, č. 1 (2016), s. 11-22 ISSN 0263-0346 Institutional support: RVO:61389021 Keywords : Extreme ultraviolet (XUV) interferometer * Aspheric interferometer mirrors * Multilayer reflection coating for 46.9 nm * Ar8+ laser application * XUV direct nanostructuring Subject RIV: BL - Plasma and Gas Discharge Physics Impact factor: 1.420, year: 2016 http://dx.doi.org/10.1017/S0263034615000786

Mean versus extreme climate in the Mediterranean region and its sensitivity to future global warming conditions

Energy Technology Data Exchange (ETDEWEB)

Paeth, H.; Hense, A. [Meteorological Inst., Univ. Bonn (Germany)

2005-06-01

The Mediterranean region (MTR) has been supposed to be very sensitive to changes in land surface and atmospheric greenhouse-gas (GHG) concentrations. Particularly, an intensification of climate extremes may be associated with severe socio-economic implications. Here, we present an analysis of climate mean and extreme conditions in this subtropical area based on regional climate model experiments, simulating the present-day and possible future climate. The analysis of extreme values (EVs) is based on the assumption that the extremes of daily precipitation and near-surface temperature are well fitted by the Generalized Pareto distribution (GPD). Return values of extreme daily events are determined using the method of L-moments. Particular emphasis is laid on the evaluation of the return values with respect to the uncertainty range of the estimate as derived from a Monte Carlo sampling approach. During the most recent 25 years the MTR has become dryer in spring but more humid especially in the western part in autumn and winter. At the same time, the whole region has been subject to a substantial warming. The strongest rainfall extremes are simulated in autumn over the Mediterranean Sea around Italy. Temperature extremes are most pronounced over the land masses, especially over northern Africa. Given the large uncertainty of the EV estimate, only 1-year return values are further analysed. During recent decades, statistically significant changes in extremes are only found for temperature. Future climate conditions may come along with a decrease in mean and extreme precipitation during the cold season, whereas an intensification of the hydrological cycle is predicted in summer and autumn. Temperature is predominantly affected over the Iberian Peninsula and the eastern part of the MTR. In many grid boxes, the signals are blurred out due to the large amount of uncertainty in the EV estimate. Thus, a careful analysis is required when making inferences about the future

Neurodevelopmental problems and extremes in BMI

Directory of Open Access Journals (Sweden)

Nóra Kerekes

2015-07-01

Full Text Available Background. Over the last few decades, an increasing number of studies have suggested a connection between neurodevelopmental problems (NDPs and body mass index (BMI. Attention deficit/hyperactivity disorder (ADHD and autism spectrum disorders (ASD both seem to carry an increased risk for developing extreme BMI. However, the results are inconsistent, and there have been only a few studies of the general population of children.Aims. We had three aims with the present study: (1 to define the prevalence of extreme (low or high BMI in the group of children with ADHD and/or ASDs compared to the group of children without these NDPs; (2 to analyze whether extreme BMI is associated with the subdomains within the diagnostic categories of ADHD or ASD; and (3 to investigate the contribution of genetic and environmental factors to BMI in boys and girls at ages 9 and 12.Method. Parents of 9- or 12-year-old twins (n = 12,496 were interviewed using the Autism—Tics, ADHD and other Comorbidities (A-TAC inventory as part of the Child and Adolescent Twin Study in Sweden (CATSS. Univariate and multivariate generalized estimated equation models were used to analyze associations between extremes in BMI and NDPs.Results. ADHD screen-positive cases followed BMI distributions similar to those of children without ADHD or ASD. Significant association was found between ADHD and BMI only among 12-year-old girls, where the inattention subdomain of ADHD was significantly associated with the high extreme BMI. ASD scores were associated with both the low and the high extremes of BMI. Compared to children without ADHD or ASD, the prevalence of ASD screen-positive cases was three times greater in the high extreme BMI group and double as much in the low extreme BMI group. Stereotyped and repetitive behaviors were significantly associated with high extreme BMIs.Conclusion. Children with ASD, with or without coexisting ADHD, are more prone to have low or high extreme BMIs than

Taxonomic study of extreme halophilic archaea isolated from the "Salar de Atacama", Chile.

Science.gov (United States)

Lizama, C; Monteoliva-Sánchez, M; Prado, B; Ramos-Cormenzana, A; Weckesser, J; Campos, V

2001-11-01

A large number of halophilic bacteria were isolated in 1984-1992 from the Atacama Saltern (North of Chile). For this study 82 strains of extreme halophilic archaea were selected. The characterization was performed by using the phenotypic characters including morphological, physiological, biochemical, nutritional and antimicrobial susceptibility test. The results, together with those from reference strains, were subjected to numerical analysis, using the Simple Matching (S(SM)) coefficient and clustered by the unweighted pair group method of association (UPGMA). Fifteen phena were obtained at an 70% similarity level. The results obtained reveal a high diversity among the halophilic archaea isolated. Representative strains from the phena were chosen to determine their DNA base composition and the percentage of DNA-DNA similarity compared to reference strains. The 16S rRNA studies showed that some of these strains constitutes a new taxa of extreme halophilic archaea.

Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery.

Science.gov (United States)

Hooper, M M; Stellato, T A; Hallowell, P T; Seitz, B A; Moskowitz, R W

2007-01-01

To determine the point prevalence of painful musculoskeletal (MSK) conditions in obese subjects before and after weight loss following bariatric surgery. Longitudinal, interventional, unblended. Forty-eight obese subjects (47 women, one man, mean age 44+/-9 years; mean body mass index (BMI) 51+/-8 kg/m(2)) recruited from an academic medical center bariatric surgery program. Comorbid medical conditions; MSK findings; BMI; Western Ontario McMaster Osteoarthritis Index (WOMAC) for pain, stiffness and function; and SF-36 for quality of life. Consecutive subjects were recruited from the University Hospitals of Cleveland Bariatric Surgery Program. Musculoskeletal signs and symptoms and non-MSK comorbid conditions were documented at baseline and at follow-up. SUBJECTS completed the SF-36 and the WOMAC questionnaires. Analyses were carried out for each MSK site, fibromyalgia syndrome (FMS) and for the cumulative effect on the spine, upper and lower extremities. The impact of change in comorbid medical conditions, BMI, physical and mental health domains of the SF-36 on the WOMAC pain subscale score was evaluated. SF-36 outcomes were compared to normal published controls. Forty-eight subjects were available for baseline and a follow-up assessment 6-12 months after gastric bypass surgery. They lost an average of 41+/-15 kg and the mean BMI decreased from 51+/-8 to 36+/-7 kg/m(2). Baseline comorbid medical conditions were present in 96% before surgery and 23% after weight loss. There was an increased prevalence of painful MSK conditions at baseline compared to general population frequencies. Musculoskeletal complaints had been present in 100% of obese subjects before, and 23% after weight loss. The greatest improvements occurred in the cervical and lumbar spine, the foot and in FMS (decreased by 90, 83, 83 and 92%, respectively). Seventy-nine percent had upper extremity MSK conditions before and 40% after weight loss. Before surgery, 100% had lower extremity MSK conditions and

Social and Biophysical Predictors of Public Perceptions of Extreme Fires

Science.gov (United States)

Hall, T. E.; Kooistra, C. M.; Paveglio, T.; Gress, S.; Smith, A. M.

2013-12-01

To date, what constitutes an 'extreme' fire has been approached separately by biophysical and social scientists. Research on the biophysical characteristics of fires has identified potential dimensions of extremity, including fire size and vegetation mortality. On the social side, factors such as the degree of immediate impact to one's life and property or the extent of social disruption in the community contribute to a perception of extremity. However, some biophysical characteristics may also contribute to perceptions of extremity, including number of simultaneous ignitions, rapidity of fire spread, atypical fire behavior, and intensity of smoke. Perceptions of these impacts can vary within and across communities, but no studies to date have investigated such perceptions in a comprehensive way. In this study, we address the question, to what extent is the magnitude of impact of fires on WUI residents' well-being explained by measurable biophysical characteristics of the fire and subjective evaluations of the personal and community-level impacts of the fire? We bring together diverse strands of psychological theory, including landscape perception, mental models, risk perception, and community studies. The majority of social science research on fires has been in the form of qualitative case studies, and our study is methodologically unique by using a nested design (hierarchical modeling) to enable generalizable conclusions across a wide range of fires and human communities. We identified fires that burned in 2011 or 2012 in the northern Rocky Mountain region that were at least 1,000 acres and that intersected (within 15 km) urban clusters or identified Census places. For fires where an adequately large number of households was located in proximity to the fire, we drew random samples of approximately 150 individuals for each fire. We used a hybrid internet (Qualtrics) and mail survey, following the Dillman method, to measure individual perceptions. We developed two

Prediction of extreme floods in the Central Andes by means of Complex Networks

Science.gov (United States)

Boers, Niklas; Bookhagen, Bodo; Barbosa, Henrique; Marwan, Norbert; Kurths, Jürgen; Marengo, Jose

2014-05-01

Based on a non-linear synchronisation measure and complex network theory, we present a novel framework for the prediction of extreme events of spatially embedded, interrelated time series. This method is general in the sense that it can be applied to any type of spatially sampled time series with significant interrelations, ranging from climate observables to biological or stock market data. In this presentation, we apply our method to extreme rainfall in South America and show how this leads to the prediction of more than 60% (90% during El Niño conditions) of extreme rainfall events in the eastern Central Andes of Bolivia and northern Argentina, with only 1% false alarms. From paleoclimatic to decadal time scales, the Central Andes continue to be subject to pronounced changes in climatic conditions. In particular, our and past work shows that frequency as well as magnitudes of extreme rainfall events have increased significantly during past decades, calling for a better understanding of the involved climatic mechanisms. Due to their large spatial extend and occurrence at high elevations, these extreme events often lead to severe floods and landslides with disastrous socioeconomic impacts. They regularly affect tens of thousands of people and produce estimated costs of the order of several hundred million USD. Alongside with the societal value of predicting natural hazards, our study provides insights into the responsible climatic features and suggests interactions between Rossby waves in polar regions and large scale (sub-)tropical moisture transport as a driver of subseasonal variability of the South American monsoon system. Predictable extreme events result from the propagation of extreme rainfall from the region of Buenos Aires towards the Central Andes given characteristic atmospheric conditions. Our results indicate that the role of frontal systems originating from Rossby waves in polar latitudes is much more dominant for controlling extreme rainfall in

The Effect of Shoulder Plyometric Training on Amortization Time and Upper-Extremity Kinematics.

Science.gov (United States)

Swanik, Kathleen A; Thomas, Stephen J; Struminger, Aaron H; Bliven, Kellie C Huxel; Kelly, John D; Swanik, Charles B

2016-12-01

Plyometric training is credited with providing benefits in performance and dynamic restraint. However, limited prospective data exist quantifying kinematic adaptations such as amortization time, glenohumeral rotation, and scapulothoracic position, which may underlie the efficacy of plyometric training for upper-extremity rehabilitation or performance enhancement. To measure upper-extremity kinematics and plyometric phase times before and after an 8-wk upper-extremity strength- and plyometric-training program. Randomized pretest-posttest design. Research laboratory. 40 recreationally active men (plyometric group, age 20.43 ± 1.40 y, height 180.00 ± 8.80 cm, weight 73.07 ± 7.21 kg; strength group, age 21.95 ± 3.40 y, height 173.98 ± 11.91 cm, weight 74.79 ± 13.55 kg). Participants were randomly assigned to either a strength-training group or a strength- and plyometric-training group. Each participant performed the assigned training for 8 wk. Dynamic and static glenohumeral and scapular-rotation measurements were taken before and after the training programs. Dynamic measurement of scapular rotation and time spent in each plyometric phase (concentric, eccentric, and amortization) during a ball-toss exercise were recorded while the subjects were fitted with an electromagnetic tracking system. Static measures included scapular upward rotation at 3 different glenohumeral-abduction angles, glenohumeral internal rotation, and glenohumeral external rotation. Posttesting showed that both groups significantly decreased the time spent in the amortization, concentric, and eccentric phases of a ball-toss exercise (P plyometric-training group exhibited an increase in internal rotation that was not present in the strength-training group (P plyometrics and strength training for reducing commonly identified upper-extremity-injury risk factors and improving upper-extremity performance.

Characteristics of sub-daily precipitation extremes in observed data and regional climate model simulations

Czech Academy of Sciences Publication Activity Database

Beranová, Romana; Kyselý, Jan; Hanel, M.

2018-01-01

Roč. 132, 1-2 (2018), s. 515-527 ISSN 0177-798X R&D Projects: GA ČR(CZ) GA14-18675S Institutional support: RVO:68378289 Keywords : sub-daily precipitation * regional climate models * extremes * Czech Republic Subject RIV: DG - Athmosphere Sciences, Meteorology OBOR OECD: Meteorology and atmospheric sciences Impact factor: 2.640, year: 2016 https://link.springer.com/article/10.1007/s00704-017-2102-0

Evaluation of a morphing based method to estimate muscle attachment sites of the lower extremity.

Science.gov (United States)

Pellikaan, P; van der Krogt, M M; Carbone, V; Fluit, R; Vigneron, L M; Van Deun, J; Verdonschot, N; Koopman, H F J M

2014-03-21

To generate subject-specific musculoskeletal models for clinical use, the location of muscle attachment sites needs to be estimated with accurate, fast and preferably automated tools. For this purpose, an automatic method was used to estimate the muscle attachment sites of the lower extremity, based on the assumption of a relation between the bone geometry and the location of muscle attachment sites. The aim of this study was to evaluate the accuracy of this morphing based method. Two cadaver dissections were performed to measure the contours of 72 muscle attachment sites on the pelvis, femur, tibia and calcaneus. The geometry of the bones including the muscle attachment sites was morphed from one cadaver to the other and vice versa. For 69% of the muscle attachment sites, the mean distance between the measured and morphed muscle attachment sites was smaller than 15 mm. Furthermore, the muscle attachment sites that had relatively large distances had shown low sensitivity to these deviations. Therefore, this morphing based method is a promising tool for estimating subject-specific muscle attachment sites in the lower extremity in a fast and automated manner. Copyright © 2013 Elsevier Ltd. All rights reserved.

Extreme climate, not extreme weather: the summer of 1816 in Geneva, Switzerland

Directory of Open Access Journals (Sweden)

R. Auchmann

2012-02-01

Full Text Available We analyze weather and climate during the "Year without Summer" 1816 using sub-daily data from Geneva, Switzerland, representing one of the climatically most severely affected regions. The record includes twice daily measurements and observations of air temperature, pressure, cloud cover, wind speed, and wind direction as well as daily measurements of precipitation. Comparing 1816 to a contemporary reference period (1799–1821 reveals that the coldness of the summer of 1816 was most prominent in the afternoon, with a shift of the entire distribution function of temperature anomalies by 3–4 °C. Early morning temperature anomalies show a smaller change for the mean, a significant decrease in the variability, and no changes in negative extremes. Analyzing cloudy and cloud-free conditions separately suggests that an increase in the number of cloudy days was to a significant extent responsible for these features. A daily weather type classification based on pressure, pressure tendency, and wind direction shows extremely anomalous frequencies in summer 1816, with only one day (compared to 20 in an average summer classified as high-pressure situation but a tripling of low-pressure situations. The afternoon temperature anomalies expected from only a change in weather types was much stronger negative in summer 1816 than in any other year. For precipitation, our analysis shows that the 80% increase in summer precipitation compared to the reference period can be explained by 80% increase in the frequency of precipitation, while no change could be found neither in the average intensity of precipitation nor in the frequency distribution of extreme precipitation. In all, the analysis shows that the regional circulation and local cloud cover played a dominant role. It also shows that the summer of 1816 was an example of extreme climate, not extreme weather.

Quantitative assessment based on kinematic measures of functional impairments during upper extremity movements: A review.

Science.gov (United States)

de los Reyes-Guzmán, Ana; Dimbwadyo-Terrer, Iris; Trincado-Alonso, Fernando; Monasterio-Huelin, Félix; Torricelli, Diego; Gil-Agudo, Angel

2014-08-01

Quantitative measures of human movement quality are important for discriminating healthy and pathological conditions and for expressing the outcomes and clinically important changes in subjects' functional state. However the most frequently used instruments for the upper extremity functional assessment are clinical scales, that previously have been standardized and validated, but have a high subjective component depending on the observer who scores the test. But they are not enough to assess motor strategies used during movements, and their use in combination with other more objective measures is necessary. The objective of the present review is to provide an overview on objective metrics found in literature with the aim of quantifying the upper extremity performance during functional tasks, regardless of the equipment or system used for registering kinematic data. A search in Medline, Google Scholar and IEEE Xplore databases was performed following a combination of a series of keywords. The full scientific papers that fulfilled the inclusion criteria were included in the review. A set of kinematic metrics was found in literature in relation to joint displacements, analysis of hand trajectories and velocity profiles. These metrics were classified into different categories according to the movement characteristic that was being measured. These kinematic metrics provide the starting point for a proposed objective metrics for the functional assessment of the upper extremity in people with movement disorders as a consequence of neurological injuries. Potential areas of future and further research are presented in the Discussion section. Copyright © 2014 Elsevier Ltd. All rights reserved.

Defining Extreme Events: A Cross-Disciplinary Review

Science.gov (United States)

McPhillips, Lauren E.; Chang, Heejun; Chester, Mikhail V.; Depietri, Yaella; Friedman, Erin; Grimm, Nancy B.; Kominoski, John S.; McPhearson, Timon; Méndez-Lázaro, Pablo; Rosi, Emma J.; Shafiei Shiva, Javad

2018-03-01

Extreme events are of interest worldwide given their potential for substantial impacts on social, ecological, and technical systems. Many climate-related extreme events are increasing in frequency and/or magnitude due to anthropogenic climate change, and there is increased potential for impacts due to the location of urbanization and the expansion of urban centers and infrastructures. Many disciplines are engaged in research and management of these events. However, a lack of coherence exists in what constitutes and defines an extreme event across these fields, which impedes our ability to holistically understand and manage these events. Here, we review 10 years of academic literature and use text analysis to elucidate how six major disciplines—climatology, earth sciences, ecology, engineering, hydrology, and social sciences—define and communicate extreme events. Our results highlight critical disciplinary differences in the language used to communicate extreme events. Additionally, we found a wide range in definitions and thresholds, with more than half of examined papers not providing an explicit definition, and disagreement over whether impacts are included in the definition. We urge distinction between extreme events and their impacts, so that we can better assess when responses to extreme events have actually enhanced resilience. Additionally, we suggest that all researchers and managers of extreme events be more explicit in their definition of such events as well as be more cognizant of how they are communicating extreme events. We believe clearer and more consistent definitions and communication can support transdisciplinary understanding and management of extreme events.

