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Sample records for stage iv pressure

  1. Are stage IV vestibular schwannomas preoperatively different from other stages?

    Science.gov (United States)

    Tringali, Stéphane; Dubreuil, Christian; Zaouche, Sandra; Ferber-Viart, Chantal

    2008-01-01

    The aim of this study was to focus on the clinical and paraclinical symptoms of patients suffering from Stage IV vestibular schwannomas (VSs). In this prospective study, we included 734 patients who have VS and candidates for operation. Patients were classified as having Stage I, II, III, or IV tumors according to Tos criteria as evaluated by magnetic resonance imaging. PREOPERATIVE CLINICAL EVALUATION: We recorded the occurrence of complaints (%) and duration (yr) of hearing loss, tinnitus, and balance disorder. Preoperative paraclinical evaluation included pure-tone (PTA) and speech audiometry, auditory brainstem response (ABR) patterns, and vestibular deficit at videonystamography (VNG). Continuous variables were compared between Stage IV and other stages using analysis of variance. Qualitative variables expressed as a percentage of presence were compared between Stage IV and other stages using percentage comparison. Quantitative Parameters. Patients with Stage IV VS were significantly younger as compared with patients with other stages. Stage IV hearing loss was greater compared with other stages at 250 and 500 Hz but smaller at 2,000 and 8,000 Hz. We found no difference in the loss of PTA between Stage IV and the other stages. Speech discriminancy score was smaller in Stage IV. The durations of hearing loss, tinnitus, and balance disorders were similar whatever the tumor stage. Auditory brainstem response patterns showed no difference in Wave III latency between Stage IV VS and other stages, whereas Wave V latency and V-I interval were higher in Stage IV. Both ABR threshold and VNG caloric deficit were higher in Stage IV VS compared with other stages. Qualitative Parameters. The percentage of patients with Stage IV was lower than that with Stages II and III. The percentage of men and women was similar in all stages. The occurrence of hearing loss was similar in all stages, whereas that of tinnitus was lower in Stage IV compared with Stages I and II. In

  2. Chemotherapy Toxicity On Quality of Life in Older Patients With Stage I, Stage II, Stage III, or Stage IV Ovarian Epithelial, Primary Peritoneal Cavity, or Fallopian Tube Cancer

    Science.gov (United States)

    2017-05-03

    Stage I Ovarian Cancer; Stage IA Fallopian Tube Cancer; Stage IB Fallopian Tube Cancer; Stage IC Fallopian Tube Cancer; Stage II Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIB Fallopian Tube Cancer; Stage IIC Fallopian Tube Cancer; Stage III Ovarian Cancer; Stage III Primary Peritoneal Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIC Fallopian Tube Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer; Stage IV Primary Peritoneal Cancer

  3. Disseminated neuroblastoma (stage IV and IV-S) in the first year of life. Outcome related to age and stage. Italian Cooperative Group on Neuroblastoma.

    Science.gov (United States)

    De Bernardi, B; Pianca, C; Boni, L; Brisigotti, M; Carli, M; Bagnulo, S; Corciulo, P; Mancini, A; De Laurentis, C; Di Tullio, M T

    1992-09-15

    Infants (age 0-11 months) with disseminated neuroblastoma are known to have a better prognosis than older children with the disease, but there is little information regarding factors that influence the outcome of the disease in these patients. The authors report a series of 110 infants with disseminated neuroblastoma with disease diagnosed between March 1976 and February 1991 in 21 institutions participating in the Italian Cooperative Group on Neuroblastoma (ICGNB). Of the 110 infants, 34 had Stage IV disease, and 76 had Stage IV-S disease. The 5-year survival probability was 77% for all patients, 71% for those with Stage IV disease, and 81% for those with Stage IV-S disease. Of the 34 infants with Stage IV disease, the 9 who were 5 months or younger at the time of disease diagnosis are all alive (1 with active disease) at 7-143 months after diagnosis, whereas of the 25 infants who were 6-11 months of age at the time of disease diagnosis, 10 have died. Of the 76 infants with Stage IV-S disease, 12/64 who were 5 months of age or younger at the time of disease diagnosis died (mostly of massive hepatomegaly); 9 of these deaths occurred in infants with disease diagnosed before they were 2 months old, whereas 1 death occurred in the 12 infants with disease diagnosed when they were 6-11 months old. Four infants with Stage IV-S disease achieved complete disease remission and subsequently had relapse of disease. High levels of serum LDH and low urinary excretion of vanillylmandelic acid were associated with worse prognosis. The authors suggest that infants older than 6 months of age who have Stage IV disease require aggressive therapy. For infants with disease diagnosed before they are 2 months old, Stage IV-S disease may have a worse prognosis than Stage IV disease.

  4. Radiotherapy for stage IV oropharyngeal cancer

    International Nuclear Information System (INIS)

    Nakamura, Kaori; Akimoto, Tetsuo; Motegi, Atsushi

    2008-01-01

    Fifty-seven patients with stage IVA-B oropharyngeal cancer treated by definitive radiotherapy in our facility from January 1993 to August 2005 were retrospectively analyzed. The age of the patients was 34-84 (median 62) years old. Thirty-four were male and 14 were female. Subsite of the tumor was anterior: 16, lateral: 39, posterior: 1, and superior: 1. Forty-nine patients were treated with chemotherapy. Induction chemotherapy (ICT) was done in 25 patients, ICT+concurrent chemoradiotherapy (CCRT) in 15 patients, and CCRT in 9 patients. A dose of 60-82 Gy (median 72 Gy) by hyperfractionated radiotherapy, at 1.2 Gy/fraction twice a day, was delivered in 37 patients, and 60-72 Gy (median 66 Gy) with a conventional daily fractionation in 20 patients. Salvage surgery was performed in 5 patients as a part of primary treatment after radiotherapy. The 5-year cause-specific survival rate and disease-free survival rate were 52.9% and 51.4%, respectively. By univariate analysis, the impact of age, sex, T-stage, N-stage, histological differentiation, chemotherapy and fractionation of radiation therapy on survivals were evaluated. T-stage, N-stage and histological differentiation were significantly covariate correlated with survival. The treatment results were not satisfactory. Further investigation of the treatment strategy to improve the treatment outcome of advanced oropharyngeal cancer is desired. (author)

  5. Pazopanib Hydrochloride in Treating Patients With Stage IV or Recurrent Nasopharyngeal Cancer

    Science.gov (United States)

    2015-11-16

    Recurrent Lymphoepithelioma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Stage IV Lymphoepithelioma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Nasopharynx

  6. Coefficient of work-hardening in stage-IV

    CSIR Research Space (South Africa)

    Nabarro, FRN

    1994-04-15

    Full Text Available The theory of work hardening in stage IV depends on the relation between the relative misorientation Psi of neighbouring subgrains and the plastic strain gamma (Psi = B gamma exp). The value of the constant B is suggested to be better related...

  7. Neoadjuvant chemotherapy in patients with stages III/IV breast ...

    African Journals Online (AJOL)

    Neoadjuvant chemotherapy in patients with stages III/IV breast cancer disease surgical experience at Muhimbili National Hospital, Dar es Salaam, Tanzania. ... Results: Patient had mean age of 44.14±8.42 years, with age ranging from 29 to 65 years. 81.5% of patients were 50 years and below and were premenopausal.

  8. Treatment of Decubitis Ulcer Stage IV in the Patient with Polytrauma and Vertical Share Pelvic Fracture, Diagnosed Entherocollitis and Deep Wound Infection withClostridium Difficilewith Combined Negative Pressure Wound Therapy (NPWT) and Faecal Management System: Case Report.

    Science.gov (United States)

    Stojmenski, Slavcho; Merdzanovski, Igor; Gavrilovski, Andrej; Pejkova, Sofija; Dzokic, Gjorge; Tudzarova, Smilja

    2017-06-15

    The aim of this paper was to present a case with the successful treatment of decubitis ulcer stage IV in the patient with polytrauma and vertical share pelvic fracture and diagnosed entherocollitis combined with deep wound infection with Clostridium difficile treated with combined Negative Pressure Wound Therapy (NPWT) and faecal management system. Patient D.S.1967 treated on Traumatology Clinic after tentamen suicide on 9.2.2015 with diagnosis: brain contusion; contusion of thoracal space; vertical share pelvic fracture; open fracture type II of the right calcaneus; fracture of the left calcaneus; fracture on the typical place of the left radius; fracture of the right radius with dislocation. As a first step during the treatment in Intensive care unit we perform transcondylar extension of the left leg, and in that time we cannot operate because of the brain contusion. Four weeks after this treatment we intent to perform stabilisation of the pelvic ring, fixation of both arms, and fixation of both calcanear bones. But at the time before performing the saurgery, the patient got an intensive enterocollitis from Escherichia colli and Clostridium difficile , and during the inadequate treatment of enterocollitis she got a big decubitus on both gluteal regia Grade IV and deep muscular necrosis. Several times we perform a necrectomy of necrotic tissue but the wound become bigger and the infection have a progressive intention. In that time we used VAK system for 6 weeks combined with faecal management system and with local necrectomy and system application of Antibiotics and Flagyl for enterocollitis in doses prescripted from specialists from Infective clinic. This new device to manage faecal deep decubital infection and enterocollitis with Clostridium difficile are considered as adequate. 8Flexi-Seal ® FMS has been also used. After two months we succeed to minimize the gluteal wound on quoter from the situation from the beginning and we used for next two months wound

  9. Acceptance and Commitment Therapy in Improving Well-Being in Patients With Stage III-IV Cancer and Their Partners

    Science.gov (United States)

    2018-02-06

    Malignant Female Reproductive System Neoplasm; Malignant Hepatobiliary Neoplasm; Partner; Stage III Breast Cancer; Stage III Cervical Cancer; Stage III Colorectal Cancer; Stage III Lung Cancer; Stage III Prostate Cancer; Stage III Skin Melanoma; Stage III Uterine Corpus Cancer; Stage IIIA Breast Cancer; Stage IIIA Cervical Cancer; Stage IIIA Colorectal Cancer; Stage IIIA Lung Carcinoma; Stage IIIA Skin Melanoma; Stage IIIA Uterine Corpus Cancer; Stage IIIB Breast Cancer; Stage IIIB Cervical Cancer; Stage IIIB Colorectal Cancer; Stage IIIB Lung Carcinoma; Stage IIIB Skin Melanoma; Stage IIIB Uterine Corpus Cancer; Stage IIIC Breast Cancer; Stage IIIC Colorectal Cancer; Stage IIIC Skin Melanoma; Stage IIIC Uterine Corpus Cancer; Stage IV Breast Cancer; Stage IV Cervical Cancer; Stage IV Colorectal Cancer; Stage IV Lung Cancer; Stage IV Prostate Cancer; Stage IV Skin Melanoma; Stage IV Uterine Corpus Cancer; Stage IVA Cervical Cancer; Stage IVA Colorectal Cancer; Stage IVA Uterine Corpus Cancer; Stage IVB Cervical Cancer; Stage IVB Colorectal Cancer; Stage IVB Uterine Corpus Cancer

  10. Campylobacteremia in stage IV gliosarcoma with bevacizumab treatment

    Directory of Open Access Journals (Sweden)

    Ping Liu

    2012-04-01

    Full Text Available Primary campylobacter enteritis with secondary bacteremia was diagnosed in an immunocompromised patient with stage IV gliosarcoma. She developed mild diarrhea followed by systemic symptoms with transient generalized weakness and fever. She was treated with azithromycin and had a full recovery and without relapse through 2 months of follow-up. Her diagnosis was confirmed by a positive stool culture for Campylobacter sp. and blood culture for Campylobacter jejuni/coli.

  11. Central nervous system relapse of treated stage IV neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Palasis, S.; Egelhoff, J.C.; Koch, B.L.; Ball, W.S. Jr. [Department of Radiology, Children`s Hospital Medical Center, Cincinnati, OH (United States); Morris, J.D. [Department of Pediatrics, Children`s Hospital Medical Center, Cincinnati, OH (United States)

    1998-12-01

    Neuroblastoma is the most common extracranial solid tumor in pediatrics. The long-term survival of patients with advanced-stage neurobastoma has remarkably improved secondary to aggressive treatment protocols including autologous bone marrow transplant (BMT). As a result, a different natural history of this disease is being reported with unusual, late manifestations. The central nervous system (CNS), once a rare site of disease, is being involved with increasing frequency. Appropriate neuroimaging in these patients is important. Two cases of patients with treated stage IV neuroblastoma who developed isolated CNS metastases are presented. The proposed pathogenesis and neuroradiologic manifestations of this complication are reviewed. (orig.) With 2 figs., 23 refs.

  12. Cytoreductive surgery for stage IV epithelial ovarian cancer.

    Science.gov (United States)

    Zang, R Y; Zhang, Z Y; Cai, S M; Li, Z T; Chen, J; Tang, M Q; Liu, Q

    1999-12-01

    We tried to determine the role of cytoreductive surgery for stage IV epithelial ovarian cancer and in what conditions this surgical procedure could carry the best benefits. From January 1986 to December 1997, seventy-one of 73 patients with stage IV epithelial ovarian cancer who were treated in Cancer Hospital of Shanghai Medical University were retrospectively reviewed. Clinical information including age, grade, histology, presence of ascites, size of residual disease, site of extra-abdominal metastasis, whether initially presenting as metastatic disease or not, neo-adjuvant chemotherapy, platinum-based chemotherapy and second-line chemotherapy was obtained. Survival was calculated by life-table and survival curves were computed using the Kaplan-Meier method with differences in survival estimated by log-rank test. Independent prognostic factors were identified by Cox's proportional hazards regression model. The median age of the patients' population was 54 years (range 22-82), median follow-up time was 12 months (range 3 to 130) and estimated 5-year survival rate 6.1%. Thirty out of 71 (42.3%) patients were successfully debulked (< or = 1 cm) at the time of initial surgery. There was a significant difference in five-year survival rate between patients optimally (14.1%) vs suboptimally (0%) cytoreduced, with an estimated median survival in the optimal group of 23 months vs 9 months in the suboptimal group (P=0.0001, long-rank test). When the variables were factorized, only in patients with malignant pleural effusion or positive supraclavicular lymph nodes, optimal cytoreduction could get the greatest benefits. Multivariate analysis revealed that the size of residual disease and ascites were independent factors of survival. However, only ascites was the prognostic factor of progression-free survival. Optimal cytoreductive surgery is an important determinant of survival in women with stage IV epithelial ovarian cancer, mainly in those with malignant pleural effusion

  13. Circulating Tumor DNA in Predicting Outcomes in Patients With Stage IV Head and Neck Cancer or Stage III-IV Non-small Cell Lung Cancer

    Science.gov (United States)

    2018-01-12

    Metastatic Squamous Neck Cancer With Occult Primary Squamous Cell Carcinoma; Salivary Gland Squamous Cell Carcinoma; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IV Non-small Cell Lung Cancer; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IVA Salivary Gland Cancer; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVA Verrucous Carcinoma of the Oral Cavity; Stage IVB Salivary Gland Cancer; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVB Verrucous Carcinoma of the Larynx; Stage IVB Verrucous Carcinoma of the Oral Cavity; Stage IVC Salivary Gland Cancer; Stage IVC Squamous Cell Carcinoma of the Larynx; Stage IVC Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVC Squamous Cell Carcinoma of the Oropharynx; Stage IVC Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVC Verrucous Carcinoma of the Larynx; Stage IVC Verrucous Carcinoma of the Oral Cavity; Tongue Cancer; Untreated Metastatic Squamous Neck Cancer With Occult Primary

  14. Aflibercept and FOLFOX6 Treatment for Previously Untreated Stage IV Colorectal Cancer

    Science.gov (United States)

    2018-04-03

    Mucinous Adenocarcinoma of the Colon; Mucinous Adenocarcinoma of the Rectum; Signet Ring Adenocarcinoma of the Colon; Signet Ring Adenocarcinoma of the Rectum; Stage IV Colon Cancer; Stage IV Rectal Cancer

  15. Palliative Care in Improving Quality of Life and Symptoms in Patients With Stage III-IV Pancreatic or Ovarian Cancer

    Science.gov (United States)

    2014-12-18

    Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Pancreatic Cancer; Stage III Pancreatic Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Ovarian Germ Cell Tumor; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Pancreatic Cancer

  16. The cost of unresectable stage III or stage IV melanoma in Italy

    Directory of Open Access Journals (Sweden)

    Maio Michele

    2012-11-01

    Full Text Available Abstract Background In recent decades, melanoma incidence has been increasing in European countries; in 2006, there were approximately 60,000 cases leading to 13,000 deaths. Within Europe there is some geographical variation in the incidence of melanoma, with the highest rates reported in Scandinavia (15 cases per 100,000 inhabitants per year and the lowest in the Mediterranean countries (5 to 7 cases per 100,000 inhabitants per year. Methods The present article is based on the information collected in the MELODY study (MELanoma treatment patterns and Outcomes among patients with unresectable stage III or stage IV Disease: a retrospective longitudinal survey. In that study, the medical charts of patients were reviewed to document current treatment patterns and to analyse information on patients, disease characteristics and healthcare resource utilization related to the treatment of advanced melanoma regarding patients who presented with a diagnosis of malignant melanoma (stage I to IV at participating sites between 01 July, 2005 and 30 June, 2006. Results Summarizing, though the length of the follow-up period varies among sample patients, an amount of the yearly cost per patient can be estimated, dividing the average per patient total cost (€ 5.040 by the average follow-up duration (17.5 months and reporting to one year; on these grounds, unresectable stage III or stage IV melanoma in Italy would cost € 3,456 per patient per year.

  17. Intravital Microscopy for Identifying Tumor Vessels in Patients With Stage IA-IV Melanoma That is Being Removed by Surgery

    Science.gov (United States)

    2017-06-05

    Recurrent Melanoma; Stage IA Skin Melanoma; Stage IB Skin Melanoma; Stage IIA Skin Melanoma; Stage IIB Skin Melanoma; Stage IIC Skin Melanoma; Stage IIIA Skin Melanoma; Stage IIIB Skin Melanoma; Stage IIIC Skin Melanoma; Stage IV Skin Melanoma

  18. Infantile tibia vara: Treatment of Langenskiold stage IV

    Directory of Open Access Journals (Sweden)

    Umrani Salil

    2008-01-01

    Full Text Available An eight year old girl presented with a progressively increasing deformity of the left proximal tibia since last 2 years. She had no history of trauma, fever and swelling of left knee. There were no obvious signs of rickets/muscular dystrophy. She had 25 degrees of tibia vara clinically with lateral thrust and a prominent fibular head. The radiograph of left knee revealed tibia vara with medial beaking and a significant depression of the medial tibial epiphysis and metaphysis. A computed tomography (CTscan revealed significant depression of the medial tibial epiphysis but no bony bar in the physis or fusion of the medical tibial epiphysis. There was a posterior slope in addition to the medial one. She was treated with elevation of the medial tibial hemiplateau with subtuberosity valgus derotation dome osteotomy. She also underwent a lateral proximal tibial hemiphysiodesis (temporary stapling. A prophylactic subcutaneons anterolateral compartment fasciotomy was also performed. All osteotomies united in 2 months. All deformities were corrected and she regained a knee range of 0 to 130 degrees. At final followup (4 years, there was no recurrence of varus deformity, knee was stable, with 1cm of leg length discrepancy. In Langenskiold stage IV tibia vara, elevation of medial tibial plateau, a subtuberosity valgus derotation osteotomy and a concomitant lateral hemiephiphysiodesis has given good results.

  19. Prediction of survival in patients with Stage IV kidney cancer

    Directory of Open Access Journals (Sweden)

    L. V. Mirilenko

    2015-01-01

    Full Text Available The efficiency of treatment was evaluated and the predictors of adjusted survival (AS were identified in patients with disseminated kidney cancer treated at the Republican Research and Practical Center for Oncology and Medical Radiology in 1999 to 2011 (A.E. Okeanov, P.I. Moiseev, L.F. Levin. Malignant tumors in Belarus, 2001–2012. Edited by O.G. Sukonko. Seven factors (regional lymph node metastases; distant bone metastases; a high-grade tumor; sarcomatous tumor differentiation; hemoglobin levels of < 125 g/l in women and < 150 g/l in men; an erythrocyte sedimentation rate of 40 mm/h; palliative surgery were found to have an independent, unfavorable impact on AS. A multidimensional model was built to define what risk group low (no more than 2 poor factors, moderate (3–4 poor factors, and high (more than 4 poor factors the patients with Stage IV kidney cancer belonged to. In these groups, the median survival was 34.7, 17.2, and 4.0 months and 3-year AS rates were 48.6, 24.6, and 3.2 %, respectively. 

  20. The extended surface forces apparatus. IV. Precision static pressure control

    OpenAIRE

    Schurtenberger E; Heuberger M

    2011-01-01

    We report on design and performance of an extended surface forces apparatus (eSFA) built into a pressurized system. The aim of this instrument is to provide control over static pressure and temperature to facilitate direct surface force experiments in equilibrium with fluids at different loci of their phase diagram. We built an autoclave that can bear a miniature eSFA. To avoid mechanical or electrical feedtroughs the miniature apparatus uses an external surface coarse approach stage under am...

  1. Pembrolizumab and Ruxolitinib Phosphate in Treating Patients With Metastatic Stage IV Triple Negative Breast Cancer

    Science.gov (United States)

    2018-03-05

    Breast Carcinoma Metastatic in the Bone; Estrogen Receptor Negative; HER2/Neu Negative; Progesterone Receptor Negative; Recurrent Breast Carcinoma; Stage IV Breast Cancer; Triple-Negative Breast Carcinoma

  2. Gamma-Secretase/Notch Signalling Pathway Inhibitor RO4929097 in Treating Patients With Stage IV Melanoma

    Science.gov (United States)

    2016-05-06

    Acral Lentiginous Malignant Melanoma; Lentigo Maligna Malignant Melanoma; Nodular Malignant Melanoma; Recurrent Melanoma; Solar Radiation-related Skin Melanoma; Stage IV Melanoma; Superficial Spreading Malignant Melanoma

  3. Intravital Microscopy in Evaluating Patients With Primary Peritoneal, Fallopian Tube, or Stage IA-IV Ovarian Cancer

    Science.gov (United States)

    2017-12-28

    Fallopian Tube Carcinoma; Primary Peritoneal Carcinoma; Stage I Ovarian Cancer; Stage IA Ovarian Cancer; Stage IB Ovarian Cancer; Stage IC Ovarian Cancer; Stage II Ovarian Cancer; Stage IIA Ovarian Cancer; Stage IIB Ovarian Cancer; Stage IIC Ovarian Cancer; Stage III Ovarian Cancer; Stage IIIA Ovarian Cancer; Stage IIIB Ovarian Cancer; Stage IIIC Ovarian Cancer; Stage IV Ovarian Cancer

  4. Clinical experience with radiation enhancement by hyperbaric oxygen in children with recurrent neuroblastoma stage IV

    NARCIS (Netherlands)

    Voûte, P. A.; van der Kleij, A. J.; de Kraker, J.; Hoefnagel, C. A.; Tiel-van Buul, M. M.; van Gennip, H.

    1995-01-01

    The high risk group of patients with neuroblastoma are children over 1 year with stage IV disease. Most series report a maximum of 20% survival at 5 years. For recurrent neuroblastoma stage IV, cure rates are not reported in the literature, but they are nil. Any treatment for recurrent neuroblastoma

  5. Elevated pretreatment blood pressure and IV thrombolysis in stroke.

    Science.gov (United States)

    Dirks, Maaike; Zonneveld, Thomas P; Dippel, Diederik W J; Nederkoorn, Paul J; van de Beek, Diederik; van Oostenbrugge, Robert J; Kruyt, Nyika D

    2015-04-07

    We investigated whether an active blood pressure-lowering strategy is associated with more patients receiving thrombolytics compared with a conservative "watch and measure" strategy, and assessed safety and functional outcome of these 2 treatment strategies. This is a post hoc analysis in 2 randomized controlled stroke trials, the PRACTISE (Promoting Acute Thrombolysis in Ischemic Stroke) and the PASS (Preventive Antibiotics in Stroke Study). We included all patients with elevated pretreatment blood pressure above 185/110 mm Hg at presentation but otherwise eligible for IV thrombolysis (IVT). The decision to use an active or conservative strategy was in accordance with local hospital treatment guidelines. The primary outcome was the proportion of patients treated with IVT. Secondary outcomes were (1) symptomatic intracranial hemorrhage (increased neurologic deficit with a concomitant hemorrhage on neuroimaging), (2) functional outcome at 3 months, and (3) the door-to-needle time. We included 224 patients, 66 (29%) received the active and 158 (71%) the conservative strategy. In the active group, 55 patients (83%) received thrombolytics vs 87 (55%) in the conservative group, an increase of 28% (95% confidence interval: 16%-40%). If only patients actually treated with IVT were considered, the rate of symptomatic intracranial hemorrhage was 7% in both groups. There was no difference in door-to-needle time. Active blood pressure lowering was associated with an increased proportion of patients treated with IVT compared with a conservative strategy, without a difference in symptomatic hemorrhage rate. © 2015 American Academy of Neurology.

  6. The extended surface forces apparatus. IV. Precision static pressure control.

    Science.gov (United States)

    Schurtenberger, E; Heuberger, M

    2011-10-01

    We report on design and performance of an extended surface forces apparatus (eSFA) built into a pressurized system. The aim of this instrument is to provide control over static pressure and temperature to facilitate direct surface force experiments in equilibrium with fluids at different loci of their phase diagram. We built an autoclave that can bear a miniature eSFA. To avoid mechanical or electrical feedtroughs the miniature apparatus uses an external surface coarse approach stage under ambient conditions. The surface separation is thus pre-adjusted to approximately ~3 μm before sliding the apparatus into the autoclave. Inside the autoclave, the surface separation can be further controlled with a magnetic drive at sub-Ångstrom precision over a 14 μm range. The autoclave pressure can then be set and maintained between 20 mbar and 170 bars with few mbar precision. The autoclave is connected to a specially designed pressurization system to precondition the fluids. The temperature can be controlled between -20 and 60 °C with few mK precision. We demonstrate the operation of the instrument in the case of gaseous or liquid carbon dioxide. Thanks to a consequent decoupling of the eSFA mechanical loop from the autoclave structure, the obtained measurement stability and reproducibility, at elevated pressures, is comparable to the one established for the conventional eSFA, operated under ambient conditions.

  7. The extended surface forces apparatus. IV. Precision static pressure control

    Science.gov (United States)

    Schurtenberger, E.; Heuberger, M.

    2011-10-01

    We report on design and performance of an extended surface forces apparatus (eSFA) built into a pressurized system. The aim of this instrument is to provide control over static pressure and temperature to facilitate direct surface force experiments in equilibrium with fluids at different loci of their phase diagram. We built an autoclave that can bear a miniature eSFA. To avoid mechanical or electrical feedtroughs the miniature apparatus uses an external surface coarse approach stage under ambient conditions. The surface separation is thus pre-adjusted to approximately ˜3 μm before sliding the apparatus into the autoclave. Inside the autoclave, the surface separation can be further controlled with a magnetic drive at sub-Ångstrom precision over a 14 μm range. The autoclave pressure can then be set and maintained between 20 mbar and 170 bars with few mbar precision. The autoclave is connected to a specially designed pressurization system to precondition the fluids. The temperature can be controlled between -20 and 60 °C with few mK precision. We demonstrate the operation of the instrument in the case of gaseous or liquid carbon dioxide. Thanks to a consequent decoupling of the eSFA mechanical loop from the autoclave structure, the obtained measurement stability and reproducibility, at elevated pressures, is comparable to the one established for the conventional eSFA, operated under ambient conditions.

  8. Treatment of Decubitis Ulcer Stage IV in the Patient with Polytrauma and Vertical Share Pelvic Fracture, Diagnosed Entherocollitis and Deep Wound Infection with Clostridium Difficile with Combined Negative Pressure Wound Therapy (NPWT and Faecal Management System: Case Report

    Directory of Open Access Journals (Sweden)

    Slavcho Stojmenski

    2017-06-01

    CONCLUSION: When faecal incontinence as a result of enterocollitis with Clostridium difficile does occur, a limiting contact with the patient’s skin is extremely important as breakdown can occur rapidly. In addition to tissue injury, faecal incontinence can have a major impact on the patient’s dignity and result in prolonged hospital stay. The main outcomes assested in the case studies were resolution of of decubital ulcers as a result of faecal incontinence, patient comfort and ease of application of the FMS and NPWT. The soft flexible catheter was easily inserted without discomfort to the patients. It gently conformed to the rectal vault, reducing significantly the risk of necrosis, and the risk for prolonged necrosis in cases with previously developed necrosis. FMS was successful in diverting faecal fluid away from the perineal tissue and resolved any decubitus ulcer developed previously in combination with use of NPWT. So, we can recommend this combination in those cases especially with polytraumatismus, vertical share pelvis fracture combined with diarrhea and deep wound infection of decubital ulcers Grade IV infected with Cl. difficile.

  9. Concepts to meet non-road stage IV / Tier 4 emission legislation; Konzepte fuer die Emissionsgesetzgebung. Non-Road Stage IV / Tier 4

    Energy Technology Data Exchange (ETDEWEB)

    Cartus, T.; Herrmuth, H.; Stein, G. [AVL List GmbH, Graz (Austria); Scherm, P. [Euromot - European Association of Internal Combustion Engine Mfrs., Frankfurt am Main (Germany)

    2007-12-15

    By December 2007, the EC will have to submit a new proposal for Stage IV emissions limits for Non-Road Mobile Machinery. Industry is committed to contributing to this process and has asked AVL to carry out a study as a neutral engineering company. The main topics of this study are described in this article. (orig.)

  10. Metformin Hydrochloride and Combination Chemotherapy in Treating Patients With Stage III-IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

    Science.gov (United States)

    2018-02-06

    Brenner Tumor; Malignant Ascites; Malignant Pleural Effusion; Ovarian Clear Cell Cystadenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mixed Epithelial Carcinoma; Ovarian Serous Cystadenocarcinoma; Ovarian Undifferentiated Adenocarcinoma; Recurrent Fallopian Tube Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Primary Peritoneal Cavity Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIA Primary Peritoneal Cavity Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIB Primary Peritoneal Cavity Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Ovarian Germ Cell Tumor; Stage IIIC Primary Peritoneal Cavity Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Primary Peritoneal Cavity Cancer

  11. Walking Versus Jogging in Stages III and IV of the Bruce Treadmill Test.

    Science.gov (United States)

    Cundiff, D.; Schwane, J.

    Observations during research involving the Bruce Treadmill Test (BTMT) indicating that Stage III for females and Stage IV for males represented speeds which are intermediate between comfortable walking and confortable jogging for many subjects, prompted this study to determine ways to obtain more consistent group results. Twenty-eight subjects…

  12. Disorientations and their role on the work-hardening in stage IV

    DEFF Research Database (Denmark)

    Pantleon, W.

    2005-01-01

    The eect of deformation-induced disorientations on work-hardening of metals is modelled by dislocation dynamics. By incorporating excess dislocations related to disori- entations, Kocks' dislocation model describing stage III hardening is extended to stage IV. Disorientations evolving from purely...

  13. Long-term survival in stage IV melanoma after repetitive surgical therapy.

    Science.gov (United States)

    Tomov, Tsvetomir; Siegel, Robert; Bembenek, Andreas

    2008-05-01

    Surgical therapy in patients with stage IV melanoma is controversial and always an individual decision. We report the case of a young melanoma patient, who underwent resection of 5 distant metastases from 4 different organ systems. Thereby, the patient achieved a stable state of disease and a good quality of life for up to now 67 months without any evidence for further tumor manifestations at present. A systemic chemo- or immunotherapy was never applied. In selected patients with stage IV melanoma, surgery alone can provide long-term survival with good quality of life. (c) 2008 S. Karger AG, Basel

  14. Quantification of functional abilities in Rett syndrome: a comparison between stages III and IV

    Directory of Open Access Journals (Sweden)

    Monteiro CBM

    2014-07-01

    Full Text Available Carlos BM Monteiro,1 Geert JP Savelsbergh,2 Ana RP Smorenburg,3 Zodja Graciani,4 Camila Torriani-Pasin,5 Luiz Carlos de Abreu,6 Vitor E Valenti,7 Fernando Kok41School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil; 2MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, the Netherlands; 3Burke-Cornell Medical Research Institute, White Plains, NY, USA; 4Department of Neurology, University of São Paulo, São Paulo, Brazil; 5Motor Behavior Laboratory, University of São Paulo, São Paulo, Brazil; 6Laboratory of Scientific Writing, Department of Morphology and Physiology, School of Medicine of ABC, Santo Andre, Brazil; 7Department of Speech Language and Hearing Therapy, Faculty of Philosophy and Sciences, UNESP, Marilia, BrazilAbstract: We aimed to evaluate the functional abilities of persons with Rett syndrome (RTT in stages III and IV. The group consisted of 60 females who had been diagnosed with RTT: 38 in stage III, mean age (years of 9.14, with a standard deviation of 5.84 (minimum 2.2/maximum 26.4; and 22 in stage IV, mean age of 12.45, with a standard deviation of 6.17 (minimum 5.3/maximum 26.9. The evaluation was made using the Pediatric ­Evaluation of Disability Inventory, which has 197 items in the areas of self-care, mobility, and social function. The results showed that in the area of self-care, stage III and stage IV RTT persons had a level of 24.12 and 18.36 (P=0.002, respectively. In the area of mobility, stage III had 37.22 and stage IV had 14.64 (P<0.001, while in the area of social function, stage III had 17.72 and stage IV had 12.14 (P=0.016. In conclusion, although persons with stage III RTT have better functional abilities when compared with stage IV, the areas of mobility, self-care, and social function are quite affected, which shows a great functional dependency and need for help in basic activities of daily life.Keywords: Rett syndrome, disability

  15. Stage IV work-hardening related to disorientations in dislocation structures

    DEFF Research Database (Denmark)

    Pantleon, W.

    2004-01-01

    The effect of deformation-induced disorientations on the work-hardening of metals is modelled based on dislocation dynamics. Essentially, Kocks’ dislocation model describing stage III hardening is extended to stage IV by incorporation of excess dislocations related to the disorientations....... Disorientations evolving from purely statistical reasons — leading to a square root dependence of the average disorientation angle on strain — affect the initial work-hardening rate (and the saturation stress) of stage III only slightly. On the other hand, deterministic contributions to the development...... of disorientations, as differences in the activated slip systems across boundaries, cause a linear increase of the flow stress at large strains. Such a constant work-hardening rate is characteristic for stage IV....

  16. False negative rate of syndesmotic injury in pronation-external rotation stage IV ankle fractures

    Directory of Open Access Journals (Sweden)

    Kwang-Soon Song

    2013-01-01

    Full Text Available Background: To investigate false negative rate in the diagnosis of diastasis on initial static anteroposterior radiograph and reliability of intraoperative external rotational stress test for detection of concealed disruption of syndesmosis in pronation external rotation (PER stage IV (Lauge-Hansen ankle fractures. Materials and Methods: We prospectively studied 34 PER stage IV ankle fractures between September 2001 and September 2008. Twenty (59% patients show syndesmotic injury on initial anteroposterior radiographs. We performed an intraoperative external rotation stress test in other 14 patients with suspicious PER stage IV ankle fractures, which showed no defined syndesmotic injury on anteroposterior radiographs inspite of a medial malleolar fracture, an oblique fibular fracture above the syndesmosis and fracture of the posterior tubercle of the tibia. Results: All 14 fractures showed different degrees of tibiofibular clear space (TFCS and tibiofibular overlapping (TFO on the external rotation stress test radiograph compared to the initial plain anteroposterior radiograph. It is important to understand the fracture pattern characterstic of PER stage IV ankle fractures even though it appears normal on anteroposterior radiographs, it is to be confirmed for the concealed syndesmotic injury through a routine intraoperative external rotational stress radiograph.

  17. Side Effects and Toxicities of Targeted Therapies in Stage IV Melanoma

    DEFF Research Database (Denmark)

    Ascierto, Paolo A; Bastholt, Lars; Hersey, Peter

    2013-01-01

    kinase inhibitors generally cause fatigue, whereas immunomodulatory agents induce a specific set of adverse events known as immune-related adverse events (irAEs). Despite the incidence of adverse events, these agents hold promise for the treatment of stage IV melanoma. With new treatment opportunities...

  18. Survival of de novo stage IV breast cancer patients over three decades.

    Science.gov (United States)

    Hölzel, Dieter; Eckel, Renate; Bauerfeind, Ingo; Baier, Bernd; Beck, Thomas; Braun, Michael; Ettl, Johannes; Hamann, Ulrich; Harbeck, Nadia; Kiechle, Marion; Mahner, Sven; Schindlbeck, Christian; de Waal, Johann; Engel, Jutta

    2017-03-01

    De novo stage IV breast cancer patients (BC IV ) depict a clinical picture not influenced by adjuvant therapy. Therefore, the time-dependent impact of changes in diagnostics and treatments on progression and survival can best be evaluated in this subgroup. BC IV patients from 1978 to 2013 registered in the Munich Cancer Registry were divided into four periods, and the trends were analysed. Survival was estimated by Kaplan-Meier methods, and prognostic factors were fitted with Cox proportional hazard models. Between 1978 and 2013, 88,759 patients were diagnosed with 92,807 cases of invasive and non-invasive BC. Of these patients, 4756 patients had distant metastases (MET) at diagnosis. The 5-year survival rate improved from 17.4 to 24.7%, while the pattern of metastases did not change. Improved staging diagnostics, a screening programme and primary systemic therapy changed the composition of prognostic strata. Patients with a similar composition as the 1978-1987 cohort exhibited a median survival difference of 13 months; however, neither univariate nor multivariate analysis showed a survival effect for the four periods as a surrogate indicator for changing treatments. HER2+ patients have with 27.6 months a slightly longer survival than all other BC IV patients. Survival of de novo BC IV has only modestly improved since the late 1970s, partially masked by changing distributions of prognostic factors due to changes in diagnostics.

  19. Fixation with autogenous osteochondral grafts for the treatment of osteochondritis dissecans (stages III and IV)

    Science.gov (United States)

    Balacó, Inês

    2007-01-01

    This paper presents a clinical and functional assessment of the cases of osteochondritis dissecans (OCD) treated with small mosaicplasty type osteochondral grafts. Between 1999 and 2004, we operated on 12 knees with OCD stages III and IV. They were assessed using the International Cartilage Research Society (ICRS) scale, the Visual Analogue Scale (VAS) scale, X-ray and magnetic resonance imaging (MRI). The study was carried out using a clinical series, was retrospective and had a level of evidence of 4. Before surgery, all patients were in classes III and IV on the ICRS scale (four in class III and eight in class IV). At the time of surgery, the patient age was 27.5 ± 7.9 years, with male predominance (75%). Eleven of the cases were assessed as classes I and II on the ICRS scale (seven in class I and four in class II), with one patient in class IV. X-ray assessment was less favourable, revealing alterations in the articular space in 75% of cases. The results show that this technique enables the biological fixation of fragments and, functionally, the clinical results obtained were very good. The osteochondral grafts avoid the implantation of foreign material and make use of bone fragments of the same rigidity as the OCD fragment. We conclude that the technique described is an excellent alternative to the techniques normally used for the fixation of stage III and IV OCD. PMID:18038231

  20. Long-term treatment with the oncolytic ECHO-7 virus Rigvir of a melanoma stage IV M1c patient, a small cell lung cancer stage IIIA patient, and a histiocytic sarcoma stage IV patient-three case reports.

    Science.gov (United States)

    Alberts, Pēteris; Olmane, Evija; Brokāne, Linda; Krastiņa, Zanda; Romanovska, Māra; Kupčs, Kārlis; Isajevs, Sergejs; Proboka, Guna; Erdmanis, Romualds; Nazarovs, Jurijs; Venskus, Dite

    2016-10-01

    Oncolytic virotherapy is a recent addition to cancer treatment. Here, we describe positive treatment outcomes in three patients using Rigvir virotherapy. One of the patients is diagnosed with melanoma stage IV M1c, one with small cell lung cancer stage IIIA, and one with histiocytic sarcoma stage IV. The diagnoses of all patients are verified by histology or cytology. All patients started Rigvir treatment within a few months after being diagnosed and are currently continuing Rigvir treatment. The degree of regression of the disease has been determined by computed tomography. Safety assessment of adverse events graded according to NCI CTCAE did not show any value above grade 1 during Rigvir(®) treatment. Using current standard treatments, the survival of patients with the present diagnoses is low. In contrast, the patients described here were diagnosed 3.5, 7.0, and 6.6 years ago, and their condition has improved and been stabile for over 1.5, 6.5, and 4 years, respectively. These observations suggest that virotherapy using Rigvir can successfully be used in long-term treatment of patients with melanoma stage IV M1c, small cell lung cancer stage IIIA, and histiocytic sarcoma stage IV and therefore could be included in prospective clinical studies. © 2016 International Virotherapy Center. APMIS published by John Wiley & Sons Ltd.

  1. Nivolumab and Plinabulin in Treating Patients With Stage IIIB-IV, Recurrent, or Metastatic Non-small Cell Lung Cancer

    Science.gov (United States)

    2017-08-29

    ALK Gene Translocation; EGFR Activating Mutation; Recurrent Non-Small Cell Lung Carcinoma; ROS1 Gene Translocation; Stage IIIB Non-Small Cell Lung Cancer AJCC v7; Stage IV Non-Small Cell Lung Cancer AJCC v7

  2. Primary Tumor Thickness is a Prognostic Factor in Stage IV Melanoma: A Retrospective Study of Primary Tumor Characteristics.

    Science.gov (United States)

    Luen, Stephen; Wong, Siew Wei; Mar, Victoria; Kelly, John W; McLean, Catriona; McArthur, Grant A; Haydon, Andrew

    2018-01-01

    Stage IV melanoma exhibits a diverse range of tumor biology from indolent to aggressive disease. Many important prognostic factors have already been identified. Despite this, the behavior of metastatic melanoma remains difficult to predict. We sought to determine if any primary tumor characteristics affect survival following the diagnosis of stage IV melanoma. All patients diagnosed with stage IV melanoma between January 2003 and December 2012 were identified from the Victorian Melanoma Service database. Retrospective chart review was performed to collect data on primary tumor characteristics (thickness, ulceration, mitotic rate, melanoma subtype, or occult primary). Known and suspected prognostic factors were additionally collected (time to diagnosis of stage IV disease, age, sex, stage, receipt of chemotherapy, and era of recurrence). The effect of primary tumor characteristics on overall survival from the date of diagnosis of stage IV disease was assessed. A total of 227 patients with a median follow-up of 5 years from diagnosis of stage IV disease were identified. Median overall survival of the cohort was 250 days.Of the primary tumor characteristics assessed, only tumor thickness affected survival from diagnosis of stage IV disease, hazard ratio=1.09 (1.02 to 1.16), P=0.008. This remained significant in multivariate analysis, P=0.007. Other primary tumor characteristics did not significantly influence survival. Primary tumor thickness is a significant prognostic factor in stage IV melanoma. Our data suggest that the biology of the primary melanoma may persist to influence the behavior of metastatic disease.

  3. Stimulation of vitellogenin uptake in Stage IV Xenopus oocytes by treatment with chorionic gonadotropin in vitro

    International Nuclear Information System (INIS)

    Wiley, H.S.; Dumont, J.N.

    1978-01-01

    Ovarian fragments from Xenopus laevis were incubated with various concentrations of human chorionic gonadotropin (hCG) and Stage IV oocytes were subsequently tested for their ability to incorporate vitellogenin. Such oocytes displayed incorporation rates up to 350% greater than controls. This was accompanied by increased endocytotic activity. hCG-stimulated uptake is dose dependent and reaches a maximum at 100 IU/ml, at which concentration ovulation also occurs. At 100 IU/ml of hCG, there is a lag period of at least 12 h between gonadotropin treatment and increased vitellogenin incorporation. Because hCG has little effect on isolated (dissected) cultured Stage IV oocytes which have lost their follicle cells, it is postulated that intact follicle cells are required for the induction of vitellogenin uptake

  4. A proteomics panel for predicting optimal primary cytoreduction in stage III/IV ovarian cancer

    DEFF Research Database (Denmark)

    Risum, Signe; Høgdall, Estrid; Engelholm, Svend A

    2009-01-01

    The objective of this prospective study was to evaluate CA-125 and a 7-marker panel as predictors of incomplete primary cytoreduction in patients with stage III/IV ovarian cancer (OC). From September 2004 to January 2008, serum from 201 patients referred to surgery for a pelvic tumor was analyzed...... for CA-125. In addition, serum was analyzed for 7 biomarkers using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. These biomarkers were combined into a single-valued ovarian-cancer-risk index (OvaRI). CA-125 and OvaRI were evaluated as predictors of cytoreduction in 75...... stage III/IV patients using receiver operating characteristic curves. Complete primary cytoreduction (no macroscopic residual disease) was achieved in 31% (23/75) of the patients. The area under the receiver operating characteristic curve was 0.66 for CA-125 and 0.75 for OvaRI. The sensitivity...

  5. Hypofractionated Image Guided Radiation Therapy in Treating Patients With Stage IV Breast Cancer

    Science.gov (United States)

    2017-06-26

    Central Nervous System Metastases; Invasive Ductal Breast Carcinoma; Invasive Ductal Breast Carcinoma With Predominant Intraductal Component; Invasive Lobular Breast Carcinoma; Invasive Lobular Breast Carcinoma With Predominant in Situ Component; Liver Metastases; Lobular Breast Carcinoma in Situ; Lung Metastases; Male Breast Cancer; Medullary Ductal Breast Carcinoma With Lymphocytic Infiltrate; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Recurrent Breast Cancer; Stage IV Breast Cancer; Tubular Ductal Breast Carcinoma; Tumors Metastatic to Brain

  6. Men and women show similar survival outcome in stage IV breast cancer.

    Science.gov (United States)

    Wu, San-Gang; Zhang, Wen-Wen; Liao, Xu-Lin; Sun, Jia-Yuan; Li, Feng-Yan; Su, Jing-Jun; He, Zhen-Yu

    2017-08-01

    To evaluate the clinicopathological features, patterns of distant metastases, and survival outcome between stage IV male breast cancer (MBC) and female breast cancer (FBC). Patients diagnosed with stage IV MBC and FBC between 2010 and 2013 were included using the Surveillance, Epidemiology, and End Results program. Univariate and multivariate Cox regression analyses were used to analyze risk factors for overall survival (OS). A total of 4997 patients were identified, including 60 MBC and 4937 FBC. Compared with FBC, patients with MBC were associated with a significantly higher rate of estrogen receptor-positive, progesterone receptor-positive, unmarried, lung metastases, and a lower frequency of liver metastases. Univariate and multivariate analyses showed no significant difference in OS between MBC and FBC. In the propensity score-matched population, there was also no difference in survival between MBC and FBC. Multivariate analysis of MBC showed that OS was longer for patients aged 50-69 years and with estrogen receptor-positive disease. There was no significant difference in survival outcome between stage IV MBC and FBC, but significant differences in clinicopathological features and patterns of metastases between the genders. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Survival analysis of stage IV metastatic gastric cancer patients treated with HangAm-Plus.

    Science.gov (United States)

    Park, Jae-Woo; Yoon, Jeungwon; Cho, Chong-Kwan; Lee, Yeon-Weol; Yoo, Hwa-Seung

    2014-01-01

    To evaluate the efficacy of HangAm-Plus (HAP) on stage IV metastatic gastric cancer by analyzing the treated patients' overall survival outcome. Following the study eligibility, overall survival and one year survival rate of 44 stage IV metastatic gastric cancer patients who visited East-West Cancer Center (EWCC) were analyzed. The study consisted of two arms: HAP treatment only (n=18) and combined treatment of concurrent conventional chemotherapy and HAP (n=26). Patient characteristics by gender, age, surgical intervention, Eastern Cooperative Oncology Group (ECOG) score, treatment duration (HAP group (5.1 months). One-year survival rate of combined treatment group and HAP group was 38.5%±9.5% and 33.3%±11.1%, respectively (P>0.05). One-year survival rate of those received more and less than 4-week treatment was 57.1%±18.7% and 8.3%±8.0%, respectively (P=0.001). The study supports the safety and potential efficacy of HAP treatment in prevention of chemo-related side effects for stage IV metastatic gastric cancer treated with conventional chemotherapy. Further studies are needed to investigate and confirm the results before applying the treatment in clinical settings.

  8. Fosaprepitant Dimeglumine, Palonosetron Hydrochloride, and Dexamethasone in Preventing Nausea and Vomiting Caused by Cisplatin in Patients With Stage III or Stage IV Head and Neck Cancer Undergoing Chemotherapy and Radiation Therapy

    Science.gov (United States)

    2017-04-13

    Nausea and Vomiting; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx

  9. Genetically Modified T Cells in Treating Patients With Stage III-IV Non-small Cell Lung Cancer or Mesothelioma

    Science.gov (United States)

    2018-01-12

    Advanced Pleural Malignant Mesothelioma; HLA-A*0201 Positive Cells Present; Recurrent Non-Small Cell Lung Carcinoma; Recurrent Pleural Malignant Mesothelioma; Stage III Non-Small Cell Lung Cancer AJCC v7; Stage III Pleural Malignant Mesothelioma AJCC v7; Stage IIIA Non-Small Cell Lung Cancer AJCC v7; Stage IIIB Non-Small Cell Lung Cancer AJCC v7; Stage IV Non-Small Cell Lung Cancer AJCC v7; Stage IV Pleural Malignant Mesothelioma AJCC v7; WT1 Positive

  10. Optimum surgical staging and rational use of radiodiagnostic methods in case of ovarial carcinomas (stages III and IV)

    Energy Technology Data Exchange (ETDEWEB)

    Szepesi, T.; Schratter, A.; Kaercher, K.H.; Szalay, S.; Breitenecker, G.; Janisch, H.; Wickenhauser, J.

    1982-10-01

    Pretherapeutic informations furnished by surgery and histopathology are of special importance for the local high voltage therapy of the operated ovarial carcinoma. The intraoperative state does not only confirm the diagnosis, but also reveals the full biologic extension of the tumor and, thus, the correct staging. Supplementary radiodiagnostic examinations are necessary if the informations furnished by the surgeon are not complete. Between Feb 1977 and Feb 1981, we treated 55 patients suffering from ovarial carcinomas with a combined simultaneous radio-chemotherapy (45 patients with stage III and 10 with stage IV). The first operations had been performed at gynecologic depts. of other hospitals in 60% of all cases, at surgical depts. of other hospitals in 20% of all cases and at the II. Gynecologic Clinic of Vienna Univ. in only 20% of all cases. The definitive staging was established by postoperative analyses of X-ray views of the chest, liver-spleen scintigrams, ultrasonic examination, computed tomography, lymphoscintigraphy and lymphography. 36 women were submitted to an early therapeutic second operation. In most of all cases the retroperitoneal manifestations were correctly recognized by the different radiodiagnostic methods; histopathology was superior in only 8% of all cases. The rate of retroperitoneal metastases is 45% out of the total collective and 40% out of patients in stage III. With the therapy method applied, the survival time does not depend upon the retroperitoneal state as long as there are no tumor manifestations with a maximum diameter of more than 2 cm. The liver metastases described after the first operation do not necessarily correspond to such manifestations; often they are rather tumorous peritoneal layers. More attention should be given to the state of the subdiaphragmatic region, because manifestations in this region are an unfavorable diagnostic factor. Patients in stage III have possibly still curative chances.

  11. Anti-SEMA4D Monoclonal Antibody VX15/2503 With Nivolumab or Ipilimumab in Treating Patients With Stage III or IV Melanoma

    Science.gov (United States)

    2018-02-01

    Metastatic Melanoma; Stage III Cutaneous Melanoma AJCC v7; Stage IIIA Cutaneous Melanoma AJCC v7; Stage IIIB Cutaneous Melanoma AJCC v7; Stage IIIC Cutaneous Melanoma AJCC v7; Stage IV Cutaneous Melanoma AJCC v6 and v7

  12. 46 CFR 53.01-3 - Adoption of section IV of the ASME Boiler and Pressure Vessel Code.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Adoption of section IV of the ASME Boiler and Pressure... Boiler and Pressure Vessel Code. (a) Heating boilers shall be designed, constructed, inspected, tested, and stamped in accordance with section IV of the ASME Boiler and Pressure Vessel Code (incorporated by...

  13. Capmatinib, Ceritinib, Regorafenib, or Entrectinib in Treating Patients With BRAF/NRAS Wild-Type Stage III-IV Melanoma

    Science.gov (United States)

    2017-12-20

    ALK Fusion Protein Expression; BRAF wt Allele; Invasive Skin Melanoma; MET Fusion Gene Positive; NRAS wt Allele; NTRK1 Fusion Positive; NTRK2 Fusion Positive; NTRK3 Fusion Positive; RET Fusion Positive; ROS1 Fusion Positive; Stage III Cutaneous Melanoma AJCC v7; Stage IIIA Cutaneous Melanoma AJCC v7; Stage IIIB Cutaneous Melanoma AJCC v7; Stage IIIC Cutaneous Melanoma AJCC v7; Stage IV Cutaneous Melanoma AJCC v6 and v7

  14. Probability analysis of MCO over-pressurization during staging

    International Nuclear Information System (INIS)

    Pajunen, A.L.

    1997-01-01

    The purpose of this calculation is to determine the probability of Multi-Canister Overpacks (MCOs) over-pressurizing during staging at the Canister Storage Building (CSB). Pressurization of an MCO during staging is dependent upon changes to the MCO gas temperature and the build-up of reaction products during the staging period. These effects are predominantly limited by the amount of water that remains in the MCO following cold vacuum drying that is available for reaction during staging conditions. Because of the potential for increased pressure within an MCO, provisions for a filtered pressure relief valve and rupture disk have been incorporated into the MCO design. This calculation provides an estimate of the frequency that an MCO will contain enough water to pressurize beyond the limits of these design features. The results of this calculation will be used in support of further safety analyses and operational planning efforts. Under the bounding steady state CSB condition assumed for this analysis, an MCO must contain less than 1.6 kg (3.7 lbm) of water available for reaction to preclude actuation of the pressure relief valve at 100 psid. To preclude actuation of the MCO rupture disk at 150 psid, an MCO must contain less than 2.5 kg (5.5 lbm) of water available for reaction. These limits are based on the assumption that hydrogen generated by uranium-water reactions is the sole source of gas produced within the MCO and that hydrates in fuel particulate are the primary source of water available for reactions during staging conditions. The results of this analysis conclude that the probability of the hydrate water content of an MCO exceeding 1.6 kg is 0.08 and the probability that it will exceed 2.5 kg is 0.01. This implies that approximately 32 of 400 staged MCOs may experience pressurization to the point where the pressure relief valve actuates. In the event that an MCO pressure relief valve fails to open, the probability is 1 in 100 that the MCO would experience

  15. Spectrum of bone marrow changes in patients of chronic kidney disease (stage iii, iv and v)

    International Nuclear Information System (INIS)

    Latif, R.K.; Khan, S.A.; Ahmad, S.Q.; Arshad, U.

    2017-01-01

    To see the various hematological changes in the bone marrow of patients with chronic kidney disease (CKD) stage III, IV and V. Study Design: Cross sectional observational study.Place and Duration of Study: Study was conducted in the department of haematology (Pathology), Army Medical College, Rawalpindi and duration was one year, from Mar 2015 to Feb 2016. Material and Methods: Patients of both sexes and all age groups with CKD stage III, IV and V were included in this study. Patients' histories were recorded. Complete blood counts, bone marrow aspiration and trephine biopsy were done and evaluated microscopically. Mean blood counts of the patients in three groups of CKD were compared. Frequencies of various bone marrow (BM) findings in patients of CKD were calculated. Results: Out of 57 patients, 41 (71.9%) were males while 16 (28%) were females. Mean age was 60 years. There was no statistically significant difference between the mean hemoglobin, mean white cell count and mean platelets count of the patients in three groups of CKD. Reactive changes due to underlying CKD and inflammation were the most frequent findings in the BM of the patients. Conclusion: Anaemia of mild to moderate severity and reactive changes in the BM are the most frequent haematological findings encountered in patients suffering from advanced stage CKD. Since CKD is predominantly a disease of the elderly so it is not rare to find the co-morbidities including plasmacytosis, malignancies and their effects on the BM in patients of CKD. (author)

  16. Unusual computed tomography findings of radionecrosis after chemoradiation of stage IV hypopharyngeal cancer: a case report

    Directory of Open Access Journals (Sweden)

    Baba Yuh

    2011-01-01

    Full Text Available Abstract Introduction Radionecrosis (post-radiotherapy laryngeal submucosal inflammation and necrosis is a complication of (chemo radiotherapy for hypopharyngeal cancer that is difficult to differentiate from tumor recurrence. Case presentation A 67-year-old Japanese man presented with a condition extremely difficult to diagnose differentially as radionecrosis or tumor recurrence after radiotherapy for hypopharyngeal cancer. Although tumor recurrence was suspected from clinical conditions and computed tomography findings, pathologic analysis revealed no evidence of tumor recurrence, and successful therapy with steroids and antibiotics reduced the mucosal edema. Conclusion Our findings emphasize the wide spectrum of radiographic presentation of radionecrosis after chemoradiation of stage IV hypopharyngeal cancer.

  17. Family Caregiver Palliative Care Intervention in Supporting Caregivers of Patients With Stage II-IV Gastrointestinal, Gynecologic, Urologic and Lung Cancers

    Science.gov (United States)

    2018-02-12

    Uterine Sarcoma; Stage IV Bladder Cancer; Stage IV Gastric Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Pancreatic Cancer; Stage IV Renal Cell Cancer; Stage IV Urethral Cancer; Stage IVA Cervical Cancer; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVA Uterine Sarcoma; Stage IVB Cervical Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer; Stage IVB Uterine Sarcoma; Ureter Cancer; Stage IIA Lung Carcinoma; Stage IIB Lung Carcinoma; Stage IIIA Lung Carcinoma; Stage IIIB Lung Carcinoma

  18. High-pressure measurements of hydrogen phase IV using synchrotron infrared spectroscopy.

    Science.gov (United States)

    Zha, Chang-sheng; Liu, Zhenxian; Ahart, Muhtar; Boehler, Reinhard; Hemley, Russell J

    2013-05-24

    Phase IV of dense solid hydrogen has been identified by its infrared spectrum using high-pressure synchrotron radiation techniques. The spectrum exhibits a sharp vibron band at higher frequency and lower intensity than that for phase III, indicating the stability of molecular H(2) with decreased intermolecular interactions and charge transfer between molecules. A low-frequency vibron having a strong negative pressure shift indicative of strongly interacting molecules is also observed. The character of the spectrum is consistent with an anisotropic, mixed layer structure related to those recently predicted theoretically. Phase IV was found to be stable from 220 GPa (300 K) to at least 340 GPa (near 200 K), with the I-III-IV triple point located. Infrared transmission observed to the lowest photon energies measured places constraints on the electronic properties of the phase.

  19. Papillary cystadenoma of the epididymis in a 12-year-old survivor of stage IV neuroblastoma

    Directory of Open Access Journals (Sweden)

    Nnenaya Agochukwu

    2018-04-01

    Full Text Available Papillary cystadenoma of the epididymis (PCE is the second most common benign neoplasm of the epididymis [1]. It is very uncommon and has never been reported in a prepubertal male. It may occur sporadically, but more often occurs in association with von Hippel- Lindau (VHL disease [2]. There have been over 60 reports of patients with such tumors, with the youngest patient being 16 years old.We present the case of a 12- year old male with a history of stage IV neuroblastoma. He presented with a left paratesticular mass that was discovered on routine follow up physical exam with his pediatric oncologist. He was asymptomatic at the time of presentation with no signs or symptoms of hypoandrogenism. A computed tomography scan of the abdomen and pelvis was negative for lymphadenopathy and additional disease sites. Given the patient's history of stage IV neuroblastoma, there was suspicion of yolk sac tumor or metastases; he underwent an open radical left orchiectomy. Frozen section was consistent with yolk sac tumor, however final pathology revealed normal testicle with PCE.To date, this patient is the youngest reported patient with this diagnosis; furthermore papillary cystadenoma of the epididymis has never been reported in a patient with neuroblastoma. Keywords: Papillary cystadenoma, Epididymis, Prepubertal male, Neuroblastoma

  20. [Surgical treatment of the primary tumor in stage IV breast cancer].

    Science.gov (United States)

    Jiménez Anula, Juan; Sánchez Andújar, Belén; Machuca Chiriboga, Pablo; Navarro Cecilia, Joaquín; Dueñas Rodríguez, Basilio

    2015-01-01

    The aim of the study was to analyze the impact of loco-regional surgery on survival of patients with stage IV breast cancer. Retrospective study that included patients with breast cancer and synchronous metastases. Patients with ECOG above 2 and high-risk patients were excluded. The following variables were evaluated: age, tumor size, nodal involvement, histological type, histological grade, hormone receptor status, HER2 overexpression, number of affected organs, location of metastases and surgical treatment. The impact of surgery and several clinical and pathologic variables on survival was analyzed by Cox regression model. A total of 69 patients, of whom 36 (52.2%) underwent surgery (study group) were included. After a mean follow-up of 34 months, the median survival of the series was 55 months and no significant differences between the study group and the group of patients without surgery (P=0.187) were found. Two factors associated with worse survival were identified: the number of organs with metastases (HR=1.69, IC 95%: 1.05-2.71) and triple negative breast cancer (HR=3.49, IC 95%: 1.39-8.74). Loco-regional surgery, however, was not associated with survival. Loco-regional surgical treatment was not associated with improved survival inpacientes with stage IV breast cancer. The number of organs with metastases and tumors were triple negative prognostic factors for survival. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Pressure-induced staging transitions and stage disorder in dilute potassium-graphite intercalation compounds

    International Nuclear Information System (INIS)

    Fischer, J.E.; Kim, H.J.

    1987-01-01

    We extend our previous study of high-pressure staging transitions and stage disorder to dilute potassium-graphite intercalation compounds, using the Hendricks-Teller analysis of elastic neutron scattering (00L) profiles measured at 300 K over a broad q range. The dilute regime begins at a concentration [K]/[C]approx. <1/33, all samples in this regime behaving qualitatively the same at high pressure. A continuous transition starts immediately near P = 0, leading to a well-ordered higher stage with no apparent connection to in-plane density or structure. This is stable only over a small range, transforming abruptly at slightly higher P to a still higher stage or stage mixture, the index of which is consistent with the specific in-plane density imposed by commensurate 2 x 2 lockin. Disorder generally increases with average stage index (i.e., with increasing P or decreasing [K]/[C] ratio), consistent with the theory of Kirczenow. Disorder in the most dilute samples is better represented by a skewed distribution of many stage packages than by a random mixture of two or three different stage cells

  2. Multi-stage versus single-stage inflation and deflation cycle for alternating low pressure air mattresses to prevent pressure ulcers in hospitalised patients: a randomised-controlled clinical trial.

    Science.gov (United States)

    Demarré, L; Beeckman, D; Vanderwee, K; Defloor, T; Grypdonck, M; Verhaeghe, S

    2012-04-01

    The duration and the amount of pressure and shear must be reduced in order to minimize the risk of pressure ulcer development. Alternating low pressure air mattresses with multi-stage inflation and deflation cycle of the air cells have been developed to relieve pressure by sequentially inflating and deflating the air cells. Evidence about the effectiveness of this type of mattress in clinical practice is lacking. This study aimed to compare the effectiveness of an alternating low pressure air mattress that has a standard single-stage inflation and deflation cycle of the air cells with an alternating low pressure air mattress with multi-stage inflation and deflation cycle of the air cells. A randomised controlled trial was performed in a convenience sample of 25 wards in five hospitals in Belgium. In total, 610 patients were included and randomly assigned to the experimental group (n=298) or the control group (n=312). In the experimental group, patients were allocated to an alternating low pressure air mattress with multi-stage inflation and deflation cycle of the air cells. In the control group, patients were allocated to an alternating low pressure air mattress with a standard single-stage inflation and deflation cycle of the air cells. The outcome was defined as cumulative pressure ulcer incidence (Grade II-IV). An intention-to-treat analysis was performed. There was no significant difference in cumulative pressure ulcer incidence (Grade II-IV) between both groups (Exp.=5.7%, Contr.=5.8%, p=0.97). When patients developed a pressure ulcer, the median time was 5.0 days in the experimental group (IQR=3.0-8.5) and 8.0 days in the control group (IQR=3.0-8.5) (Mann-Whitney U-test=113, p=0.182). The probability to remain pressure ulcer free during the observation period in this trial did not differ significantly between the experimental group and the control group (log-rank χ(2)=0.013, df=1, p=0.911). An alternating low pressure air mattress with multi-stage inflation

  3. Assessment of the prognostic value of the 8th AJCC staging system for patients with clinically staged prostate cancer; A time to sub-classify stage IV?

    Directory of Open Access Journals (Sweden)

    Omar Abdel-Rahman

    Full Text Available The American Joint Committee on Cancer (AJCC staging system (8th edition for prostate cancer has been published. The current study seeks to validate the prognostic performance of the changes in the new system among clinically staged prostate cancer patients registered within the surveillance, epidemiology and end results (SEER database.SEER database (2004-2014 has been accessed through SEER*Stat program and AJCC 7th and 8th edition stages were calculated utilizing T, N and M stages as well as baseline prostatic specific antigen (PSA and grade group. Cancer-specific and overall survival analyses according to 6th, 7th and 8th editions were conducted through Kaplan-Meier analysis. Moreover, multivariate analysis was conducted through a Cox proportional hazard model.A total of 110499 patients with prostate cancer were identified in the period from 2004-2014.For cancer- specific survival according to 8th AJCC, all pair wise P values for comparison were significant (<0.01 except for stage IIA vs. IIB; while for overall survival according to 8th AJCC, all pair wise P values for comparison were significant (<0.02 except for stage IIIA vs. IIIB. Results of c-index assessment for cancer-specific survival for the three AJCC editions were as follows: c-index for AJCC 6th edition was 0.816; c-index for AJCC 7th edition was 0.897; c-index for AJCC 8th edition was 0.907. For stage IVB prostate cancer (i.e.M1 disease, further sub-staging was proposed according to M1 sub-stage (i.e. M1a, M1b and M1c. Pair wise comparison between these proposed sub-stages was conducted for both cancer-specific and overall survival. For both cancer-specific and overall survival, all pair wise P values for comparisons were <0.0001.Compared to older staging systems (6th and 7th, the 8th system is more discriminatory. Further sub-classification of stage IV disease is suggested.

  4. The last stage of Earth's formation: Increasing the pressure

    Science.gov (United States)

    Lock, S. J.; Stewart, S. T.; Mukhopadhyay, S.

    2017-12-01

    A range of high-energy, high-angular momentum (AM) giant impacts have been proposed as a potential trigger for lunar origin. High-energy, high-AM collisions create a previously unrecognized planetary object, called a synestia. Terrestrial synestias exceed the corotation limit for a rocky planet, forming an extended structure with a corotating inner region and disk-like outer region. We demonstrate that the internal pressures of Earth-like planets do not increase monotonically during the giant impact stage, but can vary substantially in response to changes in rotation and thermal state. The internal pressures in an impact-generated synestia are much lower than in condensed, slowly rotating planets of the same mass. For example, the core-mantle boundary (CMB) pressure can be as low as 60 GPa for a synestia with Earth mass and composition, compared to 136 GPa in the present-day Earth. The lower pressures are due to the low density and rapid rotation of the post-impact structure. After a high-AM Moon-forming impact, the internal pressures in the interior of the synestia would have increased to present-day Earth values in two stages: first by vapor condensation and second by removal of AM from the Earth during the tidal evolution of the Moon. The pressure evolution of the Earth has several implications. Metal-silicate equilibration after the impact would have occurred at much lower pressures than has previously been assumed. The observed moderately siderophile element abundances in the mantle may be consistent with equilibration at the bottom of a deep, lower-pressure magma ocean. In addition, the pressure at the CMB during cooling is coincident with, or lower than, the proposed intersection of liquid adiabats with the mantle liquidus. The mantle would hence freeze from the bottom up and there would be no basal magma ocean. The subsequent pressure increase and tidal heating due to the Moon's orbital evolution likely induces melting in the lowermost mantle. Increasing

  5. ACTOplus Met XR in Treating Patients With Stage I-IV Oral Cavity or Oropharynx Cancer Undergoing Definitive Treatment

    Science.gov (United States)

    2018-03-02

    Oral Cavity Neoplasm; Oropharyngeal Neoplasm; Stage I Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage I Oropharyngeal Squamous Cell Carcinoma AJCC v6 and v7; Stage II Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage II Oropharyngeal Squamous Cell Carcinoma AJCC v6 and v7; Stage III Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage III Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IV Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage IV Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVA Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage IVA Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVB Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage IVB Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVC Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage IVC Oropharyngeal Squamous Cell Carcinoma AJCC v7

  6. Differential Impact of Anastomotic Leak in Patients With Stage IV Colonic or Rectal Cancer

    DEFF Research Database (Denmark)

    Nordholm-Carstensen, Andreas; Rolff, Hans Christian; Krarup, Peter-Martin

    2017-01-01

    cancer (p = 0.04) but not on those with rectal cancer (p = 0.91). Anastomotic leak was followed by the decreased administration of adjuvant chemotherapy in patients with colon cancer (p = 0.007) but not in patients with rectal cancer (p = 0.47). Finally, anastomotic leak had a detrimental impact...... on metastasectomy rates after colon cancer but not on resection rates of rectal cancer. LIMITATIONS: Retrospective data on the selection criteria for primary tumor resection and metastatic tumor load were unavailable. CONCLUSIONS: The impact of anastomotic leak on patients differed between stage IV colon and rectal...... cancers. Survival and eligibility to receive chemotherapy and metastasectomy differed between patients with colon and rectal cancers. When planning for primary tumor resection, these factors should be considered....

  7. BigBOSS: The Ground-Based Stage IV BAO Experiment

    Energy Technology Data Exchange (ETDEWEB)

    Schlegel, David; Bebek, Chris; Heetderks, Henry; Ho, Shirley; Lampton, Michael; Levi, Michael; Mostek, Nick; Padmanabhan, Nikhil; Perlmutter, Saul; Roe, Natalie; Sholl, Michael; Smoot, George; White, Martin; Dey, Arjun; Abraham, Tony; Jannuzi, Buell; Joyce, Dick; Liang, Ming; Merrill, Mike; Olsen, Knut; Salim, Samir

    2009-04-01

    The BigBOSS experiment is a proposed DOE-NSF Stage IV ground-based dark energy experiment to study baryon acoustic oscillations (BAO) and the growth of structure with an all-sky galaxy redshift survey. The project is designed to unlock the mystery of dark energy using existing ground-based facilities operated by NOAO. A new 4000-fiber R=5000 spectrograph covering a 3-degree diameter field will measure BAO and redshift space distortions in the distribution of galaxies and hydrogen gas spanning redshifts from 0.2< z< 3.5. The Dark Energy Task Force figure of merit (DETF FoM) for this experiment is expected to be equal to that of a JDEM mission for BAO with the lower risk and cost typical of a ground-based experiment.

  8. Advanced-stage III/IV follicular lymphoma. Treatment strategies for individual patients

    Energy Technology Data Exchange (ETDEWEB)

    Heinzelmann, Frank; Bamberg, Michael; Weinmann, Martin [Dept. of Radiation Oncology, Univ. of Tuebingen (Germany); Ottinger, Hellmut [Dept. of Bone Marrow Transplantation, Univ. of Essen (Germany); Engelhard, Marianne [Dept. of Radiation Oncology, Univ. of Essen (Germany); Soekler, Martin [Dept. of Internal Medicine II, Univ. of Tuebingen (Germany)

    2010-05-15

    Background: in patients with advanced-stage III/IV follicular lymphoma (FL), there are many treatment options available. The current challenge is to choose the optimal strategy for the individual patient. Methods: the literature was reviewed with respect to treatment strategies in patients with advanced FL by screening the PubMed databank. Results: in advanced-stage III/IV FL, median survival may approach 8-10 years. Treatment strategies include a watch-and-wait strategy, chemoimmunotherapy, monotherapy with rituximab, and - as an experimental approach so far - radioimmunotherapy. The use of autologous hematopoietic stem cell transplantation (HSCT) for patients in first remission or chemosensitive relapse prolongs progression-free survival while the effect on overall survival remains unclear compared to standard chemotherapy. However, long-term results are flawed by high relapse rates and risk of secondary malignancies. In patients with relapsed/chemoresistant disease, allogeneic HSCT constitutes the only curative approach but is associated with high treatment-related mortality. In the palliative setting, low-dose involved-field irradiation constitutes an effective treatment option in order to control local symptoms with potential long-lasting response. Conclusion: in case of advanced-disease FL, asymptomatic patients can be managed expectantly. In symptomatic patients, chemoimmunotherapy is regarded as standard therapy. In symptomatic elderly patients with relevant comorbidities, rituximab {+-} single-agent chemotherapy, or low-dose involved-field radiotherapy might be appropriate. For younger patients with chemoresistant/relapsed disease, allogeneic HSCT might be considered, since advances in supportive care and better patient selection have resulted in improved outcomes. (orig.)

  9. Ten years experience of managing the primary tumours in patients with stage IV colorectal cancers.

    Science.gov (United States)

    Aslam, Muhammad Imran; Kelkar, Ashish; Sharpe, David; Jameson, John Stuart

    2010-01-01

    Approximately 20% of patients with colorectal cancer have metastases at the time of presentation. Such patients are often offered systemic chemotherapy but debate continues as to whether these patients benefit from resection of the primary tumour. We describe our ten years experience of managing the primary tumours in patients with stage IV colorectal cancer. The aim of this study was to describe the overall survival of patients undergoing surgery in these circumstances and to determine whether any prognostic indicators could be identified. 920 consecutive patients presenting with stage IV colorectal cancer disease were identified from the Leicester Colorectal Cancer database. Patients undergoing resection of the primary tumour (Resection Group) with the residual metastatic disease were compared to those patients who had not their primary tumour excised (Non-Resection Group). Various different variables in two groups were compared by using Mann-Whitney U test. Kaplan-Meier survival analysis and log-rank test were used to compare the overall survivals. Univariate analysis was performed for each group to elicit the significant prognostic factors whereas Cox regression model was used to identify the independent predictors of overall survival. The Kaplan-Meier survival analysis of two groups showed prolonged survival for Resection Group compared to the Non-Resection Group (median; 14.5 Vs 5.83 months, p = fixity, ASA grade, mode of surgery, post-operative chemotherapy and sites of metastasis as significant factors (p fixity (p = 0.012) and lymph nodal involvement (p = 0.042) were independent predictors for overall survival. Treatment with post-operative chemotherapy and a smaller volume of liver metastases were associated with prolonged survival (p fixity and ASA grade can help to decide the patients who will benefit from surgery. Copyright (c) 2010 Surgical Associates Ltd. All rights reserved.

