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Staggered chiral random matrix theory

International Nuclear Information System (INIS)

Osborn, James C.

2011-01-01

We present a random matrix theory for the staggered lattice QCD Dirac operator. The staggered random matrix theory is equivalent to the zero-momentum limit of the staggered chiral Lagrangian and includes all taste breaking terms at their leading order. This is an extension of previous work which only included some of the taste breaking terms. We will also present some results for the taste breaking contributions to the partition function and the Dirac eigenvalues.
Inhibition of autophagy by TAB2 and TAB3.

Science.gov (United States)

Criollo, Alfredo; Niso-Santano, Mireia; Malik, Shoaib Ahmad; Michaud, Mickael; Morselli, Eugenia; Mariño, Guillermo; Lachkar, Sylvie; Arkhipenko, Alexander V; Harper, Francis; Pierron, Gérard; Rain, Jean-Christophe; Ninomiya-Tsuji, Jun; Fuentes, José M; Lavandero, Sergio; Galluzzi, Lorenzo; Maiuri, Maria Chiara; Kroemer, Guido

2011-11-11

Autophagic responses are coupled to the activation of the inhibitor of NF-κB kinase (IKK). Here, we report that the essential autophagy mediator Beclin 1 and TGFβ-activated kinase 1 (TAK1)-binding proteins 2 and 3 (TAB2 and TAB3), two upstream activators of the TAK1-IKK signalling axis, constitutively interact with each other via their coiled-coil domains (CCDs). Upon autophagy induction, TAB2 and TAB3 dissociate from Beclin 1 and bind TAK1. Moreover, overexpression of TAB2 and TAB3 suppresses, while their depletion triggers, autophagy. The expression of the C-terminal domain of TAB2 or TAB3 or that of the CCD of Beclin 1 competitively disrupts the interaction between endogenous Beclin 1, TAB2 and TAB3, hence stimulating autophagy through a pathway that requires endogenous Beclin 1, TAK1 and IKK to be optimally efficient. These results point to the existence of an autophagy-stimulatory 'switch' whereby TAB2 and TAB3 abandon inhibitory interactions with Beclin 1 to engage in a stimulatory liaison with TAK1.
Numerical simulation and experiment on multilayer stagger-split die.

Science.gov (United States)

Liu, Zhiwei; Li, Mingzhe; Han, Qigang; Yang, Yunfei; Wang, Bolong; Sui, Zhou

2013-05-01

A novel ultra-high pressure device, multilayer stagger-split die, has been constructed based on the principle of "dividing dies before cracking." Multilayer stagger-split die includes an encircling ring and multilayer assemblages, and the mating surfaces of the multilayer assemblages are mutually staggered between adjacent layers. In this paper, we investigated the stressing features of this structure through finite element techniques, and the results were compared with those of the belt type die and single split die. The contrast experiments were also carried out to test the bearing pressure performance of multilayer stagger-split die. It is concluded that the stress distributions are reasonable and the materials are utilized effectively for multilayer stagger-split die. And experiments indicate that the multilayer stagger-split die can bear the greatest pressure.
Unsteady aerodynamic response of mistuned cascade to incoming wakes. 1st Report. ; Mistuning of stagger angle. Fukin prime itsu yokuretsu no hiteijo oto kaiseki. 1. ; Stagger kaku wo fukin prime itsuka shita baai

Energy Technology Data Exchange (ETDEWEB)

Funazaki, K [Iwate University, Iwate (Japan). Faculty of Engineering

1991-09-25

Interference between fan blades in a turbo-fan engine and struts also being a structural member may induce fan blade oscillation and noise, thereby presenting itself as an obstacle in development efforts. Therefore, this paper proposes a method to analyze unsteady aerodynamic responses of mistuned cascade with varied stagger angles, as well as elucidates the effects of the mistuned stagger angles by means of numerical calculations. The non-steady pressure distribution on the blades is affected by the mistuning, but its extent varies with phase difference in the incoming viscid wake. As its result, the non-steady lift acting on the blades varies with the mistuning. In this case, it is possible to reduce the size of the non-steady lift depending on the conditions of blade arrangement and incoming phase difference. The size of the non-steady lift under the same phase incoming condition has a close correlation with the steady lift. It was shown that the quasi-steady analysis is effective in the case of the same phase condition. 8 refs., 14 figs., 1 tab.
Perturbative improvement of staggered fermions using fat links

International Nuclear Information System (INIS)

Lee, Weonjong

2002-01-01

We study the possibility of improving staggered fermions using various fat links in order to reduce perturbative corrections to the gauge-invariant staggered fermion operators. We prove five theorems on SU(3) projection, triviality in renormalization, multiple SU(3) projections, uniqueness, and equivalence. As a result of these theorems, we show that, at the one-loop level, the renormalization of staggered fermion operators is identical between SU(3) projected Fat7 links and hypercubic links, as long as the action and operators are constructed by imposing the same perturbative improvement condition. In addition, we propose a new view of SU(3) projection as a tool of tadpole improvement for the staggered fermion doublers. As a conclusion, we present alternative choices of constructing fat links to improve the staggered fermion action and operators, which deserve further investigation
On staggered indecomposable Virasoro modules

International Nuclear Information System (INIS)

Kytoelae, Kalle; Ridout, David

2009-01-01

In this article, certain indecomposable Virasoro modules are studied. Specifically, the Virasoro mode L 0 is assumed to be nondiagonalizable, possessing Jordan blocks of rank 2. Moreover, the module is further assumed to have a highest weight submodule, the 'left module', and that the quotient by this submodule yields another highest weight module, the 'right module'. Such modules, which have been called staggered, have appeared repeatedly in the logarithmic conformal field theory literature, but their theory has not been explored in full generality. Here, such a theory is developed for the Virasoro algebra using rather elementary techniques. The focus centers on two different but related questions typically encountered in practical studies: How can one identify a given staggered module, and how can one demonstrate the existence of a proposed staggered module. Given just the values of the highest weights of the left and right modules, themselves subject to simple necessary conditions, invariants are defined which together with the knowledge of the left and right modules uniquely identify a staggered module. The possible values of these invariants form a vector space of dimension 0, 1, or 2, and the structures of the left and right modules limit the isomorphism classes of the corresponding staggered modules to an affine subspace (possibly empty). The number of invariants and affine restrictions is purely determined by the structures of the left and right modules. Moreover, in order to facilitate applications, the expressions for the invariants and restrictions are given by formulas as explicit as possible (they generally rely on expressions for Virasoro singular vectors). Finally, the text is liberally peppered throughout with examples illustrating the general concepts. These have been carefully chosen for their physical relevance or for the novel features they exhibit.
On staggered indecomposable Virasoro modules

Energy Technology Data Exchange (ETDEWEB)

Kytoelae, Kalle [Geneve Univ. (Switzerland); Ridout, David [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany)