Management of the mangled extremity

NARCIS (Netherlands)

Prasarn, Mark L.; Helfet, David L.; Kloen, Peter

2012-01-01

The management of a mangled extremity continues to be a matter of debate. With modern advances in trauma resuscitation, microvascular tissue transfer, and fracture fixation, severe traumatic extremity injuries that would historically have been amputated are often salvaged. Even if preserving a

Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach.

Science.gov (United States)

Lemmon, Joshua A; Janis, Jeffrey E; Rohrich, Rod J

2008-09-01

After studying this article, the participant should be able to: 1. Understand the anatomy of the fingertip. 2. Describe the methods of evaluating fingertip injuries. 3. Discuss reconstructive options for various tip injuries. The fingertip is the most commonly injured part of the hand, and therefore fingertip injuries are among the most frequent injuries that plastic surgeons are asked to treat. Although microsurgical techniques have enabled replantation of even very distal tip amputations, it is relatively uncommon that a distal tip injury will be appropriate for replantation. In the event that replantation is not pursued, options for distal tip soft-tissue reconstruction must be considered. This review presents a straightforward method for evaluating fingertip injuries and provides an algorithm for fingertip reconstruction.

Adaptation strategies of endolithic chlorophototrophs to survive the hyperarid and extreme solar radiation environment of the Atacama Desert

Czech Academy of Sciences Publication Activity Database

Wierzchos, J.; DiRuggiero, J.; Vítek, Petr; Artieda, O.; Souza-Egipsy, V.; Škaloud, P.; Tisza, M.; Davilla, A. F.; Vilchez, C.; Garbayo, I.; Ascaso, C.

2015-01-01

Roč. 6, č. 934 (2015), s. 1-17 ISSN 1664-302X R&D Projects: GA MŠk EE2.3.20.0246 Institutional support: RVO:67179843 Keywords : Atacama Desert * carotenoids * endolithic chlorophototrophs * extreme environment * gypsum * scytonemin Subject RIV: EF - Botanics Impact factor: 4.165, year: 2015

Living with extreme weather events - perspectives from climatology, geomorphological analysis, chronicles and opinion polls

Science.gov (United States)

Auer, I.; Kirchengast, A.; Proske, H.

2009-09-01

The ongoing climate change debate focuses more and more on changing extreme events. Information on past events can be derived from a number of sources, such as instrumental data, residual impacts in the landscape, but also chronicles and people's memories. A project called "A Tale of Two Valleys” within the framework of the research program "proVision” allowed to study past extreme events in two inner-alpine valleys from the sources mentioned before. Instrumental climate time series provided information for the past 200 years, however great attention had to be given to the homogeneity of the series. To derive homogenized time series of selected climate change indices methods like HOCLIS and Vincent have been applied. Trend analyses of climate change indices inform about increase or decrease of extreme events. Traces of major geomorphodynamic processes of the past (e.g. rockfalls, landslides, debris flows) which were triggered or affected by extreme weather events are still apparent in the landscape and could be evaluated by geomorphological analysis using remote sensing and field data. Regional chronicles provided additional knowledge and covered longer periods back in time, however compared to meteorological time series they enclose a high degree of subjectivity and intermittent recordings cannot be obviated. Finally, questionnaires and oral history complemented our picture of past extreme weather events. People were differently affected and have different memories of it. The joint analyses of these four data sources showed agreement to some extent, however also showed some reasonable differences: meteorological data are point measurements only with a sometimes too coarse temporal resolution. Due to land-use changes and improved constructional measures the impact of an extreme meteorological event may be different today compared to earlier times.

A decade of weather extremes

NARCIS (Netherlands)

Coumou, Dim; Rahmstorf, Stefan

The ostensibly large number of recent extreme weather events has triggered intensive discussions, both in- and outside the scientific community, on whether they are related to global warming. Here, we review the evidence and argue that for some types of extreme - notably heatwaves, but also

Attitude extremity, consensus and diagnosticity

NARCIS (Netherlands)

van der Pligt, J.; Ester, P.; van der Linden, J.

1983-01-01

Studied the effects of attitude extremity on perceived consensus and willingness to ascribe trait terms to others with either pro- or antinuclear attitudes. 611 Ss rated their attitudes toward nuclear energy on a 5-point scale. Results show that attitude extremity affected consensus estimates. Trait

Extreme Events in Nature and Society

CERN Document Server

Albeverio, Sergio; Kantz, Holger

2006-01-01

Significant, and usually unwelcome, surprises, such as floods, financial crisis, epileptic seizures, or material rupture, are the topics of Extreme Events in Nature and Society. The book, authored by foremost experts in these fields, reveals unifying and distinguishing features of extreme events, including problems of understanding and modelling their origin, spatial and temporal extension, and potential impact. The chapters converge towards the difficult problem of anticipation: forecasting the event and proposing measures to moderate or prevent it. Extreme Events in Nature and Society will interest not only specialists, but also the general reader eager to learn how the multifaceted field of extreme events can be viewed as a coherent whole.

Controlling extreme events on complex networks

Science.gov (United States)

Chen, Yu-Zhong; Huang, Zi-Gang; Lai, Ying-Cheng

2014-08-01

Extreme events, a type of collective behavior in complex networked dynamical systems, often can have catastrophic consequences. To develop effective strategies to control extreme events is of fundamental importance and practical interest. Utilizing transportation dynamics on complex networks as a prototypical setting, we find that making the network ``mobile'' can effectively suppress extreme events. A striking, resonance-like phenomenon is uncovered, where an optimal degree of mobility exists for which the probability of extreme events is minimized. We derive an analytic theory to understand the mechanism of control at a detailed and quantitative level, and validate the theory numerically. Implications of our finding to current areas such as cybersecurity are discussed.

A single pH fluorescent probe for biosensing and imaging of extreme acidity and extreme alkalinity.

Science.gov (United States)

Chao, Jian-Bin; Wang, Hui-Juan; Zhang, Yong-Bin; Li, Zhi-Qing; Liu, Yu-Hong; Huo, Fang-Jun; Yin, Cai-Xia; Shi, Ya-Wei; Wang, Juan-Juan

2017-07-04

A simple tailor-made pH fluorescent probe 2-benzothiazole (N-ethylcarbazole-3-yl) hydrazone (Probe) is facilely synthesized by the condensation reaction of 2-hydrazinobenzothiazole with N-ethylcarbazole-3-formaldehyde, which is a useful fluorescent probe for monitoring extremely acidic and alkaline pH, quantitatively. The pH titrations indicate that Probe displays a remarkable emission enhancement with a pK a of 2.73 and responds linearly to minor pH fluctuations within the extremely acidic range of 2.21-3.30. Interestingly, Probe also exhibits strong pH-dependent characteristics with pK a 11.28 and linear response to extreme-alkalinity range of 10.41-12.43. In addition, Probe shows a large Stokes shift of 84 nm under extremely acidic and alkaline conditions, high selectivity, excellent sensitivity, good water-solubility and fine stability, all of which are favorable for intracellular pH imaging. The probe is further successfully applied to image extremely acidic and alkaline pH values fluctuations in E. coli cells. Copyright © 2017 Elsevier B.V. All rights reserved.

Near-extreme system condition and near-extreme remaining useful time for a group of products

International Nuclear Information System (INIS)

Wang, Hai-Kun; Li, Yan-Feng; Huang, Hong-Zhong; Jin, Tongdan

2017-01-01

When a group of identical products is operating in field, the aggregation of failures is a catastrophe to engineers and customers who strive to develop reliable and safe products. In order to avoid a swarm of failures in a short time, it is essential to measure the degree of dispersion from different failure times in a group of products to the first failure time. This phenomenon is relevant to the crowding of system conditions near the worst one among a group of products. The group size in this paper represents a finite number of products, instead of infinite number or a single product. We evaluate the reliability of the product fleet from two aspects. First, we define near-extreme system condition and near-extreme failure time for offline solutions, which means no online observations. Second, we apply them to a continuous degradation system that breaks down when it reaches a soft failure threshold. By using particle filtering in the framework of prognostics and health management for a group of products, we aim to estimate near-extreme system condition and further predict the remaining useful life (RUL) using online solutions. Numerical examples are provided to demonstrate the effectiveness of the proposed method. - Highlights: • The aggregation of failures is measured for a group of identical products. • The crowding of failures is quantitated by the near-extreme evaluations. • Near-extreme system condition are given for offline solutions. • Near-extreme remaining useful time are provided for online solutions.

Treatment of Fingertip Amputation in Adults by Palmar Pocketing of the Amputated Part

Directory of Open Access Journals (Sweden)

Mi Sun Jung

2012-07-01

Full Text Available BackgroundFirst suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults.MethodsBetween 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm.ResultsOf a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results.ConclusionsA composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.

Effects of Progressive Body Weight Support Treadmill Forward and Backward Walking Training on Stroke Patients' Affected Side Lower Extremity's Walking Ability.

Science.gov (United States)

Kim, Kyunghoon; Lee, Sukmin; Lee, Kyoungbo

2014-12-01

[Purpose] The purpose of the present study was to examine the effects of progressive body weight supported treadmill forward and backward walking training (PBWSTFBWT), progressive body weight supported treadmill forward walking training (PBWSTFWT), progressive body weight supported treadmill backward walking training (PBWSTBWT), on stroke patients' affected side lower extremity's walking ability. [Subjects and Methods] A total of 36 chronic stroke patients were divided into three groups with 12 subjects in each group. Each of the groups performed one of the progressive body weight supported treadmill training methods for 30 minute, six times per week for three weeks, and then received general physical therapy without any other intervention until the follow-up tests. For the assessment of the affected side lower extremity's walking ability, step length of the affected side, stance phase of the affected side, swing phase of the affected side, single support of the affected side, and step time of the affected side were measured using optogait and the symmetry index. [Results] In the within group comparisons, all the three groups showed significant differences between before and after the intervention and in the comparison of the three groups, the PBWSTFBWT group showed more significant differences in all of the assessed items than the other two groups. [Conclusion] In the present study progressive body weight supported treadmill training was performed in an environment in which the subjects were actually walked, and PBWSTFBWT was more effective at efficiently training stroke patients' affected side lower extremity's walking ability.

Mortality impact of extreme winter temperatures

Science.gov (United States)

Díaz, Julio; García, Ricardo; López, César; Linares, Cristina; Tobías, Aurelio; Prieto, Luis

2005-01-01

During the last few years great attention has been paid to the evaluation of the impact of extreme temperatures on human health. This paper examines the effect of extreme winter temperature on mortality in Madrid for people older than 65, using ARIMA and GAM models. Data correspond to 1,815 winter days over the period 1986 1997, during which time a total of 133,000 deaths occurred. The daily maximum temperature (Tmax) was shown to be the best thermal indicator of the impact of climate on mortality. When total mortality was considered, the maximum impact occured 7 8 days after a temperature extreme; for circulatory diseases the lag was between 7 and 14 days. When respiratory causes were considered, two mortality peaks were evident at 4 5 and 11 days. When the impact of winter extreme temperatures was compared with that associated with summer extremes, it was found to occur over a longer term, and appeared to be more indirect.

Cortical reorganization associated lower extremity motor recovery as evidenced by functional MRI and diffusion tensor tractography in a stroke patient.

Science.gov (United States)

Jang, Sung Ho; You, Sung H; Kwon, Yong-Hyun; Hallett, Mark; Lee, Mi Young; Ahn, Sang Ho

2005-01-01

Recovery mechanisms supporting upper extremity motor recovery following stroke are well established, but cortical mechanism associated with lower extremity motor recovery is unknown. The aim of this study was to assess cortical reorganization associated with lower extremity motor recovery in a hemiparetic patient. Six control subjects and a 17 year-old woman with left intracerebral hemorrhage due to an arterio-venous malformation rupture were evaluated. The motor function of the paretic (left) hip and knee had recovered slowly to the extent of her being able to overcome gravity for 10 months after the onset of stroke. However, her paretic upper extremity showed no significant motor recovery. Blood oxygenation level dependent (BOLD) functional MRI at 1.5 Tesla was used to determine the acutual location of cortical activation in the predefined regions of interest. Concurrently, Diffusion Tensor Imaging (DTI) in combination with a novel 3D-fiber reconstruction algorithm was utilized to investigate the pattern of the corticospinal pathway connectivity between the areas of the motor stream. All subjects' body parts were secured in the scanner and performed a sequential knee flexion-extension with a predetermined angle of 0-60 degrees at 0.5 Hz. Controls showed anticipated activation in the contralateral sensorimotor cortex (SM1) and the descending corticospinal fibers stemming from motor cortex. In contrast to control normal subjects, the stroke patient showed fMRI activation only in the unaffected (right) primary SM1 during either paretic or nonparetic knee movements. DTT fiber tracing data showed that the corticospinal tract fibers were found only in the unaffected hemisphere but not in the affected hemisphere. Our results indicate that an ipsilateral motor pathway from the unaffected (right) motor cortex to the paretic (right) leg was present in this patient. This study raises the potential that the contralesional (ipsilateral) SM1 is involved in cortical

Statistics of extremes theory and applications

CERN Document Server

Beirlant, Jan; Segers, Johan; Teugels, Jozef; De Waal, Daniel; Ferro, Chris

2006-01-01

Research in the statistical analysis of extreme values has flourished over the past decade: new probability models, inference and data analysis techniques have been introduced; and new application areas have been explored. Statistics of Extremes comprehensively covers a wide range of models and application areas, including risk and insurance: a major area of interest and relevance to extreme value theory. Case studies are introduced providing a good balance of theory and application of each model discussed, incorporating many illustrated examples and plots of data. The last part of the book covers some interesting advanced topics, including  time series, regression, multivariate and Bayesian modelling of extremes, the use of which has huge potential.  

The diagnosis of a fully flexed neck position MRI diagnosis in juvenile muscular atrophy of the distal upper extremity

International Nuclear Information System (INIS)

Liu Huaijun; Li Caiying; He Dan; Chi Chen; Cui Caixia; Huang Boyuan; Wang Guoshi; Zhu Qingfeng

2006-01-01

Objective: To investigate the value of the diagnosis of MRI during neck flexion in juvenile muscular atrophy of the distal upper extremity. Methods: Five young male patients (mean age 21 years old) with clinical and electrophysiological alterations were performed MR examination with routine neck position and a fully flexed neck position. Eight age-match young men were examined as control subjects. SE T 1 WI, T 2 WI, Fluid-attenuated inversion recovery (FLAIR) sequences were scanned. Results: A distinctive finding in the disorder was forward displacement of the cervical dural sac, compressive flattening of the lower cervical cord during neck flexion and flow void in the posterior epidural space. The forward displacement was significantly greater in patients than in age-matched control subjects. Conclusion: Flexed neck position MRI is helpful to find radiological abnormalities of the lower cervical dural sac and spinal cord, which were combined with clinical disorder to diagnose juvenile muscular atrophy of the distal upper extremity. (authors)

Strengths of lower extremity and lower trunk muscles in females with patellofemoral pain syndrome

Directory of Open Access Journals (Sweden)

Fateme Bokaee

2010-09-01

Full Text Available Introduction: Patellofemoral pain syndrome (PFPS is one of the most common orthopaedic problemsof the knee joint. Muscular weakness considered as a risk factor of this syndrome. Muscular weaknesscan alter lower extremity kinematics and lead to this syndrome. Also according to the kinetic chain,weakness in one motor segment can influence other motor segments. So the aim of this study was todetermine the association between muscular strengths of both lower extremity and trunks muscles andPFPS.Materials and Methods: 40 women participated in this study (20 subjects with PFPS and 20 ascontrols. In both groups isometric strengths of the lower extremity and lower trunk muscles wereevaluated with Nicholas hand-held dynamometer and then compared with each other.Results: There was a significant decrease in strength of the hip abductors, adductors, external rotators,flexors and extensors, quadriceps, ankle plantarflexors, dorsiflexors, flexor and lateral flexors of the trunkin patients with PFPS.Conclusion: Our results indicate that decrease in strength of the hip and trunk muscles is associatedwith the knee injury. It seems strengthening of muscles of these areas to be effective in preventing theinjury, reducing the risk of more injury and treatment of patients with this syndrome.

Modulation of extreme temperatures in Europe under extreme values of the North Atlantic Oscillation Index.

Science.gov (United States)

Beniston, Martin

2018-03-10

This paper reports on the influence that extreme values in the tails of the North Atlantic Oscillation (NAO) Index probability density function (PDF) can exert on temperatures in Europe. When the NAO Index enters into its lowest (10% quantile or less) and highest (90% quantile or higher) modes, European temperatures often exhibit large negative or positive departures from their mean values, respectively. Analyses of the joint quantiles of the Index and temperatures (i.e., the simultaneous exceedance of particular quantile thresholds by the two variables) show that temperatures enter into the upper or lower tails of their PDF when the NAO Index also enters into its extreme tails, more often that could be expected from random statistics. Studies of this nature help further our understanding of the manner by which mechanisms of decadal-scale climate variability can influence extremes of temperature-and thus perhaps improve the forecasting of extreme temperatures in weather and climate models. © 2018 New York Academy of Sciences.

Climate change, climatic variation and extreme biological responses.

Science.gov (United States)

Palmer, Georgina; Platts, Philip J; Brereton, Tom; Chapman, Jason W; Dytham, Calvin; Fox, Richard; Pearce-Higgins, James W; Roy, David B; Hill, Jane K; Thomas, Chris D

2017-06-19

Extreme climatic events could be major drivers of biodiversity change, but it is unclear whether extreme biological changes are (i) individualistic (species- or group-specific), (ii) commonly associated with unusual climatic events and/or (iii) important determinants of long-term population trends. Using population time series for 238 widespread species (207 Lepidoptera and 31 birds) in England since 1968, we found that population 'crashes' (outliers in terms of species' year-to-year population changes) were 46% more frequent than population 'explosions'. (i) Every year, at least three species experienced extreme changes in population size, and in 41 of the 44 years considered, some species experienced population crashes while others simultaneously experienced population explosions. This suggests that, even within the same broad taxonomic groups, species are exhibiting individualistic dynamics, most probably driven by their responses to different, short-term events associated with climatic variability. (ii) Six out of 44 years showed a significant excess of species experiencing extreme population changes (5 years for Lepidoptera, 1 for birds). These 'consensus years' were associated with climatically extreme years, consistent with a link between extreme population responses and climatic variability, although not all climatically extreme years generated excess numbers of extreme population responses. (iii) Links between extreme population changes and long-term population trends were absent in Lepidoptera and modest (but significant) in birds. We conclude that extreme biological responses are individualistic, in the sense that the extreme population changes of most species are taking place in different years, and that long-term trends of widespread species have not, to date, been dominated by these extreme changes.This article is part of the themed issue 'Behavioural, ecological and evolutionary responses to extreme climatic events'. © 2017 The Authors.