  10. Burst pressure investigation of filament wound type IV composite pressure vessel

    Science.gov (United States)

    Farhood, Naseer H.; Karuppanan, Saravanan; Ya, H. H.; Baharom, Mohamad Ariff

    2017-12-01

    Currently, composite pressure vessels (PVs) are employed in many industries such as aerospace, transportations, medical etc. Basically, the use of PVs in automotive application as a compressed natural gas (CNG) storage cylinder has been growing rapidly. Burst failure due to the laminate failure is the most critical failure mechanism for composite pressure vessels. It is predominantly caused by excessive internal pressure due to an overfilling or an overheating. In order to reduce fabrication difficulties and increase the structural efficiency, researches and studies are conducted continuously towards the proper selection of vessel design parameters. Hence, this paper is focused on the prediction of first ply failure pressure for such vessels utilizing finite element simulation based on Tsai-Wu and maximum stress failure criterions. The effects of laminate stacking sequence and orientation angle on the burst pressure were investigated in this work for a constant layered thickness PV. Two types of winding design, A [90°2/∓θ16/90°2] and B [90°2/∓θ]ns with different orientations of helical winding reinforcement were analyzed for carbon/epoxy composite material. It was found that laminate A sustained a maximum burst pressure of 55 MPa for a sequence of [90°2/∓15°16/90°2] while the laminate B returned a maximum burst pressure of 45 MPa corresponding to a stacking sequence of [90°2/±15°/90°2/±15°/90°2/±15° ....] up to 20 layers for a constant vessel thickness. For verification, a comparison was done with the literature under similar conditions of analysis and good agreement was achieved with a maximum difference of 4% and 10% for symmetrical and unsymmetrical layout, respectively.

  11. Efficacy of Multimodal Therapy in the Survival Outcomes of Advanced-Stage (Stage III-Stage IV) Oral Carcinoma Patients: An Institutional Experience in Asian Indian Population.

    Science.gov (United States)

    Dhawan, Amit; Duggal, Prahlad; Bhullar, Ramandeep Singh; Kaur, Tejinder; Sandhu, Amneet; Kaur, Kirandeep

    2018-03-01

    Primary ablative surgery followed by post-op radiotherapy (S-RT) remains the mainstay of treatment for stage III-stage IV oral carcinoma. A retrospective analysis of survival rates of advanced-stage OSCC patients treated with multimodal therapies (S-RT or combined chemoradiation) was performed to analyse the outcome for patient survival and whether addition of adjuvant chemotherapy (S-CRT) improves survival. Demographic, pathological, treatment and follow-up data of 128 patients were included in the study. Sixty-nine patients received S-RT, while 55 patients were opted for S-CRT. Overall survival, disease-specific survival and disease-free survival were estimated with Kaplan-Meier analysis and compared between groups with Cox regression analysis. Survival was significantly influenced by the type of modality and regional spread of disease. S-CRT group had improved overall, disease-specific, disease-free and metastasis-free survival compared to S-RT group. A survival advantage of 10% was achieved in S-CRT group compared to S-RT group even in patients with extracapsular spread and perineural invasion. Addition of adjuvant chemotherapy to S-RT improves survival outcomes in advanced OSCC, especially in patients with regional spread of disease.

  12. Carboplatin and Paclitaxel With or Without Bevacizumab Compared to Docetaxel, Carboplatin, and Paclitaxel in Treating Patients With Stage II, Stage III, or Stage IV Ovarian Epithelial, Fallopian Tube, or Primary Peritoneal Cavity Carcinoma (Cancer)

    Science.gov (United States)

    2013-03-18

    Brenner Tumor; Fallopian Tube Cancer; Ovarian Carcinosarcoma; Ovarian Clear Cell Cystadenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mixed Epithelial Carcinoma; Ovarian Mucinous Cystadenocarcinoma; Ovarian Serous Cystadenocarcinoma; Ovarian Undifferentiated Adenocarcinoma; Primary Peritoneal Cavity Cancer; Stage II Ovarian Epithelial Cancer; Stage III Ovarian Epithelial Cancer; Stage IV Ovarian Epithelial Cancer

  13. Survival Analysis of 1,742 Patients with Stage IV Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Hong PENG

    2011-04-01

    Full Text Available Background and objective At present non-small cell lung cancer (NSCLC is still the leading cause of death induced by cancer. The aim of this study is to investigate the prognostic factors of advanced NSCLC. Methods Total 1,742 cases of stage IV NSCLC data from Jan 4, 2000 to Dec 25, 2008 in Shanghai Chest Hospital were collected, confirmed by pathological examinations. Analysis was made to observe the impact of treatment on prognosis in gender, age, smoking history, pathology, classification, clinical TNM stage. Survival rate, survival difference were evaluated by Kaplan-Meire method and Logrank test respectively. The prognosis were analyzed by Cox multivariate regression. Results The median survival time of 1,742 patients was 10.0 months (9.5 months-10.5 months. One, two, three, four, and five-year survival rates were 44%, 22%, 13%, 9%, 6% respectively. The median survivals of single or multiple metastasis were 11 months vs 7 months (P < 0.001. Survival time were different in metastasic organs, with the median survival time as follows: lung for about 12 months (11.0 months-12.9 months, bone for 9 months (8.3 months-9.6 months, brain for 8 months (6.8 months-9.1 months, liver, adrenal gland, distannt lymph node metastasis for 5 months (3.8 months-6.1 months, and subcutaneous for 3 months (1.7 months-4.3 months. The median survival times of adenocarcinoma (n=1,086, 62% and squamous cell carcinoma cases (n=305, 17.5% were 12 months vs 8 months (P < 0.001. The median survival time of chemotherapy and best supportive care were 11 months vs 6 months (P < 0.001; the median survival times of with and without radiotherapy were 11 months vs 9 months (P=0.017. Conclusion Gender, age, gross type, pathological type, clinical T stage, N stage, numbers of metastatic organ, smoking history, treatment of advanced non-small cell lung cancer were independent prognostic factors.

  14. Properties of type IV plaster considering variation in the mold/model position during setting stage

    Directory of Open Access Journals (Sweden)

    Tarcisio José de Arruda Paes Junior

    2010-04-01

    Full Text Available Objective: To assess the influence of the position of the mold during the setting stage of type IV stone plaster Durone (Dentsply Ind. Com., Rio de Janeiro, Brazil, on the following properties: surface hardness and roughness. Methods: For the roughness test, two groups (n=6 in the form of pellets were prepared. In the first group, the surface of the base of the device was turned down during the plaster setting stage (N, in the second group this position was inverted, which has been described as an act of capsize it (E. For analysis, a roughness meter with reading precision of 0.01 μm was used. With regard to the hardness analysis, two groups with conical-shaped samples were obtained. The plasters were left to set under the same conditions of the mold/model position described for the previous experiment. Hardness measurement was performed in a durometer with a spherical penetrating tip for Rockwell readout. Three measurements were performed for each test specimen in both tests. Results: The hardness (N - 39.8, standard deviation = 3.3, E - 30.8, standard deviation = 5.6 and roughness data (N - 0.67, standard deviation = 0.17, E - 0.74, standard deviation = 0.13 submitted to the Student’s-t test (5% showed no statistically significant differences for the roughness test (0.489, but showed statistically significant differences for the hardness test (0.014. Conclusion: The variation in the mold/model position influenced the final characteristics of the specimens in terms of hardness, since those obtained with the capsize technique showed lower surface hardness, whereas for roughness these differences were not statistically significant.

  15. Stimulation of protein synthesis in stage IV Xenopus oocytes by microinjected insulin

    International Nuclear Information System (INIS)

    Miller, D.S.

    1989-01-01

    The effects of intracellular insulin on protein synthesis were examined in intact cells and isolated, undiluted cellular components. [35S]Methionine incorporation into protein was measured in Stage IV oocytes from Xenopus laevis maintained under paraffin oil. Radiolabel and insulin were introduced into the cytoplasm by microinjection. After a short delay (approximately 15 min), injected insulin stimulated the rate of methionine incorporation. Stimulation was dose-dependent, increasing with injected doses in the 7-50-fmol range. Neither proinsulin nor insulin-like growth factor 1 were as effective as insulin in stimulating protein synthesis; microinjected epidermal growth factor and the A and B chains of insulin were without effect. When oocyte surface membranes were removed under oil, the resulting cytoplasm-nucleus samples exhibited methionine incorporation rates that were comparable to those found in intact cells. Microinjection of insulin increased rates of methionine incorporation in cytoplasm-nucleus samples; the effects of external (prior to transfer to oil) and internal (microinjection in oil) insulin exposure were additive. Cytoplasm samples (nuclei and surface membranes removed under oil) also synthesized protein and responded to microinjected insulin. However, insulin responses were reduced relative to cells and to cytoplasm-nucleus samples. 125I-Insulin was degraded rapidly after microinjection into oocytes. Degradation occurred in both the nucleus and cytoplasm. Degradation was delayed by injecting bacitracin into the cells and delaying degradation increased the effectiveness of a low dose of injected insulin

  16. The hyperfractionation in the oropharynx carcinomas treatment: stages III and IV

    International Nuclear Information System (INIS)

    Pinto, L.H.J.

    1990-01-01

    From April 1986 until May 1989. 112 patients with stages III and IV oropharynx carcinomas were included in a protocol comparing the use of Hyperfractionation and Conventional Fractionation. The doses were 6600 rad in 33 fractions of 200 rad for the conventional fractionation and 7040 rad in 64 fractions, two fractions of 110 rad per day for the hyperfractionation. As of January 1990 an analysis was performed in 98 patients, with a median follow-up of 14 months. The probability of complete responses in the oropharynx was 74%, with 84% for the hyperfractionation and 64% for the conventional fractionation ( p < 0,05). Survival was improved in 42 months for those patients treated with hyperfractionation: 27% versus 8% (p < 0,05). In patients with lesions out of the base of the tongue and in those with Karnofsky performance status of 50%, 60% and 70%, survival was improved with the use of hyperfractionation (p = 0,02 and p 0,006 respectively. The study demonstrates the superiority of hyperfractionation over the classical fractionation in the treatment of patients with carcinoma of the oropharynx. (author)

  17. Effects of cardiac resynchronization therapy in patients with inotrope-dependent class IV end-stage heart failure

    Directory of Open Access Journals (Sweden)

    Ikutaro Nakajima

    2013-12-01

    Conclusion: CRT did not result in significant reverse remodeling in patients with inotrope-dependent class IV end-stage HF. However, it contributed to dramatically improve the cardiovascular outcomes at least in the short-term period in some patients.

  18. Differential Impact of Anastomotic Leak in Patients With Stage IV Colonic or Rectal Cancer: A Nationwide Cohort Study.

    Science.gov (United States)

    Nordholm-Carstensen, Andreas; Rolff, Hans Christian; Krarup, Peter-Martin

    2017-05-01

    Anastomotic leak has a negative impact on the prognosis of patients who undergo colorectal cancer resection. However, data on anastomotic leak are limited for stage IV colorectal cancers. The purpose of this study was to investigate the impact of anastomotic leak on survival and the decision to administer chemotherapy and/or metastasectomy after elective surgery for stage IV colorectal cancer. This was a nationwide, retrospective cohort study. Data were obtained from the Danish Colorectal Cancer Group, the Danish Pathology Registry, and the National Patient Registry. Patients who were diagnosed with stage IV colorectal cancer between 2009 and 2013 and underwent elective resection of their primary tumors were included. The primary outcome was all-cause mortality depending on the occurrence of anastomotic leak. Secondary outcomes were the administration of and time to adjuvant chemotherapy, metastasectomy rate, and risk factors for leak. Of the 774 patients with stage IV colorectal cancer who were included, 71 (9.2%) developed anastomotic leaks. Anastomotic leak had a significant impact on the long-term survival of patients with colon cancer (p = 0.04) but not on those with rectal cancer (p = 0.91). Anastomotic leak was followed by the decreased administration of adjuvant chemotherapy in patients with colon cancer (p = 0.007) but not in patients with rectal cancer (p = 0.47). Finally, anastomotic leak had a detrimental impact on metastasectomy rates after colon cancer but not on resection rates of rectal cancer. Retrospective data on the selection criteria for primary tumor resection and metastatic tumor load were unavailable. The impact of anastomotic leak on patients differed between stage IV colon and rectal cancers. Survival and eligibility to receive chemotherapy and metastasectomy differed between patients with colon and rectal cancers. When planning for primary tumor resection, these factors should be considered.

  19. Pressurized water reactor core instrument tube ruptures: Experimental simulation at the ROSA-IV LSTF

    International Nuclear Information System (INIS)

    Kukita, Y.; Asaka, H.; Nakamura, H.; Tasaka, K.

    1990-01-01

    A small-break loss-of-coolant accident (SBLOCA) initiated by the rupture of pressurized water reactor (PWR) core instrument tubes was simulated using the ROSA-IV Large Scale Test Facility (LSTF). The experimental results were characterized by a single-phase liquid discharge continuing for a long period until the pressure vessel coolant inventory was significantly depleted. This experiment was analyzed using three advanced LOCA analysis codes, RELAP5/MOD2, TRACPF1/MOD1 and CATHARE-1, to assess the predictive abilities of these codes. Although all these codes simulated the experimental results qualitatively, discrepancies were found between the predictions and data regarding the break flowrate, spatial distribution of coolant in the primary system and core rod temperature responses. (orig.)

  20. PET-Adjusted Intensity Modulated Radiation Therapy and Combination Chemotherapy in Treating Patients With Stage II-IV Non-small Cell Lung Cancer

    Science.gov (United States)

    2018-03-22

    Metastatic Malignant Neoplasm in the Brain; Recurrent Non-Small Cell Lung Carcinoma; Stage IIA Non-Small Cell Lung Carcinoma; Stage IIB Non-Small Cell Lung Carcinoma; Stage IIIA Non-Small Cell Lung Cancer; Stage IIIB Non-Small Cell Lung Cancer; Stage IV Non-Small Cell Lung Cancer

  1. Palliative Care Intervention in Improving Symptom Control and Quality of Life in Patients With Stage II-IV Non-small Cell Lung Cancer and Their Family Caregivers

    Science.gov (United States)

    2017-10-16

    Caregiver; Psychological Impact of Cancer and Its Treatment; Recurrent Non-small Cell Lung Cancer; Stage IIA Non-small Cell Lung Cancer; Stage IIB Non-small Cell Lung Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IV Non-small Cell Lung Cancer

  2. A single centre experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer

    Directory of Open Access Journals (Sweden)

    Coyle Catherine

    2010-12-01

    Full Text Available Abstract Background Chemo-radiotherapy offers an alternative to primary surgery and adjuvant therapy for the management of locally advanced stage IV squamous cell carcinomas of the tonsil. Methods A retrospective analysis was performed of the outcomes of 41 patients with locoregionally advanced squamous cell carcinoma of the tonsil treated non-surgically at the Yorkshire Cancer Centre between January 2004 and December 2005. Due to long radiotherapy waiting times, patients received induction chemotherapy with cisplatin and 5-fluorouracil followed by either cisplatin concurrent chemoradiotherapy or radiotherapy alone. Results Median age was 55 years (range 34-76 years and 28 (68% patients were male. 35/41 patients (85% received 2 or more cycles of induction chemotherapy. Following induction chemotherapy, 32/41 patients (78% had a clinical response. Concomitant chemotherapy was given to 30/41 (73%. All patients received the planned radiotherapy dose with no delays. There were no treatment related deaths. Six (15% patients had gastrostomy tubes placed before treatment, and 22 (54% required nasogastric tube placement during or after treatment for nutritional support. 17 patients required unplanned admissions during treatment for supportive care. At 4 months post treatment assessment 35 out of 41 (85% patients achieved complete clinical and radiographic response. Median follow-up is 38 months (8-61 months. Local and regional control rate in complete responders at 3 years was 91%. Distant metastases have been found in 4 (9.8% patients. Three year progression-free survival rate in all patients is 75%. The 3-year cause specific survival and overall survival are 75% and 66% respectively. Conclusion Cisplatin-based induction and concurrent chemoradiotherapy provides excellent tumour control with acceptable toxicity for patients with locally advanced tonsillar cancer.

  3. A classification prognostic score to predict OS in stage IV well-differentiated neuroendocrine tumors.

    Science.gov (United States)

    Pusceddu, Sara; Barretta, Francesco; Trama, Annalisa; Botta, Laura; Milione, Massimo; Buzzoni, Roberto; de Braud, Filipppo; Mazzaferro, Vincenzo; Pastorino, Ugo; Seregni, Ettore; Mariani, Luigi; Gatta, Gemma; Di Bartolomeo, Maria; Femia, Daniela; Prinzi, Natalie; Coppa, Jorgelina; Panzuto, Francesco; Antonuzzo, Lorenzo; Bajetta, Emilio; Maria, Brizzi Pia; Campana, Davide; Catena, Laura; Comber, Harry; Dwane, Fiona; Fazio, Nicola; Faggiano, Antongiulio; Giuffrida, Dario; Henau, Kris; Ibrahim, Toni; Marconcini, Riccardo; Massironi, Sara; Žakelj, Maja Primic; Spada, Francesca; Tafuto, Salvatore; Van Eycken, Elizabeth; Van der Zwan, Jan Maaten; Žagar, Tina; Giacomelli, Luca; Miceli, Rosalba

    2018-03-20

    No validated prognostic tool is available for predicting overall survival (OS) of patients with well-differentiated neuroendocrine tumors (WDNETs). This study, conducted in three independent cohorts of patients from five different European countries, aimed to develop and validate a classification prognostic score for OS in patients with stage IV WDNETs. We retrospectively collected data on 1387 patients: (i) patients treated at the Istituto Nazionale Tumori (Milan, Italy; n=515); (ii) European cohort of rare NET patients included in the European RARECAREnet database (n=457); (iii) Italian multicentric cohort of pancreatic NET (pNETs) patients treated at 24 Italian institutions (n=415). The score was developed using data from patients included in cohort (i) (training set); external validation was performed by applying the score to the data of the two independent cohorts (ii) and (iii) evaluating both calibration and discriminative ability (Harrell C statistic). We used data on age, primary tumor site, metastasis (synchronous vs metachronous), Ki67, functional status and primary surgery to build the score, which was developed for classifying patients into three groups with differential 10-year OS: I) Favorable-risk group: 10-year OS ≥70%; II) Intermediate-risk group: 30% ≤10-year OS OS <30%. The Harrell C statistic was 0.661 in the training set, and 0.626 and 0.601 in the RARECAREnet and Italian multicentric validation sets, respectively. In conclusion, based on the analysis of three 'field-practice' cohorts collected in different settings, we defined and validated a prognostic score to classify patients into three groups with different long-term prognoses.

  4. Adjuvant Nivolumab versus Ipilimumab in Resected Stage III or IV Melanoma.

    Science.gov (United States)

    Weber, Jeffrey; Mandala, Mario; Del Vecchio, Michele; Gogas, Helen J; Arance, Ana M; Cowey, C Lance; Dalle, Stéphane; Schenker, Michael; Chiarion-Sileni, Vanna; Marquez-Rodas, Ivan; Grob, Jean-Jacques; Butler, Marcus O; Middleton, Mark R; Maio, Michele; Atkinson, Victoria; Queirolo, Paola; Gonzalez, Rene; Kudchadkar, Ragini R; Smylie, Michael; Meyer, Nicolas; Mortier, Laurent; Atkins, Michael B; Long, Georgina V; Bhatia, Shailender; Lebbé, Celeste; Rutkowski, Piotr; Yokota, Kenji; Yamazaki, Naoya; Kim, Tae M; de Pril, Veerle; Sabater, Javier; Qureshi, Anila; Larkin, James; Ascierto, Paolo A

    2017-11-09

    Nivolumab and ipilimumab are immune checkpoint inhibitors that have been approved for the treatment of advanced melanoma. In the United States, ipilimumab has also been approved as adjuvant therapy for melanoma on the basis of recurrence-free and overall survival rates that were higher than those with placebo in a phase 3 trial. We wanted to determine the efficacy of nivolumab versus ipilimumab for adjuvant therapy in patients with resected advanced melanoma. In this randomized, double-blind, phase 3 trial, we randomly assigned 906 patients (≥15 years of age) who were undergoing complete resection of stage IIIB, IIIC, or IV melanoma to receive an intravenous infusion of either nivolumab at a dose of 3 mg per kilogram of body weight every 2 weeks (453 patients) or ipilimumab at a dose of 10 mg per kilogram every 3 weeks for four doses and then every 12 weeks (453 patients). The patients were treated for a period of up to 1 year or until disease recurrence, a report of unacceptable toxic effects, or withdrawal of consent. The primary end point was recurrence-free survival in the intention-to-treat population. At a minimum follow-up of 18 months, the 12-month rate of recurrence-free survival was 70.5% (95% confidence interval [CI], 66.1 to 74.5) in the nivolumab group and 60.8% (95% CI, 56.0 to 65.2) in the ipilimumab group (hazard ratio for disease recurrence or death, 0.65; 97.56% CI, 0.51 to 0.83; Pmelanoma, adjuvant therapy with nivolumab resulted in significantly longer recurrence-free survival and a lower rate of grade 3 or 4 adverse events than adjuvant therapy with ipilimumab. (Funded by Bristol-Myers Squibb and Ono Pharmaceutical; CheckMate 238 ClinicalTrials.gov number, NCT02388906 ; Eudra-CT number, 2014-002351-26 .).

  5. A single centre experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer

    International Nuclear Information System (INIS)

    D Prestwich, Robin J; Kancherla, Kiran; Oksuz, Didem Colpan; Williamson, Deborah; Dyker, Karen E; Coyle, Catherine; Sen, Mehmet

    2010-01-01

    Chemo-radiotherapy offers an alternative to primary surgery and adjuvant therapy for the management of locally advanced stage IV squamous cell carcinomas of the tonsil. A retrospective analysis was performed of the outcomes of 41 patients with locoregionally advanced squamous cell carcinoma of the tonsil treated non-surgically at the Yorkshire Cancer Centre between January 2004 and December 2005. Due to long radiotherapy waiting times, patients received induction chemotherapy with cisplatin and 5-fluorouracil followed by either cisplatin concurrent chemoradiotherapy or radiotherapy alone. Median age was 55 years (range 34-76 years) and 28 (68%) patients were male. 35/41 patients (85%) received 2 or more cycles of induction chemotherapy. Following induction chemotherapy, 32/41 patients (78%) had a clinical response. Concomitant chemotherapy was given to 30/41 (73%). All patients received the planned radiotherapy dose with no delays. There were no treatment related deaths. Six (15%) patients had gastrostomy tubes placed before treatment, and 22 (54%) required nasogastric tube placement during or after treatment for nutritional support. 17 patients required unplanned admissions during treatment for supportive care. At 4 months post treatment assessment 35 out of 41 (85%) patients achieved complete clinical and radiographic response. Median follow-up is 38 months (8-61 months). Local and regional control rate in complete responders at 3 years was 91%. Distant metastases have been found in 4 (9.8%) patients. Three year progression-free survival rate in all patients is 75%. The 3-year cause specific survival and overall survival are 75% and 66% respectively. Cisplatin-based induction and concurrent chemoradiotherapy provides excellent tumour control with acceptable toxicity for patients with locally advanced tonsillar cancer

  6. Comparative effectiveness of primary tumor resection in patients with stage IV colon cancer.

    Science.gov (United States)

    Alawadi, Zeinab; Phatak, Uma R; Hu, Chung-Yuan; Bailey, Christina E; You, Y Nancy; Kao, Lillian S; Massarweh, Nader N; Feig, Barry W; Rodriguez-Bigas, Miguel A; Skibber, John M; Chang, George J

    2017-04-01

    Although the safety of combination chemotherapy without primary tumor resection (PTR) in patients with stage IV colon cancer has been established, questions remain regarding a potential survival benefit with PTR. The objective of this study was to compare mortality rates in patients who had colon cancer with unresectable metastases who did and did not undergo PTR. An observational cohort study was conducted among patients with unresectable metastatic colon cancer identified from the National Cancer Data Base (2003-2005). Multivariate Cox regression analyses with and without propensity score weighting (PSW) were performed to compare survival outcomes. Instrumental variable analysis, using the annual hospital-level PTR rate as the instrument, was used to account for treatment selection bias. To account for survivor treatment bias, in situations in which patients might die soon after diagnosis from different reasons, a landmark method was used. In the total cohort, 8641 of 15,154 patients (57%) underwent PTR, and 73.8% of those procedures (4972 of 6735) were at landmark. PTR was associated with a significant reduction in mortality using Cox regression (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.44-0.47) or PSW (HR, 0.46; 95% CI, 0. 44-0.49). However, instrumental variable analysis revealed a much smaller effect (relative mortality rate, 0.91; 95% CI, 0.87-0.96). Although a smaller benefit was observed with the landmark method using Cox regression (HR, 0.6; 95% CI, 0.55-0.64) and PSW (HR, 0.59; 95% CI, 0.54-0.64), instrumental variable analysis revealed no survival benefit (relative mortality rate, 0.97; 95% CI, 0.87-1.06). Among patients with unresectable metastatic colon cancer, after adjustment for confounder effects, PTR was not associated with improved survival compared with systemic chemotherapy; therefore, routine noncurative PTR is not recommended. Cancer 2017;123:1124-1133. © 2016 American Cancer Society. © 2016 American Cancer Society.

  7. Phase II trial of the regulatory T cell-depleting agent, denileukin diftitox, in patients with unresectable stage IV melanoma

    International Nuclear Information System (INIS)

    Telang, Sucheta; Gragg, Hana; Clem, Brian F; McMasters, Kelly M; Miller, Donald M; Chesney, Jason; Rasku, Mary Ann; Clem, Amy L; Carter, Karen; Klarer, Alden C; Badger, Wesley R; Milam, Rebecca A; Rai, Shesh N; Pan, Jianmin

    2011-01-01

    We previously found that administration of an interleukin 2/diphtheria toxin conjugate (DAB/IL2; Denileukin Diftitox; ONTAK) to stage IV melanoma patients depleted CD4 + CD25 HI Foxp3 + regulatory T cells and expanded melanoma-specific CD8 + T cells. The goal of this study was to assess the clinical efficacy of DAB/IL2 in an expanded cohort of stage IV melanoma patients. In a single-center, phase II trial, DAB/IL2 (12 μg/kg; 4 daily doses; 21 day cycles) was administered to 60 unresectable stage IV melanoma patients and response rates were assessed using a combination of 2-[ 18 F]-fluoro-2-deoxy-glucose (FDG)-positron emission tomography (PET) and computed tomography (CT) imaging. After DAB/IL2 administration, 16.7% of the 60 patients had partial responses, 5% stable disease and 15% mixed responses. Importantly, 45.5% of the chemo/immuno-naïve sub-population (11/60 patients) experienced partial responses. One year survival was markedly higher in partial responders (80 ± 11.9%) relative to patients with progressive disease (23.7 ± 6.5%; p value < 0.001) and 40 ± 6.2% of the total DAB/IL2-treated population were alive at 1 year. These data support the development of multi-center, randomized trials of DAB/IL2 as a monotherapy and in combination with other immunotherapeutic agents for the treatment of stage IV melanoma. http://www.clinicaltrials.gov/ct2/show/NCT00299689

  8. Miscellaneous syndromes and their management: occult breast cancer, breast cancer in pregnancy, male breast cancer, surgery in stage IV disease.

    Science.gov (United States)

    Colfry, Alfred John

    2013-04-01

    Surgical therapy for occult breast cancer has traditionally centered on mastectomy; however, breast conservation with whole breast radiotherapy followed by axillary lymph node dissection has shown equivalent results. Patients with breast cancer in pregnancy can be safely and effectively treated; given a patient's pregnancy trimester and stage of breast cancer, a clinician must be able to guide therapy accordingly. Male breast cancer risk factors show strong association with BRCA2 mutations, as well as Klinefelter syndrome. Several retrospective trials of surgical therapy in stage IV breast cancer have associated a survival advantage with primary site tumor extirpation. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Survival Impact of Adjuvant Radiation Therapy in Masaoka Stage II to IV Thymomas: A Systematic Review and Meta-analysis

    International Nuclear Information System (INIS)

    Lim, Yu Jin; Kim, Eunji; Kim, Hak Jae; Wu, Hong-Gyun; Yan, Jinchun; Liu, Qin; Patel, Shilpen

    2016-01-01

    Purpose: To evaluate the survival impact of postoperative radiation therapy (PORT) in stage II to IV thymomas, using systematic review and meta-analysis. Methods and Materials: A database search was conducted with EMBASE, PubMed, Web of Science, Cochrane Library, and Ovid from inception to August 2015. Thymic carcinomas were excluded, and studies comparing overall survival (OS) with and without PORT in thymomas were included. The hazard ratios (HRs) of OS were extracted, and a random-effects model was used in the pooled analysis. Results: Seven retrospective series with a total of 1724 patients were included and analyzed. Almost all of the patients underwent macroscopically complete resection, and thymoma histology was confirmed by the World Health Organization criteria. In the overall analysis of stage II to IV thymomas, OS was not altered with the receipt of PORT (HR 0.79, 95% confidence interval [CI] 0.58-1.08). Although PORT was not associated with survival difference in Masaoka stage II disease (HR 1.45, 95% CI 0.83-2.55), improved OS was observed with the addition of PORT in the discrete pooled analysis of stage III to IV (HR 0.63, 95% CI 0.40-0.99). Significant heterogeneity and publication bias were not found in the analyses. Conclusions: From the present meta-analysis of sole primary thymomas, we suggest the potential OS benefit of PORT in locally advanced tumors with macroscopically complete resection, but not in stage II disease. Further investigations with sufficient survival data are needed to establish detailed treatment indications.

  10. Survival Impact of Adjuvant Radiation Therapy in Masaoka Stage II to IV Thymomas: A Systematic Review and Meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Yu Jin; Kim, Eunji [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Hak Jae, E-mail: khjae@snu.ac.kr [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Wu, Hong-Gyun [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Cancer Research Institute, Seoul National University College of Medicine, Seoul (Korea, Republic of); Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul (Korea, Republic of); Yan, Jinchun [Department of Radiation Oncology, Dalian Medical University, Liaoning (China); Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China); Liu, Qin [The Wistar Institute, Philadelphia, Pennsylvania (United States); Patel, Shilpen [Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington (United States)

    2016-04-01

    Purpose: To evaluate the survival impact of postoperative radiation therapy (PORT) in stage II to IV thymomas, using systematic review and meta-analysis. Methods and Materials: A database search was conducted with EMBASE, PubMed, Web of Science, Cochrane Library, and Ovid from inception to August 2015. Thymic carcinomas were excluded, and studies comparing overall survival (OS) with and without PORT in thymomas were included. The hazard ratios (HRs) of OS were extracted, and a random-effects model was used in the pooled analysis. Results: Seven retrospective series with a total of 1724 patients were included and analyzed. Almost all of the patients underwent macroscopically complete resection, and thymoma histology was confirmed by the World Health Organization criteria. In the overall analysis of stage II to IV thymomas, OS was not altered with the receipt of PORT (HR 0.79, 95% confidence interval [CI] 0.58-1.08). Although PORT was not associated with survival difference in Masaoka stage II disease (HR 1.45, 95% CI 0.83-2.55), improved OS was observed with the addition of PORT in the discrete pooled analysis of stage III to IV (HR 0.63, 95% CI 0.40-0.99). Significant heterogeneity and publication bias were not found in the analyses. Conclusions: From the present meta-analysis of sole primary thymomas, we suggest the potential OS benefit of PORT in locally advanced tumors with macroscopically complete resection, but not in stage II disease. Further investigations with sufficient survival data are needed to establish detailed treatment indications.

  11. Carboplatin, Paclitaxel, Bevacizumab, and Veliparib in Treating Patients With Newly Diagnosed Stage II-IV Ovarian Epithelial, Fallopian Tube, or Primary Peritoneal Cancer

    Science.gov (United States)

    2018-03-02

    Fallopian Tube Carcinosarcoma; Fallopian Tube Clear Cell Adenocarcinoma; Fallopian Tube Endometrioid Adenocarcinoma; Fallopian Tube Mucinous Adenocarcinoma; Fallopian Tube Serous Neoplasm; Fallopian Tube Transitional Cell Carcinoma; Ovarian Brenner Tumor; Ovarian Carcinosarcoma; Ovarian Clear Cell Adenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mucinous Adenocarcinoma; Ovarian Seromucinous Tumor; Ovarian Serous Adenocarcinoma; Ovarian Transitional Cell Carcinoma; Primary Peritoneal Serous Adenocarcinoma; Stage IIA Fallopian Tube Cancer AJCC v6 and v7; Stage IIA Ovarian Cancer AJCC V6 and v7; Stage IIB Fallopian Tube Cancer AJCC v6 and v7; Stage IIB Ovarian Cancer AJCC v6 and v7; Stage IIC Fallopian Tube Cancer AJCC v6 and v7; Stage IIC Ovarian Cancer AJCC v6 and v7; Stage IIIA Fallopian Tube Cancer AJCC v7; Stage IIIA Ovarian Cancer AJCC v6 and v7; Stage IIIA Primary Peritoneal Cancer AJCC v7; Stage IIIB Fallopian Tube Cancer AJCC v7; Stage IIIB Ovarian Cancer AJCC v6 and v7; Stage IIIB Primary Peritoneal Cancer AJCC v7; Stage IIIC Fallopian Tube Cancer AJCC v7; Stage IIIC Ovarian Cancer AJCC v6 and v7; Stage IIIC Primary Peritoneal Cancer AJCC v7; Stage IV Fallopian Tube Cancer AJCC v6 and v7; Stage IV Ovarian Cancer AJCC v6 and v7; Stage IV Primary Peritoneal Cancer AJCC v7; Undifferentiated Fallopian Tube Carcinoma; Undifferentiated Ovarian Carcinoma

  12. Feasibility study of Californium-252 for the therapy of stage IV cervical cancer.

    Science.gov (United States)

    Maruyama, Y; Van Nagell, J R; Yoneda, J; Donaldson, E; Gallion, H; Patel, P; Kryscio, R J

    1988-06-15

    Twenty patients with Stage IVA and IVB cervic cancers were treated with Californium-252 (Cf) neutron brachytherapy (NT) in a feasibility trial between 1976 and 1986. Eleven patients had Stage IVA disease; nine patients had Stage IVB disease. Patient compliance with therapy was poor in four of nine patients with Stage IVB disease, and the 50% survival time was 6 months. In Stage IVA disease there were 18% 3-year survivals. For those that failed, the 50% survival time was 7.5 months. Because of the frequency of disseminated metastases, effective adjuvant therapy needs to be developed to use after the tumor debulking therapy, especially for Stage IVB disease. A single early Cf-NT implant followed by 6000 cGy of whole-pelvis fractionated radiation would accomplish this adequately for local tumor control and palliation.

  13. Combined intra-arterial infusion and systemic chemoradiotherapy for stage IV squamous cell carcinoma of the mandibular gingiva

    International Nuclear Information System (INIS)

    Nakasato, Tatsuhiko; Akahane, Akio; Kikuchi, Koyo; Ehara, Shigeru; Izumisawa, Mitsuru; Shoji, Satoru; Kogi, Shintaro; Mizuki, Harumi; Sugiyama, Yoshiki

    2012-01-01

    The purpose of this study was to show the effectiveness of combining intra-arterial infusion and systemic chemotherapy with concurrent radiotherapy for treatment of stage IV mandibular gingival cancer. A total of 23 patients with mandibular gingival cancer were treated with either docetaxel by intra-arterial infusion followed by systemic chemoradiotherapy with cisplatinum and 5-fluorouracil as a monthly regimen, or with docetaxel and cisplatinum by intra-arterial infusion followed by systemic chemoradiotherapy with 5-fluorouracil as a weekly or biweekly regimen. Tumor responses, locoregional control, overall survival, disease-specific survival, and adverse events were evaluated. Of the 23 patients enrolled in the study, 22 completed the treatment. With regard to clinical stages, 82% were diagnosed as IVA and 18% IVB. Complete and partial response was observed in 82 and 18%, respectively. Five-year overall survival, disease-specific survival, and locoregional control were 51, 70, and 72%, respectively. No statistically significant difference was seen between the monthly regimen and the weekly plus biweekly regimen, although the latter resulted in longer survival and 88% control. Combined intra-arterial infusion and systemic chemoradiotherapy may be an effective treatment for patients with stage IV mandibular gingival cancer. (author)

  14. A Formal Palliative Care Service Improves the Quality of Care in Patients with Stage IV Cancer and Bowel Obstruction.

    Science.gov (United States)

    Gabriel, Emmanuel; Kukar, Moshim; Groman, Adrienne; Alvarez-Perez, Amy; Schneider, Jaclyn; Francescutti, Valerie

    2017-02-01

    Patients with stage IV cancer and bowel obstruction present a complicated management problem. The aim of this study was to evaluate the role of the palliative care service (PC) in the management of this complex disease process. A retrospective analysis was conducted of all patients admitted to Roswell Park Cancer Institute with stage IV cancer and bowel obstruction from 2009 to 2012 after the institution of a formal PC. This cohort was matched to similar patients from 2005 to 2008 (no palliative care service or NPC). Patient characteristics and outcomes included baseline demographics, comorbid conditions, do-not-resuscitate (DNR) status, laboratory parameters, medical and surgical management, length of stay, symptom relief, and disposition status. A total of 19 patients were identified in the PC group. Based on the PC group baseline characteristics, 19 patients were identified for the NPC group using matched values. Regarding outcomes, there were significant differences in the medication regimens (narcotics, octreotide, and Decadron) between the 2 groups. In the PC group, 14 of 19 patients showed improvement compared to 9 of 19 in the NPC group. Nearly 60% of patients in the PC group had a formal DNR order versus 10.5% in NPC ( P = .002). A significantly higher percentage of patients were discharged to hospice in the PC group (47.4% vs 0.0%, P = .006). Palliative care consultation improves the quality of care for patients with stage IV cancer and bowel obstruction, with particular benefits in symptom management, end-of-life discussion, and disposition to hospice.

  15. Bone radioisotope scanning: usefulness in the evaluation and observation of patients with breast cancer in clinical stage II, III, IV

    International Nuclear Information System (INIS)

    Cano P, R.A.

    1995-01-01

    The clinical records of 420 patients with diagnosis of breast cancer well documented by the pathological anatomy in clinical stage II, III and IV were reviewed. In each one of them has been done at least a bone scanning during the diagnosis. In 52 cases carried out sericeous dosages of CA 15-3 and in some cases it was necessary to administer Samarium-153 EDTMP as palliative therapy of bone pain. The presence of secondary gamma-graphic focuses was 0/84 cases (0%) in clinical stage II, 54/265 cases (20%) in III and 41/91 cases (45%) in IV. The one focus appeared in 6.7% of the cases. In 7 of the 52 cases that received sericeous dosages of CA 15-3 were detected secondary osseous lesions, and 5 of them presented a marker elevation. The bone scanning has shown in many cases the presence of getters focuses in singular places of skeleton, urinary excretory system or mammary tissue. The gamma rays from Sm-153 allowed us to get some appropriate basal views post-therapy of the secondary lesions. The results show that the great incidence of secondary lesions in the skeleton occurred in cases of stages III and IV unlike other countries. The serial repetition of the radioisotope scanning. The presence of one focus in the skeleton of a patient with a well-known neoplasia makes us to do a careful evaluation of the focus nature. The presence of tracer accumulation in the kidney, ureter and bladder allows us to infer the pathology of excretory system that is the first evidence of its presence in many cases. (author). 71 refs., 7 figs., 6 tabs

  16. Prognostic Significance of Peritoneal Metastasis in Stage IV Colorectal Cancer Patients With R0 Resection: A Multicenter, Retrospective Study.

    Science.gov (United States)

    Arakawa, Keiichi; Kawai, Kazushige; Ishihara, Soichiro; Hata, Keisuke; Nozawa, Hiroaki; Oba, Koji; Sugihara, Kenichi; Watanabe, Toshiaki

    2017-10-01

    Stage IV colorectal cancer encompasses various clinical conditions. The differences in prognosis after surgery between different metastatic organs have not been fully investigated. This study aimed to assess prognostic significance in peritoneal metastasis in R0 resected stage IV colorectal cancer. We conducted a multicenter retrospective study of patients with R0 resected stage IV colorectal cancer; they were categorized into 3 groups according to the number and location of metastatic organs, including single-organ metastasis in the peritoneum, single-organ metastasis at sites except the peritoneum, and multiple-organ metastases. This study used data accumulated by the Japanese Study Group for Postoperative Follow-Up of Colorectal Cancer. A total of 1133 patients with R0 resected stage IV colorectal cancer were registered retrospectively between 1997 and 2007 in 20 referral hospitals. Cancer-specific survival rates between the groups were measured. The median cancer-specific survival of the single-organ metastasis in the peritoneum group was considerably shorter than that of the single-organ metastasis at a site other than the peritoneum group and was almost comparable to that of the multiple-organ metastases group (3.41 years, 6.20 years, and 2.99 years). In a multivariate analysis of cancer-specific survival, peritoneal dissemination was confirmed as an independent prognostic factor of survival. The median postrecurrence survival of single-organ metastasis in the peritoneum group was considerably shorter than that of the single-organ metastasis at a site other than the peritoneum group. Approximately half of the patients who experienced recurrence of single-organ metastasis in the peritoneum experienced peritoneal recurrence. This was a retrospective, population-based study that requires a prospective design to validate its conclusions. Peritoneal metastasis of colorectal cancer frequently recurred in the peritoneum even after R0 resection. The cancer

  17. Phase II Study of HER-2/Neu Intracellular Domain Peptide-Based Vaccine Administered to Stage IV HER2 Positive Breast Cancer Patients Receiving Trastuzumab

    National Research Council Canada - National Science Library

    Disis, Mary L

    2005-01-01

    .... This proposal outlines a Phase II clinical trial designed to estimate survival in Stage IV HER2 positive breast cancer patients with no evidence of disease and receiving trastuzumab and a HER2 ICD peptide based vaccine...

  18. Phase II Study of HER-2/neu Intracellular Domain Peptide-Based Vaccine Administered to Stage IV HER2 Positive Breast Cancer Patients Receiving Trastuzumab

    National Research Council Canada - National Science Library

    Disis, Mary L

    2006-01-01

    The primary purpose of this grant is to determine the overall survival benefit in Stage IV HER2 positive breast cancer patients vaccinated with a HER2 ICD peptide-based vaccine while receiving maintenance trastuzumab...

  19. Phase II Study of HER-2/neu Intracellular Domain Peptide-Based Vaccine Administered to Stage IV HER2 Positive Breast Cancer Patients Receiving Trastuzumab

    National Research Council Canada - National Science Library

    Disis, Mary L

    2007-01-01

    The primary purpose of this grant is to determine the overall survival benefit in Stage IV HER2 positive breast cancer patients vaccinated with a HER2 ICD peptide-based vaccine while receiving maintenance trastuzumab...

  20. CORRELATION OF OCULAR PERFUSION PRESSURE AND INTRAOCULAR PRESSURE CHANGES DURING HAEMODIALYSIS IN END STAGE RENAL DISEASE- AN OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    T. R. Anuradha

    2017-12-01

    Full Text Available BACKGROUND Chronic kidney disease patients on haemodialysis have a transient raise in intraocular pressure and decrease in ocular perfusion pressure. This is used in early detection of glaucomatous optic nerve damage and subsequent irreversible visual loss. MATERIALS AND METHODS 100 chronic kidney disease patients under haemodialysis in the nephrology department, Stanley medical college for more than one month were included in the study. We recorded complete history, and all participants were subjected to Intraocular pressure and blood pressure measurement at 3 different timings during haemodialysis session. Mean Arterial Pressure (MAP, Ocular Perfusion Pressure (OPP, Systolic Ocular Perfusion Pressure (SOPP, Diastolic Ocular Perfusion Pressure (DOPP and Mean Ocular Perfusion Pressure (MOPP were calculated. RESULTS Mean IOP from the initiation to the end of haemodialysis was found to be increased. Mean arterial pressure, ocular perfusion pressure, systolic ocular perfusion pressure, diastolic ocular perfusion pressure, mean ocular perfusion pressure was found to be decreased from the initiation to the end of haemodialysis. At the end of study period, 10% were found to develop early glaucomatous field defects and early optic nerve head changes in both eyes at follow-up. CONCLUSION Our study reveals the importance of screening and monitoring of intraocular pressure and characteristic early optic nerve head changes and early visual field changes of glaucoma in end-stage renal disease patients who are on haemodialysis.

  1. Pressure, stress, and strain distribution in the double-stage diamond anvil cell

    Energy Technology Data Exchange (ETDEWEB)

    Lobanov, Sergey S., E-mail: slobanov@carnegiescience.edu [Geophysical Laboratory, Carnegie Institution of Washington, Washington, District of Columbia 20015 (United States); V.S. Sobolev Institute of Geology and Mineralogy SB RAS, Novosibirsk 630090 (Russian Federation); Prakapenka, Vitali B.; Prescher, Clemens [Center for Advanced Radiation Sources, University of Chicago, Chicago, Illinois 60632 (United States); Konôpková, Zuzana; Liermann, Hanns-Peter [Photon Science DESY, D-22607 Hamburg (Germany); Crispin, Katherine L. [Geophysical Laboratory, Carnegie Institution of Washington, Washington, District of Columbia 20015 (United States); Zhang, Chi [Key Laboratory of Earth and Planetary Physics, Institute of Geology and Geophysics CAS, Beijing 100029 (China); Goncharov, Alexander F. [Geophysical Laboratory, Carnegie Institution of Washington, Washington, District of Columbia 20015 (United States); Key Laboratory of Materials Physics, Institute of Solid State Physics CAS, Hefei 230031 (China); University of Science and Technology of China, Hefei 230026 (China)

    2015-07-21

    Double stage diamond anvil cells (DACs) of two designs have been assembled and tested. We used a standard symmetric DAC with flat or beveled culets as a primary stage and CVD microanvils machined by a focused ion beam as a second. We evaluated pressure, stress, and strain distributions in gold and a mixture of gold and iron as well as in secondary anvils using synchrotron x-ray diffraction with a micro-focused beam. A maximum pressure of 240 GPa was reached independent of the first stage anvil culet size. We found that the stress field generated by the second stage anvils is typical of conventional DAC experiments. The maximum pressures reached are limited by strains developing in the secondary anvil and by cupping of the first stage diamond anvil in the presented experimental designs. Also, our experiments show that pressures of several megabars may be reached without sacrificing the first stage diamond anvils.

  2. Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer.

    Science.gov (United States)

    Kleespies, Axel; Füessl, Kathrin E; Seeliger, Hendrik; Eichhorn, Martin E; Müller, Mario H; Rentsch, Markus; Thasler, Wolfgang E; Angele, Martin K; Kreis, Martin E; Jauch, Karl-Walter

    2009-09-01

    The benefit of elective primary tumor resection for non-curable stage IV colorectal cancer (CRC) remains largely undefined. We wanted to identify risk factors for postoperative complications and short survival. Using a prospective database, we analyzed potential risk factors in 233 patients, who were electively operated for non-curable stage IV CRC between 1996 and 2002. Patients with recurrent tumors, resectable metastases, emergency operations, and non-resective surgery were excluded. Risk factors for increased postoperative morbidity and limited postoperative survival were identified by multivariate analyses. Patients with colon cancer (CC = 156) and rectal cancer (RC = 77) were comparable with regard to age, sex, comorbidity, American Society of Anesthesiologists score, carcinoembryonic antigen levels, hepatic spread, tumor grade, resection margins, 30-day mortality (CC 5.1%, RC 3.9%) and postoperative chemotherapy. pT4 tumors, carcinomatosis, and non-anatomical resections were more common in colon cancer patients, whereas enterostomies (CC 1.3%, RC 67.5%, p 50%, and comorbidity >1 organ. Prognostic factors for limited postoperative survival were hepatic tumor load >50%, pT4 tumors, lymphatic spread, R1-2 resection, and lack of chemotherapy. Palliative resection is associated with a particularly unfavorable outcome in rectal cancer patients presenting with a locally advanced tumor (pT4, expected R2 resection) or an extensive comorbidity, and in all CRC patients who show a hepatic tumor load >50%. For such patients, surgery might be contraindicated unless the tumor is immediately life-threatening.

  3. Steered molecular dynamics simulations of a type IV pilus probe initial stages of a force-induced conformational transition.

    Directory of Open Access Journals (Sweden)

    Joseph L Baker

    2013-04-01

    Full Text Available Type IV pili are long, protein filaments built from a repeating subunit that protrudes from the surface of a wide variety of infectious bacteria. They are implicated in a vast array of functions, ranging from bacterial motility to microcolony formation to infection. One of the most well-studied type IV filaments is the gonococcal type IV pilus (GC-T4P from Neisseria gonorrhoeae, the causative agent of gonorrhea. Cryo-electron microscopy has been used to construct a model of this filament, offering insights into the structure of type IV pili. In addition, experiments have demonstrated that GC-T4P can withstand very large tension forces, and transition to a force-induced conformation. However, the details of force-generation, and the atomic-level characteristics of the force-induced conformation, are unknown. Here, steered molecular dynamics (SMD simulation was used to exert a force in silico on an 18 subunit segment of GC-T4P to address questions regarding the nature of the interactions that lead to the extraordinary strength of bacterial pili. SMD simulations revealed that the buried pilin α1 domains maintain hydrophobic contacts with one another within the core of the filament, leading to GC-T4P's structural stability. At the filament surface, gaps between pilin globular head domains in both the native and pulled states provide water accessible routes between the external environment and the interior of the filament, allowing water to access the pilin α1 domains as reported for VC-T4P in deuterium exchange experiments. Results were also compared to the experimentally observed force-induced conformation. In particular, an exposed amino acid sequence in the experimentally stretched filament was also found to become exposed during the SMD simulations, suggesting that initial stages of the force induced transition are well captured. Furthermore, a second sequence was shown to be initially hidden in the native filament and became exposed upon

  4. Steered molecular dynamics simulations of a type IV pilus probe initial stages of a force-induced conformational transition.

    Science.gov (United States)

    Baker, Joseph L; Biais, Nicolas; Tama, Florence

    2013-04-01

    Type IV pili are long, protein filaments built from a repeating subunit that protrudes from the surface of a wide variety of infectious bacteria. They are implicated in a vast array of functions, ranging from bacterial motility to microcolony formation to infection. One of the most well-studied type IV filaments is the gonococcal type IV pilus (GC-T4P) from Neisseria gonorrhoeae, the causative agent of gonorrhea. Cryo-electron microscopy has been used to construct a model of this filament, offering insights into the structure of type IV pili. In addition, experiments have demonstrated that GC-T4P can withstand very large tension forces, and transition to a force-induced conformation. However, the details of force-generation, and the atomic-level characteristics of the force-induced conformation, are unknown. Here, steered molecular dynamics (SMD) simulation was used to exert a force in silico on an 18 subunit segment of GC-T4P to address questions regarding the nature of the interactions that lead to the extraordinary strength of bacterial pili. SMD simulations revealed that the buried pilin α1 domains maintain hydrophobic contacts with one another within the core of the filament, leading to GC-T4P's structural stability. At the filament surface, gaps between pilin globular head domains in both the native and pulled states provide water accessible routes between the external environment and the interior of the filament, allowing water to access the pilin α1 domains as reported for VC-T4P in deuterium exchange experiments. Results were also compared to the experimentally observed force-induced conformation. In particular, an exposed amino acid sequence in the experimentally stretched filament was also found to become exposed during the SMD simulations, suggesting that initial stages of the force induced transition are well captured. Furthermore, a second sequence was shown to be initially hidden in the native filament and became exposed upon stretching.

  5. Prediction of pressure between packers of staged fracturing pipe strings in high-pressure deep wells and its application

    Directory of Open Access Journals (Sweden)

    Fuxiang Zhang

    2015-03-01

    Full Text Available Addressing to the deteriorated load conditions of working string and packers caused by annular pressure drop between packers during the staged stimulation of high-pressure deep well, one 2D temperature field transient prediction model for borehole under injecting conditions which considers such influences as friction heat, convection heat exchange was set up, based on energy conservation principle and borehole heat transfer theory. By means of analyzing the influences of borehole temperature and pressure changes on the annular volume between packers, and in combination with borehole temperature transient prediction model, annular fluid PVT equations of state, radial deformation model of tubing and formation transient seepage equation, a typical high-pressure deep well inter-packer annular pressure prediction model was established. Taking a high-pressure gas well in Tarim Oilfield for example, the inter-packer annular pressure prediction was conducted, on which, the mechanical analysis on packers and working strings was carried out. The analysis results show that although the pipe string is safe in the viewpoint of conventional design methods, it is still susceptible to failure after the annular pressure drop between packers was taken into consideration. Such factor should be fully considered in the design of staged stimulation pipe strings, and this prediction model provides new thoughts for the optimal design of high-pressure deep well staged stimulation pipe strings.

  6. Mathematical modeling of the heat treatment and combustion of a coal particle. IV. Ignition stage

    Science.gov (United States)

    Enkhjargal, Kh.; Salomatov, V. V.

    2011-07-01

    The present paper is the continuation of the previous publications of the present authors in the Journal of Engineering Physics under the general title in which three sequential stages of the thermal preparation of a carbon particle for combustion are considered: heating, drying, and the yield of volatiles. The present paper is devoted to a detailed investigation of the stage of ignition of a carbon particle under the conditions of external radiative-convective supply that most adequately reflects the furnace medium. The characteristics of thermal ignition of a carbon matrix were studied with the aid of the adiabatic method. Such parameters as time and the heating temperature, the time of induction, the total time and the temperature of ignition of a carbon particle, the scale temperature, etc. have been found. The degree of dependence of the time of ignition on the initial temperature of the particle, the temperature of the external medium, heat transfer coefficient, and other inlet data has been analyzed.

  7. Uterine Prolapse Following Fundal Pressure in the First Stage of ...

    African Journals Online (AJOL)

    ANNALS

    through the cervical os as they were both high up in the pelvis. An attempt at replacing the prolapsed cervix to its normal position failed. Figure 1. Uterovaginal prolapse with oedematous cervix. A diagnosis of multipara with a second degree uterine prolapse most likely due to fundal pressure and obstructed labor was made.

  8. Preliminary use of a hydrogel containing enzymes in the treatment of stage II and stage III pressure ulcers.

    Science.gov (United States)

    Parnell, Linda K S; Ciufi, Brandi; Gokoo, Charles F

    2005-08-01

    Considerable progress has been made in the prevention and treatment of pressure ulcers but they remain a significant healthcare problem, particularly among the elderly. Treatment may include the use of wound dressings such as hydrogels as well as debridement products that contain relatively high concentrations of various enzymes. Unlike enzymes found in debridement products, low concentrations of endopeptidase enzymes can cleave to denatured proteins. Many endopeptidases have been reported to enhance the healing process. To evaluate the effect of a hydrogel wound dressing containing a combination of endopeptidases on pressure ulcers, a 12-week prospective preliminary study was conducted involving 10 nursing home patients with Stage II (n = 3) or Stage III (n = 7) ulcers that had failed to respond to previous treatments. Seven subjects (three with Stage II ulcers and four with Stage III ulcers) completed the study. Healing was based on wound closure by re-epithelialization as determined by area measurement and clinical assessment. All three Stage II ulcers and two of the Stage III ulcers healed completely; four Stage III ulcers were categorized as healing (>60% improvement) after 12 weeks of care. No dressing-related adverse events occurred and subject acceptance of the product, including comfort, was high. These results suggest that additional studies designed to define the possible contribution of endopeptidase enzymes in wound healing are warranted.

  9. Rituximab for the first-line treatment of stage III/IV follicular non-Hodgkin's lymphoma.

    Science.gov (United States)

    Dundar, Y; Bagust, A; Hounsome, J; McLeod, C; Boland, A; Davis, H; Walley, T; Dickson, R

    2009-06-01

    This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of rituximab for the first-line treatment of stage III/IV follicular non-Hodgkin's lymphoma (FNHL) based upon the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The manufacturer's scope restricts the intervention to rituximab in combination with CVP (cyclophosphamide, vincristine and prednisolone) (R-CVP); the only comparator used was CVP alone. The evidence from the one included randomised controlled trial (RCT) suggests that the addition of rituximab to a CVP chemotherapy regimen has a positive effect on the outcomes of time to treatment failure, disease progression, overall tumour response, duration of response and time to new lymphoma treatment in patients with stage III/IV FNHL compared with CVP alone. Adverse events were comparable between the two arms. This study was confirmed as the only relevant RCT. The economic analyses provided by the manufacturer were modelled using a three-state Markov model with with the health states being defined as progression-free survival (PFS), progressed (in which patients have relapsed) and death (which is an absorbing state). The model generated results for a cohort of patients with an initial age of 53 and makes no distinction between men and women. The model is basic in design, with several serious design flaws and key parameter values that are probably incompatible. Attempting to rectify the identified errors and limitations of the model did not increase the incremental cost-effectiveness ratio (ICER) above 30,000 pounds. Although the cost-effectiveness results obtained appear to be compelling in support of R-CVP compared with CVP for the trial population the results may not be so convincing for a more representative population. The results of the ERG analysis on the impact of age suggest that ICERs increase

  10. Complete resection of the primary lesion improves survival of certain patients with stage IV non-small cell lung cancer.

    Science.gov (United States)

    Chikaishi, Yasuhiro; Shinohara, Shinji; Kuwata, Taiji; Takenaka, Masaru; Oka, Soichi; Hirai, Ayako; Yoneda, Kazue; Kuroda, Kouji; Imanishi, Naoko; Ichiki, Yoshinobu; Tanaka, Fumihiro

    2017-12-01

    The standard treatment for patients with stage IV non-small cell lung cancer (NSCLC) is systemic chemotherapy. However, certain patients, such as those with oligometastasis or M1a disease undergo resection of the primary lesion. We conducted a retrospective review of the records of 1,471 consecutive patients with NSCLC who underwent resection of the primary lesion for between June 2005 and May 2016. The present study included 38 patients with stage IV NSCLC who underwent complete resection of the primary lesion as first-line treatment. The median follow-up duration for the 38 patients (27 men) was 17.7 months (range, 1-82.3 months). The T factors were T1/T2/T3/T4 in 4/16/12/6 patients, respectively. The N factors were N0/N1/N2/N3 in 16/8/12/2 patients, respectively. The M factors were M1a/M1b/M1c in 19/13/6 patients, respectively. Of the 19 M1a patients, 11 were classified as cM0. We introduced the novel classification M-better/M-worse. M-better includes cM0 patients and M1b and M1c patients in whom all lesions have been locally controlled. M-worse includes cM1a patients and M1b and M1c patients in whom lesions cannot be locally controlled. The new M-better/M-worse statuses were 24/14 patients, respectively. The histology of NSCLC was adenocarcinoma/squamous cell carcinoma/others in 30/5/3 patients, respectively. The 5-year overall survival rate was 29%, and the median survival time was 725 days. Squamous cell carcinoma and M-worse were significant factors predicting poor outcomes (P=0.0017, P=0.0007, respectively). Even for stage IV NSCLC patients, resection of the primary lesion may be beneficial, especially for those with M-better status and those not diagnosed with squamous-cell carcinoma (SCC).

  11. Differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer

    Directory of Open Access Journals (Sweden)

    Kim IY

    2015-11-01

    Full Text Available Ik Yong Kim,1,* Bo Ra Kim,2,* Hyun Soo Kim,2 Young Wan Kim1 1Department of Surgery, Division of Colorectal Surgery, 2Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea *These authors contributed equally to this work Purpose: To identify differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer. We also evaluated short-term and oncologic outcomes after laparoscopy and open surgery.Methods: A total of 100 consecutive stage IV patients undergoing open (n=61 or laparoscopic (n=39 major resection were analyzed. There were four cases (10% of conversion to laparotomy in the laparoscopy group.Results: Pathological T4 tumors (56% vs 26%, primary colon cancers (74% vs 51%, and larger tumor diameter (6 vs 5 cm were more commonly managed with open surgery. Right colectomy was more common in the open surgery group (39% and low anterior resection was more common in the laparoscopy group (39%, P=0.002. Hepatic metastases in segments II, III, IVb, V, and VI were more frequently resected with laparoscopy (100% than with open surgery (56%, although the difference was not statistically significant. In colon and rectal cancers, mean operative time and 30-day complication rates of laparoscopy and open surgery did not differ. In both cancers, mean time to soft diet and length of hospital stay were shorter in the laparoscopy group. Mean time from surgery to chemotherapy commencement was significantly shorter with laparoscopy than with open surgery. In colon and rectal cancers, 2-year cancer-specific and progression-free survival rates were similar between the laparoscopy and open surgery groups.Conclusion: Based on our findings, laparoscopy can be selected as an initial approach in patients with a primary tumor without adjacent organ invasion and patients without primary tumor-related symptoms. In selected stage

  12. Multimodal physiotherapeutic management for stage-IV osteitis pubis in a 15-year old soccer athlete: a case report.

    Science.gov (United States)

    Vijayakumar, P; Nagarajan, M; Ramli, Ayiesah

    2012-01-01

    Osteitis pubis among soccer athletes is a disabling painful condition and it is difficult to manage without integrating a multimodal treatment approach. There is limited scientific evidence on the effectiveness of exercise in treating Osteitis pubis especially when it progress to a chronic painful condition. The purpose of this case report is to discuss the successful multimodal physiotherapeutic management for a 15-year old soccer athlete diagnosed with stage-IV Osteitis pubis. Land and water based active core muscle strengthening exercises, Proprioceptive neuromuscular facilitation techniques (PNF) and Manual Therapy are some of the essential components incorporated in multimodal intervention approach with emphasis to water based strength and endurance training exercises. The athlete was able to make progress to a successful recovery from his chronic painful condition and accomplished the clearly established clinical outcomes during each phase of rehabilitation.

  13. Treatment patterns of advanced malignant melanoma (stage III-IV) - A review of current standards in Europe.

    Science.gov (United States)

    Harries, Mark; Malvehy, Josep; Lebbe, Céleste; Heron, Louise; Amelio, Justyna; Szabo, Zsolt; Schadendorf, Dirk

    2016-06-01

    With the recent emergence of immunotherapies and novel targeted treatments for advanced and metastatic melanoma such as selective B-Raf inhibitors and checkpoint inhibitors, the treatment landscape in Europe has changed considerably. The aim of this review was to provide an overview of current treatment pathways in Europe for the treatment of advanced melanoma, unresectable stage III-IV. A literature search of four databases was conducted to identify publications reporting on the treatment patterns of advanced and metastatic melanoma (stage III-IV) in European populations. Seven full-text publications and two conference abstracts reported on observational studies of melanoma treatment practices in France, Italy and the United Kingdom. Treatment patterns were identified for two time periods: 2005-2009 and 2011-2012. Common treatments reported for both periods included chemotherapy with dacarbazine, fotemustine or temozolomide. The main differences between the two periods were the introduction and prescription of immunotherapy ipilimumab and targeted therapy vemurafenib between 2011 and 2012. Across the three countries studied, the types of treatments prescribed between 2005 and 2009 were relatively similar, however, with noticeable differences in the frequency and priority of administration. Treatment practices for advanced melanoma vary markedly across different European countries and continue to evolve with the introduction of new therapies. The results of this review highlight a considerable evidence gap with regards to recent treatment patterns for advanced melanoma in Europe, especially post-2011 after the introduction of novel therapeutic agents, and more recently with the introduction of programmed cell death 1 inhibitors. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Stage III & IV colon and rectal cancers share a similar genetic profile: a review of the Oregon Colorectal Cancer Registry.

    Science.gov (United States)

    Gawlick, Ute; Lu, Kim C; Douthit, Miriam A; Diggs, Brian S; Schuff, Kathryn G; Herzig, Daniel O; Tsikitis, Vassiliki L

    2013-05-01

    Determining the molecular profile of colon and rectal cancers offers the possibility of personalized cancer treatment. The purpose of this study was to determine whether known genetic mutations associated with colorectal carcinogenesis differ between colon and rectal cancers and whether they are associated with survival. The Oregon Colorectal Cancer Registry is a prospectively maintained, institutional review board-approved tissue repository with associated demographic and clinical information. The registry was queried for any patient with molecular analysis paired with clinical data. Patient demographics, tumor characteristics, microsatellite instability status, and mutational analysis for p53, AKT, BRAF, KRAS, MET, NRAS, and PIK3CA were analyzed. Categorical variables were compared using chi-square tests. Continuous variables between groups were analyzed using Mann-Whitney U tests. Kaplan-Meier analysis was used for survival studies. Comparisons of survival were made using log-rank tests. The registry included 370 patients: 69% with colon cancer and 31% with rectal cancer. Eighty percent of colon cancers and 68% of rectal cancers were stages III and IV. Mutational analysis found no significant differences in detected mutations between colon and rectal cancers, except that there were significantly more BRAF mutations in colon cancers compared with rectal cancers (10% vs 0%, P colon versus rectal cancers when stratified by the presence of KRAS, PIK3CA, and BRAF mutations. Stage III and IV colon and rectal cancers share similar molecular profiles, except that there were significantly more BRAF mutations in colon cancers compared with rectal cancers. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Staging properties of potassium-ammonia ternary graphite intercalation compounds at high ammonia pressure

    Science.gov (United States)

    Qian, X. W.; Solin, S. A.

    1989-04-01

    The pressure dependence of the (00l) x-ray diffraction patterns of the ternary graphite intercalation compound K(NH3)xC24 has been studied in the range 0.5-11 kbar (for which x~4.5) using a diamond anvil cell. A special apparatus for loading the cell with liquid ammonia at room temperature has been constructed and is briefly described. In these experiments, the pressure-transmitting fluid was also an intercalant, namely ammonia. Therefore, the chemical potential of this species was linearly coupled to the applied pressure in contrast to the usual case where the pressure-transmitting fluid is chemically passive. The pressure dependences of the basal spacings and of the relative intensities of key reflections have been measured, as have the compressibilities of the stage-1 and stage-2 components of the two-phase system. Basal-spacing anomalies and anomalies in the relative intensities occur at pressures of ~3.5 and 8.0 kbar and are tentatively attributed to in-plane coordination changes in the potassium-ammonia ratio. Using thermodynamic arguments and Le Chatelier's principle we show quantitatively that a staging phase transition from pure stage-1 phase to an admixture of stage-1 and stage-2 is expected with increased pressure above 10 bar in agreement with experiment. The saturation ammonia compositions (x values) of the admixed stages are found to be 4.5 and 5.4 for the stage-1 and -2 components, respectively. This result is interpreted as evidence that the composition is not sterically limited but is determined by the binding energy of ammonia for potassium and by the perturbation to this energy from the guest-host interaction.

  16. Can Locoregional Treatment of the Primary Tumor Improve Outcomes for Women With Stage IV Breast Cancer at Diagnosis?

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, David H.A., E-mail: dhanguyen@yahoo.com [British Columbia Cancer Agency, Department of Radiation Oncology, BC (Canada); Departement de Radio-Oncologie, Hopital Maisonneuve-Rosemont, Montreal, Quebec (Canada); Truong, Pauline T. [British Columbia Cancer Agency, Department of Radiation Oncology, BC (Canada); Breast Cancer Outcomes Unit, British Columbia Cancer Agency, BC (Canada); University of British Columbia, BC (Canada); Alexander, Cheryl; Walter, Caroline V.; Hayashi, Emily; Christie, Jennifer [Breast Cancer Outcomes Unit, British Columbia Cancer Agency, BC (Canada); Lesperance, Mary [Department of Mathematics and Statistics, University of Victoria, BC (Canada)

    2012-09-01

    Purpose: To examine the effect of locoregional treatment (LRT) of the primary tumor on survival in patients with Stage IV breast cancer at diagnosis. Methods and Materials: The study cohort comprised 733 women referred to the British Columbia Cancer Agency between 1996 and 2005 with newly diagnosed clinical or pathologic M1 breast cancer. Tumor and treatment characteristics, overall survival (OS), and locoregional progression-free survival were compared between patients treated with (n = 378) and without (n = 355) LRT of the primary disease. Multivariable analysis was performed with Cox regression modeling. Results: The median follow-up time was 1.9 years. LRT consisted of surgery alone in 67% of patients, radiotherapy alone in 22%, and both in 11%. LRT was used more commonly in women with age <50 years, Eastern Cooperative Oncology Group (ECOG) performance status 0-1, Stage T1-2 tumors, N0-1 disease, limited M1 burden, and asymptomatic M1 disease (all p < 0.05). Systemic therapy was used in 92% of patients who underwent LRT and 85% of patients who did not. In patients treated with LRT compared with those without LRT, the 5-year OS rates were 21% vs. 14% (p < 0.001), and the rates of locoregional progression-free survival were 72% vs. 46% (p < 0.001). Among 378 patients treated with LRT, the rates of 5-year OS were higher in patients with age <50, ECOG performance status 0-1, estrogen receptor-positive disease, clear surgical margins, single subsite, bone-only metastasis, and one to four metastatic lesions (all p < 0.003). On multivariable analysis, LRT was associated with improved OS (hazard ratio, 0.78; 95% confidence interval, 0.64-0.94, p = 0.009). Conclusion: Locoregional treatment of the primary disease is associated with improved survival in some women with Stage IV breast cancer at diagnosis. Among those treated with LRT, the most favorable rates of survival were observed in subsets with young age, good performance status, estrogen receptor-positive disease

  17. Complete pathological response (ypT0N0M0) after preoperative chemotherapy alone for stage IV rectal cancer.

    Science.gov (United States)

    Naiken, Surennaidoo P; Toso, Christian; Rubbia-Brandt, Laura; Thomopoulos, Theodoros; Roth, Arnaud; Mentha, Gilles; Morel, Philippe; Gervaz, Pascal

    2014-01-17

    Complete pathological response occurs in 10-20% of patients with rectal cancer who are treated with neoadjuvant chemoradiation therapy prior to pelvic surgery. The possibility that complete pathological response of rectal cancer can also occur with neoadjuvant chemotherapy alone (without radiation) is an intriguing hypothesis. A 66-year old man presented an adenocarcinoma of the rectum with nine liver metastases (T3N1M1). He was included in a reverse treatment, aiming at first downsizing the liver metastases by chemotherapy, and subsequently performing the liver surgery prior to the rectum resection. The neoadjuvant chemotherapy consisted in a combination of oxaliplatin, 5-FU, irinotecan, leucovorin and bevacizumab (OCFL-B). After a right portal embolization, an extended right liver lobectomy was performed. On the final histopathological analysis, all lesions were fibrotic, devoid of any viable cancer cells. One month after liver surgery, the rectoscopic examination showed a near-total response of the primary rectal adenocarcinoma, which convinced the colorectal surgeon to perform the low anterior resection without preoperative radiation therapy. Macroscopically, a fibrous scar was observed at the level of the previously documented tumour, and the histological examination of the surgical specimen did not reveal any malignant cells in the rectal wall as well as in the mesorectum. All 15 resected lymph nodes were free of tumour, and the final tumour stage was ypT0N0M0. Clinical outcome was excellent, and the patient is currently alive 5 years after the first surgery without evidence of recurrence. The presented patient with stage IV rectal cancer and liver metastases was in a unique situation linked to its inclusion in a reversed treatment and the use of neoadjuvant chemotherapy alone. The observed achievement of a complete pathological response after chemotherapy should promote the design of prospective randomized studies to evaluate the benefits of chemotherapy

  18. Generation of High Pressure Oxygen via Electrochemical Pumping in a Multi-Stage Electrolysis Stack

    Science.gov (United States)

    Setlock, John A (Inventor); Green, Robert D (Inventor); Farmer, Serene (Inventor)

    2017-01-01

    An oxygen pump can produce high-purity high-pressure oxygen. Oxygen ions (O(2-)) are electrochemically pumped through a multi-stage electrolysis stack of cells. Each cell includes an oxygen-ion conducting solid-state electrolyte between cathode and anode sides. Oxygen dissociates into the ions at the cathode side. The ions migrate across the electrolyte and recombine at the anode side. An insulator is between adjacent cells to electrically isolate each individual cell. Each cell receives a similar volt potential. Recombined oxygen from a previous stage can diffuse through the insulator to reach the cathode side of the next stage. Each successive stage similarly incrementally pressurizes the oxygen to produce a final elevated pressure.

  19. Low-pressure reversible axial fan designed with different specific work of elementary stages

    Directory of Open Access Journals (Sweden)

    Bogdanović Božidar P.

    2012-01-01

    Full Text Available Low-pressure axial fan impellers designed according to the principle of equal specific work of all elementary stages have blades whose profile near the fan hub is under a significantly larger inclination angle than at the impeller periphery. In order to minimize the spatial curvature of the fan blades and the fan hub length, impeller blades of low-pressure axial fans can be designed with different specific work of elementary stages, so that the specific work of elementary stages is smaller at the hub than at the periphery. This paper presents the operating characteristics of a low-pressure reversible axial fan with straight blade profiles, designed with different specific work of elementary stages. The fan was tested on a standard test rig, with air intake loading on the suction side of the fan.

  20. Abnormalities of plantar pressure distribution in early, intermediate, and late stages of diabetic neuropathy.

    Science.gov (United States)

    Sacco, Isabel C N; Hamamoto, Adriana N; Tonicelli, Lucas M G; Watari, Ricky; Ortega, Neli R S; Sartor, Cristina D

    2014-09-01

    Inconsistent findings with regard to plantar pressure while walking in the diabetic population may be due to the heterogeneity of the studied groups resulting from the classification/grouping criteria adopted. The clinical diagnosis and classification of diabetes have inherent uncertainties that compromise the definition of its onset and the differentiation of its severity stages. A fuzzy system could improve the precision of the diagnosis and classification of diabetic neuropathy because it takes those uncertainties into account and combines different assessment methods. Here, we investigated how plantar pressure abnormalities evolve throughout different severity stages of diabetic polyneuropathy (absent, n=38; mild, n=20; moderate, n=47; severe, n=24). Pressure distribution was analysed over five areas while patients walked barefoot. Patients with mild neuropathy displayed an increase in pressure-time integral at the forefoot and a lower peak pressure at the heel. The peak and pressure-time integral under the forefoot and heel were aggravated in later stages of the disease (moderate and severe) compared with early stages of the disease (absent and mild). In the severe group, lower pressures at the lateral forefoot and hallux were observed, which could be related to symptoms that develop with the aggravation of neuropathy: atrophy of the intrinsic foot muscles, reduction of distal muscle activity, and joint stiffness. Although there were clear alterations over the forefoot and in a number of plantar areas with higher pressures within each severity stage, they did not follow the aggravation evolution of neuropathy classified by the fuzzy model. Based on these results, therapeutic interventions should begin in the early stages of this disease to prevent further consequences of the disease. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

    Science.gov (United States)

    Masters, Gregory A.; Temin, Sarah; Azzoli, Christopher G.; Giaccone, Giuseppe; Baker, Sherman; Brahmer, Julie R.; Ellis, Peter M.; Gajra, Ajeet; Rackear, Nancy; Schiller, Joan H.; Smith, Thomas J.; Strawn, John R.; Trent, David; Johnson, David H.