2009-06-15

In this article, certain indecomposable Virasoro modules are studied. Specifically, the Virasoro mode L0 is assumed to be non-diagonalisable, possessing Jordan blocks of rank two. Moreover, the module is further assumed to have a highest weight submodule, the ''left module'', and that the quotient by this submodule yields another highest weight module, the ''right module''. Such modules, which have been called staggered, have appeared repeatedly in the logarithmic conformal field theory literature, but their theory has not been explored in full generality. Here, such a theory is developed for the Virasoro algebra using rather elementary techniques. The focus centres on two different but related questions typically encountered in practical studies: How can one identify a given staggered module, and how can one demonstrate the existence of a proposed staggered module. Given just the values of the highest weights of the left and right modules, themselves subject to simple necessary conditions, invariants are defined which together with the knowledge of the left and right modules uniquely identify a staggered module. The possible values of these invariants form a vector space of dimension zero, one or two, and the structures of the left and right modules limit the isomorphism classes of the corresponding staggered modules to an affine subspace (possibly empty). The number of invariants and affine restrictions is purely determined by the structures of the left and right modules. Moreover, in order to facilitate applications, the expressions for the invariants and restrictions are given by formulae as explicit as possible (they generally rely on expressions for Virasoro singular vectors). Finally, the text is liberally peppered throughout with examples illustrating the general concepts. These have been carefully chosen for their physical relevance or for the novel features they exhibit. (orig.)
On staggered indecomposable Virasoro modules

International Nuclear Information System (INIS)

Kytoelae, Kalle; Ridout, David

2009-06-01

In this article, certain indecomposable Virasoro modules are studied. Specifically, the Virasoro mode L0 is assumed to be non-diagonalisable, possessing Jordan blocks of rank two. Moreover, the module is further assumed to have a highest weight submodule, the ''left module'', and that the quotient by this submodule yields another highest weight module, the ''right module''. Such modules, which have been called staggered, have appeared repeatedly in the logarithmic conformal field theory literature, but their theory has not been explored in full generality. Here, such a theory is developed for the Virasoro algebra using rather elementary techniques. The focus centres on two different but related questions typically encountered in practical studies: How can one identify a given staggered module, and how can one demonstrate the existence of a proposed staggered module. Given just the values of the highest weights of the left and right modules, themselves subject to simple necessary conditions, invariants are defined which together with the knowledge of the left and right modules uniquely identify a staggered module. The possible values of these invariants form a vector space of dimension zero, one or two, and the structures of the left and right modules limit the isomorphism classes of the corresponding staggered modules to an affine subspace (possibly empty). The number of invariants and affine restrictions is purely determined by the structures of the left and right modules. Moreover, in order to facilitate applications, the expressions for the invariants and restrictions are given by formulae as explicit as possible (they generally rely on expressions for Virasoro singular vectors). Finally, the text is liberally peppered throughout with examples illustrating the general concepts. These have been carefully chosen for their physical relevance or for the novel features they exhibit. (orig.)
On staggered indecomposable Virasoro modules

Science.gov (United States)

Kytölä, Kalle; Ridout, David

2009-12-01

In this article, certain indecomposable Virasoro modules are studied. Specifically, the Virasoro mode L0 is assumed to be nondiagonalizable, possessing Jordan blocks of rank 2. Moreover, the module is further assumed to have a highest weight submodule, the "left module," and that the quotient by this submodule yields another highest weight module, the "right module." Such modules, which have been called staggered, have appeared repeatedly in the logarithmic conformal field theory literature, but their theory has not been explored in full generality. Here, such a theory is developed for the Virasoro algebra using rather elementary techniques. The focus centers on two different but related questions typically encountered in practical studies: How can one identify a given staggered module, and how can one demonstrate the existence of a proposed staggered module. Given just the values of the highest weights of the left and right modules, themselves subject to simple necessary conditions, invariants are defined which together with the knowledge of the left and right modules uniquely identify a staggered module. The possible values of these invariants form a vector space of dimension 0, 1, or 2, and the structures of the left and right modules limit the isomorphism classes of the corresponding staggered modules to an affine subspace (possibly empty). The number of invariants and affine restrictions is purely determined by the structures of the left and right modules. Moreover, in order to facilitate applications, the expressions for the invariants and restrictions are given by formulas as explicit as possible (they generally rely on expressions for Virasoro singular vectors). Finally, the text is liberally peppered throughout with examples illustrating the general concepts. These have been carefully chosen for their physical relevance or for the novel features they exhibit.
Investigation of deformation mechanisms of staggered nanocomposites using molecular dynamics

Energy Technology Data Exchange (ETDEWEB)

Mathiazhagan, S., E-mail: smathi.research@gmail.com; Anup, S., E-mail: anupiist@gmail.com

2016-08-19

Biological materials with nanostructure of regularly or stair-wise staggered arrangements of hard platelets reinforced in a soft protein matrix have superior mechanical properties. Applications of these nanostructures to ceramic matrix composites could enhance their toughness. Using molecular dynamics simulations, mechanical behaviour of the bio-inspired nanocomposites is studied. Regularly staggered model shows better flow behaviour compared to stair-wise staggered model due to the symmetrical crack propagation along the interface. Though higher stiffness and strength are obtained for stair-wise staggered models, rapid crack propagation reduces the toughness. Arresting this crack propagation could lead to superior mechanical properties in stair-wise staggered models. - Highlights: • The deformation behaviour of staggered nanocomposites is studied. • Stair-wise staggered model has high stiffness and strength, but low toughness. • Rapid crack growth in overlap region causes this low toughness. • Toughness could be enhanced by arresting interfacial crack in the overlap.
Investigation of deformation mechanisms of staggered nanocomposites using molecular dynamics

International Nuclear Information System (INIS)

Mathiazhagan, S.; Anup, S.

2016-01-01

Biological materials with nanostructure of regularly or stair-wise staggered arrangements of hard platelets reinforced in a soft protein matrix have superior mechanical properties. Applications of these nanostructures to ceramic matrix composites could enhance their toughness. Using molecular dynamics simulations, mechanical behaviour of the bio-inspired nanocomposites is studied. Regularly staggered model shows better flow behaviour compared to stair-wise staggered model due to the symmetrical crack propagation along the interface. Though higher stiffness and strength are obtained for stair-wise staggered models, rapid crack propagation reduces the toughness. Arresting this crack propagation could lead to superior mechanical properties in stair-wise staggered models. - Highlights: • The deformation behaviour of staggered nanocomposites is studied. • Stair-wise staggered model has high stiffness and strength, but low toughness. • Rapid crack growth in overlap region causes this low toughness. • Toughness could be enhanced by arresting interfacial crack in the overlap.
Investigation of deformation mechanisms of staggered nanocomposites using molecular dynamics

Science.gov (United States)

Mathiazhagan, S.; Anup, S.