On the Extreme Wave Height Analysis

DEFF Research Database (Denmark)

Burcharth, H. F.; Liu, Zhou

1994-01-01

The determination of the design wave height is usually based on the statistical analysis of long-term extreme wave height measurements. After an introduction to the procedure of the extreme wave height analysis, the paper presents new development concerning various aspects of the extreme wave...... height analysis. Finally, the paper gives a practical example based on a data set of the hindcasted wave heights for a deep water location in the Mediterranean Sea....

Far-Infrared Radiation Thermotherapy Improves Tissue Fibrosis in Chronic Extremity Lymphedema.

Science.gov (United States)

Li, Ke; Zhang, Zheng; Liu, Ning Fei; Sadigh, Parviz; Evans, Verity Joyce; Zhou, Huihong; Gao, Weiqing; Zhang, Yi Xin

2017-09-29

Fibrosis can enhance the exacerbation of lymphedema, which becomes obvious in late stage II-III lymphedema. However, whether far-infrared radiation thermotherapy (FIRT) can cure lymphedema fibrosis is still lack of research. This research was to investigate the therapeutic effect of FIRT on tissue fibrosis in the treatment of Late stage II-III lymphedema. Patients accepted only FIRT for a total of 20 sessions. The treatment session duration was 2 hours, and a stable machine temperature of 42°C was maintained throughout treatments. Clinical evaluation and laboratory evaluation were conducted before and after FIRT. Clinical outcome measures included circumference of affected extremity, skin elasticity, ultrasound, patients' subjective assessment, and quality of life (QOL). Laboratory outcome measures included serum and local lymphedema tissue fluid concentrations of fibrosis associated cytokines, tissue growth factor beta-1 (TGF-β1), interleukin (IL)-1β, IL-4, IL-18, and caspase-1. Between 2015 and 2016, clinical evaluation of 64 patients with late stage II-III lymphedema was conducted. From this group, 12 cases (18.75%) underwent simultaneous laboratory evaluation. Circumferences of affected extremities improved significantly following treatment (p pain, discomfort, and numbness (p effective treatment for lymphedema tissue fibrosis; it reduces the concentration of fibrosis cytokines in local lymphedema tissues. Consequently, this treatment can reduce the density of fibrosed tissue in the affected extremity, increase skin elasticity, significantly improve clinical symptoms, and improve QOL of patients.

Performance testing of extremity dosimeters, Study 2

International Nuclear Information System (INIS)

Harty, R.; Reece, W.D.; Hooker, C.D.

1990-04-01

The Health Physics Society Standards Committee (HPSSC) Working Group on Performance Testing of Extremity Dosimeters has issued a draft of a proposed standard for extremity dosimeters. The draft standard proposes methods to be used for testing dosimetry systems that determine occupational radiation dose to the extremities and the performance criterion used to determine compliance with the standard. Pacific Northwest Laboratory (PNL) has conducted two separate evaluations of the performance of extremity dosimeter processors to determine the appropriateness of the draft standard, as well as to obtain information regarding the performance of extremity dosimeters. Based on the information obtained during the facility visits and the results obtained from the performance testing, it was recommended that changes be made to ensure that the draft standard is appropriate for extremity dosimeters. The changes include: subdividing the mixture category and the beta particle category; eliminating the neutron category until appropriate flux-to-dose equivalent conversion factors are derived; and changing the tolerance level for the performance criterion to provide consistency with the performance criterion for whole body dosimeters, and to avoid making the draft standard overly difficult for processors of extremity dosimeters to pass. 20 refs., 10 figs., 6 tabs

The Efficacy of Iopamidol (Pamiray 370) in Aortic and Extremity CT Angiography

International Nuclear Information System (INIS)

Lee, Yoo Jin; Lee, Jong Min; Lee, Hui Joong; Park, Ji Won

2010-01-01

To evaluate the clinical safety and radiological feasibility of a domestic iopamidol-based contrast media (Pamiray 370) during an aortic and extremity CT angiography. Between August and December of 2008, 100 patients (M:F=51:49; mean age, 59 years) underwent an aortic and extremity CT angiography using Pamiray 370 based with informed consent. All changes in vital signs, clinical symptoms, and adverse reactions to the contrast media were monitored. Two radiologists assessed the image quality of the CT angiography. A statistical comparison was conducted using an independent t-test and a Mann-Whitney test based on the 100-patient group studied using Optiray 350. The contrast enhancement of the descending aorta in the arterial phase showed a statistically greater efficacy (p<0.001) of Pamiray 370 compared to Optiray 350, which was the routine contrast media for CT angiography for our institute. Adverse reaction signs were evident in 3%(3/100) of the subjects. All of them showed mild and transient reactions such as vomiting (n=2) and coughing (n=1), with no medical treatment required. Contrast media related symptoms including dizziness (n=7), nausea (n=3), headaches (n=2), and injection site pain (n=1), were noted in 12%(12/100). The clinical efficacy of Pamiray 370 was acceptable for the aortic and extremity CT angiography, in terms of clinical safety, tolerance, and image quality

Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device.

Science.gov (United States)

Jackson, Steven M; Cheng, M Samuel; Smith, A Russell; Kolber, Morey J

2017-02-01

Hand held dynamometry (HHD) is a more objective way to quantify muscle force production (MP) compared to traditional manual muscle testing. HHD reliability can be negatively impacted by both the strength of the tester and the subject particularly in the lower extremities due to larger muscle groups. The primary aim of this investigation was to assess intrarater reliability of HHD with use of a portable stabilization device for lower extremity MP in an athletic population. Isometric lower extremity strength was measured for bilateral lower extremities including hip abductors, external rotators, adductors, knee extensors, and ankle plantar flexors was measured in a sample of healthy recreational runners (8 male, 7 females, = 30 limbs) training for a marathon. These measurements were assessed using an intrasession intrarater reliability design. Intraclass correlation coefficients (ICC) were calculated using 3,1 model based on the single rater design. The standard error of measurement (SEM) for each muscle group was also calculated. ICC were excellent ranging from ICC (3,1) = 0.93-0.98 with standard error of measurements ranging from 0.58 to 17.2 N. This study establishes the use of a HHD with a portable stabilization device as demonstrating good reliability within testers for measuring lower extremity muscle performance in an active healthy population. Copyright © 2016 Elsevier Ltd. All rights reserved.

DIRECTIONS OF EXTREME TOURISM IN UKRAINE

Directory of Open Access Journals (Sweden)

L. V. Martseniuk

2016-02-01

Full Text Available Purpose. In the world market of tourist services the extreme tourism is very popular, as it does not require the significant financial costs and enables year on year to increase the offers of holiday packages, associated with active travel. Ukraine has significant potential for the development of extreme kinds of rest, but it is not developed enough. Forms of extreme tourism are unknown for domestic tourists, and therefore, they formed a negative attitude. The aim of the article is the analysis of extreme resort potential of Ukraine and promotion of the development of extreme tourism destinations in the travel market. Theoretical and methodological basis of research is the system analysis of the problems of ensuring the competitiveness of the tourism industry, theoretical principles of economic science in the field of the effectiveness of extreme tourism and management of tourist flows. Methodology. The author offers the directions of tourist flows control, which differ from the current expansion of services to tourists in Ukraine. The development of extreme tourism with the help of co-operation of railways and sport federations was proposed. Findings. During the research the author proved that the implementation of the tasks will be promote: 1 increase in budget revenues at all levels of the inner extreme tourism; 2 raise the image of Ukraine and Ukrainian Railways; 3 increase the share of tourism and resorts in the gross domestic product to the level of developed countries; 4 bringing the number of employees in tourism and resorts to the level of developed countries; 5 the creation of an effective system of monitoring the quality of tourist services; 6 the creation of an attractive investment climate for attracting the investment in the broad development of tourism, engineering and transport and municipal infrastructure; 7 improvement the safety of tourists, ensure the effective protection of their rights and legitimate interests and

Atlas-Based Automatic Generation of Subject-Specific Finite Element Tongue Meshes.

Science.gov (United States)

Bijar, Ahmad; Rohan, Pierre-Yves; Perrier, Pascal; Payan, Yohan

2016-01-01

Generation of subject-specific 3D finite element (FE) models requires the processing of numerous medical images in order to precisely extract geometrical information about subject-specific anatomy. This processing remains extremely challenging. To overcome this difficulty, we present an automatic atlas-based method that generates subject-specific FE meshes via a 3D registration guided by Magnetic Resonance images. The method extracts a 3D transformation by registering the atlas' volume image to the subject's one, and establishes a one-to-one correspondence between the two volumes. The 3D transformation field deforms the atlas' mesh to generate the subject-specific FE mesh. To preserve the quality of the subject-specific mesh, a diffeomorphic non-rigid registration based on B-spline free-form deformations is used, which guarantees a non-folding and one-to-one transformation. Two evaluations of the method are provided. First, a publicly available CT-database is used to assess the capability to accurately capture the complexity of each subject-specific Lung's geometry. Second, FE tongue meshes are generated for two healthy volunteers and two patients suffering from tongue cancer using MR images. It is shown that the method generates an appropriate representation of the subject-specific geometry while preserving the quality of the FE meshes for subsequent FE analysis. To demonstrate the importance of our method in a clinical context, a subject-specific mesh is used to simulate tongue's biomechanical response to the activation of an important tongue muscle, before and after cancer surgery.

Angiography of the upper extremity

International Nuclear Information System (INIS)

Janevski, B.K.

1982-01-01

This thesis provides a description of the technical and medical aspects of arteriography of the upper extremity and an extensive analysis of the angiographic anatomy and pathology of 750 selective studies performed in more than 500 patients. A short historical review is provided of angiography as a whole and of arteriography of the hand in particular. The method of percutaneous transfemoral catheterization of the arteries of the upper extremity and particularly the arteries of the hand is considered, discussing the problems the angiographer encounters frequently, describing the angiographic complications which may occur and emphasizing the measures to keep them to a minimum. The use of vasodilators in hand angiography is discussed. A short description of the embryological patterns persisting in the arteries of the arm is included in order to understand the congenital variations of the arteries of the upper extremity. The angiographic patterns and clinical aspects of the most common pathological processes involving the arteries of the upper extremities are presented. Special attention is paid to the correlation between angiography and pathology. (Auth.)

Sovereign Default Analysis through Extreme Events Identification

Directory of Open Access Journals (Sweden)

Vasile George MARICA

2015-06-01

Full Text Available This paper investigates contagion in international credit markets through the use of a novel jump detection technique proposed by Chan and Maheuin (2002. This econometrical methodology is preferred because it is non-linear by definition and not a subject to volatility bias. Also, the identified jumps in CDS premiums are considered as outliers positioned beyond any stochastic movement that can and is already modelled through well-known linear analysis. Though contagion is hard to define, we show that extreme discrete movements in default probabilities inferred from CDS premiums can lead to sound economic conclusions about the risk profile of sovereign nations in international bond markets. We find evidence of investor sentiment clustering for countries with unstable political regimes or that are engaged in armed conflict. Countries that have in their recent history faced currency or financial crises are less vulnerable to external unexpected shocks. First we present a brief history of sovereign defaults with an emphasis on their increased frequency and geographical reach, as financial markets become more and more integrated. We then pass to a literature review of the most important definitions for contagion, and discuss what quantitative methods are available to detect the presence of contagion. The paper continues with the details for the methodology of jump detection through non-linear modelling and its use in the field of contagion identification. In the last sections we present the estimation results for simultaneous jumps between emerging markets CDS and draw conclusions on the difference of behavior in times of extreme movement versus tranquil periods.

Acclimatization to extreme heat

Science.gov (United States)

Warner, M. E.; Ganguly, A. R.; Bhatia, U.

2017-12-01

Heat extremes throughout the globe, as well as in the United States, are expected to increase. These heat extremes have been shown to impact human health, resulting in some of the highest levels of lives lost as compared with similar natural disasters. But in order to inform decision makers and best understand future mortality and morbidity, adaptation and mitigation must be considered. Defined as the ability for individuals or society to change behavior and/or adapt physiologically, acclimatization encompasses the gradual adaptation that occurs over time. Therefore, this research aims to account for acclimatization to extreme heat by using a hybrid methodology that incorporates future air conditioning use and installation patterns with future temperature-related time series data. While previous studies have not accounted for energy usage patterns and market saturation scenarios, we integrate such factors to compare the impact of air conditioning as a tool for acclimatization, with a particular emphasis on mortality within vulnerable communities.

Timing of electromyographic activity and ranges of motion during simple motor tasks of upper extremities

Directory of Open Access Journals (Sweden)

Syczewska Małgorzata

2017-10-01

Full Text Available Study aim: Improvement of the upper extremities’ performance is one of the key aims in the rehabilitation process. In order to achieve high effectiveness of this process the amount of functional improvement achieved by a patient during the therapy needs to be assessed. The aim of this study was to obtain electromyographic (EMG activity profiles of the upper extremity muscles during execution of simple tasks in healthy subjects. Additionally the ranges of wrist, elbow and shoulder joints were measured and reported during performed trials. The second aim was to determine whether the movement execution and ranges of move­ments and muscular activity depend on age. Material and methods: Twenty-eight healthy adults, age range 21 to 65 years old, participated in the study. Surface electrodes were placed bilaterally on 7 upper extremity muscles. To obtain information about the beginning and end of the movement task and ranges of upper extremity joints, 13 markers were placed on the elbows and wrists of both upper extremities. The move­ments of the segments were calculated (distal vs proximal in five simple functional tasks (each task involved only one joint, performed while sitting. Kinematic data were collected by the VICON 460 system, and electromyographic data with the Mo­tion Lab EMG system. Results: Charts of timing of EMG activity of the upper extremity muscles together with ranges of upper extremity joint motion were obtained. Conclusion: The results show that the number of muscles activated and the time (or percentage of the task during which they are active depend on the type of the task and age. These data can be used as a reference in evaluation of functional deficits of patients.

Climate change scenarios of precipitation extremes in the Carpathian region based on an ENSEMBLE of regional climate models

Czech Academy of Sciences Publication Activity Database

Gaál, Ladislav; Beranová, Romana; Hlavčová, K.; Kyselý, Jan

2014-01-01

Roč. 2014, č. 943487 (2014), s. 1-14 ISSN 1687-9309 R&D Projects: GA ČR(CZ) GA14-18675S Institutional support: RVO:68378289 Keywords : precipitation extremes * regional climate models * climate change Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 0.946, year: 2014 http://www.hindawi.com/journals/amete/2014/943487/

Examine Precipitation Extremes in Terms of Storm Properties

Science.gov (United States)

Jiang, P.; Yu, Z.; Chen, L.; Gautam, M. R.; Acharya, K.

2017-12-01

The increasing potential of the extreme precipitation is of significant societal concern. Changes in precipitation extremes have been mostly examined using extreme precipitation indices or Intensity-Duration-Frequency (IDF) analyses, which often fail to reveal the characteristics of an integrated precipitation event. In this study, we will examine the precipitation extremes in terms of storm properties including storm duration, storm intensity, total storm precipitation, and within storm pattern. Single storm event will be identified and storm properties will be determined based on the hourly precipitation time series in the selected locations in southwest United States. Three types of extreme precipitation event will be recognized using the criteria as (1) longest storm duration; (2) Highest storm intensity; and (3) largest total precipitation over a storm. The trend and variation of extreme precipitation events will be discussed for each criterion. Based on the comparisons of the characteristics of extreme precipitation events identified using different criteria, we will provide guidelines for choosing proper criteria for extreme precipitation analysis in specific location.

Influence of Anthropogenic Climate Change on Planetary Wave Resonance and Extreme Weather Events.

Science.gov (United States)

Mann, Michael E; Rahmstorf, Stefan; Kornhuber, Kai; Steinman, Byron A; Miller, Sonya K; Coumou, Dim

2017-03-27

Persistent episodes of extreme weather in the Northern Hemisphere summer have been shown to be associated with the presence of high-amplitude quasi-stationary atmospheric Rossby waves within a particular wavelength range (zonal wavenumber 6-8). The underlying mechanistic relationship involves the phenomenon of quasi-resonant amplification (QRA) of synoptic-scale waves with that wavenumber range becoming trapped within an effective mid-latitude atmospheric waveguide. Recent work suggests an increase in recent decades in the occurrence of QRA-favorable conditions and associated extreme weather, possibly linked to amplified Arctic warming and thus a climate change influence. Here, we isolate a specific fingerprint in the zonal mean surface temperature profile that is associated with QRA-favorable conditions. State-of-the-art ("CMIP5") historical climate model simulations subject to anthropogenic forcing display an increase in the projection of this fingerprint that is mirrored in multiple observational surface temperature datasets. Both the models and observations suggest this signal has only recently emerged from the background noise of natural variability.

[Injury mechanisms in extreme violence settings].

Science.gov (United States)

Arcaute-Velazquez, Fernando Federico; García-Núñez, Luis Manuel; Noyola-Vilallobos, Héctor Faustino; Espinoza-Mercado, Fernando; Rodríguez-Vega, Carlos Eynar

2016-01-01

Extreme violence events are consequence of current world-wide economic, political and social conditions. Injury patterns found among victims of extreme violence events are very complex, obeying several high-energy injury mechanisms. In this article, we present the basic concepts of trauma kinematics that regulate the clinical approach to victims of extreme violence events, in the hope that clinicians increase their theoretical armamentarium, and reflecting on obtaining better outcomes. Copyright © 2016. Published by Masson Doyma México S.A.

Robust Subjective Visual Property Prediction from Crowdsourced Pairwise Labels.

Science.gov (United States)

Fu, Yanwei; Hospedales, Timothy M; Xiang, Tao; Xiong, Jiechao; Gong, Shaogang; Wang, Yizhou; Yao, Yuan

2016-03-01

The problem of estimating subjective visual properties from image and video has attracted increasing interest. A subjective visual property is useful either on its own (e.g. image and video interestingness) or as an intermediate representation for visual recognition (e.g. a relative attribute). Due to its ambiguous nature, annotating the value of a subjective visual property for learning a prediction model is challenging. To make the annotation more reliable, recent studies employ crowdsourcing tools to collect pairwise comparison labels. However, using crowdsourced data also introduces outliers. Existing methods rely on majority voting to prune the annotation outliers/errors. They thus require a large amount of pairwise labels to be collected. More importantly as a local outlier detection method, majority voting is ineffective in identifying outliers that can cause global ranking inconsistencies. In this paper, we propose a more principled way to identify annotation outliers by formulating the subjective visual property prediction task as a unified robust learning to rank problem, tackling both the outlier detection and learning to rank jointly. This differs from existing methods in that (1) the proposed method integrates local pairwise comparison labels together to minimise a cost that corresponds to global inconsistency of ranking order, and (2) the outlier detection and learning to rank problems are solved jointly. This not only leads to better detection of annotation outliers but also enables learning with extremely sparse annotations.