    2015-01-01

    Purpose To provide evidence-based recommendations to update the American Society of Clinical Oncology guideline on systemic therapy for stage IV non–small-cell lung cancer (NSCLC). Methods An Update Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of randomized controlled trials from January 2007 to February 2014. Results This guideline update reflects changes in evidence since the previous guideline. Recommendations There is no cure for patients with stage IV NSCLC. For patients with performance status (PS) 0 to 1 (and appropriate patient cases with PS 2) and without an EGFR-sensitizing mutation or ALK gene rearrangement, combination cytotoxic chemotherapy is recommended, guided by histology, with early concurrent palliative care. Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 (bevacizumab may be added to carboplatin plus paclitaxel if no contraindications); combination or single-agent chemotherapy or palliative care alone for those with PS 2; afatinib, erlotinib, or gefitinib for those with sensitizing EGFR mutations; crizotinib for those with ALK or ROS1 gene rearrangement; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma. Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break. In the second-line setting, recommendations include docetaxel, erlotinib, gefitinib, or pemetrexed for patients with nonsquamous cell carcinoma; docetaxel, erlotinib, or gefitinib for those with squamous cell carcinoma; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib. In the third-line setting, for patients who have not received erlotinib or gefitinib, treatment with erlotinib is

  2. Survival outcome depending on different treatment strategies in advanced stages III and IV laryngeal cancers: an audit of data from two European centres.

    Science.gov (United States)

    Karlsson, Therese R; Al-Azzawe, Mohammed; Aziz, Luaay; Hurman, David; Finizia, Caterina

    2014-03-01

    In light of continued uncertainty regarding efficacy of treatment of Stages III and IV laryngeal tumours, this study aims to evaluate organ-preservation strategies, comprising radiotherapy and chemoradiotherapy versus surgical treatment (laryngectomy ± adjuvant treatment) by encompassing the long-established practice at two internationally acclaimed tertiary centres not previously presented in published literature. Retrospective review was conducted of non-randomised prospectively maintained Stages III and IV disease patient databases at two tertiary centres: Sahlgrenska University Hospital (SU) in Gothenburg, Sweden, and Aberdeen Royal Infirmary (ARI) in Aberdeen, Scotland. Primary outcome measures included 3-year overall, disease-specific survival and local control depending on treatment. A total of 176 patients were identified. Sixty-five patients (37 %) presented with Stage III tumours, of which 51 patients received organ-preserving treatment and 14 underwent total laryngectomy. The corresponding figures for the 111 patients (63 %) presenting with Stage IV disease were 42 and 69. Three-year overall and disease-specific survival for Stage III was 58 and 73 %, respectively. The corresponding figures for Stage IV disease were 42 and 53 %. The choice of treatment did not appear to significantly influence survival for Stage III (p = 0.56) or IV (p = 0.93) disease. The choice of treatment, whether organ preservation or surgery, does not seem to significantly influence the overall or disease-specific survival. Therefore, other factors such as quality of life and voice and efficacy of salvage treatments are perhaps more likely to indicate the preferred treatment options, but larger randomised trials are needed.

  3. Concomitant postoperative radiation and chemotherapy following surgery was associated with improved overall survival in patients with FIGO stages III and IV endometrial cancer

    International Nuclear Information System (INIS)

    Nakayama, Kentaro; Ishikawa, Masako; Miyazaki, Khoji; Nagai, Yutaka; Aoki, Yoichi

    2010-01-01

    The aim of this study was to investigate the usefulness of concomitant postoperative radiation and chemotherapy in patients with the International Federation of Gynecology and Obstetrics (FIGO) stages III and IV endometrial cancer. A retrospective review at Shimane University and Ryukyu University, Japan, was performed of 76 patients with FIGO stages III and IV endometrial cancer. All patients had received a comprehensive staging procedure including hysterectomy, bilateral salpingo-oophorectomy, ±selective pelvic/aortic lymphadenectomy, surgical debulking, and treatment with adjuvant chemotherapy and/or radiotherapy. Seventy-six patients with FIGO stages III and IV endometrial cancer were identified who received postoperative adjuvant therapies; 26% (N=20) received radiotherapy alone, 40% (N=30) chemotherapy alone, and 34% (N=26) chemotherapy and radiotherapy. The median age was 55 years; 92% had the endometrioid type and 97% were optimally debulked. The median follow-up period was 54 (range 6-188) months. Combination therapy with chemotherapy and radiation correlated with longer overall survival compared with either chemotherapy alone (P=0.0298) or chemotherapy alone+radiation alone (P=0.0345). Combination therapy correlated with longer overall survival compared with radiation alone with marginal significance (P=0.0521). No significant differences in the disease-free interval were seen among the combination therapy and chemotherapy alone or radiation alone groups. Combined treatment with radiation and chemotherapy may improve overall survival in patients with FIGO stages III and IV endometrial cancer. (author)

  4. Decubitus grade IV (deep pressure sore) with intact skin in a patient with spinal cord injury

    NARCIS (Netherlands)

    Theunissen, C.C.W.; Zeilstra, J.T.; van Voorst Vader, P.C.; Kardaun, S.H.; Leeman, F.W.J.

    2006-01-01

    Even with intact skin the possibility of pressure sores should not be dismissed. Early recognition of a pressure sore is important for adequate treatment and prevention of progression. Multidisciplinary intervention is essential. A wheelchair patient with spinal cord injury is described, who

  5. Concomitant chemoirradiation for stage III-IV nasopharyngeal carcinoma in Chinese patients: results of a matched cohort analysis

    International Nuclear Information System (INIS)

    Chua, Daniel T.T.; Sham, Jonathan S.T.; Au, Gordon K.H.; Choy, Damon

    2002-01-01

    Purpose: To evaluate the toxicity and efficacy of concomitant chemoirradiation (CRT) followed by adjuvant chemotherapy compared with radiotherapy (RT) alone in Chinese patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Methods and Materials: Between March 1997 and September 2000, 47 Chinese patients with Stage III (n=9, 19%) and IV (n=38, 81%) NPC were treated with by CRT using cisplatin 100 mg/m 2 on Days 1, 22, and 43 of RT, plus adjuvant chemotherapy using cisplatin 80 mg/m 2 for 1 day and 5-fluorouracil 1 g/m 2 for 4 days on Days 71, 99, and 127. These patients were then compared with a cohort of 47 patients treated between 1990 and 1993 with RT alone, who were matched with respect to T stage, N stage, nodal bilaterality, nodal level, and nodal size. The RT techniques were similar in the two groups but different dose and fractionation schemes were used. The median biologic equivalent dose to 2 Gy per fraction delivered to the nasopharynx was 68 Gy in the CRT group and 65.3 Gy in the RT-alone group. Results: The compliance rates were 62% for concomitant chemotherapy and 40% for adjuvant chemotherapy. No treatment-related deaths occurred. At the end of treatment, 96% of the CRT group and 79% of the RT-alone group achieved a complete response (p=0.013). With a median follow-up of 26 months, the 3-year relapse-free survival, disease-specific survival, overall survival, local relapse-free survival, nodal relapse-free survival, and distant metastasis-free survival rate for the CRT group and the RT-alone group was 62% vs. 44% (p=0.048), 67% vs. 71% (p=0.88), 65% vs. 69% (p=0.93), 87% vs. 75% (p=0.059), 95% vs. 80% (p=0.026), and 75% vs. 70% (p=0.84), respectively. Conclusion: Our experience indicates that concomitant CRT improves locoregional control in Chinese patients with locoregionally advanced NPC, but our analyses failed to detect any impact on distant failure and survival. The failure to reduce distant metastasis and improve survival may have

  6. In-situ Fourier transform infrared spectroscopy gas phase studies of vanadium (IV) oxide coating by atmospheric pressure chemical vapour deposition using vanadyl (IV) acetylacetonate

    Energy Technology Data Exchange (ETDEWEB)

    Vernardou, D. [Institute for Materials Research, University of Salford, Cockroft Building, Salford, Manchester, M5 4WT (United Kingdom); Pemble, M.E. [Tyndall National institute, Lee Maltings, Prospect Row, Cork (Ireland)], E-mail: martyn.pemble@tyndall.ie; Sheel, D.W. [Institute for Materials Research, University of Salford, Cockroft Building, Salford, Manchester, M5 4WT (United Kingdom)

    2008-05-30

    This paper describes the use of in-situ Fourier transform infrared spectroscopy to monitor the gas phase reactions of the formation of VO{sub 2} thin films from VO(acac){sub 2} under atmospheric pressure chemical vapour deposition conditions. In the absence of O{sub 2}, it is found that anhydride species may form, while there is also some evidence of ester species. In the presence of O{sub 2}, the spectra obtained are almost identical to those in the absence of O{sub 2}. However in this case, there is also some indication for the enhanced production of CO and the suppression of the formation of C-H species. A possible mechanism for the formation of VO{sub 2} is proposed, which involves the release of two C{sub 3}H{sub 4} molecules and the decomposition of vanadyl (IV) acetylacetonate into VO(CH{sub 3}COO){sub 2}, which then further decomposes to yield (CH{sub 3}CO){sub 2}O and VO{sub 2}. However, while spectroscopic evidence for the formation of these species is presented, the mechanism proposed cannot be confirmed on the basis of these data alone.

  7. Fundal pressure during the second stage of labor in a tertiary obstetric center: a prospective analysis.

    Science.gov (United States)

    Moiety, Fady M Shawky; Azzam, Amal Z

    2014-04-01

    To ascertain whether uterine fundal pressure should have a role in the management of the second stage of labor and to determine its prevalence, benefits and adverse maternal-fetal outcomes. This was a prospective observational study set in a tertiary teaching and research obstetric hospital. A total of 8097 women in labor between 37 and 42 gestational weeks with a singleton cephalic presentation were enrolled. Subjects were subdivided into two groups: fundal pressure group (n=1974 women) and control group (n=6123 women). The primary outcome measure was the duration of the second stage. The secondary outcome measures were maternal outcomes (immediate or delayed) and neonatal outcomes. The prevalence of fundal pressure in our center was 24.38%. Fundal pressure maneuver significantly shortened the duration of the second stage among primiparous women, increased the risk of severe perineal laceration and admission to neonatal intensive care unit in comparison to the non-fundal group. Delayed maternal outcomes showed significant increase in dyspareunia and de novo stress urinary incontinence in the fundal pressure group. Although fundal pressure maneuver shortens the duration of the second stage of labor among primiparous women, it should not be used except when indicated, and under strict guidelines owing to its adverse maternal and fetal outcomes. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  8. Gene expression patterns in CD4+ peripheral blood cells in healthy subjects and stage IV melanoma patients.

    Science.gov (United States)

    Felts, Sara J; Van Keulen, Virginia P; Scheid, Adam D; Allen, Kathleen S; Bradshaw, Renee K; Jen, Jin; Peikert, Tobias; Middha, Sumit; Zhang, Yuji; Block, Matthew S; Markovic, Svetomir N; Pease, Larry R

    2015-11-01

    Melanoma patients exhibit changes in immune responsiveness in the local tumor environment, draining lymph nodes, and peripheral blood. Immune-targeting therapies are revolutionizing melanoma patient care increasingly, and studies show that patients derive clinical benefit from these newer agents. Nonetheless, predicting which patients will benefit from these costly therapies remains a challenge. In an effort to capture individual differences in immune responsiveness, we are analyzing patterns of gene expression in human peripheral blood cells using RNAseq. Focusing on CD4+ peripheral blood cells, we describe multiple categories of immune regulating genes, which are expressed in highly ordered patterns shared by cohorts of healthy subjects and stage IV melanoma patients. Despite displaying conservation in overall transcriptome structure, CD4+ peripheral blood cells from melanoma patients differ quantitatively from healthy subjects in the expression of more than 2000 genes. Moreover, 1300 differentially expressed genes are found in transcript response patterns following activation of CD4+ cells ex vivo, suggesting that widespread functional discrepancies differentiate the immune systems of healthy subjects and melanoma patients. While our analysis reveals that the transcriptome architecture characteristic of healthy subjects is maintained in cancer patients, the genes expressed differentially among individuals and across cohorts provide opportunities for understanding variable immune states as well as response potentials, thus establishing a foundation for predicting individual responses to stimuli such as immunotherapeutic agents.

  9. Detection of EGFR mutations with mutation-specific antibodies in stage IV non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Viteri Santiago

    2010-12-01

    Full Text Available Abstract Background Immunohistochemistry (IHC with mutation-specific antibodies may be an ancillary method of detecting EGFR mutations in lung cancer patients. Methods EGFR mutation status was analyzed by DNA assays, and compared with IHC results in five non-small-cell lung cancer (NSCLC cell lines and tumor samples from 78 stage IV NSCLC patients. Results IHC correctly identified del 19 in the H1650 and PC9 cell lines, L858R in H1975, and wild-type EGFR in H460 and A549, as well as wild-type EGFR in tumor samples from 22 patients. IHC with the mAb against EGFR with del 19 was highly positive for the protein in all 17 patients with a 15-bp (ELREA deletion in exon 19, whereas in patients with other deletions, IHC was weakly positive in 3 cases and negative in 9 cases. IHC with the mAb against the L858R mutation showed high positivity for the protein in 25/27 (93% patients with exon 21 EGFR mutations (all with L858R but did not identify the L861Q mutation in the remaining two patients. Conclusions IHC with mutation-specific mAbs against EGFR is a promising method for detecting EGFR mutations in NSCLC patients. However these mAbs should be validated with additional studies to clarify their possible role in routine clinical practice for screening EGFR mutations in NSCLC patients.

  10. Surgical reconstruction of pressure ulcer defects: a single- or two-stage procedure?

    LENUS (Irish Health Repository)

    Laing, Tereze A

    2012-02-01

    BACKGROUND: The surgical management of pressure ulcers traditionally involved staged procedures, with initial debridement of necrotic or infected material followed by reconstruction at a later date when the wound was deemed viable and free of gross infection. However, over the past decade, it has been suggested that a single-stage procedure, combining initial debridement and definitive reconstruction, may provide advantages over staged surgery. We present our experience with the staged approach and review the current evidence for both methods. SUBJECTS AND SETTINGS: : We reviewed medical records of all patients referred to our service for pressure ulcer management between October 2001 and October 2007. The National Rehabilitation Hospital is the national center in Ireland for primary rehabilitation of adults and children suffering from spinal and brain injury, serving patients locally and from around the country. METHODS: All subjects who were managed surgically underwent a 2-stage procedure, with initial debridement and subsequent reconstruction. The main outcome measures were length of hospital stay, postoperative morbidity and mortality, and time to complete ulcer healing. RESULTS: Forty-one of 108 patients with 58 pressure ulcers were managed surgically. All patients underwent initial surgical debridement and 20 patients underwent subsequent pressure ulcer reconstruction. Postreconstructive complications occurred in 5 patients (20%). The mean time to complete ulcer healing was 17.4 weeks. Partial flap necrosis occurred in 3 patients, but there were no episodes of flap failure. CONCLUSIONS: We achieved favorable results with a 2-stage reconstruction technique and suggest that the paucity of evidence related to single-stage procedures does not support a change in surgical management.

  11. Theoretical evaluation of the efficiency of gas single-stage reciprocating compressor medium pressure units

    Science.gov (United States)

    Busarov, S. S.; Vasil'ev, V. K.; Busarov, I. S.; Titov, D. S.; Panin, Ju. N.

    2017-08-01

    Developed earlier and tested in such working fluid as air, the technology of calculating the operating processes of slow-speed long-stroke reciprocating stages let the authors to obtain successful results concerning compression of gases to medium pressures in one stage. In this connection, the question of the efficiency of the application of slow-speed long-stroke stages in various fields of technology and the national economy, where the working fluid is other gas or gas mixture, is topical. The article presents the results of the efficiency evaluation of single-stage compressor units on the basis of such stages for cases when ammonia, hydrogen, helium or propane-butane mixture is used as the working fluid.

  12. Prognostic value of some tumor markers in unresectable stage IV oropharyngeal carcinoma patients treated with concomitant radiochemotherapy

    International Nuclear Information System (INIS)

    Soba, Erika; Budihna, Marjan; Smid, Lojze; Gale, Nina; Lesnicar, Hotimir; Zakotnik, Branko; Strojan, Primoz

    2015-01-01

    The aim of the study was to investigate how the expression of tumor markers p21, p27, p53, cyclin D1, EGFR, Ki-67, and CD31 influenced the outcome of advanced inoperable oropharyngeal carcinoma patients, treated with concomitant radiochemotherapy. The pretreatment biopsy specimens of 74 consecutive patients with inoperable stage IV oropharyngeal squamous cell carcinoma treated with concomitant radiochemotherapy were in retrospective study processed by immunochemistry for p21, p27, p53, cyclin D1, EGFR, Ki-67, and CD31. Disease-free survival (DFS) was assessed according to the expression of tumor markers. Patients with a high expression of p21 (≥10%), p27 (>50%), Ki-67 (>50%), CD31 (>130 vessels/mm2) and low expression of p53 (<10%), cyclin D1 (<10%) and EGFR (<10%) (favorable levels - FL) had better DFS than patients with a low expression of p21 (<10%), p27 (≤50%), Ki-67 (≤50%), CD31 (<130 vessels/mm2) and high expression of p53 (≥10%), cyclin D1 (≥10%) and EGFR (≥10%) (unfavorable levels - UL). However, statistical significance in survival between FL and UL was achieved only for p27 and cyclin D1. DFS significantly decreased with an increasing number of markers with an unfavorable level per tumor (1–4 vs. 5–7) (78% vs. 32%, respectively; p = 0.004). The number of markers per tumor with UL of expression retained prognostic significance also in multivariate analysis. Statistical significance in survival between FL and UL emerged only for p27 and cyclin D1. The number of markers per tumor with UL of expression was an independent prognostic factor for an adverse outcome

  13. Disruption of transitional stages in 24-h blood pressure in renal transplant recipients

    Directory of Open Access Journals (Sweden)

    Marcelo E Katz

    2012-03-01

    Full Text Available Patients with kidney replacement exhibit disrupted circadian rhythms. Most studies measuring blood pressure use the dipper/non-dipper classification, which does not consider analysis of transitional stages between low and high blood pressure, confidence intervals nor shifts in the time of peak, while assuming subjective onsets of night and day phases. In order to better understand the nature of daily variation of blood pressure in these patients, we analyzed 24h recordings from 41 renal transplant recipients using the non-symmetrical double-logistic fitting assessment which does not assume abruptness nor symmetry in ascending and descending stages of the blood pressure profile, and a cosine best-fitting regression method (Cosinor. Compared with matched controls, double-logistic fitting showed that the times for most of transitional stages (ascending systolic and descending systolic, diastolic and mean arterial pressure had a wider distribution along the 24 h. The proportion of individuals without daily blood pressure rhythm in the transplanted group was larger only for systolic arterial pressure, and the amplitude showed no significant difference. Furthermore, the transplant recipient group had a less pronounced slope in descending systolic and ascending mean blood pressure. Cosinor analysis confirmed the phase related changes, showing a wider distribution of times of peak (acrophases. We conclude that daily disruptions in renal transplant recipients can be explained not only by absence in diurnal variation, but also in changes in waveform-related parameters of the rhythm, and that distortions in the phase of the rhythm are the most consistent finding for the patients.

  14. A phase 2, multicenter, open-label study of sepantronium bromide (YM155) plus docetaxel in patients with stage III (unresectable) or stage IV melanoma

    International Nuclear Information System (INIS)

    Kudchadkar, Ragini; Ernst, Scott; Chmielowski, Bartosz; Redman, Bruce G; Steinberg, Joyce; Keating, Anne; Jie, Fei; Chen, Caroline; Gonzalez, Rene; Weber, Jeffrey

    2015-01-01

    Survivin is a microtubule-associated protein believed to be involved in preserving cell viability and regulating tumor cell mitosis, and it is overexpressed in many primary tumor types, including melanoma. YM155 is a first-in-class survivin suppressant. The purpose of this Phase 2 study was to evaluate the 6-month progression-free survival (PFS) rate in patients with unresectable Stage III or IV melanoma receiving a combination of YM155 plus docetaxel. The study had two parts: Part 1 established the dose of docetaxel that was tolerable in combination with YM155, and Part 2 evaluated the tolerable docetaxel dose (75 mg/m 2 ) in combination with YM155 (5 mg/m 2 per day continuous infusion over 168 h every 3 weeks). The primary endpoint was 6-month PFS rate. Secondary endpoints were objective response rate (ORR), 1-year overall survival (OS) rate, time from first response to progression, clinical benefit rate (CBR), and safety. Sixty-four patients with metastatic melanoma were treated with docetaxel and YM155. Eight patients received an initial docetaxel dose of 100 mg/m 2 and 56 patients received 75 mg/m 2 of docetaxel. Six-month PFS rate per Independent Review Committee (IRC) was 34.8% (n = 64; 95% CI, 21.3–48.6%), and per Investigator was 31.3% (n = 64; 95% CI, 19.5–43.9%). The best ORR (complete response [CR] + partial response [PR]) per IRC was 12.5% (8/64). The stable disease (SD) rate was 51.6% (33/64), leading to a CBR (CR + PR + SD) of 64.1% (41/64). Estimated probability of 1-year survival was 56.3%. YM155 is a novel agent showing modest activity when combined with docetaxel for treating patients with melanoma. YM155 was generally well tolerated, but the predetermined primary efficacy endpoint (i.e., 6-month PFS rate ≥20%) was not achieved

  15. Pressure ulcer risk factors in persons with SCI: Part I: Acute and rehabilitation stages.

    Science.gov (United States)

    Gélis, A; Dupeyron, A; Legros, P; Benaïm, C; Pelissier, J; Fattal, C

    2009-02-01

    Pressure ulcers (PUs) are a common complication following a spinal-cord injury (SCI). Good prevention requires identifying the individuals at risk for developing PUs. Risk assessment scales used nowadays were designed on pathophysiological concepts and are not SCI-specific. Recently, an epidemiological approach to PU risk factors has been proposed to design an SCI-specific assessment tool. The first results seem quite disappointing, probably because of the level of evidence of the risk factors used. To determine PU risk factors correlated to the patients with SCI, medical care management during the acute as well as in the rehabilitation and chronic stages. This first part focuses on identifying the risk factors during the acute and rehabilitation stages. Systematic review of the literature. Six studies met our inclusion criteria. The risk factors during the acute stage of an SCI are essentially linked to care management and treatment modalities. There is insufficient evidence to make a recommendation on medical risk factors, except for low blood pressure on admission to the Emergency Room, with a moderate level of evidence. Regarding the rehabilitation stage, no study was deemed relevant. Additional observational studies are needed, for both the acute and rehabilitation stages, to improve this level of evidence. However, this systematic review unveiled the need for a carefully assessed t care management and the related practices, especially during the acute stage of an SCI.

  16. Effects of Concord grape juice on ambulatory blood pressure in prehypertension and stage 1 hypertension123

    Science.gov (United States)

    Dohadwala, Mustali M; Hamburg, Naomi M; Holbrook, Monika; Kim, Brian H; Duess, Mai-Ann; Levit, Aaron; Titas, Megan; Chung, William B; Vincent, Felix B; Caiano, Tara L; Frame, Alissa A; Keaney, John F

    2010-01-01

    Background: Consumption of flavonoid-containing foods may be useful for the management of hypertension. Objective: We investigated whether 100% Concord grape juice lowers blood pressure in patients with prehypertension and stage 1 hypertension. Design: We conducted a double-blind crossover study to compare the effects of grape juice (7 mL · kg−1 · d−1) and matched placebo beverage on 24-h ambulatory blood pressure, stress-induced changes in blood pressure, and biochemical profile. Participants consumed each beverage for 8 wk with a 4-wk rest period between beverages. They ceased consumption of grapes and other flavonoid-containing beverages throughout the study. Results: We enrolled 64 otherwise healthy patients taking no antihypertensive medications (31% women, 42% black, age 43 ± 12 y). Baseline mean (±SD) cuff blood pressure was 138 ± 7 (systolic)/82 ± 7 (diastolic) mm Hg. No effects on the primary endpoint of 24-h mean systolic blood pressure, diastolic blood pressure, or stress-induced changes in blood pressure were observed. A secondary endpoint was nocturnal dip in systolic pressure. At baseline, nocturnal pressure was 8.3 ± 7.1% lower at night than during daytime. The mean nocturnal dip increased 1.4 percentage points after grape juice and decreased 2.3 percentage points after placebo (P = 0.005). Fasting blood glucose was 91 ± 10 mg/dL at baseline for the entire cohort. Glucose decreased 2 mg/dL after consumption of grape juice and increased 1 mg/dL after consuming the placebo (P = 0.03). Conclusions: We observed no effect of grape juice on ambulatory blood pressure in this cohort of relatively healthy individuals with modestly elevated blood pressure. Secondary analyses suggested favorable effects on nocturnal dip and glucose homeostasis that may merit further investigation. This trial was registered at clinicaltrials.gov as NCT00302809. PMID:20844075

  17. The Hampton-Gledhill 2-stage pressure risk-assessment system.

    Science.gov (United States)

    Gledhill, Lee; Hampton, Sylvie

    Pressure ulcers are largely preventable and, therefore, patients dying of large, necrotic pressure damage is an unacceptable situation. Lee Gledhill is both a nurse and a barrister and has been involved in many cases involving nurses facing court proceedings when their patients' primary cause of death is pressure ulcers. Sylvie Hampton, has acted as expert witness in some of these cases. It became obvious to the two authors that had healthcare assistants (HCAs) been more aware of how pressure damage could be detected and then prevented, some of the supervising nurses would not have been facing legal charges. The authors decided to produce a simple method of assessing first-stage skin changes for HCAs to not only recognize these changes, but also to have a framework in place describing the actions they need to take. This framework was produced as a card (the Hampton-Gledhill 2-stage pressure risk-assessment system). The card is being validated in many nursing homes and hospitals around the UK and in Jersey.

  18. Bioelectrical impedance phase angle in clinical practice: implications for prognosis in stage IIIB and IV non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Grutsch James F

    2009-01-01

    Full Text Available Abstract Background A frequent manifestation of advanced lung cancer is malnutrition, timely identification and treatment of which can lead to improved patient outcomes. Bioelectrical impedance analysis (BIA is an easy-to-use and non-invasive technique to evaluate changes in body composition and nutritional status. We investigated the prognostic role of BIA-derived phase angle in advanced non-small cell lung cancer (NSCLC. Methods A case series of 165 stages IIIB and IV NSCLC patients treated at our center. The Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of phase angle, independent of stage at diagnosis and prior treatment history. Results 93 were males and 72 females. 61 had stage IIIB disease at diagnosis while 104 had stage IV. The median phase angle was 5.3 degrees (range = 2.9 – 8. Patients with phase angle 5.3 had 12.4 months (95% CI: 10.5 to 18.7; n = 84; (p = 0.02. After adjusting for age, stage at diagnosis and prior treatment history we found that every one degree increase in phase angle was associated with a relative risk of 0.79 (95% CI: 0.64 to 0.97, P = 0.02. Conclusion We found BIA-derived phase angle to be an independent prognostic indicator in patients with stage IIIB and IV NSCLC. Nutritional interventions targeted at improving phase angle could potentially lead to an improved survival in patients with advanced NSCLC.

  19. Factors associated with a poor prognosis for the IVF-ICSI live birth rate in women with rAFS stage III and IV endometriosis.

    Science.gov (United States)

    Roux, Pauline; Perrin, Jeanne; Mancini, Julien; Agostini, Aubert; Boubli, Léon; Courbiere, Blandine

    2017-07-01

    To assess the factors associated with a poor prognosis for a cumulative IVF live birth rate (LBR) in women with stage III and IV endometriosis according to the revised classification of the American Fertility Society (rAFS). A retrospective cohort study was conducted between January 1, 2010, and December 31, 2014, in our Reproductive Medicine Center. We analyzed different factors associated with a poor prognosis for a cumulative IVF LBR in women with rAFS stage III and IV endometriosis. A total of 101 patients were included, representing 232 IVF-ICSI cycles and 212 embryo transfers. The primary endpoint was the cumulative LBR per cycle and per patient. The cumulative LBR per cycle was 14.7% (n = 34) and that per patient was 31.7% (n = 32). The cumulative LBR was significantly decreased by active smoking [ adj OR = 3.4, 95% CI (1.12-10.60), p = 0.031], poor ovarian response (POR) according to the Bologna criteria [ adj OR = 11.5, 95% CI (1.37-96.83), p = 0.024], and rAFS stage IV [ adj OR = 3.2, 95% CI (1.13-8.95), p = 0.024]. The cumulative LBR per women was 59.4% without factors associated with a poor prognosis and 25.6% in the case of one factor, and it decreased to 7.7% in the case of two or three factors (p endometriosis had a negative impact on the IVF-ICSI cumulative LBR for women with rAFS stage III and IV endometriosis. Because smoking dramatically decreases the LBR with endometriosis, stopping smoking before IVF-ICSI should be strongly advised.

  20. ACTOplus Met XR in Treating Patients With Stage I-IV Oral Cavity or Oropharynx Cancer Undergoing Definitive Treatment | Division of Cancer Prevention

    Science.gov (United States)

    This randomized phase IIb trial studies how well ACTOplus met XR works in treating in patients with stage I-IV oral cavity or oropharynx cancer that are undergoing definitive treatment. Chemoprevention is the use of drugs to keep oral cavity or oropharynx cancer from forming or coming back. The use of ACTOplus met XR may slow disease progression in patients with oral cavity or oropharynx cancer. |

  1. Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer: Analysis of therapeutic results in 112 cases

    International Nuclear Information System (INIS)

    Mitsudo, Kenji; Koizumi, Toshiyuki; Iida, Masaki; Iwai, Toshinori; Nakashima, Hideyuki; Oguri, Senri; Kioi, Mitomu; Hirota, Makoto; Koike, Izumi; Hata, Masaharu; Tohnai, Iwai

    2014-01-01

    Purpose: To evaluate the therapeutic results and rate of organ preservation in patients with stage III or IV oral cancer treated with retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy. Materials and methods: One hundred and twelve patients with stage III and IV oral squamous cell carcinoma underwent intra-arterial chemoradiotherapy. Catheterization from the superficial temporal and occipital arteries was performed. Treatment consisted of superselective intra-arterial chemotherapy (docetaxel, total 60 mg/m 2 , cisplatin, total 150 mg/m 2 ) and daily concurrent radiotherapy (total of 60 Gy) for 6 weeks. Results: The median follow-up for all patients was 46.2 months (range, 10–76 months). After intra-arterial chemoradiotherapy, primary site complete response was achieved in 98 (87.5%) of 112 cases. Five-year survival and local control rates were 71.3% and 79.3%, respectively. Grade 3 or 4 toxicities included mucositis in 92.0%, neutropenia in 30.4%, dermatitis in 28.6%, anemia in 26.8%, and thrombocytopenia in 7.1% of patients. Grade 3 toxicities included dysphagia in 72.3%, nausea/vomiting in 21.4%, fever in 8.0%, and renal failure in 0.9% of patients. Conclusion: Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer provided good overall survival and local control

  2. Locally Advanced Stage IV Squamous Cell Carcinoma of the Head and Neck: Impact of Pre-Radiotherapy Hemoglobin Level and Interruptions During Radiotherapy

    International Nuclear Information System (INIS)

    Rades, Dirk; Stoehr, Monika; Kazic, Nadja; Hakim, Samer G.; Walz, Annette; Schild, Steven E.; Dunst, Juergen

    2008-01-01

    Purpose: Stage IV head and neck cancer patients carry a poor prognosis. Clear understanding of prognostic factors can help to optimize care for the individual patient. This study investigated 11 potential prognostic factors including pre-radiotherapy hemoglobin level and interruptions during radiotherapy for overall survival (OS), metastases-free survival (MFS), and locoregional control (LC) after radiochemotherapy. Methods and Materials: Eleven factors were investigated in 153 patients receiving radiochemotherapy for Stage IV squamous cell head and neck cancer: age, gender, Karnofsky performance score (KPS), tumor site, grading, T stage, N stage, pre-radiotherapy hemoglobin level, surgery, chemotherapy type, and interruptions during radiotherapy >1 week. Results: On multivariate analysis, improved OS was associated with KPS 90-100 (relative risk [RR], 2.36; 95% confidence interval [CI], 1.20-4.93; p = .012), hemoglobin ≥12 g/dL (RR, 1.88; 95% CI, 1.01-3.53; p = .048), and no radiotherapy interruptions (RR, 2.59; 95% CI, 1.15-5.78; p = .021). Improved LC was significantly associated with lower T stage (RR, 2.17; 95% CI, 1.16-4.63; p = .013), hemoglobin ≥12 g/dL (RR, 4.12; 95% CI, 1.92-9.09; p 1 week. It appears important to avoid anemia and radiotherapy interruptions to achieve the best treatment results

  3. Acetylcysteine reduces plasma homocysteine concentration and improves pulse pressure and endothelial function in patients with end-stage renal failure

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Rinder, Christiane; Beige, Joachim

    2004-01-01

    Increased oxidative stress, elevated plasma homocysteine concentration, increased pulse pressure, and impaired endothelial function constitute risk factors for increased mortality in patients with end-stage renal failure.......Increased oxidative stress, elevated plasma homocysteine concentration, increased pulse pressure, and impaired endothelial function constitute risk factors for increased mortality in patients with end-stage renal failure....

  4. Detecting early stage pressure ulcer on dark skin using multispectral imager

    Science.gov (United States)

    Yi, Dingrong; Kong, Linghua; Sprigle, Stephen; Wang, Fengtao; Wang, Chao; Liu, Fuhan; Adibi, Ali; Tummala, Rao

    2010-02-01

    We are developing a handheld multispectral imaging device to non-invasively inspect stage I pressure ulcers in dark pigmented skins without the need of touching the patient's skin. This paper reports some preliminary test results of using a proof-of-concept prototype. It also talks about the innovation's impact to traditional multispectral imaging technologies and the fields that will potentially benefit from it.

  5. Application of skin traction for surgical treatment of grade IV pressure sore: a clinical report of 160 cases.

    Science.gov (United States)

    Chen, X; Jiang, Z; Chen, Z; Wang, D

    2011-01-01

    Retrospective clinical study. To assess the method of primary surgical closure of pressure sores developed by the Ruixin Hospital for burns. Nanjing, China. The study included 235 grade IV pressure sores of 160 patients, M:F = 119:41. Their age ranged from 19 to 93 years (mean = 47.4, s.d. ± 15.7). The primary disease was spinal cord injury in 141 patients (88.1%). The location of sore spread over ischial, sacrococcygeal and trochanteric regions. The largest pressure sore measured 15 × 25 cm(2). The time from onset of sore to admission ranged from 3 months to 22 years (mean = 35.5 months, s.d. ± 55.8). Local preoperative preparation included external skin traction using adhesive tapes, wound cleaning and change of dressing. General condition was checked and improved by supportive measures. Operation procedures included thorough debridement, excision of hidden minor scars, mobilizing opposing skin flaps and meticulous haemostasis before closure. Skin traction continued after the operation until the wound was healed. All but 10 sores healed primarily. These 10 sores healed after a revision. The length of stay in hospital ranged from 20 to 140 days (mean = 45.1 days, s.d. ± 21.1). Follow-up period was 2-51 months (mean = 22 months, s.d. ± 12.5). Two ischial sores recurred owing to long sitting. They were cured with the same method. Three illustrative cases are presented. The method is simple and enjoys a high success rate with a short stay in hospital and hence is cost effective. The recurrence is rare.

  6. Prospective Cohort Study Depending on the Use of Palliative Care for Advanced Stage of Cancer Patients

    Science.gov (United States)

    2017-09-05

    Stage IV Breast Cancer; Stage IV Pancreatic Cancer; Stage IV Colon Cancer; Stage IV Gastric Cancer; Stage IV Lung Cancer; Stage IV Liver Cancer; Malignant Hematologic Neoplasm; Biliary Cancer Metastatic; Pediatric Leukemia; Pediatric Lymphoma; Pediatric Brain Tumor; Pediatric Solid Tumor

  7. Diet and Physical Activity Change or Usual Care in Improving Progression-Free Survival in Patients With Previously Treated Stage II, III, or IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

    Science.gov (United States)

    2018-02-14

    Fallopian Tube Clear Cell Adenocarcinoma; Fallopian Tube Endometrioid Adenocarcinoma; Fallopian Tube Mucinous Adenocarcinoma; Fallopian Tube Serous Adenocarcinoma; Fallopian Tube Transitional Cell Carcinoma; Malignant Ovarian Brenner Tumor; Ovarian Clear Cell Adenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mucinous Adenocarcinoma; Ovarian Seromucinous Carcinoma; Ovarian Serous Adenocarcinoma; Ovarian Transitional Cell Carcinoma; Primary Peritoneal Serous Adenocarcinoma; Stage IIA Fallopian Tube Cancer AJCC v6 and v7; Stage IIA Ovarian Cancer AJCC V6 and v7; Stage IIB Fallopian Tube Cancer AJCC v6 and v7; Stage IIB Ovarian Cancer AJCC v6 and v7; Stage IIC Fallopian Tube Cancer AJCC v6 and v7; Stage IIC Ovarian Cancer AJCC v6 and v7; Stage IIIA Fallopian Tube Cancer AJCC v7; Stage IIIA Ovarian Cancer AJCC v6 and v7; Stage IIIA Primary Peritoneal Cancer AJCC v7; Stage IIIB Fallopian Tube Cancer AJCC v7; Stage IIIB Ovarian Cancer AJCC v6 and v7; Stage IIIB Primary Peritoneal Cancer AJCC v7; Stage IIIC Fallopian Tube Cancer AJCC v7; Stage IIIC Ovarian Cancer AJCC v6 and v7; Stage IIIC Primary Peritoneal Cancer AJCC v7; Stage IV Fallopian Tube Cancer AJCC v6 and v7; Stage IV Ovarian Cancer AJCC v6 and v7; Stage IV Primary Peritoneal Cancer AJCC v7; Undifferentiated Fallopian Tube Carcinoma; Undifferentiated Ovarian Carcinoma

  8. Clinical significance of Fusobacterium nucleatum, epithelial–mesenchymal transition, and cancer stem cell markers in stage III/IV colorectal cancer patients

    Directory of Open Access Journals (Sweden)

    Yan X

    2017-10-01

    Full Text Available Xuebing Yan,1,* Liguo Liu,2,* Hao Li,1,* Huanlong Qin,1 Zhenliang Sun1,3 1Department of General Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 2Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 3Central Laboratory, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, South Campus, Shanghai, China *These authors contributed equally to this work Abstract: Colorectal cancer (CRC is a common digestive malignancy and emerging studies have closely linked its initiation and development with gut microbiota changes. Fusobacterium nucleatum (Fn has been recently identified as a pathogenic bacteria for CRC; however, its prognostic significance for patients is poorly investigated and is less for patients within late stage. Therefore, in this study, we made efforts to analyze its level and prognostic significance in a retrospective cohort of 280 stage III/IV CRC patients. We found that the Fn level was abnormally high in tumor tissues and correlated with tumor invasion, lymph node metastasis status, and distant metastasis. We also identified it as an independent adverse prognostic factor for cancer-specific survival (CSS and disease-free survival (DFS. The following subgroup analysis indicated that Fn level could stratify CSS and DFS in stage IIIB/C and IV patients but failed in stage IIIA patients. In addition, stage III/IV patients with low Fn level were found to benefit more from adjuvant chemotherapy than those with high Fn level, in terms of DFS. Finally, we analyzed the expression and clinical significance of epithelial-to-mesenchymal transition (EMT markers (E-cadherin and N-cadherin and cancer stem cell (CSC markers (Nanog, Oct-4, and Sox-2 in CRC tissues. The results indicated that N-cadherin, Nanog, Oct-4, and Sox-2 were adverse prognostic factors in these patients, while the opposite was true for E-cadherin. More importantly, expression of E

  9. Pressure ulcer risk factors in persons with spinal cord injury part 2: the chronic stage.

    Science.gov (United States)

    Gélis, A; Dupeyron, A; Legros, P; Benaïm, C; Pelissier, J; Fattal, C

    2009-09-01

    Pressure ulcers (PUs) are a common complication following spinal cord injury (SCI). Prevalence for persons in the chronic SCI stage varies between 15 and 30%. The risk assessment scales used nowadays were designed on pathophysiological concepts and are not SCI-specific. Recently, an epidemiological approach to PU risk factors has been proposed for designing an SCI-specific assessment tool. The first results seem quite disappointing, probably because of the level of evidence of the risk factors used. To determine PU risk factors correlated to the chronic stage of SCI. Systematic review of the literature. There are several PU risk factors for chronic SCI stage: socio-demographics, neurological, medical or behavioral. The level of evidence varies: it is quite high for the socio-demographics and neurological factors and low for behavioral factors. Behavioral risk factors (relieving the pressure, careful skin monitoring, smoking) are probably the ones for which a preventive strategy can be established. It is important to develop specific assessment tools for these behavioral risk factors to determine their relevance and evaluate the effect of therapeutic educational programs on persons with SCI.

  10. Impact of TBI on late effects in children treated by megatherapy for Stage IV neuroblastoma. A study of the French Society of Pediatric oncology

    International Nuclear Information System (INIS)

    Flandin, Isabelle; Hartmann, Olivier; Michon, Jean; Pinkerton, Ross; Coze, Carole; Stephan, Jean Louis; Fourquet, Bernard; Valteau-Couanet, Dominique; Bergeron, Christophe; Philip, Thierry; Carrie, Christian

    2006-01-01

    Purpose: To determine the contribution of total body irradiation (TBI) to late sequelae in children treated with high-dose chemotherapy and autologous bone marrow transplantation for Stage IV neuroblastoma. Patients and Methods: We compared two populations that were similar with regard to age, stage, pre-autologous bone marrow transplantation chemotherapy (CT) regimen, period of treatment, and follow-up (12 years). The TBI group (n = 32) received TBI as part of the megatherapy procedure (1982-1993), whereas the CT group (n 30) received conditioning without TBI (1985-1992). Analysis 12 years later focused on growth, weight and corpulence (body mass index) delay; hormonal deficiencies; liver, kidney, heart, ear, eye, and dental sequelae; school performance; and the incidence of secondary tumors. Results: Impact of TBI was most marked in relation to growth and weight delay, although the mean delay was not severe, probably because of treatment with growth hormones. Other consequences of TBI were thyroid insufficiency, cataracts, and a high incidence of secondary tumors. Hearing loss and dental agenesis were more prominent in the group treated with CT alone. No differences were observed in school performance. Conclusion: The most frequent side effects of TBI were cataracts, thyroid insufficiency, and growth delay, but more worrying is the risk of secondary tumors. Because of the young mean age of patients and the toxicity of TBI regimens without any survival advantage, regimens without TBI are preferable in the management of Stage IV neuroblastoma

  11. American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

    OpenAIRE

    Azzoli, Christopher G.; Giaccone, Giuseppe; Temin, Sarah

    2010-01-01

    ASCO published a guideline on use of chemotherapy in advanced stage non–small-cell lung cancer in 1997. The latest update covers treatment with chemotherapy and biologic agents and reviews literature from 2002 to 2009.

  12. Analysis of fatigue reliability for high temperature and high pressure multi-stage decompression control valve

    Science.gov (United States)

    Yu, Long; Xu, Juanjuan; Zhang, Lifang; Xu, Xiaogang

    2018-03-01

    Based on stress-strength interference theory to establish the reliability mathematical model for high temperature and high pressure multi-stage decompression control valve (HMDCV), and introduced to the temperature correction coefficient for revising material fatigue limit at high temperature. Reliability of key dangerous components and fatigue sensitivity curve of each component are calculated and analyzed by the means, which are analyzed the fatigue life of control valve and combined with reliability theory of control valve model. The impact proportion of each component on the control valve system fatigue failure was obtained. The results is shown that temperature correction factor makes the theoretical calculations of reliability more accurate, prediction life expectancy of main pressure parts accords with the technical requirements, and valve body and the sleeve have obvious influence on control system reliability, the stress concentration in key part of control valve can be reduced in the design process by improving structure.

  13. Effect of pressure relaxation during the laser heating and electron-ion relaxation stages

    Energy Technology Data Exchange (ETDEWEB)

    Chimier, B.; Tikhonchuk, V.T.; Hallo, L. [Univ Bordeaux 1, CEA, CNRS, CELIA, UMR 5107, 33 - Talence (France)

    2008-09-15

    The multi-phase equation of state by Bushman et al. (Sov. Tech. Rev. 5:1-44, 2008) is modified to describe states with different electron and ion temperatures and it is applied to the non-equilibrium evolution of an aluminum sample heated by a subpicosecond laser pulse. The sample evolution is described by the two-temperature model for the electron and ion temperatures, while the pressure and density are described by a simplified relaxation equation. The pressure relaxation in the heating stage reduces the binding energy and facilitates the electron-driven ablation. The model is applied to estimate the ablation depth of an Al target irradiated by a subpicosecond laser pulse. It improves the agreement with the experimental data and provides a new explanation of the ablation process. (authors)

  14. The Optimization of Four-Stage Low Pressure Turbine with Outlet Guide Vane

    Science.gov (United States)

    Matveev, V.; Baturin, O.; Popov, G.

    2018-01-01

    The goal of the research was to improve efficiency of four-stage low-pressure turbine with outlet guide vane (LPT) at the design point by optimization the shape of all turbine stator vanes and the stagger angles of all rotor blades. The LPT mathematical model was created by using NUMECA FineTurbo software. Several constraints were imposed the mass flow rate through the LPT and the total pressure ratio at the design point may vary within ±0.5% from the original. Parameters of the stator blade shape and rotor blades stagger angles were obtained. This new geometry of the LPT blades produce a 0.8% increase in efficiency at the design point.

  15. 2011 Focused Update of 2009 American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

    Science.gov (United States)

    Azzoli, Christopher G.; Temin, Sarah; Aliff, Timothy; Baker, Sherman; Brahmer, Julie; Johnson, David H.; Laskin, Janessa L.; Masters, Gregory; Milton, Daniel; Nordquist, Luke; Pao, William; Pfister, David G.; Piantadosi, Steven; Schiller, Joan H.; Smith, Reily; Smith, Thomas J.; Strawn, John R.; Trent, David; Giaccone, Giuseppe

    2011-01-01

    Purpose An American Society of Clinical Oncology (ASCO) focused update updates a single recommendation (or subset of recommendations) in advance of a regularly scheduled guideline update. This document updates one recommendation of the ASCO Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer (NSCLC) regarding switch maintenance chemotherapy. Clinical Context Recent results from phase III clinical trials have demonstrated that in patients with stage IV NSCLC who have received four cycles of first-line chemotherapy and whose disease has not progressed, an immediate switch to alternative, single-agent chemotherapy can extend progression-free survival and, in some cases, overall survival. Because of limitations in the data, delayed treatment with a second-line agent after disease progression is also acceptable. Recent Data Seven randomized controlled trials of carboxyaminoimidazole, docetaxel, erlotinib, gefitinib, gemcitabine, and pemetrexed have evaluated outcomes in patients who received an immediate, non–cross resistant alternative therapy (switch maintenance) after first-line therapy. Recommendation In patients with stage IV NSCLC, first-line cytotoxic chemotherapy should be stopped at disease progression or after four cycles in patients whose disease is stable but not responding to treatment. Two-drug cytotoxic combinations should be administered for no more than six cycles. For those with stable disease or response after four cycles, immediate treatment with an alternative, single-agent chemotherapy such as pemetrexed in patients with nonsquamous histology, docetaxel in unselected patients, or erlotinib in unselected patients may be considered. Limitations of this data are such that a break from cytotoxic chemotherapy after a fixed course is also acceptable, with initiation of second-line chemotherapy at disease progression. PMID:21900105

  16. A Case Series of Survival Outcomes in Patients with Advanced-stage IIIb/IV Non-small-cell Lung Cancer Treated with HangAm-Plus.

    Science.gov (United States)

    Bang, Sun-Hwi; Yoon, Jeung-Won; Cho, Chong-Kwan; Shin, Ji-Eun; Lee, Yeon-Weol; Yoo, Hwa-Seung

    2012-06-01

    Non-small-cell lung cancer (NSCLC) represents approximately 80% of all lung cancers. Unfortunately, at their time of diagnosis, most patients have advanced to unresectable disease with a very poor prognosis. The oriental herbal medicine HangAm-Plus(HAP) has been developed for antitumor purposes, and several previous studies have reported its therapeutic effects. In this study, the efficacy of HAP was evaluated as a third-line treatment for advanced-stage IIIb/IV NSCLC. The study involved six patients treated at the East- West Cancer Center (EWCC) from April 2010 to October 2011. Inoperable advanced-stage IIIb/IV NSCLC patients received 3,000 or 6,000 mg of HAP on a daily basis over a 12-week period. Computed tomography (CT) scans were obtained from the patients at the time of the initial administration and after 12 weeks of treatment. We observed and analyzed the patients overall survival (OS) and progression-free survival (PFS). Of the six patients, three expired during the study, and the three remaining patients were alive as of October 31, 2011. The OS ranged from 234 to 512 days, with a median survival of 397 days and a one-year survival rate of 66.7%. In the 12-week-interval chest CT assessment, three patients showed stable disease (SD), and the other three showed progressive disease (PD). The PFS of patients ranged from 88 to 512 days, the median PFS being 96 days. Longer OS and PFS were correlated with SD. Although not directly comparable, the OS and the PFS of this study were greater than those of the docetaxel or the best supportive care group in other studies. HAP may prolong the OS and the PFS of inoperable stage IIIb/IV NSCLC patients without significant adverse effects. In the future, more controlled clinical trials with larger samples from multi-centers should be conducted to evaluate the efficacy and the safety of HAP.

  17. Treatment of Early-Stage Pressure Ulcers by Using Autologous Adipose Tissue Grafts

    Directory of Open Access Journals (Sweden)

    Giovanni Francesco Marangi

    2014-01-01

    Full Text Available Assessing pressure ulcers (PUs in early stages allows patients to receive safer treatment. Up to now, in addition to clinical evaluation, ultrasonography seems to be the most suitable technique to achieve this goal. Several treatments are applied to prevent ulcer progression but none of them is totally effective. Furthermore, the in-depth knowledge of fat regenerative properties has led to a wide use of it. With this study the authors aim at introducing a new approach to cure and prevent the worsening of early-stage PUs by using fat grafts. The authors selected 42 patients who showed clinical and ultrasonographic evidence of early-stage PUs. Values of skin thickness, fascial integrity, and subcutaneous vascularity were recorded both on the PU area and the healthy trochanteric one, used as control region. Fat grafting was performed on all patients. At three months, abnormal ultrasonographic findings, such as reduction of cutaneous and subcutaneous thickness, discontinuous fascia, and decrease in subcutaneous vascularity, all were modified with respect to almost all the corresponding parameters of the control region. Results highlight that the use of fat grafts proved to be an effective treatment for early-stage PUs, especially in the care of neurological and chronic bedridden patients.

  18. Treatment of early-stage pressure ulcers by using autologous adipose tissue grafts.

    Science.gov (United States)

    Marangi, Giovanni Francesco; Pallara, Tiziano; Cagli, Barbara; Schena, Emiliano; Giurazza, Francesco; Faiella, Elio; Zobel, Bruno Beomonte; Persichetti, Paolo

    2014-01-01

    Assessing pressure ulcers (PUs) in early stages allows patients to receive safer treatment. Up to now, in addition to clinical evaluation, ultrasonography seems to be the most suitable technique to achieve this goal. Several treatments are applied to prevent ulcer progression but none of them is totally effective. Furthermore, the in-depth knowledge of fat regenerative properties has led to a wide use of it. With this study the authors aim at introducing a new approach to cure and prevent the worsening of early-stage PUs by using fat grafts. The authors selected 42 patients who showed clinical and ultrasonographic evidence of early-stage PUs. Values of skin thickness, fascial integrity, and subcutaneous vascularity were recorded both on the PU area and the healthy trochanteric one, used as control region. Fat grafting was performed on all patients. At three months, abnormal ultrasonographic findings, such as reduction of cutaneous and subcutaneous thickness, discontinuous fascia, and decrease in subcutaneous vascularity, all were modified with respect to almost all the corresponding parameters of the control region. Results highlight that the use of fat grafts proved to be an effective treatment for early-stage PUs, especially in the care of neurological and chronic bedridden patients.

  19. Staged, High-Pressure Oxy-Combustion Technology: Development and Scale-Up

    Energy Technology Data Exchange (ETDEWEB)

    Axelbaum, Richard [Washington Univ., St. Louis, MO (United States); Kumfer, Benjamin [Washington Univ., St. Louis, MO (United States); Gopan, Akshay [Washington Univ., St. Louis, MO (United States); Yang, Zhiwei [Washington Univ., St. Louis, MO (United States); Phillips, Jeff [Electric Power Research Inst. (EPRI), Palo Alto, CA (United States); Pint, Bruce [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2017-12-29

    The immediate need for a high efficiency, low cost carbon capture process has prompted the recent development of pressurized oxy-combustion. With a greater combustion pressure the dew point of the flue gas is increased, allowing for effective integration of the latent heat of flue gas moisture into the Rankine cycle. This increases the net plant efficiency and reduces costs. A novel, transformational process, named Staged, Pressurized Oxy-Combustion (SPOC), achieves additional step changes in efficiency and cost reduction by significantly reducing the recycle of flue gas. The research and development activities conducted under Phases I and II of this project (FE0009702) include: SPOC power plant cost and performance modeling, CFD-assisted design of pressurized SPOC boilers, theoretical analysis of radiant heat transfer and ash deposition, boiler materials corrosion testing, construction of a 100 kWth POC test facility, and experimental testing. The results of this project have advanced the technology readiness level (TRL) of the SPOC technology from 1 to 5.

  20. Micro-mechanical modelling of ductile failure in 6005A aluminium using a physics based strain hardening larw including stage IV

    DEFF Research Database (Denmark)

    Simar, Aude; Nielsen, Kim Lau; de Meester, Bruno

    2010-01-01

    The strain hardening and damage behaviour of isothermally heat treated 6005A aluminium is investigated in order to link the thermal treatment conditions, microstructure and fracture strain. The need for a plastic flow rule involving a stage IV hardening at large strain was found essential...... allows for the simulation of the full tensile response curves up to cracking initiation and final failure. Reasonable agreement is found when comparing the predicted and experimentally measured fracture strains for a wide range of heat treatment conditions using real microstructure based parameters....

  1. Catalytic conversion of light alkanes-proof-of-concept stage - Phase IV. Topical report, February 1, 1994--January 31, 1995

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-31

    This report details the research performed on Phase IV of the extended Cooperative Agreement. This Phase, entitled C{sub 1}-C{sub 4} Research, provides the research support which accompanies the C{sub 4} Proof-of-Concept Phase (Phase V) as the two major activities of the Cooperative Agreement during calendar 1993. It is the objective of this phase to understand the nature of the catalysts and catalytic activity of perhaloporphyrin complexes uncovered during Phases I-III in order that superior catalytic materials can be made and tested which meet commercial criteria for the oxidation of the C{sub 1}-C{sub 4} light alkane gases found in natural gas and other available hydrocarbon streams. During Phase IV, we have examined the physical and electronic structures of the very active perhaloporphyrin catalysts which we have developed, and have gained an understanding of the properties which make them active. This has led us to design and synthesize materials which are cheaper, more active, more robust and, in general superior for carrying out practical catalysis. Our early generation perhaloporphyrin catalysts, while exhibiting unprecedented catalytic activity, were far too expensive for use in converting natural gas or its C{sub 1}-C{sub 4} components.

  2. Staged, High-Pressure Oxy-Combustion Technology: Development and Scale-Up

    Energy Technology Data Exchange (ETDEWEB)

    Axelbaum, Richard; Xia, Fei; Gopan, Akshay; Kumfer, Benjamin

    2014-09-30

    Washington University in St. Louis and its project partners are developing a unique pressurized oxy-combustion process that aims to improve efficiency and costs by reducing the recycling of flue gas to near zero. Normally, in the absence of recycled flue gas or another inert gas, combustion of fuel and oxygen results in a dramatic increase in temperature of the combustion products and radiant energy, as compared to combustion in air. High heat flux to the boiler tubes may result in a tube surface temperatures that exceed safe operating limits. In the Staged Pressurized Oxy-Combustion (SPOC) process, this problem is addressed by staging the delivery of fuel and by novel combustion design that allows control of heat flux. In addition, the main mode of heat transfer to the steam cycle is by radiation, as opposed to convection. Therefore, the requirement for recycling large amounts of flue gas, for temperature control or to improve convective heat transfer, is eliminated, resulting in a reduction in auxiliary loads. The following report contains a detailed summary of scientific findings and accomplishments for the period of Oct. 1, 2013 to Sept 30, 2014. Results of ASPEN process and CFD modelling activities aimed at improving the SPOC process and boiler design are presented. The effects of combustion pressure and fuel moisture on the plant efficiency are discussed. Combustor pressure is found to have only a minor impact beyond 16 bar. For fuels with moisture content greater than approx 30%, e.g. coal/water slurries, the amount of latent heat of condensation exceeds that which can be utilized in the steam cycle and plant efficiency is reduced significantly. An improved boiler design is presented that achieves a more uniform heat flux profile. In addition, a fundamental study of radiation in high-temperature, high-pressure, particle-laden flows is summarized which provides a more complete understanding of heat transfer in these unusual conditions and to allow for

  3. A case of small cell cancer of the breast in a male with synchronous stage IV non-small cell lung carcinoma

    Directory of Open Access Journals (Sweden)

    Laurie Matt

    2013-09-01

    Full Text Available Extrapulmonary small cell carcinomas (EPSCC are extremely rare. Most reports indicate success with therapy directed at the tumor as if it was pulmonary small cell carcinoma Primary small cell carcinoma of the breast is an uncommon form of EPSCC. Differentiating between a primary small cell carcinoma of the breast from metastatic disease to the breast is very important. According to the literature, there have been approximately 70 cases reported worldwide. Of these cases, only two cases are documented in men. Prognosis is varied and depends on stage of disease at presentation. A combination of surgery, chemotherapy and/or radiation is required to adequately treat patients with small cell carcinoma of the breast. We present a case of a male patient diagnosed with stage IV non-small cell lung carcinoma first and then subsequently diagnosed with a concurrent small cell carcinoma of the breast responding to treatment with concurrent chemotherapy and radiation.

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

    Science.gov (United States)

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

    2011-11-01

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

  5. Hypofractionated stereotactic body radiation therapy for elderly patients with stage IIB–IV nonsmall cell lung cancer who are ineligible for or refuse other treatment modalities

    Directory of Open Access Journals (Sweden)

    Karam SD

    2014-10-01

    Full Text Available Sana D Karam,1 Zachary D Horne,2 Robert L Hong,2 Don McRae,2 David Duhamel,3 Nadim M Nasr2 1Department of Radiation Oncology, University of Colorado, Denver, CO, USA; 2Department of Radiation Oncology, 3Department of Pulmonary/Critical Care Medicine, Virginia Hospital Center, Arlington, VA, USA Objective: In elderly patients with stage IIB–IV nonsmall cell lung cancer who cannot tolerate chemotherapy, conventionally fractionated radiotherapy is the treatment of choice. We present our experience with hypofractionated stereotactic body radiation therapy (SBRT in the treatment of this patient population. Methods: Thirty-three patients with a median age of 80 years treated with fractionated SBRT were retrospectively analyzed. Most patients were smokers and had preexisting lung disease and either refused treatment or were ineligible. A median prescribed dose of 40 Gy was delivered to the prescription isodose line over a median of five treatments. The majority of patients (70% did not receive chemotherapy. Results: With a median follow-up of 9 months (range: 4–40 months, the actuarial median overall survival (OS and progression-free survival were 12 months for both. One year actuarial survival outcomes were 75%, 58%, 44%, and 48% for local control, regional control, progression-free survival, and OS, respectively. Increased volume of disease was a statistically significant predictor of worse OS. Three patients developed a grade 1 cough that peaked 3 weeks after treatment and resolved within 1 month. One patient developed grade 1 tracheal mucositis and three patients developed grade 1 pneumonitis. Both resolved 6 weeks after treatment. Three patients died within the first month of treatment, but the cause of death did not appear to be related to the treatment. Conclusion: Hypofractionated SBRT is a relatively safe and convenient treatment option for elderly patients with inoperable stage IIB–IV nonsmall cell lung cancer. However, given the small

  6. Reproducibility of proximal and distal transcutaneous oxygen pressure measurements during exercise in stage 2 arterial claudication.

    Science.gov (United States)

    Bouyé, P; Picquet, J; Jaquinandi, V; Enon, B; Leftheriotis, G; Saumet, J-L; Abraham, P

    2004-06-01

    Although transcutaneous oxygen pressure measurements (tcpO2) are largely used in the investigation of vascular patients, its reproducibility is still debated. Indeed an unpredictable gradient exists between arterial and transcutaneous oxygen pressure. We hypothesised that indices taking into account changes over time and independent of absolute starting values would be more reproducible than other indices. comparative test-retest procedure (1 to 13 days between tests). institutional practice, ambulatory care. 15 subjects with stage 2 claudication. tcpO2 recordings at rest and at exercise during the 2 treadmill tests. calculation of the Delta-from-rest of oxygen pressure index (limb tcpO2 changes minus chest tcpO2 changes), of the resting - or minimal values attained during exercise - of absolute tcpO2 and of the regional perfusion index (regional perfusion index: ration of limb to chest). Both absolute tcpO2 and regional perfusion index at rest showed low reproducibility. During exercise the best reproducibility was attained through Delta-from-rest of oxygen pressure index calculation. Equations from the linear regression analysis (test 2 versus test 1) were 0.88 x -4.2 (r(2)=0.82) at the buttock level and 0.82 x -3.8 (r(2)=0.80) at the calf level. TcpO2 measurement on the calf or buttock during exercise, is a reproducible measurement in patients with vascular claudication, specifically when corrected for exercise-induced systemic pO2 changes trough Delta-from-rest of oxygen pressure calculation.

  7. Impact of intracranial extension on survival in stage IV nasopharyngeal carcinoma: identification of a subset of patients with better prognosis.

    Science.gov (United States)

    Hu, Yu-Chang; Chang, Ching-Hsiung; Chen, Chien-Hsun; Ger, Luo-Ping; Liu, Wen-Shan; Lin, Li-Ching; Leung, Chung-Man; Chang, Kuo-Chen

    2011-01-01

    T-stage is an imperfect prognostic indicator for patients with nasopharyngeal carcinoma. We evaluated the effect of extent of intracranial involvement on survival after conventional radiotherapy in patients with Stage T4 nasopharyngeal carcinoma. We conducted a retrospective analysis of the results of computed tomography, magnetic resonance imaging and treatment outcomes in 84 consecutive patients with Stage T4 nasopharyngeal carcinoma during the period September 1993 to December 2002 in Taiwan. The patients were subcategorized into those who had limited intracranial involvement (primary nasopharyngeal tumors with involvement of the unilateral cavernous sinus or the parasellar region only) or extensive involvement (extension of the tumors to the bilateral cavernous sinus or the parasellar region, into the orbit and the ethmoid sinus anteriorly, or to the prepontine region and the posterior cranial fossa). Extensive intracranial involvement was found in 51.2% of the patients. Among these patients, the 5-year rate of overall survival after conventional radiotherapy was only 3.4%. In contrast, the 5-year survival among patients with limited intracranial involvement was 42.9%. This difference was significant (P nasopharyngeal carcinoma, better treatment outcomes were associated with limited intracranial involvement. We conclude that a subdivision of Stage T4 nasopharyngeal carcinoma disease based on the extent of intracranial involvement would provide better prognostic information.

  8. Cost-Utility Analysis of Lipegfilgrastim Compared to Pegfilgrastim for the Prophylaxis of Chemotherapy-Induced Neutropenia in Patients with Stage II-IV Breast Cancer

    Directory of Open Access Journals (Sweden)

    Esse I. H. Akpo

    2017-09-01

    Full Text Available Background: Lipegfilgrastim (Lonquex® has demonstrated to be non-inferior to pegfilgrastim (Neulasta® in reducing the duration of severe neutropenia (SN in patients with stage II−IV breast cancer. Compared to pegfilgrastim, lipegfilgrastim also demonstrated statistically significant lower time to ANC recovery in cycles 1–3, lower incidence of SN in cycle 2 and lower depth of absolute neutrophil count (ANC nadir in cycles 2 and 3. The aim of this study was to quantify the cost utility of lipegfilgrastim compared to pegfilgrastim in stage II−IV breast cancer patients, taking the perspective of the Belgian payer over a lifetime horizon.Methods: Two Markov models were developed to track on- and post-chemotherapy related complications, including SN, febrile neutropenia (FN, chemotherapy dose delay, chemotherapy relative dose intensity of less than 85%, infection, death rates, and quality-adjusted life years (QALYs. Data on costs (2015 value and effects were obtained from literature, national references, and complemented by a survey of clinical experts using a modified Delphi method. Both deterministic and probabilistic sensitivity analyses were carried out. Outcomes measures included costs, QALYs and life-years (LY.Results: At current equivalent price of €1,169, treatment with lipegfilgrastim was associated with overall costs of €9,845 vs. €10,208 for pegfilgrastim and overall QALYs of 13.977 vs. 13.925 for pegfilgrastim. Life expectancy was increased by 21 days (or 0.058 LY gained. The difference in costs stem from avoided infection, SN and FN cases in the lipegfilgrastim compared to the pegfilgrastim group. Similarly, the difference in QALYs was explained by the difference in the number of patients in the chemotherapy/G-CSF Markov state followed by infection and FN between lipegfilgrastim and pegfilgrastim. The probability of lipegfilgrastim to be cost-effective compared to pegfilgrastim was 68, 79, and 83% at the willingness

  9. Influence of {sup 18}F-FDG PET/CT on therapy management in patients with stage III/IV malignant melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Schuele, Susann-Cathrin; Nikolaou, Konstantin; Pfannenberg, Christina [Eberhard-Karls-University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Eigentler, Thomas Kurt; Garbe, Claus [Eberhard-Karls-University Tuebingen, Skin Cancer Programme, Department of Dermatology, Tuebingen (Germany); Fougere, Christian la [Eberhard-Karls-University Tuebingen, Department of Nuclear Medicine, Tuebingen (Germany)

    2016-03-15

    To evaluate the influence of {sup 18}F-FDG PET/CT in comparison to CT alone on treatment decisions in patients with advanced melanoma and to analyse the 5-year survival data in comparison to literature data. Therapy management in 64 consecutive patients (primary staging n = 52; surveillance n = 12) with stage III/IV melanoma who underwent {sup 18}F-FDG PET/CT between 2004 and 2005 in our department was retrospectively analysed. Treatment decisions were made by two dermatooncologists for each patient twice, first based on the CT results and then based on the PET/CT results. Therapy changes based on the PET/CT results were classified as ''major'' (e.g. change from metastasectomy to systemic therapy) or ''minor'' (e.g. change from first to second line chemotherapy). The 5-year survival data of different patient cohorts were calculated. In the 52 patients in the primary staging group, the results of {sup 18}F-FDG PET/CT led to therapy change in 59 % and a major therapy change in 52 %. {sup 18}F-FDG PET/CT led to the avoidance of futile operations in 13 patients with suspicious lesions on CT that were deemed nontumorous on PET/CT. In the 12 patients in the surveillance group, the results of {sup 18}F-FDG PET/CT led to therapy change in 33 % and a major change in 17 %. The 5-year survival rates were 30 % in the entire cohort, 34 % in the primary staging group, and 17 % in the surveillance group. A significant overall survival benefit was observed in patients in whom {sup 18}F-FDG PET/CT excluded metastases or in whom metastases could be completely removed compared with patients who were not eligible for surgery (41 % vs. 10 %). Primary staging of patients with stage III/IV melanoma should be performed with {sup 18}F-FDG PET/CT, leading to higher diagnostic accuracy and enabling individualized therapeutic management, especially optimal patient selection for metastasectomy. This strategy may extend long-term survival even in patients

  10. Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN-IV Study.

    Science.gov (United States)

    Kelishadi, Roya; Qorbani, Mostafa; Motlagh, Mohammad Esmaeil; Heshmat, Ramin; Ardalan, Gelayol; Bahreynian, Maryam

    2016-01-01

    This study was conducted to explore the association of eating frequency (EF) with anthropometric indices and blood pressure (BP) in children and adolescents. This nationwide cross-sectional study was performed on a multi-stage sample of 14,880 students, aged 6-18 years, living in 30 provinces in Iran. Parents were asked to report dietary intake of children as frequency of food groups and/or items. EF was defined as the sum of the daily consumption frequency of main meals and snacks. Association of EF with weight disorders, abdominal obesity, and elevated BP was assessed using different logistic regression models adjusted for potential confounding factors. Eating more frequently (≥ 6 vs. ≤ 3) was found among students who were at younger age (11.91 vs. 13.29 years) (pobese compared to those who had EF ≤ 3. Having EF of 4 (OR: 0.82, CI: 0.71-0.94), 5 (OR: 0.86, CI: 0.74-0.99), and ≥ 6 (OR: 0.73, CI: 0.63-0.85) was related to lower prevalence of abdominal adiposity. Higher EF was associated with lower mean values of anthropometric and BP measures, as well as with lower prevalence of generalized and abdominal obesity in children and adolescents. Longitudinal studies are needed to assess the long-term effects of EF on body composition in the pediatric age group. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  11. The effect of homogenization pressure and stages on the amounts of Lactic and Acetic acids of probiotic yoghurt

    Directory of Open Access Journals (Sweden)

    R Massoud

    2014-12-01

    Full Text Available Nowadays the use of probiotic products especially yogurt, due to having wonderful and health properties, has become popular in the world. In this study, the effect of homogenization pressure (100, 150 and 200 bars and stage (single and two on the amount of lactic and acetic acids was investigated. Yoghurts were manufactured from low-fat milk treated using high pressure homogenization at 100,150 and 200 bar and at 60°C. The amount of lactic and acetic acids was determined after the days 1, 7, 14 and 21 of storage at 4ºC. The experiments were set up using a completely randomized design. With the increase of pressure and stage of homogenization, the amount of both acids was increased (p<0.01. The greatest amount of lactic and acetic acids during the storage period was observed in the sample homogenized at a pressure of 200 bars and two stages.

  12. Prognostic impact of carcinoembryonic antigen and carbohydrate antigen 19-9 in stage IV colorectal cancer patients after R0 resection.

    Science.gov (United States)

    Abe, Shinya; Kawai, Kazushige; Ishihara, Soichiro; Nozawa, Hiroaki; Hata, Keisuke; Kiyomatsu, Tomomichi; Tanaka, Toshiaki; Watanabe, Toshiaki

    2016-10-01

    Although preoperative carcinoembryonic antigen (pre-CEA) and carbohydrate antigen 19-9 (pre-CA 19-9) are reportedly prognostic indicators for colorectal cancer (CRC), the prognostic roles of postoperative CEA (post-CEA) and CA 19-9 (post-CA 19-9) shortly after surgery have not been clarified in patients with curatively resected stage IV CRC. The aim of this study was to evaluate the predictive abilities of post-CEA and post-CA 19-9. A total of 129 consecutive patients who had stage IV CRC and underwent R0 resection were retrospectively analyzed. Pre-CEA and post-CEA and CA 19-9 levels were measured within 1 mo before and 3 mo after surgery, respectively. Relapse-free survival (RFS) and overall survival were estimated using the Kaplan-Meier method, and multivariate analysis was performed using the Cox proportional hazards model. Pre-CEA was elevated (≥5.0 ng/mL) in 73.6% of the patients and remained elevated after surgery in 32.7% of the patients. Elevated post-CA 19-9 (≥50 U/mL) was observed in 9.5% of the patients. Neither elevated pre-CEA nor elevated pre-CA 19-9 was significantly associated with RFS but both elevated post-CEA and elevated post-CA 19-9 were associated with markedly reduced RFS (P = 0.0002 and P = 0.0004, respectively). When considered in combination, post-CEA and post-CA 19-9 significantly stratified RFS and was an independent predictive factor for recurrence (P = 0.0035), as was lymphatic invasion (P = 0.0015). Post-CA 19-9 was the only evident independent predictive factor for overall survival (P = 0.0336). In patients with stage IV CRC who underwent curative resection, the combination of post-CEA and post-CA 19-9 at 3 mo after surgery was a potent prognostic indicator for recurrence. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. A Case Series of Survival Outcomes in Patients with Advanced-stage IIIb/IV Non-small-cell Lung Cancer Treated with HangAm-Plus

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    Bang Sun-Hwi

    2012-06-01

    Full Text Available Background and Objectives: Non-small-cell lung cancer (NSCLC represents approximately 80% of all lung cancers. Unfortunately, at their time of diagnosis, most patients have advanced to unresectable disease with a very poor prognosis. The oriental herbal medicine HangAm-Plus (HAP has been developed for antitumor purposes, and several previous studies have reported its therapeutic effects. In this study, the efficacy of HAP was evaluated as a third-line treatment for advanced-stage IIIb/IV NSCLC. Methods: The study involved six patients treated at the East- West Cancer Center (EWCC from April 2010 to October 2011. Inoperable advanced-stage IIIb/IV NSCLC patients received 3,000 or 6,000 mg of HAP on a daily basis over a 12-week period. Computed tomography (CT scans were obtained from the patients at the time of the initial administration and after 12 weeks of treatment. We observed and analyzed the patients overall survival (OS and progression-free survival (PFS. Results: Of the six patients, three expired during the study, and the three remaining patients were alive as of October 31, 2011. The OS ranged from 234 to 512 days, with a median survival of 397 days and a one-year survival rate of 66.7%. In the 12-week-interval chest CT assessment, three patients showed stable disease (SD, and the other three showed progressive disease (PD. The PFS of patients ranged from 88 to 512 days, the median PFS being 96 days. Longer OS and PFS were correlated with SD. Although not directly comparable, the OS and the PFS of this study were greater than those of the docetaxel or the best supportive care group in other studies. Conclusion: HAP may prolong the OS and the PFS of inoperable stage IIIb/IV NSCLC patients without significant adverse effects. In the future, more controlled clinical trials with larger samples from multi-centers should be conducted to evaluate the efficacy and the safety of HAP.

  14. Primary colectomy in patients with stage IV colon cancer and unresectable distant metastases improves overall survival: results of a multicentric study.