2016-08-01

Biological materials with nanostructure of regularly or stair-wise staggered arrangements of hard platelets reinforced in a soft protein matrix have superior mechanical properties. Applications of these nanostructures to ceramic matrix composites could enhance their toughness. Using molecular dynamics simulations, mechanical behaviour of the bio-inspired nanocomposites is studied. Regularly staggered model shows better flow behaviour compared to stair-wise staggered model due to the symmetrical crack propagation along the interface. Though higher stiffness and strength are obtained for stair-wise staggered models, rapid crack propagation reduces the toughness. Arresting this crack propagation could lead to superior mechanical properties in stair-wise staggered models.
Estimation of Parameters of CCF with Staggered Testing

International Nuclear Information System (INIS)

Kim, Myung-Ki; Hong, Sung-Yull

2006-01-01

Common cause failures are extremely important in reliability analysis and would be dominant to risk contributor in a high reliable system such as a nuclear power plant. Of particular concern is common cause failure (CCF) that degrades redundancy or diversity implemented to improve a reliability of systems. Most of analyses of parameters of CCF models such as beta factor model, alpha factor model, and MGL(Multiple Greek Letters) model deal a system with a nonstaggered testing strategy. Non-staggered testing is that all components are tested at the same time (or at least the same shift) and staggered testing is that if there is a failure in the first component, all the other components are tested immediately, and if it succeeds, no more is done until the next scheduled testing time. Both of them are applied in the nuclear power plants. The strategy, however, is not explicitly described in the technical specifications, but implicitly in the periodic test procedure. For example, some redundant components particularly important to safety are being tested with staggered testing strategy. Others are being performed with non-staggered testing strategy. This paper presents the parameter estimator of CCF model such as beta factor model, MGL model, and alpha factor model with staggered testing strategy. In addition, a new CCF model, rho factor model, is proposed and its parameter is presented with staggered testing strategy
jmzTab: a java interface to the mzTab data standard.

Science.gov (United States)

Xu, Qing-Wei; Griss, Johannes; Wang, Rui; Jones, Andrew R; Hermjakob, Henning; Vizcaíno, Juan Antonio

2014-06-01

mzTab is the most recent standard format developed by the Proteomics Standards Initiative. mzTab is a flexible tab-delimited file that can capture identification and quantification results coming from MS-based proteomics and metabolomics approaches. We here present an open-source Java application programming interface for mzTab called jmzTab. The software allows the efficient processing of mzTab files, providing read and write capabilities, and is designed to be embedded in other software packages. The second key feature of the jmzTab model is that it provides a flexible framework to maintain the logical integrity between the metadata and the table-based sections in the mzTab files. In this article, as two example implementations, we also describe two stand-alone tools that can be used to validate mzTab files and to convert PRIDE XML files to mzTab. The library is freely available at http://mztab.googlecode.com. © 2014 The Authors PROTEOMICS Published by Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.
A staggered-grid convolutional differentiator for elastic wave modelling

Science.gov (United States)

Sun, Weijia; Zhou, Binzhong; Fu, Li-Yun

2015-11-01

The computation of derivatives in governing partial differential equations is one of the most investigated subjects in the numerical simulation of physical wave propagation. An analytical staggered-grid convolutional differentiator (CD) for first-order velocity-stress elastic wave equations is derived in this paper by inverse Fourier transformation of the band-limited spectrum of a first derivative operator. A taper window function is used to truncate the infinite staggered-grid CD stencil. The truncated CD operator is almost as accurate as the analytical solution, and as efficient as the finite-difference (FD) method. The selection of window functions will influence the accuracy of the CD operator in wave simulation. We search for the optimal Gaussian windows for different order CDs by minimizing the spectral error of the derivative and comparing the windows with the normal Hanning window function for tapering the CD operators. It is found that the optimal Gaussian window appears to be similar to the Hanning window function for tapering the same CD operator. We investigate the accuracy of the windowed CD operator and the staggered-grid FD method with different orders. Compared to the conventional staggered-grid FD method, a short staggered-grid CD operator achieves an accuracy equivalent to that of a long FD operator, with lower computational costs. For example, an 8th order staggered-grid CD operator can achieve the same accuracy of a 16th order staggered-grid FD algorithm but with half of the computational resources and time required. Numerical examples from a homogeneous model and a crustal waveguide model are used to illustrate the superiority of the CD operators over the conventional staggered-grid FD operators for the simulation of wave propagations.
Staggering towards a calculation of weak amplitudes

Energy Technology Data Exchange (ETDEWEB)

Sharpe, S.R.

1988-09-01

An explanation is given of the methods required to calculate hadronic matrix elements of the weak Hamiltonians using lattice QCD with staggered fermions. New results are presented for the 1-loop perturbative mixing of the weak interaction operators. New numerical techniques designed for staggered fermions are described. A preliminary result for the kaon B parameter is presented. 24 refs., 3 figs.
Heavy-light semileptonic decays in staggered chiral perturbation theory

Science.gov (United States)

Aubin, C.; Bernard, C.

2007-07-01

We calculate the form factors for the semileptonic decays of heavy-light pseudoscalar mesons in partially quenched staggered chiral perturbation theory (SχPT), working to leading order in 1/mQ, where mQ is the heavy-quark mass. We take the light meson in the final state to be a pseudoscalar corresponding to the exact chiral symmetry of staggered quarks. The treatment assumes the validity of the standard prescription for representing the staggered “fourth-root trick” within SχPT by insertions of factors of 1/4 for each sea-quark loop. Our calculation is based on an existing partially quenched continuum chiral perturbation theory calculation with degenerate sea quarks by Bećirević, Prelovsek, and Zupan, which we generalize to the staggered (and nondegenerate) case. As a byproduct, we obtain the continuum partially quenched results with nondegenerate sea quarks. We analyze the effects of nonleading chiral terms, and find a relation among the coefficients governing the analytic valence mass dependence at this order. Our results are useful in analyzing lattice computations of form factors B→π and D→K, when the light quarks are simulated with the staggered action.
Synthetic staggered architecture composites

International Nuclear Information System (INIS)

Dutta, Abhishek; Tekalur, Srinivasan Arjun

2013-01-01

Highlights: ► Composite design inspired by nature. ► Tuning microstructure via changing ceramic content and aspect ratio. ► Experimental display of structure–property correlationship in synthetic composites. - Abstract: Structural biocomposites (for example, nacre in seashells, bone, etc.) are designed according to the functional role they are delegated for. For instance, bone is primarily designed for withstanding time-dependent loading (for example, withstanding stresses while running, jumping, accidental fall) and hence the microstructure is designed primarily from enhanced toughness and moderate stiffness point of view. On the contrary, seashells (which lie in the abyss of oceans) apart from providing defense to the organism (it is hosting) against predatory attacks, are subjected to static loading (for example, enormous hydrostatic pressure). Hence, emphasis on the shell structure evolution is directed primarily towards providing enhanced stiffness. In order to conform between stiffness and toughness, nature precisely employs a staggered arrangement of inorganic bricks in a biopolymer matrix (at its most elementary level of architecture). Aspect ratio and content of ceramic bricks are meticulously used by nature to synthesize composites having varying degrees of stiffness, strength and toughness. Such an amazing capability of structure–property correlationship has rarely been demonstrated in synthetic composites. Therefore, in order to better understand the mechanical behavior of synthetic staggered composites, the problem becomes two-pronged: (a) synthesize composites with varying brick size and contents and (b) experimental investigation of the material response. In this article, an attempt has been made to synthesize and characterize staggered ceramic–polymer composites having varying aspect ratio and ceramic content using freeze-casting technique. This will in-turn help us in custom-design manufacture of hybrid bio-inspired composite materials
Wake-Model Effects on Induced Drag Prediction of Staggered Boxwings