Extremely low temperature properties of epoxy GFRP

International Nuclear Information System (INIS)

Kadotani, Kenzo; Nagai, Matao; Aki, Fumitake.

1983-01-01

The examination of fiber-reinforced plastics, that is, plastics such as epoxy, polyester and polyimide reinforced with high strength fibers such as glass, carbon, boron and steel, for extremely low temperature use began from the fuel tanks of rockets. Therafter, the trial manufacture of superconducting generators and extremely low temperature transformers and the manufacture of superconducting magnets for nuclear fusion experimental setups became active, and high performance FRPs have been adopted, of which the extremely low temperature properties have been sufficiently grasped. Recently, the cryostats made of FRPs have been developed, fully utilizing such features of FRPs as high strength, high rigidity, non-magnetic material, insulation, low heat conductivity, light weight and the freedom of molding. In this paper, the mechanical properties at extremely low temperature of the plastic composite materials used as insulators and structural materials for extremely low temperature superconducting equipment is outlined, and in particular, glass fiber-reinforced epoxy laminates are described somewhat in detail. The fracture strain of GFRP at extremely low temperature is about 1.3 times as large as that at room temperature, but at extremely low temperature, clear cracking occurred at 40% of the fracture strain. The linear thermal contraction of GFRP showed remarkable anisotropy. (Kako, I.)

Extreme weather events and infectious disease outbreaks.

Science.gov (United States)

McMichael, Anthony J

2015-01-01

Human-driven climatic changes will fundamentally influence patterns of human health, including infectious disease clusters and epidemics following extreme weather events. Extreme weather events are projected to increase further with the advance of human-driven climate change. Both recent and historical experiences indicate that infectious disease outbreaks very often follow extreme weather events, as microbes, vectors and reservoir animal hosts exploit the disrupted social and environmental conditions of extreme weather events. This review article examines infectious disease risks associated with extreme weather events; it draws on recent experiences including Hurricane Katrina in 2005 and the 2010 Pakistan mega-floods, and historical examples from previous centuries of epidemics and 'pestilence' associated with extreme weather disasters and climatic changes. A fuller understanding of climatic change, the precursors and triggers of extreme weather events and health consequences is needed in order to anticipate and respond to the infectious disease risks associated with human-driven climate change. Post-event risks to human health can be constrained, nonetheless, by reducing background rates of persistent infection, preparatory action such as coordinated disease surveillance and vaccination coverage, and strengthened disaster response. In the face of changing climate and weather conditions, it is critically important to think in ecological terms about the determinants of health, disease and death in human populations.

Health-related quality of life and emotional and behavioral difficulties after extreme preterm birth: developmental trajectories

Directory of Open Access Journals (Sweden)

Bente Johanne Vederhus

2015-01-01

Full Text Available Background. Knowledge of long-term health related outcomes in contemporary populations born extremely preterm (EP is scarce. We aimed to explore developmental trajectories of health-related quality of life (HRQoL and behavior from mid-childhood to early adulthood in extremely preterm and term-born individuals.Methods. Subjects born at gestational age ≤28 weeks or with birth weight ≤1,000 g within a region of Norway in 1991–92 and matched term-born control subjects were assessed at 10 and 18 years. HRQoL was measured with the Child Health Questionnaire (CHQ and behavior with the Child Behavior Checklist (CBCL, using parent assessment at both ages and self-assessment at 18 years.Results. All eligible EP (n = 35 and control children participated at 10 years, and 31 (89% and 29 (83% at 18 years. At 10 years, the EP born boys were given significantly poorer scores by their parents than term-born controls on most CHQ and CBCL scales, but the differences were minor at 18 years; i.e., significant improvements had occurred in several CHQ (self-esteem, general health and parental impact-time and CBCL (total problem, internalizing and anxious/depressed scales. For the girls, the differences were smaller at 10 years and remained unchanged by 18 years. Emotional/behavioral difficulties at 10 years similarly predicted poorer improvement on CHQ-scales for both EP and term-born subjects at 18 years. Self-assessment of HRQoL and behavior at 18 years was similar in the EP and term-born groups on most scales.Conclusions. HRQoL and behavior improved towards adulthood for EP born boys, while the girls remained relatively similar, and early emotional and behavioral difficulties predicted poorer development in HRQoL through adolescence. These data indicate that gender and a longitudinal perspective should be considered when addressing health and wellbeing after extremely preterm birth.

Extreme Ionizing-Radiation-Resistant Bacterium

Science.gov (United States)

Vaishampayan, Parag A.; Venkateswaran, Kasthuri J.; Schwendner, Petra

2013-01-01

potential for transfer, and subsequent proliferation, on another solar body such as Mars and Europa. These organisms are more likely to escape planetary protection assays, which only take into account presence of spores. Hence, presences of extreme radiation-resistant Deinococcus in the cleanroom facility where spacecraft are assembled pose a serious risk for integrity of life-detection missions. The microorganism described herein was isolated from the surfaces of the cleanroom facility in which the Phoenix Lander was assembled. The isolated bacterial strain was subjected to a comprehensive polyphasic analysis to characterize its taxonomic position. This bacterium exhibits very low 16SrRNA similarity with any other environmental isolate reported to date. Both phenotypic and phylogenetic analyses clearly indicate that this isolate belongs to the genus Deinococcus and represents a novel species. The name Deinococcus phoenicis was proposed after the Phoenix spacecraft, which was undergoing assembly, testing, and launch operations in the spacecraft assembly facility at the time of isolation. D. phoenicis cells exhibited higher resistance to ionizing radiation (cobalt-60; 14 kGy) than the cells of the D. radiodurans (5 kGy). Thus, it is in the best interest of NASA to thoroughly characterize this organism, which will further assess in determining the potential for forward contamination. Upon the completion of genetic and physiological characteristics of D. phoenicis, it will be added to a planetary protection database to be able to further model and predict the probability of forward contamination.

Subjective sensation on sleep, fatigue, and thermal comfort in winter shelter-analogue settings

Science.gov (United States)

Maeda, Kazuki; Mochizuki, Yosuke; Tsuzuki, Kazuyo; Nabeshima, Yuki

2017-10-01

We aimed to examine sleep in shelter-analogue settings in winter to determine the subjective sensation and environmental conditions in evacuation shelters. Twelve young healthy students took part in the sleep study of two nights for seven hours from Midnight to 7 AM in the gymnasium. One night the subject used a pair of futons and on the other the subject used the emergency supplies of four blankets and a set of portable partitions. During the night, air temperature, humidity and air velocity were measured in the area around the sleeping subjects. Sleep parameters measured by actigraphy, skin temperature, microclimate temperature, rectal temperature, and the heart rates of the subjects were continuously measured and recorded during the sleeping period. The subjects completed questionnaires regarding their thermal comfort and subjective sleep before and after the sleep. The subjects felt more coldness on their head and peripheral parts of the body using the emergency blankets than the futon during the sleep. Moreover, fatigue was felt more on the lower back and lower extremities from using emergency blankets than the futon after sleep. However, the sleep efficiency index and subjective sleep evaluation by OSA questionnaire did not reveal any good correlationship. The emergency supplies should be examined for their suitability to provide comfortable and healthy sleep in the shelter-analogue settings.

Management of penile defects: a review.

Science.gov (United States)

Guizhong, Li; Feng, He; Guangling, Huang; Libo, Man; Kun, Liu; Yuming, Shen

2012-06-01

Penile amputation is a rare injury. Although, in principle, penile replantation can be performed using a variety of methods, few, if any, standardized procedures exist to deal with this medical emergency. The value of the various microsurgical techniques for replantation of the penis remains uncertain. This article provides a review of the management of penile defects and complications. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Stellar extreme ultraviolet astronomy

International Nuclear Information System (INIS)

Cash, W.C. Jr.

1978-01-01

The design, calibration, and launch of a rocket-borne imaging telescope for extreme ultraviolet astronomy are described. The telescope, which employed diamond-turned grazing incidence optics and a ranicon detector, was launched November 19, 1976, from the White Sands Missile Range. The telescope performed well and returned data on several potential stellar sources of extreme ultraviolet radiation. Upper limits ten to twenty times more sensitive than previously available were obtained for the extreme ultraviolet flux from the white dwarf Sirius B. These limits fall a factor of seven below the flux predicted for the star and demonstrate that the temperature of Sirius B is not 32,000 K as previously measured, but is below 30,000 K. The new upper limits also rule out the photosphere of the white dwarf as the source of the recently reported soft x-rays from Sirius. Two other white dwarf stars, Feige 24 and G191-B2B, were observed. Upper limits on the flux at 300 A were interpreted as lower limits on the interstellar hydrogen column densities to these stars. The lower limits indicate interstellar hydrogen densitites of greater than .02 cm -3 . Four nearby stars (Sirius, Procyon, Capella, and Mirzam) were observed in a search for intense low temperature coronae or extended chromospheres. No extreme ultraviolet radiation from these stars was detected, and upper limits to their coronal emisson measures are derived

Peripheral Nerve Dysfunction in Middle-Aged Subjects Born with Thalidomide Embryopathy.

Directory of Open Access Journals (Sweden)

Alessia Nicotra

Full Text Available Phocomelia is an extremely rare congenital malformation that emerged as one extreme of a range of defects resulting from in utero exposure to thalidomide. Individuals with thalidomide embryopathy (TE have reported developing symptoms suggestive of peripheral nervous system dysfunction in the mal-developed limbs in later life.Case control study comparing TE subjects with upper limb anomalies and neuropathic symptoms with healthy controls using standard neurophysiological testing. Other causes of a peripheral neuropathy were excluded prior to assessment.Clinical examination of 17 subjects with TE (aged 50.4±1.3 [mean±standard deviation] years, 10 females and 17 controls (37.9±9.0 years; 8 females demonstrated features of upper limb compressive neuropathy in three-quarters of subjects. Additionally there were examination findings suggestive of mild sensory neuropathy in the lower limbs (n = 1, L5 radiculopathic sensory impairment (n = 1 and cervical myelopathy (n = 1. In TE there were electrophysiological changes consistent with a median large fibre neuropathic abnormality (mean compound muscle action potential difference -6.3 mV ([-9.3, -3.3], p = 0.0002 ([95% CI], p-value and reduced sympathetic skin response amplitudes (-0.8 mV ([-1.5, -0.2], p = 0.0089 in the affected upper limbs. In the lower limbs there was evidence of sural nerve dysfunction (sensory nerve action potential -5.8 μV ([-10.7, -0.8], p = 0.0232 and impaired warm perception thresholds (+3.0°C ([0.6, 5.4], p = 0.0169.We found a range of clinical features relevant to individuals with TE beyond upper limb compressive neuropathies supporting the need for a detailed neurological examination to exclude other treatable pathologies. The electrophysiological evidence of large and small fibre axonal nerve dysfunction in symptomatic and asymptomatic limbs may be a result of the original insult and merits further investigation.

Two case studies on NARCCAP precipitation extremes

Science.gov (United States)

Weller, Grant B.; Cooley, Daniel; Sain, Stephan R.; Bukovsky, Melissa S.; Mearns, Linda O.

2013-09-01

We introduce novel methodology to examine the ability of six regional climate models (RCMs) in the North American Regional Climate Change Assessment Program (NARCCAP) ensemble to simulate past extreme precipitation events seen in the observational record over two different regions and seasons. Our primary objective is to examine the strength of daily correspondence of extreme precipitation events between observations and the output of both the RCMs and the driving reanalysis product. To explore this correspondence, we employ methods from multivariate extreme value theory. These methods require that we account for marginal behavior, and we first model and compare climatological quantities which describe tail behavior of daily precipitation for both the observations and model output before turning attention to quantifying the correspondence of the extreme events. Daily precipitation in a West Coast region of North America is analyzed in two seasons, and it is found that the simulated extreme events from the reanalysis-driven NARCCAP models exhibit strong daily correspondence to extreme events in the observational record. Precipitation over a central region of the United States is examined, and we find some daily correspondence between winter extremes simulated by reanalysis-driven NARCCAP models and those seen in observations, but no such correspondence is found for summer extremes. Furthermore, we find greater discrepancies among the NARCCAP models in the tail characteristics of the distribution of daily summer precipitation over this region than seen in precipitation over the West Coast region. We find that the models which employ spectral nudging exhibit stronger tail dependence to observations in the central region.

Extreme Hypofractionated Image-Guided Radiotherapy for Prostate Cancer

Directory of Open Access Journals (Sweden)

Carlo Greco

2013-09-01

Full Text Available An emerging body of data suggests that hypofractionated radiation schedules, where a higher dose per fraction is delivered in a smaller number of sessions, may be superior to conventional fractionation schemes in terms of both tumour control and toxicity profile in the management of adenocarcinoma of the prostate. However, the optimal hypofractionation scheme is still the subject of scientific debate. Modern computer-driven technology enables the safe implementation of extreme hypo fractionation (often referred to as stereotactic body radiation therapy [SBRT]. Several studies are currently being conducted to clarify the yet unresolved issues regarding treatment techniques and fractionation regimens. Recently, the American Society for Radiation Oncology (ASTRO issued a model policy indicating that data supporting the use of SBRT for prostate cancer have matured to a point where SBRT could be considered an appropriate alternative for select patients with low-to-intermediate risk disease. The present article reviews some of the currently available data and examines the impact of tracking technology to mitigate intra-fraction target motion, thus, potentially further improving the clinical outcomes of extreme hypofractionated radiation therapy in appropriately selected prostate cancer patients. The Champalimaud Centre for the Unknown (CCU’s currently ongoing Phase I feasibility study is described; it delivers 45 Gy in five fractions using prostate fixation via a rectal balloon, and urethral sparing via catheter placement with on-line intra-fractional motion tracking through beacon transponder technology.

Altered States of Consciousness during an Extreme Ritual

Science.gov (United States)

Loewald, Tonio; Comber, Evelyn M.; Hanson, Sarah A.; Pruitt, Bria

2016-01-01

Extreme rituals (body-piercing, fire-walking, etc.) are anecdotally associated with altered states of consciousness—subjective alterations of ordinary mental functioning (Ward, 1984)—but empirical evidence of altered states using both direct and indirect measures during extreme rituals in naturalistic settings is limited. Participants in the “Dance of Souls”, a 3.5-hour event during which participants received temporary piercings with hooks or weights attached to the piercings and danced to music provided by drummers, responded to measures of two altered states of consciousness. Participants also completed measures of positive and negative affect, salivary cortisol (a hormone associated with stress), self-reported stress, sexual arousal, and intimacy. Both pierced participants (pierced dancers) and non-pierced participants (piercers, piercing assistants, observers, drummers, and event leaders) showed evidence of altered states aligned with transient hypofrontality (Dietrich, 2003; measured with a Stroop test) and flow (Csikszentmihalyi, 1990; Csikszentmihalyi & Csikszentmihalyi, 1990; measured with the Flow State Scale). Both pierced and non-pierced participants also reported decreases in negative affect and psychological stress and increases in intimacy from before to after the ritual. Pierced and non-pierced participants showed different physiological reactions, however, with pierced participants showing increases in cortisol and non-pierced participants showing decreases from before to during the ritual. Overall, the ritual appeared to induce different physiological effects but similar psychological effects in focal ritual participants (i.e., pierced dancers) and in participants adopting other roles. PMID:27175897

Altered States of Consciousness during an Extreme Ritual.

Directory of Open Access Journals (Sweden)

Ellen M Lee

Full Text Available Extreme rituals (body-piercing, fire-walking, etc. are anecdotally associated with altered states of consciousness-subjective alterations of ordinary mental functioning (Ward, 1984-but empirical evidence of altered states using both direct and indirect measures during extreme rituals in naturalistic settings is limited. Participants in the "Dance of Souls", a 3.5-hour event during which participants received temporary piercings with hooks or weights attached to the piercings and danced to music provided by drummers, responded to measures of two altered states of consciousness. Participants also completed measures of positive and negative affect, salivary cortisol (a hormone associated with stress, self-reported stress, sexual arousal, and intimacy. Both pierced participants (pierced dancers and non-pierced participants (piercers, piercing assistants, observers, drummers, and event leaders showed evidence of altered states aligned with transient hypofrontality (Dietrich, 2003; measured with a Stroop test and flow (Csikszentmihalyi, 1990; Csikszentmihalyi & Csikszentmihalyi, 1990; measured with the Flow State Scale. Both pierced and non-pierced participants also reported decreases in negative affect and psychological stress and increases in intimacy from before to after the ritual. Pierced and non-pierced participants showed different physiological reactions, however, with pierced participants showing increases in cortisol and non-pierced participants showing decreases from before to during the ritual. Overall, the ritual appeared to induce different physiological effects but similar psychological effects in focal ritual participants (i.e., pierced dancers and in participants adopting other roles.

Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial.

Science.gov (United States)

Esmaeilzadeh, Sina; Ozcan, Emel; Capan, Nalan

2014-01-01

The aim of the study was to determine effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders (WUEMSDs) among computer workers. Four hundred computer workers answered a questionnaire on work-related upper extremity musculoskeletal symptoms (WUEMSS). Ninety-four subjects with WUEMSS using computers at least 3 h a day participated in a prospective, randomized controlled 6-month intervention. Body posture and workstation layouts were assessed by the Ergonomic Questionnaire. We used the Visual Analogue Scale to assess the intensity of WUEMSS. The Upper Extremity Function Scale was used to evaluate functional limitations at the neck and upper extremities. Health-related quality of life was assessed with the Short Form-36. After baseline assessment, those in the intervention group participated in a multicomponent ergonomic intervention program including a comprehensive ergonomic training consisting of two interactive sessions, an ergonomic training brochure, and workplace visits with workstation adjustments. Follow-up assessment was conducted after 6 months. In the intervention group, body posture (p 0.05). Ergonomic intervention programs may be effective in reducing ergonomic risk factors among computer workers and consequently in the secondary prevention of WUEMSDs.

Impacts of hydrometeorological extremes in the Bohemian-Moravian Highlands in 1706–1889 as derived from taxation records

Czech Academy of Sciences Publication Activity Database

Dolák, Lukáš; Brázdil, Rudolf; Valášek, H.