    Science.gov (United States)

    Karoui, Mehdi; Roudot-Thoraval, Françoise; Mesli, Farida; Mitry, Emmanuel; Aparicio, Thomas; Des Guetz, Gaetan; DesGuetz, Gaetan; Louvet, Christophe; Landi, Bruno; Tiret, Emmanuel; Sobhani, Iradj

    2011-08-01

    Whether patients with stage IV colon cancer and unresectable distant metastases should be managed by primary colectomy followed by chemotherapy or immediate chemotherapy without resection of the primary tumor is still controversial. This study aimed to evaluate predictive factors associated with survival in patients with stage IV colon cancer and unresectable distant metastases. This large retrospective multicentric study included 6 academic hospitals. This study was conducted at 6 Paris University Hospitals (Assistance Publique-Hôpitaux de Paris; Saint Antoine, Henri Mondor, Ambroise Paré, Hôpital Europeen Gorges Pompidou, Bichat, and Avicenne). Between 1998 and 2007, 208 patients with good performance status and stage IV colon cancer with unresectable distant metastases received chemotherapy, either as initial management or after primary tumor resection. Survival was estimated by use of the Kaplan-Meier method. Factors associated with survival were tested by means of a log-rank test. Results were expressed as median values with 95% confidence intervals. Factors independently related to survival were tested using a Cox regression model adjusted for a propensity score. Of the 208 patients, 85 underwent colectomy before chemotherapy, whereas 123 were treated with use of primary chemotherapy with or without biotherapy. At univariate analysis, the following factors were significantly associated with survival: primary colectomy (P = .031), secondary curative surgery (P < .001), well-differentiated primary tumor (P < .001), exclusive liver metastases (P < .027), absence of need for colonic stent (P = .009), and addition of antiangiogenic (P = .001) or anti-epidermal growth factor receptor (P = .013) drugs to chemotherapy. After Cox multivariate analysis and after adjusting for the propensity score, all of these factors, with the exception of two, colonic stent and anti-epidermal growth factor receptor drug, were found to be independently associated with overall

  15. Association of "Elevated Blood Pressure" and "Stage 1 Hypertension" With Cardiovascular Mortality Among an Asian Population.

    Science.gov (United States)

    Talaei, Mohammad; Hosseini, Naeimeh; Koh, Angela S; Yuan, Jian-Min; Koh, Woon-Puay

    2018-04-10

    The new American College of Cardiology/American Heart Association high blood pressure (BP) guidelines in the United States have lowered definition of hypertension by defining normal as systolic/diastolic BP hypertension as systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. We investigated the association between the new hypertension definition and cardiovascular disease mortality among Chinese in Singapore. We used data from 30 636 participants of a population-based cohort, the SCHS (Singapore Chinese Health Study), who had BPs measured using a standard protocol at ages 46 to 85 years between 1994 and 2005. Information on lifestyle factors was collected at recruitment (1993-1998) and follow-up 1 interviews (1999 and 2004). Mortality was identified via nationwide registry linkage up to December 31, 2016. Neither elevated BP (hazard ratio, 0.89; 95% confidence interval, 0.74-1.07) nor stage 1 hypertension (hazard ratio, 0.94; 95% confidence interval, 0.81-1.11) was associated with increased risk of cardiovascular mortality compared with normal BP in the whole cohort. Stage 1 hypertension was associated with increased cardiovascular risk only in those hypertension may not be associated with increased cardiovascular mortality across all ages among Chinese in Singapore, but that the at-risk subpopulation is limited to those <65 years of age and without a prior cardiovascular disease. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  16. Phase 3 Trial of Postoperative Chemotherapy Alone Versus Chemoradiation Therapy in Stage III-IV Gastric Cancer Treated With R0 Gastrectomy and D2 Lymph Node Dissection

    International Nuclear Information System (INIS)

    Kim, Tae Hyun; Park, Sook Ryun; Ryu, Keun Won; Kim, Young-Woo; Bae, Jae-Moon; Lee, Jun Ho; Choi, Il Ju; Kim, Yeon-Joo; Kim, Dae Yong

    2012-01-01

    Purpose: To compare chemotherapy alone with chemoradiation therapy in stage III-IV(M0) gastric cancer treated with R0 gastrectomy and D2 lymph node dissection. Methods and Materials: The chemotherapy arm received 5 cycles of fluorouracil and leucovorin (FL), and the chemoradiation therapy arm received 1 cycle of FL, then radiation therapy of 45 Gy concurrently with 2 cycles of FL, followed by 2 cycles of FL. Intent-to-treat analysis and per-protocol analyses were performed. Results: Between May 6, 2002 and June 29, 2006, a total of 90 patients were enrolled. Forty-four were randomly assigned to the chemotherapy arm and 46 to the chemoradiation therapy arm. Treatment was completed as planned by 93.2% of patients in the chemotherapy arm and 87.0% in the chemoradiation therapy arm. Overall intent-to-treat analysis showed that addition of radiation therapy to chemotherapy significantly improved locoregional recurrence-free survival (LRRFS) but not disease-free survival. In subgroup analysis for stage III, chemoradiation therapy significantly prolonged the 5-year LRRFS and disease-free survival rates compared with chemotherapy (93.2% vs 66.8%, P=.014; 73.5% vs 54.6%, P=.056, respectively). Conclusions: Addition of radiation therapy to chemotherapy could improve the LRRFS in stage III gastric cancer treated with R0 gastrectomy and D2 lymph node dissection.

  17. Paclitaxel Albumin-Stabilized Nanoparticle Formulation and Bevacizumab in Treating Patients With Stage IV Melanoma That Cannot Be Removed by Surgery or Gynecological Cancers

    Science.gov (United States)

    2018-02-05

    Cervical Adenosarcoma; Cervical Adenosquamous Carcinoma; Cervical Carcinosarcoma; Cervical Squamous Cell Carcinoma, Not Otherwise Specified; Endometrial Clear Cell Adenocarcinoma; Endometrial Endometrioid Adenocarcinoma; Endometrial Mixed Adenocarcinoma; Endometrial Mucinous Adenocarcinoma; Endometrial Squamous Cell Carcinoma; Endometrial Transitional Cell Carcinoma; Endometrial Undifferentiated Carcinoma; Fallopian Tube Adenocarcinoma; Fallopian Tube Clear Cell Adenocarcinoma; Fallopian Tube Mucinous Adenocarcinoma; Fallopian Tube Serous Adenocarcinoma; Fallopian Tube Transitional Cell Carcinoma; Malignant Ovarian Epithelial Tumor; Malignant Peritoneal Neoplasm; Ovarian Carcinosarcoma; Ovarian Clear Cell Adenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mucinous Adenocarcinoma; Ovarian Serous Adenocarcinoma; Ovarian Transitional Cell Carcinoma; Primary Peritoneal Serous Adenocarcinoma; Recurrent Fallopian Tube Carcinoma; Recurrent Melanoma; Recurrent Ovarian Carcinoma; Recurrent Primary Peritoneal Carcinoma; Stage IV Skin Melanoma; Undifferentiated Fallopian Tube Carcinoma; Undifferentiated Ovarian Carcinoma; Uterine Corpus Carcinosarcoma

  18. [A case of advanced gastric cancer diagnosed as stage IV responding to combined modality therapy and surviving for a long duration].

    Science.gov (United States)

    Shimada, Masanari; Murakami, Nozomu; Tanada, Yasuko; Endo, Naoki; Kadoya, Shinichi; Yamada, Tetsuji; Kurumatani, Hiroshi; Doyama, Hisashi

    2013-05-01

    A 47-year-old woman was diagnosed as advanced gastric cancer of cardia(poorly-differentiated adenocarcionoma), with multiple para-aortic lymph node and liver metastasis, in March, 2005. We attempted neo-adjuvant chemotherapy with docetaxel(DOC), cisplatin(CDDP), and S-1(DCS). After 3 courses of DCS, we confirmed that the para-aortic lymph nodes and liver metastasis became small. Then, we were able to perform total gastrectomy, splenectomy, and D2 lymph node dissection. Additionally, we performed an intraoperative radiofrequency ablation to the scar of the liver metastasis. Histopathologically, we identified lymph node metastases in #1 and #16b1 pre. S-1 and DOC were administered as adjuvant chemotherapy. At seven years since the operation, the patient has shown no signs of recurrence. Combined modality therapy for advanced gastric cancer diagnosed with stage IV can be an effective treatment, so we hope that it will be established as a standard therapy.

  19. Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN-IV Study

    Directory of Open Access Journals (Sweden)

    Roya Kelishadi

    2016-04-01

    Full Text Available Abstract Objectives: This study was conducted to explore the association of eating frequency (EF with anthropometric indices and blood pressure (BP in children and adolescents. Methods: This nationwide cross-sectional study was performed on a multi-stage sample of 14,880 students, aged 6–18 years, living in 30 provinces in Iran. Parents were asked to report dietary intake of children as frequency of food groups and/or items. EF was defined as the sum of the daily consumption frequency of main meals and snacks. Association of EF with weight disorders, abdominal obesity, and elevated BP was assessed using different logistic regression models adjusted for potential confounding factors. Results: Eating more frequently (≥6 vs. ≤3 was found among students who were at younger age (11.91 vs. 13.29 years (p < 0.001. Students who reported an EF of 4 (OR: 0.67, CI: 0.57–0.79, 5 (OR: 0.74, CI: 0.62–0.87, and 6 (OR: 0.54, CI: 0.44–0.65 had lower odds of being obese compared to those who had EF ≤ 3. Having EF of 4 (OR: 0.82, CI: 0.71–0.94, 5 (OR: 0.86, CI: 0.74–0.99, and ≥6 (OR: 0.73, CI: 0.63–0.85 was related to lower prevalence of abdominal adiposity. Conclusion: Higher EF was associated with lower mean values of anthropometric and BP measures, as well as with lower prevalence of generalized and abdominal obesity in children and adolescents. Longitudinal studies are needed to assess the long-term effects of EF on body composition in the pediatric age group.

  20. Efficacy of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy for Stage IV Triple-Negative Breast Cancer.

    Science.gov (United States)

    İyikesici, Mehmet Salih; Slocum, Abdul Kadir; Slocum, Ayshe; Berkarda, Ferhan Bulent; Kalamian, Miriam; Seyfried, Thomas N

    2017-07-07

    Triple-negative breast cancer (TNBC) is more aggressive and metastatic than other breast cancer types. Cytotoxic chemotherapy is presently the predominant systemic therapy for TNBC patients. This case report highlights the influence of metabolically supported chemotherapy (MSCT), ketogenic diet (KD), hyperthermia (HT), and hyperbaric oxygen therapy (HBOT) in an overweight 29-year-old woman with stage IV (T4N3M1) triple-negative invasive ductal carcinoma of the breast. The patient presented with an observable mass in her left breast detected during a physical examination in December 2015. Magnetic resonance imaging revealed a Breast Imaging Reporting and Data System Category 5 tumor and multiple lymphadenomegaly in the left axilla. A Tru-Cut biopsy led to the diagnosis of a triple-negative nuclear grade 2 invasive ductal carcinoma. The patient was admitted to ChemoThermia Oncology Center, Istanbul, Turkey in October 2016, and a whole body (18F)-fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography (PET-CT) scan revealed a 77 mm x 55 mm primary tumor in her left breast, multiple left pectoral and axillary lymph nodes, multiple widespread liver masses, and an upper left nodular abdominal lesion. The patient received a treatment protocol consisting of MSCT, KD, HT, and HBOT. A follow-up whole body 18F-FDG PET-CT scan in February 2017 showed a complete therapeutic response with no evidence of abnormal FDG uptake. The patient continued to receive this treatment protocol and in April 2017 underwent a mastectomy, which revealed a complete pathological response consistent with the response indicated by her PET-CT imaging. This single case study presents evidence of a complete clinical, radiological, and pathological response following a six-month treatment period using a combination of MSCT and a novel metabolic therapy in a patient with stage IV TNBC.

  1. [A case of stage IV rectal cancer with whom EPA oral nutritional supplements could resolve cachectic condition and promote patient compliance with cancer chemotherapy].

    Science.gov (United States)

    Hamamura, Kenji; Nakaya, Maki; Nakagawa, Mio; Miyazaki, Mitsukazu; Miki, Chikao

    2011-05-01

    We report a case of a Stage IV rectal cancer patient for whom EPA oral nutritional supplements promoted treatment compliance with cancer chemotherapy by resolving a refractory cachectic condition. A 76-year-old male who developed a local re-growth of residual disease and multiple lung metastases after abdomino-perineal resection for lower rectal cancer was referred to our clinic for chemotherapy. On admission, he suffered from a loss of appetite as well as a 30% loss of usual body weight, caused by a cachectic condition with systemic inflammatory response. On starting chemotherapy, his daily diet was supplemented with EPA containing oral nutritional supplements (EPA ONS). Within 2 weeks after initiating EPA ONS treatment, the systemic inflammatory response resolved, and at the same time, body weight and the serum level of albumin increased, which allowed treatment compliance with aggressive multidrug chemotherapy. The patient gained 10 kg in body weight even after 12 months of aggressive chemotherapy, and has attained a longstanding partial remission from the disease. Although cancer cachexia is generally regarded as an end-stage irreversible pathological condition, EPA ONS may promote patient compliance with cancer chemotherapy by resolving cachectic condition, and thus may improve survival.

  2. Paclitaxel plus Carboplatin Chemotherapy for Primary Peritoneal Carcinoma: A Study of 22 Cases and Comparison with Stage III–IV Ovarian Serous Carcinoma

    Directory of Open Access Journals (Sweden)

    R. Kawaguchi

    2012-04-01

    Full Text Available The aim of this study was to assess the clinical characteristics and outcome of patients with either primary peritoneal carcinoma (PPC or ovarian serous carcinoma (OSC treated with paclitaxel plus carboplatin chemotherapy. We retrospectively identified 22 PPC patients and 55 stage III–IV OSC patients treated between 2002 and 2007. After exploratory laparotomy, all patients received paclitaxel and carboplatin every 3 weeks, with the goal of optimal cytoreduction. There were no statistically significant differences between the PPC and OSC groups with regard to tumor stage, residual tumor after debulking surgery (initial or interval, serum cancer antigen (CA 125 levels at diagnosis, and completion of first-line chemotherapy. The progression-free survival (PFS durations were 12.7 months (95% CI, 6.3–18.5 in the patients with PPC and 15.9 months (95% CI, 13.3–18.5 in those with OSC (p = 0.016. However, the median survival durations were 26.5 months (95% CI, 14.6–38.3 in the patients with PPC and 38 months (95% CI, 23.8–53.8 in those with OSC (p = 0.188. Survival was longer for all patients whose CA125 levels normalized to 26 U/ml during and after treatment. Overall survival (OS of the patients with PPC was similar to that of the patients with OSC, suggesting that management for advanced-stage OSC would be similar to that for PPC. The combination of optimal debulking with paclitaxel plus carboplatin chemotherapy may offer patients the most effective treatment. The CA125 nadir after cytoreductive surgery can be considered a prognostic factor for OS and PFS in patients with PPC.

  3. Belgian Contribution to the IAEA CRP-IV Programme on Assuring Structural Integrity of Reactor Pressure Vessel

    International Nuclear Information System (INIS)

    Van Walle, E.; Chaouadi, R.; Scibetta, M.; Puzzolante, J.L.; Fabry, A.; Van de Velde, J.

    1997-10-01

    This report contains the actual status of the Belgian contribution to the IAEA CRP-IV program. Besides Charpy-V impact tests on as-received CRP-IV JRQ-specimens, fracture toughness tests were performed on two geometries: PCCV-specimens and CRB-specimens. The Charpy-V impact results correspond very well with the as-received CRP-III results. The fracture toughness data are also very consistent with identical tests recently performed on remaining as-received CRP-III material. Irradiated broken Charpy-V samples were reconstituted and tested in PCCV-mode. This was done in order to investigate the evolution of the ASME-curve versus the evolution of the mastercurve with irradiation. Initial results were reported. A new CHIVAS-irradiation in the CALLISTO-loop of the BR-2-reactor to support this investigation, is under preparation

  4. Non-auditory effects of noise in industry. IV. A field study on industrial noise and blood pressure

    NARCIS (Netherlands)

    Verbeek, J. H.; van Dijk, F. J.; de Vries, F. F.

    1987-01-01

    Audiometry and casual blood pressure measurements were carried out among industrial workers exposed to noise levels exceeding 80 dB(A). Workers with long-term noise exposure had increased blood pressure, after correction for age. Only a weak correlation was observed between noise-induced hearing

  5. Our Experiences with Erlotinib in Second and Third Line Treatment Patients with Advanced Stage Iiib/ Iv Non-Small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Bakir Mehić

    2008-11-01

    Full Text Available HeadHER1/EGFR is known to play a pivotal role in tumorigenesis and is overexpressed in up to 80% of NSCLCs. The study of an Expanded Access Clinical Program of Erlotinib in NSCLC is a phase IV openlabel, non-randomized, multicenter trial in patients with advanced (inoperable stage IIIb/IV NSCLC who were eligible for treatment with erlotinib but had no access to trial participation. Patients for the study from Bosnia and Herzegovina (B&H were selected from two Clinical centres (Sarajevo and Banja Luka. The aim of study was to evaluated efficacy and tolerability of erlotinib monotherapy in this setting. All patients who received at least one dose of erlotinib and data were entered in the database as of the CRF cut-off date of 14th May 2008 were included in analysis of data (n = 19. This population is defined as the Intent to Treat (ITT population and includes all patients who had at least one dose of erlotinib regardless of whether major protocol violations were incurred. The findings are consistent with the results of the randomized, placebo-controlled BR.21 study. Indicating that erlotinib is an effective option for patients with advanced NSCLC who are unsuitable for, or who have previously failed standard chemotherapy. In B&H group of patients DCR was almost 84%, and PFS was approximately 24,7 weeks (compared with 44% and 9,7 weeks for erlotinib reported in phase III. Almost three quarter of the patients received erlotinib as their second line of therapy. Overall, erlotinib was well tolerated; there were no patients who withdrew due to a treatment-related AE (mainly rash and there were few dose reductions. 24% of patients experienced an SAE (most commonly gastrointestinal (GI disorders.

  6. Phase 2 Study of Docetaxel, Cisplatin, and Concurrent Radiation for Technically Resectable Stage III-IV Squamous Cell Carcinoma of the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Inohara, Hidenori, E-mail: hinohara@ent.med.osaka-u.ac.jp [Department of Otorhinolaryngology—Head and Neck Surgery, Osaka University Faculty of Medicine, Suita, Osaka (Japan); Takenaka, Yukinori; Yoshii, Tadashi; Nakahara, Susumu; Yamamoto, Yoshifumi; Tomiyama, Yoichiro [Department of Otorhinolaryngology—Head and Neck Surgery, Osaka University Faculty of Medicine, Suita, Osaka (Japan); Seo, Yuji; Isohashi, Fumiaki; Suzuki, Osamu; Yoshioka, Yasuo; Sumida, Iori; Ogawa, Kazuhiko [Department of Radiation Oncology, Osaka University Faculty of Medicine, Suita, Osaka (Japan)

    2015-04-01

    Purpose: We investigated the efficacy and safety of weekly low-dose docetaxel and cisplatin therapy concurrent with conventionally fractionated radiation in patients with technically resectable stage III-IV squamous cell carcinoma of the head and neck. Methods and Materials: Between March 2004 and October 2011, we enrolled 117 patients, of whom 116 were analyzable (43 had oropharyngeal cancer, 54 had hypopharyngeal cancer, and 19 had laryngeal cancer), and 85 (73%) had stage IV disease. Radiation consisted of 66 Gy in 33 fractions. Docetaxel, 10 mg/m{sup 2}, followed by cisplatin, 20 mg/m{sup 2}, administered on the same day were given once a week for 6 cycles. The primary endpoint was overall complete response (CR) rate after chemoradiation therapy. Human papillomavirus (HPV) DNA in oropharyngeal cancer was examined by PCR. Results: Of 116 patients, 82 (71%) completed treatment per protocol; 102 (88%) received the full radiation therapy dose; and 90 (78%) and 12 (10%) patients received 6 and 5 chemotherapy cycles, respectively. Overall CR rate was 71%. After median follow-up of 50.9 months (range: 15.6-113.9 months for surviving patients), 2-year and 4-year overall survival rates were 82% and 68%, respectively. Cumulative 2-year and 4-year local failure rates were 27% and 28%, respectively, whereas distant metastasis rates were 15% and 22%, respectively. HPV status in oropharyngeal cancer was not associated with treatment efficacy. Acute toxicity included grade 3 and 4 in-field mucositis in 73% and 5% of patients, respectively, whereas myelosuppression and renal injury were minimal. No patients died of toxicity. Feeding tube dependence in 8% and tracheostomy in 1% of patients were evident at 2 years postchemoradiation therapy in patients who survived without local treatment failure. Conclusions: Local control and survival with this regimen were satisfactory. Although acute toxicity, such as mucositis, was common, late toxicity, such as laryngoesophageal

  7. Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study

    Directory of Open Access Journals (Sweden)

    Renan Oliveira Vaz-de-Melo

    Full Text Available CONTEXT AND OBJECTIVES: Assessment of central blood pressure (BP has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a β-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients.DESIGN AND SETTING: Experimental single cohort study conducted in the outpatient clinic of a university hospital.METHODS: Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR, central BP and augmentation index before and after 3 months of using nebivolol.RESULTS: 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2 with large abdominal waist (102.1 ± 7.2 cm. There were significant decreases in peripheral systolic BP (P = 0.0020, diastolic BP (P = 0.0049, HR (P < 0.0001 and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083 after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment.CONCLUSIONS: Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP.

  8. Lung resection is safe and feasible among stage IV cancer patients: An American College of Surgeons National Surgical Quality Improvement Program analysis.

    Science.gov (United States)

    Bateni, Sarah B; David, Elizabeth A; Bold, Richard J; Cooke, David T; Meyers, Frederick J; Canter, Robert J

    2017-05-01

    Operative resection can be associated with improved survival for selected patients with stage IV malignancies but may also be associated with prohibitive acute morbidity and mortality. We sought to evaluate rates of acute morbidity and mortality after lung resection in patients with disseminated malignancy with primary lung cancer and non-lung cancer pulmonary metastatic disease. For 2011-2012, 6,360 patients were identified from the American College of Surgeons National Surgical Quality Improvement Program undergoing lung resections, including 603 patients with disseminated malignancy. Logistic regression analyses were used to compare outcomes between patients with and without disseminated malignancy. After controlling for preoperative and intraoperative differences, we observed no statistically significant differences in rates of 30-day overall and serious morbidity or mortality between disseminated malignancy and non-disseminated malignancy patients (P > .05). Disseminated malignancy patients were less likely to have a prolonged duration of stay and be discharged to a facility compared to non-disseminated malignancy patients (P < .05). Subgroup analyses by procedure type and diagnosis showed similar results. Disseminated malignancy patients undergoing lung resections experienced low rates of overall morbidity, serious morbidity, and mortality comparable to non-disseminated malignancy patients. These data suggest that lung resections may be performed safely on carefully selected, disseminated malignancy patients with both primary lung cancer and pulmonary metastatic disease, with important implications for multimodality care. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Does Type of Tumor Histology Impact Survival among Patients with Stage IIIB/IV Non-Small Cell Lung Cancer Treated with First-Line Doublet Chemotherapy?

    Science.gov (United States)

    Clements, Karen M.; Peltz, Gerson; Faries, Douglas E.; Lang, Kathleen; Nyambose, Joshua; Earle, Craig C.; Sugarman, Katherine P.; Taylor, Douglas C. A.; Thompson, David; Marciniak, Martin D.

    2010-01-01

    Chemotherapy regimens may have differential efficacy by histology in nonsmall cell lung cancer (NSCLC). We examined the impact of histology on survival of patients (N = 2,644) with stage IIIB/IV NSCLC who received first-line cisplatin/carboplatin plus gemcitabine (C/C+G) and cisplatin/carboplatin plus a taxane (C/C+T) identified retrospectively in the SEER cancer registry (1997–2002). Patients with squamous and nonsquamous cell carcinoma survived 8.5 months and 8.1 months, respectively (P = .018). No statistically significant difference was observed in survival between C/C+G and C/C+T in both histologies. Adjusting for clinical and demographic characteristics, the effect of treatment regimen on survival did not differ by histology (P for interaction = .257). There was no statistically significant difference in hazard of death by histology in both groups. These results contrast the predictive role of histology and improved survival outcomes observed for cisplatin-pemetrexed regimens in advanced nonsquamous NSCLC. PMID:22482053

  10. Does Type of Tumor Histology Impact Survival among Patients with Stage IIIB/IV Non-Small Cell Lung Cancer Treated with First-Line Doublet Chemotherapy?

    Directory of Open Access Journals (Sweden)

    Karen M. Clements

    2010-01-01

    Full Text Available Chemotherapy regimens may have differential efficacy by histology in nonsmall cell lung cancer (NSCLC. We examined the impact of histology on survival of patients (N=2,644 with stage IIIB/IV NSCLC who received first-line cisplatin/carboplatin plus gemcitabine (C/C+G and cisplatin/carboplatin plus a taxane (C/C+T identified retrospectively in the SEER cancer registry (1997–2002. Patients with squamous and nonsquamous cell carcinoma survived 8.5 months and 8.1 months, respectively (P=.018. No statistically significant difference was observed in survival between C/C+G and C/C+T in both histologies. Adjusting for clinical and demographic characteristics, the effect of treatment regimen on survival did not differ by histology (P for interaction =.257. There was no statistically significant difference in hazard of death by histology in both groups. These results contrast the predictive role of histology and improved survival outcomes observed for cisplatin-pemetrexed regimens in advanced nonsquamous NSCLC.

  11. Predictors of acute grade 4 swallowing toxicity in patients with stages III and IV squamous carcinoma of the head and neck treated with radiotherapy alone

    International Nuclear Information System (INIS)

    Poulsen, Michael Geoffrey; Riddle, Bena; Keller, Jacqui; Porceddu, Sandro V.; Tripcony, Lee

    2008-01-01

    Purpose: The purpose of the study was to investigate the predictive factors for acute grade 4 swallowing toxicity in an attempt to identify which patients may benefit from early intervention with enteral feeding during curative radiation treatment for localised Stages 3-4 squamous cell carcinoma of the head and neck. It was hypothesised that craniocaudal length of the treatment field to the upper neck and pharynx would correlate with grade 4 swallowing toxicity due to the increased volume of pharynx irradiated. Patients and methods: Toxicity data were collected prospectively as part of a phase III randomised trial (TROG 91:01) that assigned patients to either conventional (CRT) or accelerated radiotherapy (ART). Patients were randomly assigned to either CRT, using a single 2 Gy per day to a dose of 70 Gy in 35 fractions in 49 days or to ART, using 1.8 Gy twice a day to a dose of 59.4 Gy in 33 fractions in 24 days. Treatment allocation was stratified for site and stage. Accrual commenced in 1991 and the trial was closed in 1998 when the target of 350 patients was reached. Potential factors were analysed that predicted for Grade IV swallowing toxicity. Results: The treatment field lengths >82 mm for the second phase increased the probability of requiring intervention with percutaneous endoscopic gastrostomy (PEG) or Nasogastric tube (NGT). The probability of grade 4 swallowing was 36% if the phase 2 treatment length was >82 mm vs 16% for less ≤82 mm (p = 0.0001). A predictive enteral grading score (PEG score) was derived using the Cox regression coefficients: Field length of the boost volume >82 mm scored 3 points, Stage grouping greater than 1 scored 1 point, altered fractionation scored 2 points, ECOG greater than 1 scored 1 point. The PEG score was 45% if the score was ≥6 and 19% if the score was <6 (p = 0.0). Conclusions: More attention needs to be focused on developing robust dose and volume constraints for the pharyngeal mucosa and the musculature in order

  12. Long-lasting complete response status of advanced stage IV gall bladder cancer and colon cancer after combined treatment including autologous formalin-fixed tumor vaccine: two case reports.

    Science.gov (United States)

    Imaoka, Yuki; Kuranishi, Fumito; Miyazaki, Tsubasa; Yasuda, Hiroko; Ohno, Tadao

    2017-09-11

    The prognosis of advanced (stage IV) cancer of the digestive organs is very poor. We have previously reported a case of advanced breast cancer with bone metastasis that was successfully treated with combined treatments including autologous formalin-fixed tumor vaccine (AFTV). Herein, we report the success of this approach in advanced stage IV (heavily metastasized) cases of gall bladder cancer and colon cancer. Case 1: A 61-year-old woman with stage IV gall bladder cancer (liver metastasis and lymph node metastasis) underwent surgery in May 2011, including partial resection of the liver. She was treated with AFTV as the first-line adjuvant therapy, followed by conventional chemotherapy. This patient is still alive without any recurrence, as confirmed with computed tomography, for more than 5 years. Case 2: A 64-year-old man with stage IV colon cancer (multiple para-aortic lymph node metastases and direct abdominal wall invasion) underwent non-curative surgery in May 2006. Following conventional chemotherapy, two courses of AFTV and radiation therapy were administered sequentially. This patient has had no recurrence for more than 5 years. We report the success of combination therapy including AFTV in cases of liver-metastasized gall bladder cancer and abdominal wall-metastasized colon cancer. Both patients experienced long-lasting, complete remission. Therefore, combination therapies including AFTV should be considered in patients with advanced cancer of the digestive organs.

  13. Pressure/cross-sectional area relations in the proximal urethra of healthy males: the time dependent pressure response following forced dilation. Part IV: results in healthy volunteers

    DEFF Research Database (Denmark)

    Bagi, Per; Bøtker-Rasmussen; Kristensen, Jørgen Kvist

    2002-01-01

    The significance of the anatomical location and age on the urethral response to a sudden forced dilation was studied in 30 healthy males aged 23-85 years. The pressure decay after dilation was fitted with a double exponential function of the form: P(t) = P(equ) + P(alpha)e(-t/tau(alpha) + P...... of the pressure decay following dilation proved significantly related to age in all urethral segments. The causal background for this correlation is uncertain, but may be discovered in age dependent changes in the periluminal tissue composition, or in changing neuromuscular activity in these structures....

  14. The optimum intermediate pressure of two-stages vapor compression refrigeration cycle for Air-Conditioning unit

    Science.gov (United States)

    Ambarita, H.; Sihombing, H. V.

    2018-03-01

    Vapor compression cycle is mainly employed as a refrigeration cycle in the Air-Conditioning (AC) unit. In order to save energy, the Coefficient of Performance (COP) of the need to be improved. One of the potential solutions is to modify the system into multi-stages vapor compression cycle. The suitable intermediate pressure between the high and low pressures is one of the design issues. The present work deals with the investigation of an optimum intermediate pressure of two-stages vapor compression refrigeration cycle. Typical vapor compression cycle that is used in AC unit is taken into consideration. The used refrigerants are R134a. The governing equations have been developed for the systems. An inhouse program has been developed to solve the problem. COP, mass flow rate of the refrigerant and compressor power as a function of intermediate pressure are plotted. It was shown that there exists an optimum intermediate pressure for maximum COP. For refrigerant R134a, the proposed correlations need to be revised.

  15. Pressure/cross-sectional area relations in the proximal urethra of healthy males: the time dependent pressure response following forced dilation. Part IV: results in healthy volunteers

    DEFF Research Database (Denmark)

    Bagi, Per; Bøtker-Rasmussen; Kristensen, Jørgen Kvist

    2002-01-01

    The significance of the anatomical location and age on the urethral response to a sudden forced dilation was studied in 30 healthy males aged 23-85 years. The pressure decay after dilation was fitted with a double exponential function of the form: P(t) = P(equ) + P(alpha)e(-t/tau(alpha) + P...

  16. Fundal pressure versus controlled cord traction as part of the active management of the third stage of labour.

    Science.gov (United States)

    Peña-Martí, G; Comunián-Carrasco, G

    2007-10-17

    There are two basic interventions to help to deliver the placenta as part of the active management of the third stage of labour: (1) fundal pressure, and (2) controlled traction on the umbilical cord. Both of these methods may, in addition, have adverse outcomes. Fundal pressure may interrupt the process of placental detachment and cause pain, haemorrhage or uterine inversion, and controlled cord traction, if undertaken before placental separation or without prior administration of a uterotonic drug, may have similar adverse effects. The obstetric clinical practice on this issue is not standardised. To determine the efficacy of fundal pressure versus controlled cord traction as part of the active management of the third stage of labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 2), MEDLINE (January 1966 to April 2006), EMBASE (January 1988 to April 2006) and LILACS (1982 to April 2006). We searched for published and unpublished randomised and quasi-randomised controlled trials. Two review authors independently identified potential studies from the literature search and assessed them for methodological quality and appropriateness of inclusion. The search strategies yielded five studies for consideration of inclusion. However, none of these studies fulfilled the requirements for inclusion in this review. We identified no randomised controlled trials comparing the efficacy of fundal pressure versus controlled cord traction as part of the active management of the third stage of labour. Hence controlled cord traction, after awaiting signs of placental separation, should remain the third component of the active management of third stage of labour, and follow the routine administration of a uterotonic drug and cord clamping.

  17. Survival Outcomes and Patterns of Recurrence in Patients with Stage III or IV Oropharyngeal Cancer Treated with Primary Surgery or Radiotherapy.

    Science.gov (United States)

    Debenham, Brock J; Banerjee, Robyn; Warkentin, Heather; Ghosh, Sunita; Scrimger, Rufus; Jha, Naresh; Parliament, Matthew

    2016-07-26

    To compare and contrast the patterns of failure in patients with locally advanced squamous cell oropharyngeal cancers undergoing curative-intent treatment with primary surgery or radiotherapy +/- chemotherapy. Two hundred and thirty-three patients with stage III or IV oropharyngeal squamous cell carcinoma who underwent curative-intent treatment from 2006-2012, were reviewed. The median length of follow-up for patients still alive at the time of analysis was 4.4 years. Data was collected retrospectively from a chart review. One hundred and thirty-nine patients underwent primary surgery +/- adjuvant therapy, and 94 patients underwent primary radiotherapy +/- chemotherapy (CRT). Demographics were similar between the two groups, except primary radiotherapy patients had a higher age-adjusted Charleston co-morbidity score (CCI). Twenty-nine patients from the surgery group recurred; 15 failed distantly only, seven failed locoregionally, and seven failed both distantly and locoregionally. Twelve patients recurred who underwent chemoradiotherapy; ten distantly alone, and two locoregionally. One patient who underwent radiotherapy (RT) alone failed distantly. Two and five-year recurrence-free survival rates for patients undergoing primary RT were 86.6% and 84.9% respectively. Two and five-year recurrence-free survival rates for primary surgery was 80.9% and 76.3% respectively (p=0.21). There was no significant difference in either treatment when they were stratified by p16 status or smoking status. Our analysis does not show any difference in outcomes for patients treated with primary surgery or radiotherapy. Although the primary pattern of failure in both groups was distant metastatic disease, some local failures may be preventable with careful delineation of target volumes, especially near the base of skull region.

  18. Association of drug transporter expression with mortality and progression-free survival in stage IV head and neck squamous cell carcinoma.

    Directory of Open Access Journals (Sweden)

    Rolf Warta

    Full Text Available Drug transporters such as P-glycoprotein (ABCB1 have been associated with chemotherapy resistance and are considered unfavorable prognostic factors for survival of cancer patients. Analyzing mRNA expression levels of a subset of drug transporters by quantitative reverse transcription polymerase chain reaction (qRT-PCR or protein expression by tissue microarray (TMA in tumor samples of therapy naïve stage IV head and neck squamous cell carcinoma (HNSCC (qRT-PCR, n = 40; TMA, n = 61, this in situ study re-examined the significance of transporter expression for progression-free survival (PFS and overall survival (OS. Data from The Cancer Genome Atlas database was used to externally validate the respective findings (n = 317. In general, HNSCC tended to lower expression of drug transporters compared to normal epithelium. High ABCB1 mRNA tumor expression was associated with both favorable progression-free survival (PFS, p = 0.0357 and overall survival (OS, p = 0.0535. Similar results were obtained for the mRNA of ABCC1 (MRP1, multidrug resistance-associated protein 1; PFS, p = 0.0183; OS, p = 0.038. In contrast, protein expression of ATP7b (copper transporter ATP7b, mRNA expression of ABCG2 (BCRP, breast cancer resistance protein, ABCC2 (MRP2, and SLC31A1 (hCTR1, human copper transporter 1 did not correlate with survival. Cluster analysis however revealed that simultaneous high expression of SLC31A1, ABCC2, and ABCG2 indicates poor survival of HNSCC patients. In conclusion, this study militates against the intuitive dogma where high expression of drug efflux transporters indicates poor survival, but demonstrates that expression of single drug transporters might indicate even improved survival. Prospectively, combined analysis of the 'transportome' should rather be performed as it likely unravels meaningful data on the impact of drug transporters on survival of patients with HNSCC.

  19. Radiochemotherapy including cisplatin alone versus cisplatin + 5-fluorouracil for locally advanced unresectable stage IV squamous cell carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Tribius, Silke; Kilic, Yasemin; Kronemann, Stefanie; Schroeder, Ursula; Hakim, Samer; Schild, Steven E.; Rades, Dirk

    2009-01-01

    Background and purpose: the optimal radiochemotherapy regimen for advanced head-and-neck cancer is still debated. This nonrandomized study compares two cisplatin-based radiochemotherapy regimens in 128 patients with locally advanced unresectable stage IV squamous cell carcinoma of the head and neck (SCCHN). Patients and methods: concurrent chemotherapy consisted of either two courses cisplatin (20 mg/m 2 /d1-5 + 29-33; n = 54) or two courses cisplatin (20 mg/m 2 /d1-5 + 29-33) + 5-fluorouracil (5-FU; 600 mg/m 2 /d1-5 + 29-33; n = 74). Results: at least one grade 3 toxicity occurred in 25 of 54 patients (46%) receiving cisplatin alone and in 52 of 74 patients (70%) receiving cisplatin + 5-FU. The latter regimen was particularly associated with increased rates of mucositis (p = 0.027) and acute skin toxicity (p = 0.001). Seven of 54 (13%) and 20 of 74 patients (27%) received only one chemotherapy course due to treatment-related acute toxicity. Late toxicity in terms of xerostomia, neck fibrosis, skin toxicity, and lymphedema was not significantly different. The 2-year locoregional control rates were 67% after cisplatin alone and 52% after cisplatin + 5-FU (p = 0.35). The metastases-free survival rates were 79% and 69%, respectively (p = 0.65), and the overall survival rates 70% and 51%, respectively (p = 0.10). On multivariate analysis, outcome was significantly associated with performance status, T-category, N-category, hemoglobin level prior to radiotherapy, and radiotherapy break > 1 week. Conclusion: two courses of fractionated cisplatin (20 mg/m 2 /day) alone appear preferable, as this regimen resulted in similar outcome and late toxicity as two courses of cisplatin + 5-FU, but in significantly less acute toxicity. (orig.)

  20. Stages III and IV Squamous Cell Carcinoma of the Mouth: Three-Year Experience with Superselective Intraarterial Chemotherapy Using Cisplatin Prior to Definitive Treatment

    International Nuclear Information System (INIS)

    Hirai, Toshinori; Korogi, Yukunori; Hamatake, Satoshi; Nishimura, Ryuichi; Baba, Yuji; Takahashi, Mutsumasa; Uji, Yasuyoshi; Taen, Akira

    1999-01-01

    Purpose: This study was designed to assess the 3-year experience with superselective intraarterial chemotherapy prior to definitive treatment for stages III and IV squamous cell carcinomas of the mouth. Methods: Twenty-two patients prospectively received superselective intraarterial chemotherapy using relatively low-dose cisplatin via a transfemoral approach. The locations of the tumors were the tongue (n= 12), gingiva (n= 5), buccal mucosa (n= 2), hard palate (n= 1), floor of the mouth (n= 1), and lip (n= 1). After intraarterial chemotherapy, 21 patients underwent surgery (n= 14), radiation therapy (n= 6), or both (n= 1). The survival rate of 25 patients who underwent surgery with/without radiation therapy until 1992 at Kumamoto University Hospital was also evaluated as a historical control. The survival curve was calculated with the Kaplan-Meier method, and the statistical difference between survival curves was determined with the generalized Wilcoxon test. Results: The overall response rate was 95% [complete response (tumor completely resolved), 24%; partial response (tumor reduction ≥50%), 71%]. Fifty-two intraarterial infusions were performed without any catheter-related complications. Mild and transient local toxicity such as edema or mucositis of the infused area was relatively common. One patient died of renal failure from cisplatin. After a median follow-up of 20 months (range 2-41 months), the estimated 3-year survival rate for patients who underwent intraarterial chemotherapy plus surgery was 91%. The survival of the patients who underwent intraarterial chemotherapy plus surgery tended to be longer than that of the historical control. Conclusions: Early tumor reduction without delay of subsequent treatments can be obtained by intraarterial chemotherapy while minimizing complications and possibly improving survival. Further investigations of long-term survival with larger series need to be performed

  1. Malignant pleural disease is highly associated with subsequent peritoneal metastasis in patients with stage IV non-small cell lung cancer independent of oncogene status.

    Science.gov (United States)

    Patil, Tejas; Aisner, Dara L; Noonan, Sinead A; Bunn, Paul A; Purcell, William T; Carr, Laurie L; Camidge, D Ross; Doebele, Robert C

    2016-06-01

    Peritoneal metastasis from lung cancer is an uncommon clinical event and there are limited data on what factors predict peritoneal progression. This study retrospectively investigated whether patterns of metastatic spread and oncogene status in patients with advanced non-small cell lung cancer (NSCLC) are associated with peritoneal metastasis. Patients with metastatic non-squamous NSCLC (n=410) were identified at the University of Colorado Cancer Center. Sites of metastatic disease and baseline oncogene status (EGFR, ALK, KRAS, or triple negative) were documented via a retrospective chart review. In patients with EGFR mutations who developed peritoneal disease, we documented the presence of known resistance mechanisms. Median time to peritoneal metastasis, time from peritoneal disease to death, and overall survival were collected. Eight percent (33/410) patients in this study developed peritoneal metastasis. Malignant pleural disease at baseline was significantly associated with subsequent peritoneal spread. There was no association between oncogene status and peritoneal metastasis. Three patients with EGFR mutations who developed peritoneal metastasis had documented resistance to tyrosine kinase inhibitors (TKIs) in the ascitic fluid. Median time from stage IV disease to peritoneal metastasis was 16.5 months (range 0.6-108 months). There were no differences in overall survival between patients who developed peritoneal metastasis and those who did not. Malignant pleural disease is highly associated with peritoneal metastasis in patients with advanced NSCLC. The underlying mechanism is not clear. The presence of resistance mutations in ascitic fluid implies that poor drug penetration is unlikely to be the dominant mechanism. Despite being a late clinical finding, there were no differences in overall survival between patients who developed peritoneal metastasis and those who did not. Additional studies exploring treatment related factors in patients with malignant

  2. VAC Therapy in Large Infected Sacral Pressure Ulcer Grade IV-Can Be an Alternative to Flap Reconstruction?

    Science.gov (United States)

    Batra, R K; Aseeja, Veena

    2014-04-01

    Vacuum-assisted closure (VAC) therapy is a new entrant in wound care after growth factors and alginate or hydrocolloid dressing, in the treatment of pressure ulcers. We have been using this technique for diabetic foot ulcers. A young nondiabetic man presented with a large sacral bed sore after high doses of ionotropes in an intensive care unit for treating severe hypotension. His wound was debrided, and instead of flap surgery in such infected wound, he was treated with VAC therapy. The complete wound healing was achieved in 6 weeks and at half the cost of flap surgery. Moreover, the chances of flap failure and its related complications were eliminated.

  3. Cisplatin, Intensity-Modulated Radiation Therapy, and Pembrolizumab in Treating Patients With Stage III-IV Head and Neck Squamous Cell Carcinoma

    Science.gov (United States)

    2018-04-09

    CDKN2A-p16 Negative; Stage III Hypopharyngeal Squamous Cell Carcinoma AJCC v7; Stage III Laryngeal Squamous Cell Carcinoma AJCC v6 and v7; Stage III Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage III Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVA Hypopharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVA Laryngeal Squamous Cell Carcinoma AJCC v7; Stage IVA Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage IVA Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVB Hypopharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVB Laryngeal Squamous Cell Carcinoma AJCC v7; Stage IVB Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage IVB Oropharyngeal Squamous Cell Carcinoma AJCC v7

  4. Feasibility and Efficacy of Induction Docetaxel, Cisplatin, and 5-Fluorouracil Chemotherapy Combined With Cisplatin Concurrent Chemoradiotherapy for Nonmetastatic Stage IV Head-and-Neck Squamous Cell Carcinomas

    International Nuclear Information System (INIS)

    Prestwich, Robin J.; Öksüz, Didem Çolpan; Dyker, Karen; Coyle, Catherine; Şen, Mehmet

    2011-01-01

    Purpose: To report the experience of treating selected fit patients with locally advanced head-and-neck squamous cell carcinoma with three cycles of induction TPF (docetaxel 75 mg/m 2 , cisplatin 75 mg/m 2 , 5-fluorouracil 750 mg/m 2 , Days 2–5) followed by concurrent three-weekly bolus cisplatin 100 mg/m 2 chemoradiotherapy. Methods and Materials: Between March 2006 and February 2010, 66 patients with nonmetastatic Stage IV head-and-neck squamous cell carcinoma were treated in a single institution with three cycles of induction TPF, followed by radical radiotherapy with concurrent cisplatin 100 mg/m 2 . Results: Median age was 54 years (range, 33–69 years). Median follow-up was 21 months (range, 4–55 months). During TPF, Grade 3 toxicity occurred in 18 patients (27%), dose modifications in 10 (15%), delays in 3 (5%), and unplanned admissions in 6 (9%); a clinical tumor response was documented in 60 patients (91%). Median time from the final cycle of TPF to commencing radiotherapy was 22 days. Sixty-two patients (94%) received radical radiotherapy, and all completed treatment with no delays ≥3 days. One, two, and three cycles of concurrent cisplatin were delivered to 18 patients (29%), 38 patients (61%), and 3 patients (5%), respectively. Ninety-two percent of patients received enteral feeding; median weight loss during treatment was 7%. Forty-two patients (68%) had unplanned admissions with no on-treatment deaths. Three unrelated deaths occurred after treatment. At 1 year after treatment, 21% of patients without disease progression remained gastrostomy dependent. Of 58 assessable patients, 50 (86%) achieved a complete response after treatment. One- and 2-year progression-free survival, cause-specific survival, and overall survival were 88%, 92%, and 86% and 80%, 85%, and 80%, respectively. Conclusion: The combination of induction TPF with concurrent cisplatin chemoradiotherapy in patients with locally advanced head and neck squamous cell carcinoma is

  5. Longitudinal observations on circadian blood pressure variation in chronic kidney disease stages 3-5

    DEFF Research Database (Denmark)

    Elung-Jensen, T.; Strandgaard, S.; Kamper, Anne-Lise

    2008-01-01

    /non-dipper status prospectively in a study on dosage of enalapril in progressive chronic kidney disease (CKD) stages 3-5. METHODS: In 34 patients, 24-h ambulatory BP (A&D TM2421) was measured at baseline and every 4 months for 1 year or until the need for renal replacement therapy. For each BP recording patients...

  6. Economic Analysis on Direct Use of Spent Pressurized Water Reactor Fuel in CANDU Reactors - IV: DUPIC Fuel Cycle Cost

    International Nuclear Information System (INIS)

    Ko, Won Il; Choi, Hangbok; Yang, Myung Seung

    2001-01-01

    This study examines the economics of the DUPIC fuel cycle using unit costs of fuel cycle components estimated based on conceptual designs. The fuel cycle cost (FCC) was calculated by a deterministic method in which reference values of fuel cycle components are used. The FCC was then analyzed by a Monte Carlo simulation to get the uncertainty of the FCC associated with the unit costs of the fuel cycle components. From the deterministic analysis on the equilibrium fuel cycle model, the DUPIC FCC was estimated to be 6.21 to 6.34 mills/kW.h for DUPIC fuel options, which is a little smaller than that of the once-through FCC by 0.07 to 0.27 mills/kW.h. Considering the uncertainty (0.40 to 0.44 mills/kW.h) of the FCC estimated by the Monte Carlo simulation method, the cost difference between the DUPIC and once-through fuel cycle is negligible. On the other hand, the material balance calculation has shown that the DUPIC fuel cycle can save natural uranium resources by ∼20% and reduce the spent fuel arising by ∼65% compared with the once-through fuel cycle. In conclusion, the DUPIC fuel cycle is comparable with the once-through fuel cycle from the viewpoint of FCC. In the future, it should be important to consider factors such as the environmental benefit owing to natural uranium savings, the capability of reusing spent pressurized water reactor fuel, and the safeguardability of the fuel cycle when deciding on an advanced nuclear fuel cycle option

  7. Longitudinal observations on circadian blood pressure variation in chronic kidney disease stages 3-5

    DEFF Research Database (Denmark)

    Elung-Jensen, T.; Strandgaard, S.; Kamper, Anne-Lise

    2008-01-01

    BACKGROUND: It has been suggested that status as a 'non-dipper' determined from 24-h blood pressure (BP) recordings is associated with increased risk of end-organ damage but little is known about the consistency of dipper status in renal patients. The present post hoc analysis evaluated dipper/no...

  8. Stage design

    International Nuclear Information System (INIS)

    Shacter, J.

    1975-01-01

    A method is described of cycling gases through a plurality of diffusion stages comprising the steps of admitting the diffused gases from a first diffusion stage into an axial compressor, simultaneously admitting the undiffused gases from a second diffusion stage into an intermediate pressure zone of said compressor corresponding in pressure to the pressure of said undiffused gases, and then admitting the resulting compressed mixture of diffused and undiffused gases into a third diffusion stage

  9. Hope for progress after 40 years of futility? Novel approaches in the treatment of advanced stage III and IV non-small-cell-lung cancer: Stereotactic body radiation therapy, mediastinal lymphadenectomy, and novel systemic therapy

    OpenAIRE

    Fung, Simon Fung Fee; Warren, Graham W.; Singh, Anurag K.

    2012-01-01

    Non-small-cell lung cancer (NSCLC) remains a leading cause of cancer mortality. The majority of patients present with advanced (stage III-IV) disease. Such patients are treated with a variety of therapies including surgery, radiation, and chemotherapy. Despite decades of work, however, overall survival in this group has been resistant to any substantial improvement. This review briefly details the evolution to the current standard of care for advanced NSCLC, advances in systemic therapy, and ...

  10. A method for measuring the local gas pressure within a gas-flow stage in situ in the transmission electron microscope

    Energy Technology Data Exchange (ETDEWEB)

    Colby, R. [Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA (United States); Alsem, D.H. [Hummingbird Scientific, Lacey, WA (United States); Liyu, A.; Kabius, B. [Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA (United States)

    2015-06-15

    Environmental transmission electron microscopy (TEM) has enabled in situ experiments in a gaseous environment with high resolution imaging and spectroscopy. Addressing scientific challenges in areas such as catalysis, corrosion, and geochemistry can require pressures much higher than the ∼20 mbar achievable with a differentially pumped environmental TEM. Gas flow stages, in which the environment is contained between two semi-transparent thin membrane windows, have been demonstrated at pressures of several atmospheres. However, the relationship between the pressure at the sample and the pressure drop across the system is not clear for some geometries. We demonstrate a method for measuring the gas pressure at the sample by measuring the ratio of elastic to inelastic scattering and the defocus of the pair of thin windows. This method requires two energy filtered high-resolution TEM images that can be performed during an ongoing experiment, at the region of interest. The approach is demonstrated to measure greater than atmosphere pressures of N{sub 2} gas using a commercially available gas-flow stage. This technique provides a means to ensure reproducible sample pressures between different experiments, and even between very differently designed gas-flow stages. - Highlights: • Method developed for measuring gas pressure within a gas-flow stage in the TEM. • EFTEM and CTF-fitting used to calculate amount and volume of gas. • Requires only a pair of images without leaving region of interest. • Demonstrated for P > 1 atm with a common commercial gas-flow stage.

  11. A method for measuring the local gas pressure within a gas-flow stage in situ in the transmission electron microscope

    International Nuclear Information System (INIS)

    Colby, R.; Alsem, D.H.; Liyu, A.; Kabius, B.

    2015-01-01

    Environmental transmission electron microscopy (TEM) has enabled in situ experiments in a gaseous environment with high resolution imaging and spectroscopy. Addressing scientific challenges in areas such as catalysis, corrosion, and geochemistry can require pressures much higher than the ∼20 mbar achievable with a differentially pumped environmental TEM. Gas flow stages, in which the environment is contained between two semi-transparent thin membrane windows, have been demonstrated at pressures of several atmospheres. However, the relationship between the pressure at the sample and the pressure drop across the system is not clear for some geometries. We demonstrate a method for measuring the gas pressure at the sample by measuring the ratio of elastic to inelastic scattering and the defocus of the pair of thin windows. This method requires two energy filtered high-resolution TEM images that can be performed during an ongoing experiment, at the region of interest. The approach is demonstrated to measure greater than atmosphere pressures of N 2 gas using a commercially available gas-flow stage. This technique provides a means to ensure reproducible sample pressures between different experiments, and even between very differently designed gas-flow stages. - Highlights: • Method developed for measuring gas pressure within a gas-flow stage in the TEM. • EFTEM and CTF-fitting used to calculate amount and volume of gas. • Requires only a pair of images without leaving region of interest. • Demonstrated for P > 1 atm with a common commercial gas-flow stage

  12. Misconduct Policies, Academic Culture and Career Stage, Not Gender or Pressures to Publish, Affect Scientific Integrity.

    Directory of Open Access Journals (Sweden)

    Daniele Fanelli

    Full Text Available The honesty and integrity of scientists is widely believed to be threatened by pressures to publish, unsupportive research environments, and other structural, sociological and psychological factors. Belief in the importance of these factors has inspired major policy initiatives, but evidence to support them is either non-existent or derived from self-reports and other sources that have known limitations. We used a retrospective study design to verify whether risk factors for scientific misconduct could predict the occurrence of retractions, which are usually the consequence of research misconduct, or corrections, which are honest rectifications of minor mistakes. Bibliographic and personal information were collected on all co-authors of papers that have been retracted or corrected in 2010-2011 (N=611 and N=2226 papers, respectively and authors of control papers matched by journal and issue (N=1181 and N=4285 papers, respectively, and were analysed with conditional logistic regression. Results, which avoided several limitations of past studies and are robust to different sampling strategies, support the notion that scientific misconduct is more likely in countries that lack research integrity policies, in countries where individual publication performance is rewarded with cash, in cultures and situations were mutual criticism is hampered, and in the earliest phases of a researcher's career. The hypothesis that males might be prone to scientific misconduct was not supported, and the widespread belief that pressures to publish are a major driver of misconduct was largely contradicted: high-impact and productive researchers, and those working in countries in which pressures to publish are believed to be higher, are less-likely to produce retracted papers, and more likely to correct them. Efforts to reduce and prevent misconduct, therefore, might be most effective if focused on promoting research integrity policies, improving mentoring and training

  13. Stages of polymer transformation during remote plasma oxidation (RPO) at atmospheric pressure

    Science.gov (United States)

    Luan, P.; Oehrlein, G. S.

    2018-04-01

    The interaction of cold temperature plasma sources with materials can be separated into two types: ‘direct’ and ‘remote’ treatments. Compared to the ‘direct’ treatment which involves energetic charged species along with short-lived, strongly oxidative neutral species, ‘remote’ treatment by the long-lived weakly oxidative species is less invasive and better for producing uniformly treated surfaces. In this paper, we examine the prototypical case of remote plasma oxidation (RPO) of polymer materials by employing a surface micro-discharge (in a N2/O2 mixture environment) treatment on polystyrene. Using material characterization techniques including real-time ellipsometry, x-ray photoelectron spectroscopy, and Fourier-transform infrared spectroscopy, the time evolution of polymer film thickness, refractive index, surface, and bulk chemical composition were evaluated. These measurements revealed three consecutive stages of polymer transformation, i.e. surface adsorption and oxidation, bulk film permeation and thickness expansion followed by the material removal as a result of RPO. By correlating the observed film thickness changes with simultaneously obtained chemical information, we found that the three stages were due to the three effects of weakly oxidative species on polymers: (1) surface oxidation and nitrate (R-ONO2) chemisorption, (2) bulk oxidation, and (3) etching. Our results demonstrate that surface adsorption and oxidation, bulk oxidation, and etching can all happen during one continuous plasma treatment. We show that surface nitrate is only adsorbed on the top few nanometers of the polymer surface. The polymer film expansion also provided evidence for the diffusion and reaction of long-lived plasma species in the polymer bulk. Besides, we found that the remote plasma etched surface was relatively rich in O-C=O (ester or carboxylic acid). These findings clarify the roles of long-lived weakly oxidative plasma species on polymers and advance

  14. Erosion study of final stage blading of low pressure steam turbines

    Science.gov (United States)

    Dehouve, J.; Nardin, P.; Zeghmati, M.

    1999-04-01

    In order to increase our knowledge of erosion phenomena, the Steam Turbine Groupe (STG) of ALSTOM has been using an erosion test facility in the C.R.T.V. (Centre de Recherche Turbines à Vapeur). This test facility simulates erosion in low pressure steam turbine cylinders in order to compare the erosion resistance of various blade materials (12% chromium steel, titanium alloys, etc.) and their protection (superficial hardening, coatings, etc.). This test facility also allows us to understand the mechanism causing damage at a macroscopic level (impact energy of the droplets and the loss of eroded volume) and at a microscopic level (residual stress and metallurgic analysis) and therefore to determine an evolution law of material surface damage. In this paper, the behaviour of the materials (12% chromium steel and titanium alloys), which has been analysed by image production measurement methods, will be presented according to different impact velocities.

  15. (IV) phosphates

    Indian Academy of Sciences (India)

    M(IV) phosphates of the class of tetravalent metal acid (TMA) salts where M (IV) = Zr, Ti, Sn has been synthesized by the sol-gel method. These materials have been characterized for elemental analysis (ICP-AES), thermal analysis (TGA, DSC), X-ray analysis and FTIR spectroscopy. Chemical resistivity of these materials ...

  16. Cementless total hip arthroplasty for patients with Crowe type III or IV developmental dysplasia of the hip: two-stage total hip arthroplasty following skeletal traction after soft tissue release for irreducible hips.

    Science.gov (United States)

    Yoon, Pil Whan; Kim, Jung Il; Kim, Dong Ok; Yu, Cheol Hwan; Yoo, Jeong Joon; Kim, Hee Joong; Yoon, Kang Sup

    2013-09-01

    Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA. Retrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks. The mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively. The short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.

  17. IPP-rich milk protein hydrolysate lowers blood pressure in subjects with stage 1 hypertension, a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kloek Joris

    2010-11-01

    Full Text Available Abstract Background Milk derived peptides have been identified as potential antihypertensive agents. The primary objective was to investigate the effectiveness of IPP-rich milk protein hydrolysates (MPH on reducing blood pressure (BP as well as to investigate safety parameters and tolerability. The secondary objective was to confirm or falsify ACE inhibition as the mechanism underlying BP reductions by measuring plasma renin activity and angiotensin I and II. Methods We conducted a randomized, placebo-controlled, double blind, crossover study including 70 Caucasian subjects with prehypertension or stage 1 hypertension. Study treatments consisted of daily consumption of two capsules MPH1 (each containing 7.5 mg Isoleucine-Proline-Proline; IPP, MPH2 (each containing 6.6 mg Methionine-Alanine-Proline, 2.3 mg Leucine-Proline-Proline, 1.8 mg IPP, or placebo (containing cellulose for 4 weeks. Results In subjects with stage 1 hypertension, MPH1 lowered systolic BP by 3.8 mm Hg (P = 0.0080 and diastolic BP by 2.3 mm Hg (P = 0.0065 compared with placebo. In prehypertensive subjects, the differences in BP between MPH1 and placebo were not significant. MPH2 did not change BP significantly compared with placebo in stage I hypertensive or prehypertensive subjects. Intake of MPHs was well tolerated and safe. No treatment differences in hematology, clinical laboratory parameters or adverse effects were observed. No significant differences between MPHs and placebo were found in plasma renin activity, or angiotensin I and II. Conclusions MPH1, containing IPP and no minerals, exerts clinically relevant BP lowering effects in subjects with stage 1 hypertension. It may be included in lifestyle changes aiming to prevent or reduce high BP. Trial registration ClinicalTrials.gov NCT00471263

  18. Effects of Friction and Anvil Design on Plastic Deformation during the Compression Stage of High-Pressure Torsion

    Energy Technology Data Exchange (ETDEWEB)

    Song, Yuepeng; Chen, Miaomiao; Xu, Baoyan; Guo, Jing; Xu, Lingfeng; Wang, Zheng [Mechanical and Electronic Engineering College, Tai’an (China); Gao, Dongsheng [Shandong Provincial Key Laboratory of Horticultural Machineries and Equipments, Tai’an (China); Kim, Hyoung Seop [Department of Materials Science and Engineering, Pohang (Korea, Republic of)

    2016-11-15

    Herein, we report the results of our investigation on the effect of friction and anvil design on the heterogeneous plastic-deformation characteristics of copper during the compressive stage of high-pressure torsion (HPT), using the finite element method. The results indicate that the friction and anvil geometry play important roles in the homogeneity of the deformation. These variables affect the heterogeneous level of strain in the HPT compressed disks, as well as the flash in the disk edge region. The heterogeneous plastic deformation of the disks becomes more severe with the increasing depth of the cavity, as anvil angle and friction coefficient increase. However, the homogeneity increases with increases in the wall angle. The length of flash and the area of the dead metal zone increase with the depth of the cavity, while they decrease at a wall angle of 180°.

  19. Reliability of center of pressure measures for assessing the development of sitting postural control through the stages of sitting.

    Science.gov (United States)

    Wickstrom, Jordan; Stergiou, Nick; Kyvelidou, Anastasia

    2017-07-01

    Cerebral palsy (CP) impairs an individual's ability to move and control one's posture. Unfortunately, the signs and symptoms of CP may not be apparent before age two. Evaluating sitting posture is a potential way to assess the developing mechanisms that contribute to CP. The purpose of this project was to determine the reliability of linear and nonlinear measures, including inter- and intrastage reliability, when used to analyze the center of pressure (COP) time series during the stages of sitting development in children with typical development (TD) and with/at-risk for cerebral palsy (CP). We hypothesized that nonlinear tools would be more reliable than linear tools in assessing childrens' sitting development, and reliability would increase with development. COP data was recorded for three trials at eight sessions. Linear parameters used were root mean square, range of sway for the anterior-posterior (AP) and medial-lateral (ML) directions, and sway path. Nonlinear parameters used were Approximate Entropy, the largest Lyapunov Exponent, and Correlation Dimension for the AP and ML direction. Participants consisted of 33 children with TD and 26 children with/at-risk for CP. Our results determined that COP is a moderately reliable method for assessing the development of sitting postural control in stages in both groups. Thus, clinicians may be able to use measures from COP data across stages to assess the efficacy of therapeutic interventions that are intended to improve sitting postural abilities in children with/at-risk for CP. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Hope for progress after 40 years of futility? Novel approaches in the treatment of advanced stage III and IV non-small-cell-lung cancer: Stereotactic body radiation therapy, mediastinal lymphadenectomy, and novel systemic therapy.

    Science.gov (United States)

    Fung, Simon Fung Fee; Warren, Graham W; Singh, Anurag K

    2012-01-01

    Non-small-cell lung cancer (NSCLC) remains a leading cause of cancer mortality. The majority of patients present with advanced (stage III-IV) disease. Such patients are treated with a variety of therapies including surgery, radiation, and chemotherapy. Despite decades of work, however, overall survival in this group has been resistant to any substantial improvement. This review briefly details the evolution to the current standard of care for advanced NSCLC, advances in systemic therapy, and novel techniques (stereotactic body radiation therapy [SBRT], and transcervical extended mediastinal lymphadenectomy [TEMLA] or video-assisted mediastinal lymphadenectomy [VAMLA]) that have been used in localized NSCLC. The utility of these techniques in advanced stage therapy and potential methods of combining these novel techniques with systemic therapy to improve survival are discussed.

  1. Study of Stage-wise Pressure Pulsation in an Electric Submersible Pump under Variable Frequency Operation at Shut-off Condition

    Science.gov (United States)

    Dhanasekaran, A.; Kumaraswamy, S.

    2018-01-01

    Pressure pulsation causes vibration in the Electric Submersible Pump (ESP) and affects the life and performance of its system. ESP systems are installed at depths ranging from a few meters to several hundred meters. Unlike pumps used on the surface, once they are installed they become inaccessible for maintenance or for any kind of diagnostic measurement that might be taken directly on them. Therefore a detailed knowledge of mean and fluctuating pressures is required to achieve an optimal pressure distribution inside the ESP. This paper presents the results of an experimental investigation of the stage-wise pulsating pressure in ESP at shut-off condition at different speeds. Experiments were conducted on a pump having five stages. A variable frequency drive was used to operate the pump at five different speeds. Piezoresistive transducers were mounted at each stage of ESP to capture the unsteady pressure signals. Fast Fourier Transformation was carried out on the pressure signals to convert into frequency domain and the spectra of pressure pulsation signals were analyzed. The obtained results indicated the existence of fundamental frequency corresponding to the speed of rotation times the number of impeller blades and of the whole series of harmonics of higher frequencies.

  2. A CFD Case Study of a Fan Stage with Split Flow Path Subject to Total Pressure Distortion Inflow

    Science.gov (United States)

    To, Wai-Ming

    2017-01-01

    This report is the documentation of the work performed under the Hypersonic Project of the NASA's Fundamental Aeronautics Program. It was funded through Task Number NNC10E444T under GESS-2 Contract NNC06BA07B. The objective of the task is to develop advanced computational tools for the simulation of multi-stage turbomachinery in support of aeropropulsion. This includes work elements in extending the TURBO code and validating the multi-stage URANS (Unsteady Reynolds Averaged Navier Stokes) simulation results with the experimental data. The unsteady CFD (Computation Fluid Dynamics) calculations were performed in full wheel mode with and without screen generated total pressure distortion at the computational inflow boundary, as well as in single passage phase lag mode for uniform inflow. The experimental data were provided by NASA from the single stage RTA (Revolutionary Turbine Accelerator) fan test program.Significant non-uniform flow condition at the fan-face of the aeropropulsion system is frequentlyencountered in many of the advanced aerospace vehicles. These propulsion systems can be eithera podded or an embedded design employed in HWB (Hybrid Wing Body) airframe concept. It isalso a topic of interest in military applications, in which advanced air vehicles have already deployedsome form of embedded propulsion systems in their design because of the requirementsof compact and low observable inlets. Even in the conventional airframe/engine design, the fancould operate under such condition when the air vehicle is undergoing rapid maneuvering action.It is believed that a better understanding of the fan’s aerodynamic and aeromechanical responseto this type of operating condition or off design operation would be beneficial to designing distortiontolerant blades for improved engine operability.The objective for this research is to assess the capability of turbomachinery code as an analysistool in understanding the effects and evaluating the impact of flow distortion

  3. Effects of hemodialysis on corneal and anterior chamber morphometry and intraocular pressure in patients with end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Mehtap Caglayan

    Full Text Available ABSTRACT Purpose: To evaluate the effects of hemodialysis (HD on corneal and anterior chamber morphometry, as well as intraocular pressure (IOP in patients with end-stage renal disease. Methods: Fifty right eyes were examined 30 minutes before and after HD. IOP was measured with a Goldmann applanation tonometer, and Ehlers' formula was used to calculate the corrected IOP values. The central corneal thickness (CCT, corneal volume (CV, keratometric values, anterior chamber depth (ACD, aqueous depth (AQD, anterior chamber volume (ACV, and anterior chamber angle (ACA in the nasal and temporal quadrants were measured with a Sirius anterior segment analysis system. Blood urea nitrogen levels, body mass, and systolic and diastolic arterial pressure were also measured before and after HD. Results: The mean age was 60.80 ± 13.38 (range: 35-80 years. The mean uncorrected and corrected IOP values decreased from 18.06 ± 3.91 and 18.31 ± 4.83 mmHg to 16.94 ± 3.87 and 16.95 ± 4.74 mmHg after HD, respectively (p=0.011 and p=0.003, respectively. The mean CCT decreased from 536.38 ± 24.73 to 533.18 ± 27.25 µm (p=0.002, and the mean CV decreased from 57.52 ± 3.15 to 55.68 ± 3.55 mm³ (p0.05 for all values. There were no significant correlations between the ocular and systemic parameters (p>0.05 for all correlations. Conclusions: Uncorrected IOP, corrected IOP, CCT, and CV values decreased after HD, whereas the anterior chamber morphometry values remained similar between the measurements performed before and after HD.

  4. Two-Stage Progressive Femoral Lowering Followed by Cementless Total Hip Arthroplasty for Treating Crowe IV-Hartofilakidis Type 3 Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Binazzi, Roberto

    2015-05-01

    High developmental dysplasia of the hip is commonly treated with total hip arthroplasty and shortening osteotomy. We present a two stage technique, consisting of progressive femoral lowering followed by total hip arthroplasty. The clinico-radiographic results of eleven patients (twelve hips) who were operated on with the two-stage technique were evaluated at a mean follow-up of 11 ± 5 years. At the final follow-up, ten patients (eleven hips) had a mean Harris hip score of 85 ± 5 points with no implant loosening. One patient (one hip) was revised at 5 years due to infection. No neurovascular complications were observed in any patients. With this technique, we could place the cup in the anatomical position and obtain complete limb symmetry with excellent clinical results at long-term. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Five-year disease-free survival among stage II-IV breast cancer patients receiving FAC and AC chemotherapy in phase II clinical trials of Panagen.

    Science.gov (United States)

    Proskurina, Anastasia S; Gvozdeva, Tatiana S; Potter, Ekaterina A; Dolgova, Evgenia V; Orishchenko, Konstantin E; Nikolin, Valeriy P; Popova, Nelly A; Sidorov, Sergey V; Chernykh, Elena R; Ostanin, Alexandr A; Leplina, Olga Y; Dvornichenko, Victoria V; Ponomarenko, Dmitriy M; Soldatova, Galina S; Varaksin, Nikolay A; Ryabicheva, Tatiana G; Uchakin, Peter N; Rogachev, Vladimir A; Shurdov, Mikhail A; Bogachev, Sergey S

    2016-08-18

    We report on the results of a phase II clinical trial of Panagen (tablet form of fragmented human DNA preparation) in breast cancer patients (placebo group n = 23, Panagen n = 57). Panagen was administered as an adjuvant leukoprotective agent in FAC and AC chemotherapy regimens. Pre-clinical studies clearly indicate that Panagen acts by activating dendritic cells and induces the development of adaptive anticancer immune response. We analyzed 5-year disease-free survival of patients recruited into the trial. Five-year disease-free survival in the placebo group was 40 % (n = 15), compared with the Panagen arm - 53 % (n = 51). Among stage III patients, disease-free survival was 25 and 52 % for placebo (n = 8) and Panagen (n = 25) groups, respectively. Disease-free survival of patients with IIIB + C stage was as follows: placebo (n = 6)-17 % vs Panagen (n = 18)-50 %. Disease-free survival rate (17 %) of patients with IIIB + C stage breast cancer receiving standard of care therapy is within the global range. Patients who additionally received Panagen demonstrate a significantly improved disease-free survival rate of 50 %. This confirms anticancer activity of Panagen. ClinicalTrials.gov NCT02115984 from 04/07/2014.

  6. Combined treatment with ipilimumab and intratumoral interleukin-2 in pretreated patients with stage IV melanoma-safety and efficacy in a phase II study.

    Science.gov (United States)

    Weide, Benjamin; Martens, Alexander; Wistuba-Hamprecht, Kilian; Zelba, Henning; Maier, Ludwig; Lipp, Hans-Peter; Klumpp, Bernhard D; Soffel, Daniel; Eigentler, Thomas K; Garbe, Claus

    2017-04-01

    Treatment of advanced melanoma patients with ipilimumab results in improved survival. However, only about 20% of treated patients experience long-term benefit. Combining treatment of ipilimumab with other drugs may improve immune activation and potentially enhance clinical efficacy. The aims of the phase II clinical trial reported here were to investigate tolerability and efficacy of a combined immunotherapeutic strategy comprising standard systemic ipilimumab at 3 mg/kg four times at 3-week intervals and intratumorally injected IL-2 at 9 MIU daily twice weekly for four weeks in pretreated melanoma patients with distant metastasis. The primary endpoint was the disease control rate according to immune-related response criteria at week 12; tolerability according to Common Terminology Criteria for Adverse Events criteria was secondary endpoint. No objective responses were observed in the 15 enrolled patients. Three patients had stable disease 12 weeks after starting treatment, yielding a disease control rate of 20%. Tolerability of this combination treatment was acceptable. Observed adverse events were those expected from the respective monotherapies. Autoimmune colitis was observed in two patients. Grade III/IV adverse events were observed in 40% of patients, and no treatment-related deaths occurred. Thus, this combined immunotherapy is associated with adverse events similar to those associated with the respective monotherapies. However, this study does not provide any evidence of improved efficacy of the combination over ipilimumab alone.

  7. The effects of stair climbing on arterial stiffness, blood pressure, and leg strength in postmenopausal women with stage 2 hypertension.

    Science.gov (United States)

    Wong, Alexei; Figueroa, Arturo; Son, Won-Mok; Chernykh, Oksana; Park, Song-Young

    2018-02-12

    Menopause is accompanied by a progressive arterial stiffening associated with increases in blood pressure (BP) and decline in muscular function. It is crucial to prevent or reduce the negative effects of menopause on vascular and muscular function by implementing appropriate lifestyle interventions, such as exercise training. We examined the effects of a stair climbing (SC) regimen on arterial stiffness (pulse wave velocity [PWV]), BP, and leg strength in postmenopausal women with stage 2 hypertension. Using a parallel experimental design, participants were randomly assigned to either SC (n = 21) or nonexercising control group (n = 20) for 12 weeks. Participants in the SC group trained 4 d/wk, climbing 192 steps 2 to 5 times/d. Participants' brachial-to-ankle PWV (baPWV), BP, and leg strength were measured at baseline and after 12 weeks of their assigned intervention. There was a significant group by time interaction (P hypertensive postmenopausal women. The decrease in arterial stiffness partially explained the improvements in SBP and leg strength. SC may be an effective intervention in the prevention and treatment of menopause/aging-related vascular complications and muscle weakness.

  8. Blood Pressure Test

    Science.gov (United States)

    ... pressure monitors may have some limitations. Tracking your blood pressure readings It can be helpful in diagnosing or ... more Stage 2 high blood pressure (hypertension) Elevated blood pressure and stages 1 and 2 high blood pressure ( ...