Directory of Open Access Journals (Sweden)

Julian Schirra

2018-01-01

Full Text Available For staggered boxwings the predictions of induced drag that rely on common potential-flow methods can be of limited accuracy. For example, linear, freestream-fixed wake models cannot resolve effects related to wake deflection and roll-up, which can have significant affects on the induced drag projection of these systems. The present work investigates the principle impact of wake modelling on the accuracy of induced drag prediction of boxwings with stagger. The study compares induced drag predictions of a higher-order potential-flow method that uses fixed and relaxed-wake models, and of an Euler-flow method. Positive-staggered systems at positive angles of attack are found to be particularly prone to higher-order wake effects due to vertical contraction of wakes trajectories, which results in smaller effective height-to-span ratios than compared with negative stagger and thus closer interactions between trailing wakes and lifting surfaces. Therefore, when trying to predict induced drag of positive staggered boxwings, only a potential-flow method with a fully relaxed-wake model will provide the high-degree of accuracy that rivals that of an Euler method while being computationally significantly more efficient.
XFEM Modelling of Multi-holes Plate with Single-row and Staggered Holes Configurations

Directory of Open Access Journals (Sweden)

Supar Khairi

2017-01-01

Full Text Available Joint efficiency is the key to composite structures assembly design, good structures response is dependent upon multi-holes behavior as subjected to remote loading. Current benchmarking work were following experimental testing series taken from literature on multi-holes problem. Eleven multi-hole configurations were investigated with various pitch and gage distance of staggered holes and non-staggered holes (single-row holes. Various failure modes were exhibited, most staggered holes demonstrates staggered crack path but non-staggered holes series displayed crack path along net-section plane. Stress distribution were carried out and good agreement were exhibited in experimental observation as reported in the respective literature. Consequently, strength prediction work were carried out under quasi-static loading, most showed discrepancy between 8% -31%, better prediction were exhibited in thicker and non-staggered holes plate combinations.

Thermodynamic Bethe Ansatz for the Spin-1/2 Staggered XXZ- Model

OpenAIRE

Mkhitaryan, V. V.; Sedrakyan, A. G.

2003-01-01

We develop the technique of Thermodynamic Bethe Ansatz to investigate the ground state and the spectrum in the thermodynamic limit of the staggered $XXZ$ models proposed recently as an example of integrable ladder model. This model appeared due to staggered inhomogeneity of the anisotropy parameter $\\Delta$ and the staggered shift of the spectral parameter. We give the structure of ground states and lowest lying excitations in two different phases which occur at zero temperature.
Perimenopausal Bleeding and Bleeding After Menopause

Science.gov (United States)

... Patients About ACOG Perimenopausal Bleeding and Bleeding After Menopause Home For Patients Search FAQs Perimenopausal Bleeding and ... 2011 PDF Format Perimenopausal Bleeding and Bleeding After Menopause Gynecologic Problems What are menopause and perimenopause? What ...
Staggering but not knocked out

Energy Technology Data Exchange (ETDEWEB)

Anon.

2012-11-01

Italy's PV market is staggering like a boxer almost knocked out. It has been hit hard by the country's deep economic recession. Conto Energia V has been yet another blow with cuts of up to 40 % in the solar feed-in tariffs. But the situation is not hopeless.
Revisiting the even-odd staggering in fission-fragment yields

International Nuclear Information System (INIS)

Caamano, M.; Rejmund, F.; Schmidt, K. H.

2010-01-01

The even-odd staggering observed in the experimental fission-fragment nuclear-charge yields is investigated over a wide systematics of fission fragments measured at Lohengrin in direct kinematics and at GSI in inverse kinematics. The general increase of the even-odd staggering in the fission-fragment charge yields towards asymmetric charge splits is explained by the absorption of the unpaired nucleons by the heavy fragment. As a consequence, the well established trend of even-odd staggering in the fission fragment charge yields to decrease with the fissility is attributed in part to the asymmetry evolution of the charge distribution. This interpretation is strongly supported by the data measured at GSI, which cover the complete charge distribution and include precise yields at symmetry. They reveal that the even-odd effect around symmetry remains constant over a large range of fissility. (authors)
Fan Stagger Angle for Dirt Rejection

Science.gov (United States)

Gallagher, Edward J. (Inventor); Rose, Becky E. (Inventor); Brilliant, Lisa I. (Inventor)

2015-01-01

A gas turbine engine includes a spool, a turbine coupled to drive the spool, a propulsor coupled to be rotated about an axis by the turbine through the spool, and a gear assembly coupled between the propulsor and the spool such that rotation of the turbine drives the propulsor at a different speed than the spool. The propulsor includes a hub and a row of propulsor blades that extend from the hub. Each of the propulsor blades has a span between a root at the hub and a tip, and a chord between a leading edge and a trailing edge. The chord forms a stagger angle alpha with the axis, and the stagger angle alpha is less than 15 deg. at a position along the propulsor blade that is within an inboard 20% of the span.
Numerical properties of staggered quarks with a taste-dependent mass term

CERN Document Server

de Forcrand, Philippe; Panero, Marco

2012-01-01

The numerical properties of staggered Dirac operators with a taste-dependent mass term proposed by Adams [1,2] and by Hoelbling [3] are compared with those of ordinary staggered and Wilson Dirac operators. In the free limit and on (quenched) interacting configurations, we consider their topological properties, their spectrum, and the resulting pion mass. Although we also consider the spectral structure, topological properties, locality, and computational cost of an overlap operator with a staggered kernel, we call attention to the possibility of using the Adams and Hoelbling operators without the overlap construction. In particular, the Hoelbling operator could be used to simulate two degenerate flavors without additive mass renormalization, and thus without fine-tuning in the chiral limit.
{Delta}I = 2 energy staggering in normal deformed dysprosium nuclei

Energy Technology Data Exchange (ETDEWEB)

Riley, M.A.; Brown, T.B.; Archer, D.E. [Florida State Univ., Tallahassee, FL (United States)] [and others

1996-12-31

Very high spin states (I{ge}50{Dirac_h}) have been observed in {sup 155,156,157}Dy. The long regular band sequences, free from sharp backbending effects, observed in these dysprosium nuclei offer the possibility of investigating the occurence of any {Delta}I = 2 staggering in normal deformed nuclei. Employing the same analysis techniques as used in superdeformed nuclei, certain bands do indeed demonstrate an apparent staggering and this is discussed.
Staggered and short-period solutions of the saturable discrete nonlinear Schrodinger equation

DEFF Research Database (Denmark)

Khare, A.; Rasmussen, K.O.; Samuelsen, Mogens Rugholm

2009-01-01

We point out that the nonlinear Schrodinger lattice with a saturable nonlinearity also admits staggered periodic aswell as localized pulse-like solutions. Further, the same model also admits solutions with a short period. We examine the stability of these solutions and find that the staggered as ...
Effect of Stagger on the Vibroacoustic Loads from Clustered Rockets

Science.gov (United States)

Rojo, Raymundo; Tinney, Charles E.; Ruf, Joseph H.