2015-01-01

Roč. 120, č. 4 (2015), s. 465-488 ISSN 1212-0014 R&D Projects: GA ČR(CZ) GA13-19831S Institutional support: RVO:67179843 Keywords : historical climatology * ice-age * documentary * vulnerability * temperatures * europe * winter * hydrometeorological extremes * taxation records * damage * impacts * Bohemian-Moravian Highlands Subject RIV: EH - Ecology, Behaviour Impact factor: 0.415, year: 2015

Political extremism and violence in Denmark 1917-1940

DEFF Research Database (Denmark)

Larsen, Chris Holmsted

. Regarding the interwar years, the Danish political parties and conditions had many structural and ideological similarities with the neighboring German Weimar Republic. But more important, the situation also differed significantly in terms of particular historical and actor-based conditions– e.g. in terms...... of generalization, but since the research-subject of political violence, in a Danish context, is largely absent and at best minimal, I have concluded that for the sake of the wider perspective, it is imperative to focus on the framework as a prerequisite for a more detailed study of political violence in Denmark....... Therefore, a crucial question is why did the political extremism and violence of the interwar years not manage to scuttle the Danish democracy? And second, why were both fascist and communist protagonists unsuccessful in subverting parliamentarism through a strategy of political violence? To gain...

How does public opinion become extreme?

Science.gov (United States)

Ramos, Marlon; Shao, Jia; Reis, Saulo D S; Anteneodo, Celia; Andrade, José S; Havlin, Shlomo; Makse, Hernán A

2015-05-19

We investigate the emergence of extreme opinion trends in society by employing statistical physics modeling and analysis on polls that inquire about a wide range of issues such as religion, economics, politics, abortion, extramarital sex, books, movies, and electoral vote. The surveys lay out a clear indicator of the rise of extreme views. The precursor is a nonlinear relation between the fraction of individuals holding a certain extreme view and the fraction of individuals that includes also moderates, e.g., in politics, those who are "very conservative" versus "moderate to very conservative" ones. We propose an activation model of opinion dynamics with interaction rules based on the existence of individual "stubbornness" that mimics empirical observations. According to our modeling, the onset of nonlinearity can be associated to an abrupt bootstrap-percolation transition with cascades of extreme views through society. Therefore, it represents an early-warning signal to forecast the transition from moderate to extreme views. Moreover, by means of a phase diagram we can classify societies according to the percolative regime they belong to, in terms of critical fractions of extremists and people's ties.

How does public opinion become extreme?

Science.gov (United States)

Ramos, Marlon; Shao, Jia; Reis, Saulo D. S.; Anteneodo, Celia; Andrade, José S.; Havlin, Shlomo; Makse, Hernán A.

2015-05-01

We investigate the emergence of extreme opinion trends in society by employing statistical physics modeling and analysis on polls that inquire about a wide range of issues such as religion, economics, politics, abortion, extramarital sex, books, movies, and electoral vote. The surveys lay out a clear indicator of the rise of extreme views. The precursor is a nonlinear relation between the fraction of individuals holding a certain extreme view and the fraction of individuals that includes also moderates, e.g., in politics, those who are “very conservative” versus “moderate to very conservative” ones. We propose an activation model of opinion dynamics with interaction rules based on the existence of individual “stubbornness” that mimics empirical observations. According to our modeling, the onset of nonlinearity can be associated to an abrupt bootstrap-percolation transition with cascades of extreme views through society. Therefore, it represents an early-warning signal to forecast the transition from moderate to extreme views. Moreover, by means of a phase diagram we can classify societies according to the percolative regime they belong to, in terms of critical fractions of extremists and people’s ties.

Sequences of extremal radially excited rotating black holes.

Science.gov (United States)

Blázquez-Salcedo, Jose Luis; Kunz, Jutta; Navarro-Lérida, Francisco; Radu, Eugen

2014-01-10

In the Einstein-Maxwell-Chern-Simons theory the extremal Reissner-Nordström solution is no longer the single extremal solution with vanishing angular momentum, when the Chern-Simons coupling constant reaches a critical value. Instead a whole sequence of rotating extremal J=0 solutions arises, labeled by the node number of the magnetic U(1) potential. Associated with the same near horizon solution, the mass of these radially excited extremal solutions converges to the mass of the extremal Reissner-Nordström solution. On the other hand, not all near horizon solutions are also realized as global solutions.

Different bacterial communities in heat and gamma irradiation treated replant disease soils revealed by 16S rRNA gene analysis – contribution to improved aboveground apple plant growth?

Directory of Open Access Journals (Sweden)

Bunlong eYim

2015-11-01

Full Text Available Replant disease (RD severely affects apple production in propagation tree nurseries and in fruit orchards worldwide. This study aimed to investigate the effects of soil disinfection treatments on plant growth and health in a biotest in two different RD soil types under greenhouse conditions and to link the plant growth status with the bacterial community composition at the time of plant sampling. In the biotest performed we observed that the aboveground growth of apple rootstock M26 plants after eight weeks was improved in the two RD soils either treated at 50 °C or with gamma irradiation compared to the untreated RD soils. Total community DNA was extracted from soil loosely adhering to the roots and quantitative real-time PCR revealed no pronounced differences in 16S rRNA gene copy numbers. 16S rRNA gene-based bacterial community analysis by denaturing gradient gel electrophoresis (DGGE and 454-pyrosequencing revealed significant differences in the bacterial community composition even after eight weeks of plant growth. In both soils, the treatments affected different phyla but only the relative abundance of Acidobacteria was reduced by both treatments. The genera Streptomyces, Bacillus, Paenibacillus and Sphingomonas had a higher relative abundance in both heat treated soils, whereas the relative abundance of Mucilaginibacter, Devosia and Rhodanobacter was increased in the gamma-irradiated soils and only the genus Phenylobacterium was increased in both treatments. The increased abundance of genera with potentially beneficial bacteria, i.e. potential degraders of phenolic compounds might have contributed to the improved plant growth in both treatments.

Complex Plasma Research Under Extreme Conditions

International Nuclear Information System (INIS)

Ishihara, Osamu

2008-01-01

Complex plasma research under extreme conditions is described. The extreme conditions include low-dimensionality for self-organized structures of dust particles, dust magnetization in high magnetic field, criticality in phase transition, and cryogenic environment for Coulomb crystals and dust dynamics.

Epidemiology and Impact on Performance of Lower Extremity Stress Injuries in Professional Basketball Players.

Science.gov (United States)

Khan, Moin; Madden, Kim; Burrus, M Tyrrell; Rogowski, Joseph P; Stotts, Jeff; Samani, Marisa J; Sikka, Robby; Bedi, Asheesh

Professional basketball players in the National Basketball Association (NBA) subject their lower extremities to significant repetitive loading during both regular-season and off-season training. Little is known about the incidence of lower extremity bony stress injuries and their impact on return to play and performance in these athletes. Stress injuries of the lower extremity will have significant impact on performance. Case series. Level 4. All bony stress injuries from 2005 to 2015 were identified from the NBA. Number of games missed due to injury and performance statistics were collected from 2 years prior to injury to 2 years after the injury. A linear regression analysis was performed to determine the impact of injury for players who returned to sport. A total of 76 lower extremity bony stress injuries involving 75 NBA players (mean age, 25.4 ± 4.1 years) were identified. Fifty-five percent (42/76) involved the foot, and most injuries occurred during the regular season (82.9%, 63/76), with half occurring within the first 6 weeks. Among players who sustained a fifth metatarsal stress fracture, 42.9% were unable to return to professional play. Players who sustained stress injuries had reduced play performance, specifically related to number of games played ( P = 0.014) and number of steals per game ( P = 0.004). Players who had surgery had significantly better performance at 2 years than those who were managed nonoperatively, independent of the type of injury (β = 4.561; 95% CI, 1.255-7.868). Lower extremity bony stress injuries may significantly affect both short- and long-term player performance and career length. Stress injuries result in decreased player performance, and surgical intervention results in improved performance metrics compared with those treated using conservative methods. Stress injuries result in decreased player performance, and surgical intervention results in improved performance metrics.

ANTERIOR KNEE PAIN AND LOWER EXTREMITY FUNCTIONS IN INDIAN ADOLESCENT POPULATION

Directory of Open Access Journals (Sweden)

Riddhi Shroff

2016-01-01

Full Text Available Background & Purpose - Anterior knee pain is one of the most common musculoskeletal complain seen in Indian adolescent population with high incidence among those who are active in sports and recreation. The purpose of this study was to investigate the age of onset of anterior knee pain, to find its effect on sports participation and also to find the activities which are maximally affected due to anterior knee pain in Indian population. Method- A questionnaire based survey was conducted among 50 subjects using three outcome measures namely self made demographic questionnaire, anterior knee pain scale and lower extremity functional scale. Result- Maximally affected activities are running, jumping & squatting and maximally affected functions are squatting, running on uneven ground, making sharp turns while running and hopping with increase incidence of anterior knee pain among those who participate daily in sports. Conclusion- The study concluded, that in adolescent age group of 11-17 years, anterior knee pain is more prevalent in adolescent girls with the age of onset being around 13 years for girls & 14.5 years in boys and it also showed moderate positive correlation between anterior knee pain and lower extremity functions.

Extreme project. Progress report 2006; Projet EXTREME. Rapport d'avancement 2006

Energy Technology Data Exchange (ETDEWEB)

Eyrolle, F.; Masson, O.; Charmasson, S

2007-07-01

The E.X.T.R.E.M.E. project introduced in 2005 to the S.E.S.U.R.E. / L.E.R.C.M. has for objectives to acquire data on the consequences of the extreme climatic meteorological episodes on the distribution of the artificial radioisotopes within the various compartments of the geosphere. This report presents the synthesis of the actions developed in 2006 in positioning and in co financing of the project by means of regional or national research programs (C.A.R.M.A., E.X.T.R.E.M.A., E.C.C.O.R.E.V.I.), of data acquisition, valuation and scientific collaboration. (N.C.)

Modeling extreme PM10 concentration in Malaysia using generalized extreme value distribution

Science.gov (United States)

Hasan, Husna; Mansor, Nadiah; Salleh, Nur Hanim Mohd

2015-05-01

Extreme PM10 concentration from the Air Pollutant Index (API) at thirteen monitoring stations in Malaysia is modeled using the Generalized Extreme Value (GEV) distribution. The data is blocked into monthly selection period. The Mann-Kendall (MK) test suggests a non-stationary model so two models are considered for the stations with trend. The likelihood ratio test is used to determine the best fitted model and the result shows that only two stations favor the non-stationary model (Model 2) while the other eleven stations favor stationary model (Model 1). The return level of PM10 concentration that is expected to exceed the maximum once within a selected period is obtained.

Thumb fingertip reconstruction with palmar V-Y flaps combined with bone and nail bed grafts following amputation.

Science.gov (United States)

Zhou, Xiao; Wang, Libo; Mi, Jingyi; Xu, Yajun; Rui, Yongjun; Xue, Mingyu; Shen, Xiaofang; Qiang, Li

2015-04-01

The aim of treating thumb fingertip amputations with no indication for replantation is to reestablish functional and esthetic properties. From March 2005 to October 2008, we treated 14 patients with thumb fingertip amputation using palmar V-Y flaps combined with bone and nail bed grafts. There were 10 men and 4 women, whose ages at surgery ranged from 19 to 63 years (mean 35.8 years). In all, 11 of the injuries occurred in the dominant hand. According to Allen's classification, two were type II, seven were type III, and five were type IV. All patients underwent emergency surgery, with a time delay after injury of 3-12 h (mean 6.4 h). In each case, the amputation was a crush or avulsion injury, making microsurgical replantation not feasible. All of the flaps survived. At 8-17 months (average 12.8 months) of follow-up, the average subjective satisfaction score was 8.64. All patients experienced cold intolerance, and none of the patients complained of dysesthesia. Favorable results (excellent or good) were found in 78.6%. Thin primary nails appeared on the grafted nail bed about 3 weeks after surgery, following which the newly formed nail thickened and developed a more natural appearance. In one case, the new nail plate showed abnormal thickening due to hyperkeratosis. The bone graft healed at 5 weeks. The mean two-point discrimination was 7.5 mm. Grip strength was 10% less than that in the unaffected hand. Metacarpophalangeal and proximal interphalangeal joint mobility losses were less than 10°. All patients returned to their jobs. No patients had postoperative complications. We believe that the combination of palmar V-Y flap and bone and nail bed grafts provides a distinct advantage over other choices. It improves function when replantation is not an option.

Prevention of Lower Extremity Injuries in Basketball

Science.gov (United States)

Taylor, Jeffrey B.; Ford, Kevin R.; Nguyen, Anh-Dung; Terry, Lauren N.; Hegedus, Eric J.

2015-01-01

Context: Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates. Objective: To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears. Data Sources: PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlled Trials were searched in January 2015. Study Selection: Studies were included if they were randomized controlled or prospective cohort trials, contained a population of competitive basketball athletes, and reported lower extremity injury incidence rates specific to basketball players. In total, 426 individual studies were identified. Of these, 9 met the inclusion criteria. One other study was found during a hand search of the literature, resulting in 10 total studies included in this meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 2. Data Extraction: Details of the intervention (eg, neuromuscular vs external support), size of control and intervention groups, and number of injuries in each group were extracted from each study. Injury data were classified into 3 groups based on the anatomic diagnosis reported (general lower extremity injury, ankle sprain, ACL rupture). Results: Meta-analyses were performed independently for each injury classification. Results indicate that prophylactic programs significantly reduced the incidence of general lower extremity injuries (odds ratio [OR], 0.69; 95% CI, 0.57-0.85; P basketball athletes. Conclusion: In basketball players, prophylactic programs may be effective in reducing the risk of general lower extremity injuries and ankle sprains, yet not ACL injuries. PMID:26502412

Extreme Weather Events and Climate Change Attribution

Energy Technology Data Exchange (ETDEWEB)

Thomas, Katherine [National Academy of Sciences, Washington, DC (United States)

2016-03-31

A report from the National Academies of Sciences, Engineering, and Medicine concludes it is now possible to estimate the influence of climate change on some types of extreme events. The science of extreme event attribution has advanced rapidly in recent years, giving new insight to the ways that human-caused climate change can influence the magnitude or frequency of some extreme weather events. This report examines the current state of science of extreme weather attribution, and identifies ways to move the science forward to improve attribution capabilities. Confidence is strongest in attributing types of extreme events that are influenced by climate change through a well-understood physical mechanism, such as, the more frequent heat waves that are closely connected to human-caused global temperature increases, the report finds. Confidence is lower for other types of events, such as hurricanes, whose relationship to climate change is more complex and less understood at present. For any extreme event, the results of attribution studies hinge on how questions about the event's causes are posed, and on the data, modeling approaches, and statistical tools chosen for the analysis.

Sensitivity of European wheat to extreme weather

DEFF Research Database (Denmark)

Mäkinen, H; Kaseva, J; Trnka, M

2018-01-01

The frequency and intensity of extreme weather is increasing concomitant with changes in the global climate change. Although wheat is the most important food crop in Europe, there is currently no comprehensive empirical information available regarding the sensitivity of European wheat to extreme...... weather. In this study, we assessed the sensitivity of European wheat yields to extreme weather related to phenology (sowing, heading) in cultivar trials across Europe (latitudes 37.21° to 61.34° and longitudes −6.02° to 26.24°) during the period 1991–2014. All the observed agro-climatic extremes (≥31 °C...... wheat cultivars that responded positively (+10%) to drought after sowing, or frost during winter (−15 °C and −20 °C). Positive responses to extremes were often shown by cultivars associated with specific regions, such as good performance under high temperatures by southern-origin cultivars. Consequently...

[Crossing borders. The motivation of extreme sportsmen].

Science.gov (United States)

Opaschowski, H W

2005-08-01

In his article "Crossing borders -- the motivation of extreme sportsmen" the author gets systematically to the bottom of the question of why extreme sportsmen voluntarily take risks and endanger themselves. Within the scope of a representative sampling 217 extreme sportsmen -- from the fields of mountain biking, trekking and free climbing, canoyning, river rafting and deep sea diving, paragliding, parachuting, bungee jumping and survival training -- give information about their personal motives. What fascinates them? The attraction of risk? The search for sensation? Or the drop out of everyday life? And what comes afterwards? Does in the end the whole life become an extreme sport? Fact is: they live extremely, because they want to move beyond well-trodden paths. To escape the boredom of everyday life they are searching for the kick, the thrill, the no-limit experience. It's about calculated risk between altitude flight and deep sea adventure.

Is prescribed lower extremity weight-bearing status after geriatric lower extremity trauma associated with increased mortality?

Science.gov (United States)

Gitajn, Ida Leah; Connelly, Daniel; Mascarenhas, Daniel; Breazeale, Stephen; Berger, Peter; Schoonover, Carrie; Martin, Brook; O'Toole, Robert V; Pensy, Raymond; Sciadini, Marcus

2018-02-01

Evaluate whether mortality after discharge is elevated in geriatric fracture patients whose lower extremity weight-bearing is restricted. Retrospective cohort study SETTING: Urban Level 1 trauma center PATIENTS/PARTICIPANTS: 1746 patients >65 years of age INTERVENTION: Post-operative lower extremity weight-bearing status MAIN OUTCOME MEASURE: Mortality, as determined by the Social Security Death Index RESULTS: Univariate analysis demonstrated that patients who were weight-bearing as tolerated on bilateral lower extremities (BLE) had significantly higher 5-year mortality compared to patients with restricted weight-bearing on one lower extremity and restricted weight-bearing on BLE (30%, 21% and 22% respectively, p bearing as tolerated on BLE, restricted weight-bearing on one lower extremity had a hazard ratio (HR) of 0.97 (95% confidence interval 0.78 to 1.20, p = 0.76) and restricted weight-bearing in BLE had a HR of 0.91 (95% confidence interval 0.60 to 1.36, p = 0.73). In geriatric patients, prescribed weight-bearing status did not have a statistically significant association with mortality after discharge, when controlling for age, sex, body mass index, medical comorbidities, Injury Severity Scale (ISS), mechanism of injury, nonoperative treatment and admission GCS. This remained true in when the analysis was restricted to operative injuries only. Copyright © 2017 Elsevier Ltd. All rights reserved.