  9. Intensity-Modulated Radiotherapy with a Simultaneous Integrated Boost Combined with Chemotherapy in Stages III-IV Hypopharynx-Larynx Cancer: Treatment Compliance and Clinical Outcomes

    International Nuclear Information System (INIS)

    Franchin, G.; Gobitti, C.; Minatel, E.; Furlan, C.; Trovo, M.G.; Vaccher, E.; Talamini, R.; Grando, G.; Barzan, L.; Drigo, A.

    2014-01-01

    Objectives. Retrospective review of our experience using intensity-modulated radiotherapy with simultaneous integrated boost (SIB-IMRT) combined with chemotherapy as the primary treatment of locoregionally advanced larynx and hypopharynx cancers. Materials and Methods. Between September 2008 and June 2012, 60 patients (26 with larynx and 34 hypopharynx cancers) were treated. Our policy was to offer SIB-IMRT plus concurrent cisplatin to patients affected by larynx cancer stage T3N0-N1 and NCT with TPF (docetaxel/cisplatin/fluorouracil) followed by SIB-IMRT to patients with larynx cancer stage T2-4N2-3 or hypopharynx cancer T2-4N0-3. SIB-IMRT consisted in a total dose of 70.95 Gy (2.15 Gy/fraction, 5 fractions/week) to the gross primary and nodal disease and differentiated dosages for high risk and low risk nodal regions. Results. Complete remission was achieved in 53/60 (88%) of patients. At a median follow up of 31 months (range 9–67), the rate of overall survival and locoregional control with functional larynx at 3 years were 68% and 60%, respectively. T stage (T1–3 versus T4) resulted in being significant for predicting 3-year freedom from relapse (it was 69% and 35%, resp., for T1–T3 and T4 tumors; (Ρ =0.35),while site of primary disease (larynx versus hypopharynx) was not significant (Ρ =0.35). Conclusion. Our results indicated that combining SIB-IMRT with induction chemotherapy or concurrent chemotherapy is an effective treatment strategy for organ preservation in advanced larynx/hypopharynx cancer.

  10. Hybrid maize breeding with doubled haploids. IV. Number versus size of crosses and importance of parental selection in two-stage selection for testcross performance.

    Science.gov (United States)

    Wegenast, Thilo; Longin, C Friedrich H; Utz, H Friedrich; Melchinger, Albrecht E; Maurer, Hans Peter; Reif, Jochen C

    2008-07-01

    Parental selection influences the gain from selection and the optimum allocation of test resources in breeding programs. We compared two hybrid maize (Zea mays L.) breeding schemes with evaluation of testcross progenies: (a) doubled haploid (DH) lines in both stages (DHTC) and (b) S(1) families in the first stage and DH lines within S(1) families in the second stage (S(1)TC-DHTC). Our objectives were to (1) determine the optimum allocation regarding the number of crosses, S(1) families, DH lines, and test locations, (2) investigate the impact of parental selection on the optimum allocation and selection gain (DeltaG), and (3) compare the maximum DeltaG achievable with each breeding scheme. Selection gain was calculated by numerical integration. Different assumptions were made regarding the budget, variance components, correlation between the mean phenotypic performance of the parents and the mean genotypic value of the testcross performance of their progenies (rho( P )), and the composition of the finally selected test candidates. In comparison with randomly chosen crosses, maximum DeltaG was largely increased with parental selection in both breeding schemes. With an increasing correlation rho( P ), this superiority increased strongly, while the optimum number of crosses decreased in favor of an increased number of test candidates within crosses. Thus, concentration on few crosses among the best parental lines might be a promising approach for short-term success in advanced cycle breeding. Breeding scheme S(1)TC-DHTC led to a larger DeltaG but had a longer cycle length than DHTC. However, with further improvements in the DH technique and the realization of more than two generations per year, early testing of S(1) families prior to production of DH lines would become very attractive in hybrid maize breeding.

  11. Safety and efficacy of PDpoetin for management of anemia in patients with end stage renal disease on maintenance hemodialysis: results from a phase IV clinical trial

    Directory of Open Access Journals (Sweden)

    Abbas Norouzi Javidan

    2014-09-01

    Full Text Available Recombinant human erythropoietin (rHuEPO is available for correcting anemia. PDpoetin, a new brand of rHuEPO, has been certified by Food and Drug Department of Ministry of Health and Medical Education of Iran for clinical use in patients with chronic kidney disease. We conducted this post-marketing survey to further evaluate the safety and efficacy of PDpoetin for management of anemia in patients on maintenance hemodialysis. Patients from 4 centers in Iran were enrolled for this multicenter, open-label, uncontrolled phase IV clinical trial. Changes in blood chemistry, hemoglobin and hematocrit levels, renal function, and other characteristics of the patients were recorded for 4 months; 501 of the patients recruited, completed this study. Mean age of the patients was 50.9 (±16.2 years. 48.7% of patients were female. Mean of the hemoglobin value in all of the 4 centers was 9.29 (±1.43 g/dL at beginning of the study and reached 10.96 (±2.23 g/dL after 4 months and showed significant increase overall (P<0.001. PDpoetin dose was stable at 50-100 U/kg thrice weekly. Hemorheologic disturbancesand changes in blood electrolytes was not observed. No case of immunological reactions to PDpoetin was observed. Our study, therefore, showed that PDpoetin has significantly raised the level of hemoglobin in the hemodialysis patients (about 1.7±0.6 g/dL. Anemia were successfully corrected in 49% of patients under study. Use of this biosimilar was shown to be safe and effective for the maintenance of hemoglobin in patients on maintenance hemodialysis.

  12. Chemotherapy versus best supportive care in stage IV non-small cell lung cancer, non metastatic to the brain Quimioterapia versus melhor tratamento de suporte em câncer de pulmão estádio clínico IV não metastático para o sistema nervoso central

    Directory of Open Access Journals (Sweden)

    Agnaldo Anelli

    2001-04-01

    Full Text Available Stage IV non-small cell lung cancer is a fatal disease, with a median survival of 14 months. Systemic chemotherapy is the most common approach. However the impact in overall survival and quality of life still a controversy. OBJECTIVES: To determine differences in overall survival and quality of life among patients with stage IV non-small cell lung cancer non-metastatic to the brain treated with best supportive care versus systemic chemotherapy. PATIENTS: From February 1990 through December 1995, 78 eligible patients were admitted with the diagnosis of stage IV non-small cell lung cancer . Patients were divided in 2 groups: Group A (n=31 -- treated with best supportive care , and Group B (n=47 -- treated with systemic chemotherapy. RESULTS: The median survival time was 23 weeks (range 5 -- 153 weeks in Group A and 55 weeks (range 7.4 -- 213 weeks in Group B (p=0.0018. In both groups, the incidence of admission for IV antibiotics and need of blood transfusions were similar. Patients receiving systemic chemotherapy were also stratified into those receiving mytomycin, vinblastin, and cisplatinum, n=25 and those receiving other combination regimens (platinum derivatives associated with other drugs, n=22. Patients receiving mytomycin, vinblastin, and cisplatinum, n=25 had a higher incidence of febrile neutropenia and had their cycles delayed for longer periods of time than the other group. These patients also had a shorter median survival time (51 versus 66 weeks, p=0.005. CONCLUSION: In patients with stage IV non-small cell lung cancer, non-metastatic to the brain, chemotherapy significantly increases survival compared with best supportive care.O câncer de pulmão de células não pequenas em estádio IV é uma doença fatal, com uma sobrevida mediana de seis meses. Quimioterapia é a abordagem mais freqüente, apresentando um impacto na sobrevida controverso e questionável alteração na qualidade de vida. OBJETIVOS: Comparar o impacto na

  13. Long-Term Survival of a Patient with Brainstem and Recurrent Brain Metastasis from Stage IV Nonsmall Cell Lung Cancer Treated with Multiple Gamma Knife Radiosurgeries and Craniotomies: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Andrew F. Lamm

    2012-01-01

    Full Text Available The prognosis of patients diagnosed with stage IV nonsmall cell lung cancer that have brain and brainstem metastasis is very poor, with less than a third surviving a year past their initial date of diagnosis. We present the rare case of a 57-year-old man who is a long-term survivor of brainstem and recurrent brain metastasis, after aggressive treatment. He is now five and a half years out from diagnosis and continues to live a highly functional life without evidence of disease. Four separate Gamma Knife stereotactic radiosurgeries in conjunction with two craniotomies were utilized since his initial diagnosis to treat recurrent brain metastasis while chemoradiation therapy and thoracic surgery were used to treat his primary disease in the right upper lung. In his situation, Gamma Knife radiosurgery proved to be a valuable, safe, and effective tool for the treatment of multiply recurrent brain metastases within critical normal structures.

  14. Physical activity and sedentary behaviour at different life stages and adult blood pressure in the 1958 British cohort.

    Science.gov (United States)

    Pouliou, Theodora; Ki, Myung; Law, Catherine; Li, Leah; Power, Chris

    2012-02-01

    To investigate whether physical activity or sedentary behaviour at different life stages is associated with blood pressure (BP) in mid-adulthood; activity levels have accumulative associations with BP; and adult body mass index (BMI) mediates associations. Information on activity and television-viewing was available at several ages (23, 33, 42, 45 years) and BP at 45 years for the 1958 British birth cohort (n = 9927). Associations were examined with and without adjustment for covariates. Active adults, generally, had lower mean systolic and diastolic BP and risk of hypertension than nonactive, although varying by age. After adjustment for covariates, systolic and diastolic BP for active men at 23 years or at 45 years were 1-2 mmHg lower; similar associations were seen for women active at 33 years. Some but not all associations attenuated with further adjustment for BMI: odds ratio (OR) for hypertension associated with 23 years activity changed from 0.82 [95% confidence interval (CI) 0.74, 0.91] to 0.79 (0.70, 0.90) after BMI adjustment. Independent associations of activity at more than one age were found, such that prevalence of hypertension was higher in men active at 23 years but not at 45 years, than men sustaining activity (39 vs. 31%). Sitting at work was unrelated to BP, but there was a trend of higher BP with greater television-viewing: for example risk of hypertension was higher by 10-12% per h/day television-viewing at 45 years after adjustment for covariates, attenuating after allowance for BMI. Our study suggests that there are benefits to BP of becoming and sustaining active lifestyles and minimizing television-viewing over many years of adulthood, with a mediating role for BMI.

  15. Heart rate response to blood pressure variations: sympathetic activation versus baroreflex response in patients with end-stage renal disease.

    Science.gov (United States)

    Sapoznikov, Dan; Dranitzki Elhalel, Michal; Rubinger, Dvora

    2013-01-01

    Continuous systolic blood pressure (SBP) and interbeat intervals (IBI) recordings reveal sequences of consecutive beats in which SBP and heart rate change in opposite direction, representing negative feedback baroreflex mechanisms, as well as sequences in which SBP and heart rate change in the same direction (non-baroreflex), believed to represent feedforward control mechanisms. The present study was undertaken to assess the relationship between baroreflex and non-baroreflex sequences in end stage renal insufficiency. Continuous beat-to-beat SBP and IBI monitoring was performed in patients on chronic hemodialysis (HD, n=72), in age-matched patients after renal transplantation (TX, n=41) and healthy (control) individuals (C, n=34). The proportion of baroreflex and nonbaroreflex episodes and the b coefficients (the regression line slope of SBP-IBI correlation) were determined using a newly developed 1 minute sliding window method, the classical sequence technique and the "Z" coefficient method. Analysis using the 1 minute sliding window showed an increased proportion of baroreflex episodes in controls and HD, and predominance of nonbaroreflex episodes in TX. An increased proportion of nonbaroreflex episodes in TX patients relative to HD was also revealed by the "Z" method. Baroreflex and nonbaroreflex b coefficients obtained by all methods were markedly decreased in HD. This alteration was reversed at least partly in TX. In HD, both baroreflex and nonbaroreflex b coefficients were inversely correlated to age and CRP levels; in TX, the nonbaroreflex b coefficient was influenced by the type of calcineurin inhibitor. Renal status affects the contribution of baroreflex and nonbaroreflex mechanisms and the strength of SBP-IBI relationship. The predominant contribution of nonbaroreflex mechanisms in TX may be suggestive of enhanced central sympathetic control. Our data may be relevant for understanding of the pathogenesis and selection of appropriate treatment of post

  16. Maintenance based Bevacizumab versus complete stop or continuous therapy after induction therapy in first line treatment of stage IV colorectal cancer: A meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Tamburini, Emiliano; Rudnas, Britt; Santelmo, Carlotta; Drudi, Fabrizio; Gianni, Lorenzo; Nicoletti, Stefania V L; Ridolfi, Claudio; Tassinari, Davide

    2016-08-01

    In stage IV colorectal cancer, bevacizumab-based maintenance therapy, complete stop therapy and continuous therapy are considered all possible approaches after first line induction chemotherapy. However, there are no clear data about which approach is preferable. All randomized phase III trials comparing bevacizumab-based maintenance therapy (MB) with complete stop therapy (ST) or with continuous therapy (CT) were considered eligible and included into the analysis. Primary endpoint was the Time to failure strategies (TFS). Secondary endpoints were Overall Survival (OS) and Progression free survival (PFS). Meta-analysis was performed in line with the PRISMA statement. 1892 patients of five trials were included into the analysis. A significant improvement in TFS (HR 0.79; CI 95% 0.7-0.9 p=0.0005) and PFS (HR 0.56; CI 95% 0.44-0.71 p<0.00001) were observed in favour of MB versus ST. A trend, but not statistically significant, in favour of MB versus ST was also observed for OS (HR 0.88; CI 95% 0.77-1.01, p=0.08). Comparing maintenance therapy versus continuous therapy no statistically differences were observed in the outcomes evaluated (OS 12 months OR 1.1 p=0.62, OS 24 months OR 1 p=1, OS 36 months OR 0.54 p=0.3, TFS 12 months OR 0.76 p=0.65). Our meta-analysis suggests that use of MB approach increases TFS, PFS compared to ST. Although without observing any statistically advantage, it should be highlighted that MB versus ST showed a trend in favour of MB. We observed no difference between MB and CT. MB should be considered the standard regimen in patients with stage IV colorectal cancer after first line induction therapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Glycaemic, blood pressure and lipid goal attainment and chronic kidney disease stage of type 2 diabetic patients treated in primary care practices.

    Science.gov (United States)

    Corcillo, Antonella; Pivin, Edward; Lalubin, Fabrice; Pitteloud, Nelly; Burnier, Michel; Zanchi, Anne

    2017-07-11

    The prevalence of chronic kidney disease and diabetes is rising in Europe. These patients are at high cardiovascular and renal risk and need a challenging multifactorial therapeutic approach. The goal of this cross-sectional study was to examine the treatment and attainments of goals related to cardiovascular risk factors within chronic kidney disease stages in type 2 diabetic patients followed up by primary care physicians in Switzerland. Each participating physician entered into a web database the anonymised data of up to 15 consecutive diabetic patients attending her/his office between December 2013 and June 2014. Diabetes, hypertension and lipid lowering therapies were analysed, as well as glycated haemoglobin (HbA1c), blood pressure and low-density lipoprotein-cholesterol (LDL-c) levels and goal attainments by KDIGO chronic kidney disease stage 1 to 4. A total of 1359 patients (mean age 66.5±12.4 years) were included by 109 primary care physicians. Chronic kidney disease stages 0-2, 3a, 3 b and 4 were present in 77.6%, 13.9%, 6.1%, and 2.4%, respectively. Average HbA1c was independent of chronic kidney disease stage and close to 7%; more than half of the patients reached the HbA1c goal. Eighty-four percent of patients were hypertensive and only 18.2% reached the then current Swiss or American Diabetes Association 2013 blood pressure goals. Despite loosening of blood pressure goals in 2015, only half of the patients reached them and most needed multiple therapies. Increased body mass index and advanced chronic kidney disease stage decreased the chance of reaching blood pressure goals. Lipid lowering therapy was prescribed in 62.1% of cases, with average LDL-c levels similar across chronic kidney disease stages. Only 42% of patients reached the LDL-c goal of primary prevention and 32% reached primary care physicians in Switzerland. Goal attainments for HbA1c and LDL-c were not influenced by chronic kidney disease stages, in contrast to blood pressure. Reaching

  18. Presión Monárquica y Resistencia Municipal: Jerez de la Frontera contra el Gobierno de Felipe IV Royal pressure and municipal resistance: Jerez de la Frontera against the Government of Philip IV

    Directory of Open Access Journals (Sweden)

    Jose Manuel DÍAZ BLANCO

    2012-12-01

    Full Text Available Este artículo intenta narrar y explicar los sucesos ocurridos en Jerez de la Frontera el año de 1637, cuando el Cabildo de la ciudad intentó resistirse a las innovaciones de la política fiscal de la Monarquía después del estallido de la guerra entre Francia y España. Para conseguir este objetivo, la primera parte resalta la crisis económica sufrida por Jerez desde finales del siglo XVI y presta una atención singular al principal proyecto de dinamización comercial de la ciudad: la construcción de un canal entre el Guadalquivir y el Guadalete, fracasado por el rechazo de la Monarquía. La segunda parte narra los acontecimientos de 1637 y propone explicar la violencia política como una consecuencia de la falta de apoyo que la ciudad había recibido del Gobierno. Este cuadro permite situar Jerez en el mapa de las convulsiones políticas que la historiografía ha detectado en la Castilla de Felipe IV.This article intends to tell and explain the events happened at Jerez de la Frontera in 1637, when the town council –Cabildo– of the city resisted to the innovations of the Monarchy’s fiscal policy after the war between Spain and France. The first part of the article sheds light on the economic crisis suffered by Jerez since the end of the sixteenth century and pays special attention to the main project of commercial revitalization of the city: the building of a channel between the rivers Guadalquivir and Guadalete, which failed due to the Monarchy’s opposition. The second part of the article tells the events of 1637 and intends to explain the political violence as a consequence of the city’s lack of support of the government. This picture allows situating Jerez in the map of the political upheavals that the historiography has detected in Philip IV’s Castile.

  19. Closing the loop: modelling of heart failure progression from health to end-stage using a meta-analysis of left ventricular pressure-volume loops.

    Science.gov (United States)

    Warriner, David R; Brown, Alistair G; Varma, Susheel; Sheridan, Paul J; Lawford, Patricia; Hose, David R; Al-Mohammad, Abdallah; Shi, Yubing

    2014-01-01

    The American Heart Association (AHA)/American College of Cardiology (ACC) guidelines for the classification of heart failure (HF) are descriptive but lack precise and objective measures which would assist in categorising such patients. Our aim was two fold, firstly to demonstrate quantitatively the progression of HF through each stage using a meta-analysis of existing left ventricular (LV) pressure-volume (PV) loop data and secondly use the LV PV loop data to create stage specific HF models. A literature search yielded 31 papers with PV data, representing over 200 patients in different stages of HF. The raw pressure and volume data were extracted from the papers using a digitising software package and the means were calculated. The data demonstrated that, as HF progressed, stroke volume (SV), ejection fraction (EF%) decreased while LV volumes increased. A 2-element lumped parameter model was employed to model the mean loops and the error was calculated between the loops, demonstrating close fit between the loops. The only parameter that was consistently and statistically different across all the stages was the elastance (Emax). For the first time, the authors have created a visual and quantitative representation of the AHA/ACC stages of LVSD-HF, from normal to end-stage. The study demonstrates that robust, load-independent and reproducible parameters, such as elastance, can be used to categorise and model HF, complementing the existing classification. The modelled PV loops establish previously unknown physiological parameters for each AHA/ACC stage of LVSD-HF, such as LV elastance and highlight that it this parameter alone, in lumped parameter models, that determines the severity of HF. Such information will enable cardiovascular modellers with an interest in HF, to create more accurate models of the heart as it fails.

  20. Closing the loop: modelling of heart failure progression from health to end-stage using a meta-analysis of left ventricular pressure-volume loops.

    Directory of Open Access Journals (Sweden)

    David R Warriner

    Full Text Available INTRODUCTION: The American Heart Association (AHA/American College of Cardiology (ACC guidelines for the classification of heart failure (HF are descriptive but lack precise and objective measures which would assist in categorising such patients. Our aim was two fold, firstly to demonstrate quantitatively the progression of HF through each stage using a meta-analysis of existing left ventricular (LV pressure-volume (PV loop data and secondly use the LV PV loop data to create stage specific HF models. METHODS AND RESULTS: A literature search yielded 31 papers with PV data, representing over 200 patients in different stages of HF. The raw pressure and volume data were extracted from the papers using a digitising software package and the means were calculated. The data demonstrated that, as HF progressed, stroke volume (SV, ejection fraction (EF% decreased while LV volumes increased. A 2-element lumped parameter model was employed to model the mean loops and the error was calculated between the loops, demonstrating close fit between the loops. The only parameter that was consistently and statistically different across all the stages was the elastance (Emax. CONCLUSIONS: For the first time, the authors have created a visual and quantitative representation of the AHA/ACC stages of LVSD-HF, from normal to end-stage. The study demonstrates that robust, load-independent and reproducible parameters, such as elastance, can be used to categorise and model HF, complementing the existing classification. The modelled PV loops establish previously unknown physiological parameters for each AHA/ACC stage of LVSD-HF, such as LV elastance and highlight that it this parameter alone, in lumped parameter models, that determines the severity of HF. Such information will enable cardiovascular modellers with an interest in HF, to create more accurate models of the heart as it fails.

  1. Boost Pressure Control Strategy to Account for Transient Behavior and Pumping Losses in a Two-Stage Turbocharged Air Path Concept

    Directory of Open Access Journals (Sweden)

    Thivaharan Albin

    2016-07-01

    Full Text Available Increasingly complex air path concepts are investigated to achieve a substantial reduction in fuel consumption while improving the vehicle dynamics. One promising technology is the two-stage turbocharging for gasoline engines, where a high pressure and a low pressure turbocharger are placed in series. For exploiting the high potential, a control concept has to be developed that allows for coordinated management of the two turbocharger stages. In this paper, the control strategy is investigated. Therefore, the effect of the actuated values on transient response and pumping losses is analyzed. Based on these findings, an optimization-based control algorithm is developed that allows taking both requirements into account. The developed new controller allows achieving a fast transient response, while at the same time reducing pumping losses in stationary operation.

  2. Comparative effect of fixed dose combination of Amlodipine + Bisoprolol versus Amlodipine and Bisoprolol alone on blood pressure in stage-2 essential hypertensive patients.

    Directory of Open Access Journals (Sweden)

    Shirure PA,Tadvi NA, Bajait CS, Baig MS, Gade PR

    2012-09-01

    Full Text Available Background: Employment of low dose combinations of two antihypertensives, with different mode of action has gained acceptance worldwide for the treatment of mild to moderate hypertension. However, most studies in hypertensive disease have focused on monotherapy. The combination therapy in the treatment of hypertension is largely extrapolated from these monotherapy studies. Objectives: To study and compare the effect of amlodipine, bisoprolol and fixed dose combination of amlodipine + bisoprolol on blood pressure in stage-2 essential hypertensive patients. Methods: The present study was carried out in Department of Pharmacology in collaboration with Department of Medicine at Government Medical College and Hospital, Aurangabad. Results and Conclusion : Amlodipine + bisoprolol in fixed dose combination have showed significant blood pressure control in patients of stage-2 essential hypertension and the antihypertensive effect was greater than individual monotherapy study groups.

  3. Phase II Trial of Combined Modality Therapy With Concurrent Topotecan Plus Radiotherapy Followed by Consolidation Chemotherapy for Unresectable Stage III and Selected Stage IV Non-Small-Lung Cancer

    International Nuclear Information System (INIS)

    Seung, Steven K.; Ross, Helen J.

    2009-01-01

    Purpose: The optimal combination of chemotherapy and radiotherapy (RT) and the role of consolidation chemotherapy in patients with locally advanced non-small-cell lung cancer (NSCLC) are unknown. Topotecan is active against NSCLC, can safely be combined with RT at effective systemic doses, and can be given by continuous infusion, making it an attractive study agent against locally advanced NSCLC. Methods and Materials: In this pilot study, 20 patients were treated with infusion topotecan 0.4 mg/m 2 /d with three-dimensional conformal RT to 63 Gy both delivered Monday through Friday for 7 weeks. Patients without progression underwent consolidation chemotherapy with etoposide and a platinum agent for one cycle followed by two cycles of docetaxel. The study endpoints were treatment response, time to progression, survival, and toxicity. Results: Of the 20 patients, 19 completed induction chemoradiotherapy and 13 completed consolidation. Of the 20 patients, 18 had a partial response and 1 had stable disease after induction chemoradiotherapy. The 3-year overall survival rate was 32% (median, 18 months). The local and distant progression-free survival rate was 30% (median, 21 months) and 58% (median, not reached), respectively. Three patients developed central nervous system metastases, 1 within 228 days, 1 within 252 days, and 1 within 588 days. Three patients had pulmonary emboli. Therapy was well tolerated with 1 of 20 developing Grade 4 lymphopenia. Grade 3 hematologic toxicity was seen in 17 of 20 patients but was not clinically significant. Other Grade 3 toxicities included esophagitis in 3, esophageal stricture in 2, fatigue in 8, and weight loss in 1. Grade 3 pneumonitis occurred in 6 of 20 patients. Conclusion: Continuous infusion topotecan with RT was well tolerated and active in the treatment of poor-risk patients with unresectable Stage III NSCLC

  4. Three-Dimensional Radiation Therapy to the Primary Tumor With Concurrent Chemotherapy in Patients With Stage IV Non-Small Cell Lung Cancer: Results of a Multicenter Phase 2 Study From PPRA-RTOG, China.

    Science.gov (United States)

    Su, ShengFa; Li, Tao; Lu, Bing; Wang, XiaoHu; Li, JianCheng; Chen, Ming; Lu, You; Bai, YuJu; Hu, YinXiang; Ouyang, WeiWei; Ma, Zhu; Li, QingSong; Li, HuiQin; Wang, Yu

    2015-11-15

    The aim of this prospective multi-institutional phase 2 study was to investigate disease control, survival outcomes, and toxicity after thoracic three-dimensional radiation therapy (3D-RT) with concurrent chemotherapy for newly diagnosed stage IV non-small cell lung cancer (NSCLC). Eligible patients were 18 to 80 years of age, had a Karnofsky performance status (KPS) score ≥70%, and newly diagnosed stage IV NSCLC with limited metastatic disease (defined as involving ≤3 organs). Patients received platinum-doublet chemotherapy with concurrent irradiation to the primary tumor. Primary endpoints were overall survival (OS) and acute toxicity. From May 2008 to May 2012, 198 eligible patients were enrolled from 7 cancer centers. Most patients died with distant metastasis; only 10% died with isolated primary recurrence. Median OS time was 13.0 months (95% confidence interval [CI]: 11.7-14.3); OS rates were 53.5% at 1 year, 15.8% at 2 years, and 9.2% at 3 years. Median progression-free survival (PFS) time was 9.0 months (95% CI: 7.7-10.3); corresponding PFS rates were 30.8%, 8.2%, and 6.1%. The 1-year, 2-year, and 3-year local (primary tumor) control rates were 78.8%, 57.7%, and 55.4%. Multivariate analysis showed that delivery of ≥63 Gy to the primary tumor (P=.014), having a primary tumor volume acute toxicities were hematologic: leukopenia (37.9%), thrombocytopenia (10.1%), and anemia (6.9%). No patients experienced grade 4 or 5 radiation-related toxicity; 2.5% had acute grade 3 pneumonitis, and 6.6% had acute grade 3 radiation esophagitis. Thoracic 3D-RT to the primary tumor with concurrent chemotherapy led to satisfactory survival outcomes with acceptable toxicity. Radiation dose, primary tumor volume, and PFS after treatment all predicted survival in these patients with limited-metastasis NSCLC. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  5. Three-Dimensional Radiation Therapy to the Primary Tumor With Concurrent Chemotherapy in Patients With Stage IV Non-Small Cell Lung Cancer: Results of a Multicenter Phase 2 Study From PPRA-RTOG, China

    Energy Technology Data Exchange (ETDEWEB)

    Su, ShengFa [Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, and Guizhou Cancer Hospital, Guiyang (China); Teaching and Research Section of Oncology, Guizhou Medical University, Guiyang (China); Li, Tao [Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu (China); Lu, Bing, E-mail: lbgymaaaa@163.com [Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, and Guizhou Cancer Hospital, Guiyang (China); Teaching and Research Section of Oncology, Guizhou Medical University, Guiyang (China); Wang, XiaoHu, E-mail: xhwanggansu@163.com [Department of Radiation Oncology, Gansu Cancer Hospital, Lanzhou (China); Li, JianCheng [Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou (China); Chen, Ming [Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou (China); Lu, You [Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu (China); Bai, YuJu [Department of Oncology, Affiliated Hospital of Zunyi Medical College, Zunyi (China); Hu, YinXiang; Ouyang, WeiWei; Ma, Zhu; Li, QingSong; Li, HuiQin; Wang, Yu [Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, and Guizhou Cancer Hospital, Guiyang (China); Teaching and Research Section of Oncology, Guizhou Medical University, Guiyang (China)

    2015-11-15

    Purpose: The aim of this prospective multi-institutional phase 2 study was to investigate disease control, survival outcomes, and toxicity after thoracic three-dimensional radiation therapy (3D-RT) with concurrent chemotherapy for newly diagnosed stage IV non-small cell lung cancer (NSCLC). Methods and Materials: Eligible patients were 18 to 80 years of age, had a Karnofsky performance status (KPS) score ≥70%, and newly diagnosed stage IV NSCLC with limited metastatic disease (defined as involving ≤3 organs). Patients received platinum-doublet chemotherapy with concurrent irradiation to the primary tumor. Primary endpoints were overall survival (OS) and acute toxicity. Results: From May 2008 to May 2012, 198 eligible patients were enrolled from 7 cancer centers. Most patients died with distant metastasis; only 10% died with isolated primary recurrence. Median OS time was 13.0 months (95% confidence interval [CI]: 11.7-14.3); OS rates were 53.5% at 1 year, 15.8% at 2 years, and 9.2% at 3 years. Median progression-free survival (PFS) time was 9.0 months (95% CI: 7.7-10.3); corresponding PFS rates were 30.8%, 8.2%, and 6.1%. The 1-year, 2-year, and 3-year local (primary tumor) control rates were 78.8%, 57.7%, and 55.4%. Multivariate analysis showed that delivery of ≥63 Gy to the primary tumor (P=.014), having a primary tumor volume <134 cm{sup 3} (P=.008), and having a stable or higher KPS score after treatment (P=.01) were independent predictors of better OS. The most common severe (grades 3-4) acute toxicities were hematologic: leukopenia (37.9%), thrombocytopenia (10.1%), and anemia (6.9%). No patients experienced grade 4 or 5 radiation-related toxicity; 2.5% had acute grade 3 pneumonitis, and 6.6% had acute grade 3 radiation esophagitis. Conclusions: Thoracic 3D-RT to the primary tumor with concurrent chemotherapy led to satisfactory survival outcomes with acceptable toxicity. Radiation dose, primary tumor volume, and PFS after treatment all

  6. A case of home care of a 103-year-old patient with Alzheimer’ s disease complicated with stage III pressure ulcer

    Directory of Open Access Journals (Sweden)

    Zheng Wang

    2017-04-01

    Full Text Available This paper reported a case of home care for a 103-year-old AD patient with stage III pressure ulcers. After ten weeks of professional home care, including the guidance for caregivers, such as posture putting, wound decompression, nutritional support, clinical nurse specialist come to home to give wound assessment and care, the ulcer was eventually healed. It is suggested that for the senior AD patients, intelligent auxiliary equipment can be introduced into the family in the future, it can help reduce the pressure of the affected side, reduce the burden on caregivers, meanwhile, wound specialist nurses came to the caregiver to give systemic instructions, prevent the occurrence and development of pressure ulcers.

  7. Asteroids IV

    Science.gov (United States)

    Michel, Patrick; DeMeo, Francesca E.; Bottke, William F.

    . Asteroids, like planets, are driven by a great variety of both dynamical and physical mechanisms. In fact, images sent back by space missions show a collection of small worlds whose characteristics seem designed to overthrow our preconceived notions. Given their wide range of sizes and surface compositions, it is clear that many formed in very different places and at different times within the solar nebula. These characteristics make them an exciting challenge for researchers who crave complex problems. The return of samples from these bodies may ultimately be needed to provide us with solutions. In the book Asteroids IV, the editors and authors have taken major strides in the long journey toward a much deeper understanding of our fascinating planetary ancestors. This book reviews major advances in 43 chapters that have been written and reviewed by a team of more than 200 international authorities in asteroids. It is aimed to be as comprehensive as possible while also remaining accessible to students and researchers who are interested in learning about these small but nonetheless important worlds. We hope this volume will serve as a leading reference on the topic of asteroids for the decade to come. We are deeply indebted to the many authors and referees for their tremendous efforts in helping us create Asteroids IV. We also thank the members of the Asteroids IV scientific organizing committee for helping us shape the structure and content of the book. The conference associated with the book, "Asteroids Comets Meteors 2014" held June 30-July 4, 2014, in Helsinki, Finland, did an outstanding job of demonstrating how much progress we have made in the field over the last decade. We are extremely grateful to our host Karri Muinonnen and his team. The editors are also grateful to the Asteroids IV production staff, namely Renée Dotson and her colleagues at the Lunar and Planetary Institute, for their efforts, their invaluable assistance, and their enthusiasm; they made life as

  8. Evaluación de la actividad insecticida de Solanum macranthum (Dunal sobre ninfas de los estadios IV y V de Rhodnius pallescens, Rhodnius prolixus, Rhodnius colombiensis Insecticidal activity assessment of Solanum macranthum (Dunal on IV and V stages nymphs of Rhodnius pallescens, Rhodnius prolixus, Rhodnius colombiensis

    Directory of Open Access Journals (Sweden)

    Jorge Enrique Hernández Carvajal

    2010-03-01

    Full Text Available La enfermedad de Chagas o tripanosomiasis americana es una enfermedad parasitaria crónica causada por el Trypanosoma cruzi, el cual es transmitido por diversas especies de triatominos. Dicha enfermedad genera un problema de salud pública en el departamento de Tolima-Colombia al afectar poblaciones de bajos recursos económicos, entre ellas comunidades indígenas. Teniendo en cuenta la resistencia presentada por los triatominos a los insecticidas convencionales, surge la necesidad de buscar nuevas alternativas de control de estos insectos desde el punto de vista biológico y químico. En esta investigación se evaluó la actividad insecticida en ninfas de IV y V estadio de Rhodnius pallescens, Rhodnius prolixus y Rhodnius colombiensis, con extractos hidroalcohólicos de hojas de Solanum macranthum (Dunal, a diferentes concentraciones, con exposición de 12, 24 y 36 h. Solanum macranthum (Dunal presentó la máxima actividad insecticida pasadas 24 h y utilizando concentraciones inferiores a 0,3 mg/mL.Chagas' disease or American trypanosomiasis is a chronic parasitic condition caused by Trypanosoma cruzi which is transmissible by many Triatoma species. Such disease is a public health problem in Tolima department, Colombia affecting the populations with low economic incomes, mainly the indigenous ones. Taking into account the resistance of Triatoma to conventional insecticides, and from the biologic and chemical point of view, it is necessary to look for new control alternatives for these insects. In this research we assessed the insecticidal activity in nymphs of IV and V stage from Rhodnius pallescens, Rhodnius prolixus and Rhodnius colombiensis using hydro-alcoholic extracts from Solanum macranthum (Dunal leaves at different concentrations exposed during 12, 24 and 36 hours. Solanum macrathum (Dunal had a maximum insecticidal activity after 24 hours and using lower concentrations (0,3 mg/mL.

  9. Prognostic factors in Hodgkin's disease stage IV

    DEFF Research Database (Denmark)

    Specht, L.; Nissen, N.I.

    1988-01-01

    blood values, together with exploratory laparotomy and treatment were examined in multivariate analyses. With regard to disease-free survival, the only factors of independent prognostic significance were sex and lymphocytopenia. With regard to overall survival the factors of independent significance...

  10. Cutaneous head and neck melanoma in OPTiM, a randomized phase 3 trial of talimogene laherparepvec versus granulocyte-macrophage colony-stimulating factor for the treatment of unresected stage IIIB/IIIC/IV melanoma.

    Science.gov (United States)

    Andtbacka, Robert H I; Agarwala, Sanjiv S; Ollila, David W; Hallmeyer, Sigrun; Milhem, Mohammed; Amatruda, Thomas; Nemunaitis, John J; Harrington, Kevin J; Chen, Lisa; Shilkrut, Mark; Ross, Merrick; Kaufman, Howard L

    2016-12-01

    Cutaneous head and neck melanoma has poor outcomes and limited treatment options. In OPTiM, a phase 3 study in patients with unresectable stage IIIB/IIIC/IV melanoma, intralesional administration of the oncolytic virus talimogene laherparepvec improved durable response rate (DRR; continuous response ≥6 months) compared with subcutaneous granulocyte-macrophage colony-stimulating factor (GM-CSF). Retrospective review of OPTiM identified patients with cutaneous head and neck melanoma given talimogene laherparepvec (n = 61) or GM-CSF (n = 26). Outcomes were compared between talimogene laherparepvec and GM-CSF treated patients with cutaneous head and neck melanoma. DRR was higher for talimogene laherparepvec-treated patients than for GM-CSF treated patients (36.1% vs 3.8%; p = .001). A total of 29.5% of patients had a complete response with talimogene laherparepvec versus 0% with GM-CSF. Among talimogene laherparepvec-treated patients with a response, the probability of still being in response after 12 months was 73%. Median overall survival (OS) was 25.2 months for GM-CSF and had not been reached with talimogene laherparepvec. Treatment with talimogene laherparepvec was associated with improved response and survival compared with GM-CSF in patients with cutaneous head and neck melanoma. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1752-1758, 2016. © 2016 The Authors Head & Neck Published by Wiley Periodicals, Inc.

  11. Double-blind, placebo-controlled first in human study to investigate an oral vaccine aimed to elicit an immune reaction against the VEGF-Receptor 2 in patients with stage IV and locally advanced pancreatic cancer

    International Nuclear Information System (INIS)

    Niethammer, Andreas G; Springer, Marco; Grenacher, Lars; Buchler, Markus W; Koch, Moritz; Weitz, Jürgen; Haefeli, Walter E; Schmitz-Winnenthal, Friedrich H; Lubenau, Heinz; Mikus, Gerd; Knebel, Philipp; Hohmann, Nicolas; Leowardi, Christine; Beckhove, Philipp; Akhisaroglu, Mustafa; Ge, Yingzi

    2012-01-01

    The investigational oral DNA vaccine VXM01 targets the vascular endothelial growth factor receptor 2 (VEGFR-2) and uses Salmonella typhi Ty21a as a vector. The immune reaction elicited by VXM01 is expected to disrupt the tumor neovasculature and, consequently, inhibit tumor growth. VXM01 potentially combines the advantages of anti-angiogenic therapy and active immunotherapy. This phase I trial examines the safety, tolerability, and immunological and clinical responses to VXM01. The randomized, placebo-controlled, double blind dose-escalation study includes up to 45 patients with locally advanced and stage IV pancreatic cancer. The patients will receive four doses of VXM01 or placebo in addition to gemcitabine as standard of care. Doses from 10 6 cfu up to 10 10 cfu of VXM01 will be evaluated in the study. An independent data safety monitoring board (DSMB) will be involved in the dose-escalation decisions. In addition to safety as primary endpoint, the VXM01-specific immune reaction, as well as clinical response parameters will be evaluated. The results of this study shall provide the first data regarding the safety and immunogenicity of the oral anti-VEGFR-2 vaccine VXM01 in cancer patients. They will also define the recommended dose for phase II and provide the basis for further clinical evaluation, which may also include additional cancer indications. EudraCT No.: 2011-000222-29, NCT01486329, ISRCTN68809279

  12. Azospirillum IV

    Energy Technology Data Exchange (ETDEWEB)

    Klingmuller, W.

    1988-01-01

    This book's contents include: Advances in the genetics of Azospirillum brasilense Sp7: Use of Tn5 mutagenesis for gene mapping and identification; Characterization of DNA segments adjacent to the nifHDK genes of Azospirillum brasilense by Sp7 Tn5 site-directed mutagenesis; Selection at the chemostat of Azospirillum brasilense Cd N/sub 2/-fixing at high O/sub 2/ pressure. Root hair deformation induced on maize and medicago by an Azospirillum transconjugant containing a Rhizobium meliloti nodulation region. Azospirilla are bacteria that live in association with the roots of many grain crops. Since these bacteria bind molecular nitrogen from the air and excrete plant growth substances, interest has focussed on their potential to increase crop yields.

  13. Daily blueberry consumption improves blood pressure and arterial stiffness in postmenopausal women with pre- and stage 1-hypertension: a randomized, double-blind, placebo-controlled clinical trial.

    Science.gov (United States)

    Johnson, Sarah A; Figueroa, Arturo; Navaei, Negin; Wong, Alexei; Kalfon, Roy; Ormsbee, Lauren T; Feresin, Rafaela G; Elam, Marcus L; Hooshmand, Shirin; Payton, Mark E; Arjmandi, Bahram H

    2015-03-01

    Postmenopausal women have a high prevalence of hypertension and often develop arterial stiffness thereby increasing cardiovascular disease risk. Although antihypertensive drug therapies exist, increasing numbers of people prefer natural therapies. In vivo studies and a limited number of clinical studies have demonstrated the antihypertensive and vascular-protective effects of blueberries. To examine the effects of daily blueberry consumption for 8 weeks on blood pressure and arterial stiffness in postmenopausal women with pre- and stage 1-hypertension. This was an 8-week, randomized, double-blind, placebo-controlled clinical trial. Forty-eight postmenopausal women with pre- and stage 1-hypertension recruited from the greater Tallahassee, FL, area participated. Participants were randomly assigned to receive either 22 g freeze-dried blueberry powder or 22 g control powder. Resting brachial systolic and diastolic blood pressures were evaluated and arterial stiffness was assessed using carotid-femoral pulse wave velocity and brachial-ankle pulse wave velocity. C-reactive protein, nitric oxide, and superoxide dismutase were measured at baseline, 4 weeks, and 8 weeks. Statistical analysis was performed using a split plot model of repeated measures analysis of variance. After 8 weeks, systolic blood pressure and diastolic blood pressure (131±17 mm Hg [Pblueberry powder group, whereas there were no changes in the group receiving the control powder. Nitric oxide levels were greater (15.35±11.16 μmol/L; Pblueberry powder group at 8 weeks compared with baseline values (9.11±7.95 μmol/L), whereas there were no changes in the control group. Daily blueberry consumption may reduce blood pressure and arterial stiffness, which may be due, in part, to increased nitric oxide production. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  14. Morphology of {gamma}' precipitates of nickel-based superalloy serviced as first stage high pressure turbine nozzle guide vane

    Energy Technology Data Exchange (ETDEWEB)

    Miura, Nobuhiro; Nakada, Kouji; Kondo, Yoshihiro [National Defense Academy, Yokosuka, Kanagawa (Japan)

    2010-07-01

    The morphology of {gamma}' precipitates of the nickel-based superalloy serviced as the first stage high pressure turbine nozzle guide vane of the jet engine was examined. The aim of this work was to estimate the temperature and the stress distribution, and the stress direction of the vane in service. The vane was cut into four parts perpendicular to the longitudinal direction of the vane at 5, 25, 35 and 45mm from the root. These parts were designated as the root, 25mm, 35mm and tip parts. Microstructure observations by a FE-SEM were carried out on the forty-six portions at the vicinity of the interface between the coating layer and the matrix on the suction and pressure sides. At the root parts of the pressure and suction sides, most of the {gamma}' precipitates kept cuboidal in shape, and the secondary {gamma}' precipitates were observed in the {gamma} matrix channels. On the contrary, at the trailing edge side of the pressure and suction sides of the 25 and 35mm parts and at the leading edge of the pressure side of the tip part, well aligned rafted {gamma}/{gamma}' structures were appeared in the direction parallel to the surface at the vicinity of the interface of the vane. Furthermore, at the trailing edge of the pressure side of the middle parts, the rafted {gamma}/{gamma}' structures start to collapse. Consequently, the vane in service, at the trailing edge sides of the pressure side the 25 and 35mm parts were exposed to the highest temperature and stress conditions. And this microstructure evidence indicated that the multi-axial compressive stress parallel to the nozzle surface was expected to act on the vane in service. (orig.)

  15. High pressure measurement of the uniaxial stress of host layers on intercalants and staging transformation of intercalation compounds

    CERN Document Server

    Park, T R; Kim, H; Min, P

    2002-01-01

    A layered double-hydroxide intercalation compound was synthesized to measure the uniaxial stress the host layers exert on the intercalants. To measure the uniaxial stress, we employed the photoluminescence (PL) from the intercalated species, the Sm ion complex, as it is sensitive to the deformation of the intercalants. Of the many PL peaks the Sm ion complex produces, the one that is independent of the counter-cation environment was chosen for the measurement since the Sm ion complexes are placed under a different electrostatic environment after intercalation. The peak position of the PL was redshifted linearly with increasing hydrostatic pressure on the intercalated sample. Using this pressure-induced redshifting rate and the PL difference at ambient pressure between the pre-intercalation and the intercalated ions, we found that, in the absence of external pressure, the uniaxial stress exerted on the samarium ion complexes by the host layers was about 13.9 GPa at room temperature. Time-resolved PL data also ...

  16. Association between breakfast intake with anthropometric measurements, blood pressure and food consumption behaviors among Iranian children and adolescents: the CASPIAN-IV study.

    Science.gov (United States)

    Ahadi, Z; Qorbani, M; Kelishadi, R; Ardalan, G; Motlagh, M E; Asayesh, H; Zeynali, M; Chinian, M; Larijani, B; Shafiee, G; Heshmat, R

    2015-06-01

    The aim of this study is to assess the association between breakfast intake with anthropometric measurements and blood pressure among Iranian children and adolescents. The second goal is to investigate the correction of breakfast consumption with other food consumption behaviors. In this national survey, 13,486 children and adolescents, aged 6-18 years, were selected by multistage, cluster sampling method from rural and urban areas of 31 provinces of Iran (2011-2012). Physical measurements included height, weight, waist circumference, and blood pressure. Food habits were assessed by self-reported questionnaire. Breakfast frequency was defined as skippers (eating breakfast 0-2 days/week), semi-skippers (eating breakfast 3-4 days/week) and non-skippers (eating breakfast 5-7 days/week). The data were analyzed by the STATA package. Of the participants, 18.9%, 13.2% and 67.9%, were breakfast skippers, semi-skippers and non-skippers respectively. The prevalence of overweight and obesity among breakfast skippers were higher than non-skippers counterparts (P-value breakfast skippers and non-skippers group were 22.6% (CI 95%: 21-24.3) and 17.9% (CI 95%: 17-18.6), respectively. Blood pressure did not significantly differ between non-skippers students and breakfast skippers (P-value = 0.1). Non-skipping adolescents ate more fresh fruits, dried fruits, vegetables and drank milk more frequently compared with breakfast skipper; while the skippers showed a higher intake of salty snack, soft drinks, packed fruit juice and fast foods (all P-value breakfast consumption is significantly associated with lower body fatness and healthier dietary habits but that further study, using controlled intervention trials, is required to test whether this represents a causal relationship. Copyright © 2015. Published by Elsevier Ltd.

  17. Association of junk food consumption with high blood pressure and obesity in Iranian children and adolescents: the CASPIAN-IV Study

    OpenAIRE

    Payab, Moloud; Kelishadi, Roya; Qorbani, Mostafa; Motlagh, Mohammad Esmaeil; Ranjbar, Shirin Hasani; Ardalan, Gelayol; Zahedi, Hoda; Chinian, Mohammad; Asayesh, Hamid; Larijani, Bagher; Heshmat, Ramin

    2015-01-01

    OBJECTIVE: This study aimed to evaluate the association of junk food consumption with hypertension and obesity in a national sample of Iranian children and adolescents. METHODS: This nationwide study was conducted in 2011-2012 among 14,880 students, aged 6-18 years, selected by cluster sampling from 30 provinces. Weight, height, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), as well as systolic and diastolic blood pressure (BP) were m...

  18. The Impact of Hemodialysis Frequency and Duration on Blood Pressure Management and Quality of Life in End-Stage Renal Disease Patients

    Science.gov (United States)

    Shafiee, Mohammad Ali; Chamanian, Pouyan; Shaker, Pouyan; Shahideh, Yasmin; Broumand, Behrooz

    2017-01-01

    Cardiovascular complications are the most prominent causes of morbidity and mortality among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients undergoing standard hemodialysis (HD) therapy. Cardiovascular disease risk is increased significantly through persistent hypertension and blood pressure (BP) fluctuation, which are the most common complications of CKD. It was hypothesized that an extended approach with lengthier and more frequent dialysis sessions, referred to in this paper as “extended hemodialysis” (EHD), can potentially lower and stabilize blood pressure, and consequently reduce the rate of morbidity and mortality. A greater reduction of volume (salt and water) with higher frequency can improve patient quality of life (QOL). Eleven papers, including clinical trials and systematic reviews were chosen and analyzed. The extracted data was used to evaluate the change in blood pressure levels between standard HD and EHD. Overall, the studies showed that EHD resulted in improved blood pressure management; therefore, we concluded that there will be a decrease in cardiovascular disease risk, stroke, and morbidity and mortality rate. There will be also an improvement in patient QOL due to beneficial effects of the EHD. PMID:28869490

  19. Therapeutic effect of Jinlongshe Granule () on quality of life of stage IV gastric cancer patients using EORTC QLQ-C30: A double-blind placebo-controlled clinical trial.

    Science.gov (United States)

    Sun, Da-zhi; Jiao, Jian-peng; Zhang, Xuan; Xu, Jing-yu; Ye, Min; Xiu, Li-juan; Zhao, Ying; Lu, Ye; Liu, Xuan; Zhao, Jing; Shi, Jun; Qin, Zhi-feng; Wei, Pin-kang

    2015-08-01

    To evaluate the impact of Jinlongshe Granule (, JLSG) on quality of life (QOL) of stage IV gastric cancer patients. This randomized, double-blind and placebo-controlled clinical trial included 50 patients with advanced gastric cancer. They were equally randomized into a JLSG group and a placebo group. Patients in both groups received routine Chinese herbal decoctions according to Chinese medicine (CM) treatment based on syndrome differentiation. Patients in JLSG group received additional JLSG, and those in the placebo group received an additional placebo. In the JLSG group, 19 patients who completed the study were used for analysis. In the placebo group, finally the data of 20 patients who completed the study were used for analysis. The treatment course was at least 3 months, and the follow-up duration was at least 6 months in 5 interviews. Repeated measurements of the subscale items and individual items in European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30) obtained at the 5 interviews were compared using different patient groups, changes over time and changes within one group over time independently to observe the tendency of changes in the scores. Using time as the variant, there was signifificant difference in 4 functional scales (physical, role, emotional and social, P0.05), insomnia (P0.05) and financial difficulties (Pplacebo group and group over time were used as variants (P<0.05 or P<0.01). Additional use of JLSG on the basis of routine CM treatment could improve the somatic function, role function, emotional function, social function, cognitive function and general QOL of patients with advanced gastric cancer, and relieve the symptoms of fatigue, nausea and vomiting, pain, loss of appetite and constipation.

  20. Mucopolysaccharidosis type IV

    Science.gov (United States)

    MPS IV; Morquio syndrome; Mucopolysaccharidosis type IVA; MPS IVA; Galactosamine-6-sulfatase deficiency; Mucopolysaccharidosis type IVB; MPS IVB; Beta galactosidase deficiency; Lysosomal storage disease - mucopolysaccharidosis type IV

  1. An Experimental Investigation of the Flow Physics Associated With End Wall Losses and Large Rotor Tip Clearances as Found in the Rear Stages of a High Pressure Compressor

    Science.gov (United States)

    Berdanier, Reid A.; Key, Nicole L.

    2015-01-01

    The focus of this work was to characterize the fundamental flow physics and the overall performance effects due to increased rotor tip clearance heights in axial compressors. Data have been collected in the three-stage axial research compressor at Purdue University with a specific focus on analyzing the multistage effects resulting from the tip leakage flow. Three separate rotor tip clearance heights were studied with nominal tip clearance heights of 1.5%, 3.0%, and 4.0% based on a constant annulus height. Overall compressor performance was investigated at four corrected speedlines (100%, 90%, 80%, and 68%) for each of the three tip clearance configurations using total pressure and total temperature rakes distributed throughout the compressor. The results have confirmed results from previous authors showing a decrease of total pressure rise, isentropic efficiency, and stall margin which is approximately linear with increasing tip clearance height. The stall inception mechanisms have also been evaluated at the same corrected speeds for each of the tip clearance configurations. Detailed flow field measurements have been collected at two loading conditions, nominal loading (NL) and high loading (HL), on the 100% corrected speedline for the smallest and largest tip clearance heights (1.5% and 4.0%). Steady detailed radial traverses of total pressure at the exit of each stator row have been supported by flow visualization techniques to identify regions of flow recirculation and separation. Furthermore, detailed radial traverses of time-resolved total pressures at the exit of each rotor row have been measured with a fast-response pressure probe. These data have helped to quantify the size of the leakage flow at the exit of each rotor. Thermal anemometry has also been implemented to evaluate the time-resolved three-dimensional components of velocity throughout the compressor and calculate blockage due to the rotor tip leakage flow throughout the compressor. These

  2. Verification of an altitude decompression sickness prevention protocol for Shuttle operations utilizing a 10.s psi pressure stage

    Science.gov (United States)

    Waligora, J. M.; Horrigan, D. J., Jr.; Conkin, J.; Hadley, A. T., III

    1984-01-01

    Three test series involving 173-man tess were conducted to define and verify a pre-extravehicular activity (EVA) denitrogenation procedure that would provide acceptable protection against altitude decompression sickness while minimizing the required duration of oxygen (O2) prebreathe in the suit prior to EVA. The tests also addressed the safety, in terms of incidence of decompression sickness, of conducting EVA's on consecutive days rather than on alternate days. The tests were conducted in an altitude chamber, subjects were selected as representative of the astronaut population, and EVA periods were simulated by reducing the chamber pressure to suit pressure while the subjects breathed O2 with masks and worked at EVA representative work rates. A higher than anticipated incidence of both venous bubbles (55%) and symptoms (26%) was measured following all denitrogenation protocols in this test. For the most part, symptoms were very minor and stabilized, diminished, or disappeared in the six-hour tests. Instances of clear, possible, or potential systemic symptoms were encountered only after use of the unmodified 10.2 psi protocol and not after the modified 10.2 psi protocol, the 3.5-hour O2 prebreathed protocol, or the 4.0-hour O2 prebreathe protocol. The high incidence of symptoms is ascribed to the type and duration of exercise and the sensitivity of the reporting technique to minor symptoms. Repeated EVA exposures after only 17 hours did not increase symptom or bubble incidence.

  3. Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial.

    Science.gov (United States)

    Cohen, Debbie L; Bloedon, Leanne T; Rothman, Rand L; Farrar, John T; Galantino, Mary Lou; Volger, Sheri; Mayor, Christine; Szapary, Phillipe O; Townsend, Raymond R

    2011-01-01

    The prevalence of prehypertension and Stage 1 hypertension continues to increase despite being amenable to non-pharmacologic interventions. Iyengar yoga (IY) has been purported to reduce blood pressure (BP) though evidence from randomized trials is lacking. We conducted a randomized controlled trial to assess the effects of 12 weeks of IY versus enhanced usual care (EUC) (based on individual dietary adjustment) on 24-h ambulatory BP in yoga-naïve adults with untreated prehypertension or Stage 1 hypertension. In total, 26 and 31 subjects in the IY and EUC arms, respectively, completed the study. There were no differences in BP between the groups at 6 and 12 weeks. In the EUC group, 24-h systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) significantly decreased by 5, 3 and 3 mmHg, respectively, from baseline at 6 weeks (P IY group, 24 h SBP was reduced by 6 mmHg at 12 weeks compared to baseline (P = .05). 24 h DBP (P IY group at 12 weeks. Twelve weeks of IY produces clinically meaningful improvements in 24 h SBP and DBP. Larger studies are needed to establish the long term efficacy, acceptability, utility and potential mechanisms of IY to control BP.

  4. Laparostomy management using the ABThera™ open abdomen negative pressure therapy system in a grade IV open abdomen secondary to acute pancreatitis.

    Science.gov (United States)

    Fitzgerald, James E F; Gupta, Shradha; Masterson, Sarah; Sigurdsson, Helgi H

    2013-04-01

    Wound control in laparostomy for the treatment of intra-abdominal hypertension remains challenging and numerous techniques have been described. We report the first UK experience with a new commercially available device specifically designed to facilitate management of the open abdomen. A 44-year-old gentleman presented with a 3-day history of constant severe epigastric pain and associated vomiting. Amylase was markedly elevated and he was admitted for supportive management of pancreatitis, with subsequent transfer to intensive care due to severe systemic inflammatory syndrome. The patient decompensated, developing intra-abdominal hypertension with renal and respiratory failure. This was successfully managed by performing a laparostomy and using an ABThera™ Open Abdomen Negative Pressure Therapy System (KCI, San Antonio, TX). We describe its use to facilitate wound control, including enteroatmospheric fistula, allowing granulation and eventual restoration of gastrointestinal continuity 383-days after admission. We found the ABThera™ System proved to be a useful treatment adjunct, protecting intra-abdominal contents while removing large volumes of exudate and infected material from within the abdominal cavity. Complex cases such as this remain infrequent and this article provides a summary of our experience, including a review of indications for laparostomy and the underlying basic science in this difficult area. © 2012 The Authors. International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

  5. Multi-stage-flash desalination plants of relative small performance with integrated pressurized water reactors as a nuclear heat source

    International Nuclear Information System (INIS)

    Petersen, G.; Peltzer, M.

    1977-01-01

    In the Krupp-GKSS joint study MINIPLEX the requirements for seawater-desalination plants with a performance in the range of 10 000 to 80 000 m 3 distillate per day heated by a nuclear reactor are investigated. The reactor concept is similar to the Integrated Pressurized Water Reactor (IPWR) of the nuclear ship OTTO HAHN. The design study shows that IPWR systems have specific advantages up to 200 MWth compared to other reactor types at least being adapted for single- and dual-purpose desalination plants. The calculated costs of the desalinated water show that due to fuel cost advantages of reactors small and medium nuclear desalination plants are economically competetive with oil-fired plants since the steep rise of oil price in autumn 1973. (author)

  6. Association of junk food consumption with high blood pressure and obesity in Iranian children and adolescents: the CASPIAN-IV Study.

    Science.gov (United States)

    Payab, Moloud; Kelishadi, Roya; Qorbani, Mostafa; Motlagh, Mohammad Esmaeil; Ranjbar, Shirin Hasani; Ardalan, Gelayol; Zahedi, Hoda; Chinian, Mohammad; Asayesh, Hamid; Larijani, Bagher; Heshmat, Ramin

    2015-01-01

    This study aimed to evaluate the association of junk food consumption with hypertension and obesity in a national sample of Iranian children and adolescents. This nationwide study was conducted in 2011-2012 among 14,880 students, aged 6-18 years, selected by cluster sampling from 30 provinces. Weight, height, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), as well as systolic and diastolic blood pressure (BP) were measured. Junk food was divided into four categories, including salty snacks, sweets, sweetened beverages, and fast food. Subjects reported how many times they had consumed each item (daily, weekly, and seldom). The intake of sweets was significantly associated with anthropometric indices and BP levels. Moreover, a significant association was found between fast food consumption, BP levels, and anthropometric indices (except for WHtR and WHR). Sweet beverages consumption was significantly associated with anthropometric indices; however, the consumption of salty snacks was only significantly associated with height, HC, and WHR. The risk of general obesity (OR: 0.75, 95% CI: 0.65-0.87) and abdominal obesity (OR: 0.81, 95% CI: 0.72-0.92) among participants who seldom consumed sweets was less than those who consumed daily. Also, the risk of general obesity (OR: 0.85, 95% CI: 0.74-0.97) among students that seldom consumed sweetened beverages was less than subjects who consumed them on a daily basis. It was found that junk food consumption increased the risk of both general and abdominal obesity; therefore, consumption of junk food should be reduced via restricting TV advertisements and increasing taxes on junk foods. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  7. Association of junk food consumption with high blood pressure and obesity in Iranian children and adolescents: the CASPIAN-IV Study

    Directory of Open Access Journals (Sweden)

    Moloud Payab

    2015-04-01

    Full Text Available OBJECTIVE: This study aimed to evaluate the association of junk food consumption with hypertension and obesity in a national sample of Iranian children and adolescents. METHODS: This nationwide study was conducted in 2011-2012 among 14,880 students, aged 6-18 years, selected by cluster sampling from 30 provinces. Weight, height, waist circumference (WC, hip circumference (HC, waist-to-hip ratio (WHR, waist-to-height ratio (WHtR, as well as systolic and diastolic blood pressure (BP were measured. Junk food was divided into four categories, including salty snacks, sweets, sweetened beverages, and fast food. Subjects reported how many times they had consumed each item (daily, weekly, and seldom. RESULTS: The intake of sweets was significantly associated with anthropometric indices and BP levels. Moreover, a significant association was found between fast food consumption, BP levels, and anthropometric indices (except for WHtR and WHR. Sweet beverages consumption was significantly associated with anthropometric indices; however, the consumption of salty snacks was only significantly associated with height, HC, and WHR. The risk of general obesity (OR: 0.75, 95% CI: 0.65-0.87 and abdominal obesity (OR: 0.81, 95% CI: 0.72-0.92 among participants who seldom consumed sweets was less than those who consumed daily. Also, the risk of general obesity (OR: 0.85, 95% CI: 0.74-0.97 among students that seldom consumed sweetened beverages was less than subjects who consumed them on a daily basis. CONCLUSION: It was found that junk food consumption increased the risk of both general and abdominal obesity; therefore, consumption of junk food should be reduced via restricting TV advertisements and increasing taxes on junk foods.

  8. Changes in pulmonary artery systolic pressure and right ventricular function in patients with end-stage renal disease on maintenance dialysis.

    Science.gov (United States)

    Santosh, Sadashiv; Chu, Cheng; Mwangi, John; Narayan, Melin; Mosman, Amy; Nayak, Ravi; Philipneri, Marie

    2017-10-20

    Pulmonary hypertension is common in patients with end-stage renal disease, and portends a poor prognosis. There are little data in this population, and previous studies have not evaluated quantitative changes in hemodynamics over time while on maintenance dialysis. This study sought to estimate changes in pulmonary artery systolic pressure (PASP) and right ventricular function over time, and to predict PASP change using clinical variables routinely available at time of initial measurement, in patients on maintenance dialysis. We retrospectively studied patients with end-stage renal disease at a university-affiliated dialysis center who had two separate echocardiograms 1-4 years apart. Seventy-six patients (65 hemodialysis, 11 peritoneal dialysis) were included. PASP was estimated by echocardiography. Baseline PASP was predicted by left-sided valvular disease, anemia, COPD, left-ventricular mass index, and hemodialysis modality (p=0.07 for modality). Average increase in PASP was 2.41 mmHg per year. Higher rates of PASP change were predicted by E/e' ratio by tissue doppler on echocardiogram, diabetes mellitus, low LV mass, and left-sided valvular heart disease (p=0.07 for valvular disease). Patients with higher PASP had higher incidence of new-onset right ventricular dysfunction. In patients with end-stage renal disease, PASP increases over time. Changes are moderately predictable. Higher PASP predicted development of right ventricular dysfunction. This article is protected by copyright. All rights reserved.

  9. Three-Dimensional Unsteady Simulation of a Modern High Pressure Turbine Stage Using Phase Lag Periodicity: Analysis of Flow and Heat Transfer

    Science.gov (United States)

    Shyam, Vikram; Ameri, Ali; Luk, Daniel F.; Chen, Jen-Ping

    2010-01-01

    Unsteady three-dimensional RANS simulations have been performed on a highly loaded transonic turbine stage and results are compared to steady calculations as well as experiment. A low Reynolds number k- turbulence model is employed to provide closure for the RANS system. A phase-lag boundary condition is used in the periodic direction. This allows the unsteady simulation to be performed by using only one blade from each of the two rows. The objective of this paper is to study the effect of unsteadiness on rotor heat transfer and to glean any insight into unsteady flow physics. The role of the stator wake passing on the pressure distribution at the leading edge is also studied. The simulated heat transfer and pressure results agreed favorably with experiment. The time-averaged heat transfer predicted by the unsteady simulation is higher than the heat transfer predicted by the steady simulation everywhere except at the leading edge. The shock structure formed due to stator-rotor interaction was analyzed. Heat transfer and pressure at the hub and casing were also studied. Thermal segregation was observed that leads to the heat transfer patterns predicted by steady and unsteady simulations to be different.

  10. Circulating CD4+ T cells that produce IL4 or IL17 when stimulated by melan-A but not by NY-ESO-1 have negative impacts on survival of patients with stage IV melanoma.

    Science.gov (United States)

    Zelba, Henning; Weide, Benjamin; Martens, Alexander; Derhovanessian, Evelyna; Bailur, Jithendra Kini; Kyzirakos, Christina; Pflugfelder, Annette; Eigentler, Thomas K; Di Giacomo, Anna Maria; Maio, Michele; Aarntzen, Erik H J G; de Vries, Jolanda; Sucker, Antje; Schadendorf, Dirk; Büttner, Petra; Garbe, Claus; Pawelec, Graham

    2014-08-15

    We initially observed that the presence of circulating NY-ESO-1- and/or Melan-A-specific T cells in patients with stage IV melanoma was significantly associated with prolonged survival. Here, we report the ways in which the phenotypes and functions of these T cells differentially affect survival in patients preselected for NY-ESO-1 and/or Melan-A reactivity. We assayed functional antigen-reactive T cells recognizing NY-ESO-1 and/or Melan-A after in vitro stimulation using overlapping peptide pools. After restimulation, we assayed six cytokines simultaneously by intracellular cytokine staining. This allowed us to analyze the functional antigen response of both CD4(+) and CD8(+) T cells at the single-cell level. We observed that NY-ESO-1 stimulated mainly CD4(+) T cells, whereas Melan-A more often stimulated CD8(+) T cells. NY-ESO-1 reactivity was not associated with an additional impact on survival, whether CD4(+) T cells, CD8(+) T cells, or both types of T cells were responding. In contrast, recognition of Melan-A by CD4(+) T cells was associated with reduced survival in our cohort of patients preselected for NY-ESO-1 and/or Melan-A reactivity (that is, in patients with exceptionally long survival). We further observed a negative effect on survival in patients with CD4(+) T cells producing IL4 and IL17 upon Melan-A stimulation. Their prognosis was comparable to patients without any Melan-A reactivity. The nature and prognostic impact of specific T-cell responses is different according to targeted antigen. Independent from phenotype and functional aspects, NY-ESO-1 reactivity is associated with good prognosis. In terms of Melan-A, antigen-specific CD8(+) but not CD4(+) responses are associated with prolonged survival. Clin Cancer Res; 20(16); 4390-9. ©2014 AACR. ©2014 American Association for Cancer Research.

  11. An Open-Label, Randomized, Controlled Phase II Study of Paclitaxel-Carboplatin Chemotherapy With Necitumumab Versus Paclitaxel-Carboplatin Alone in First-Line Treatment of Patients With Stage IV Squamous Non-Small-Cell Lung Cancer.

    Science.gov (United States)

    Spigel, David R; Luft, Alexander; Depenbrock, Henrik; Ramlau, Rodryg; Khalil, Mazen; Kim, Joo-Hang; Mayo, Carlos; Chao, Grace Yi; Obasaju, Coleman; Natale, Ronald

    2017-09-01

    The combination of necitumumab with gemcitabine-cisplatin significantly improved overall survival (OS) in patients with stage IV squamous non-small-cell lung cancer (NSCLC), in the phase III SQUamous NSCLC treatment with the Inhibitor of EGF REceptor (SQUIRE) trial. Paclitaxel-carboplatin was selected as an alternative standard of care in the current phase II study. Patients were randomized (stratified according to Eastern Cooperative Oncology Group performance status and sex) 2:1 to ≤ six 3-week cycles (Q3W) of paclitaxel and carboplatin with or without necitumumab. Chemotherapy was paclitaxel 200 mg/m 2 on day 1 Q3W and carboplatin area under the curve 6 on day 1 Q3W. Necitumumab 800 mg, on days 1 and 8, was continued until disease progression or intolerable toxicity occurred. The primary end point was objective response rate (ORR) on the basis of Response Evaluation Criteria In Solid Tumors version 1.1. One hundred sixty-seven patients were randomized to the necitumumab-containing arm (n = 110) or the chemotherapy-only arm (n = 57). The combination of necitumumab with chemotherapy resulted in an ORR of 48.9% versus 40.0%. Median progression-free survival and OS were 5.4 versus 5.6 months (hazard ratio [HR], 1.0) and 13.2 versus 11.2 months (HR, 0.83; P = .379) in each treatment arm, respectively. Disease control rate was 87.2% versus 84.0%. Grade ≥ 3 adverse events typically associated with epidermal growth factor receptor (EGFR) monoclonal antibodies showing a > 2% increase were hypomagnesemia (5.7% vs. 0) and rash (2.8% vs. 0). Any Grade thromboembolic events occurred in < 4% of patients in either arm. The results of our study support previously reported results that the combination of necitumumab with chemotherapy improves survival in patients with advanced squamous NSCLC and shows a safety profile consistent with that of EGFR monoclonal antibodies. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. [18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches

    Energy Technology Data Exchange (ETDEWEB)

    Jong, Evelyn E.C. de; Elmpt, Wouter van; Leijenaar, Ralph T.H.; Lambin, Philippe [Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht (Netherlands); Hoekstra, Otto S. [VU University Medical Center, Department of Nuclear Medicine and PET Research, Amsterdam (Netherlands); Groen, Harry J.M. [University of Groningen and University Medical Center Groningen, Department of Pulmonary Diseases, Groningen (Netherlands); Smit, Egbert F. [VU University Medical Center, Department of Pulmonary Diseases, Amsterdam (Netherlands); The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Thoracic Oncology, Amsterdam (Netherlands); Boellaard, Ronald [University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen (Netherlands); Noort, Vincent van der [The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Biometrics, Amsterdam (Netherlands); Troost, Esther G.C. [Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht (Netherlands); Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology, Dresden (Germany); Medical Faculty and University Hospital Carl Gustav Carus of Technische Universitaet Dresden, Department of Radiotherapy and Radiation Oncology, Dresden (Germany); Dingemans, Anne-Marie C. [Maastricht University Medical Centre, Department of Pulmonology, GROW-School for Oncology and Developmental Biology, Maastricht (Netherlands)

    2017-01-15

    Nitroglycerin (NTG) is a vasodilating drug, which increases tumor blood flow and consequently decreases hypoxia. Therefore, changes in [18F] fluorodeoxyglucose positron emission tomography ([18F]FDG PET) uptake pattern may occur. In this analysis, we investigated the feasibility of [18F]FDG PET for response assessment to paclitaxel-carboplatin-bevacizumab (PCB) treatment with and without NTG patches. And we compared the [18F]FDG PET response assessment to RECIST response assessment and survival. A total of 223 stage IV non-small cell lung cancer (NSCLC) patients were included in a phase II study (NCT01171170) randomizing between PCB treatment with or without NTG patches. For 60 participating patients, a baseline and a second [18F]FDG PET/computed tomography (CT) scan, performed between day 22 and 24 after the start of treatment, were available. Tumor response was defined as a 30 % decrease in CT and PET parameters, and was compared to RECIST response at week 6. The predictive value of these assessments for progression free survival (PFS) and overall survival (OS) was assessed with and without NTG. A 30 % decrease in SUVpeak assessment identified more patients as responders compared to a 30 % decrease in CT diameter assessment (73 % vs. 18 %), however, this was not correlated to OS (SUVpeak30 p = 0.833; CTdiameter30 p = 0.557). Changes in PET parameters between the baseline and the second scan were not significantly different for the NTG group compared to the control group (p value range 0.159-0.634). The CT-based (part of the [18F]FDG PET/CT) parameters showed a significant difference between the baseline and the second scan for the NTG group compared to the control group (CT diameter decrease of 7 ± 23 % vs. 19 ± 14 %, p = 0.016, respectively). The decrease in tumoral FDG uptake in advanced NSCLC patients treated with chemotherapy with and without NTG did not differ between both treatment arms. Early PET-based response assessment showed more tumor responders

  13. In situ detection of two-stage crystallization in ZrTiCuNiBe under high pressure and high temperature

    CERN Document Server

    Sun, L L; Wu, Q; Zhan, Z J; Cao, L M; Wang, L M; Shao, G J; Zhang, J; Wang, W K

    2002-01-01

    Structural changes in bulk metallic Zr sub 4 sub 1 sub . sub 2 Ti sub 1 sub 3 sub . sub 8 Cu sub 1 sub 2 sub . sub 5 Ni sub 1 sub 0 Be sub 2 sub 2 sub . sub 5 glass subjected to heat treatments under high pressure were investigated by means of synchrotron radiation x-ray diffraction (SRXRD). In situ SRXRD measurements showed that the crystallization process of this material is comprised of two stages. Subsequent heating at 10 GPa converts the sample from the amorphous (Am) phase into a metastable fcc phase and then leads to the fcc phase changing back to the Am phase, indicating that there is a kind of 'reversible' phase transition phenomenon occurring in the alloy. Such phenomenon is explained on the basis of free energy considerations.

  14. Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Debbie L. Cohen

    2011-01-01

    Full Text Available The prevalence of prehypertension and Stage 1 hypertension continues to increase despite being amenable to non-pharmacologic interventions. Iyengar yoga (IY has been purported to reduce blood pressure (BP though evidence from randomized trials is lacking. We conducted a randomized controlled trial to assess the effects of 12 weeks of IY versus enhanced usual care (EUC (based on individual dietary adjustment on 24-h ambulatory BP in yoga-naïve adults with untreated prehypertension or Stage 1 hypertension. In total, 26 and 31 subjects in the IY and EUC arms, respectively, completed the study. There were no differences in BP between the groups at 6 and 12 weeks. In the EUC group, 24-h systolic BP (SBP, diastolic BP (DBP and mean arterial pressure (MAP significantly decreased by 5, 3 and 3 mmHg, respectively, from baseline at 6 weeks (P < .05, but were no longer significant at 12 weeks. In the IY group, 24 h SBP was reduced by 6 mmHg at 12 weeks compared to baseline (P = .05. 24 h DBP (P < .01 and MAP (P < .05 decreased significantly each by 5 mmHg. No differences were observed in catecholamine or cortisol metabolism to explain the decrease in BP in the IY group at 12 weeks. Twelve weeks of IY produces clinically meaningful improvements in 24 h SBP and DBP. Larger studies are needed to establish the long term efficacy, acceptability, utility and potential mechanisms of IY to control BP.