2016-01-01

The effect of stagger startup on the vibro-acoustic loads that form during the end- effects-regime of clustered rockets is studied using both full-scale (hot-gas) and laboratory scale (cold gas) data. Both configurations comprise three nozzles with thrust optimized parabolic contours that undergo free shock separated flow and restricted shock separated flow as well as an end-effects regime prior to flowing full. Acoustic pressure waveforms recorded at the base of the nozzle clusters are analyzed using various statistical metrics as well as time-frequency analysis. The findings reveal a significant reduction in end- effects-regime loads when engine ignition is staggered. However, regardless of stagger, both the skewness and kurtosis of the acoustic pressure time derivative elevate to the same levels during the end-effects-regime event thereby demonstrating the intermittence and impulsiveness of the acoustic waveforms that form during engine startup.
MILC staggered conjugate gradient performance on Intel KNL

Energy Technology Data Exchange (ETDEWEB)

Li, Ruiz [Indiana Univ., Bloomington, IN (United States). Dept. of Physics; Detar, Carleton [Univ. of Utah, Salt Lake City, UT (United States). Dept. of Physics and Astronomy; Doerfler, Douglas W. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). National Energy Research Scientific Computing Center (NERSC); Gottlieb, Steven [Indiana Univ., Bloomington, IN (United States). Dept. of Physics; Jha, Asish [Intel Corp., Hillsboro, OR (United States). Sofware and Services Group; Kalamkar, Dhiraj [Intel Labs., Bangalore (India). Parallel Computing Lab.; Toussaint, Doug [Univ. of Arizona, Tucson, AZ (United States). Physics Dept.

2016-11-03

We review our work done to optimize the staggered conjugate gradient (CG) algorithm in the MILC code for use with the Intel Knights Landing (KNL) architecture. KNL is the second gener- ation Intel Xeon Phi processor. It is capable of massive thread parallelism, data parallelism, and high on-board memory bandwidth and is being adopted in supercomputing centers for scientific research. The CG solver consumes the majority of time in production running, so we have spent most of our effort on it. We compare performance of an MPI+OpenMP baseline version of the MILC code with a version incorporating the QPhiX staggered CG solver, for both one-node and multi-node runs.
Kaon decay amplitudes using staggered fermions

International Nuclear Information System (INIS)

Sharpe, S.R.

1986-12-01

A status report is given of an attempt, using staggered fermions to calculate the real and imaginary parts of the amplitudes for K → ππ,. Semi-quantitative results are found for the imaginary parts, and these suggest that ε' might be smaller than previously expected in the standard model
Duplex tab exhaust nozzle

Science.gov (United States)

Gutmark, Ephraim Jeff (Inventor); Martens, Steven (nmn) (Inventor)

2012-01-01

An exhaust nozzle includes a conical duct terminating in an annular outlet. A row of vortex generating duplex tabs are mounted in the outlet. The tabs have compound radial and circumferential aft inclination inside the outlet for generating streamwise vortices for attenuating exhaust noise while reducing performance loss.
Gastrointestinal bleeding

Science.gov (United States)

... Sigmoidoscopy Alternative Names Lower GI bleeding; GI bleeding; Upper GI bleeding; Hematochezia Images GI bleeding - series Fecal occult blood test References Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman- ...
Diagnostic evaluation and aggressive surgical approach in bleeding pseudoaneurysms associated with pancreatic pseudocysts

International Nuclear Information System (INIS)

Pitkaeranta, P.; Haapiainen, R.; Kivisaari, L.; Schroeder, T.

1991-01-01

Hemorrhage is an uncommon but serious complication of pancreatic pseudocysts. When gastrointestinal bleeding or intra-abdominal hemorrhage is associated with a pancreatic pseudocysts and the usual sources of bleeding are not detected by endoscopy, the rupture of a pseudoaneurysm inside the pseudocyst should be suspected. The article present 13 cases, 11 associated with chronic and 2 with late complications after acute necrotizing pancreatitis. On the basis of sonographic findings, bleeding site was suspected in 8 of 11 patients. Computed tomography (CT) was performed on 10, and bleeding was suspected in 8. The pseudoaneurysm itself was detected by CT in one and by ultrasonography in none. Visceral angiography was performed on five patients, and the pseudoaneurysm was evident in all. External drainage with arterial ligation was done as a primary operation in five patients; four of them later underwent pancreatic resection because of rebleeding. In eight cases pancreatic resection was the initial operation; none of these patients continued to bleed or needed reoperation because of the same pseudoaneurysm. There were no intraoperative deaths, but one patient died postoperatively. Aggressive diagnostic evaluation and surgical approach are associated with a reduction in mortality and morbidity in this serious complication of pancreatic pseudocysts. 28 refs., 2 figs., 1 tab
Integral staggered point-matching method for millimeter-wave reflective diffraction gratings on electron cyclotron heating systems

International Nuclear Information System (INIS)

Xia, Donghui; Huang, Mei; Wang, Zhijiang; Zhang, Feng; Zhuang, Ge

2016-01-01

Highlights: • The integral staggered point-matching method for design of polarizers on the ECH systems is presented. • The availability of the integral staggered point-matching method is checked by numerical calculations. • Two polarizers are designed with the integral staggered point-matching method and the experimental results are given. - Abstract: The reflective diffraction gratings are widely used in the high power electron cyclotron heating systems for polarization strategy. This paper presents a method which we call “the integral staggered point-matching method” for design of reflective diffraction gratings. This method is based on the integral point-matching method. However, it effectively removes the convergence problems and tedious calculations of the integral point-matching method, making it easier to be used for a beginner. A code is developed based on this method. The calculation results of the integral staggered point-matching method are compared with the integral point-matching method, the coordinate transformation method and the low power measurement results. It indicates that the integral staggered point-matching method can be used as an optional method for the design of reflective diffraction gratings in electron cyclotron heating systems.
Integral staggered point-matching method for millimeter-wave reflective diffraction gratings on electron cyclotron heating systems

Energy Technology Data Exchange (ETDEWEB)

Xia, Donghui [State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, 430074 Wuhan (China); Huang, Mei [Southwestern Institute of Physics, 610041 Chengdu (China); Wang, Zhijiang, E-mail: wangzj@hust.edu.cn [State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, 430074 Wuhan (China); Zhang, Feng [Southwestern Institute of Physics, 610041 Chengdu (China); Zhuang, Ge [State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, 430074 Wuhan (China)

2016-10-15

Highlights: • The integral staggered point-matching method for design of polarizers on the ECH systems is presented. • The availability of the integral staggered point-matching method is checked by numerical calculations. • Two polarizers are designed with the integral staggered point-matching method and the experimental results are given. - Abstract: The reflective diffraction gratings are widely used in the high power electron cyclotron heating systems for polarization strategy. This paper presents a method which we call “the integral staggered point-matching method” for design of reflective diffraction gratings. This method is based on the integral point-matching method. However, it effectively removes the convergence problems and tedious calculations of the integral point-matching method, making it easier to be used for a beginner. A code is developed based on this method. The calculation results of the integral staggered point-matching method are compared with the integral point-matching method, the coordinate transformation method and the low power measurement results. It indicates that the integral staggered point-matching method can be used as an optional method for the design of reflective diffraction gratings in electron cyclotron heating systems.
A boundary-fitted staggered difference method for incompressible flow using Riemann geometry

International Nuclear Information System (INIS)

Koshizuka, Seiichi; Kondo, Shunsuke; Oka, Yoshiaki.