Influence of climate variability versus change at multi-decadal time scales on hydrological extremes

Science.gov (United States)

Willems, Patrick

2014-05-01

Recent studies have shown that rainfall and hydrological extremes do not randomly occur in time, but are subject to multidecadal oscillations. In addition to these oscillations, there are temporal trends due to climate change. Design statistics, such as intensity-duration-frequency (IDF) for extreme rainfall or flow-duration-frequency (QDF) relationships, are affected by both types of temporal changes (short term and long term). This presentation discusses these changes, how they influence water engineering design and decision making, and how this influence can be assessed and taken into account in practice. The multidecadal oscillations in rainfall and hydrological extremes were studied based on a technique for the identification and analysis of changes in extreme quantiles. The statistical significance of the oscillations was evaluated by means of a non-parametric bootstrapping method. Oscillations in large scale atmospheric circulation were identified as the main drivers for the temporal oscillations in rainfall and hydrological extremes. They also explain why spatial phase shifts (e.g. north-south variations in Europe) exist between the oscillation highs and lows. Next to the multidecadal climate oscillations, several stations show trends during the most recent decades, which may be attributed to climate change as a result of anthropogenic global warming. Such attribution to anthropogenic global warming is, however, uncertain. It can be done based on simulation results with climate models, but it is shown that the climate model results are too uncertain to enable a clear attribution. Water engineering design statistics, such as extreme rainfall IDF or peak or low flow QDF statistics, obviously are influenced by these temporal variations (oscillations, trends). It is shown in the paper, based on the Brussels 10-minutes rainfall data, that rainfall design values may be about 20% biased or different when based on short rainfall series of 10 to 15 years length, and

Variable ultrasonography findings of extremity lymphangioma: Pathologic correlation

International Nuclear Information System (INIS)

Oh, Jong Young; Nam, Kyung Jin; Lee, Ki Nam; Kim, Chan Sung; Lee, Jin Hwa; Kim, Dae Chul

2002-01-01

The great majority of lymphangiomas occur in the neck (75%) and axilla (20%), but extremity lymphangioma is rare. We correlate variable sonographic features of extremity lymphangioma with pathologic findings. We reviewed the sonographic findings of extremity lymphangioma in 14 patients (M:F=8:6). The all cases were histologically confirmed by operation. The variable sonographic features of extremity lymphangioma were compared to pathologic findings. The multilocular cystic mass with ill defined boundaries was distinctive sonographic appearance of extremity lymphangioma. But there were variable sonographic findings such as heterogeneous echogenic mass or homogeneous echogenic portion. The histologic section of echogenic lesion reveals clusters of abnormal

Upper extremities flexibility comparisons of collegiate "soft" martial art practitioners with other athletes.

Science.gov (United States)

Huang, C-C; Yang, Y-H; Chen, C-H; Chen, T-W; Lee, C-L; Wu, C-L; Chuang, S-H; Huang, M-H

2008-03-01

The aim of this study was to compare the flexibility of the upper extremities in collegiate students involved in Aikido (a kind of soft martial art attracting youth) training with those involved in other sports. Fifty freshmen with a similar frequency of exercise were divided into the Aikido group (n = 18), the upper-body sports group (n = 17), and the lower-body sports group (n = 15) according to the sports that they participated in. Eight classes of range of motion in upper extremities were taken for all subjects by the same clinicians. The Aikido group had significantly better flexibility than the upper-body sports group except for range of motion in shoulder flexion (p = 0.22), shoulder lateral rotation (p > 0.99), and wrist extension (p > 0.99). The Aikido group also had significantly better flexibility than the lower-body sports group (p < 0.01) and the sedentary group (p < 0.01) in all classes of range of motion. The upper-body sports group was significantly more flexible in five classes of range of motion and significantly tighter in range of motion of wrist flexion (p < 0.01) compared to the lower-body sports group. It was concluded that the youths participating in soft martial arts had good upper extremities flexibility that might not result from regular exercise alone.

Differences in lumbar spine and lower extremity kinematics during a step down functional task in people with and people without low back pain.

Science.gov (United States)

Hernandez, Alejandra; Gross, Karlie; Gombatto, Sara

2017-08-01

When functional movements are impaired in people with low back pain, they may be a contributing factor to chronicity and recurrence. The purpose of the current study was to examine lumbar spine, pelvis, and lower extremity kinematics during a step down functional task between people with and without a history of low back pain. A 3-dimensional motion capture system was used to analyze kinematics during a step down task. Total excursion of the lumbar spine, pelvis, and lower extremity segments in each plane were calculated from the start to end of the task. Separate analysis of variance tests (α=0.05) were conducted to determine the effect of independent variables of group and plane on lumbar spine, pelvis, and lower extremity kinematics. An exploratory analysis was conducted to examine kinematic differences among movement-based low back pain subgroups. Subjects with low back pain displayed less lumbar spine movement than controls across all three planes of movement (P-values=0.001-0.043). This group difference was most pronounced in the sagittal plane. For the lower extremity, subjects with low back pain displayed more frontal and axial plane knee movement than controls (P-values=0.001). There were no significant differences in kinematics among movement-based low back pain subgroups. People with low back pain displayed less lumbar region movement in the sagittal plane and more off-plane knee movements than the control group during a step down task. Clinicians can use this information when assessing lumbar spine and lower extremity movement during functional tasks, with the goal of developing movement-based interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Are extreme hydro-meteorological events a prerequisite for extreme water quality impacts? Exploring climate impacts on inland and coastal waters

Science.gov (United States)

Michalak, A. M.; Balaji, V.; Del Giudice, D.; Sinha, E.; Zhou, Y.; Ho, J. C.

2017-12-01

Questions surrounding water sustainability, climate change, and extreme events are often framed around water quantity - whether too much or too little. The massive impacts of extreme water quality impairments are equally compelling, however. Recent years have provided a host of compelling examples, with unprecedented harmful algal blooms developing along the West coast, in Utah Lake, in Lake Erie, and off the Florida coast, and huge hypoxic dead zones continuing to form in regions such as Lake Erie, the Chesapeake Bay, and the Gulf of Mexico. Linkages between climate change, extreme events, and water quality impacts are not well understood, however. Several factors explain this lack of understanding, including the relative complexity of underlying processes, the spatial and temporal scale mismatch between hydrologists and climatologists, and observational uncertainty leading to ambiguities in the historical record. Here, we draw on a number of recent studies that aim to quantitatively link meteorological variability and water quality impacts to test the hypothesis that extreme water quality impairments are the result of extreme hydro-meteorological events. We find that extreme hydro-meteorological events are neither always a necessary nor a sufficient condition for the occurrence of extreme water quality impacts. Rather, extreme water quality impairments often occur in situations where multiple contributing factors compound, which complicates both attribution of historical events and the ability to predict the future incidence of such events. Given the critical societal importance of water quality projections, a concerted program of uncertainty reduction encompassing observational and modeling components will be needed to examine situations where extreme weather plays an important, but not solitary, role in the chain of cause and effect.

A Fourier analysis of extremal events

DEFF Research Database (Denmark)

Zhao, Yuwei

is the extremal periodogram. The extremal periodogram shares numerous asymptotic properties with the periodogram of a linear process in classical time series analysis: the asymptotic distribution of the periodogram ordinates at the Fourier frequencies have a similar form and smoothed versions of the periodogram...

Analysis of experimental data: The average shape of extreme wave forces on monopile foundations and the NewForce model

DEFF Research Database (Denmark)

Schløer, Signe; Bredmose, Henrik; Ghadirian, Amin

2017-01-01

Experiments with a stiff pile subjected to extreme wave forces typical of offshore wind farm storm conditions are considered. The exceedance probability curves of the nondimensional force peaks and crest heights are analysed. The average force time history normalised with their peak values are co...... to the average shapes. For more nonlinear wave shapes, higher order terms has to be considered in order for the NewForce model to be able to predict the expected shapes.......Experiments with a stiff pile subjected to extreme wave forces typical of offshore wind farm storm conditions are considered. The exceedance probability curves of the nondimensional force peaks and crest heights are analysed. The average force time history normalised with their peak values...... are compared across the sea states. It is found that the force shapes show a clear similarity when grouped after the values of the normalised peak force, F/(ρghR2), normalised depth h/(gT2p) and presented in a normalised time scale t/Ta. For the largest force events, slamming can be seen as a distinct ‘hat...

Spectral density regression for bivariate extremes

KAUST Repository

Castro Camilo, Daniela

2016-05-11

We introduce a density regression model for the spectral density of a bivariate extreme value distribution, that allows us to assess how extremal dependence can change over a covariate. Inference is performed through a double kernel estimator, which can be seen as an extension of the Nadaraya–Watson estimator where the usual scalar responses are replaced by mean constrained densities on the unit interval. Numerical experiments with the methods illustrate their resilience in a variety of contexts of practical interest. An extreme temperature dataset is used to illustrate our methods. © 2016 Springer-Verlag Berlin Heidelberg

Modeling, Forecasting and Mitigating Extreme Earthquakes

Science.gov (United States)

Ismail-Zadeh, A.; Le Mouel, J.; Soloviev, A.

2012-12-01

Recent earthquake disasters highlighted the importance of multi- and trans-disciplinary studies of earthquake risk. A major component of earthquake disaster risk analysis is hazards research, which should cover not only a traditional assessment of ground shaking, but also studies of geodetic, paleoseismic, geomagnetic, hydrological, deep drilling and other geophysical and geological observations together with comprehensive modeling of earthquakes and forecasting extreme events. Extreme earthquakes (large magnitude and rare events) are manifestations of complex behavior of the lithosphere structured as a hierarchical system of blocks of different sizes. Understanding of physics and dynamics of the extreme events comes from observations, measurements and modeling. A quantitative approach to simulate earthquakes in models of fault dynamics will be presented. The models reproduce basic features of the observed seismicity (e.g., the frequency-magnitude relationship, clustering of earthquakes, occurrence of extreme seismic events). They provide a link between geodynamic processes and seismicity, allow studying extreme events, influence of fault network properties on seismic patterns and seismic cycles, and assist, in a broader sense, in earthquake forecast modeling. Some aspects of predictability of large earthquakes (how well can large earthquakes be predicted today?) will be also discussed along with possibilities in mitigation of earthquake disasters (e.g., on 'inverse' forensic investigations of earthquake disasters).

Instability of extremal relativistic charged spheres

International Nuclear Information System (INIS)

Anninos, Peter; Rothman, Tony

2002-01-01

With the question 'Can relativistic charged spheres form extremal black holes?' in mind, we investigate the properties of such spheres from a classical point of view. The investigation is carried out numerically by integrating the Oppenheimer-Volkov equation for relativistic charged fluid spheres and finding interior Reissner-Nordstroem solutions for these objects. We consider both constant density and adiabatic equations of state, as well as several possible charge distributions, and examine stability by both a normal mode and an energy analysis. In all cases, the stability limit for these spheres lies between the extremal (Q=M) limit and the black hole limit (R=R + ). That is, we find that charged spheres undergo gravitational collapse before they reach Q=M, suggesting that extremal Reissner-Nordstroem black holes produced by collapse are ruled out. A general proof of this statement would support a strong form of the cosmic censorship hypothesis, excluding not only stable naked singularities, but stable extremal black holes. The numerical results also indicate that although the interior mass-energy m(R) obeys the usual m/R + as Q→M. In the Appendix we also argue that Hawking radiation will not lead to an extremal Reissner-Nordstroem black hole. All our results are consistent with the third law of black hole dynamics, as currently understood

Asymmetric responses of primary productivity to precipitation extremes: A synthesis of grassland precipitation manipulation experiments

Czech Academy of Sciences Publication Activity Database

Wilcox, K. R.; Shi, Z.; Gherardi, L. A.; Lemoine, N. P.; Koerner, S. E.; Hoover, D. L.; Bork, E.; Byrne, K. M.; Cahill, J.; Collins, S. L.; Evans, S.M.; Gilgen, Anna K.; Holub, Petr; Jiang, L.; Knapp, A. K.; LeCain, D.; Liang, J.; Garcia-Palacios, P.; Penuelas, J.; Pockman, W. T.; Smith, M. D.; Sun, S.; White, S. R.; Yahdjian, L.; Zhu, K.; Luo, Y.

2017-01-01

Roč. 23, č. 10 (2017), s. 4376-4385 ISSN 1354-1013 Institutional support: RVO:86652079 Keywords : net primary productivity * terrestrial ecosystems * temperate grassland * biomass allocation * plant-communities * tallgrass prairie * climate extremes * use efficiency * united-states * global-change * aboveground net primary productivity * belowground net primary productivity * biomass allocation * climate change * grasslands * meta-analysis * root biomass Subject RIV: EH - Ecology, Behaviour OBOR OECD: Environmental sciences (social aspects to be 5.7) Impact factor: 8.502, year: 2016

Navigated Transcranial Magnetic Stimulation: A Biologically Based Assay of Lower Extremity Impairment and Gait Velocity

OpenAIRE

Peters, Heather T.; Dunning, Kari; Belagaje, Samir; Kissela, Brett M.; Ying, Jun; Laine, Jarmo; Page, Stephen J.

2017-01-01

Objectives. (a) To determine associations among motor evoked potential (MEP) amplitude, MEP latency, lower extremity (LE) impairment, and gait velocity and (b) determine the association between the presence of a detectable MEP signal with LE impairment and with gait velocity. Method. 35 subjects with chronic, stable LE hemiparesis were undergone TMS, the LE section of the Fugl-Meyer Impairment Scale (LE FM), and 10-meter walk test. We recorded presence, amplitude, and latency of MEPs in the a...

Modelling of extreme minimum rainfall using generalised extreme value distribution for Zimbabwe

Directory of Open Access Journals (Sweden)

Delson Chikobvu

2015-09-01

Full Text Available We modelled the mean annual rainfall for data recorded in Zimbabwe from 1901 to 2009. Extreme value theory was used to estimate the probabilities of meteorological droughts. Droughts can be viewed as extreme events which go beyond and/or below normal rainfall occurrences, such as exceptionally low mean annual rainfall. The duality between the distribution of the minima and maxima was exploited and used to fit the generalised extreme value distribution (GEVD to the data and hence find probabilities of extreme low levels of mean annual rainfall. The augmented Dickey Fuller test confirmed that rainfall data were stationary, while the normal quantile-quantile plot indicated that rainfall data deviated from the normality assumption at both ends of the tails of the distribution. The maximum likelihood estimation method and the Bayesian approach were used to find the parameters of the GEVD. The Kolmogorov-Smirnov and Anderson-Darling goodnessof- fit tests showed that the Weibull class of distributions was a good fit to the minima mean annual rainfall using the maximum likelihood estimation method. The mean return period estimate of a meteorological drought using the threshold value of mean annual rainfall of 473 mm was 8 years. This implies that if in the year there is a meteorological drought then another drought of the same intensity or greater is expected after 8 years. It is expected that the use of Bayesian inference may better quantify the level of uncertainty associated with the GEVD parameter estimates than with the maximum likelihood estimation method. The Markov chain Monte Carlo algorithm for the GEVD was applied to construct the model parameter estimates using the Bayesian approach. These findings are significant because results based on non-informative priors (Bayesian method and the maximum likelihood method approach are expected to be similar.

AN EXTREMELY CARBON-RICH, EXTREMELY METAL-POOR STAR IN THE SEGUE 1 SYSTEM

International Nuclear Information System (INIS)

Norris, John E.; Yong, David; Gilmore, Gerard; Wyse, Rosemary F. G.; Frebel, Anna

2010-01-01

We report the analysis of high-resolution, high signal-to-noise ratio, spectra of an extremely metal-poor, extremely C-rich red giant, Seg 1-7, in Segue 1-described in the literature alternatively as an unusually extended globular cluster or an ultra-faint dwarf galaxy. The radial velocity of Seg 1-7 coincides precisely with the systemic velocity of Segue 1, and its chemical abundance signature of [Fe/H] = -3.52, [C/Fe] = +2.3, [N/Fe] = +0.8, [Na/Fe] = +0.53, [Mg/Fe] = +0.94, [Al/Fe] = +0.23, and [Ba/Fe] < -1.0 is similar to that of the rare and enigmatic class of Galactic halo objects designated CEMP-no (carbon-rich, extremely metal-poor with no enhancement (over solar ratios) of heavy neutron-capture elements). This is the first star in a Milky Way 'satellite' that unambiguously lies on the metal-poor, C-rich branch of the Aoki et al. bimodal distribution of field halo stars in the ([C/Fe], [Fe/H])-plane. Available data permit us only to identify Seg 1-7 as a member of an ultra-faint dwarf galaxy or as debris from the Sgr dwarf spheroidal galaxy. In either case, this demonstrates that at extremely low abundance, [Fe/H ] <-3.0, star formation and associated chemical evolution proceeded similarly in the progenitors of both the field halo and satellite systems. By extension, this is consistent with other recent suggestions that the most metal-poor dwarf spheroidal and ultra-faint dwarf satellites were the building blocks of the Galaxy's outer halo.

Extremity x-ray

Science.gov (United States)

... page: //medlineplus.gov/ency/article/003461.htm Extremity x-ray To use the sharing features on this page, ... in the body Risks There is low-level radiation exposure. X-rays are monitored and regulated to provide the ...

Statistics of Extremes

KAUST Repository

Davison, Anthony C.; Huser, Raphaë l

2015-01-01

Statistics of extremes concerns inference for rare events. Often the events have never yet been observed, and their probabilities must therefore be estimated by extrapolation of tail models fitted to available data. Because data concerning the event

Seasonal temperature extremes in Potsdam

Science.gov (United States)

Kundzewicz, Zbigniew; Huang, Shaochun

2010-12-01

The awareness of global warming is well established and results from the observations made on thousands of stations. This paper complements the large-scale results by examining a long time-series of high-quality temperature data from the Secular Meteorological Station in Potsdam, where observation records over the last 117 years, i.e., from January 1893 are available. Tendencies of change in seasonal temperature-related climate extremes are demonstrated. "Cold" extremes have become less frequent and less severe than in the past, while "warm" extremes have become more frequent and more severe. Moreover, the interval of the occurrence of frost has been decreasing, while the interval of the occurrence of hot days has been increasing. However, many changes are not statistically significant, since the variability of temperature indices at the Potsdam station has been very strong.

(When and where) Do extreme climate events trigger extreme ecosystem responses? - Development and initial results of a holistic analysis framework

Science.gov (United States)

Hauber, Eva K.; Donner, Reik V.