  15. Estimating average shock pressures recorded by impactite samples based on universal stage investigations of planar deformation features in quartz - Sources of error and recommendations

    Science.gov (United States)

    Holm-Alwmark, S.; Ferrière, L.; Alwmark, C.; Poelchau, M. H.

    2018-01-01

    Planar deformation features (PDFs) in quartz are the most widely used indicator of shock metamorphism in terrestrial rocks. They can also be used for estimating average shock pressures that quartz-bearing rocks have been subjected to. Here we report on a number of observations and problems that we have encountered when performing universal stage measurements and crystallographically indexing of PDF orientations in quartz. These include a comparison between manual and automated methods of indexing PDFs, an evaluation of the new stereographic projection template, and observations regarding the PDF statistics related to the c-axis position and rhombohedral plane symmetry. We further discuss the implications that our findings have for shock barometry studies. Our study shows that the currently used stereographic projection template for indexing PDFs in quartz might induce an overestimation of rhombohedral planes with low Miller-Bravais indices. We suggest, based on a comparison of different shock barometry methods, that a unified method of assigning shock pressures to samples based on PDFs in quartz is necessary to allow comparison of data sets. This method needs to take into account not only the average number of PDF sets/grain but also the number of high Miller-Bravais index planes, both of which are important factors according to our study. Finally, we present a suggestion for such a method (which is valid for nonporous quartz-bearing rock types), which consists of assigning quartz grains into types (A-E) based on the PDF orientation pattern, and then calculation of a mean shock pressure for each sample.

  16. Evaluation of four non-invasive methods for examination and characterization of pressure ulcers

    DEFF Research Database (Denmark)

    Andersen, E.S.; Karlsmark, T.

    2008-01-01

    , we here report on usability of four non-invasive techniques for evaluation of pressure ulcers. Methods: Fifteen pressure ulcers in stage 0-IV were examined using four different non-invasive techniques [redness index, skin temperature, skin elasticity (i.e. retraction time), and ultrasound scanning...... at all pressure ulcers, but none at the reference points. The skin retraction time was often higher at the location of a pressure ulcer than at the reference location. We found no correlation between the stage of the ulcers and temperature, redness index, subepidermal layer thickness, or retraction time...

  17. IV treatment at home

    Science.gov (United States)

    ... Other IV treatments you may receive after you leave the hospital include: Treatment for hormone deficiencies Medicines for severe nausea that cancer chemotherapy or pregnancy may cause Patient-controlled analgesia (PCA) for pain (this is IV ...

  18. Docetaxel, cisplatin and 5-fluorouracil induction chemotherapy followed by chemoradiotherapy or chemoradiotherapy alone in stage III-IV unresectable head and neck cancer. Results of a randomized phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Takacsi-Nagy, Zoltan; Polgar, Csaba; Major, Tibor; Fodor, Janos [National Institute of Oncology, Center of Radiotherapy, Budapest (Hungary); Hitre, Erika [National Institute of Oncology, Department of Chemotherapy and Clinical Pharmacology, Budapest (Hungary); Remenar, Eva; Kasler, Miklos [National Institute of Oncology, Department of Head and Neck and Maxillofacial Surgery, Budapest (Hungary); Oberna, Ferenc [Bacs-Kiskun County Hospital, Department of Oral, Maxillofacial and Head and Neck Surgery, Kecskemet (Hungary); Goedeny, Maria [National Institute of Oncology, Department of Radiology, Budapest (Hungary)

    2015-08-15

    Concurrent chemoradiotherapy (CRT) is the standard treatment for advanced head and neck squamous cell carcinoma. In this phase II randomized study, the efficacy and toxicity of docetaxel, cisplatin and 5-fluorouracil induction chemotherapy (ICT) followed by concurrent CRT was compared with those after standard CRT alone in patients with locally advanced, unresectable head and neck cancer. Between January 2007 and June 2009, 66 patients with advanced (stage III or IV) unresectable squamous cell carcinoma of the head and neck (oral cavity, oropharynx, hypopharynx, and larynx) were randomly assigned to two groups: one receiving two cycles of docetaxel, cisplatin, and 5-fluorouracil ICT followed by CRT with three cycles of cisplatin and one treated by CRT alone. Response rate, local tumor control (LTC), locoregional tumor control (LRTC), overall survival (OS), progression-free survival (PFS), and toxicity results were assessed. Three patients from the ICT + CRT group did not appear at the first treatment, so a total of 63 patients were evaluated in the study (30 ICT + CRT group and 33 CRT group). Three patients died of febrile neutropenia after ICT. The median follow-up time for surviving patients was 63 months (range 53-82 months). The rate of radiologic complete response was 63 % following ICT + CRT, whereas 70 % after CRT alone. There were no significant differences in the 3-year rates of LTC (56 vs. 57 %), LRTC (42 vs. 50 %), OS (43 vs. 55 %), and PFS (41 vs. 50 %) in the ICT + CRT group and in the CRT group, respectively. The rate of grade 3-4 neutropenia was significantly higher in the ICT + CRT group than in the CRT group (37 and 12 %; p = 0.024). Late toxicity (grade 2 or 3 xerostomia) developed in 59 and 42 % in the ICT + CRT and CRT groups, respectively. The addition of ICT to CRT did not show any advantage in our phase II trial, while the incidence of adverse events increased. The three deaths as a consequence of ICT call attention to the importance of

  19. Chemotherapy beyond first-line in stage IV metastatic non-small cell lung cancer Quimioterapia em câncer de pulmão não pequenas células metastático estádio IV: além da primeira linha

    Directory of Open Access Journals (Sweden)

    Riad Naim Younes

    2011-12-01

    Full Text Available OBJECTIVE: Platinum-based doublet chemotherapy is considered the standard of care for advanced non-small cell lung cancer (NSCLC. However, prognosis after recurrent or progressive disease following first-line chemotherapy is usually poor. Maintenance chemotherapy, second line treatment and even third line chemotherapy are available for patients with advanced NSCLC. Unfortunately, few patients are candidates for chemotherapy beyond first line. The present study evaluated characteristics of patients with NSCLC and outcomes of the treatment of their metastatic disease, with emphasis on second and third-line chemotherapy. METHODS: This was a retrospective observational study of 2,673 patients with metastatic, stage IV, non-small cell lung cancer admitted for treatment in two São Paulo institutions. First-line chemotherapy was defined as the first chemotherapeutic approach administered to the patient. Second and third-line chemotherapy were defined as the systemic treatment administered after discontinuing first-line chemotherapy, either for intolerance or for progressive or recurrent disease. RESULTS: Most patients (57.9% received first-line chemotherapy, and approximately 23.4% received second-line and 8% third-line regimens. Only 2.5% received fourth-line chemotherapy. Median overall survival (OS was 8 months (95% CI: 8-9 months. At univariate analyses, gender (p OBJETIVO: A quimioterapia dupla com base em platina consiste no tratamento padrão para o câncer de pulmão não pequenas células (CPNPC avançado. Contudo, o prognóstico dos pacientes com doença recorrente ou em progressão após a quimioterapia de primeira linha é ruim. Quimioterapia de manutenção, de segunda linha e até de terceira linha são tratamentos válidos para pacientes com CPNPC de estádio avançado. Infelizmente, poucos pacientes são candidatos para o tratamento quimioterápico além daquele de primeira linha. O presente estudo avalia as características de

  20. Activation of PPAR-α in the early stage of heart failure maintained myocardial function and energetics in pressure-overload heart failure.

    Science.gov (United States)

    Kaimoto, Satoshi; Hoshino, Atsushi; Ariyoshi, Makoto; Okawa, Yoshifumi; Tateishi, Shuhei; Ono, Kazunori; Uchihashi, Motoki; Fukai, Kuniyoshi; Iwai-Kanai, Eri; Matoba, Satoaki

    2017-02-01

    Failing heart loses its metabolic flexibility, relying increasingly on glucose as its preferential substrate and decreasing fatty acid oxidation (FAO). Peroxisome proliferator-activated receptor α (PPAR-α) is a key regulator of this substrate shift. However, its role during heart failure is complex and remains unclear. Recent studies reported that heart failure develops in the heart of myosin heavy chain-PPAR-α transgenic mice in a manner similar to that of diabetic cardiomyopathy, whereas cardiac dysfunction is enhanced in PPAR-α knockout mice in response to chronic pressure overload. We created a pressure-overload heart failure model in mice through transverse aortic constriction (TAC) and activated PPAR-α during heart failure using an inducible transgenic model. After 8 wk of TAC, left ventricular (LV) function had decreased with the reduction of PPAR-α expression in wild-type mice. We examined the effect of PPAR-α induction during heart failure using the Tet-Off system. Eight weeks after the TAC operation, LV construction was preserved significantly by PPAR-α induction with an increase in PPAR-α-targeted genes related to fatty acid metabolism. The increase of expression of fibrosis-related genes was significantly attenuated by PPAR-α induction. Metabolic rates measured by isolated heart perfusions showed a reduction in FAO and glucose oxidation in TAC hearts, but the rate of FAO preserved significantly owing to the induction of PPAR-α. Myocardial high-energy phosphates were significantly preserved by PPAR-α induction. These results suggest that PPAR-α activation during pressure-overloaded heart failure improved myocardial function and energetics. Thus activating PPAR-α and modulation of FAO could be a promising therapeutic strategy for heart failure. NEW & NOTEWORTHY The present study demonstrates the role of PPAR-α activation in the early stage of heart failure using an inducible transgenic mouse model. Induction of PPAR-α preserved heart

  1. Taking Care of Pressure Sores

    Science.gov (United States)

    ... Tract Infections: Indwelling (Foley) Catheter Taking Care of Pressure Sores [Download this pamphlet: "Taking Care of Pressure ... may not show up right away. Stages of pressure sores and how to care for them: STAGE ...

  2. BAROMETRIC PRESSURE and Other Data from NOAA Ship ALBATROSS IV and Other Platforms From NW Atlantic (limit-40 W) from 1995-02-11 to 1995-07-20 (NODC Accession 9600140)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Hydrochemical, hydrophysical, and other data were collected from the ENDEAVOR and NOAA Ship ALBATROSS IV from February 11, 1995 to July 20, 1995. Data were submitted...

  3. Two-stage pressure-induced Yb valence change in the hexagonal Laves phase YbAg2: Investigation by time differential perturbed angular γ -γ correlation spectroscopy method and density functional calculations

    Science.gov (United States)

    Tsvyashchenko, A. V.; Nikolaev, A. V.; Salamatin, D. A.; Velichkov, A.; Salamatin, A. V.; Novikov, A. P.; Fomicheva, L. N.; El'kin, F. S.; Bibikov, A. V.; Kozin, M. G.; Budzynski, M.

    2017-12-01

    We have studied the C14 hexagonal Laves phase of YbAg2 at normal conditions and under external pressure up to 19 GPa by the time-differential perturbed angular γ -γ correlation spectroscopy (TDPAC) using 111Cd probe nuclei. Under pressure the valence of Yb undergoes a two-stage transition from 2.8 to 3. The two-stage scenario is characterized by two distinct quadrupole frequencies of 111Cd probes in a silver sublattice, monotonically increasing with pressure and saturating at 8 and 16 GPa. Our experimental data are compared with the density functional studies of the electron band structure of YbAg2, whose results are used for discussion and interpretation of these experiments. We have found that there are two different electric field gradients at inequivalent silver sites and that 4 d states of silver participate in metal bonding, allowing for the formation of the hexagonal Laves phase.

  4. Stark Broadening of Se IV, Sn IV, Sb IV and Te IV Spectral Lines

    Directory of Open Access Journals (Sweden)

    Milan S. Dimitrijević

    2018-03-01

    Full Text Available Stark broadening parameters, line width and shift, are needed for investigations, analysis and modelling of astrophysical, laboratory, laser produced and technological plasmas. Especially in astrophysics, due to constantly increasing resolution of satellite borne spectrographs, and large terrestrial telescopes, data on trace elements, which were previously insignificant, now have increasing importance. Using the modified semiempirical method of Dimitrijević and Konjević, here, Stark widths have been calculated for 2 Se IV, 6 Sn IV, 2 Sb IV and 1 Te IV transitions. Results have been compared with existing theoretical data for Sn IV. Obtained results will be implemented in the STARK-B database, which is also a part of Virtual atomic and molecular data center (VAMDC.

  5. Safety assessment for Generation IV nuclear systems

    International Nuclear Information System (INIS)

    Leahy, T.J.

    2012-01-01

    The Generation IV International Forum (GIF) Risk and Safety Working Group (RSWG) was created to develop an effective approach for the safety of Generation IV advanced nuclear energy systems. Recent RSWG work has focused on the definition of an integrated safety assessment methodology (ISAM) for evaluating the safety of Generation IV systems. ISAM is an integrated 'tool-kit' consisting of 5 analytical techniques that are available and matched to appropriate stages of Generation IV system concept development: 1) qualitative safety features review - QSR, 2) phenomena identification and ranking table - PIRT, 3) objective provision tree - OPT, 4) deterministic and phenomenological analyses - DPA, and 5) probabilistic safety analysis - PSA. The integrated methodology is intended to yield safety-related insights that help actively drive the evolving design throughout the technology development cycle, potentially resulting in enhanced safety, reduced costs, and shortened development time

  6. Relationship between Stage of Chronic Kidney Disease and Sarcopenia in Korean Aged 40 Years and Older Using the Korea National Health and Nutrition Examination Surveys (KNHANES IV-2, 3, and V-1, 2), 2008–2011

    Science.gov (United States)

    Moon, Sung Jin; Kim, Tae Ho; Yoon, Soo Young; Chung, Jae Ho; Hwang, Hee-Jin

    2015-01-01

    Background Protein-energy wasting is common in patients with end-stage kidney disease. However, few studies have examined the relationship between early stages of chronic kidney disease (CKD) and sarcopenia. Methods We conducted a cross-sectional study based on data in the Korea National Health and Nutrition Examination Survey, 2008–2011. In total, 11,625 subjects aged 40 years or older who underwent dual-energy X-ray absorptiometry were analyzed. Sarcopenia was defined based on values of appendicular skeletal muscle mass as a percentage of body weight (ASM/Wt) two standard deviations below the gender-specific mean for young adults. Estimated glomerular filtration rates (eGFR) were calculated using the CKD-EPI equation. Results Mean age, body mass index (BMI), and HOMA-IR were higher and caloric intake, physical activity, and vitamin D level were lower in the sarcopenia groups in both men and women. As the stage of CKD increased, the prevalence of sarcopenia increased, even in the early stages of CKD (normal and CKD1, 2, and 3-5: 2.6%, 5.6%, and 18.1% in men and 5.3%, 7.1%, and 12.6% in women, respectively; p sarcopenia with respect to CKD 3–5 was 1.93 (95% CI = 1.02–3.68) in men but was not statistically significant in women. Conclusions The prevalence of sarcopenia was higher in elderly Korean patients with even mildly reduced kidney function. Stage of CKD was associated with an increased prevalence of sarcopenia in men but not women. Thus, we should evaluate the risk of sarcopenia and work to prevent it, even in patients with early CKD. PMID:26083479

  7. A two-stage fixed-bed reactor for direct hydrotreatment of volatiles from the hydropyrolysis of biomass: effect of catalyst temperature, pressure and catalyst ageing time on product characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Pindoria, R.V.; Megaritis, A.; Herod, A.A.; Kandiyoti, R. [Imperial College of Science, Technology and Medicine, London (United Kingdom). Dept. of Chemical Engineering and Chemical Technology

    1998-12-01

    This investigation involved the hydropyrolysis of biomass (eucalyptus globulus) and the immediate catalytic hydrocracking of pyrolytic oils in the second stage of the reactor. The effects of temperature, pressure and the catalyst ageing time on the final product tar have been studied using the catalyst Zeolite H-ZSM5. The catalytically hydrocracked tar/oil products were characterised and compared with the hydropyrolysis product from the first stage of the reactor to determine the effect of catalytic hydrocracking. The carbon deposition on the catalyst has been examined using thermogravimetric analysis. The tar yields after catalytic hydrocracking decreased with increasing pressure and temperature of the cracking stage. The tar yields at 10 bar pressure were greater than those at 40 bar pressure. The fresh zeolite catalyst trapped more than 40% of the product from the hydropyrolysis stage and TGA evidence indicated that this was not as carbon deposition but as volatiles trapped in the zeolite matrix. Reuse of the catalyst resulted in little more uptake of volatiles; however, extended use of the catalyst did not result in increased yields of liquid products but in increased production of light volatiles or gas. The H-ZSM5 catalyst appeared to act as a more active cracking catalyst rather than to promote hydrogenation or deoxygenation of the liquids produced in the hydropyrolysis stage. Characterisation of the liquids by SEC and UV fluorescence indicated that structural changes were relatively minor despite the significant changes in yields of liquids with process conditions. Available reaction routes do not appear to allow specific deoxygenation pathways to predominate without disintegration of parent molecules to lighter volatiles, under the conditions used here. 41 refs., 10 figs., 4 tabs.

  8. Is the use of low-pressure pulsatile lavage for pressure ulcer management associated with environmental contamination with Acinetobacter baumannii?

    Science.gov (United States)

    Ho, Chester H; Johnson, Tova; Miklacic, Joan; Donskey, Curtis J

    2009-10-01

    Ho CH, Johnson T, Miklacic J, Donskey CJ. Is the use of low-pressure pulsatile lavage for pressure ulcer management associated with environmental contamination with Acinetobacter baumannii? To determine the extent of environmental contamination associated with low-pressure pulsatile lavage of stage III or IV pressure ulcers in patients with spinal cord injury (SCI) when routine infection control precautions are used for wounds colonized or infected with Acinetobacter baumannii. Prospective investigation in which pressure ulcer cultures and environmental cultures were obtained before and after low-pressure pulsatile lavage treatment, and before and after regular dressing changes. Environmental cultures included the patient's bedrail and settle plates placed 0.6, 1.5, and 2.4m from the wound to assess airborne spread of A. baumannii. SCI inpatient unit in a Department of Veterans Affairs Medical Center. Inpatients (N=15) with SCI receiving daily low-pressure pulsatile lavage treatment for stage III or IV pressure ulcers with standard dressing change, as well as regular dressing changes without low-pressure pulsatile lavage at other times of the day. Standard, regular dressing changes and dressing changes with low-pressure pulsatile lavage. Comparison of frequency of environmental contamination with A. baumannii associated with low-pressure pulsatile lavage versus regular dressing changes. Of the 15 SCI inpatients meeting inclusion criteria, 9 (60%) grew A. baumannii from their wounds. Of the 9 patients with wound cultures positive for A. baumannii, only 1 (11%) had environmental contamination with this organism after performance of low-pressure pulsatile lavage, and the same patient had environmental contamination after a standard dressing change. The antibiotic susceptibility patterns of the wound and environmental A. baumannii isolates were identical. Low-pressure pulsatile lavage using the infection control methods described is not associated with an increased

  9. NNDSS - Table IV. Tuberculosis

    Data.gov (United States)

    U.S. Department of Health & Human Services — NNDSS - Table IV. Tuberculosis - 2016.This Table includes total number of cases reported in the United States, by region and by states, in accordance with the...

  10. NNDSS - Table IV. Tuberculosis

    Data.gov (United States)

    U.S. Department of Health & Human Services — NNDSS - Table IV. Tuberculosis - 2014.This Table includes total number of cases reported in the United States, by region and by states, in accordance with the...

  11. NNDSS - Table IV. Tuberculosis

    Data.gov (United States)

    U.S. Department of Health & Human Services — NNDSS - Table IV. Tuberculosis - 2015.This Table includes total number of cases reported in the United States, by region and by states, in accordance with the...

  12. SAGE IV Pathfinder

    Data.gov (United States)

    National Aeronautics and Space Administration — Utilizing a unique, new occultation technique involving imaging, the SAGE IV concept will meet or exceed the quality of previous SAGE measurements at a small...

  13. Relationship between Stage of Chronic Kidney Disease and Sarcopenia in Korean Aged 40 Years and Older Using the Korea National Health and Nutrition Examination Surveys (KNHANES IV-2, 3, and V-1, 2, 2008-2011.

    Directory of Open Access Journals (Sweden)

    Sung Jin Moon

    Full Text Available Protein-energy wasting is common in patients with end-stage kidney disease. However, few studies have examined the relationship between early stages of chronic kidney disease (CKD and sarcopenia.We conducted a cross-sectional study based on data in the Korea National Health and Nutrition Examination Survey, 2008-2011. In total, 11,625 subjects aged 40 years or older who underwent dual-energy X-ray absorptiometry were analyzed. Sarcopenia was defined based on values of appendicular skeletal muscle mass as a percentage of body weight (ASM/Wt two standard deviations below the gender-specific mean for young adults. Estimated glomerular filtration rates (eGFR were calculated using the CKD-EPI equation.Mean age, body mass index (BMI, and HOMA-IR were higher and caloric intake, physical activity, and vitamin D level were lower in the sarcopenia groups in both men and women. As the stage of CKD increased, the prevalence of sarcopenia increased, even in the early stages of CKD (normal and CKD1, 2, and 3-5: 2.6%, 5.6%, and 18.1% in men and 5.3%, 7.1%, and 12.6% in women, respectively; p < 0.001. In addition, a correlation analysis showed that GFR and ASM/Wt had significant correlations in both men and women. Logistic regression analyses, after adjusting for age, BMI, caloric intake, log(physical activity, vitamin D level, and log(HOMA-IR, showed that the odds ratio for sarcopenia with respect to CKD 3-5 was 1.93 (95% CI = 1.02-3.68 in men but was not statistically significant in women.The prevalence of sarcopenia was higher in elderly Korean patients with even mildly reduced kidney function. Stage of CKD was associated with an increased prevalence of sarcopenia in men but not women. Thus, we should evaluate the risk of sarcopenia and work to prevent it, even in patients with early CKD.

  14. Effects of the DASH-JUMP dietary intervention in Japanese participants with high-normal blood pressure and stage 1 hypertension: an open-label single-arm trial

    OpenAIRE

    Kawamura, Atsuko; Kajiya, Katsuko; Kishi, Hiroko; Inagaki, Junko; Mitarai, Makoto; Oda, Hiroshi; Umemoto, Seiji; Kobayashi, Sei

    2016-01-01

    The Dietary Approaches to Stop Hypertension (DASH) diet is recommended by the American Heart Association to lower blood pressure (BP); however, its effects in Japanese participants have not been rigorously studied. We assessed the effects of the DASH-Japan Ube Modified diet Program (DASH-JUMP), a modified DASH diet, on cardiometabolic and inflammatory biomarkers in Japanese participants with untreated high-normal BP or stage 1 hypertension. Fifty-eight participants (30 men and 28 women; mean ...

  15. Pressure Ulcer Prevention

    Science.gov (United States)

    2009-01-01

    Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis (anticipated pubicstion date - mid-2009) Purpose A pressure ulcer, also known as a pressure sore, decubitus ulcer, or bedsore, is defined as a localized injury to the skin/and or underlying tissue occurring most often over a bony prominence and caused by pressure, shear, or friction, alone or in combination. (1) Those at risk for developing pressure ulcers include the elderly and critically ill as well as persons with neurological impairments and those who suffer conditions associated with immobility. Pressure ulcers are graded or staged with a 4-point classification system denoting severity. Stage I represents the beginnings of a pressure ulcer and stage IV, the severest grade, consists of full thickness tissue loss with exposed bone, tendon, and or muscle. (1) In a 2004 survey of Canadian health care settings, Woodbury and Houghton (2) estimated that the prevalence of pressure ulcers at a stage 1 or greater in Ontario ranged between 13.1% and 53% with nonacute health care settings having the highest prevalence rate (Table 1). Executive Summary Table 1: Prevalence of Pressure Ulcers* Setting Canadian Prevalence,% (95% CI) Ontario Prevalence,Range % (n) Acute care 25 (23.8–26.3) 23.9–29.7 (3418) Nonacute care† 30 (29.3–31.4) 30.0–53.3 (1165) Community care 15 (13.4–16.8) 13.2 (91) Mixed health care‡ 22 (20.9

  16. Current status of NPP generation IV

    International Nuclear Information System (INIS)

    Yohanes Dwi Anggoro; Dharu Dewi; Nurlaila; Arief Tris Yuliyanto

    2013-01-01

    Today development of nuclear technology has reached the stage of research and development of Generation IV nuclear power plants (advanced reactor systems) which is an innovative development from the previous generation of nuclear power plants. There are six types of power generation IV reactors, namely: Very High Temperature Reactor (VHTR), Sodium-cooled Fast Reactor (SFR), Gas-cooled Fast Reactor (GFR), Lead-cooled Fast Reactor (LFR), Molten Salt Reactor (MSR), and Super Critical Water-cooled Reactor (SCWR). The purpose of this study is to know the development of Generation IV nuclear power plants that have been done by the thirteen countries that are members of the Gen IV International Forum (GIF). The method used is review study and refers to various studies related to the current status of research and development of generation IV nuclear power. The result of this study showed that the systems and technology on Generation IV nuclear power plants offer significant advances in sustainability, safety and reliability, economics, and proliferation resistance and physical protection. In addition, based on the research and development experience is estimated that: SFR can be used optimally in 2015, VHTR in 2020, while NPP types GFR, LFR, MSR, and SCWR in 2025. Utilization of NPP generation IV said to be optimal if fulfill the goal of NPP generation IV, such as: capable to generate energy sustainability and promote long-term availability of nuclear fuel, minimize nuclear waste and reduce the long term stewardship burden, has an advantage in the field of safety and reliability compared to the previous generation of NPP and VHTR technology have a good prospects in Indonesia. (author)

  17. IV access in dental practice.

    LENUS (Irish Health Repository)

    Fitzpatrick, J J

    2009-04-01

    Intravenous (IV) access is a valuable skill for dental practitioners in emergency situations and in IV sedation. However, many people feel some apprehension about performing this procedure. This article explains the basic principles behind IV access, and the relevant anatomy and physiology, as well as giving a step-by-step guide to placing an IV cannula.

  18. Importance of increased intraosseous pressure in the development of osteonecrosis of the femoral head: implications for treatment

    International Nuclear Information System (INIS)

    Hungerford, D.S.; Lennox, D.W.

    1985-01-01

    Early diagnosis of osteonecrosis by radiograph, bone scan, CT scan, magnetic resonance imaging (MRI), intraosseous pressure measurement, or intraosseous venogram can lead to early successful treatment. For early (Ficat stages I and II) osteonecrosis of the hip, core decompression can provide diagnostic confirmation and pain relief and may prevent progression of disease. For more advanced disease (Ficat stages II and IV), osteotomy, endoprosthetic or bipolar prosthetic replacement, total hip arthroplasty, and arthrodesis are surgical options.86 references

  19. Importance of increased intraosseous pressure in the development of osteonecrosis of the femoral head: implications for treatment

    Energy Technology Data Exchange (ETDEWEB)

    Hungerford, D.S.; Lennox, D.W.

    1985-10-01

    Early diagnosis of osteonecrosis by radiograph, bone scan, CT scan, magnetic resonance imaging (MRI), intraosseous pressure measurement, or intraosseous venogram can lead to early successful treatment. For early (Ficat stages I and II) osteonecrosis of the hip, core decompression can provide diagnostic confirmation and pain relief and may prevent progression of disease. For more advanced disease (Ficat stages II and IV), osteotomy, endoprosthetic or bipolar prosthetic replacement, total hip arthroplasty, and arthrodesis are surgical options.86 references.

  20. Dibromidodimethyldipyridineplatinum(IV

    Directory of Open Access Journals (Sweden)

    Mairéad E. Kelly

    2008-11-01

    Full Text Available In the title complex, [PtBr2(CH32(C5H5N2], the PtIV metal centre lies on a twofold rotation axis and adopts a slightly distorted octahedral coordination geometry. The structure displays weak intramolecular C—H...Br hydrogen-bonding interactions.

  1. Enhanced Design Alternative IV

    International Nuclear Information System (INIS)

    Kramer, N.E.

    1999-01-01

    This report evaluates Enhanced Design Alternative (EDA) IV as part of the second phase of the License Application Design Selection (LADS) effort. The EDA IV concept was compared to the VA reference design using criteria from the Design Input Request for LADS Phase II EDA Evaluations (CRWMS M and O 1999b) and (CRWMS M and O 1999f). Briefly, the EDA IV concept arranges the waste packages close together in an emplacement configuration known as line load. Continuous pre-closure ventilation keeps the waste packages from exceeding their 350 C cladding and 200 C (4.3.6) drift wall temperature limits. This EDA concept keeps relatively high, uniform emplacement drift temperatures (post-closure) to drive water away from the repository and thus dry out the pillars between emplacement drifts. The waste package is shielded to permit human access to emplacement drifts and includes an integral filler inside the package to reduce the amount of water that can contact the waste form. Closure of the repository is desired 50 years after first waste is emplaced. Both backfill and drip shields will be emplaced at closure to improve post-closure performance. The EDA IV concept includes more defense-in-depth layers than the VA reference design because of its backfill, drip shield, waste package shielding, and integral filler features. These features contribute to the low dose-rate to the public achieved during the first 10,000 years of repository life as shown in Figure 3. Investigation of the EDA IV concept has led to the following general conclusions: (1) The total life cycle cost for EDA IV is about $21.7 billion which equates to a $11.3 billion net present value (both figures rounded up). (2) The incidence of design basis events for EDA IV is similar to the VA reference design. (3) The emplacement of the waste packages in drifts will be similar to the VA reference design. However, heavier equipment may be required because the shielded waste package will be heavier. (4) The heavier

  2. The multi-stage tectonic evolution of the Xitieshan terrane, North Qaidam orogen, western China : From Grenville-age orogeny to early-Paleozoic ultrahigh-pressure metamorphism

    NARCIS (Netherlands)

    Zhang, Cong; Bader, Thomas; Zhang, Lifei; van Roermund, Herman

    The geodynamic evolution of the early Paleozoic ultrahigh-pressure metamorphic belt in North Qaidam, western China, is controversial due to ambiguous interpretations concerning the nature and ages of the eclogitic protoliths. Within this framework, we present new LA-ICP-MS U-Pb zircon ages from

  3. A multi-stage-flash desalination plant of relative small performance with an integrated pressurized water reactor as a nuclear heat source

    International Nuclear Information System (INIS)

    Peltzer, M.; Petersen, G.

    1976-01-01

    In the Krupp-GKSS joint study MINIPLEX the requirements for seawater-desalination-plants with a performance in the range of 10,000 to 80,000 m 3 /d heated by a nuclear reactor are investigated. The reactor concept is similar to the integrated pressurized water reactor (IPWR) of the nuclear ship OTTO HAHN. The calculated costs of the desalinated water show, that due to the fuel cost advantages of reactors small and medium nuclear desalination plants are economically competetive with oil-fired plants since the steep rise of oil price in autumn 1973. (orig.) [de

  4. A new method of analysis of standing foot pressure images for detection of the plantar ulcers in early-stage diabetic neuropathy.

    Science.gov (United States)

    Gopalakrishna Prabhu, K; Mothiram Patil, K; Srinivasan, S

    2001-01-01

    In this paper, studies are performed on a large number of diabetic patients belonging to different levels of plantar sensation loss, by analyzing the standing foot pressure images in the frequency domain. A new parameter, the power ratio (PR, the ratio of high frequency power to the total power in an image), is used to distinguish between foot pressure image patterns of diabetic neuropathic subjects (at different levels of sensation loss) and those of normal feet. The foot areas of the diabetic subjects are scanned in 10 specified areas using Semmes Weinstein's nylon monofilaments to quantify the diabetic neuropathy. A statistical study of the mean values of this parameter in different plantar areas of the feet for different levels of diabetic neuropathy indicates distinguishing trends. The result could help in the early detection of low-level sensation loss by establishing the threshold of the PR in a particular area above which there could be the possibility of plantar ulcer formation. This information could be utilized by orthopedic surgeons to devise early corrective methods to protect the feet from further damage due to plantar ulcers.

  5. Comparative Analysis of Inpatient Costs for Obstetrics and Gynecology Surgery Patients Treated With IV Acetaminophen and IV Opioids Versus IV Opioid-only Analgesia for Postoperative Pain.

    Science.gov (United States)

    Hansen, Ryan N; Pham, An T; Lovelace, Belinda; Balaban, Stela; Wan, George J

    2017-10-01

    Recovery from obstetrics and gynecology (OB/GYN) surgery, including hysterectomy and cesarean section delivery, aims to restore function while minimizing hospital length of stay (LOS) and medical expenditures. Our analyses compare OB/GYN surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia with those who received IV opioid-only analgesia and estimate differences in LOS, hospitalization costs, and opioid consumption. We performed a retrospective analysis of the Premier Database between January 2009 and June 2015, comparing OB/GYN surgery patients who received postoperative pain management with combination IV acetaminophen and IV opioids with those who received only IV opioids starting on the day of surgery and continuing up to the second postoperative day. We performed instrumental variable 2-stage least-squares regressions controlling for patient and hospital covariates to compare the LOS, hospitalization costs, and daily opioid doses (morphine equivalent dose) of IV acetaminophen recipients with that of opioid-only analgesia patients. We identified 225 142 OB/GYN surgery patients who were eligible for our study of whom 89 568 (40%) had been managed with IV acetaminophen and opioids. Participants averaged 36 years of age and were predominantly non-Hispanic Caucasians (60%). Multivariable regression models estimated statistically significant differences in hospitalization cost and opioid use with IV acetaminophen associated with $484.4 lower total hospitalization costs (95% CI = -$760.4 to -$208.4; P = 0.0006) and 8.2 mg lower daily opioid use (95% CI = -10.0 to -6.4), whereas the difference in LOS was not significant, at -0.09 days (95% CI = -0.19 to 0.01; P = 0.07). Compared with IV opioid-only analgesia, managing post-OB/GYN surgery pain with the addition of IV acetaminophen is associated with decreased hospitalization costs and reduced opioid use.

  6. Management of stage IV rectal cancer: Palliative options

    Science.gov (United States)

    Ronnekleiv-Kelly, Sean M; Kennedy, Gregory D

    2011-01-01

    Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease. PMID:21412493

  7. A randomized trial of diet and physical activity in women treated for stage II—IV ovarian cancer: Rationale and design of the Lifestyle Intervention for Ovarian Cancer Enhanced Survival (LIVES): An NRG Oncology/Gynecologic Oncology Group (GOG-225) Study☆,☆☆

    Science.gov (United States)

    Thomson, Cynthia A.; Crane, Tracy E.; Miller, Austin; Garcia, David O.; Basen-Engquist, Karen; Alberts, David S.

    2016-01-01

    Ovarian cancer is the most common cause of gynecological cancer death in United States women. Efforts to improve progression free survival (PFS) and quality of life (QoL) after treatment for ovarian cancer are necessary. Observational studies suggest that lifestyle behaviors, including diet and physical activity, are associated with lower mortality in this population. The Lifestyle Intervention for Ovarian Cancer Enhanced Survival (LIVES) NRG 0225 study is a randomized, controlled trial designed to test the hypothesis that a 24 month lifestyle intervention will significantly increase PFS after oncological therapy for stage II-IV ovarian cancer. Women are randomized 1:1 to a high vegetable and fiber, low-fat diet with daily physical activity goals or an attention control group. Secondary outcomes to be evaluated include QoL and gastrointestinal health. Moreover an a priori lifestyle adherence score will be used to evaluate relationships between adoption of the diet and activity goals and PFS. Blood specimens are collected at baseline, 6, 12 and 24 months for analysis of dietary adherence (carotenoids) in addition to mechanistic biomarkers (lipids, insulin, telomere length). Women are enrolled at NRG clinic sites nationally and the telephone based lifestyle intervention is delivered from The University of Arizona call center by trained health coaches. A study specific multi-modal telephone, email, and SMS behavior change software platform is utilized for information delivery, coaching and data capture. When completed, LIVES will be the largest behavior-based lifestyle intervention trial conducted among ovarian cancer survivors. PMID:27394382

  8. The Effect of Air Preheat at Atmospheric Pressure on the Formation of NO(x) in the Quick-Mix Sections of an Axially Staged Combustor

    Science.gov (United States)

    Vardakas, M. A.; Leong, M. Y.; Brouwer, J.; Samuelsen, G. S.; Holdeman, J. D.

    1999-01-01

    The Rich-burn/Quick-mix/Lean-burn (RQL) combustor concept has been proposed to minimize the formation of nitrogen oxides (NO(x)) in gas turbine systems. The success of this combustor strategy is dependent upon the efficiency of the mixing section bridging the fuel-rich and fuel-lean stages. Note that although these results were obtained from an experiment designed to study an RQL mixer, the link between mixing and NOx signatures is considerably broader than this application, in that the need to understand this link exists in most advanced combustors. The experiment reported herein was designed to study the effects of inlet air temperature on NO(x) formation in a mixing section. The results indicate that NO(x) emission is increased for all preheated cases compared to non-preheated cases. When comparing the various mixing modules, the affect of jet penetration is important, as this determines where NO(x) concentrations peak, and affects overall NO(x) production. Although jet air comprises 70 percent of the total airflow, the impact that jet air preheat has on overall NO(x) emissions is small compared to preheating both main and jet air flow.

  9. Evaluation of browning ratio in an image analysis of apple slices at different stages of instant controlled pressure drop-assisted hot-air drying (AD-DIC).

    Science.gov (United States)

    Gao, Kun; Zhou, Linyan; Bi, Jinfeng; Yi, Jianyong; Wu, Xinye; Zhou, Mo; Wang, Xueyuan; Liu, Xuan

    2017-06-01

    Computer vision-based image analysis systems are widely used in food processing to evaluate quality changes. They are able to objectively measure the surface colour of various products since, providing some obvious advantages with their objectivity and quantitative capabilities. In this study, a computer vision-based image analysis system was used to investigate the colour changes of apple slices dried by instant controlled pressure drop-assisted hot air drying (AD-DIC). The CIE L* value and polyphenol oxidase activity in apple slices decreased during the entire drying process, whereas other colour indexes, including CIE a*, b*, ΔE and C* values, increased. The browning ratio calculated by image analysis increased during the drying process, and a sharp increment was observed for the DIC process. The change in 5-hydroxymethylfurfural (5-HMF) and fluorescent compounds (FIC) showed the same trend with browning ratio due to Maillard reaction. Moreover, the concentrations of 5-HMF and FIC both had a good quadratic correlation (R 2  > 0.998) with the browning ratio. Browning ratio was a reliable indicator of 5-HMF and FIC changes in apple slices during drying. The image analysis system could be used to monitor colour changes, 5-HMF and FIC in dehydrated apple slices during the AD-DIC process. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

  10. Diaquatetrabromidotin(IV trihydrate

    Directory of Open Access Journals (Sweden)

    Fei Ye

    2012-09-01

    Full Text Available The title compound, [SnBr4(H2O2]·3H2O, forms large colourless crystals in originally sealed samples of tin tetrabromide. It constitutes the first structurally characterized hydrate of SnBr4 and is isostructural with the corresponding hydrate of SnCl4. It is composed of SnIV atoms octahedrally coordinated by four Br atoms and two cis-related water molecules. The octahedra exhibit site symmetry 2. They are arranged into columns along [001] via medium–strong O—H...O hydrogen bonds involving the two lattice water molecules (one situated on a twofold rotation axis while the chains are interconnected via longer O—H...Br hydrogen bonds, forming a three-dimensional network.

  11. Numerical simulation of the unsteady and turbulent flow in a high-pressure turbine stage; Simulation numerique de l'ecoulement instationnaire et turbulent dans un etage de turbine haute pression

    Energy Technology Data Exchange (ETDEWEB)

    Bastin, G.

    2004-09-15

    The aim of this study concerns the use of numerical methods for the resolution of the Reynolds Averaged Navier Stokes equations adapted to the simulation of the cooling of the trailing edge of a stator in a high pressure turbine. These methods, based on the elsA solver developed at ONERA, use a four steps Runge Kutta time discretization scheme and a Jameson centered space discretization scheme. The scheme is applied through a finite volume approach on control volume centered on the cells of a multi-block structured mesh. Turbulence is simulated either through the algebraic Michel model, or through the one-transport-equation Spalart-Allmaras model, or through the two-transport-equations k 1, k {omega} and k {epsilon} models, and through ASM model. A simulation of the flow in a bidimensional stator, without cooling, is carried out. The cooling, which is realized with trailing edge slots, is then simulated on a bidimensional stator. Because the slot is represented by meshes overlapping the mesh of the smooth blade, the Chimera method is chosen. This method makes it possible computations with overlapping meshes. The comparison with the experimental data, on these two first computations has validated this strategy to represent such slots. The tridimensional simulation of a single stator with taking account of the cooling is then realized. It showed the complex and tridimensional aspects of the main flow with focus on the influence of the cooling system. Finally two steady computations, without and with cooling, and an unsteady computation without cooling are carried out on a high pressure turbine stage. The comparison with the experimental data obtained in the frame of the European Brite-Euram program is made. These results make it possible to determine the effect of the cooling on the flow in a turbine stage. (authors)

  12. New Materials for NGNP/Gen IV

    International Nuclear Information System (INIS)

    Swindeman, Robert W.; Marriott, Douglas L.

    2009-01-01

    The bounding conditions were briefly summarized for the Next Generation Nuclear Plant (NGNP) that is the leading candidate in the Department of Energy Generation IV reactor program. Metallic materials essential to the successful development and proof of concept for the NGNP were identified. The literature bearing on the materials technology for high-temperature gas-cooled reactors was reviewed with emphasis on the needs identified for the NGNP. Several materials were identified for a more thorough study of their databases and behavioral features relative to the requirements ASME Boiler and Pressure Vessel Code, Section III, Division 1, Subsection NH.

  13. New Materials for NGNP/Gen IV

    Energy Technology Data Exchange (ETDEWEB)

    Robert W. Swindeman; Douglas L. Marriott

    2009-12-18

    The bounding conditions were briefly summarized for the Next Generation Nuclear Plant (NGNP) that is the leading candidate in the Department of Energy Generation IV reactor program. Metallic materials essential to the successful development and proof of concept for the NGNP were identified. The literature bearing on the materials technology for high-temperature gas-cooled reactors was reviewed with emphasis on the needs identified for the NGNP. Several materials were identified for a more thorough study of their databases and behavioral features relative to the requirements ASME Boiler and Pressure Vessel Code, Section III, Division 1, Subsection NH.

  14. Trading stages

    DEFF Research Database (Denmark)

    Steiner, Uli; Tuljapurkar, Shripad; Coulson, Tim

    2012-01-01

    because they are hard to use and interpret, and tools for age and stage structured populations are missing. We present easily interpretable expressions for the sensitivities and elasticities of life expectancy to vital rates in age-stage models, and illustrate their application with two biological......Interest in stage-and age structured models has recently increased because they can describe quantitative traits such as size that are left out of age-only demography. Available methods for the analysis of effects of vital rates on lifespan in stage-structured models have not been widely applied...... examples. Much of our approach relies on trading of time and mortality risk in one stage for time and risk in others. Our approach contributes to the new framework of the study of age- and stage-structured biodemography....

  15. Static Air Support Surfaces to Prevent Pressure Injuries: A Multicenter Cohort Study in Belgian Nursing Homes.

    Science.gov (United States)

    Serraes, Brecht; Beeckman, Dimitri

    2016-01-01

    The aim of this study was to investigate the incidence and risk factors for developing pressure injuries (PIs) in patients placed on a static air support surfaces: mattress overlay, heel wedge, and seat cushion. Multicenter cohort study. The sample comprised 176 residents; their mean age was 87 (SD = 6.76) years; their mean Braden Scale score was 14 (SD = 2.54). The study was performed on a convenience sample of 6 nursing homes in Belgium. Data were collected on 23 care units. The primary outcome measure, cumulative PI incidence (category [stage] II-IV) over a 30-day observation period, was calculated. Pressure injury occurrence was defined according to the 2014 European and US National Pressure Injury Advisory panels, Pan Pacific Pressure Injury Alliance classification system. The PI incidence for category (stage) II-IV was 5.1%. Six residents (3.4%) developed a category II PI, and 3 (1.7%) developed a category III PI; no category IV ulcers occurred. No significant risk factors for category II-IV PIs were identified using multivariate logistic regression. Time of sitting in a chair was found to be a risk factor for development of nonblanchable erythema (category I PI) (odds ratio = 21.608; 95% confidence interval [CI], 20.510-22.812; P = .013). The median time to develop a category II-IV PI was 16 days (interquartile range = 2-26). The interrater reliability between the observations of the researcher and nurses on-site was almost perfect (0.86; 95% CI, 0.81-0.91). We found a low incidence of PIs when using a static air overlay mattress for patients at risk in a nursing home population. Static air support surfaces, alongside patient-tailored patient repositioning protocols, should be considered to prevent PIs in this patient population.

  16. Treatment Rationale and Study Design for the JUNIPER Study: A Randomized Phase III Study of Abemaciclib With Best Supportive Care Versus Erlotinib With Best Supportive Care in Patients With Stage IV Non-Small-Cell Lung Cancer With a Detectable KRAS Mutation Whose Disease Has Progressed After Platinum-Based Chemotherapy.

    Science.gov (United States)

    Goldman, Jonathan W; Shi, Peipei; Reck, Martin; Paz-Ares, Luis; Koustenis, Andrew; Hurt, Karla C

    2016-01-01

    This clinical trial summary provides the background and rationale for the JUNIPER study (NCT02152631). JUNIPER is a randomized study of abemaciclib (200 mg orally every 12 hours) with best supportive care (BSC) versus erlotinib (150 mg orally every 24 hours) with BSC in patients with stage IV non-small-cell lung cancer (NSCLC) whose tumors have detectable Kirsten rat sarcoma (KRAS) mutations and whose disease has progressed after platinum-based chemotherapy and 1 other previous therapy, or who are not eligible for further chemotherapy. Approximately 550 patients will be randomized in a 3:2 ratio and stratified according to number of previous chemotherapy regimens (1 vs. 2), Eastern Cooperative Oncology Group performance status (0 vs. 1), sex (male vs. female), and KRAS mutation (G12C vs. others). Erlotinib was chosen as the control arm, because it is the only agent indicated for second- and third-line therapy in advanced NSCLC. Treatment will continue until disease progression or unacceptable toxicity occurs, with assessments every 28 days, followed by short-term and long-term follow-up. The coprimary efficacy objectives of this study are progression-free survival (PFS) and overall survival (OS); secondary objectives are overall response rate, changes in patient-reported pain and disease-related symptoms, changes in health status, resource utilization, safety and tolerability, and pharmacokinetics/pharmacodynamics. This design has 80% power to detect OS hazard ratio (HR) of 0.75 (type I error 0.045) and PFS HR of 0.67 (type I error 0.005). If the coprimary objectives (OS and PFS) are achieved, this study will provide a new alternative third-line treatment option for patients with NSCLC whose tumors have detectable KRAS mutations. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Comparing physical assessment with administrative data for detecting pressure ulcers in a large Canadian academic health sciences centre.

    Science.gov (United States)

    Backman, Chantal; Vanderloo, Saskia E; Miller, Toba B; Freeman, Lisa; Forster, Alan J

    2016-10-05

    This study aimed to compare classification of pressure ulcers from administrative data with a gold standard assessment, specifically; pressure ulcers confirmed by an independent physical assessment performed by trained nurse surveyors. A retrospective analysis of pooled cross-sectional samples of inpatients assessed across 3 consecutive prevalence surveys in a large academic health sciences centre between 2012 and 2013. There were 2001 patients for whom physical and chart assessments were completed, and for whom a discharge abstract was also available at the time of analysis. The cohort's mean age was 65 years and 55% were women. Based on the physical assessment findings, 14.6% of patients (n=292) had at least 1 pressure ulcer, with a total of 345 pressure ulcers documented among these patients: (stage I=162; stage II=120; stage III=22; stage IV=22 and unstageable=19). Based on coded information, 78 (3.9%) of patients had a pressure ulcer. Of patients with a pressure ulcer determined by the physical assessment, only 21% also had a pressure ulcer captured in the administrative data. Furthermore, only 6% of the patients with a hospital-acquired pressure ulcer, stage II or greater determined by the physical assessment were coded in the Discharge Abstract Database (DAD). The results of this study demonstrate that coding in the DAD may under-report and fail to accurately reflect the true burden of pressure ulcers in hospitalised patients. This may occur because the presence of pressure ulcers is currently documented in the health record by nurses and not by physicians, yet the administrative data recorded in the DAD only includes physician documented pressure ulcers. We recommend enhancements to the coding methods to monitor and report on pressure ulcers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. Pressure probe study of the water relations of Phycomyces blakesleeanus sporangiophores

    Science.gov (United States)

    Cosgrove, D. J.; Ortega, J. K.; Shropshire, W. Jr

    1987-01-01

    The physical characteristics which govern the water relations of the giant-celled sporangiophore of Phycomyces blakesleeanus were measured with the pressure probe technique and with nanoliter osmometry. These properties are important because they govern water uptake associated with cell growth and because they may influence expansion of the sporangiophore wall. Turgor pressure ranged from 1.1 to 6.6 bars (mean = 4.1 bars), and was the same for stage I and stage IV sporangiophores. Sporangiophore osmotic pressure averaged 11.5 bars. From the difference between cell osmotic pressure and turgor pressure, the average water potential of the sporangiophore was calculated to be about -7.4 bars. When sporangiophores were submerged under water, turgor remained nearly constant. We propose that the low cell turgor pressure is due to solutes in the cell wall solution, i.e., between the cuticle and the plasma membrane. Membrane hydraulic conductivity averaged 4.6 x 10(-6) cm s-1 bar-1, and was significantly greater in stage I sporangiophores than in stage IV sporangiophores. Contrary to previous reports, the sporangiophore is separated from the supporting mycelium by septa which prevent bulk volume flow between the two regions. The presence of a wall compartment between the cuticle and the plasma membrane results in anomalous osmosis during pressure clamp measurements. This behavior arises because of changes in solute concentration as water moves into or out of the wall compartment surrounding the sporangiophore. Theoretical analysis shows how the equations governing transient water flow are altered by the characteristics of the cell wall compartment.

  19. The Modern RPG IV Language

    CERN Document Server

    Cozzi, Robert

    2006-01-01

    This updated, classic work on the RPG language covers all the new functions and features that have been added since 2003, including new op codes and built-in functions, new chapters on free-format RPG IV and Web programming interfaces, information on implementing XML within RPG IV, and expanded information on procedures. This reference guide takes both novice and experienced RPG IV programmers through the language, from its foundation to its most advanced techniques. More than 100 charts and tables, as well as 350 real-life code samples of functions and operations are included, showing readers

  20. A traditional Chinese herbal formula improves pressure ulcers in paraplegic patients: A randomized, parallel-group, retrospective trial.

    Science.gov (United States)

    Liu, Xin; Meng, Qingxi; Song, Hua; Zhao, Tingbao

    2013-06-01

    In this study, the efficacy of a novel Chinese herbal formula, cure rot and flat sore ointment (CRFSO), in the management of stage IV pressure ulcers, and the effect of simultaneous comprehensive rehabilitation in improving the outcome were evaluated. A total of 35 paraplegic patients with stage IV pressure ulcers who underwent reconstruction and inpatient rehabilitation from January 2004 to September 2010 were included in the study. Arnebia root oil (ARO) was used on 16 patients with 11 ulcers (stage IV). The remaining 19 patients with 20 ulcers (stage IV) received a traditional Chinese herbal formula (CRFSO). After 28 days of treatment, the wound healing results, in particular, the healing rate, effectiveness rate, improvement rate and no response rate were evaluated. Six patients from the ARO group sought other types of therapy due to their own consideration of poor efficacy. After 28 days of treatment, the wound healing result and no response rate demonstrated a statistically significant difference (P<0.005) between the two groups, suggesting that the novel Chinese herbal formula is an effective treatment for pressure sores in paraplegic patients. All outcome variables demonstrated significant improvement in the CRFSO group compared with the ARO group after 28 days of treatment, with a higher healing rate (85% in the CRFSO group and 45.45% in the ARO group) and lower no response rate (5% in the CRFSO group and 18.18% in the ARO group). The traditional Chinese herbal formula improved pressure sores in paraplegic patients effectively and inpatient rehabilitation was also significantly improved.

  1. Staging atmospheres

    DEFF Research Database (Denmark)

    Bille, Mikkel; Bjerregaard, Peter; Sørensen, Tim Flohr

    2015-01-01

    The article introduces the special issue on staging atmospheres by surveying the philosophical, political and anthropological literature on atmosphere, and explores the relationship between atmosphere, material culture, subjectivity and affect. Atmosphere seems to occupy one of the classic...

  2. Effects of the DASH-JUMP dietary intervention in Japanese participants with high-normal blood pressure and stage 1 hypertension: an open-label single-arm trial.

    Science.gov (United States)

    Kawamura, Atsuko; Kajiya, Katsuko; Kishi, Hiroko; Inagaki, Junko; Mitarai, Makoto; Oda, Hiroshi; Umemoto, Seiji; Kobayashi, Sei

    2016-11-01

    The Dietary Approaches to Stop Hypertension (DASH) diet is recommended by the American Heart Association to lower blood pressure (BP); however, its effects in Japanese participants have not been rigorously studied. We assessed the effects of the DASH-Japan Ube Modified diet Program (DASH-JUMP), a modified DASH diet, on cardiometabolic and inflammatory biomarkers in Japanese participants with untreated high-normal BP or stage 1 hypertension. Fifty-eight participants (30 men and 28 women; mean age 54.1±8.1 years) with untreated high-normal BP or stage 1 hypertension followed the DASH-JUMP (salt 8.0 g per day) for 2 months. After the intervention period, they resumed their usual diets for 4 months. The DASH-JUMP significantly decreased the participants' body mass index values (24.6±3.5 kg m -2 at baseline23.2±3.3 kg m -2 at 2 months, P=0.000), BP (153±14/91±11 mm Hg at baseline130±16/80±9 mm Hg at 2 months, P=0.000 and 139±16/85±10 mm Hg at 6 months, P=0.000), fasting serum glucose level (100±26 mg dl - 1 94±15 mg dl - 1 at 2 months, P=0.003) and fasting insulin level (6.9±5.9 μIU ml -1 4.4±2.7 μIU ml -1 at 2 months, P=0.000). The mean compliance of the participants for the DASH-JUMP diet was 88.5%. The DASH-JUMP diet reduced cardiovascular risk factors and may be an effective nutritional strategy for preventing cardiovascular events.

  3. Generation IV reactors: economics

    International Nuclear Information System (INIS)

    Dupraz, B.; Bertel, E.

    2003-01-01

    The operating nuclear reactors were built over a short period: no more than 10 years and today their average age rounds 18 years. EDF (French electricity company) plans to renew its reactor park over a far longer period : 30 years from 2020 to 2050. According to EDF this objective implies 3 constraints: 1) a service life of 50 to 60 years for a significant part of the present operating reactors, 2) to be ready to built a generation 3+ unit in 2020 which infers the third constraint: 3) to launch the construction of an EPR (European pressurized reactor) prototype as soon as possible in order to have it operating in 2010. In this scheme, generation 4 reactor will benefit the feedback experience of generation 3 and will take over in 2030. Economic analysis is an important tool that has been used by the generation 4 international forum to select the likely future reactor systems. This analysis is based on 4 independent criteria: the basic construction cost, the construction time, the operation and maintenance costs and the fuel cycle cost. This analysis leads to the evaluation of the global cost of electricity generation and of the total investment required for each of the reactor system. The former defines the economic competitiveness in a de-regulated energy market while the latter is linked to the financial risk taken by the investor. It appears, within the limits of the assumptions and models used, that generation 4 reactors will be characterized by a better competitiveness and an equivalent financial risk when compared with the previous generation. (A.C.)

  4. Preventing Pressure Sores

    Medline Plus

    Full Text Available ... OTR/L Sarah Harrison, OT Anne Bryden, OT The Role of the Social Worker after Spinal Cord Injury Patti Rogers, ... do to prevent pressure sores? play_arrow What role does diet and hydration play in ... play_arrow What are the six stages of a pressure sore and how ...

  5. Disease severity staging system for idiopathic pulmonary fibrosis in Japan.

    Science.gov (United States)

    Kondoh, Yasuhiro; Taniguchi, Hiroyuki; Kataoka, Kensuke; Furukawa, Taiki; Ando, Masahiko; Murotani, Kenta; Mishima, Michiaki; Inoue, Yoshikazu; Ogura, Takashi; Bando, Masashi; Hagiwara, Koichi; Suda, Takafumi; Chiba, Hirofumi; Takahashi, Hiroki; Sugiyama, Yukihiko; Homma, Sakae

    2017-11-01

    In Japan, the classification of disease severity of idiopathic pulmonary fibrosis (IPF) (J-system) has been used in making decisions on medical care subsidies. The present J-system consists of arterial partial pressure of oxygen (PaO 2 ) and exercise desaturation in stages of I-IV. It provides a good prognostic classification in stages III and IV, but not in stages I and II. Therefore, we propose a revised system to improve discriminative ability in stages I and II. We compared the revised J-system with the present J-system using Cox proportional hazards model to predict mortality rate. We also evaluated the recently proposed GAP (Gender, Age and Physiology) system in comparison to both J-systems. Two-hundred and fifteen IPF patients were studied retrospectively. A univariate model showed that the present and revised J-systems and a modified GAP system were all significant prognostic factors. The C-statistic for discriminating prognosis was higher in the revised J-system than the modified GAP system and the present J-system (0.677, 0.652 and 0.659, respectively). The C-statistics of these models produced from the 10 000 bootstrap samples were similar to those of the original models, suggesting good internal validation (0.665 (95% CI: 0.621-0.705), 0.645 (0.600-0.686) and 0.659 (0.616-0.700), respectively). Multivariate analysis revealed that the revised J-system (P = 0.0038) and the modified GAP system (P = 0.0029) were independent prognostic factors. The revised J-system can provide a better mortality prediction than the present one. Both the revised J-system and the modified GAP system are independent and valuable tools for prognostication and clinical management for IPF. © 2017 Asian Pacific Society of Respirology.

  6. Plutonium(IV) and thorium(IV) hydrous polymer chemistry

    International Nuclear Information System (INIS)

    Johnson, G.L.; Toth, L.M.

    1978-05-01

    The recent attention given to Pu(IV) polymers has warranted a review of plutonium and thorium hydrolysis chemistry with respect to the various experimental approaches and insights gained therein. Differing terminologies used in the experimental procedures have often confused the understanding of the chemical processes which occur between the first hydrolysis reaction of the tetravalent actinide and its final dehydration to form the crystalline oxide. This report focuses on the polymer aging reaction which is defined here in terms of A. W. Thomas' ol to oxo conversion reaction and involves simply the conversion of hydroxyl-bridged polymer links to oxygen-bridged linkages. Thorium(IV) hydrolytic reactions are included because they are analogous in many respects to those of Pu(IV) and offer a simpler chemical system for experimental study. Future work using spectroscopic techniques should significantly improve the description of this aging phenomenon

  7. Management of Chronic Pressure Ulcers

    Science.gov (United States)

    2009-01-01

    significant differences in complete healing were detected among other modern dressings. There is evidence that polyurethane foam dressings and hydrocellular dressings are more absorbent and easier to remove than hydrocolloid dressings in ulcers with moderate to high exudates. In deeper ulcers (stage III and IV), the use of alginate with hydrocolloid resulted in significantly greater reduction in the size of the ulcers compared to hydrocolloid alone. Studies on sustained silver-releasing dressing demonstrated a tendency for reducing the risk of infection and promoting faster healing, but the sample sizes were too small for statistical analysis or for drawing conclusions. Biological Therapies The efficacy of platelet-derived growth factors (PDGFs), fibroblast growth factor, and granulocyte-macrophage colony stimulating factor in improving complete healing of chronic pressure ulcers has not been established. Presently only Regranex, a recombinant PDGF, has been approved by Health Canada and only for treatment of diabetic ulcers in the lower extremities. A March 2008 US Food and Drug Administration (FDA) communication reported increased deaths from cancers in people given three or more prescriptions for Regranex. Limited low-quality evidence on skin matrix and engineered skin equivalent suggests a potential role for these products in healing refractory advanced chronic pressure ulcers, but the evidence is insufficient to draw a conclusion. Adjunctive Physical Therapy There is evidence that electrical stimulation may result in a significantly greater reduction in the surface area and more complete healing of stage II to IV ulcers compared with sham therapy. No conclusion on the efficacy of electrotherapy can be drawn because of significant statistical heterogeneity, small sample sizes, and methodological flaws. The efficacy of other adjunctive physical therapies [electromagnetic therapy, low-level laser (LLL) therapy, ultrasound therapy, ultraviolet light therapy, and negative

  8. Confirmatory factor analysis of the WAIS-IV/WMS-IV.

    Science.gov (United States)

    Holdnack, James A; Xiaobin Zhou; Larrabee, Glenn J; Millis, Scott R; Salthouse, Timothy A

    2011-06-01

    The Wechsler Adult Intelligence Scale-fourth edition (WAIS-IV) and the Wechsler Memory Scale-fourth edition (WMS-IV) were co-developed to be used individually or as a combined battery of tests. The independent factor structure of each of the tests has been identified; however, the combined factor structure has yet to be determined. Confirmatory factor analysis was applied to the WAIS-IV/WMS-IV Adult battery (i.e., age 16-69 years) co-norming sample (n = 900) to test 13 measurement models. The results indicated that two models fit the data equally well. One model is a seven-factor solution without a hierarchical general ability factor: Verbal Comprehension, Perceptual Reasoning, Processing Speed, Auditory Working Memory, Visual Working Memory, Auditory Memory, and Visual Memory. The second model is a five-factor model composed of Verbal Comprehension, Perceptual Reasoning, Processing Speed, Working Memory, and Memory with a hierarchical general ability factor. Interpretative implications for each model are discussed.

  9. Development of generation IV nuclear energy systems

    International Nuclear Information System (INIS)

    Matsui, Kazuaki; Oka, Yoshiaki; Ogawa, Masuro; Ichimiya, Masakazu; Noda, Hiroshi

    2003-01-01

    The fifth 'Generation IV International Forum (GIF), Policy Group Meetings' was held at the Zen-Nikku Hotel in Tokyo, on September 19-20, 2002, under participations of Abraham, Secretary of DOE in U.S.A., Columbani, Secretary of CEA in France, Fujiie, Chairman of CAE in Japan, Kano, Parliamental Minister of MIS in Japan, and so on. Ten nations entering GIF (Argentina, Brazil, Canada, France, Japan, Korea, South Africa, Switzerland, U.K., and U.S.A.) selected six next generation nuclear energy concepts for objects of international cooperative research and development aiming at its practice by 2030. These concepts applicable to not only power generation, but also hydrogen production, sea water purification, and so on, are sodium liquid metal cooled reactor (Japan), high temperature gas cooled reactor (France), Super-critical pressure water cooled reactor (SCWR: Canada), Lead metal cooled reactor (Switzerland), Gas cooled fast reactor (U.S.A.), and molten salts reactor. On the generation IV nuclear reactor systems aiming to further upgrade their sustainability, safety, economical efficiency, and nuclear non proliferation, the 'Plans on Technical Development' (Road-map) to decide priority of their R and Ds has been cooperatively discussed under frameworks of international research cooperation by the GIF members nations. Here were shared descriptions on nuclear fuel cycle as a remise of technical evaluation and adopted concepts by Japanese participants contributing to making up the Road-map. (G.K.)

  10. Free-format RPG IV

    CERN Document Server

    Martin, Jim

    2013-01-01

    This how-to guide offers a concise and thorough introduction to the increased productivity, better readability, and easier program maintenance that comes with the free-format style of programming in RPG IV. Although free-format information is available in IBM manuals, it is not separated from everything else, thereby requiring hours of tedious research to track down the information needed. This book provides everything one needs to know to write RPG IV in the free-format style, and author Jim Martin not only teaches rules and syntax but also explains how this new style of coding has the pot

  11. Impact of osmotic pressure and gelling in the generation of highly stable single core water-in-oil-in-water (W/O/W) nano multiple emulsions of aspirin assisted by two-stage ultrasonic cavitational emulsification.

    Science.gov (United States)

    Tang, Siah Ying; Sivakumar, Manickam; Nashiru, Billa

    2013-02-01

    The present investigation focuses in investigating the effect of osmotic pressure, gelling on the mean droplet diameter, polydispersity index, droplet size stability of the developed novel Aspirin containing water-in-oil-in-water (W/O/W) nano multiple emulsion. The aspirin-loaded nano multiple emulsion formulation was successfully generated using two-stage ultrasonic cavitational emulsification which had been reported in author's previous study. The osmotic behavior of ultrasonically prepared nano multiple emulsions were also examined with different glucose concentrations both in the inner and outer aqueous phases. In addition, introducing gelatin into the formulation also observed to play an important role in preventing the interdroplet coalescence via the formation of interfacial rigid film. Detailed studies were also made on the possible mechanisms of water migration under osmotic gradient which primarily caused by the permeation of glucose. Besides, the experimental results have shown that the interfacial tension between the two immiscible phases decreases with varying the composition of organic phase. Although the W/O/W emulsion prepared with the inner/outer glucose weight ratio of 1-0.5% (w/w) showed an excellent droplet stability, the formulation containing 0.5% (w/w) glucose in the inner aqueous phase appeared to be the most stable with minimum change in the mean droplet size upon one-week storage period. Based on the optimization, nano multiple emulsion droplets with the mean droplet diameter of around 400 nm were produced using 1.25% (w/w) Span 80 and 0.5% Cremophore EL. Overall, our investigation makes a pathway in proving that the use of ultrasound cavitation is an efficient yet promising approach in the generation of stable and uniform nano multiple emulsions and could be used in the encapsulation of various active pharmaceutical ingredients in the near future. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Staging Mobilities

    DEFF Research Database (Denmark)

    Jensen, Ole B.

    In recent years, the social sciences have taken a “mobilities turn.” There has been a developing realisation that mobilities do not “just happen.” Mobilities are carefully and meticulously designed, planned and staged (from above). However, they are equally importantly acted out, performed and li......, the book asks: what are the physical, social, technical, and cultural conditions to the staging of contemporary urban mobilities?...... that mobility is more than movement between point A and B. It explores how the movement of people, goods, information, and signs influences human understandings of self, other and the built environment. Moving towards a new understanding of the relationship between movement, interaction and environments...

  13. VeVeRa-IV

    NARCIS (Netherlands)

    Evelien Eggink; Debbie Oudijk; Klarita Sadiraj

    2012-01-01

    Original title: VeVeRa-IV The Dutch population is set to age rapidly in the coming years. More and more people will also attain a very great age. This means that the need for home care and care provided in nursing or residential care homes will also increase. As part of the Long-term Care

  14. 11. IV avati Draakoni galeriis...

    Index Scriptorium Estoniae

    2005-01-01

    Tanel Saare (sünd. 1979) näitus "Gott und huhn episode IV: seed shower". Eksponeeritakse väljavõtteid aktsioonidest aastatel 2000-2004 Turus, Nürnbergis, Berliinis, Lohusalus ja Soulis. Osa aktsioone toimus koos rühmitusega Non Grata

  15. Phase IV of Drug Development

    Directory of Open Access Journals (Sweden)

    Viraj Suvarna

    2010-01-01

    Full Text Available Not all Phase IV studies are post-marketing surveillance (PMS studies but every PMS study is a phase IV study. Phase IV is also an important phase of drug development. In particular, the real world effectiveness of a drug as evaluated in an observational, non-interventional trial in a naturalistic setting which complements the efficacy data that emanates from a pre-marketing randomized controlled trial (RCT. No matter how many patients are studied pre-marketing in a controlled environment, the true safety profile of a drug is characterized only by continuing safety surveillance through a spontaneous adverse event monitoring system and a post-marketing surveillance/non-interventional study. Prevalent practice patterns can generate leads that could result in further evaluation of a new indication via the RCT route or even a signal that may necessitate regulatory action (change in labeling, risk management/minimization action plan. Disease registries are another option as are the large simple hybrid trials. Surveillance of spontaneously reported adverse events continues as long as a product is marketed. And so Phase IV in that sense never ends.

  16. A chiral Mn(IV)

    Indian Academy of Sciences (India)

    Singlecrystal X-ray analysis revealed that compound 1 crystallises in the monoclinic 21 space group with six mononuclear [MnIVL2] units in the asymmetric unit along with three solvent DMF molecules. In the crystal structure, each Mn(IV) complex, acting as the building unit, undergoes supramolecular linking through C-H ...

  17. [Value of transcutaneous staged dynamic oximetry of stage II arteritis of the leg].

    Science.gov (United States)

    Grard, C; Desmytterre, J; Vinckier, L; Hatron, P Y; Roux, J P; Warembourg, H; Devulder, B

    1990-03-01

    The clinical and prognostic value of transcutaneous oxygen pressure measurements at rest has been established in Leriche Stage III and IV occlusive peripheral arterial disease but is controversial in Stage II because there is an overlap of transcutaneous pO2 (Tc pO2) values with those of normal subjects. The authors report the results of Tc pO2 measurements during exercise testing in a group of patients with Stage II occlusive arterial disease of the lower limbs. Seventy-eight patients with an average age of 53 years (range 40 to 65 years) whose claudication perimeter and site of pain had been carefully assessed and who had also recently undergone Doppler arterial examination and arteriography and 35 control subjects with an average age of 54 years (range 45 to 70 years) were studied. The Tc pO2 was continuously measured with a multimodular Kontron Supermon at 4 different sites simultaneously: precordium (reference probe), thigh, calf and foot in the dorsal recumbent position after 30 minutes rest, during a standardised exercise stress test at 50 watts and during the recovery phase. The results were expressed as ratio of tissue oxygenation (RTO): thigh, calf or foot Tc pO2/precordial Tc pO2 X 100 in order to take into account the patients cardiorespiratory status and adaptation to exercise. The RTO in normal subjects remained at the upper limits of the resting value throughout exercise and then returned slowly to basal values during the recovery phase.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Glycogen Storage Disease Type IV

    DEFF Research Database (Denmark)

    Bendroth-Asmussen, Lisa; Aksglaede, Lise; Gernow, Anne B

    2016-01-01

    molecular genetic analyses confirmed glycogen storage disease Type IV with the finding of compound heterozygosity for 2 mutations (c.691+2T>C and c.1570C>T, p.R524X) in the GBE1 gene. We conclude that glycogen storage disease Type IV can cause early miscarriage and that diagnosis can initially be made......A 30-yr-old woman presented with 2 consecutive miscarriages within 7 mo. Histopathologic examination of the placental tissue showed intracytoplasmic inclusion vacuoles with a strong reaction in Periodic acid-Schiff staining and a slightly pallor reaction in alcian blue staining. Additional...... on histopathologic examination. Genetic analysis is required to confirm the diagnosis and to offer prenatal genetic testing in future pregnancies....

  19. New analytical methodology for analysing S(IV) species at low pH solutions by one stage titration method (bichromatometry) with a clear colour change. Could potentially replace the state-of-art-method iodometry at low pH analysis due higher accuracy.

    Science.gov (United States)

    Santasalo-Aarnio, Annukka; Galfi, Istvan; Virtanen, Jorma; Gasik, Michael M

    2017-01-01

    A new, faster and more reliable analytical methodology for S(IV) species analysis at low pH solutions by bichromatometry is proposed. For decades the state of the art methodology has been iodometry that is still well justified method for neutral solutions, thus at low pH media possess various side reactions increasing inaccuracy. In contrast, the new methodology has no side reactions at low pH media, requires only one titration step and provides a clear color change if S(IV) species are present in the solution. The method is validated using model solutions with known concentrations and applied to analyses of gaseous SO2 from purged solution in low pH media samples. The results indicate that bichromatometry can accurately analyze SO2 from liquid samples having pH even below 0 relevant to metallurgical industrial processes.

  20. Uruguay; 2011 Article IV Consultation

    OpenAIRE

    International Monetary Fund

    2011-01-01

    This 2011 Article IV Consultation highlights that the growth momentum in Uruguay has continued into 2011 but a slowdown is under way, led by weaker exports and slower public investment. Uruguay’s economic and financial vulnerabilities are modest, and the government has reduced debt vulnerabilities significantly and built important financial buffers. Executive Directors have commended authorities’ skillful macroeconomic management that has underpinned Uruguay’s excellent economic performance, ...

  1. A Grade IV Isthmic Spondylolisthesis.

    Science.gov (United States)

    Kolber, Morey J; Hanney, William J

    2017-12-01

    A 15-year-old adolescent boy was referred by an orthopaedic surgeon for treatment of right gluteal and thigh pain. Following treatment that reduced his pain, he experienced acute onset of bilateral radiculopathy. He was referred back to the physician, who ordered radiographs and magnetic resonance imaging, which identified a grade IV isthmic spondylolisthesis at the L5-S1 level. J Orthop Sports Phys Ther 2017;47(12):971. doi:10.2519/jospt.2017.7547.

  2. Phase relations in the system NaCl-KCl-H2O: IV. Differential thermal analysis of the sylvite liquidus in the KCl-H2O binary, the liquidus in the NaCl-KCl-H2O ternary, and the solidus in the NaCl-KCl binary to 2 kb pressure, and a summary of experimental data for thermodynamic-PTX analysis of solid-liquid equilibria at elevated P-T conditions

    Science.gov (United States)

    Chou, I.-Ming; Sterner, S.M.; Pitzer, Kenneth S.

    1992-01-01

    The sylvite liquidus in the binary system KCl-H2O and the liquidus in the ternary system NaCl-KCl-H2O were determined by using isobaric differential thermal analysis (DTA) cooling scans at pressures up to 2 kbars. Sylvite solubilities along the three-phase curve in the binary system KCl-H2O were obtained by the intersection of sylvite-liquidus isopleths with the three-phase curve in a P-T plot. These solubility data can be represented by the equation Wt.% KCl (??0.2) = 12.19 + 0.1557T - 5.4071 ?? 10-5 T2, where 400 ??? T ??? 770??C. These data are consistent with previous experimental observations. The solidus in the binary system NaCl-KCl was determined by using isobaric DTA heating scans at pressures up to 2 kbars. Using these liquidus and solidus data and other published information, a thermodynamic-PTX analysis of solid-liquid equilibria at high pressures and temperatures for the ternary system has been performed and is presented in an accompanying paper (Part V of this series). However, all experimental liquidus, solidus, and solvus data used in this analysis are summarized in this report (Part IV) and they are compared with the calculated values based on the analysis. ?? 1992.

  3. [Clinic significance of nm23, collage IV and PCNA expression in non-small cell lung cancer].