1990-01-01

A boundary-fitted staggered difference method (BFSDM) is investigated for incompressible flow in nuclear plants. BFSDM employs control cells for scalars, staggered location of velocity components, and integrated formulation of div=0. Governing equations are written as coordinate-free forms using Riemann geometry. Flow velocity is represented with contravariant physical components in the present method. Connection terms emerge as source terms in the coordinate-free governing equations. These terms are studied from the viewpoints of physical meaning, numerical stability, and conservative property. Some flows on a round or slant boundary are solved using boundary-fitted curvilinear (BFC) grids and rectangular grids to compare the present method and the rectangular-type (R-type) staggered difference method (SDM). Supercomputing of the present method, including vector processing, is also discussed compared with the R-type method. (author)
Energy stable and high-order-accurate finite difference methods on staggered grids

Science.gov (United States)

O'Reilly, Ossian; Lundquist, Tomas; Dunham, Eric M.; Nordström, Jan

2017-10-01

For wave propagation over distances of many wavelengths, high-order finite difference methods on staggered grids are widely used due to their excellent dispersion properties. However, the enforcement of boundary conditions in a stable manner and treatment of interface problems with discontinuous coefficients usually pose many challenges. In this work, we construct a provably stable and high-order-accurate finite difference method on staggered grids that can be applied to a broad class of boundary and interface problems. The staggered grid difference operators are in summation-by-parts form and when combined with a weak enforcement of the boundary conditions, lead to an energy stable method on multiblock grids. The general applicability of the method is demonstrated by simulating an explosive acoustic source, generating waves reflecting against a free surface and material discontinuity.
Ergovaline does not alter the severity of ryegrass staggers induced by lolitrem B.

Science.gov (United States)

Finch, S C; Vlaming, J B; Sutherland, B L; van Koten, C; Mace, W J; Fletcher, L R

2018-03-01

To investigate a possible interaction between lolitrem B and ergovaline by comparing the incidence and severity of ryegrass staggers in sheep grazing ryegrass (Lolium perenne) containing lolitrem B or ryegrass containing both lolitrem B and ergovaline. Ninety lambs, aged approximately 6 months, were grazed on plots of perennial ryegrass infected with either AR98 endophyte (containing lolitrem B), standard endophyte (containing lolitrem B and ergovaline) or no endophyte, for up to 42 days from 2 February 2010. Ten lambs were grazed on three replicate plots per cultivar. Herbage samples were collected for alkaloid analysis and lambs were scored for ryegrass staggers (scores from 0-5) weekly during the study. Any animal which was scored ≥4 was removed from the study. Concentrations of lolitrem B did not differ between AR98 and standard endophyte-infected pastures during the study period (p=0.26), and ergovaline was present only in standard endophyte pastures. Ryegrass staggers was observed in sheep grazing both the AR98 and standard endophyte plots, with median scores increasing in the third week of the study. Prior to the end of the 42-day grazing period, 22 and 17 animals were removed from the standard endophyte and AR98 plots, respectively, because their staggers scores were ≥4. The cumulative probability of lambs having scores ≥4 did not differ between animals grazing the two pasture types (p=0.41). There was no evidence for ergovaline increasing the severity of ryegrass staggers induced by lolitrem B. In situations where the severity of ryegrass staggers appears to be greater than that predicted on the basis of concentrations of lolitrem B, the presence of other tremorgenic alkaloids should be investigated.
Aircraft rotor blade with passive tuned tab

Science.gov (United States)

Campbell, T. G. (Inventor)

1985-01-01

A structure for reducing vibratory airloading in a rotor blade with a leading edge and a trailing edge includes a cut out portion at the trailing edge. A substantially wedge shaped cross section, inertially deflectable tab, also with a leading edge and a trailing edge is pivotally mounted in the cut out portion. The trailing edge of the tab may move above and below the rotor blade. A torsion strap applies force against the tab when the trailing edge of the tab is above and below the rotor blade. A restraining member is slidably movable along the torsion strap to vary torsional biasing force supplied by the torsion bar to the tab. A plurality of movable weights positioned between plates vary a center of gravity of the tab. Skin of the tab is formed from unidirectional graphite and fiberglass layers. Sliders coupled with a pinned degree of freedom at rod eliminate bending of tab under edgewise blade deflection.

Gap states and edge properties of rectangular graphene quantum dot in staggered potential

Science.gov (United States)

Jeong, Y. H.; Eric Yang, S.-R.

2017-09-01

We investigate edge properties of a gapful rectangular graphene quantum dot in a staggered potential. In such a system gap states with discrete and closely spaced energy levels exist that are spatially located on the left or right zigzag edge. We find that, although the bulk states outside the energy gap are nearly unaffected, spin degeneracy of each gap state is lifted by the staggered potential. We have computed the occupation numbers of spin-up and -down gap states at various values of the strength of the staggered potential. The electronic and magnetic properties of the zigzag edges depend sensitively on these numbers. We discuss the possibility of applying this system as a single electron spintronic device.
Reaction mechanisms and staggering in S+Ni collisions

International Nuclear Information System (INIS)

D'Agostino, M.; Bruno, M.; Gulminelli, F.; Morelli, L.; Baiocco, G.; Bardelli, L.; Barlini, S.; Cannata, F.; Casini, G.; Geraci, E.; Gramegna, F.; Kravchuk, V.L.; Marchi, T.; Moroni, A.; Ordine, A.; Raduta, Ad.R.

2011-01-01

The reactions 32 S+ 58 Ni and 32 S+ 64 Ni are studied at 14.5 A MeV. After a selection of the collision mechanism, we show that important even-odd effects are present in the isotopic fragment distributions when the excitation energy is small. Close to the multifragmentation threshold this staggering appears hidden by the rapid variation of the production yields with the fragment size. Once this effect is accounted for, the staggering appears to be a universal feature of fragment production, slightly enhanced when the emission source is neutron poor. A closer look at the behavior of the production yields as a function of the neutron excess N-Z, reveals that odd-even effects cannot be explained by pairing effects in the nuclear masses alone, but depend in a more complex way on the de-excitation chain.
Optimization of the Single Staggered Wire and Tube Heat Exchanger

Directory of Open Access Journals (Sweden)

Arsana I Made

2016-01-01

Full Text Available Wire and tube heat exchanger consists of a coiled tube, and wire is welded on the two sides of it in normal direction of the tube. Generally,wire and tube heat exchanger uses inline wire arrangement between the two sides, whereas in this study, it used staggered wire arrangement that reduces the restriction of convection heat transfer. This study performed the optimization of single staggered wire and tube heat exchanger to increase the capacity and reduce the mass of the heat exchanger. Optimization was conducted with the Hooke-Jeeves method, which aims to optimize the geometry of the heat exchanger, especially on the diameter (dw and the distance between wires (pw. The model developed to present heat transfer correlations on single staggered wire and tube heat exchanger was valid. The maximum optimization factor obtained when the diameter wire was 0.9 mm and the distance between wires (pw was 11 mm with the fref value = 1.5837. It means that the optimized design only using mass of 59,10 % and could transfer heat about 98,5 % from the basis design.
Pseudo-spectral method using rotated staggered grid for elastic wave propagation in 3D arbitrary anisotropic media