2015-04-01

In the context of ongoing climate change, extremes are likely to increase in magnitude and frequency. One of the most important consequences of these changes is that the associated ecological risks and impacts are potentially rising as well. In order to better anticipate and understand these impacts, it therefore becomes more and more crucial to understand the general connection between climate extremes and the response and functionality of ecosystems. Among other region of the world, Europe presents an excellent test case for studies concerning the interaction between climate and biosphere, since it lies in the transition region between cold polar and warm tropical air masses and thus covers a great variety of different climatic zones and associated terrestrial ecosystems. The large temperature differences across the continent make this region particularly interesting for investigating the effects of climate change on biosphere-climate interactions. However, previously used methods for defining an extreme event typically disregard the necessity of taking seasonality as well as seasonal variance appropriately into account. Furthermore, most studies have focused on the impacts of individual extreme events instead of considering a whole inventory of extremes with their respective spatio-temporal extents. In order to overcome the aforementioned research gaps, this work introduces a new approach to studying climate-biosphere interactions associated with extreme events, which comprises three consecutive steps: (1) Since Europe exhibits climatic conditions characterized by marked seasonality, a novel method is developed to define extreme events taking into account the seasonality in all quantiles of the probability distribution of the respective variable of interest. This is achieved by considering kernel density estimates individually for each observation date during the year, including the properly weighted information from adjacent dates. By this procedure, we obtain

Uncertainties in extreme precipitation under climate change conditions

DEFF Research Database (Denmark)

Sunyer Pinya, Maria Antonia

of adaptation strategies, but these changes are subject to uncertainties. The focus of this PhD thesis is the quantification of uncertainties in changes in extreme precipitation. It addresses two of the main sources of uncertainty in climate change impact studies: regional climate models (RCMs) and statistical...... downscaling methods (SDMs). RCMs provide information on climate change at the regional scale. SDMs are used to bias-correct and downscale the outputs of the RCMs to the local scale of interest in adaptation strategies. In the first part of the study, a multi-model ensemble of RCMs from the European ENSEMBLES...... project was used to quantify the uncertainty in RCM projections over Denmark. Three aspects of the RCMs relevant for the uncertainty quantification were first identified and investigated. These are: the interdependency of the RCMs; the performance in current climate; and the change in the performance...

Adventure and Extreme Sports.

Science.gov (United States)

Gomez, Andrew Thomas; Rao, Ashwin

2016-03-01

Adventure and extreme sports often involve unpredictable and inhospitable environments, high velocities, and stunts. These activities vary widely and include sports like BASE jumping, snowboarding, kayaking, and surfing. Increasing interest and participation in adventure and extreme sports warrants understanding by clinicians to facilitate prevention, identification, and treatment of injuries unique to each sport. This article covers alpine skiing and snowboarding, skateboarding, surfing, bungee jumping, BASE jumping, and whitewater sports with emphasis on epidemiology, demographics, general injury mechanisms, specific injuries, chronic injuries, fatality data, and prevention. Overall, most injuries are related to overuse, trauma, and environmental or microbial exposure. Copyright © 2016 Elsevier Inc. All rights reserved.

The Effect of Elevation on Volumetric Measurements of the Lower Extremity

Directory of Open Access Journals (Sweden)

Cordial M. Gillette

2017-07-01

Full Text Available Background: The empirical evidence for the use of RICE (rest, ice, compression, elevation has been questioned regarding its   clinical effectiveness. The component of RICE that has the least literature regarding its effectiveness is elevation. Objective: The objective of this study was to determine if various positions of elevation result in volumetric changes of the lower extremity. Methodology: A randomized crossover design was used to determine the effects of the four following conditions on volumetric changes of the lower extremity: seated at the end of a table (seated, lying supine (flat, lying supine with the foot elevated 12 inches off the table (elevated, and lying prone with the knees bent to 90 degrees (prone. The conditions were randomized using a Latin Square. Each subject completed all conditions with at least 24 hours between each session. Pre and post volumetric measurements were taken using a volumetric tank. The subject was placed in one of the four described testing positions for 30 minutes. The change in weight of the displaced water was the main outcome measure. The data was analyzed using an ANOVA of the pre and post measurements with a Bonferroni post hoc analysis. The level of significance was set at P<.05 for all analyses. Results: The only statistically significant difference was between the gravity dependent position (seated and all other positions (p <.001. There was no significant difference between lying supine (flat, on a bolster (elevated, or prone with the knees flexed to 90 degrees (prone. Conclusions: From these results, the extent of elevation does not appear to have an effect on changes in low leg volume. Elevation above the heart did not significantly improve reduction in limb volume, but removing the limb from a gravity dependent position might be beneficial.

Atomic collisions under extreme conditions in space

International Nuclear Information System (INIS)

Itikawa, Yukikazu

1987-01-01

In space, atoms and molecules are often placed under the extreme conditions which are very difficult to be realized on Earth. For instance, extremely hot and dense plasmas are found in and around various stellar objects (e.g., neutron stars) on one hand and extremely cold and diffuse gases prevail in interstellar space on the other. There is so strong a magnetic field that electron clouds in atoms and molecules are distorted. The study of atomic collisions under the extreme conditions is not only helpful in understanding the astrophysical environment but also reveals new aspects of the physics of atoms and molecules. This paper is an invitation to the study. (References are not exhaustive but only provide a clue with which more details can be found.) (author)

Multidecadal oscillations in rainfall and hydrological extremes

Science.gov (United States)

Willems, Patrick

2013-04-01

Many studies have anticipated a worldwide increase in the frequency and intensity of precipitation extremes and floods since the last decade(s). Natural variability by climate oscillations partly determines the observed evolution of precipitation extremes. Based on a technique for the identification and analysis of changes in extreme quantiles, it is shown that hydrological extremes have oscillatory behaviour at multidecadal time scales. Results are based on nearly independent extremes extracted from long-term historical time series of precipitation intensities and river flows. Study regions include Belgium - The Netherlands (Meuse basin), Ethiopia (Blue Nile basin) and Ecuador (Paute basin). For Belgium - The Netherlands, the past 100 years showed larger and more hydrological extremes around the 1910s, 1950-1960s, and more recently during the 1990-2000s. Interestingly, the oscillations for southwestern Europe are anti-correlated with these of northwestern Europe, thus with oscillation highs in the 1930-1940s and 1970s. The precipitation oscillation peaks are explained by persistence in atmospheric circulation patterns over the North Atlantic during periods of 10 to 15 years. References: Ntegeka V., Willems P. (2008), 'Trends and multidecadal oscillations in rainfall extremes, based on a more than 100 years time series of 10 minutes rainfall intensities at Uccle, Belgium', Water Resources Research, 44, W07402, doi:10.1029/2007WR006471 Mora, D., Willems, P. (2012), 'Decadal oscillations in rainfall and air temperature in the Paute River Basin - Southern Andes of Ecuador', Theoretical and Applied Climatology, 108(1), 267-282, doi:0.1007/s00704-011-0527-4 Taye, M.T., Willems, P. (2011). 'Influence of climate variability on representative QDF predictions of the upper Blue Nile Basin', Journal of Hydrology, 411, 355-365, doi:10.1016/j.jhydrol.2011.10.019 Taye, M.T., Willems, P. (2012). 'Temporal variability of hydro-climatic extremes in the Blue Nile basin', Water

Enhancing the Extreme Climate Index (ECI) to monitor climate extremes for an index-based insurance scheme across Africa

Science.gov (United States)

Helmschrot, J.; Malherbe, J.; Chamunorwa, M.; Muthige, M.; Petitta, M.; Calmanti, S.; Cucchi, M.; Syroka, J.; Iyahen, E.; Engelbrecht, F.

2017-12-01

Climate services are a key component of National Adaptation Plan (NAP) processes, which require the analysis of current climate conditions, future climate change scenarios and the identification of adaptation strategies, including the capacity to finance and implement effective adaptation options. The Extreme Climate Facility (XCF) proposed by the African Risk Capacity (ARC) developed a climate index insurance scheme, which is based on the Extreme Climate Index (ECI): an objective, multi-hazard index capable of tracking changes in the frequency or magnitude of extreme weather events, thus indicating possible shifts to a new climate regime in various regions. The main hazards covered by ECI are extreme dry, wet and heat events, with the possibility of adding other region-specific risk events. The ECI is standardized across broad geographical regions, so that extreme events occurring under different climatic regimes in Africa can be compared. Initially developed by an Italian company specialized in Climate Services, research is now conducted at the CSIR and SASSCAL, to verify and further develop the ECI for application in southern African countries, through a project initiated by the World Food Programme (WFP) and ARC. The paper will present findings on the most appropriate definitions of extremely wet and dry conditions in Africa, in terms of their impact across a multitude of sub-regional climates of the African continent. Findings of a verification analysis of the ECI, as determined through vegetation monitoring data and the SASSCAL weather station network will be discussed. Changes in the ECI under climate change will subsequently be projected, using detailed regional projections generated by the CSIR and through the Coordinated Regional Downscaling Experiment (CORDEX). This work will be concluded by the development of a web-based climate service informing African Stakeholders on climate extremes.

Climate change & extreme weather vulnerability assessment framework.

Science.gov (United States)

2012-12-01

The Federal Highway Administrations (FHWAs) Climate Change and Extreme Weather Vulnerability : Assessment Framework is a guide for transportation agencies interested in assessing their vulnerability : to climate change and extreme weather event...

Spatial extreme value analysis to project extremes of large-scale indicators for severe weather.

Science.gov (United States)

Gilleland, Eric; Brown, Barbara G; Ammann, Caspar M

2013-09-01

Concurrently high values of the maximum potential wind speed of updrafts ( W max ) and 0-6 km wind shear (Shear) have been found to represent conducive environments for severe weather, which subsequently provides a way to study severe weather in future climates. Here, we employ a model for the product of these variables (WmSh) from the National Center for Atmospheric Research/United States National Center for Environmental Prediction reanalysis over North America conditioned on their having extreme energy in the spatial field in order to project the predominant spatial patterns of WmSh. The approach is based on the Heffernan and Tawn conditional extreme value model. Results suggest that this technique estimates the spatial behavior of WmSh well, which allows for exploring possible changes in the patterns over time. While the model enables a method for inferring the uncertainty in the patterns, such analysis is difficult with the currently available inference approach. A variation of the method is also explored to investigate how this type of model might be used to qualitatively understand how the spatial patterns of WmSh correspond to extreme river flow events. A case study for river flows from three rivers in northwestern Tennessee is studied, and it is found that advection of WmSh from the Gulf of Mexico prevails while elsewhere, WmSh is generally very low during such extreme events. © 2013 The Authors. Environmetrics published by JohnWiley & Sons, Ltd.

Nutrition security under extreme events

Science.gov (United States)

Martinez, A.

2017-12-01

Nutrition security under extreme events. Zero hunger being one of the Sustainable Development Goal from the United Nations, food security has become a trending research topic. However extreme events impact on global food security is not yet 100% understood and there is a lack of comprehension of the underlying mechanisms of global food trade and nutrition security to improve countries resilience to extreme events. In a globalized world, food is still a highly regulated commodity and a strategic resource. A drought happening in a net food-exporter will have little to no effect on its own population but the repercussion on net food-importers can be extreme. In this project, we propose a methodology to describe and quantify the impact of a local drought to human health at a global scale. For this purpose, nutrition supply and global trade data from FAOSTAT have been used with domestic food production from national agencies and FAOSTAT, global precipitation from the Climate Research Unit and health data from the World Health Organization. A modified Herfindahl-Hirschman Index (HHI) has been developed to measure the level of resilience of one country to a drought happening in another country. This index describes how a country is dependent of importation and how diverse are its importation. Losses of production and exportation due to extreme events have been calculated using yield data and a simple food balance at country scale. Results show that countries the most affected by global droughts are the one with the highest dependency to one exporting country. Changes induced by droughts also disturbed their domestic proteins, fat and calories supply resulting most of the time in a higher intake of calories or fat over proteins.

Superradiantly stable non-extremal Reissner-Nordstroem black holes

Energy Technology Data Exchange (ETDEWEB)

Huang, Jia-Hui [School of Physics and Telecommunication Engineering, South China Normal University, Laboratory of Quantum Engineering and Quantum Materials, Guangzhou (China); Mai, Zhan-Feng [Beijing Normal University, Department of Physics, Center for Advanced Quantum Studies, Beijing (China)

2016-06-15

The superradiant stability is investigated for non-extremal Reissner-Nordstroem black holes. We use an algebraic method to demonstrate that all non-extremal Reissner-Nordstroem black holes are superradiantly stable against a charged massive scalar perturbation. This improves the results obtained before for non-extremal Reissner-Nordstroem black holes. (orig.)

Diamonds on Diamond: structural studies at extreme conditions on the Diamond Light Source.

Science.gov (United States)

McMahon, M I

2015-03-06

Extreme conditions (EC) research investigates how the structures and physical and chemical properties of materials change when subjected to extremes of pressure and temperature. Pressures in excess of one million times atmospheric pressure can be achieved using a diamond anvil cell, and, in combination with high-energy, micro-focused radiation from a third-generation synchrotron such as Diamond, detailed structural information can be obtained using either powder or single-crystal diffraction techniques. Here, I summarize some of the research drivers behind international EC research, and then briefly describe the techniques by which high-quality diffraction data are obtained. I then highlight the breadth of EC research possible on Diamond by summarizing four examples from work conducted on the I15 and I19 beamlines, including a study which resulted in the first research paper from Diamond. Finally, I look to the future, and speculate as to the type of EC research might be conducted at Diamond over the next 10 years. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Measurement of the extreme ankle range of motion required by female ballet dancers.

Science.gov (United States)

Russell, Jeffrey A; Kruse, David W; Nevill, Alan M; Koutedakis, Yiannis; Wyon, Matthew A

2010-12-01

Female ballet dancers require extreme ankle motion, especially plantar flexion, but research about measuring such motion is lacking. The purposes of this study were to determine in a sample of ballet dancers whether non-weight-bearing ankle range of motion is significantly different from the weight-bearing equivalent and whether inclinometric plantar flexion measurement is a suitable substitute for standard plantar flexion goniometry. Fifteen female ballet dancers (5 university, 5 vocational, and 5 professional dancers; age 21 ± 3.0 years) volunteered. Subjects received 5 assessments on 1 ankle: non-weight-bearing goniometry dorsiflexion (NDF) and plantar flexion (NPF), weight-bearing goniometry in the ballet positions demi-plié (WDF) and en pointe (WPF), and non-weight-bearing plantar flexion inclinometry (IPF). Mean NDF was significantly lower than WDF (17° ± 1.3° vs 30° ± 1.8°, P ballet proficiency. The authors conclude that assessment of extreme ankle motion in female ballet dancers is challenging, and goniometry and inclinometry appear to measure plantar flexion differently.

Discussion: Reconstruction of Fingertip Amputation: Necrosis Is Expected

OpenAIRE

Jung, Mi Sun; Lim, Young Kook; Hong, Yong Taek; Kim, Hoon Nam; Ki, Sae Hwi

2012-01-01

Background First suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults. Methods Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation ...

Function Preservation After Conservative Resection and Radiotherapy for Soft-tissue Sarcoma of the Distal Extremity: Utility and Application of the Toronto Extremity Salvage Score (TESS).

Science.gov (United States)

Cassidy, Richard J; Indelicato, Daniel J; Gibbs, Charles P; Scarborough, Mark T; Morris, Christopher G; Zlotecki, Robert A

2016-12-01

To evaluate outcomes after conservative resection and radiotherapy (RT) for soft-tissue sarcoma (STS) of the distal extremity, with assessment of functional quality of life using the validated Toronto Extremity Salvage Score (TESS) questionnaire and Common Terminology Criteria for Adverse Events (CTCAE), v4.0. Thirty-three patients with STS involving the hand/wrist (N=18) or foot/ankle (N=15) complex received adjuvant RT with conservative resection and were evaluated for local tumor control, survival, toxicities, and preservation of objective functional ability. Eight patients were treated with preoperative RT (median dose, 50.4 Gy) and 25 with postoperative RT (median dose, 61.8 Gy). Median follow-up was 11.5 years. Functional outcomes were measured using TESS; patients with amputations were excluded from the TESS analysis. Adverse events related to gait, limb edema, skin infection, wound complication, and wound dehiscence were assessed using the CTCAE. The 5- and 10-year local control rates were both 90%. The 10-year cause-specific, absolute, and distant metastasis-free survival rates were 97%, 87%, and 84%, respectively. Three patients had an amputation for reasons other than local recurrence or treatment complications and underwent amputation for patient preference. One third of the subjects (11/33 patients) were able to complete the TESS questionnaire; scores ranged from 88 to 100 (mean, 98.2). CTCAEv4 acute adverse events occurred in 2 cases: 1 patient had a grade 3 skin infection and 1 had a grade 2 wound complication of dehiscence. For management of distal extremity STS, the combination of adjuvant RT and conservative surgery achieves excellent local control and overall survival with few adverse events. In addition, through application of the TESS survey instrument, we have demonstrated that this treatment plan achieves robust functional preservation objectively and quantifiably.

Risk assessment of precipitation extremes in northern Xinjiang, China

Science.gov (United States)

Yang, Jun; Pei, Ying; Zhang, Yanwei; Ge, Quansheng

2018-05-01

This study was conducted using daily precipitation records gathered at 37 meteorological stations in northern Xinjiang, China, from 1961 to 2010. We used the extreme value theory model, generalized extreme value (GEV) and generalized Pareto distribution (GPD), statistical distribution function to fit outputs of precipitation extremes with different return periods to estimate risks of precipitation extremes and diagnose aridity-humidity environmental variation and corresponding spatial patterns in northern Xinjiang. Spatiotemporal patterns of daily maximum precipitation showed that aridity-humidity conditions of northern Xinjiang could be well represented by the return periods of the precipitation data. Indices of daily maximum precipitation were effective in the prediction of floods in the study area. By analyzing future projections of daily maximum precipitation (2, 5, 10, 30, 50, and 100 years), we conclude that the flood risk will gradually increase in northern Xinjiang. GEV extreme value modeling yielded the best results, proving to be extremely valuable. Through example analysis for extreme precipitation models, the GEV statistical model was superior in terms of favorable analog extreme precipitation. The GPD model calculation results reflect annual precipitation. For most of the estimated sites' 2 and 5-year T for precipitation levels, GPD results were slightly greater than GEV results. The study found that extreme precipitation reaching a certain limit value level will cause a flood disaster. Therefore, predicting future extreme precipitation may aid warnings of flood disaster. A suitable policy concerning effective water resource management is thus urgently required.

Cardiovascular consequences of extreme prematurity: the EPICure study.

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McEniery, Carmel M; Bolton, Charlotte E; Fawke, Joseph; Hennessy, Enid; Stocks, Janet; Wilkinson, Ian B; Cockcroft, John R; Marlow, Neil

2011-07-01

The long-term consequences of extreme prematurity are becoming increasingly important, given recent improvements in neonatal intensive care. The aim of the current study was to examine the cardiovascular consequences of extreme prematurity in 11-year-olds born at or before 25 completed weeks of gestation. Age and sex-matched classmates were recruited as controls. Information concerning perinatal and maternal history was collected, and current anthropometric characteristics were measured in 219 children born extremely preterm and 153 classmates. A subset of the extremely preterm children (n = 68) and classmates (n = 90) then underwent detailed haemodynamic investigations, including measurement of supine blood pressure (BP), aortic pulse wave velocity (aPWV, a measure of aortic stiffness) and augmentation index (AIx, a measure of arterial pressure wave reflections). Seated brachial systolic and diastolic BP were not different between extremely preterm children and classmates (P = 0.3 for both), although there was a small, significant elevation in supine mean and diastolic BP in the extremely preterm children (P prematurity is associated with altered arterial haemodynamics in children, not evident from the examination of brachial BP alone. Moreover, the smaller, preresistance and resistance vessels rather than large elastic arteries appear to be most affected. Children born extremely preterm may be at increased future cardiovascular risk.