    Science.gov (United States)

    Yu, Q; Ma, L; Jing, S; Xu, Y; Geng, D

    2001-12-20

    To study the significance of nm23, collagen IV and PCNA expressions in non-small cell lung cancer. Expressions of the nm23, collagen IV and PCNA in 84 cases of non-small cell lung cancer were examined with SP immunohistochemical technique. Of the 84 cases, there were squamous cell carcinoma 42, adenocarcinoma 42, stage I 27, stage II 24, stage III 24, and stage IV 9. Statistical analysis was performed with Chi-Square test. Expressions of the nm23, collagen IV and PCNA in 84 cases of non-small cell lung cancer were 60. 7% ( 51/ 84) , 75. 0% ( 63/ 84) and 53. 6% ( 45/ 84) respectively. There was negative correlation between the lymph node metastasis and the expressions of nm23 and collagen IV in squamous cell carcinoma, and the expressions of collagen IV and PCNA were associated with tumor differentiation. No correlation was found between TNM stage and expressions of nm23, collagen IV and PCNA. The results indicate that nm23, collagen IV and PCNA participate the modulation of metastasis of non-small cell lung cancer and that they may be used to evaluate the potential of metastasis.

  4. Cloning, expression, and activity of type IV antifreeze protein from cultured subtropical olive flounder (Paralichthys olivaceus

    Directory of Open Access Journals (Sweden)

    Jong Kyu Lee

    2016-10-01

    Full Text Available Abstract Antifreeze proteins (AFPs lower the freezing point but not the melting point of aqueous solutions by inhibiting the growth of ice crystals via an adsorption-inhibition mechanism. However, the function of type IV AFP (AFP IV is questionable, as its antifreeze activity is on the verge of detectable limits, its physiological concentration in adult fish blood is too low to function as a biological antifreeze, and its homologues are present even in fish from tropic oceans as well as freshwater. Therefore, we speculated that AFP IV may have gained antifreeze activity not by selective pressure but by chance. To test this hypothesis, we cloned, expressed, and assayed AFP IV from cultured subtropical olive flounder (Paralichthys olivaceus, which do not require antifreeze protein for survival. Among the identified expressed sequence tags of the flounder liver sample, a 5′-deleted complementary DNA (cDNA sequence similar to the afp4 gene of the longhorn sculpin was identified, and its full-length cDNA and genome structure were examined. The deduced amino acid sequence of flounder AFP IV shared 55, 53, 52, and 49 % identity with those of Pleuragramma antarcticum, Myoxocephalus octodecemspinosus, Myoxocephalus scorpius, and Notothenia coriiceps, respectively. Furthermore, the genomic structure of this gene was conserved with those of other known AFP IVs. Notably, the recombinant AFP IV showed a weak but distinct thermal hysteresis of 0.07 ± 0.01 °C at the concentration of 0.5 mg/mL, and ice crystals in an AFP IV solution grew star-shaped, which are very similar to those obtained from other polar AFP IVs. Taken together, our results do not support the hypothesis of evolution of AFP IV by selective pressure, suggesting that the antifreeze activity of AFP IV may have been gained by chance.

  5. Determination of U(IV) by spectrophotometry

    International Nuclear Information System (INIS)

    Coutinho, C.M.C.; Bastos, E.T.R.; Bastos, M.B.R.

    1984-01-01

    The determination of uranium (IV) concentration in acid solutions in the presence of U (IV), Fe (II) and Ti (IV) by spectrophotometry is studied, aiming at controlling the solutions in the ion exchange columns, used for uranium enrichment by isotope exchange. (E.G.) [pt

  6. Gene expression profiles in stages II and III colon cancers

    DEFF Research Database (Denmark)

    Thorsteinsson, Morten; Kirkeby, Lene T; Hansen, Raino

    2012-01-01

    were retrieved from the Gene Expression Omnibus (GEO) (n¿=¿111) in addition to a Danish data set (n¿=¿37). All patients had stages II and III colon cancers. A Prediction Analysis of Microarray classifier, based on the 128-gene signature and the original training set of stage I (n¿=¿65) and stage IV (n......¿=¿76) colon cancers, was reproduced. The stages II and III colon cancers were subsequently classified as either stage I-like (good prognosis) or stage IV-like (poor prognosis) and assessed by the 36 months cumulative incidence of relapse. RESULTS: In the GEO data set, results were reproducible in stage...... correctly predicted as stage IV-like, and the remaining patients were predicted as stage I-like and unclassifiable, respectively. Stage II patients could not be stratified. CONCLUSIONS: The 128-gene signature showed reproducibility in stage III colon cancer, but could not predict recurrence in stage II...

  7. Comparison of new AJCC staging system with old AJCC staging system in nasopharyngeal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Se Mie; Wu, Hong Gyun; Park, Charn II [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    2000-12-01

    This study was designed to examine the reliability of the new version of the AJCC staging system (1997) of nasopharyngeal carcinoma in comparison with the AJCC staging system of 1992. Between 1983 and 1996, 185 patients with histologically proven nasopharyngeal carcinoma were treated with radiation therapy at the Department of Therapeutic Radiology Seoul National University Hospital. For these patients, AJCC staging system of 1992 was compared with the 1997 version, by reviewing hospital records, computed tomography (CT) and/or magnetic resonance imaging (MRI). 5-year overall survival rates according to the 1992 and 1997 AJCC staging systems were 100%, and 100% at stage I; 100%, and 68.8% at stage ll;61.4%, and 63.8% at stage III; 61.1%, and 63.2% at stage IV. 5-year overall survival rates of each classification showed significant differences between stages (p=0.0049 for the old version, p=0.01 for the new), but no significant difference was found between the staging systems except at stage II. The new AJCC staging system allows staging as reliably as the 1992 version, but the adequacy of the newly modified staging classification should be confirmed by further clinical examination.

  8. A worldwide overview of generation IV systems

    International Nuclear Information System (INIS)

    Gauche, F.; Guidez, J.

    2017-01-01

    The Generation IV International Forum (GIF) is an initiative of the American Department of Energy (DOE) whose purpose is to create an international cooperation for proposing and studying a new generation of nuclear reactors. GIF's work began in 2000 and 6 types of reactors were rapidly proposed. This article gives an overview of the work done so far. The sodium-cooled fast reactor is the most advanced concept because there is a technological continuity from the first sodium reactors operating in the fifties. The use of a lead eutectic as heat transfer fluid is hampered by its corrosion power on metals. The molten salt reactor is a very innovative concept that requires a complex and adapting chemistry for the on-line reprocessing. High-temperature and Very-High-Temperature reactors (HTR an VHTR) require materials that can sustain high temperatures. The difficulty to design such materials has hindered the development of this concept. Gas-cooled fast reactors show difficulties to evacuate residual heat in case of accident. The supercritical water-cooled reactor concept wants to take advantage of the increased heat capacity of water in particular conditions. Technical issues like the resistance to high pressure or corrosion or safety issues have delayed this concept so far. (A.C.)

  9. Prognostic Value of Bismuth Typing and Modified T-stage in Hilar Cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Shengen Yi

    2015-01-01

    Conclusion: The majority of our patients with HCC were characterized as Subtype IV in Bismuth typing and Stage T3 in modified T-stage. Both Bismuth typing and modified T-stage showed prognostic value in HCC. Compared with Bismuth typing, modified T-stage is a better indicator of the resectability of HCC.

  10. Esophageal dysfunction in different stages of Parkinson's disease.

    Science.gov (United States)

    Suttrup, I; Suttrup, J; Suntrup-Krueger, S; Siemer, M-L; Bauer, J; Hamacher, C; Oelenberg, S; Domagk, D; Dziewas, R; Warnecke, T

    2017-01-01

    Dysphagia is a clinically relevant symptom in patients with Parkinson's disease (PD) leading to pronounced reduction in quality of life and other severe complications. Parkinson's disease-related dysphagia may affect the oral and pharyngeal, as well as the esophageal phase of swallowing. To examine the nature and extend of esophageal dysphagia in different stages of PD and their relation to oropharyngeal dysfunction, we examined 65 PD patients (mean age 66.3±9.7 years, mean disease duration 7.9±5.8 years, mean Hoehn & Yahr [H&Y] stage 2.89±0.91) and divided into three groups (early [H&Y I+II; n=21], intermediate [H&Y III; n=25], and advanced stadium [H&Y IV+V; n=19]), using esophageal high-resolution manometry (HRM) to detect esophageal motor disorders. Oropharyngeal impairment was assessed using fiberoptic endoscopic evaluation of swallowing. Major esophageal motor disorders were detected in nearly one third of the PD patients. Minor impairment of the esophageal body was present in 95% of participants and throughout all disease stages with pathological findings especially in peristalsis and intrabolus pressure (IBP). The IBP was found to significantly increase in the advanced stadium. Although dysfunction of the upper and lower esophageal sphincters was observed in individual patients, alterations in these esophageal segments revealed no statistical significance compared with normative data. No clear association was found between the occurrence of oropharyngeal dysphagia and esophageal impairment. Esophageal body impairment in PD is a frequent phenomenon during all disease stages, which possibly reflects α-synucleinopathy in the enteric nervous system. © 2016 John Wiley & Sons Ltd.

  11. Pressure ulcer occurrence following the great East Japan Earthquake: observations from a disaster medical assistance team.

    Science.gov (United States)

    Sato, Tomoya; Ichioka, Shigeru

    2012-04-01

     Persons with limited mobility are at risk for pressure ulcers. The development of pressure ulcers following earthquakes has been reported secondary to disaster-related spinal cord injury. In the aftermath of the Great East Japan Earthquake, members of a disaster medical assistance team (DMAT), which included plastic surgeons and wound, ostomy, and continence (WOC) nurses working in acute care hospitals, temporary clinics, evacuation centers, and the community noticed an increase in the number of requests for pressure ulcer care. A review of hospital records and verbal reports from the community suggested that the incidence of Stage III and Stage IV pressure ulcers was 7.7% in an acute care hospital and 26.4% in home care patients - almost 10 times higher than the normal reported incidence in Japan. Patients were mostly elderly and did not have spinal cord injuries. Alternating-pressure air mattresses stopped working, alternative pressure-redistribution devices could not be delivered, caregivers could not reach the homebound, and evacuation centers did not have enough mattresses. It is believed that the high percentage of elderly living in the affected areas of Japan, combined with limited resources, manpower, and the absence of utilities, increased the number of persons with deep pressure ulcers. Following natural disasters, DMAT wound care specialists can make important contributions to the prevention of these wounds while providing much-needed care to prevent pressure ulcer-related complications. Clinician observations suggest that the risk of pressure-related injuries following a natural disaster is high, especially among the elderly.

  12. Dynamic modeling of uteroplacental blood flow in IUGR indicates vortices and elevated pressure in the intervillous space - a pilot study

    Science.gov (United States)

    Roth, Christian J.; Haeussner, Eva; Ruebelmann, Tanja; Koch, Franz V.; Schmitz, Christoph; Frank, Hans-Georg; Wall, Wolfgang A.

    2017-01-01

    Ischemic placental disease is a concept that links intrauterine growth retardation (IUGR) and preeclampsia (PE) back to insufficient remodeling of uterine spiral arteries. The rheological consequences of insufficient remodeling of uterine spiral arteries were hypothesized to mediate the considerably later manifestation of obstetric disease. However, the micro-rheology in the intervillous space (IVS) cannot be examined clinically and rheological animal models of the human IVS do not exist. Thus, an in silico approach was implemented to provide in vivo inaccessible data. The morphology of a spiral artery and the inflow region of the IVS were three-dimensionally reconstructed to provide a morphological stage for the simulations. Advanced high-end supercomputing resources were used to provide blood flow simulations at high spatial resolution. Our simulations revealed turbulent blood flow (high-velocity jets and vortices) combined with elevated blood pressure in the IVS and increased wall shear stress at the villous surface in conjunction with insufficient spiral artery remodeling only. Post-hoc histological analysis of uterine veins showed evidence of increased trophoblast shedding in an IUGR placenta. Our data support that rheological alteration in the IVS is a relevant mechanism linking ischemic placental disease to altered structural integrity and function of the placenta.

  13. Understanding cancer staging

    Science.gov (United States)

    ... detailed information about the cancer stage. TNM Staging System The most common system for staging cancer in the form of solid tumor is the TNM system. Most providers and cancer centers use it to stage ...

  14. Two-Stage Centrifugal Fan

    Science.gov (United States)

    Converse, David

    2011-01-01

    Fan designs are often constrained by envelope, rotational speed, weight, and power. Aerodynamic performance and motor electrical performance are heavily influenced by rotational speed. The fan used in this work is at a practical limit for rotational speed due to motor performance characteristics, and there is no more space available in the packaging for a larger fan. The pressure rise requirements keep growing. The way to ordinarily accommodate a higher DP is to spin faster or grow the fan rotor diameter. The invention is to put two radially oriented stages on a single disk. Flow enters the first stage from the center; energy is imparted to the flow in the first stage blades, the flow is redirected some amount opposite to the direction of rotation in the fixed stators, and more energy is imparted to the flow in the second- stage blades. Without increasing either rotational speed or disk diameter, it is believed that as much as 50 percent more DP can be achieved with this design than with an ordinary, single-stage centrifugal design. This invention is useful primarily for fans having relatively low flow rates with relatively high pressure rise requirements.

  15. Policy-induced market introduction of Generation IV reactor systems

    International Nuclear Information System (INIS)

    Heek, Aliki Irina van; Roelofs, Ferry

    2011-01-01

    Almost 10 years ago the U.S. Department of Energy (DOE) started the Generation IV Initiative (GenIV) with 9 other national governments with a positive ground attitude towards nuclear energy. Some of these Generation IV systems, like the fast reactors, are nearing the demonstration stage. The question on how their market introduction will be implemented becomes increasingly urgent. One main topic for future reactor technologies is the treatment of radioactive waste products. Technological solutions to this issue are being developed. One possible process is the transformation of long-living radioactive nuclides into short living ones; a process known as transmutation, which can be done in a nuclear reactor only. Various Generation IV reactor concepts are suitable for this process, and of these systems most experience has been gained with the sodium-cooled fast reactor (SFR). However, both these first generation SFR plants and their Generation IV successors are designed as electricity generating plants, and therefore supposed to be commercially viable in the electricity markets. Various studies indicate that the generation costs of a combined LWR-(S)FR nuclear generating park (LWR: light water reactor) will be higher than that of an LWR-only park. To investigate the effects of the deployment of the different reactors and fuel cycles on the waste produced, resources used and costs incurred as a function of time, a dynamic fuel cycle assessment is performed. This study will focus on the waste impact of the introduction of a fraction of fast reactors in the European nuclear reactor park with a cost increase as described in the previous paragraph. The nuclear fuel cycle scenario code DANESS is used for this, as well as the nuclear park model of the EU-27 used for the previous study. (orig.)

  16. Randomized, Placebo-Controlled, Phase III Trial of Yeast-Derived Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) Versus Peptide Vaccination Versus GM-CSF Plus Peptide Vaccination Versus Placebo in Patients With No Evidence of Disease After Complete Surgical Resection of Locally Advanced and/or Stage IV Melanoma: A Trial of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group (E4697).

    Science.gov (United States)

    Lawson, David H; Lee, Sandra; Zhao, Fengmin; Tarhini, Ahmad A; Margolin, Kim A; Ernstoff, Marc S; Atkins, Michael B; Cohen, Gary I; Whiteside, Theresa L; Butterfield, Lisa H; Kirkwood, John M

    2015-12-01

    We conducted a double-blind, placebo-controlled trial to evaluate the effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) and peptide vaccination (PV) on relapse-free survival (RFS) and overall survival (OS) in patients with resected high-risk melanoma. Patients with completely resected stage IV or high-risk stage III melanoma were grouped by human leukocyte antigen (HLA) -A2 status. HLA-A2-positive patients were randomly assigned to receive GM-CSF, PV, both, or placebo; HLA-A2-negative patients, GM-CSF or placebo. Treatment lasted for 1 year or until recurrence. Efficacy analyses were conducted in the intent-to-treat population. A total of 815 patients were enrolled. There were no significant improvements in OS (stratified log-rank P = .528; hazard ratio, 0.94; 95% repeated CI, 0.77 to 1.15) or RFS (P = .131; hazard ratio, 0.88; 95% CI, 0.74 to 1.04) in the patients assigned to GM-CSF (n = 408) versus those assigned to placebo (n = 407). The median OS times with GM-CSF versus placebo treatments were 69.6 months (95% CI, 53.4 to 83.5 months) versus 59.3 months (95% CI, 44.4 to 77.3 months); the 5-year OS probability rates were 52.3% (95% CI, 47.3% to 57.1%) versus 49.4% (95% CI, 44.3% to 54.3%), respectively. The median RFS times with GM-CSF versus placebo were 11.4 months (95% CI, 9.4 to 14.8 months) versus 8.8 months (95% CI, 7.5 to 11.2 months); the 5-year RFS probability rates were 31.2% (95% CI, 26.7% to 35.9%) versus 27.0% (95% CI, 22.7% to 31.5%), respectively. Exploratory analyses showed a trend toward improved OS in GM-CSF-treated patients with resected visceral metastases. When survival in HLA-A2-positive patients who received PV versus placebo was compared, RFS and OS were not significantly different. Treatment-related grade 3 or greater adverse events were similar between GM-CSF and placebo groups. Neither adjuvant GM-CSF nor PV significantly improved RFS or OS in patients with high-risk resected melanoma. Exploratory analyses suggest

  17. Genetics Home Reference: glycogen storage disease type IV

    Science.gov (United States)

    ... Home Health Conditions Glycogen storage disease type IV Glycogen storage disease type IV Printable PDF Open All Close All ... Javascript to view the expand/collapse boxes. Description Glycogen storage disease type IV (GSD IV) is an inherited disorder ...

  18. The role of hydrostatic pressure on developmental stages of Pomatoceros lamarcki (Polychaeta: Serpulidae) exposed to water accommodated fractions of crude oil and positive genotoxins at simulated depths of 1000-3000 m

    Energy Technology Data Exchange (ETDEWEB)

    Vevers, William F., E-mail: william.vevers@plymouth.ac.u [Marine Biological Association, Laboratory, Citadel Hill, Plymouth PL1 2PB (United Kingdom); National Oceanography Centre, Empress Dock, Southampton SO14 3ZH (United Kingdom); School of Biological Sciences, University of Plymouth, Drake Circus, Plymouth PL4 8AA (United Kingdom); Dixon, David R. [Marine Biological Association, Laboratory, Citadel Hill, Plymouth PL1 2PB (United Kingdom); National Oceanography Centre, Empress Dock, Southampton SO14 3ZH (United Kingdom); Dixon, Linda R.J. [Marine Biological Association, Laboratory, Citadel Hill, Plymouth PL1 2PB (United Kingdom)

    2010-05-15

    The effect of high hydrostatic pressures on the ecotoxicological profile of pollutants is an unexplored research area. Using Pomatoceros lamarcki as a surrogate organism for this eco-barotoxicological study, it was found that in a 48 h larval bioassay with water accommodated fractions (WAF) of crude oil of up to 15.1 mg L{sup -1} (total hydrocarbon content) and hydrostatic pressures up to 300 bar (3000 m), an additive response was found (p < 0.001) rather than any synergism (p = 0.881). Comprehensive cytogenetic analysis of 6-h (15 deg. C) embryos exposed to WAF (0.19 mg L{sup -1}) at 100 bar showed no effects on mitotic fidelity or cell division rate over the 1 bar treatment. However, embryo's treated with the clastogen mitomycin-c at 100 bar exhibited a significant increase in mitotic aberrations over 1 bar treated as was the case with hypo/hypersaline treatments (p < 0.05). Conversely, an increase in hydrostatic pressure actually reduced the effects of spindle inhibition by the aneugen colchicine (p < 0.05). - The synergistic eco-barotoxicological relationship between chemical stress and elevations in hydrostatic pressure is largely a membrane integrity phenomenon.

  19. Interpretation of electrocardiographic, echocardiographic and biochemical findings during different stages of Canine Visceral Leishmaniasis

    Directory of Open Access Journals (Sweden)

    Ural K

    2017-09-01

    Full Text Available Objective. The purpose of the present study was to test the hypothesis that cardiac alterations participate within different stages of CVL. Materials and methods. Twenty-eight dogs were diagnosed with CVL, were classified [based on clinical signs, rapid ELISA/IFAT, hematological and serum biochemical tests, urinary protein/creatinine ratio, ECG and ECHO]. as follows; group I (mild disease, group II (moderate disease, group III (severe disease, group IV (very severe disease and group V included healthy controls. Results. Ig G antibodies against leishmaniasis as tested by IFAT, were deemed 1/64 to 1/16000 among infected groups. There were statistical significance regarding mean values for WBC [among healthy control group (V. and other groups (p=0.049], RBC [among stage III-stage IV and other groups (p=0.001], Hb [between stage I and stage III-stage IV (p=0.008, HCT [between stage I and other groups (p = 0.001] MCHC [between stage I and stage II- stage IV (p=0.046], serum creatinine [(p=0.008 stage IV and stage I-II within group V], serum protein [(p=0.002 among stage IV and stage I-III- healthy control groups] and serum albumine [(p=0.004 among stage IV and stage I-II]. There was no alteration in CTnI concentrations,among groups. UPC analysis revealed statistical difference among control group and stage II to IV dogs (p=0.000. Moderate or severe ECG abnormalities were detected in 6/28 of diseased dogs. Regarding ECHO examination LA/ Ao value presented significant difference (p=0.003 among stage IV and other groups. Conclusions. It may be suggested that establishing Leishvet Working Group to those of dogs classified into stage I to IV, ECG [left atrial/ventricular enlargement, myocardial hypoxia] and ECHO [left atrial dilation, decrased/increased LVIDs, decrased/increased LVIDd, shortened FS and EF (systolic dysfunction] alterations must be taken into account along with hematological and serum biochemical analysis.

  20. A Gaussian IV estimator of cointegrating relations

    DEFF Research Database (Denmark)

    Bårdsen, Gunnar; Haldrup, Niels

    2006-01-01

    -nonparametricestimators. Theoretically ideal instruments can be defined to ensure a limitingGaussian distribution of IV estimators, but unfortunately such instruments areunlikely to be found in real data. In the present paper we suggest an IV estimatorwhere the Hodrick-Prescott filtered trends are used as instruments forthe regressors...... in cointegrating regressions. These instruments are almost idealand simulations show that the IV estimator using such instruments alleviatethe endogeneity problem extremely well in both finite and large samples....

  1. In situ investigation of laser-induced ignition and the early stages of methane-air combustion at high pressures using a rapidly tuned diode laser at 2.55 microm.

    Science.gov (United States)

    Lackner, Maximilian; Forsich, Christian; Winter, Franz; Kopecek, Herbert; Wintner, Ernst

    2003-11-01

    The laser-induced ignition of methane/air-mixtures at elevated pressures was investigated by an absorption spectroscopic technique. A room temperature continuous wave InGaAsSb/AlGaAsSb quantum well ridge diode laser was wavelength tuned around 2.55 mum by periodically modulating the injection current from 0 to 174 mA at a 5 kHz repetition rate. The laser heat sink temperature was fixed at 291 K. The infrared laser beam was sent through the pressurized combustion vessel perpendicularly to the igniting laser beam (Nd:YAG laser, 10 ns pulse duration, 20 mJ) at the position of the ignition spark. Fuel-rich to fuel-lean mixtures of methane/air (air equivalence ratio 0.89, 1.06, 1.42, 2.50) were investigated at initial pressures of up to 3 MPa. The initial temperature was 473 K, the volume of the combustion vessel 0.9x10(-3) m(3). The formation of water vapor in the vicinity of the laser spark was tracked by the diode laser. The time resolution of the measurements was 0.2 ms for a total continuous measurement time of up to 1 s. In this way, the laser-induced ignition and its accompanying effects could be investigated on a time scale spanning four orders of magnitude. Apart from the absorbance of water vapor which could be determined semi-quantitatively (due to the effects of severe pressure broadening at high pressures and the ignorance of the exact temperature distribution after ignition), the emissions from the flame (broadband, 1-10 mum) and a gas inhomogeneity index were recorded. The gas inhomogeneity index was obtained by extracting a frequency variable from the time-dependent fluctuations of the transmitted laser intensities and calculating its derivation. The absorbance of water vapor, the emissions from the flame and the gas inhomogeneity index were found to be a powerful tool to characterize laser-induced ignition. Major implications of in situ species concentration measurements at high pressures for the design and development of high-load combustors are

  2. Pressure Sores

    Science.gov (United States)

    Pressure sores are areas of damaged skin caused by staying in one position for too long. They ... wheelchair, or are unable to change your position. Pressure sores can cause serious infections, some of which ...

  3. Studies of binary cerium(IV)-praseodymium(IV) and cerium(IV)-terbium(IV) oxides as pigments for ceramic applications

    International Nuclear Information System (INIS)

    Furtado, L.M.L.

    1991-01-01

    It was investigated a series of pigments of general composition Ce 1-x Pr x O 2 , and Ce x Tb y O 2 , exhibiting radish and brown colors, respectively, and high temperature stability. The pigments were obtained by dissolving appropriate amounts of the pure lanthanide oxides in acids and precipitating the rare earths as mixed oxalates, which were isolated and calcined under air, at 1000 0 C. X-Ray powder diffractograms were consistent with a cubic structure for the pigments. Magnetic susceptibility measurements, using Gouy method, indicated the presence of Pr(IV) ions in the Ce 1-x Pr x O 2 pigments and of Terbium predominantly as Tb(III) ions in the Ce-tb mixed oxides. A new method, based on suspension of solid samples in PVA-STB gels (STB = sodium tetradecaborate), was employed for the measurements of the electronic spectra of the pigments. The thermal behaviour the pigments was investigated by the calcination of the oxalates in the temperature range of 500 to 1200 O C, from 10 to 60 minutes. (author)

  4. Alle har en historie, IV

    DEFF Research Database (Denmark)

    Ydegaard, Torbjørn

    Alle har en historie IV: Pædagogik med Freedom Writers lader et væld af pædagogiske facetter udspringe af den kendte skole-film Freedom Writers’ scener og handlinger. Der er både fokus på en almen tilgang til pædagogik og på Freedom Writer-metodikken, dels gennem de filmscener, der sættes til...... drøftelse, dels gennem foreslåede øvelser. Det styrende princip i bogen er filmens scener og kronologi. Til hver afdeling af filmen knytter der sig oplæg til pædagogiske drøftelser primært rettet mod udsatte unge – og unge i al almindelighed – samt øvelser, der kan anvendes i mange forskellige...... undervisningssammenhænge. Bogens målgruppe er først og fremmest studerende inden for de pædagogiske fagområder, samt professionelle, der arbejder med unge, uanset baggrund. Torbjørn Ydegaard er kandidat i pædagogik, lektor ved University College Syd og uddannet Freedom Writer Teacher....

  5. Pressure Controller

    Science.gov (United States)

    1981-01-01

    EPIC is Electronic Pressure Indicating Controller produced by North American Manufacturing Company. It is a high-sensitivity device for improving combustion efficiency in industrial furnaces that interprets a signal from a pressure transducer on a furnace and regulates furnace pressure accordingly. A controller can provide savings of from five to 25 percent of an industrial user's annual furnace fuel bill.

  6. Intracranial Pressure

    DEFF Research Database (Denmark)

    Hvedstrup, Jeppe; Radojicic, Aleksandra; Moudrous, Walid

    2018-01-01

    OBJECTIVE: To compare a new method of noninvasive intracranial pressure (nICP) measurement with conventional lumbar puncture (LP) opening pressure. METHODS: In a prospective multicenter study, patients undergoing LP for diagnostic purposes underwent intracranial pressure measurements with HeadSen...

  7. Research on Normal Human Plantar Pressure Test

    Directory of Open Access Journals (Sweden)

    Liu Xi Yang

    2016-01-01

    Full Text Available FSR400 pressure sensor, nRF905 wireless transceiver and MSP40 SCM are used to design the insole pressure collection system, LabVIEW is used to make HMI of data acquisition, collecting a certain amount of normal human foot pressure data, statistical analysis of pressure distribution relations about five stages of swing phase during walking, using the grid closeness degree to identify plantar pressure distribution pattern recognition, and the algorithm simulation, experimental results demonstrated this method feasible.

  8. Should epithelial ovarian carcinoma metastatic to the inguinal lymph nodes be assigned stage IVB?

    Science.gov (United States)

    Nasioudis, Dimitrios; Chapman-Davis, Eloise; Frey, Melissa K; Caputo, Thomas A; Witkin, Steven S; Holcomb, Kevin

    2017-10-01

    According to the revised FIGO staging system women with ovarian carcinoma and inguinal lymph node (LN) metastases, formerly stage III, are now considered stage IVB. In this study we compare their survival to that of women with stage III and stage IV disease. Women diagnosed with epithelial ovarian carcinoma were drawn from the Surveillance, Epidemiology, and End Results database (2004-2013). Four groups were formed: group 1 (stage IV due to positive inguinal nodes), group 2 (stage III with positive para-aortic/pelvic nodes), group 3 (stage IV with positive distant nodes) and group 4 (stage IV with distant metastases). Overall (OS) and cancer-specific survival (CSS) rates were evaluated with the Kaplan-Meier method. The log-rank test and Cox-hazard models were employed for univariate and multivariate survival analysis. A total of 11,152 women were identified. Five-year OS for women in group 1 (n=151) was 46.3% compared to 44.9% for those in group 2 (n=4,403) (p=0.4), 32.9% in group 3 (n=642) (pOvarian cancer patients with stage IV ovarian cancer due solely to inguinal nodal metastases have similar survival as those with pelvic/para-aortic nodal involvement and improved survival compared to those harboring distant metastases. Our findings do not support the reclassification of these patients as stage IVB. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Zirconium (IV) complexes with some polymethylenediimines | Na ...

    African Journals Online (AJOL)

    The syntheses of zirconium (IV) complexes have been carried out by the reaction of oxozirconium (IV) chloride with the appropriate diimines (Schiff bases). The complexes were isolated as yellow solids which are stable to heat. The complexes were found to be insoluble in most solvents. The infrared spectra, elemental ...

  10. IVS Working Group 4: VLBI Data Structures

    Science.gov (United States)

    Gipson, John

    2010-01-01

    In 2007 the IVS Directing Board established IVS Working Group 4 on VLBI Data Structures. This note discusses the current VLBI data format, goals for a new format, the history and formation of the Working Group, and a timeline for the development of a new VLBI data format.

  11. Astragaloside IV liposomes ameliorates adriamycin-induced ...

    African Journals Online (AJOL)

    Background: Radix Astragali was one of the main compositions of 'Modified Danggui Buxue Decoction' used for treatment of various kidney diseases. Astragaloside IV was the active composition of Radix Astragali. Astragaloside IV liposomes were used for the treatment of adriamycin-induced nephropathy (AN) rats.

  12. Pressure Ulcers Surveillance Report

    Directory of Open Access Journals (Sweden)

    Zehra Esin Gencer

    2015-04-01

    Full Text Available Objective: Pressure ulcer is a chronic wound. It reduces the quality of life of the elderly and individuals with restricted range of motion. It prolongs hospital stay and increases the risk of complications. The cost is quite high. Preventive actions for the prevention of pressure ulcers should be developed. Planning protocols and standards of care are among the main targets. Material and Method: Research was conducted in one-year period between 2012 May and 2013 May on patients who were followed up in Akdeniz University Hospital clinics and intensive care unit with pressure ulcers. The research population consisted of 569 patients. Patient data were recorded in SPSS 16 for Windows program. Statistical analyzes were performed with retrospective methods. The demographic characteristics of patients with pressure ulcers were analyzed as frequency and descriptive statistics. Prevalence and incidence of one year were calculated. Results: Of the patients, 58% were males, 42% were females. Of the patients, 36% were in the age range of 61-80 years, and their average length of stay was 42,9 days. Of the patients, 70% were at stage 2 and 3. In 15% of patients pressure ulcers occurred on the first day of hospitalization. Pressure ulcers were developed between days 2 and 10 in 59% of the patients. Prevalence rate was 2.5%, the incidence was 1.9%, the prevalence rate was 5.9% in the intensive care unit. Conclusion: It is easier to prevent pressure ulcers than treating.

  13. Generation IV reactors: international projects

    International Nuclear Information System (INIS)

    Carre, F.; Fiorini, G.L.; Kupitz, J.; Depisch, F.; Hittner, D.

    2003-01-01

    Generation IV international forum (GIF) was initiated in 2000 by DOE (American department of energy) in order to promote nuclear energy in a long term view (2030). GIF has selected 6 concepts of reactors: 1) VHTR (very high temperature reactor system, 2) GHR (gas-cooled fast reactor system), 3) SFR (sodium-cooled fast reactor system, 4) SCWR (super-critical water-cooled reactor system), 5) LFR (lead-cooled fast reactor system), and 6) MFR (molten-salt reactor system). All these 6 reactor systems have been selected on criteria based on: - a better contribution to sustainable development (through their aptitude to produce hydrogen or other clean fuels, or to have a high energy conversion ratio...) - economic profitability, - safety and reliability, and - proliferation resistance. The 6 concepts of reactors are examined in the first article, the second article presents an overview of the results of the international project on innovative nuclear reactors and fuel cycles (INPRO) within IAEA. The project finished its first phase, called phase-IA. It has produced an outlook into the future role of nuclear energy and defined the need for innovation. The third article is dedicated to 2 international cooperations: MICANET and HTR-TN. The purpose of MICANET is to propose to the European Commission a research and development strategy in order to develop the assets of nuclear energy for the future. Future reactors are expected to be more multiple-purposes, more adaptable, safer than today, all these developments require funded and coordinated research programs. The aim of HTR-TN cooperation is to promote high temperature reactor systems, to develop them in a long term perspective and to define their limits in terms of burn-up and operating temperature. (A.C.)

  14. Materials for generation-IV nuclear reactors

    International Nuclear Information System (INIS)

    Alvarez, M. G.

    2009-01-01

    Materials science and materials development are key issues for the implementation of innovative reactor systems such as those defined in the framework of the Generation IV. Six systems have been selected for Generation IV consideration: gas-cooled fast reactor, lead-cooled fast reactor, molten salt-cooled reactor, sodium-cooled fast reactor, supercritical water-cooled reactor, and very high temperature reactor. The structural materials need to resist much higher temperatures, higher neutron doses and extremely corrosive environment, which are beyond the experience of the current nuclear power plants. For this reason, the first consideration in the development of Generation-IV concepts is selection and deployment of materials that operate successfully in the aggressive operating environments expected in the Gen-IV concepts. This paper summarizes the Gen-IV operating environments and describes the various candidate materials under consideration for use in different structural applications. (author)

  15. Hybrid staging of a Lysholm positive displacement engine with two Westinghouse two stage impulse Curtis turbines

    Energy Technology Data Exchange (ETDEWEB)

    Parker, D.A.

    1982-06-01

    The University of California at Berkeley has tested and modeled satisfactorly a hybrid staged Lysholm engine (positive displacement) with a two stage Curtis wheel turbine. The system operates in a stable manner over its operating range (0/1-3/1 water ratio, 120 psia input). Proposals are made for controlling interstage pressure with a partial admission turbine and volume expansion to control mass flow and pressure ratio for the Lysholm engine.

  16. Engineering design of the Aries-IV gaseous divertor

    International Nuclear Information System (INIS)

    Hasan, M.Z.; Najmabadi, F.; Sharafat, S.

    1994-01-01

    ARIES-IV is a conceptual, D-T burning, steady-state tokamak fusion reactor producing 1000 MWe net. It operates in the second plasma stability regime. The structural material is SiC composite and the primary coolant is helium at 10MPa base pressure. ARIES-IV uses double-null divertors for particle control. Total thermal power recovered from the divertors is 425MW, which is 16% of the total reactor thermal power. Among the desirable goals of divertor design were to avoid the use of tungsten and to use the same structural material and primary coolant as in the blanket design. In order to reduce peak heat flux, the innovative gaseous divertor has been used in ARIES-IV. A gaseous divertor reduces peak heat flux by increasing the surface area and by distributing particle and radiation energy more uniformly. Another benefit of gaseous divertor is the reduction of plasma temperature in the divertor chamber, so that material erosion due to sputtering, can be diminished. This makes the use of low-Z material possible in a gaseous divertor

  17. Phase Transitions in Layered Diguanidinium Hexachlorostannate(IV)

    DEFF Research Database (Denmark)

    Szafranski, Marek; Ståhl, Kenny

    2016-01-01

    is different. The transitions involve also transformations in the networks of N-H center dot center dot center dot Cl hydrogen bonds. The large volume (similar to 3%) and entropy (similar to R ln 3) change at the transition between phases II and III, and the giant pressure coefficient of -755 K GPa(-1......Five crystalline phases of diguanidinium hexachlorostannate(IV), [C(NH2)(3)](2)SnCl6, have been identified and characterized by calorimetric and dielectric measurements, single crystal X-ray diffraction at atmospheric and high pressure, and synchrotron X-ray powder diffraction. The crystal...... structures of all phases are built of similar layers in which the tin hexachloride anions are connected to the guanidinium cations by N-H center dot center dot center dot Cl hydrogen bonds, forming a interact primarily by Coulombic forces between the ions from ap. double H-bonded sheets. The layers, neutral...

  18. Prostate cancer staging

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000397.htm Prostate cancer staging To use the sharing features on this ... trials you may be able to join How Prostate Cancer Staging is Done Initial staging is based on ...

  19. Safety Design Criteria (SDC) for Gen-IV Sodium-cooled Fast Reactor

    International Nuclear Information System (INIS)

    Nakai, Ryodai

    2013-01-01

    SDC Development Background & Objectives: • Safety Design Criteria (SDC) Development for Gen-IV SFR: – Proposed at the GIF Policy Group (PG) meeting in October 2010 –SDC “harmonization” is increasingly important for: • Realization of enhanced safety designs meeting to Gen-IV safety goals and safety approach common to SFR systems; • Preparation for the forthcoming licensing in the near future; • Because Gen-IV SFR are progressing into conceptual design stage. • The SDC is the Reference criteria: – Of the designs of safety-related Structures, Systems & Components that are specific to the SFR system; – For clarifying the requisites systematically & comprehensively; – When the technology developers apply the basic safety approach and use the codes & standards for conceptual design of the Gen-IV SFR system

  20. Numerical simulation of probability of air migration from a pressurizer during reflux cooling

    International Nuclear Information System (INIS)

    Utanohara, Yoichi; Murase, Michio

    2009-01-01

    An accurate evaluation of the behaviors of non-condensable gases accumulated in the steam generator (SG) U-tubes is important to predict the performance of the reflux cooling, since the migration behaviors of such gases existing in the pressurizer to the SG U-tubes is not clarified yet. In this research, the steam and the air behaviors in the pressurizer was therefore analyzed numerically during reflux cooling using FLUENT 6.3.26 in order to investigate the possibility of air migration to the hot leg. In the present analysis, the pressurizer of ROSA-IV/LSTF experiment was employed as a calculation domain, since the experimental data of the loss of residual heat removal event during the mid-loop operation are available. Two stages were assumed; (1) Phase 1: latent heat accumulates in the wall of the pressurizer and is eventually released to the outside, (2) Phase 2: the wall heats up to the saturation temperature of the steam, and only heat loss to the outside occurs. The prediction indicates that in Phase 1 the air does not migrate into the surge line in neither laminar nor turbulent flow conditions, while in Phase 2 the air migrates into the hot leg only in the laminar flow condition. Judging from the previous experiment of axisymmetric free jet, the flow pattern in the pressurizer seems to be turbulent. In addition, a comparison of the analytical results of the fluid temperatures near the wall of pressurizer with ROSA-IV/LSTF experiment results suggests that the turbulent flow calculation results are more realistic. It has been therefore concluded that the turbulent calculation is more reasonable and the possibility of air migration into the hot leg is low. (author)

  1. Generation IV PR and PP methods and applications

    International Nuclear Information System (INIS)

    Bari, Robert A.

    2008-01-01

    This paper presents an evaluation methodology for proliferation resistance and physical protection (PR and PP) of Generation IV nuclear energy systems (NESs). For a proposed NES design, the methodology defines a set of challenges, analyzes system response to these challenges, and assesses outcomes. The challenges to the NES are the threats posed by potential actors (proliferant States or sub-national adversaries). The characteristics of Generation IV systems, both technical and institutional, are used to evaluate the response of the system and determine its resistance against proliferation threats and robustness against sabotage and terrorism threats. The outcomes of the system response are expressed in terms of six measures for PR and three measures for PP, which are the high-level PR and PP characteristics of the NES. The methodology is organized to allow evaluations to be performed at the earliest stages of system design and to become more detailed and more representative as design progresses. Uncertainty of results are recognized and incorporated into the evaluation at all stages. The results are intended for three types of users: system designers, program policy makers, and external stakeholders. Particular current relevant activities will be discussed in this regard. The methodology has been illustrated in a series of demonstration and case studies and these will be summarized in the paper. (author)

  2. Tackling dipeptidyl peptidase IV in neurological disorders

    Directory of Open Access Journals (Sweden)

    Ghaith Al-Badri

    2018-01-01

    Full Text Available Dipeptidyl peptidase IV (DPP-IV is a serine protease best known for its role in inactivating glucagon-like peptide-1 (GLP-1, pituitary adenylate cyclase-activating polypeptide (PACAP and glucose-dependent insulinotropic peptide (GIP, three stimulators of pancreatic insulin secretion with beneficial effects on glucose disposal. Owing to the relationship between DPP-IV and these peptides, inhibition of DPP-IV enzyme activity is considered as an attractive treatment option for diabetic patients. Nonetheless, increasing studies support the idea that DPP-IV might also be involved in the development of neurological disorders with a neuroinflammatory component, potentially through its non-incretin activities on immune cells. In this review article, we aim at highlighting recent literature describing the therapeutic value of DPP-IV inhibitors for the treatment of such neurological conditions. Finally, we will illustrate some of the promising results obtained using berberine, a plant extract with potent inhibitory activity on DPP-IV.

  3. Surprising Coordination Geometry Differences in Ce(IV)- and Pu(IV)-Maltol Complexes

    Energy Technology Data Exchange (ETDEWEB)

    Lawrence Berkeley National Laboratory; Raymond, Kenneth; Szigethy, Geza; Xu, Jide; Gorden, Anne E.V.; Teat, Simon J.; Shuh, David K.; Raymond, Kenneth N.

    2008-02-12

    As part of a study to characterize the detailed coordination behavior of Pu(IV), single crystal X-ray diffraction structures have been determined for Pu(IV) and Ce(IV) complexes with the naturally-occurring ligand maltol (3-hydroxy-2-methyl-pyran-4-one) and its derivative bromomaltol (5-bromo-3-hydroxy-2-methyl-pyran-4-one). Although Ce(IV) is generally accepted as a structural analog for Pu(IV), and the maltol complexes of these two metals are isostructural, the corresponding bromomaltol complexes are strikingly different with respect to ligand orientation about the metal ion: All complexes exhibit trigonal dodecahedral coordination geometry but the Ce(IV)-bromomaltol complex displays an uncommon ligand arrangement not mirrored in the Pu(IV) complex, although the two metal species are generally accepted to be structural analogs.

  4. Market opportunities: U.S. - PADD IV

    International Nuclear Information System (INIS)

    Garner, R.P.

    1997-01-01

    The current supply and demand balance, the short and long term expectations and marketing opportunities for Canadian crude oil in PADD IV, the Rocky Mountain region in the US, were reviewed. It was suggested that market opportunities in PADD IV are derived from the following four factors: (1) crude oil declines within that area, (2) federal regulations, (3) competitive presence with markets, and (4) population growth. The overall conclusion was that Canadian producers and PADD IV refiners will be looking at an ever-growing relationship based on freight equalized world crude prices. 8 tabs., 5 figs

  5. Preparation and characterization of complexes of uranium(VI), vanadium(IV), titanium(IV), zirconium(IV) and hafnium(IV) with mercapto triazoles

    International Nuclear Information System (INIS)

    Sengupta, S.K.

    1983-01-01

    Complexes of UO 2 (VI), VO(VI), Tio(IV), ZrO(IV) and HfO(IV) with 4-amino-5-mercapto-3-trifluoromethyl-1,2,4-triazole (HAFT), 4-benzylidene-amino-5-mercapto-3-trifluoromethyl-1,2,4-triazole (HBFT) and 4-salicylidene-amino-5-mercapto-3-trifluoromethyl-1,2,3,-triazole (H 2 SFT) have been prepared and characterized on the basis of elemental analysis, electrical conductance, magnetic susceptibility and spectral (electronic and infrared) data. The ligands HAFT and HBFT act as NS - bidentate chelating agents whereas H 2 SFT acts as NS - O - tridentate chelating agent. (author)

  6. Preoperative staging of lung cancer with combined PET-CT

    DEFF Research Database (Denmark)

    Fischer, Barbara; Lassen, Ulrik; Mortensen, Jann

    2009-01-01

    BACKGROUND: Fast and accurate staging is essential for choosing treatment for non-small-cell lung cancer (NSCLC). The purpose of this randomized study was to evaluate the clinical effect of combined positron-emission tomography and computed tomography (PET-CT) on preoperative staging of NSCLC....... METHODS: We randomly assigned patients who were referred for preoperative staging of NSCLC to either conventional staging plus PET-CT or conventional staging alone. Patients were followed until death or for at least 12 months. The primary end point was the number of futile thoracotomies, defined as any...... one of the following: a thoracotomy with the finding of pathologically confirmed mediastinal lymph-node involvement (stage IIIA [N2]), stage IIIB or stage IV disease, or a benign lung lesion; an exploratory thoracotomy; or a thoracotomy in a patient who had recurrent disease or death from any cause...

  7. Fluid element in SAP IV

    International Nuclear Information System (INIS)

    Yilmaz, C.; Akkas, N.

    1979-01-01

    In previous studies a fluid element is incorporated in the widely used general purpose finite element program SAPIV. This type of problem is of interest in the design of nuclear components involving geometric complexities and nonlinearities. The elasticity matrix of a general-purpose finite element program is modified in such a way that it becomes possible to idealize fluid as a structural finite element with zero shear modulus and a given bulk modules. Using the modified version of SAPIV, several solid-fluid interactions problems are solved. The numerical solutions are compared with the available analytical solutions. They are shown to be in reasonable aggrement. It is also shown that by solving an exterior-fluid interaction problem, the pressure wave propagation in the acoustic medium can be solved with the same approach. In this study, two of the problem not studied in the previous work will be presented. These problems are namely the effects of the link elements used at solid-fluid interfaces and of the concentrated loads on the response of the fluid medium. Truss elements are used as the link elements. After these investigations, it is decided that general purpose finite element programs with slight modifications can be used in the safety analysis of nuclear reactor plants. By this procedure it is possible to handle two-dimensional plane strain and tridimensional axisymmetric problems of this type. (orig.)

  8. Pressure ulcers.

    Science.gov (United States)

    Reddy, Madhuri

    2011-04-28

    Unrelieved pressure or friction of the skin, particularly over bony prominences, can lead to pressure ulcers in up to one third of people in hospitals or community care, and one fifth of nursing home residents. Pressure ulcers are more likely in people with reduced mobility and poor skin condition, such as older people or those with vascular disease. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of preventive interventions in people at risk of developing pressure ulcers? What are the effects of treatments in people with pressure ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 64 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: air-filled vinyl boots, air-fluidised supports, alternating-pressure surfaces (including mattresses), alternative foam mattresses, constant low-pressure supports, debridement, electric profiling beds, electrotherapy, hydrocellular heel supports, low-air-loss beds (including hydrotherapy beds), low-level laser therapy, low-tech constant-low-pressure supports, medical sheepskin overlays, nutritional supplements, orthopaedic wool padding, pressure-relieving overlays on operating tables, pressure-relieving surfaces, repositioning (regular "turning"), seat cushions, standard beds, standard care, standard foam mattresses, standard tables, surgery, therapeutic ultrasound, topical lotions and

  9. Experimental facilities for Generation IV reactors research

    International Nuclear Information System (INIS)

    Krecanova, E.; Di Gabriele, F.; Berka, J.; Zychova, M.; Macak, J.; Vojacek, A.

    2013-06-01

    Centrum Vyzkumu Rez (CVR) is research and development Company situated in Czech Republic and member of the UJV group. One of its major fields is material research for Generation IV reactor concepts, especially supercritical water-cooled reactor (SCWR), very high temperature/gas-cooled fast reactor (VHTR/GFR) and lead-cooled fast reactor (LFR). The CVR is equipped by and is building unique experimental facilities which simulate the environment in the active zones of these reactor concepts and enable to pre-qualify and to select proper constructional materials for the most stressed components of the facility (cladding, vessel, piping). New infrastructure is founded within the Sustainable Energy project focused on implementation the Generation IV and fusion experimental facilities. The research of SCWR concept is divided to research and development of the constructional materials ensured by SuperCritical Water Loop (SCWL) and fuel components research on Fuel Qualification Test loop (SCWL-FQT). SCWL provides environment of the primary circuits of European SCWR, pressure 25 MPa, temperature 600 deg. C and its major purpose is to simulate behavior of the primary medium and candidate constructional materials. On-line monitoring system is included to collect the operational data relevant to experiment and its evaluation (pH, conductivity, chemical species concentration). SCWL-FQT is facility focused on the behavior of cladding material and fuel at the conditions of so-called preheater, the first pass of the medium through the fuel (in case of European SCWR concept). The conditions are 450 deg. C and 25 MPa. SCWL-FQT is unique facility enabling research of the shortened fuel rods. VHTR/GFR research covers material testing and also cleaning methods of the medium in primary circuit. The High Temperature Helium Loop (HTHL) enables exposure of materials and simulates the VHTR/GFR core environment to analyze the behavior of medium, especially in presence of organic compounds and

  10. Diorganotin(IV) Complexes with Methionine Methyl Ester. Equilibria ...

    African Journals Online (AJOL)

    IV) (DBT) and diphenyltin(IV) (DPT) was investigated at 25 °C and 0.1 mol dm–3 ionic strength in water for dimethyltin(IV) and in 50 % dioxane–water mixture for dibutyltin(IV) and diphenyltin(IV). Methionine methyl ester forms1:1 and 1:2 ...

  11. Between Stage and Screen

    NARCIS (Netherlands)

    Tornqvist, Egil

    1996-01-01

    Ingmar Bergman is worldwide known as a film and stage director. Yet no-one has attempted to compare his stage and screen activities. In Between stage and screen Egil Tornqvist examines formal and thematical correspondences and differences between a number of Bergman's stage, screen, and radio

  12. IV&V Project Assessment Process Validation

    Science.gov (United States)

    Driskell, Stephen

    2012-01-01

    The Space Launch System (SLS) will launch NASA's Multi-Purpose Crew Vehicle (MPCV). This launch vehicle will provide American launch capability for human exploration and travelling beyond Earth orbit. SLS is designed to be flexible for crew or cargo missions. The first test flight is scheduled for December 2017. The SLS SRR/SDR provided insight into the project development life cycle. NASA IV&V ran the standard Risk Based Assessment and Portfolio Based Risk Assessment to identify analysis tasking for the SLS program. This presentation examines the SLS System Requirements Review/System Definition Review (SRR/SDR), IV&V findings for IV&V process validation correlation to/from the selected IV&V tasking and capabilities. It also provides a reusable IEEE 1012 scorecard for programmatic completeness across the software development life cycle.

  13. Cutaneous Lymphoma International Consortium Study of Outcome in Advanced Stages of Mycosis Fungoides and Sézary Syndrome

    DEFF Research Database (Denmark)

    Scarisbrick, Julia J; Prince, H Miles; Vermeer, Maarten H

    2015-01-01

    PURPOSE: Advanced-stage mycosis fungoides (MF; stage IIB to IV) and Sézary syndrome (SS) are aggressive lymphomas with a median survival of 1 to 5 years. Clinical management is stage based; however, there is wide range of outcome within stages. Published prognostic studies in MF/SS have been sing...

  14. Pressure ulcer prevention: an evidence-based analysis.

    Science.gov (United States)

    2009-01-01

    In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers.Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series.PRESSURE ULCER PREVENTION: an evidence based analysisThe cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation)MANAGEMENT OF CHRONIC PRESSURE ULCERS: an evidence-based analysis (anticipated pubicstion date - mid-2009) PURPOSE: A pressure ulcer, also known as a pressure sore, decubitus ulcer, or bedsore, is defined as a localized injury to the skin/and or underlying tissue occurring most often over a bony prominence and caused by pressure, shear, or friction, alone or in combination. (1) Those at risk for developing pressure ulcers include the elderly and critically ill as well as persons with neurological impairments and those who suffer conditions associated with immobility. Pressure ulcers are graded or staged with a 4-point classification system denoting severity. Stage I represents the beginnings of a pressure ulcer and stage IV, the severest grade, consists of full thickness tissue loss with exposed bone, tendon, and or muscle. (1) In a 2004 survey of Canadian health care settings, Woodbury and Houghton (2) estimated that the prevalence of pressure ulcers at a stage 1 or greater in Ontario ranged between 13.1% and 53% with nonacute health care settings having the highest prevalence rate (Table 1). Executive Summary Table 1: Prevalence of Pressure Ulcers()SettingCanadian Prevalence,% (95% CI)Ontario Prevalence,Range % (n)Acute care25 (23.8-26.3)23.9-29.7 (3418)Nonacute care30 (29.3-31.4)30.0-53.3 (1165)Community care15 (13.4-16.8)13.2 (91)Mixed health care22 (20.9-23.4)13.1-25.7 (3100)All health care settings26 (25

  15. Mirizzi Syndrome Type IV: A challenging diagnosis

    Directory of Open Access Journals (Sweden)

    Daniel Navarini

    2016-05-01

    Full Text Available Mirizzi Syndrome type IV is an extremely rare condition, which is confused with the diagnosis of cholangiocarcinoma in many cases. This report describes a case of a forty-three-year old patient, who was forwarded to our department of general surgery with a high suspicion of a choledochal neoplasic lesion. During the hospitalization he was diagnosed with Mirizzi Syndrome type IV. We concisely describe the case and the literature review about this pathology.

  16. COBRA-IV wire wrap data comparisons

    International Nuclear Information System (INIS)

    Donovan, T.E.; George, T.L.; Wheeler, C.L.

    1979-02-01

    Thermal hydraulic analyses of hexagonally packed wire-wrapped fuel assemblies are complicated by the induced crossflow between adjacent subchannels. The COBRA-IV computer code simultaneously solves the hydrodynamics and thermodynamics of fuel assemblies. The modifications and the results are presented which are predicted by the COBRA-IV calculation. Comparisons are made with data measured in five experimental models of a wire-wrapped fuel assembly

  17. Spectral characteristics of caries-related autofluorescence spectra and their use for diagnosis of caries stage

    Science.gov (United States)

    Son, Sung-Ae; Jung, Kyeong-Hoon; Ko, Ching-Chang; Kwon, Yong Hoon

    2016-01-01

    The purpose of the present study was to identify factors useful for diagnosis of the caries stage from laser-induced autofluorescence (AF) spectra. Affected teeth were accurately staged and allocated to four groups: sound, stage II, stage III, or stage IV. A 405-nm laser was used to produce AF spectra. The spectrum factors analyzed were spectrum slope at 550 to 600 nm, spectral area from 500 and 590 nm, and intensity ratio of peaks 625 and 667 nm (625/667 nm). DIAGNOdent was used as control measurement. AF spectra of sound teeth had a peak near 500 nm followed by a smooth decline to 800 nm. As caries progressed, some specimens in stages II to IV showed one or two peak(s) near 625 and 667 nm. Slopes at 550 to 600 nm and areas under the curve at 500 to 590 nm were significantly different (p<0.001) for each stage. Two-peak ratios were also significantly different (p<0.001) except for stage III and stage IV. DIAGNOdent readings for sound and stage II and stage III and IV were not significantly different. Among the studied factors, the spectrum slope at 550 to 600 nm and area under curve at 500 to 590 nm could be useful treatment decision-making tools for carious lesions.

  18. A comparative study of proton transport properties of zirconium (IV ...

    Indian Academy of Sciences (India)

    Keywords. Proton conductors; proton transport properties; solid electrolytes; ionic conductors; proton conduction in zirconium (IV) phosphonates; proton transport properties in Zr(IV) amino phosphonates.

  19. Pressure Drop

    Science.gov (United States)

    Lawson, Mike

    2010-01-01

    Mike Lawson briefly discussed pressure drop for aerospace applications and presented short stories about adventures experienced while working at NASA and General Dynamics, including exposure to technologies like the Crew and Equipment Translation Aid (CETA) cart and the SWME.

  20. BAHAN AJAR BERBASIS PENDIDIKAN KARAKTER UNTUK SISWA KELAS IV SEKOLAH DASAR

    Directory of Open Access Journals (Sweden)

    Pity Asriani

    2017-11-01

    Full Text Available This study aims to produce character education based teaching materials for grade IV elementary school. The writer used the 4D model (Thiagarajan, et al., 1974 for his research and development. The 4D model consists of four stages. They are defining, designing, developing, and disseminating. Types of data used are qualitative. Data were collected by validity testing, questionnaire, observation, and character assessment. This study produced a character education based teaching materials for grade IV elementary school. That is the student book and the teacher book. The results showed that character education based teaching materials for grade IV elementary school is compliant to use in learning since it has met the expected criteria according to the assessment of the material experts, linguists, media experts, teachers, and students. Penelitian ini bertujuan menghasilkan bahan ajar berbasis pendidikan karakter untuk kelas IV Sekolah Dasar. Model penelitian dan pengembangan yang digunakan adalah model pengembangan 4D (Thiagarajan, dkk., 1974. Model 4-D ini terdiri atas tahap pendefinisian (define, perancangan (design, pengembangan (develop, dan penyebaran (disseminate. Jenis data yang digunakan yaitu data kualitatif. Data dikumpulkan melalui uji validasi, angket, observasi, dan penilaian karakter. Penelitian ini menghasilkan bahan ajar berbasis pendidikan karakter untuk kelas IV Sekolah Dasar yang terdiri atas Buku Siswa dan Buku Guru. Hasil penelitian menunjukkan bahwa bahan ajar berbasis pendidikan karakter untuk kelas IV Sekolah Dasar ini telah memenuhi persyaratan untuk digunakan dalam pembelajaran karena telah memenuhi kriteria menurut penilaian ahli materi, ahli bahasa, ahli desain, guru, dan siswa.

  1. Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States.

    Science.gov (United States)

    Padula, William V; Makic, Mary Beth F; Mishra, Manish K; Campbell, Jonathan D; Nair, Kavita V; Wald, Heidi L; Valuck, Robert J

    2015-06-01

    Prevention of pressure ulcers, one of the hospital-acquired conditions (HACs) targeted by the 2008 nonpayment policy of the Centers for Medicare & Medicaid Services (CMS), is a critical issue. This study was conducted to determine the comparative effectiveness of quality improvement (QI) interventions associated with reduced hospital-acquired pressure ulcer (HAPU) rates. In an quasi-experimental design, interrupted time series analyses were conducted to determine the correlation between HAPU incidence rates and adoption of QI interventions. Among University HealthSystem Consortium hospitals, 55 academic medical centers were surveyed from September 2007 through February 2012 for adoption patterns of QI interventions for pressure ulcer prevention, and hospital-level data for 5,208 pressure ulcer cases were analyzed. Between- and within-hospital reduction significance was tested with t-tests post-CMS policy intervention. Fifty-three (96%) of the 55 hospitals used QI interventions for pressure ulcer prevention. The effect size analysis identified five effective interventions that each reduced pressure ulcer rates by greater than 1 case per 1,000 patient discharges per quarter: leadership initiatives, visual tools, pressure ulcer staging, skin care, and patient nutrition. The greatest reductions in rates occurred earlier in the adoption process (pinterventions had clinically meaningful associations with reduced stage III and IV HAPU incidence rates in 55 academic medical centers. These QI interventions can be used in support of an evidence-based prevention protocol for pressure ulcers. Hospitals can not only use these findings from this study as part of a QI bundle for preventing HAPUs.

  2. Free-Format RPG IV How to Bring Your RPG Programs Into the 21st Century

    CERN Document Server

    Martin, Jim

    2005-01-01

    Traditional-format style RPG IV programmers who need information on the free-format style of coding will find everything they need in this free format how-to guide. The rules and syntax of free format RPG IV are explained as is how this new style of coding has the potential to improve overall programmer productivity from initial development through maintenance stages. Many style issues, such as named indicators and built in functions are covered, as well as such issues as program flow, data manipulation, math operations, and input and output.

  3. Population structure and maturity stages of Fritillaria borealis (Appendicularia, Tunicata: seasonal cycle in Ushuaia Bay (Beagle Channel

    Directory of Open Access Journals (Sweden)

    María Laura Presta

    2015-09-01

    Full Text Available AbstractFritillaria borealis is a cosmopolitan species, very frequent in sub-antarctic and antarctic waters. The objective of this paper was to analyze its size structure and maturity stages at two sites in Ushuaia Bay: a coastal site exposed to anthropogenic pressure (E1 and a reference site (E2 located in the external zone of the bay. Zooplankton was collected during the 2012 seasonal cycle. The sampling method involved the use of a 67 µm-mesh net. Appendicularians were classified in four maturity stages: I undifferentiated gonads, II testis and ovary differentiated, III expanded testis, IV discharged testis, expanded ovary. Our results showed that the highest densities of F. borealisoccurred in spring and summer at both sites; coinciding with high values of chlorophyll-a. The percentage of juveniles (I and II exhibited a spatial and temporal pattern similar to that observed for chlorophyll-a values. During spring-summer, juveniles and mature specimens (III and IV showed a greater gonadal development than those individuals found in autumn-winter. In conclusion, the mismatching in the population structure and the pattern of densities of F. borealis between coastal and external zones would suggest the existence of two sub-populations susceptible to the influence of the anthropogenic impact in the bay.

  4. The Contribution of IVS to IGGOS

    Science.gov (United States)

    Nothnagel, A.

    2002-05-01

    Since its inauguration in 1999, the International VLBI Service for Geodesy and Astrometry has made significant progress in the coordination and utilisation of worldwide VLBI resources. Improving the visibility of the IVS components to a wider public in turn led to a higher motivation of the individuals to contribute to the global effort. Not only the number of IVS components but also their investments in terms of funds and manpower demonstrate the increased awareness of the importance of this joint international endeavour. The different demands of the users but also of the contributors often require the definition of priorities which are only being acceptable due to the existence of a strong umbrella organisation like the IVS. Significant progress has also been made in the area of routine data analysis and combination of results. By now, six IVS Analysis Centers provide the redundancy necessary for a robust combination of the results. The use of ITRF2000 station coordinates as the basis for the IVS combined EOP series is the most recent step towards the generation of a consistent chain from the quasi-inertial frame of radio sources to system Earth.

  5. Direct complexonometric determination of thorium (IV), uranium (IV), neptunium (IV), plutonium (IV) by titration of diethylenetriaminepentaacetic acid with xylenol orange as indicator

    International Nuclear Information System (INIS)

    Rykov, A.G.; Piskunov, E.M.; Timofeev, G.A.

    1975-01-01

    The purpose of the present work was to develop a method of determining Th(IV), U(IV), Np(N) and Pu(IV) in acid solutions by titration with diethylenetriamine pentacetic acid, the indicator being xylenol orange. It has been established that Th, U, Np and Pu can be determined to within 0.5-1.5%. Th and U in quantities of tens of milligrams can be determined with greater accuracy, attaining hundredths of one per cent. During titration the determination is not hindered by singly- and doubly-charged metal ions, trivalent lanthanides and actinides, except plutonium. The proposed method can be used to determine U(IV) in the presence of considerable quantities of U(VI) and Np(IV) in the presence of Np(V). Total concentrations of uranium or neptunium are determined by reducing uranium (VI) or neptunium (V) by a standard method (for example, using metallic lead, cadmium or zinc amalgam) to the tetravalent state and applying the method described in the paper. (E.P.)

  6. Solubility studies of Np(IV)

    International Nuclear Information System (INIS)

    Zhang Yingjie; Yao Jun; Jiao Haiyang; Ren Lihong; Zhou Duo; Fan Xianhua

    2004-01-01

    The solubility of Np(IV) in simulated underground water and redistilled water has been measured with the variation of pH(6-12), storage time(0-100 days), in the presence of reducing agents (Na 2 S 2 O 4 , metallic Fe). All experiments were performed in a low oxygen concentration glove box which contained high purity, Ar (99.99%), with an oxygen content of less than 5ppm. Experiment results show that the variation of pH in solution is little effect on the solubility of Np(IV) in the two kinds of water; the measured solubility of Np(IV) is affected by the composition of solution; Na 2 S 2 O 4 as a reductant, the solubility of Np(IV) in simulated underground water is (9.23±0.48) x 10 -10 mol/L, and in distill water is (8.31±0.35) x 10 -10 mol/L; Metallic Fe as a reductant, the solubility of Np(IV) in simulated underground water is (1.85±0.56) x 10 -9 mol/L, and in distill water is (1.48±0.66) x 10 -9 mol/L. (author)

  7. Solubility studies of Np(IV)

    International Nuclear Information System (INIS)

    Zhang Yingjie; Yao Jun; Jiao Haiyang; Ren Lihong; Zhou Duo; Fan Xianhua

    2001-01-01

    The solubility of Np(IV) in simulated underground water and redistilled water has been measured with the variations of pH(6-12) and storage time (0-100 d) in the presence of reductant (Na 2 S 2 O 4 , metallic Fe). All experiments are performed in a low oxygen concentration glove box containing high purity Ar(99.99%), with an oxygen content of less than 5 x 10 -6 mol/mol. Experimental results show that the variation of pH in solution has little effect on the solubility of Np(IV) in the two kinds of water; the measured solubility of Np(IV) is affected by the composition of solution; with Na 2 S 2 O 4 as a reductant, the solubility of Np(IV) in simulated underground water is (9.23 +- 0.48) x 10 -10 mol/L, and that in redistilled water is (8.31 +- 0.35) x 10 -10 mol/L; with metallic Fe as a reductant, the solubility of Np(IV) in simulated underground water is (1.85 +- 0.56) x 10 -9 mol/L, and that in redistilled water is (1.48 +- 0.66) x 10 -9 mol/L

  8. Breast cancer staging

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000911.htm Breast cancer staging To use the sharing features on this ... Once your health care team knows you have breast cancer , they will do more tests to stage it. ...

  9. Seven Stages of Alzheimer's

    Science.gov (United States)

    ... Dementias . Learn more: Daily Care and Behaviors Severe Alzheimer's disease (late-stage) Get support Late-stage care decisions can be some of the hardest families face. Connect with other caregivers who have been through the process on our ...

  10. Stages of Adolescence

    Science.gov (United States)

    ... Español Text Size Email Print Share Stages of Adolescence Page Content Article Body Adolescence, these years from puberty to adulthood, may be roughly divided into three stages: early adolescence, generally ages eleven to fourteen; middle adolescence, ages ...

  11. Stage effect of chronic kidney disease in erectile function.

    Science.gov (United States)

    Costa, Márcio Rodrigues; Ponciano, Viviane Campos; Costa, Théo Rodrigues; Gomes, Caio Pereira; de Oliveira, Enio Chaves

    2018-01-01

    The study aims to assess the influence of the stage of chronic kidney disease and glomerular filtration rate on prevalence and degree of erectile dysfunction. This transversal study, conducted from May 2013 to December 2015, included patients with chronic kidney disease in conservative treatment, stages III/IV/V. Erectile dysfunction was evaluated by the International Index of Erectile Function. Data classically associated with erectile dysfunction were obtained by medical record review. Erectile dysfunction, degree of erectile dysfunction, and other main variables associated with erectile dysfunction were compared between patients with chronic kidney disease on conservative treatment stages III versus IV/V using the Chi-square test. The relationship between score of the International Index of Erectile Dysfunction and glomerular filtration rate was established by Pearson correlation coefficient. Two hundred and forty five patients with chronic kidney disease in con-servative treatment participated of the study. The prevalence of erectile dysfunction in patients with chronic kidney disease in stages IV/V was greater than in stage III. Glomerular filtration rate positively correlated with score of the International Index of Erectile Dysfunction. The study suggests that chronic kidney disease progression (glomerular filtration rate decrease and advance in chronic kidney disease stages) worsen erectile function. Hypothetically, diagnosis and treatment of erectile dysfunction may be anticipated with the analysis of chronic kidney disease progression. Copyright® by the International Brazilian Journal of Urology.

  12. Stage effect of chronic kidney disease in erectile function

    Directory of Open Access Journals (Sweden)

    Márcio Rodrigues Costa

    Full Text Available ABSTRACT Purpose The study aims to assess the influence of the stage of chronic kidney disease and glomerular filtration rate on prevalence and degree of erectile dysfunction. Materials and Methods This transversal study, conducted from May 2013 to December 2015, included patients with chronic kidney disease in conservative treatment, stages III/IV/V. Erectile dysfunction was evaluated by the International Index of Erectile Function. Data classically associated with erectile dysfunction were obtained by medical record review. Erectile dysfunction, degree of erectile dysfunction, and other main variables associated with erectile dysfunction were compared between patients with chronic kidney disease on conservative treatment stages III versus IV/V using the Chi-square test. The relationship between score of the International Index of Erectile Dysfunction and glomerular filtration rate was established by Pearson correlation coefficient. Results Two hundred and forty five patients with chronic kidney disease in conservative treatment participated of the study. The prevalence of erectile dysfunction in patients with chronic kidney disease in stages IV/V was greater than in stage III. Glomerular filtration rate positively correlated with score of the International Index of Erectile Dysfunction. Conclusions The study suggests that chronic kidney disease progression (glomerular filtration rate decrease and advance in chronic kidney disease stages worsen erectile function. Hypothetically, diagnosis and treatment of erectile dysfunction may be anticipated with the analysis of chronic kidney disease progression.

  13. Beyond Erikson's Eight Stages.

    Science.gov (United States)

    Whitney, Ruth

    1979-01-01

    Erik Erikson has described eight stages of the healthy personality. This essay offers a revised version of the eight stages. Although most individuals develop through the eight stages, each is personally unique because patterns of fluctuation between safety and growth differ from one individual to another. (Author)

  14. Cervical Cancer Stage IIIA

    Science.gov (United States)

    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IIIA Add to My Pictures View /Download : ... 1275x1275 View Download Large: 2550x2550 View Download Title: Cervical Cancer Stage IIIA Description: Stage IIIA cervical cancer; drawing ...

  15. Cervical Cancer Stage IVA

    Science.gov (United States)

    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IVA Add to My Pictures View /Download : ... 1575x1200 View Download Large: 3150x2400 View Download Title: Cervical Cancer Stage IVA Description: Stage IVA cervical cancer; drawing ...

  16. Cervical Cancer Stage IVB

    Science.gov (United States)

    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IVB Add to My Pictures View /Download : ... 1200x1305 View Download Large: 2400x2610 View Download Title: Cervical Cancer Stage IVB Description: Stage IVB cervical cancer; drawing ...

  17. Cervical Cancer Stage IIIB

    Science.gov (United States)

    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IIIB Add to My Pictures View /Download : ... 1425x1326 View Download Large: 2850x2651 View Download Title: Cervical Cancer Stage IIIB Description: Stage IIIB cervical cancer; drawing ...

  18. Cervical Cancer Stage IB

    Science.gov (United States)

    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IB Add to My Pictures View /Download : ... 1613x1200 View Download Large: 3225x2400 View Download Title: Cervical Cancer Stage IB Description: Stage IB1 and IB2 cervical ...

  19. Cervical Cancer Stage IA

    Science.gov (United States)

    ... historical Searches are case-insensitive Cervical Cancer Stage IA Add to My Pictures View /Download : Small: 720x576 ... Large: 3000x2400 View Download Title: Cervical Cancer Stage IA Description: Stage IA1 and IA2 cervical cancer; drawing ...

  20. ASTRID, Generation IV advanced sodium technological reactor for industrial demonstration

    International Nuclear Information System (INIS)

    Gauche, F.

    2013-01-01

    ASTRID (Advanced Sodium Technological Reactor for Industrial Demonstration) is an integrated technology demonstrator designed to demonstrate the operability of the innovative choices enabling fast neutron reactor technology to meet the Generation IV criteria. ASTRID is a sodium-cooled fast reactor with an electricity generating power of 600 MWe. In order to meet the generation IV goals, ASTRID will incorporate the following decisive innovations: -) an improved core with a very low, even negative void coefficient; -) the possible installation of additional safety devices in the core. For example, passive anti-reactivity insertion devices are explored; -) more core instrumentation; -) an energy conversion system with modular steam generators, to limit the effects of a possible sodium-water reaction, or sodium-nitrogen exchangers; -) considerable thermal inertia combined with natural convection to deal with decay heat; -)elimination of major sodium fires by bunkerization and/or inert atmosphere in the premises; -) to take into account off-site hazards (earthquake, airplane crash,...) right from the design stage; -) a complete rethink of the reactor architecture in order to limit the risk of proliferation. ASTRID will also include systems for reducing the length of refueling outages and increasing the burn-up and the duration of the cycle. In-service inspection, maintenance and repair are also taken into account right from the start of the project. The ASTRID prototype should be operational by about 2023. (A.C.)

  1. Muscle Function in Osteogenesis Imperfecta Type IV.

    Science.gov (United States)

    Veilleux, Louis-Nicolas; Darsaklis, Vasiliki B; Montpetit, Kathleen; Glorieux, Francis H; Rauch, Frank

    2017-10-01

    Results of previous studies suggest that children and adolescents with osteogenesis imperfecta (OI) type IV have muscle force deficits. However, muscle function remains to be objectively quantified in this population. This study aimed to assess upper and lower extremity muscle function in patients with OI type IV. It was carried out in the outpatient department of a pediatric orthopedic hospital; 27 individuals with OI type IV (7-21 years; 13 males), 27 age- and sex-matched individuals with OI type I, and 27 age- and sex-matched controls. Upper extremity muscle force was assessed with hydraulic hand dynamometry, and lower extremity muscle function (peak force per body weight and peak power per body mass) was measured by mechanography through five tests: multiple two-legged hopping, multiple one-legged hopping, single two-legged jump, chair-rise test, and heel-rise test. Upper-limb grip force was normal for patients with OI type IV when compared to height and sex reference data (average z-score = 0.17 ± 1.30; P = 0.88). Compared to age- and sex-matched controls, patients with OI type IV had approximately 30% lower-limb peak force and 50% peak power deficits (P values <0.05). At the lower-limb level, they had a 50% lower peak power than age- and sex-matched patients with OI type I (P < 0.05). Patients with OI type IV have normal upper-limb muscle force but a muscle function deficit at the lower-limb level. These results suggest that lower-limb muscle weakness may contribute to functional deficits in these individuals.