KAUST Repository

Zou, Peng

2017-05-10

Staggering grid is a very effective way to reduce the Nyquist errors and to suppress the non-causal ringing artefacts in the pseudo-spectral solution of first-order elastic wave equations. However, the straightforward use of a staggered-grid pseudo-spectral method is problematic for simulating wave propagation when the anisotropy level is greater than orthorhombic or when the anisotropic symmetries are not aligned with the computational grids. Inspired by the idea of rotated staggered-grid finite-difference method, we propose a modified pseudo-spectral method for wave propagation in arbitrary anisotropic media. Compared with an existing remedy of staggered-grid pseudo-spectral method based on stiffness matrix decomposition and a possible alternative using the Lebedev grids, the rotated staggered-grid-based pseudo-spectral method possesses the best balance between the mitigation of artefacts and efficiency. A 2D example on a transversely isotropic model with tilted symmetry axis verifies its effectiveness to suppress the ringing artefacts. Two 3D examples of increasing anisotropy levels demonstrate that the rotated staggered-grid-based pseudo-spectral method can successfully simulate complex wavefields in such anisotropic formations.
Vaginal Bleeding

Science.gov (United States)

... or period, is a woman's monthly bleeding.Abnormal vaginal bleeding is different from normal menstrual periods. It ... therapy) Cancer of the cervix, ovaries, uterus or vagina Thyroid problems Bleeding during pregnancy can have several ...
An implicit non-staggered Cartesian grid method for incompressible ...

Indian Academy of Sciences (India)

Immersed boundary; non-staggered; implicit; viscous flow. 1. ... functions for elastic boundaries (Saiki & Biringen 1996; Lai & Peskin 2000; Zhu & Peskin ... the effects of pressure and thereby explicitly achieving a strong coupling between them.
Stagger angle dependence of inertial and elastic coupling in bladed disks

Science.gov (United States)

Crawley, E. F.; Mokadam, D. R.

1984-01-01

Conditions which necessitate the inclusion of disk and shaft flexibility in the analysis of blade response in rotating blade-disk-shaft systems are derived in terms of nondimensional parameters. A simple semianalytical Rayleigh-Ritz model is derived in which the disk possesses all six rigid body degrees of freedom, which are elastically constrained by the shaft. Inertial coupling by the rigid body motion of the disk on a flexible shaft and out-of-plane elastic coupling due to disk flexure are included. Frequency ratios and mass ratios, which depend on the stagger angle, are determined for three typical rotors: a first stage high-pressure core compressor, a high bypass ratio fan, and an advanced turboprop. The stagger angle controls the degree of coupling in the blade-disk system. In the blade-disk-shaft system, the stagger angle determines whether blade-disk motion couples principally to the out-of-plane or in-plane motion of the disk on the shaft. The Ritz analysis shows excellent agreement with experimental results.
Abnormal uterine bleeding

Science.gov (United States)

Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding ... ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2015. www. ...
Staggering the dose of sugammadex lowers risks for severe emergence cough: a randomized control trial.

Science.gov (United States)

P S, Loh; Miskan, M M; Y Z, Chin; Zaki, R A

2017-10-11

Cough on emergence has been reported as a common adverse reaction with sugammadex reversal. We investigated if staggering the dose of sugammadex will reduce emergence cough in a single-center, randomized, double-blinded study. A hundred and twenty ASA 1-3 adults were randomly reversed with 1 mg/kg sugammadex prior to extubation followed by another 1 mg/kg immediately after extubation (staggered group), single dose of 2 mg/kg sugammadex (single bolus group) or neostigmine 0.02 mg/kg with glycopyrrolate (neostigmine group). We found 70% of patients (n = 28) reversed with single boluses of sugammadex had Grade 3 emergence cough compared to 12.5% (n = 5) in the staggered sugammadex group and 17.5% (n = 7) in the neostigmine group (p sugammadex group (n = 14, 35%, p = 0.005). On the other hand, staggering sugammadex lowered risks of developing severe cough (RR 0.2, p sugammadex group and control given neostigmine. In terms of timing, there was no delay in time taken from discontinuing anesthetic agents to reversal and extubation if sugammadex was staggered (emergence time 6.0 ± 3.2 s, p = 0.625 and reversal time 6.5 ± 3.5, p = 0.809). Staggering the dose of sugammadex for reversal will effectively decrease common emergence and early postoperative complications. ANZCTR Number ACTRN12616000116426 . Retrospectively registered on 2nd February 2016.
Numerical properties of staggered overlap fermions

CERN Document Server

de Forcrand, Philippe; Panero, Marco

2010-01-01

We report the results of a numerical study of staggered overlap fermions, following the construction of Adams which reduces the number of tastes from 4 to 2 without fine-tuning. We study the sensitivity of the operator to the topology of the gauge field, its locality and its robustness to fluctuations of the gauge field. We make a first estimate of the computing cost of a quark propagator calculation, and compare with Neuberger's overlap.
Weakly coupled S=1/2 quantum Heisenberg antiferromagnetic chains in an effective staggered field

International Nuclear Information System (INIS)

Sato, Masahiro; Oshikawa, Masaki

2002-01-01

We study weakly coupled S=1/2 quantum Heisenberg antiferromagnetic chains in an effective staggered field. Applying mean-field (MF) theory, spin-wave theory and chain MF (CMF) theory, we can see analytically some effects of the staggered field in this higher dimensional spin system. In particular, when the staggered field and the inter-chain inter-action compete with each other, we conjecture from the MF theory that a nontrivial phase is present. The spin wave theory predicts that the behavior of the gaps induced by a staggered field is different between the competitive case and the non-competitive case. When the inter-chain interactions are weak enough, we can improve the MF phase diagram by using CMF theory and the analytical results of field theories. The ordered phase region predicted by the CMF theory is fairly smaller than one of the MF theory. Cu-benzoate, CuCl 2 · 2DMSO (dimethylsulphoxide), BaCu 2 (Si 1-x Ge x ) 2 O 7 , etc., could be described by our model in enough low temperature. (author)
An optimal staggered harvesting strategy for herbaceous biomass energy crops

Energy Technology Data Exchange (ETDEWEB)

Bhat, M.G.; English, B.C. [Univ. of Tennessee, Knoxville, TN (United States)