A compliant mechanism for inspecting extremely confined spaces

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Mascareñas, David; Moreu, Fernando; Cantu, Precious; Shields, Daniel; Wadden, Jack; El Hadedy, Mohamed; Farrar, Charles

2017-11-01

We present a novel, compliant mechanism that provides the capability to navigate extremely confined spaces for the purpose of infrastructure inspection. Extremely confined spaces are commonly encountered during infrastructure inspection. Examples of such spaces can include pipes, conduits, and ventilation ducts. Often these infrastructure features go uninspected simply because there is no viable way to access their interior. In addition, it is not uncommon for extremely confined spaces to possess a maze-like architecture that must be selectively navigated in order to properly perform an inspection. Efforts by the imaging sensor community have resulted in the development of imaging sensors on the millimeter length scale. Due to their compact size, they are able to inspect many extremely confined spaces of interest, however, the means to deliver these sensors to the proper location to obtain the desired images are lacking. To address this problem, we draw inspiration from the field of endoscopic surgery. Specifically we consider the work that has already been done to create long flexible needles that are capable of being steered through the human body. These devices are typically referred to as ‘steerable needles.’ Steerable needle technology is not directly applicable to the problem of navigating maze-like arrangements of extremely confined spaces, but it does provide guidance on how this problem should be approached. Specifically, the super-elastic nitinol tubing material that allows steerable needles to operate is also appropriate for the problem of navigating maze-like arrangements of extremely confined spaces. Furthermore, the portion of the mechanism that enters the extremely confined space is completely mechanical in nature. The mechanical nature of the device is an advantage when the extremely confined space features environmental hazards such as radiation that could degrade an electromechanically operated mechanism. Here, we present a compliant mechanism

PREDICTION OF THE EXTREMAL SHAPE FACTOR OF SPHEROIDAL PARTICLES

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Daniel Hlubinka

2011-05-01

Full Text Available In the stereological unfolding problem for spheroidal particles the extremal shape factor is predicted. The theory of extreme values has been used to show that extremes of the planar shape factor of particle sections tend to the same limit distribution as extremes of the original shape factor for both the conditional and marginal distribution. Attention is then paid to the extreme shape factor conditioned by the particle size. Normalizing constants are evaluated for a parametric model and the numerical procedure is tested on real data from metallography.

CFT duals for extreme black holes

International Nuclear Information System (INIS)

Hartman, Thomas; Strominger, Andrew; Murata, Keiju; Nishioka, Tatsuma

2009-01-01

It is argued that the general four-dimensional extremal Kerr-Newman-AdS-dS black hole is holographically dual to a (chiral half of a) two-dimensional CFT, generalizing an argument given recently for the special case of extremal Kerr. Specifically, the asymptotic symmetries of the near-horizon region of the general extremal black hole are shown to be generated by a Virasoro algebra. Semiclassical formulae are derived for the central charge and temperature of the dual CFT as functions of the cosmological constant, Newton's constant and the black hole charges and spin. We then show, assuming the Cardy formula, that the microscopic entropy of the dual CFT precisely reproduces the macroscopic Bekenstein-Hawking area law. This CFT description becomes singular in the extreme Reissner-Nordstrom limit where the black hole has no spin. At this point a second dual CFT description is proposed in which the global part of the U(1) gauge symmetry is promoted to a Virasoro algebra. This second description is also found to reproduce the area law. Various further generalizations including higher dimensions are discussed.

Extreme waves at Filyos, southern Black Sea

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E. Bilyay

2011-03-01

Full Text Available A wave measurement project was carried out for a new port planned in Filyos, in the Western Black Sea region of Turkey. The measurement at a depth of 12.5 m lasted for a period of two years and 7949 records were obtained. During the analysis, it was noticed that there were 209 records in which H/H_s ratio was higher than 2.0. These higher waves in a record are called extreme waves in this study. Although the purpose of wave measurement is not to investigate extreme waves, it is believed that studying these unexpected waves could be interesting. Therefore, detailed statistical and spectral analyses on the extreme waves were done for the records. The analyses results show that the distribution of surface profiles of the records containing extreme waves deviates from Gaussian distribution with the negative skewness changing between –0.01 and –0.4 and with the high kurtosis in the range of 3.1–4.2. Although the probability of occurrence of the extreme waves is over-predicted by the Rayleigh distribution, a higher ratio of H_s/η_rms indicates that the wave height distribution can be represented by Rayleigh. The average value of the slope of the frequency spectrum at the high frequency range is proportional to f^–9 which is much steeper than the typical wind-wave frequency power law, f^{–4, –5}. The directional spreading is measured with the parameter S_max and it is in the range of 5–70 for the extreme wave records. The wave and current interaction was also investigated and it was found that in most cases, extreme waves occur when the wave and the current are almost aligned. Furthermore, it is observed that extreme waves appear within a group of high waves.

Wireless wearable range-of-motion sensor system for upper and lower extremity joints: a validation study.

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Kumar, Yogaprakash; Yen, Shih-Cheng; Tay, Arthur; Lee, Wangwei; Gao, Fan; Zhao, Ziyi; Li, Jingze; Hon, Benjamin; Tian-Ma Xu, Tim; Cheong, Angela; Koh, Karen; Ng, Yee-Sien; Chew, Effie; Koh, Gerald

2015-02-01

Range-of-motion (ROM) assessment is a critical assessment tool during the rehabilitation process. The conventional approach uses the goniometer which remains the most reliable instrument but it is usually time-consuming and subject to both intra- and inter-therapist measurement errors. An automated wireless wearable sensor system for the measurement of ROM has previously been developed by the current authors. Presented is the correlation and accuracy of the automated wireless wearable sensor system against a goniometer in measuring ROM in the major joints of upper (UEs) and lower extremities (LEs) in 19 healthy subjects and 20 newly disabled inpatients through intra (same) subject comparison of ROM assessments between the sensor system against goniometer measurements by physical therapists. In healthy subjects, ROM measurements using the new sensor system were highly correlated with goniometry, with 95% of differences sensor system were also highly correlated with goniometry, with 95% of the differences being < 20° and 25° for most movements in the major joints of UE and LE, respectively.

Lower extremity revascularization using directional atherectomy: 12-month prospective results of the DEFINITIVE LE study.

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McKinsey, James F; Zeller, Thomas; Rocha-Singh, Krishna J; Jaff, Michael R; Garcia, Lawrence A

2014-08-01

The aim of this study was to assess the safety and effectiveness of directional atherectomy (DA) for endovascular treatment of peripheral arterial disease (PAD) in infrainguinal arteries in patients with claudication or critical limb ischemia. To date, no prospective, multicenter, independently-adjudicated study has evaluated the effectiveness and durability of DA in the treatment of PAD. Previous DA studies have not been prospectively powered to evaluate any differences in outcomes in patients with and without diabetes. DEFINITIVE LE (Determination of EFfectiveness of the SilverHawk(®) PerIpheral Plaque ExcisioN System (SIlverHawk Device) for the Treatment of Infrainguinal VEssels / Lower Extremities) prospectively enrolled subjects at 47 multinational centers with an infrainguinal lesion length up to 20 cm. Primary endpoints were defined as primary patency at 12 months for claudicants and freedom from major unplanned amputation for critical limb ischemia (CLI) subjects. A pre-specified statistical hypothesis evaluated noninferiority of primary patency in diabetic versus nondiabetic claudicants. Independent angiographic and sonographic core laboratories assessed outcomes, and events were adjudicated by a clinical events committee. A total of 800 subjects were enrolled. The 12-month primary patency was 78% (95% confidence interval: 74.0% to 80.6%) in claudicants, with a 77% rate in the diabetic subgroup versus 78% in the nondiabetic subgroup (noninferior, p < 0.001). The rate of freedom from major unplanned amputation of the target limb at 12 months in CLI subjects was 95% (95% confidence interval: 90.7% to 97.4%). Periprocedural adverse events included embolization (3.8%), perforation (5.3%), and abrupt closure (2.0%). The bail-out stent rate was 3.2%. The DEFINITIVE LE study demonstrated that DA is a safe and effective treatment modality at 12 months for a diverse patient population with either claudication or CLI. Furthermore, DA was shown to be noninferior for

Accuracy and consequences of 3D-fluoroscopy in upper and lower extremity fracture treatment: A systematic review

International Nuclear Information System (INIS)

Beerekamp, M.S.H.; Sulkers, George S.I.; Ubbink, Dirk T.; Maas, Mario; Schep, Niels W.L.; Goslings, J. Carel

2012-01-01

Objectives: The aim of this systematic review was to compare the diagnostic accuracy, subjective image quality and clinical consequences of 3D-fluoroscopy with standard imaging modalities (2D-fluoroscopy, X-ray or CT) during reduction and fixation of intra-articular upper and lower extremity fractures. Methods: A systematic literature search was performed in MEDLINE, EMBASE and the Cochrane library. In total 673 articles were identified (up to March 2012). The 19 included studies described patients/cadavers with intra-articular upper/lower extremity fractures and compared 3D-fluoroscopy to standard imaging. The study was performed in accordance with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) guidelines. Diagnostic accuracy was defined by the quality of fracture reduction or implant position and, if possible, expressed as sensitivity and specificity; subjective image quality was determined by the quality of depiction of bone or implants; clinical consequences were defined as corrections in reduction or implant position following 3D-fluoroscopy. Results: Ten cadaver- and nine clinical studies were included. A meta-analysis was not possible, because studies used different scoring protocols to express diagnostic accuracy and reported incomplete data. Based on the individual studies, diagnostic accuracy of 3D-fluoroscopy was better than 2D-fluoroscopy and X-ray, but similar to CT-scanning. Subjective image quality of 3D-fluoroscopy was inferior compared to all other imaging modalities. In 11–40% of the operations additional corrections were performed after 3D-fluoroscopy, while the necessity for these corrections were not recognized based on 2D-fluoroscopic images. Conclusions: Although subjective image quality is rated inferior compared to other imaging modalities, intra-operative use of 3D-fluoroscopy is a helpful diagnostic tool for improving the quality of reduction and implant position in intra-articular fractures.

Hygienic diagnosis in extreme conditions

International Nuclear Information System (INIS)

Sofronov, G.A.

1997-01-01

Review for book by M.P. Zakharchenko, S.A. Lopatin, G.N. Novozhilov, V.I. Zakharov Hygienic diagnosis in extreme conditions is presented discussing the problem of people health preservation under extreme conditions. Hygienic diagnosis is considered illustrated by cases of hostilities (Afghan War), earthquake response in Armenia (1988) and Chernobyl accident response. Attention is paid to the estimation of radiation doses to people and characteristics of main types of dosimeters. The high scientific level of the book is marked

Extreme event statistics in a drifting Markov chain

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Kindermann, Farina; Hohmann, Michael; Lausch, Tobias; Mayer, Daniel; Schmidt, Felix; Widera, Artur

2017-07-01

We analyze extreme event statistics of experimentally realized Markov chains with various drifts. Our Markov chains are individual trajectories of a single atom diffusing in a one-dimensional periodic potential. Based on more than 500 individual atomic traces we verify the applicability of the Sparre Andersen theorem to our system despite the presence of a drift. We present detailed analysis of four different rare-event statistics for our system: the distributions of extreme values, of record values, of extreme value occurrence in the chain, and of the number of records in the chain. We observe that, for our data, the shape of the extreme event distributions is dominated by the underlying exponential distance distribution extracted from the atomic traces. Furthermore, we find that even small drifts influence the statistics of extreme events and record values, which is supported by numerical simulations, and we identify cases in which the drift can be determined without information about the underlying random variable distributions. Our results facilitate the use of extreme event statistics as a signal for small drifts in correlated trajectories.

Recent and future extreme precipitation over Ukraine

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Vyshkvarkova, Olena; Voskresenskaya, Elena

2014-05-01

The aim of study is to analyze the parameters of precipitation extremes and inequality over Ukraine in recent climate epoch and their possible changes in the future. Data of observations from 28 hydrometeorological stations over Ukraine and output of GFDL-CM3 model (CMIP5) for XXI century were used in the study. The methods of concentration index (J. Martin-Vide, 2004) for the study of precipitation inequality while the extreme precipitation indices recommended by the ETCCDI - for the frequency of events. Results. Precipitation inequality on the annual and seasonal scales was studied using estimated CI series for 1951-2005. It was found that annual CI ranges vary from 0.58 to 0.64. They increase southward from the north-west (forest zone) and the north-east (forest steppe zone) of Ukraine. CI maxima are located in the coastal regions of the Black Sea and the Sea of Azov. Annual CI spatial distribution indicates that the contribution of extreme precipitation into annual totals is most significant at the boundary zone between steppe and marine regions. At the same time precipitation pattern at the foothill of Carpathian Mountains is more homogenous. The CI minima (0.54) are typical for the winter season in foothill of Ukrainian Carpathians. The CI maxima reach 0.71 in spring at the steppe zone closed to the Black Sea coast. It should be noted that the greatest ranges of CI maximum and CI minimum deviation are typical for spring. It is associated with patterns of cyclone trajectories in that season. The most territory is characterized by tendency to decrease the contribution of extreme precipitation into the total amount (CI linear trends are predominantly negative in all seasons). Decadal and interdecadal variability of precipitation inequality associated with global processes in ocean-atmosphere system are also studied. It was shown that precipitation inequality over Ukraine on 10 - 15 % stronger in negative phase of Pacific Decadal Oscillation and in positive phase

Gunshot-induced fractures of the extremities: a review of antibiotic and debridement practices.

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Sathiyakumar, Vasanth; Thakore, Rachel V; Stinner, Daniel J; Obremskey, William T; Ficke, James R; Sethi, Manish K

2015-09-01

The use of antibiotic prophylaxis and debridement is controversial when treating low- and high-velocity gunshot-induced fractures, and established treatment guidelines are currently unavailable. The purpose of this review was to evaluate the literature for the prophylactic antibiotic and debridement policies for (1) low-velocity gunshot fractures of the extremities, joints, and pelvis and (2) high-velocity gunshot fractures of the extremities. Low-velocity gunshot fractures of the extremities were subcategorized into operative and non-operative cases, whereas low-velocity gunshot fractures of the joints and pelvis were evaluated based on the presence or absence of concomitant bowel injury. In the absence of surgical necessity for fracture care such as concomitant absence of gross wound contamination, vascular injury, large soft-tissue defect, or associated compartment syndrome, the literature suggests that superficial debridement for low-velocity ballistic fractures with administration of antibiotics is a satisfactory alternative to extensive operative irrigation and debridement. In operative cases or those involving bowel injuries secondary to pelvic fractures, the literature provides support for and against extensive debridement but does suggest the use of intravenous antibiotics. For high-velocity ballistic injuries, the literature points towards the practice of extensive immediate debridement with prophylactic intravenous antibiotics. Our systematic review demonstrates weak evidence for superficial debridement of low-velocity ballistic fractures, extensive debridement for high-velocity ballistic injuries, and antibiotic use for both types of injury. Intra-articular fractures seem to warrant debridement, while pelvic fractures with bowel injury have conflicting evidence for debridement but stronger evidence for antibiotic use. Given a relatively low number of studies on this subject, we recommend that further high-quality research on the debridement and

Nonsmoker Exposure to Secondhand Cannabis Smoke. III. Oral Fluid and Blood Drug Concentrations and Corresponding Subjective Effects.

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Cone, Edward J; Bigelow, George E; Herrmann, Evan S; Mitchell, John M; LoDico, Charles; Flegel, Ronald; Vandrey, Ryan

2015-09-01

The increasing use of highly potent strains of cannabis prompted this new evaluation of human toxicology and subjective effects following passive exposure to cannabis smoke. The study was designed to produce extreme cannabis smoke exposure conditions tolerable to drug-free nonsmokers. Six experienced cannabis users smoked cannabis cigarettes [5.3% Δ(9)-tetrahydrocannabinol (THC) in Session 1 and 11.3% THC in Sessions 2 and 3] in a closed chamber. Six nonsmokers were seated alternately with smokers during exposure sessions of 1 h duration. Sessions 1 and 2 were conducted with no ventilation and ventilation was employed in Session 3. Oral fluid, whole blood and subjective effect measures were obtained before and at multiple time points after each session. Oral fluid was analyzed by ELISA (4 ng/mL cutoff concentration) and by LC-MS-MS (limit of quantitation) for THC (1 ng/mL) and total THCCOOH (0.02 ng/mL). Blood was analyzed by LC-MS-MS (0.5 ng/mL) for THC, 11-OH-THC and free THCCOOH. Positive tests for THC in oral fluid and blood were obtained for nonsmokers up to 3 h following exposure. Ratings of subjective effects correlated with the degree of exposure. Subjective effect measures and amounts of THC absorbed by nonsmokers (relative to smokers) indicated that extreme secondhand cannabis smoke exposure mimicked, though to a lesser extent, active cannabis smoking. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Modelling precipitation extremes in the Czech Republic: update of intensity–duration–frequency curves

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Michal Fusek

2016-11-01

Full Text Available Precipitation records from six stations of the Czech Hydrometeorological Institute were subject to statistical analysis with the objectives of updating the intensity–duration–frequency (IDF curves, by applying extreme value distributions, and comparing the updated curves against those produced by an empirical procedure in 1958. Another objective was to investigate differences between both sets of curves, which could be explained by such factors as different measuring instruments, measuring stations altitudes and data analysis methods. It has been shown that the differences between the two sets of IDF curves are significantly influenced by the chosen method of data analysis.

Changes in the probability of co-occurring extreme climate events

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Diffenbaugh, N. S.

2017-12-01

Extreme climate events such as floods, droughts, heatwaves, and severe storms exert acute stresses on natural and human systems. When multiple extreme events co-occur, either in space or time, the impacts can be substantially compounded. A diverse set of human interests - including supply chains, agricultural commodities markets, reinsurance, and deployment of humanitarian aid - have historically relied on the rarity of extreme events to provide a geographic hedge against the compounded impacts of co-occuring extremes. However, changes in the frequency of extreme events in recent decades imply that the probability of co-occuring extremes is also changing, and is likely to continue to change in the future in response to additional global warming. This presentation will review the evidence for historical changes in extreme climate events and the response of extreme events to continued global warming, and will provide some perspective on methods for quantifying changes in the probability of co-occurring extremes in the past and future.