  2. Oxochloroalkoxide of the Cerium (IV and Titanium (IV as oxides precursor

    Directory of Open Access Journals (Sweden)

    Machado Luiz Carlos

    2002-01-01

    Full Text Available The Cerium (IV and Titanium (IV oxides mixture (CeO2-3TiO2 was prepared by thermal treatment of the oxochloroisopropoxide of Cerium (IV and Titanium (IV. The chemical route utilizing the Cerium (III chloride alcoholic complex and Titanium (IV isopropoxide is presented. The compound Ce5Ti15Cl16O30 (iOPr4(OH-Et15 was characterized by elemental analysis, FTIR and TG/DTG. The X-ray diffraction patterns of the oxides resulting from the thermal decomposition of the precursor at 1000 degreesC for 36 h indicated the formation of cubic cerianite (a = 5.417Å and tetragonal rutile (a = 4.592Å and (c = 2.962 Å, with apparent crystallite sizes around 38 and 55nm, respectively.

  3. Vectorization at the KENO-IV code

    International Nuclear Information System (INIS)

    Asai, K.; Higuchi, K.; Katakura, J.

    1986-01-01

    The multigroup criticality safety code KENO-IV has been vectorized and tested on the FACOM VP-100 vector processor. At first, the vectorized KENO-IV on a scalar processor was slower than the original one by a factor of 1.4 because of the overhead introduced by vectorization. Making modifications of algorithms and techniques for vectorization, the vectorized version has become faster than the original one by a factor of 1.4 on the vector processor. For further speedup of the code, some improvements on compiler and hardware, especially on addition of Monte Carlo pipelines to the vector processor, are discussed

  4. Gen IV. Technical and economical aspects

    International Nuclear Information System (INIS)

    Kaluzny, Y.; Legee, F.

    2010-01-01

    In this presentation author deals with development of nuclear reactor type of Generation IV. He concluded that: - Nuclear energy is competitive with regards to the other generation sources; Its competitiveness also increases with CO 2 cost. Considering the nuclear cost breakdown of LWR reactors, it turns out that the uranium is currently not in the range of a threshold for FBR deployment; - The global balance of uranium supply and demand and also innovation required to fulfil GEN IV objectives would probably imply the emergence of fast reactor competitiveness after the turn of the mid-century; - We shall need fast reactors in the coming decade.

  5. Functions in Free-Format RPG IV

    CERN Document Server

    Martin, Jim

    2009-01-01

    Written especially for programmers adopting a free-format style, this manual explores the role of functions in writing RPG IV programs. Demonstrating the potential of functions, many topics are explored such as details about existing RPG IV built-in functions, writing new functions, using ILE concepts to use C functions, and utilizing IBM API's functions. Explaining how to write small programs, either as sub-procedures or modules, and how to gather those parts together to make programs that are easy to write and maintain, this is a natural next step for programmers familiar with a free-format

  6. Mnemonics for DSM-IV personality disorders.

    Science.gov (United States)

    Pinkofsky, H B

    1997-09-01

    The paper presents several mnemonics to assist clinicians in recalling DSM-IV diagnostic criteria for personality disorders. The mnemonics are acronyms, and each letter is associated with a specific criterion. Each acronym reflects a facet of the related disorder; for example, the acronym for the diagnostic criteria for paranoid personality disorder is SUSPECT, and for histrionic personality disorder it is PRAISE ME. The mnemonics have been used to teach students and residents the conceptual nature of DSM-IV disorders and to help them remember the criteria.

  7. Uprated OMS engine for upper stage propulsion

    Science.gov (United States)

    Boyd, William C.

    1986-01-01

    The results of a pre-development component demonstration program on the use of a gas generator-driven turbopump that increases the Space Shuttle's Orbital Maneuvering Engine (OME) operating pressure are given. Tests and analysis confirm the the capability of the concept to meet or exceed performance and life requirements. Storable propellant upper stage concepts are also discussed.

  8. The newly proposed clinical and post-neoadjuvant treatment staging classifications for gastric adenocarcinoma for the American Joint Committee on Cancer (AJCC) staging.

    Science.gov (United States)

    In, Haejin; Ravetch, Ethan; Langdon-Embry, Marisa; Palis, Bryan; Ajani, Jaffer A; Hofstetter, Wayne L; Kelsen, David P; Sano, Takeshi

    2018-01-01

    New stage grouping classifications for clinical (cStage) and post-neoadjuvant treatment (ypStage) stage for gastric adenocarcinoma have been proposed for the eighth edition of the AJCC manual. This article summarizes the analysis for these stages. Gastric adenocarcinoma patients diagnosed in 2004-2009 were identified from the National Cancer Database (NCDB). The cStage cohort included both surgical and nonsurgical cases, and the ypStage cohort included only patients who had chemotherapy or radiation therapy before surgery. Survival differences between the stage groups were determined by the log-rank test and prognostic accuracy was assessed by concordance index. Analysis was performed using SAS 9.4 (SAS, Cary, NC, USA). Five strata for cStage and four strata for ypStage were developed. The 5-year survival rates for cStages were 56.77%, 47.39%, 33.1%, 25.9%, and 5.0% for stages I, IIa, IIb, III, and IV, respectively, and the rates for ypStage were 74.2%, 46.3%, 19.2%, and 11.6% for stages I, II, III, and IV, respectively. The log-rank test showed that survival differences were well stratified and stage groupings were ordered and distinct (p < 0.0001). The proposed cStage and ypStage classification was sensitive and specific and had high prognostic accuracy (cStage: c index = 0.81, 95% CI, 0.79-0.83; ypStage: c index = 0.80, 95% CI, 0.73-0.87). The proposed eighth edition establishes two new staging schemata that provide essential prognostic data for patients before treatment and for patients who have undergone surgery following neoadjuvant therapy. These additions are a significant advance to the AJCC staging manual and will provide critical guidance to clinicians in making informed decisions throughout the treatment course.

  9. Cetuximab, Cisplatin, and Radiation Therapy in Treating Patients With Stage IB, Stage II, Stage III, or Stage IVA Cervical Cancer

    Science.gov (United States)

    2014-12-29

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  10. The Prognostic and Predictive Value of Soluble Type IV Collagen in Colorectal Cancer

    DEFF Research Database (Denmark)

    Rolff, Hans Christian; Christensen, Ib Jarle; Vainer, Ben

    2016-01-01

    PURPOSE: To investigate the prognostic and predictive biomarker value of type IV collagen in colorectal cancer. EXPERIMENTAL DESIGN: Retrospective evaluation of two independent cohorts of patients with colorectal cancer included prospectively in 2004-2005 (training set) and 2006-2008 (validation...... and validation set, respectively. The prognostic impact was present both in patients with metastatic and nonmetastatic disease. The predictive value of the marker was investigated in stage II and III patients. In the training set, type IV collagen was prognostic both in the subsets of patients receiving...... set). Plasma samples were available from 297 (training set) and 482 (validation set) patients. Type IV collagen determinations were performed using an ELISA. From the training set, 222 tumors were available for IHC. Clinical and follow-up data were retrieved from patient files and national registries...

  11. Industrial Waste Landfill IV upgrade package

    Energy Technology Data Exchange (ETDEWEB)

    1994-03-29

    The Y-12 Plant, K-25 Site, and ORNL are managed by DOE`s Operating Contractor (OC), Martin Marietta Energy Systems, Inc. (Energy Systems) for DOE. Operation associated with the facilities by the Operating Contractor and subcontractors, DOE contractors and the DOE Federal Building result in the generation of industrial solid wastes as well as construction/demolition wastes. Due to the waste streams mentioned, the Y-12 Industrial Waste Landfill IV (IWLF-IV) was developed for the disposal of solid industrial waste in accordance to Rule 1200-1-7, Regulations Governing Solid Waste Processing and Disposal in Tennessee. This revised operating document is a part of a request for modification to the existing Y-12 IWLF-IV to comply with revised regulation (Rule Chapters 1200-1-7-.01 through 1200-1-7-.08) in order to provide future disposal space for the ORR, Subcontractors, and the DOE Federal Building. This revised operating manual also reflects approved modifications that have been made over the years since the original landfill permit approval. The drawings referred to in this manual are included in Drawings section of the package. IWLF-IV is a Tennessee Department of Environmental and Conservation/Division of Solid Waste Management (TDEC/DSWM) Class 11 disposal unit.

  12. Industrial Waste Landfill IV upgrade package

    International Nuclear Information System (INIS)

    1994-01-01

    The Y-12 Plant, K-25 Site, and ORNL are managed by DOE's Operating Contractor (OC), Martin Marietta Energy Systems, Inc. (Energy Systems) for DOE. Operation associated with the facilities by the Operating Contractor and subcontractors, DOE contractors and the DOE Federal Building result in the generation of industrial solid wastes as well as construction/demolition wastes. Due to the waste streams mentioned, the Y-12 Industrial Waste Landfill IV (IWLF-IV) was developed for the disposal of solid industrial waste in accordance to Rule 1200-1-7, Regulations Governing Solid Waste Processing and Disposal in Tennessee. This revised operating document is a part of a request for modification to the existing Y-12 IWLF-IV to comply with revised regulation (Rule Chapters 1200-1-7-.01 through 1200-1-7-.08) in order to provide future disposal space for the ORR, Subcontractors, and the DOE Federal Building. This revised operating manual also reflects approved modifications that have been made over the years since the original landfill permit approval. The drawings referred to in this manual are included in Drawings section of the package. IWLF-IV is a Tennessee Department of Environmental and Conservation/Division of Solid Waste Management (TDEC/DSWM) Class 11 disposal unit

  13. Reexamination of uranium (IV) phosphate chemistry

    International Nuclear Information System (INIS)

    During the past 40 years, few papers concerning uranium (IV) phosphate chemistry have been cited as references in usual textbooks and nobody, up to now, has questioned their veracity. In recent studies on uranium (IV) phosphates, the author's found that some of them, like U 3 (PO 4 ) 4 , do not exist or, like (U 2 O 3 )P 2 O 7 , were wrongly identified. Thus, the reinvestigation of uranium(IV) phosphates was decided to be necessary. Some new compounds were prepared and identified. From previously published results, this paper draws up a balance sheet of the scope concerning the complete understanding of the chemistry of tetravalent uranium phosphates. This new approach is given in terms of a survey of the literature errors to set the facts in their true light. Two synoptic schemes are given to bring forward evidence of new compounds, U(UO 2 )(PO 4 ) 2 and U 2 O(PO 4 ) 2 , which appear to be significant in the chemistry of uranium (IV) phosphates

  14. Bis(4-methylpiperidinium hexachloridostannate(IV

    Directory of Open Access Journals (Sweden)

    Madeleine Helliwell

    2008-04-01

    Full Text Available The crystal structure of the title compound, (C6H14N2[SnCl6], is built of 4-methylpiperidinium cations, occupying special positions on the mirror plane, and hexachloridostannate(IV anions on a special position of 2/m symmetry. The ions are linked via N—H...Cl hydrogen bonds into chains running along the b axis.

  15. Painlevé IV coherent states

    Energy Technology Data Exchange (ETDEWEB)

    Bermudez, David, E-mail: david.bermudez@weizmann.ac.il [Department of Physics of Complex Systems, Weizmann Institute of Science, Rehovot 76100 (Israel); Departamento de Física, Cinvestav, A.P. 14-740, 07000 México D.F. (Mexico); Contreras-Astorga, Alonso, E-mail: aloncont@iun.edu [Department of Mathematics and Actuarial Science, Indiana University Northwest, 3400 Broadway, Gary IN 46408 (United States); Departamento de Física, Cinvestav, A.P. 14-740, 07000 México D.F. (Mexico); Fernández C, David J., E-mail: david@fis.cinvestav.mx [Departamento de Física, Cinvestav, A.P. 14-740, 07000 México D.F. (Mexico)

    2014-11-15

    A simple way to find solutions of the Painlevé IV equation is by identifying Hamiltonian systems with third-order differential ladder operators. Some of these systems can be obtained by applying supersymmetric quantum mechanics (SUSY QM) to the harmonic oscillator. In this work, we will construct families of coherent states for such subset of SUSY partner Hamiltonians which are connected with the Painlevé IV equation. First, these coherent states are built up as eigenstates of the annihilation operator, then as displaced versions of the extremal states, both involving the related third-order ladder operators, and finally as extremal states which are also displaced but now using the so called linearized ladder operators. To each SUSY partner Hamiltonian corresponds two families of coherent states: one inside the infinite subspace associated with the isospectral part of the spectrum and another one in the finite subspace generated by the states created through the SUSY technique. - Highlights: • We use SUSY QM to obtain Hamiltonians with third-order differential ladder operators. • We show that these systems are related with the Painlevé IV equation. • We apply different definitions of coherent states to these Hamiltonians using the third-order ladder operators and some linearized ones. • We construct families of coherent states for such systems, which we called Painlevé IV coherent states.

  16. Genetics Home Reference: mucopolysaccharidosis type IV

    Science.gov (United States)

    ... build up inside the lysosomes are called lysosomal storage disorders. In MPS IV, GAGs accumulate to toxic levels ... clinical manifestation and natural course of Morquio A disease. J Inherit Metab Dis. 2007 ... and Morquio B patients. J Lipid Res. 2007 Oct;48(10):2275-82. Epub ...

  17. Painlevé IV coherent states

    International Nuclear Information System (INIS)

    Bermudez, David; Contreras-Astorga, Alonso; Fernández C, David J.

    2014-01-01

    A simple way to find solutions of the Painlevé IV equation is by identifying Hamiltonian systems with third-order differential ladder operators. Some of these systems can be obtained by applying supersymmetric quantum mechanics (SUSY QM) to the harmonic oscillator. In this work, we will construct families of coherent states for such subset of SUSY partner Hamiltonians which are connected with the Painlevé IV equation. First, these coherent states are built up as eigenstates of the annihilation operator, then as displaced versions of the extremal states, both involving the related third-order ladder operators, and finally as extremal states which are also displaced but now using the so called linearized ladder operators. To each SUSY partner Hamiltonian corresponds two families of coherent states: one inside the infinite subspace associated with the isospectral part of the spectrum and another one in the finite subspace generated by the states created through the SUSY technique. - Highlights: • We use SUSY QM to obtain Hamiltonians with third-order differential ladder operators. • We show that these systems are related with the Painlevé IV equation. • We apply different definitions of coherent states to these Hamiltonians using the third-order ladder operators and some linearized ones. • We construct families of coherent states for such systems, which we called Painlevé IV coherent states

  18. A comparative study of the reactivity of Zr(IV), Hf(IV) and Th(IV) metallocene complexes: Thorium is not a Group IV metal after all

    International Nuclear Information System (INIS)

    Jantunen, Kimberly C.; Scott, Brian L.; Kiplinger, Jaqueline L.

    2007-01-01

    Thorium(IV) is often considered to show similar chemistry to Group IV transition metals. However, studies in our laboratory have shown that this generalization is incorrect. This report presents direct comparisons where the Th(IV) metallocene complexes (C 5 Me 5 ) 2 ThR 2 (R = CH 3 , Ph, CH 2 Ph) undergo unique chemical reactivity with pyridine, 2-picoline, pyridine N-oxide, 2-picoline N-oxide, and benzonitrile, while the Group IV metal analogues (C 5 R 5 ) 2 M(CH 3 ) 2 (R = H, CH 3 ; M = Zr, Hf) do not. We also report revised high-yield syntheses for the zirconium and hafnium starting materials, (C 5 H 5 ) 2 MR 2 (M = Zr, Hf; R = CH 3 , Ph, CH 2 Ph), using Grignard reagents for alkylation in addition to the X-ray crystal structures of (C 5 H 5 ) 2 Hf(Ph) 2 and (C 5 H 5 ) 2 Hf(CH 2 Ph) 2

  19. A comparative study of the reactivity of Zr(IV), Hf(IV) and Th(IV) metallocene complexes: Thorium is not a Group IV metal after all

    Energy Technology Data Exchange (ETDEWEB)

    Jantunen, Kimberly C.; Scott, Brian L. [Los Alamos National Laboratory, Mail Stop J514, Los Alamos, NM 87545 (United States); Kiplinger, Jaqueline L. [Los Alamos National Laboratory, Mail Stop J514, Los Alamos, NM 87545 (United States)], E-mail: kiplinger@lanl.gov

    2007-10-11

    Thorium(IV) is often considered to show similar chemistry to Group IV transition metals. However, studies in our laboratory have shown that this generalization is incorrect. This report presents direct comparisons where the Th(IV) metallocene complexes (C{sub 5}Me{sub 5}){sub 2}ThR{sub 2} (R = CH{sub 3}, Ph, CH{sub 2}Ph) undergo unique chemical reactivity with pyridine, 2-picoline, pyridine N-oxide, 2-picoline N-oxide, and benzonitrile, while the Group IV metal analogues (C{sub 5}R{sub 5}){sub 2}M(CH{sub 3}){sub 2} (R = H, CH{sub 3}; M = Zr, Hf) do not. We also report revised high-yield syntheses for the zirconium and hafnium starting materials, (C{sub 5}H{sub 5}){sub 2}MR{sub 2} (M = Zr, Hf; R = CH{sub 3}, Ph, CH{sub 2}Ph), using Grignard reagents for alkylation in addition to the X-ray crystal structures of (C{sub 5}H{sub 5}){sub 2}Hf(Ph){sub 2} and (C{sub 5}H{sub 5}){sub 2}Hf(CH{sub 2}Ph){sub 2}.

  20. Leveraging Information Technology. Track IV: Support Services.

    Science.gov (United States)

    CAUSE, Boulder, CO.

    Seven papers from the 1987 CAUSE conference's Track IV, Support Services, are presented. They include: "Application Development Center" (John F. Leydon); "College Information Management System: The Design and Implementation of a Completely Integrated Office Automation and Student Information System" (Karen L. Miselis);…

  1. Gen IV Materials Handbook Implementation Plan

    International Nuclear Information System (INIS)

    Rittenhouse, P.; Ren, W.

    2005-01-01

    A Gen IV Materials Handbook is being developed to provide an authoritative single source of highly qualified structural materials information and materials properties data for use in design and analyses of all Generation IV Reactor Systems. The Handbook will be responsive to the needs expressed by all of the principal government, national laboratory, and private company stakeholders of Gen IV Reactor Systems. The Gen IV Materials Handbook Implementation Plan provided here addresses the purpose, rationale, attributes, and benefits of the Handbook and will detail its content, format, quality assurance, applicability, and access. Structural materials, both metallic and ceramic, for all Gen IV reactor types currently supported by the Department of Energy (DOE) will be included in the Gen IV Materials Handbook. However, initial emphasis will be on materials for the Very High Temperature Reactor (VHTR). Descriptive information (e.g., chemical composition and applicable technical specifications and codes) will be provided for each material along with an extensive presentation of mechanical and physical property data including consideration of temperature, irradiation, environment, etc. effects on properties. Access to the Gen IV Materials Handbook will be internet-based with appropriate levels of control. Information and data in the Handbook will be configured to allow search by material classes, specific materials, specific information or property class, specific property, data parameters, and individual data points identified with materials parameters, test conditions, and data source. Details on all of these as well as proposed applicability and consideration of data quality classes are provided in the Implementation Plan. Website development for the Handbook is divided into six phases including (1) detailed product analysis and specification, (2) simulation and design, (3) implementation and testing, (4) product release, (5) project/product evaluation, and (6) product

  2. Gen IV Materials Handbook Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    Rittenhouse, P.; Ren, W.

    2005-03-29

    A Gen IV Materials Handbook is being developed to provide an authoritative single source of highly qualified structural materials information and materials properties data for use in design and analyses of all Generation IV Reactor Systems. The Handbook will be responsive to the needs expressed by all of the principal government, national laboratory, and private company stakeholders of Gen IV Reactor Systems. The Gen IV Materials Handbook Implementation Plan provided here addresses the purpose, rationale, attributes, and benefits of the Handbook and will detail its content, format, quality assurance, applicability, and access. Structural materials, both metallic and ceramic, for all Gen IV reactor types currently supported by the Department of Energy (DOE) will be included in the Gen IV Materials Handbook. However, initial emphasis will be on materials for the Very High Temperature Reactor (VHTR). Descriptive information (e.g., chemical composition and applicable technical specifications and codes) will be provided for each material along with an extensive presentation of mechanical and physical property data including consideration of temperature, irradiation, environment, etc. effects on properties. Access to the Gen IV Materials Handbook will be internet-based with appropriate levels of control. Information and data in the Handbook will be configured to allow search by material classes, specific materials, specific information or property class, specific property, data parameters, and individual data points identified with materials parameters, test conditions, and data source. Details on all of these as well as proposed applicability and consideration of data quality classes are provided in the Implementation Plan. Website development for the Handbook is divided into six phases including (1) detailed product analysis and specification, (2) simulation and design, (3) implementation and testing, (4) product release, (5) project/product evaluation, and (6) product

  3. Ehlers-Danlos syndrome type IV

    Science.gov (United States)

    Germain, Dominique P

    2007-01-01

    Ehlers-Danlos syndrome type IV, the vascular type of Ehlers-Danlos syndromes (EDS), is an inherited connective tissue disorder defined by characteristic facial features (acrogeria) in most patients, translucent skin with highly visible subcutaneous vessels on the trunk and lower back, easy bruising, and severe arterial, digestive and uterine complications, which are rarely, if at all, observed in the other forms of EDS. The estimated prevalence for all EDS varies between 1/10,000 and 1/25,000, EDS type IV representing approximately 5 to 10% of cases. The vascular complications may affect all anatomical areas, with a tendency toward arteries of large and medium diameter. Dissections of the vertebral arteries and the carotids in their extra- and intra-cranial segments (carotid-cavernous fistulae) are typical. There is a high risk of recurrent colonic perforations. Pregnancy increases the likelihood of a uterine or vascular rupture. EDS type IV is inherited as an autosomal dominant trait that is caused by mutations in the COL3A1 gene coding for type III procollagen. Diagnosis is based on clinical signs, non-invasive imaging, and the identification of a mutation of the COL3A1 gene. In childhood, coagulation disorders and Silverman's syndrome are the main differential diagnoses; in adulthood, the differential diagnosis includes other Ehlers-Danlos syndromes, Marfan syndrome and Loeys-Dietz syndrome. Prenatal diagnosis can be considered in families where the mutation is known. Choriocentesis or amniocentesis, however, may entail risk for the pregnant woman. In the absence of specific treatment for EDS type IV, medical intervention should be focused on symptomatic treatment and prophylactic measures. Arterial, digestive or uterine complications require immediate hospitalisation, observation in an intensive care unit. Invasive imaging techniques are contraindicated. Conservative approach is usually recommended when caring for a vascular complication in a patient suffering

  4. Ehlers-Danlos syndrome type IV

    Directory of Open Access Journals (Sweden)

    Germain Dominique P

    2007-07-01

    Full Text Available Abstract Ehlers-Danlos syndrome type IV, the vascular type of Ehlers-Danlos syndromes (EDS, is an inherited connective tissue disorder defined by characteristic facial features (acrogeria in most patients, translucent skin with highly visible subcutaneous vessels on the trunk and lower back, easy bruising, and severe arterial, digestive and uterine complications, which are rarely, if at all, observed in the other forms of EDS. The estimated prevalence for all EDS varies between 1/10,000 and 1/25,000, EDS type IV representing approximately 5 to 10% of cases. The vascular complications may affect all anatomical areas, with a tendency toward arteries of large and medium diameter. Dissections of the vertebral arteries and the carotids in their extra- and intra-cranial segments (carotid-cavernous fistulae are typical. There is a high risk of recurrent colonic perforations. Pregnancy increases the likelihood of a uterine or vascular rupture. EDS type IV is inherited as an autosomal dominant trait that is caused by mutations in the COL3A1 gene coding for type III procollagen. Diagnosis is based on clinical signs, non-invasive imaging, and the identification of a mutation of the COL3A1 gene. In childhood, coagulation disorders and Silverman's syndrome are the main differential diagnoses; in adulthood, the differential diagnosis includes other Ehlers-Danlos syndromes, Marfan syndrome and Loeys-Dietz syndrome. Prenatal diagnosis can be considered in families where the mutation is known. Choriocentesis or amniocentesis, however, may entail risk for the pregnant woman. In the absence of specific treatment for EDS type IV, medical intervention should be focused on symptomatic treatment and prophylactic measures. Arterial, digestive or uterine complications require immediate hospitalisation, observation in an intensive care unit. Invasive imaging techniques are contraindicated. Conservative approach is usually recommended when caring for a vascular

  5. Talimogene Laherparepvec in Combination With Ipilimumab in Previously Untreated, Unresectable Stage IIIB-IV Melanoma.

    Science.gov (United States)

    Puzanov, Igor; Milhem, Mohammed M; Minor, David; Hamid, Omid; Li, Ai; Chen, Lisa; Chastain, Michael; Gorski, Kevin S; Anderson, Abraham; Chou, Jeffrey; Kaufman, Howard L; Andtbacka, Robert H I

    2016-08-01

    Combining immunotherapeutic agents with different mechanisms of action may enhance efficacy. We describe the safety and efficacy of talimogene laherparepvec (T-VEC; an oncolytic virus) in combination with ipilimumab (a cytotoxic T-lymphocyte-associated antigen 4 checkpoint inhibitor) in patients with advanced melanoma. In this open-label, multicenter, phase Ib trial of T-VEC in combination with ipilimumab, T-VEC was administered intratumorally in week 1 (10(6) plaque-forming units/mL), then in week 4 and every 2 weeks thereafter (10(8) plaque-forming units/mL). Ipilimumab (3 mg/kg) was administered intravenously every 3 weeks for four infusions, beginning in week 6. The primary end point was incidence of dose-limiting toxicities. Secondary end points were objective response rate by immune-related response criteria and safety. Median duration of treatment with T-VEC was 13.3 weeks (range, 2.0 to 95.4 weeks). Median follow-up time for survival analysis was 20.0 months (1.0 to 25.4 months). Nineteen patients were included in the safety analysis. No dose-limiting toxicities occurred, and no new safety signals were detected. Grade 3/4 treatment-related adverse events (AEs) were seen in 26.3% of patients; 15.8% had AEs attributed to T-VEC, and 21.1% had AEs attributed to ipilimumab. The objective response rate was 50%, and 44% of patients had a durable response lasting ≥ 6 months. Eighteen-month progression-free survival was 50%; 18-month overall survival was 67%. T-VEC with ipilimumab had a tolerable safety profile, and the combination appeared to have greater efficacy than either T-VEC or ipilimumab monotherapy. © 2016 by American Society of Clinical Oncology.

  6. Phase II study of ipilimumab in adolescents with unresectable stage III or IV malignant melanoma

    DEFF Research Database (Denmark)

    Geoerger, Birgit; Bergeron, Christophe; Gore, Lia

    2017-01-01

    BACKGROUND: Ipilimumab is approved for the treatment of advanced melanoma in adults; however, little information on the efficacy and safety of ipilimumab in younger patients is available. METHODS: Patients aged 12 to ... malignant melanoma received ipilimumab 3 or 10 mg/kg every 3 weeks. Primary end-points were 1-year overall survival and safety. RESULTS: Over a period of 3.5 years, 12 patients received ipilimumab at either 3 mg/kg (n = 4) or 10 mg/kg (n = 8). The median number of ipilimumab doses was four for 3 mg....... There was one grade 3/4 immune-mediated adverse reaction with 3 mg/kg and five with 10 mg/kg. There were no treatment-related deaths. The study was stopped due to slow accrual. CONCLUSIONS: At >1 year follow-up, ipilimumab demonstrated activity in melanoma patients aged 12 to safety...

  7. Adjuvant Nivolumab versus Ipilimumab in Resected Stage III or IV Melanoma

    NARCIS (Netherlands)

    Weber, J.; Mandala, M.; Vecchio, M.; Gogas, H.J.; Arance, A.M.; Cowey, C.L.; Dalle, S.; Schenker, M.; Chiarion-Sileni, V.; Marquez-Rodas, I.; Grob, J.J.; Butler, M.O.; Middleton, M.R.; Maio, M.; Atkinson, V.; Queirolo, P.; Gonzalez, R.; Kudchadkar, R.R.; Smylie, M.; Meyer, N.; Mortier, L.; Atkins, M.B.; Long, G.V.; Bhatia, S.; Lebbe, C.; Rutkowski, P.; Yokota, K.; Yamazaki, N.; Kim, T.M.; Pril, V. de; Sabater, J.; Qureshi, A.; Larkin, J.; Ascierto, P.A.; Koornstra, R.H.; et al.,

    2017-01-01

    BACKGROUND: Nivolumab and ipilimumab are immune checkpoint inhibitors that have been approved for the treatment of advanced melanoma. In the United States, ipilimumab has also been approved as adjuvant therapy for melanoma on the basis of recurrence-free and overall survival rates that were higher

  8. EGFR mutation positive stage IV non-small-cell lung cancer : Treatment beyond progression

    Directory of Open Access Journals (Sweden)

    Katrijn eVan Assche

    2014-12-01

    Full Text Available Non-small-cell lung cancer (NSCLC is the leading cause of death from cancer for both men en women. Chemotherapy is the mainstay of treatment in advanced disease, but is only marginally effective. In about 30% of patients with advanced NSCLC in East Asia and in 10-15% in Western countries, EGFR mutations are found. In this population, first-line treatment with the tyrosine kinase inhibitors (TKI erlotinib, gefitinib or afatinib is recommended. The treatment beyond progression is less well-defined. In this paper we present 3 patients, EGFR mutation positive, with local progression after an initial treatment with TKI. These patients were treated with local radiotherapy. TKI was temporarily stopped and restarted after radiotherapy. We give an overview of the literature and discuss the different treatment options in case of progression after TKI: TKI continuation with or without chemotherapy, TKI continuation with local therapy, alternative dosing or switch to next-generation TKI or combination therapy. There are different options for treatment beyond progression in EGFR mutation positive metastatic NSCLC, but the optimal strategy is still to be defined. Further research on this topic is ongoing.

  9. First-Line Nivolumab in Stage IV or Recurrent Non-Small-Cell Lung Cancer.

    NARCIS (Netherlands)

    Carbone, D.P.; Reck, M.; Paz-Ares, L.; Creelan, B.; Horn, L.; Steins, M.; Felip, E.; Heuvel, M. van den; Ciuleanu, T.E.; Badin, F.; Ready, N.; Hiltermann, T.J.N.; Nair, S.; Juergens, R.; Peters, S.; Minenza, E.; Wrangle, J.M.; Rodriguez-Abreu, D.; Borghaei, H.; umenschein GR, J.r. Bl; Villaruz, L.C.; Havel, L.; Krejci, J.; rral Jaime, J. Co; Chang, H.; Geese, W.J.; Bhagavatheeswaran, P.; Chen, A.C.; Socinski, M.A.

    2017-01-01

    BACKGROUND: Nivolumab has been associated with longer overall survival than docetaxel among patients with previously treated non-small-cell lung cancer (NSCLC). In an open-label phase 3 trial, we compared first-line nivolumab with chemotherapy in patients with programmed death ligand 1

  10. Structural Analysis via Generalized Interactive Graphics - STAGING. Volume IV. Appendices to System Manual.

    Science.gov (United States)

    1979-09-01

    CLASS: MAIN SEGMENT: (DE3) OESC; P,<OCFSS STEP FOR DEFORMED MODE LENGTH: c3 LANGUAGES FTN HAS 140 SECO D - EiTtY POINTS CAN 9E ALL D F3Y: CAN CALL THE...DESCI PROCESS NAME TYPE-IN TO CREATE A NEW BEAD LENGTHS 64 LANGUAGE: FIN HAS NO SECOIDARY ENTRY POINTS CAN dE CALLEO aYt bETA -OLE. . CAN CALL THE... XIDAT CAN CALL THE FOLLOWING: - - roBL~r__lD3NAM 10D6A0B -I DRWAT ENTRY’-CL ASSf-MA IN- -- - SEGMENTI (M820) DESCI DRAW BEAU AND ADD THE ATTRIaUTE

  11. Refeeding syndrome in a vegan patient with stage IV gastric cancer: a novel case.

    Science.gov (United States)

    Brown, Teresa V; Moss, Rebecca A

    2015-03-01

    The refeeding syndrome encompasses the complex physiologic state that occurs in malnourished patients who receive nutrition after a period of decreased oral intake. The hallmark of the syndrome is hypophosphatemia, though other electrolyte imbalances and severe fluid shifts are commonly involved. Patients with newly diagnosed malignancies and those undergoing treatment for malignancies are at increased risk for developing the refeeding syndrome, however there are few reported cases or other data in the oncology literature regarding this syndrome in cancer patients. ©2015 Frontline Medical Communications.

  12. IL-21 Modulates Activation of NKT Cells in Patients with Stage IV Malignant Melanoma.

    Science.gov (United States)

    Coquet, Jonathan M; Skak, Kresten; Davis, Ian D; Smyth, Mark J; Godfrey, Dale I

    2013-10-01

    Interleukin-21 (IL-21) is a common γ-chain cytokine produced by T helper and natural killer T (NKT) cells. It has been shown to regulate the response of various lymphocyte subsets including NK, NKT, T and B cells. Owing to its potent anti-tumor function in preclinical studies and its ability to induce cytotoxicity and interferon-γ (IFN-γ) production in NK and CD8 T cells, recombinant IL-21 (rIL-21) was fast-tracked into early-phase clinical trials of patients with various malignancies. In a phase 2a trial of patients with metastatic melanoma, we analyzed the frequency and function of NKT cells in patients receiving rIL-21. NKT cells were present at a low frequency, but their levels were relatively stable in patients administered rIL-21. Unlike our observations in NK and CD8 T cells, rIL-21 appeared to reduce IFN-γ and TNF production by NKT cells, whereas it enhanced IL-4 production. It also modulated the expression of cell surface markers, specifically on CD4(-) NKT cells. In addition, an increase in CD3(+)CD56(+) NKT-like cells was observed over the course of rIL-21 administration. These results highlight that IL-21 is a potent regulator of NKT cell function in vivo.

  13. [A case of Stage IV sigmoid colon cancer cured with radical combined modality therapy].

    Science.gov (United States)

    Babaya, Akihito; Fukunaga, Mutsumi; Yamamoto, Tameyoshi; Oda, Kazuyuki; Nakata, Ken; Ohzato, Hiroki

    2013-11-01

    The patient was a 54-year-old man who had undergone resection of the sigmoid colon for unresectable sigmoid colon cancer with multiple liver( H1), lymph node, and lung metastases at the previous hospital. Chemotherapy with 5-fuorouracil, Leucovorin, and oxaliplatin (mFOLFOX6) plus bevacizumab was initiated after surgery. The outcome was partial response. The patient was introduced to our hospital because he had relocated. Based on the findings of the patient's computed tomography( CT) and positron emission tomography( PET)-CT scans, we decided to perform radical resection. We performed partial hepatectomy( S7 and S8) and pancreatoduodenectomy for metastases to the hepatoduodenal ligament lymph node. After confirming that there was no recurrence, he underwent right partial pneumonectomy. Currently, the patient shows no signs of recurrence. The therapy for colon cancer should include aggressive radical surgery to control metastasis.

  14. Immunological correlates of treatment and response in stage IV malignant melanoma patients treated with Ipilimumab

    DEFF Research Database (Denmark)

    Bjoern, Jon; Juul Nitschke, Nikolaj; Zeeberg Iversen, Trine

    2016-01-01

    with treatment failure, though not significantly. Levels of IL6 in serum above the median showed a tendency to associate with reduced survival by the 4th treatment series. Finally, treatment with Ipilimumab led to a decreased frequency of FOXP3+ regulatory T cells (p = 0.009). Conclusion: Ipilimumab leads...

  15. Relationships between dysphagia and tongue pressure during swallowing in Parkinson's disease patients.

    Science.gov (United States)

    Minagi, Y; Ono, T; Hori, K; Fujiwara, S; Tokuda, Y; Murakami, K; Maeda, Y; Sakoda, S; Yokoe, M; Mihara, M; Mochizuki, H

    2018-03-25

    Although dysphagia is a life-threatening problem in patients with Parkinson's disease (PD), the pathophysiology of oropharyngeal dysphagia is yet to be understood. This study investigated the tongue motor function during swallowing in relation to dysphagia and the severity of PD. Thirty patients with PD (14 males and 16 females; average age, 69.4 years), Hoehn and Yahr stage II-IV, in Osaka University Hospital are participated in this study. During swallowing 5 ml of water, tongue pressure on the hard palate was measured using a sensor sheet with 5 measuring points. The maximal tongue pressure at each measuring point during swallowing was compared between patients with PD and healthy controls. Subjective assessment of oropharyngeal dysphagia was performed using Swallowing Disturbance Questionnaire-Japanese. The maximal tongue pressure at each measuring point was significantly lower in patients with PD than in healthy controls (8 males and 12 females; average age, 71.6 years). Furthermore, the maximal tongue pressure was significantly lower in dysphagic PD patients than non-dysphagic PD patients. Loss of tongue pressure production at the anterior part of the hard palate was strongly related to dysphagia in the oral phase as well as in the pharyngeal phase. An abnormal pattern of tongue pressure production was more frequently observed in dysphagic PD patients than in non-dysphagic PD patients. The results suggest that tongue pressure measurement might be useful for early and quantitative detection of tongue motor disability during swallowing in patients with PD. © 2018 John Wiley & Sons Ltd.

  16. Multiple stage railgun

    International Nuclear Information System (INIS)

    Aaland, K.; Hawke, R.S.; Scudder, J.K.

    1982-01-01

    A multiple stage magnetic railgun accelerator for accelerating a projectile by movement of a plasma arc along the rails. The railgun is divided into a plurality of successive rail stages which are sequentially energized by separate energy sources as the projectile moves through the bore of the railgun. Propagation of energy from an energized rail stage back towards the breech end of the railgun can be prevented by connection of the energy sources to the rails through isolation diodes. Propagation of energy from an energized rail stage back towards the breech end of the railgun can also be prevented by dividing the rails into electrically isolated rail sections. In such case means are used to extinguish the arc at the end of each energized stage and a fuse or laser device is used to initiate a new plasma arc in the next energized rail stage

  17. [Inspiratory muscle training followed by non-invasive positive pressure ventilation in patients with severe chronic obstructive pulmonary disease: a randomized controlled trial].

    Science.gov (United States)

    Zhou, Lu-Qian; Li, Xiao-Ying; Li, Yun; Guo, Bing-Peng; Guan, Li-Li; Chen, Xin; Luo, Yu-Wen; Luo, Peng; Chen, Rong-Chang

    2016-08-20

    To investigate the effects of inspiratory muscle training followed by non-invasive positive pressure ventilation in patients with severe chronic obstructive pulmonary disease (COPD). This investigator-initiated randomized, controlled trial recruited 88 patients with stable GOLD stage IV COPD, who were randomized into 4 equal groups to continue oxygen therapy (control group) or to receive inspiratory muscle training followed by non-invasive positive pressure ventilation (IMT-NPPV group), inspiratory muscle training only (IMT group), or noninvasive positive pressure ventilation only (NPPV group) for at least 8 weeks. The outcomes of the patients were assessed including the quality of life (SRI scores), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), dyspnea (MRC scores), 6-min walking distance (6MWD) and lung function. s Compared to baseline values, SRI scores, 6MWT and MRC scores increased significantly after 8 weeks in IMT-NPPV, IMT and NPPV groups, and the improvements were significantly greater in IMT-NPPV group than in IMT and NPPV groups (Ptraining (P0.05). Inspiratory muscle training followed by non-invasive positive pressure ventilation, compared with inspiratory muscle training or non-invasive positive pressure ventilation alone, can better enhance the quality of life, strengthen the respiratory muscles, improve exercise tolerance and relieve the dyspnea in patients with COPD.

  18. An In Vitro Assessment of the Efficacy of Various IV Cannulas for the Rapid IV Fluid Administration.

    Science.gov (United States)

    Kamata, Mineto; Walia, Hina; Hakim, Mumin; Tumin, Dmitry; Tobias, Joseph D

    2017-05-01

    The current study prospectively evaluates the administration of fluid through commonly used vascular cannulas of various length and diameter. Observational, in vitro experiment. Not applicable. No human subjects. None. Fluid (500 mL) was administered via gravity flow and with pressure assistance (pressure bag set at 300 mm Hg) through various vascular cannulas including peripheral IV catheters (22 gauge, 1 inch; 20 gauge, 1.16 and 1.88 inch; and 18 gauge, 1.16 and 1.88 inch), 3-Fr central line lumens (lengths 50, 80, and 120 mm), and a 4-Fr, 10 cm Micropuncture catheter (Cook Medical, Bloomington, IN). During gravity flow, drain time decreased by approximately 50% when moving from a 22 to 20 to 18 gauge cannula and increased by approximately 20% as the catheter length increased from 50 to 80 to 120 cm. Flow rates were highest with the Micropuncture catheter, which achieved a drain time of 2.7 minutes for the 500 mL bag when infused with pressure assistance. In general, the delivery of crystalloid solutions through commonly used vascular cannulas was fastest with larger diameter and shorter length cannulas. Pressure-assisted flow was able to partially compensate for the increased resistance with smaller and longer catheters. The unique design of the tip of the Micropuncture catheter compensated for the increased length and allowed for rapid fluid delivery. This design may compensate for the increased length when longer catheters are needed for ultrasound-guided placement.

  19. Turbine stage model

    International Nuclear Information System (INIS)

    Kazantsev, A.A.

    2009-01-01

    A model of turbine stage for calculations of NPP turbine department dynamics in real time was developed. The simulation results were compared with manufacturer calculations for NPP low-speed and fast turbines. The comparison results have shown that the model is valid for real time simulation of all modes of turbines operation. The model allows calculating turbine stage parameters with 1% accuracy. It was shown that the developed turbine stage model meets the accuracy requirements if the data of turbine blades setting angles for all turbine stages are available [ru

  20. The Role of Type IV Collagen in Developing Lens in Mouse Fetuses

    Directory of Open Access Journals (Sweden)

    Mehdi Jalali

    2009-09-01

    Full Text Available Objective(sExtracellular matrix (ECM and basement membrane (BM play important roles in many developmental processes during development and after birth. Among the components of the BM, collagen fibers specially type IV are the most important parts. The aim of this study was to determine the time when collagen type IV appears in the BM of lens structure during mouse embryonic development.Materials and MethodsIn this experimental study, 22 female Balb/C mice were randomly selected and were kept under normal condition, finding vaginal plug was assumed as day zero of pregnancy. From embryonic day 10 to 20, all specimens were sacrificed by cervical dislocation and their heads were fixed, serially sectioned and immunohistochemistry study for tracing collagen type IV in lens were carried out.ResultsOur data revealed that collagen type IV appeared at the early stage of gestation day 12 in BM of anterior epithelial lens cells and the amount of this protein gradually increased until days 15-17 in ECM and posterior capsule epithelium. After this period, severe reaction was not observed in any part of the lens.ConclusionThese findings establish the important role of collagen IV in developing optic cup and any changes during critical period of pregnancy may be result in severe visual system defect

  1. On the stabilization of niobium(V) solutions by zirconium(IV) and hafnium(IV)

    DEFF Research Database (Denmark)

    Sørensen, E.; Bjerre, A.B.

    1992-01-01

    Niobium cannot be separated from zirconium or hafnium when these elements occur together in solution with common anions such as chloride and sulphate. This is ascribed to the co-polymerization of niobium(V) and the hydrolysed ionic species of zirconium(IV) and hafnium(IV) to form colloidal partic...... particles. In hydrochloric acid the particles are positively charged, whereas in sulphate solution the Zr- and Hf-sulphate complexes confer a negative charge. The two cases are considered separately....

  2. Effect of lipidmicrosphere prostaglandin combined with Shengji plaster on bedsore healing in III and IV degree

    OpenAIRE

    Su-Fang Gao; Qing-Fu Song; Shu-Ping Gao

    2016-01-01

    Objective: To observe the effect of lipidmicrosphere prostaglandin (Lipo PGE1) combined with Shengji plaster on the bedsore healing. Methods: A total of 100 patients with bedsores in III and IV degree who were admitted in our hospital from January, 2013 to January, 2015 were included in the study and divided into the observation group and the control group with 50 cases in each group according to different treatment protocols. The blood glucose, infection, and blood pressure in...

  3. Staging of cutaneous melanoma

    NARCIS (Netherlands)

    P. Mohr (P.); A.M.M. Eggermont (Alexander); A. Hauschild (Axel); A. Buzaid (A.)

    2009-01-01

    textabstractThe American Joint Committee on Cancer (AJCC) staging of cutaneous melanoma is a continuously evolving system. The identification of increasingly more accurate prognostic factors has led to major changes in melanoma staging over the years, and the current system described in this review

  4. Type IV secretion and Brucella virulence.

    Science.gov (United States)

    Boschiroli, Maria Laura; Ouahrani-Bettache, Safia; Foulongne, Vincent; Michaux-Charachon, Sylvie; Bourg, Gisele; Allardet-Servent, Annick; Cazevieille, Chantal; Lavigne, Jean-Phillipe; Liautard, Jean Pierre; Ramuz, Michel; O'Callaghan, David

    2002-12-20

    The type IV secretion system, encoded by the virB region, is a key virulence factor for Brucella. The 12 genes of the region form an operon that is specifically induced by phagosome acidification in cells after phagocytosis. We speculate that the system serves to secrete unknown effector molecules, which allow Brucella to pervert the host cell endosomal pathways and to create a novel intracellular compartment in which it can replicate. Copyright 2002 Elsevier Science B.V.

  5. Plutonium(IV) hydrous polymer chemistry

    International Nuclear Information System (INIS)

    Toth, L.M.; Dodson, K.E.

    1985-01-01

    The hydrous polymer chemistry of Pu(IV) in aqueous nitric acid solutions has been a subject of considerable interest for several years. This interest stems mainly from the fact that most nuclear fuel reprocessing schemes based on the Purex process can be hampered by the occurrence of polymer. As a result, an understanding and control of the parameters that affect polymer formation during reprocessing are studied. 2 refs

  6. Generation-IV nuclear reactors, SFR concept

    International Nuclear Information System (INIS)

    Dufour, P.

    2010-01-01

    In this presentation author deals with development of sodium-cooled fast reactors and lead-cooled fast reactors. He concluded that: - SFR is a proved concept that has never achieved industrial deployment; - The GEN IV objectives need to reconsider the design of both the core and the reactor design : innovations are being analysed; Future design will benefit from considerable feedback of design, licensing, construction and operation of PX, SPX, etc.

  7. Dipyridinium tribromidochloridobis(4-chlorophenylstannate(IV

    Directory of Open Access Journals (Sweden)

    Kong Mun Lo

    2009-06-01

    Full Text Available The tin atom in the substituted ammonium stannate(IV, (C5H6N2[SnBr3(C6H4Cl2Cl], lies on a center of symmetry in a distorted octahedral coordination geometry. Each independent halogen site is occupied by bromine and chlorine anions in an approximate 3:1 ratio. The pyridinium cation forms a hydrogen bond to only one of the halogen atoms.

  8. Sandia Pulse Reactor-IV Project

    International Nuclear Information System (INIS)

    Reuscher, J.A.

    1983-01-01

    Sandia National Laboratories has developed, designed and operated fast burst reactors for over 20 years. These reactors have been used for a variety of radiation effects programs. During this period, programs have required larger irradiation volumes primarily to expose complex electronic systems to postulated threat environments. As experiment volumes increased, a new reactor was built so that these components could be tested. The Sandia Pulse Reactor-IV is a logical evolution of the two decades of fast burst reactor development at Sandia

  9. Generation IV nuclear plant design strategies

    International Nuclear Information System (INIS)

    Altin, V.

    2007-01-01

    In this presentation Generation IV nuclear reactor design criteria are examined under the light of known nuclear properties of fissile and fertile nuclei. Their conflicting nature is elucidated along with the resulting inevitability of a multitude of designs. The designs selected as candidates for further development are evaluated with respect to their potential to serve the different design criteria, thereby revealing their more difficult aspects of realization and the strong research challenges lying ahead

  10. Predictors of cervical cancer being at an advanced stage at diagnosis in Sudan

    DEFF Research Database (Denmark)

    Ibrahim, Ahmed; Rasch, Vibeke; Pukkala, Eero

    2011-01-01

    Cervical cancer is the second most common cancer among women in Sudan, with more than two-thirds of all women with invasive cervical cancer being diagnosed at an advanced stage (stages III and IV). The lack of a screening program for cervical cancer in Sudan may contribute to the late presentation...... diagnosis) of cervical cancer in Sudan....

  11. The coronary vasoconstrictor action of extract IV from the dahlia sea anemone Tealia felina L.

    Science.gov (United States)

    Konya, R S; Elliott, R C

    1996-02-01

    Extract IV, a partially purified preparation of the toxin from the sea anemone Tealia felina, produced marked bradycardia and arrhythmias in the rat in vivo. In the Langendorff rat heart preparation perfused at constant pressure extract IV (0.0224 AU/ml) reduced the force of contraction by 81.3 +/- 7.2%, n = 6, and the coronary flow by 82.0 +/- 4.7%, n = 5. When the preparation was perfused at constant flow rate, extract IV (0.072 AU/ml) increased the coronary circulation resistance from 3.76 +/- 1.09 (control) to 36.94 +/- 12.26 mmHg/ml/min. The force of contraction was also markedly reduced. The extract produced bradycardia in preparations perfused at constant pressure but not in those perfused at constant flow rate. The extract did not affect isolated atria preparations. It was concluded that the bradycardia produced in vivo and in preparations perfused in vitro at constant pressure was probably secondary to the coronary vasospasm produced, which could contribute to the cardiotoxicity of the extract.

  12. [Application of the 2007 lung cancer staging system by International Association for the Study of Lung Cancer].

    Science.gov (United States)

    Wang, Jia; Wu, Nan; Zheng, Qing-feng; Feng, Yuan; Yan, Shi; Yang, Yue

    2009-08-18

    To compare the prognoses of non-small cell lung cancer patients based respectively on the 6th-Edition Staging System for NSCLC (the 6th-Edition Staging System) and the new staging system by the International Association for the Study of Lung Cancer (IASLC) (new staging system). Data were collected from 136 operated NSCLC patients from Sep. 2003 through Oct. 2007. Those data were staged based respectively on the 6th-Edition Staging System and the new staging system. The 2-year no-recurrence survival rate was calculated, and life span was analyzed using the Kaplan-Meier method of SPSS 13.0 software. (1) In this series, using the 6th-Edition Staging System, there were 56, 23, 53 and 4 patients in stage I, stage II, stage III and stage IV respectively; using the new staging system, there were 50, 31, 54 and 1 patients in stage I, stage II, stage III and stage IV respectively. There were 6 patients in stage I according to the 6th-Edition Staging System who had become 6 patients in stage II according to the new staging system, 1 patient in stage II 1 in stage III, 3 patients in stage III 3 in stage II, 1 patient in stage III 1 in stage IV, and 4 patients in stage IV 4 in stage III. (2) According to the 6th-Edition Staging System, the 2-year no-recurrence survival rates for Ia, Ib, IIa, IIb,IIIa, IIIb and IV were 95.0%, 83.3%, 100.0%, 63.6%, 52.1%, 80.0% and 50.0% respectively, and according to the new staging system, the 2-year cumulative survival rates for I a, Ib, IIa, IIb, IIIa, IIIb and IV were 95.5%, 89.3%, 68.4%, 63.6%, 52.8%, 50.0% and 0.0% respectively. After Chi square analysis, there was no distinguished difference between the 2 staging systems for the 2-year cumulative survival rate. (3) According to the 6th-Edition Staging System, the difference between the no-recurrence rate of stage I and stage II was not statistically significant (P = 0.232), and the difference between the no-recurrence rates of stage II and III was statistically significant(P = 0

  13. Annotations on Mexico's WISC-IV: a validity study.

    Science.gov (United States)

    Fina, Anthony D; Sánchez-Escobedo, Pedro; Hollingworth, Liz

    2012-01-01

    This project seeks to provide evidence on the internal structure of the Escala Wechsler de Inteligencia para Niños-IV (EWIN-IV; Wechsler, 2007a ) through a confirmatory factor analysis and intercorrelational study. Also provided is information on the adaptation process and other sources of validity evidence in support of the EWIN-IV norms. The standardization data for the EWIN-IV were used for all analyses. The factor loadings and correlational patterns found on the EWIN-IV are comparable to those seen in the American versions of the test. The proposed factor and scoring structure of the EWIN-IV was supported.

  14. AtchitIV gene expression is stimulated under abiotic stresses and is spatially and temporally regulated during embryo development

    Directory of Open Access Journals (Sweden)

    Liliane B. de A. Gerhardt

    2004-01-01

    Full Text Available The expression of AtchitIV gene was analysed in Arabidopsis plants submitted to abiotic stresses. Transcript accumulation was detected in leaves in response to UV light exposure, exogenous salicylic acid administration and wounding. Transgenic Arabidopsis plants carrying AtchitIV promoter::gus fusion also showed differential expression of the reporter gene in response to these treatments. The AtchitIV expression was also analysed during Arabidopsis embryo development. GUS assay demonstrated AtchitIV promoter activation in zygotic embryos from torpedo stage up to full maturation. Promoter deletion analysis indicated that all the 5' cis-acting elements responsible for the specific tissue expression are located in a region of 1083 bp, adjacent to the start of transcription. A negative regulatory region located between portions -1083 and -600 was also observed.

  15. Ionizing radiation risk assessment, BEIR IV

    International Nuclear Information System (INIS)

    1991-10-01

    This report of the Subpanel discusses the potential impact on Federal agencies and indicates individual risk factors that could be used by them in risk assessment. The approach used in this CIRRPC report was to consider the risk factors presented in BEIR IV for each radionuclide (or group radioelements) and to make some judgments regarding their validity and/or the uncertainties involved. The coverage of Radon-222 and its progeny dominated the BEIR IV report and this Subpanel felt is was proper to devote more attention to this radionuclide family. This risk factor presented in BEIR IV for radon is 350 cancer deaths per million person-working level months (WLM) of exposure for a lifetime. There is a range of opinions on the conversion from WLM to absorbed dose. As discussed in the text, the use of the WLM concept makes it difficult or infeasible to compare the risk factor for radon with that of other radionuclides which are based on organ dose. This report also includes a discussion of certain fundamental scientific and operational issues that may have decisive effect upon risk factor selection. These adjunct items are dealt with under separate headings and include discussions of threshold dose considerations, extrapolation to low doses, and age at exposure

  16. Antithrombin III is associated with acute liver failure in patients with end-stage heart failure undergoing mechanical circulatory support.

    Science.gov (United States)

    Hoefer, Judith; Ulmer, Hanno; Kilo, Juliane; Margreiter, Raimund; Grimm, Michael; Mair, Peter; Ruttmann, Elfriede

    2017-06-01

    There are few data on the role of liver dysfunction in patients with end-stage heart failure supported by mechanical circulatory support. The aim of our study was to investigate predictors for acute liver failure in patients with end-stage heart failure undergoing mechanical circulatory support. A consecutive 164 patients with heart failure with New York Heart Association class IV undergoing mechanical circulatory support were investigated for acute liver failure using the King's College criteria. Clinical characteristics of heart failure together with hemodynamic and laboratory values were analyzed by logistic regression. A total of 45 patients (27.4%) with heart failure developed subsequent acute liver failure with a hospital mortality of 88.9%. Duration of heart failure, cause, cardiopulmonary resuscitation, use of vasopressors, central venous pressure, pulmonary capillary wedge pressure, pulmonary pulsatility index, cardiac index, and transaminases were not significantly associated with acute liver failure. Repeated decompensation, atrial fibrillation (P failure in univariate analysis only. In multivariable analysis, decreased antithrombin III was the strongest single measurement indicating acute liver failure (relative risk per %, 0.84; 95% confidence interval, 0.77-0.93; P = .001) and remained an independent predictor when adjustment for the Model for End-Stage Liver Disease score was performed (relative risk per %, 0.89; 95% confidence interval, 0.80-0.99; P = .031). Antithrombin III less than 59.5% was identified as a cutoff value to predict acute liver failure with a corresponding sensitivity of 81% and specificity of 87%. In addition to the Model for End-Stage Liver Disease score, decreased antithrombin III activity tends to be superior in predicting acute liver failure compared with traditionally thought predictors. Antithrombin III measurement may help to identify patients more precisely who are developing acute liver failure during mechanical

  17. Staging for vulvar cancer.

    Science.gov (United States)

    Hacker, Neville F; Barlow, Ellen L

    2015-08-01

    Vulvar cancer has been staged by the International Federation of Gynaecology and Obstetrics (FIGO) since 1969, and the original staging system was based on clinical findings only. This system provided a very good spread of prognostic groupings. Because vulvar cancer is virtually always treated surgically, the status of the lymph nodes is the most important prognostic factor and this can only be determined with certainty by histological examination of resected lymph nodes, FIGO introduced a surgical staging system in 1988. This was modified in 1994 to include a category of microinvasive vulvar cancer (stage IA), because such patients have virtually no risk of lymph node metastases. This system did not give a reasonably even spread of prognostic groupings. In addition, patients with stage III disease were shown to be a heterogeneous group prognostically, and the number of positive nodes and the morphology of those nodes were not taken into account. A new surgical staging system for vulvar cancer was introduced by FIGO in 2009. Initial retrospective analyses have suggested that this new staging system has overcome the major deficiencies in the 1994 system. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  18. Staging for vaginal cancer.

    Science.gov (United States)

    Rajaram, Shalini; Maheshwari, Amita; Srivastava, Astha

    2015-08-01

    Vaginal cancer is a rare cancer comprising about 3% of all gynecologic cancers. Primary vaginal cancer should be carefully assigned as spread from cervix, vulva, and other metastatic tumors to vagina can occur. Although vaginal cancer traditionally occurs in older postmenopausal women, the incidence of high-risk human papillomavirus (HPV)-induced cancers is increasing in younger women. Squamous cell carcinoma is still the most common histopathologic type followed by adenocarcinoma. With decreasing use of diethylstilbestrol in pregnancy, non-diethylstilbestrol-associated cancers are described. The Federation Internationale de Gynecologie et d'Obstetrique (FIGO) staging of vaginal cancer (2009) follows the same rules as cervical cancer; it is clinically staged and allows the use of routine investigative modalities for staging. Although FIGO encourages the use of advanced imaging modalities, such as computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET), to guide therapy, the imaging findings may not be used to change or reassign the stage. TNM staging is the pathologic staging system proposed by the American Joint Committee on Cancer, and information available from examination of the resected specimen, including pelvic and inguinal lymph nodes, may be used for staging. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Management of chronic pressure ulcers: an evidence-based analysis.

    Science.gov (United States)

    2009-01-01

    dressings.There is evidence that polyurethane foam dressings and hydrocellular dressings are more absorbent and easier to remove than hydrocolloid dressings in ulcers with moderate to high exudates.In deeper ulcers (stage III and IV), the use of alginate with hydrocolloid resulted in significantly greater reduction in the size of the ulcers compared to hydrocolloid alone.Studies on sustained silver-releasing dressing demonstrated a tendency for reducing the risk of infection and promoting faster healing, but the sample sizes were too small for statistical analysis or for drawing conclusions. BIOLOGICAL THERAPIES: The efficacy of platelet-derived growth factors (PDGFs), fibroblast growth factor, and granulocyte-macrophage colony stimulating factor in improving complete healing of chronic pressure ulcers has not been established.Presently only Regranex, a recombinant PDGF, has been approved by Health Canada and only for treatment of diabetic ulcers in the lower extremities.A March 2008 US Food and Drug Administration (FDA) communication reported increased deaths from cancers in people given three or more prescriptions for Regranex.Limited low-quality evidence on skin matrix and engineered skin equivalent suggests a potential role for these products in healing refractory advanced chronic pressure ulcers, but the evidence is insufficient to draw a conclusion. ADJUNCTIVE PHYSICAL THERAPY: There is evidence that electrical stimulation may result in a significantly greater reduction in the surface area and more complete healing of stage II to IV ulcers compared with sham therapy. No conclusion on the efficacy of electrotherapy can be drawn because of significant statistical heterogeneity, small sample sizes, and methodological flaws.The efficacy of other adjunctive physical therapies [electromagnetic therapy, low-level laser (LLL) therapy, ultrasound therapy, ultraviolet light therapy, and negative pressure therapy] in improving complete closure of pressure ulcers has not been

  20. Staged bilateral carotid endarterectomy

    DEFF Research Database (Denmark)

    Schroeder, T; Sillesen, H; Engell, Hans Christian

    1986-01-01

    In a series of 56 staged bilateral carotid endarterectomies, new neurologic symptoms developed in 5% and 20% following the first and second procedure, respectively. All complications were transient or minor. The incidence of postendarterectomy hypertension was significantly higher following...... the second procedure, when operations were staged less than 3 weeks apart. A correlation between these hypertensive episodes and the occurrence of new neurologic symptoms could not be shown. However, as this correlation has been proved in several other reports, bilateral carotid endarterectomy is advised...... to be staged at least 3 weeks apart. In addition, a conservative attitude towards contralateral asymptomatic lesions is proposed....

  1. Staging of lung cancer.

    Science.gov (United States)

    de Groot, Patricia M; Carter, Brett W; Betancourt Cuellar, Sonia L; Erasmus, Jeremy J

    2015-06-01

    Primary lung cancer is the leading cause of cancer mortality in the world. Thorough clinical staging of patients with lung cancer is important, because therapeutic options and management are to a considerable degree dependent on stage at presentation. Radiologic imaging is an essential component of clinical staging, including chest radiography in some cases, computed tomography, MRI, and PET. Multiplanar imaging modalities allow assessment of features that are important for surgical, oncologic, and radiation therapy planning, including size of the primary tumor, location and relationship to normal anatomic structures in the thorax, and existence of nodal and/or metastatic disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Staging Mobilities / Designing Mobilities

    DEFF Research Database (Denmark)

    Jensen, Ole B.

    2015-01-01

    In recent years, urban research has taken a ‘mobilities turn’. There has been a developing realisation that mobilities do not ‘just happen.’ Mobilities are carefully and meticulously designed, planned and staged (from above). However, they are equally importantly acted out, performed and lived...... asks: what are the physical, social, technical, and cultural conditions to the staging of contemporary urban mobilities? The theoretical framing in the Staging mobilities book is applied to four in-depth cases in the accompanying volume Designing mobilities.This book explore how places, sites...

  3. Synthesis and evaluation of artificial antigens for astragaloside IV

    Directory of Open Access Journals (Sweden)

    Sheng-lan Yu

    Full Text Available The objective of this study was to produce artificial antigens for astragaloside IV that could be used to prepare antibodies against astragaloside IV screened in Radix astragali (Astragalus membranaceus (Fisch Bunge, Fabaceae and its preparations, using an indirect ELISA. Astragaloside IV was coupled to carrier proteins, bovine serum albumin and ovalbumin using the sodium periodate method and was then evaluated using SDS-PAGE, MALDI-TOF MS and animal immunizations. The coupling ratio of astragaloside IV to bovine serum albumin ratio was determined to be thirteen, and the indirect ELISA demonstrated that three groups of mice immunized with astragaloside IV-bovine serum albumin produced anti-astragaloside IV- bovine serum albumin-specific antibody, with a minimum serum titer of 1:9600. A method for synthesizing highly immunogenic astragaloside IV artificial antigens was successfully developed thus indicating its feasibility in the establishment of a fast immunoassay for astragaloside IV content determination in Radix astragali and its products.

  4. The role of MR imaging in staging femoral head osteonecrosis

    Energy Technology Data Exchange (ETDEWEB)

    Zibis, Aristidis H. [Department of Orthopaedic Surgery, Medical School, University of Thessaly, 22 Papakyriazi Street, Larissa 41222 (Greece); Karantanas, Apostolos H. [Department of Radiology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete 71110 (Greece); Roidis, Nikolaos T. [Department of Orthopaedic Surgery, Medical School, University of Thessaly, 22 Papakyriazi Street, Larissa 41222 (Greece); Hantes, Michael E. [Department of Orthopaedic Surgery, Medical School, University of Thessaly, 22 Papakyriazi Street, Larissa 41222 (Greece); Argiri, Paraskevi [CT-MRI Department, Larissa General Hospital, Larissa 41221 (Greece); Moraitis, Theofanis [Department of Orthopaedic Surgery, Medical School, University of Thessaly, 22 Papakyriazi Street, Larissa 41222 (Greece); Malizos, Konstantinos N. [Department of Orthopaedic Surgery, Medical School, University of Thessaly, 22 Papakyriazi Street, Larissa 41222 (Greece)]. E-mail: kmalizos@otenet.gr

    2007-07-15

    Reliability, accuracy and prognostic value of any classification system are important in evaluation and treatment of femoral head osteonecrosis. The purpose of the present study was to correlate the plain radiographs with MRI in femoral head osteonecrosis. Between 2000 and 2005, 115 hips (72 patients) were evaluated and classified according to the ARCO classification criteria with the use of plain radiographs and additional application of MRI. Classification was performed by consensus between a musculoskeletal radiologist and an orthopaedic surgeon. Sensitivity (SEN), specificity (SP), positive (PPV) and negative (NPV) predictive value of X-rays were estimated. According to MRI, 17 hips were classified as stage I, 25 as stage II, 48 as stage III and 25 as stage IV. The SEN, SP, PPV and NPV of plain radiographs were for stage II 88%, 90.5%, 78.6% and 95%; for stage III 79.2% 82%, 80.8% and 87.2%; for stage IV 76%, 100%, 100% and 90.9%, respectively. The agreement between plain radiographs and MRI was 80.6% for staging the disease, 71.2% for recording the location of the osteonecrotic lesion, 67.1% for evaluating the size of the lesion, 79.2% for the presence of collapse of the articular surface and 56.3% for the degree of collapse. In conclusion, the ARCO classification could miss important information in stages II and III, where treatment aims at preservation of the hip joint integrity. The results of the present study suggest that MRI should be incorporated in the classification of osteonecrosis (stages II and III), to add accuracy and prognostic value.

  5. The role of MR imaging in staging femoral head osteonecrosis

    International Nuclear Information System (INIS)

    Zibis, Aristidis H.; Karantanas, Apostolos H.; Roidis, Nikolaos T.; Hantes, Michael E.; Argiri, Paraskevi; Moraitis, Theofanis; Malizos, Konstantinos N.

    2007-01-01

    Reliability, accuracy and prognostic value of any classification system are important in evaluation and treatment of femoral head osteonecrosis. The purpose of the present study was to correlate the plain radiographs with MRI in femoral head osteonecrosis. Between 2000 and 2005, 115 hips (72 patients) were evaluated and classified according to the ARCO classification criteria with the use of plain radiographs and additional application of MRI. Classification was performed by consensus between a musculoskeletal radiologist and an orthopaedic surgeon. Sensitivity (SEN), specificity (SP), positive (PPV) and negative (NPV) predictive value of X-rays were estimated. According to MRI, 17 hips were classified as stage I, 25 as stage II, 48 as stage III and 25 as stage IV. The SEN, SP, PPV and NPV of plain radiographs were for stage II 88%, 90.5%, 78.6% and 95%; for stage III 79.2% 82%, 80.8% and 87.2%; for stage IV 76%, 100%, 100% and 90.9%, respectively. The agreement between plain radiographs and MRI was 80.6% for staging the disease, 71.2% for recording the location of the osteonecrotic lesion, 67.1% for evaluating the size of the lesion, 79.2% for the presence of collapse of the articular surface and 56.3% for the degree of collapse. In conclusion, the ARCO classification could miss important information in stages II and III, where treatment aims at preservation of the hip joint integrity. The results of the present study suggest that MRI should be incorporated in the classification of osteonecrosis (stages II and III), to add accuracy and prognostic value

  6. Expanding the ecological validity of WAIS-IV and WMS-IV with the Texas functional living scale.

    Science.gov (United States)

    Whipple Drozdick, Lisa; Munro Cullum, C

    2011-06-01

    Assessment of functional status is an important aspect of clinical evaluation. As part of the standardization of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV), participants completed the Texas Functional Living Scale (TFLS), a measure of Instrumental Activities of Daily Living. The relationships between TFLS and WAIS-IV and WMS-IV were examined in both normally developing and clinical samples. In general, the highest correlations were between TFLS and measures of general cognitive ability (WAIS-IV FSIQ [Full Scale IQ] and GAI [General Ability Index]) and working memory (WAIS-IV WMI [Working Memory Index] and WMS-IV VWMI [Visual Working Memory Index]). Across the clinical populations, working memory subtests were generally strongly related to TFLS performance, although this relationship was more consistent with WAIS-IV than WMS-IV. Contrast scaled scores are presented for the TFLS based on WAIS-IV or WMS-IV performance. These scores allow the evaluation of functional abilities within the context of cognitive and memory ability, enhancing and expanding the utility of the WAIS-IV and WMS-IV.

  7. Stages of Colon Cancer

    Science.gov (United States)

    ... types of surgery : Local excision or simple polypectomy . Resection and anastomosis . This is done when the tumor is too ... stage I colon cancer usually includes the following: Resection and anastomosis . Use our clinical trial search to find NCI- ...

  8. Stages of Labor

    Science.gov (United States)

    ... Moms Need Blog News & Media News Videos Mission stories Ambassadors Spotlights Tools & Resources Frequently asked media questions ... can be born. This stage can last as short as 20 minutes or as long as several ...

  9. Multiple Stages 2

    DEFF Research Database (Denmark)

    Andreasen, John

    Multiple stages 2: theatrical futures, set design, community plays, cultural capitals, democracy & drama, WWII dramas, performance on adoption, promenade about emigration, qualities in political theatre, performance analysis, dramaturgical education, Toulmin Variations...

  10. Stages of Esophageal Cancer

    Science.gov (United States)

    ... the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , ... stage of the cancer being treated. External and internal radiation therapy are used to treat esophageal cancer. A plastic ...

  11. Stages of Anal Cancer

    Science.gov (United States)

    ... the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , ... stage of the cancer being treated. External and internal radiation therapy are used to treat anal cancer. Chemotherapy Chemotherapy ...

  12. Stages of Penile Cancer

    Science.gov (United States)

    ... the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , ... stage of the cancer being treated. External and internal radiation therapy are used to treat penile cancer. Chemotherapy Chemotherapy ...

  13. Staging interrail mobilities

    DEFF Research Database (Denmark)

    Jensen, Martin Trandberg; Gyimóthy, Szilvia; Jensen, Ole B.

    2016-01-01

    This article applies the multiscalar ‘staging mobilities’ framework from the emergent subfield of mobilities design to analyse an enduring European rail travel phenomenon, interrail. This discussion extends and contributes to tourism mobilities research. Second, the article enriches previous...

  14. Two stage turbine for rockets

    Science.gov (United States)

    Veres, Joseph P.

    1993-01-01

    The aerodynamic design and rig test evaluation of a small counter-rotating turbine system is described. The advanced turbine airfoils were designed and tested by Pratt & Whitney. The technology represented by this turbine is being developed for a turbopump to be used in an advanced upper stage rocket engine. The advanced engine will use a hydrogen expander cycle and achieve high performance through efficient combustion of hydrogen/oxygen propellants, high combustion pressure, and high area ratio exhaust nozzle expansion. Engine performance goals require that the turbopump drive turbines achieve high efficiency at low gas flow rates. The low mass flow rates and high operating pressures result in very small airfoil heights and diameters. The high efficiency and small size requirements present a challenging turbine design problem. The shrouded axial turbine blades are 50 percent reaction with a maximum thickness to chord ratio near 1. At 6 deg from the tangential direction, the nozzle and blade exit flow angles are well below the traditional design minimum limits. The blade turning angle of 160 deg also exceeds the maximum limits used in traditional turbine designs.

  15. Stages of ores formation

    International Nuclear Information System (INIS)

    Khasanov, A.Kh.

    1988-01-01

    Deposit formation (especially endogenous) is the complicated, multi-stage and long process. Establishment of deposit formation succession, age-specific correlations of minerals and aggregates have a high importance at solving genetic questions. Studying of minerals correlations and mineral aggregates, succession of their crystallization and other observations let restore the history of deposit formation, pick up in it different on duration and physical and chemical conditions stages

  16. The thesis of stages fourteen years later

    Science.gov (United States)

    Beeby, C. E.

    1980-12-01

    The author indicates the changes and additions he would make to his book ` The Quality of Education in Developing Countries' (1966) if he were re-writing it in 1980. He would make clearer that his primary interest is in a continuum of change, the process of growth of a school system, and that the `stages' are only a convenient non-mathematical artifact to make the thesis more useful to administrators and planners. In the light of more recent developments and experiences, he now gives new stress to the pluralism of objectives at the stage of Meaning, and discusses the political, social, cultural and financial reasons why a country may choose not to take the difficult step from stage III to stage IV. Recent forms of alternative education, particularly those embodying plans for lifelong education, offer some hope of bypassing his thesis of stages. More consideration is given to constraints other than that of teacher qualification, though the difficulty of changing the skills, habits, attitudes and purposes in the teaching profession remain the chief obstacle to qualitative growth. Particular attention is paid to `crash' programmes where processes that are, by their very nature, successive are compressed into simultaneous or almost simultaneous ones. Some implications of the thesis of stages for teacher training are briefly dealt with. Regarding the application of the thesis to secondary education, he maintains that a better model of growth would be one based on the capacity of secondary education to respond to the changing economic and social demands of the community. Finally, he suggests three methods of testing his hypotheses and pleads that more consideration be given to building up a body of educational, theory based on the experience of developing countries over the past three decades.

  17. 77 FR 64398 - Order of Succession for HUD Region IV

    Science.gov (United States)

    2012-10-19

    ... Region IV AGENCY: Office of Field Policy and Management, HUD. ACTION: Notice of Order of Succession... Field Offices (Region IV). This Order of Succession supersedes all previous Orders of Succession for HUD Region IV. DATES: Effective Date: October 9, 2012. FOR FURTHER INFORMATION CONTACT: Lawrence D. Reynolds...

  18. Dipeptidyl peptidase IV inhibitory activity of protein hydrolyzates ...

    African Journals Online (AJOL)

    Background: Type 2 diabetes is a chronic metabolic disorder. Recently, dipeptidyl peptidase IV (DPP-IV) inhibitors that protect incretin hormones from being cleaved by DPP-IV have been used as drugs to control glycemia. This study examined the potential hypoglycemic effect of amaranth grain storage protein hydrolyzates ...

  19. Thorium(IV) and zirconium(IV) complexes of oxygen donor ligands. Pt. 12

    International Nuclear Information System (INIS)

    Agarwal, R.K.; Jain, P.C.; Kapur, V.; Sharma, S.; Srivastava, A.K.

    1980-01-01

    Crystalline thorium (IV) chelates with mono N-oxides of 2,2'-bipyridine (bipyNO) and 1,10-phenanthroline (phenNO), ThX 4 x 2L(X = Cl,Br,NO 3 or NCS) and ThX 4 x 3L(X = I or ClO 4 and L = bipyNO or phenNO) have been synthesised and characterized on the basis of i.r. spectra, molar conductance, molecular weights, t.g.a. and d.t.a. data. All the complexes are weakly diamagnetic and contain bipyNO and phenNO bonded to thorium(IV) through nitrogen and oxygen. The coordination number o