1993-12-31

Biofuel research over the past two decades indicates lignocellulosic crops are a reliable source of feedstock for alternative energy. However, under the current technology of producing, harvesting and converting biomass crops, the cost of biofuel is not competitive with conventional biofuel. Cost of harvesting biomass feedstock is a single largest component of feedstock cost so there is a cost advantage in designing a biomass harvesting system. Traditional farmer-initiated harvesting operation causes over investment. This study develops a least-cost, time-distributed (staggered) harvesting system for example switch grass, that calls for an effective coordination between farmers, processing plant and a single third-party custom harvester. A linear programming model explicitly accounts for the trade-off between yield loss and benefit of reduced machinery overhead cost, associated with the staggered harvesting system. Total cost of producing and harvesting switch grass will decline by 17.94 percent from conventional non-staggered to proposed staggered harvesting strategy. Harvesting machinery cost alone experiences a significant reduction of 39.68 percent from moving from former to latter. The net return to farmers is estimated to increase by 160.40 percent. Per tonne and per hectare costs of feedstock production will decline by 17.94 percent and 24.78 percent, respectively. These results clearly lend support to the view that the traditional system of single period harvesting calls for over investment on agricultural machinery which escalates the feedstock cost. This social loss to the society in the form of escalated harvesting cost can be avoided if there is a proper coordination among farmers, processing plant and custom harvesters as to when and how biomass crop needs to be planted and harvested. Such an institutional arrangement benefits producers, processing plant and, in turn, end users of biofuels.
LES investigation of infinite staggered wind-turbine arrays

International Nuclear Information System (INIS)

Yang, Xiaolei; Sotiropoulos, Fotis

2014-01-01

The layouts of turbines affect the turbine wake interactions and thus the wind farm performance. The wake interactions in infinite staggered wind-turbine arrays are investigated and compared with infinite aligned turbine arrays in this paper. From the numerical results we identify three types of wake behaviours, which are significantly different from wakes in aligned wind-turbine arrays. For the first type, each turbine wake interferes with the pair of staggered downstream turbine wakes and the aligned downstream turbine. For the second type, each turbine wake interacts with the first two downstream turbine wakes but does not show significant interference with the second aligned downstream turbine. For the third type, each turbine wake recovers immediately after passing through the gap of the first two downstream turbines and has little interaction with the second downstream turbine wakes The extracted power density and power efficiency are also studied and compared with aligned wind-turbine arrays
Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding

DEFF Research Database (Denmark)

Ngu, JH; Laursen, Stig Borbjerg; Chin, YK

2017-01-01

Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study.......Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study....
A study of manufacturing tubes with nano/ultrafine grain structure by stagger spinning

International Nuclear Information System (INIS)

Xia, Qinxiang; Xiao, Gangfeng; Long, Hui; Cheng, Xiuquan; Yang, Baojian

2014-01-01

Highlights: • Proposing a method of manufacturing tubes with nano/ultrafine crystal. • Obtaining the refined ferritic grains with an size of 500 nm after stagger spinning. • Obtaining the equiaxial ferritic grains with an size of 600 nm after annealing. - Abstract: A new method of manufacturing tubes with nano/ultrafine grain structure by stagger spinning and recrystallization annealing is proposed in this study. Two methods of the stagger spinning process are developed, the corresponding macroforming quality, microstructural evolution and mechanical properties of the spun tubes made of ASTM 1020 steel are analysed. The results reveal that a good surface smoothness and an improved spin-formability of spun parts can be obtained by the process combining of 3-pass spinning followed by a 580 °C × 0.5 h static recrystallization and 2-pass spinning with a 580 °C × 1 h static recrystallization annealing under the severe thinning ratio of wall thickness reduction. The ferritic grains with an average initial size of 50 μm are refined to 500 nm after stagger spinning under the 87% thinning ratio of wall thickness reduction. The equiaxial ferritic grains with an average size of 600 nm are generated through re-nucleation and grain growth by subsequent recrystallization annealing at 580 °C for 1 h heat preservation. The tensile strength of spun tubes has been founded to be proportional to the reciprocal of layer spacing of pearlite (LSP), and the elongation is inversely proportional to the reciprocal of LSP. This study shows that the developed method of stagger power spinning has the potential to be used to manufacture bulk metal components with nano/ultrafine grain structure
Structural, mechanical, and electronic properties of TaB2, TaB, IrB2, and IrB: First-principle calculations

International Nuclear Information System (INIS)

Zhao Wenjie; Wang Yuanxu

2009-01-01

First-principle calculations were performed to investigate the structural, elastic, and electronic properties of TaB 2 , TaB, IrB 2 , and IrB. The calculated equilibrium structural parameters, shear modulus, and Young's modulus of TaB 2 are well consistent with the available experimental data, and TaB 2 with P6/mmm space group has stronger directional bonding between ions than WB 2 , OsB 2 , IrN 2 , and PtN 2 . For TaB 2 , the hexagonal P6/mmm structure is more stable than the orthorhombic Pmmn one, while for IrB 2 the orthorhombic Pmmn structure is the most stable one. The high shear modulus of P6/mmm phase TaB 2 is mainly due to the strong covalent π-bonding of B-hexagon in the (0001) plane. Such a B-hexagon network can strongly resist against an applied [112-bar0] (0001) shear deformation. Correlation between the hardness and the elastic constants of TaB 2 was discussed. The band structure shows that P6/mmm phase TaB 2 and Pmmn phase IrB 2 are both metallic. The calculations show that both TaB and IrB are elastically stable with the hexagonal P6 3 /mmc structure. - Elastic constant c 44 of TaB 2 is calculated to be 235 GPa. This value is exceptionally high, exceeding those of WB 2 , OsB 2 , WB 4 , OsN 2 , IrN 2 , and PtN 2 .
Heisenberg spin-one chain in staggered magnetic field: A density matrix renormalization group study

International Nuclear Information System (INIS)

Jizhong Lou; Xi Dai; Shaojin Qin; Zhaobin Su; Lu Yu

1999-04-01

Using the density matrix renormalization group technique, we calculate numerically the low energy excitation spectrum and magnetization curve of the spin-1 antiferromagnetic chain in a staggered magnetic field, which is expected to describe the physics of R 2 BaNiO 5 (R ≠ Y) family below the Neel temperature of the magnetic rare-earth (R) sublattice. These results are valid in the entire range of the staggered field, and agree with those given by the non-linear σ model study for small fields, but differ from the latter for large fields. They are consistent with the available experimental data. The correlation functions for this model are also calculated. The transverse correlations display the anticipated exponential decay with shorter correlation length, while the longitudinal correlations show explicitly the induced staggered magnetization. (author)
Menstrual Patterns and Treatment of Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders.

Science.gov (United States)

Dowlut-McElroy, Tazim; Williams, Karen B; Carpenter, Shannon L; Strickland, Julie L

2015-12-01

To characterize menstrual bleeding patterns and treatment of heavy menstrual bleeding in adolescents with bleeding disorders. We conducted a retrospective review of female patients aged nine to 21 years with known bleeding disorders who attended a pediatric gynecology, hematology, and comprehensive hematology/gynecology clinic at a children's hospital in a metropolitan area. Prevalence of heavy menstrual bleeding at menarche, prolonged menses, and irregular menses among girls with bleeding disorders and patterns of initial and subsequent treatment for heavy menstrual bleeding in girls with bleeding disorders. Of 115 participants aged nine to 21 years with known bleeding disorders, 102 were included in the final analysis. Of the 69 postmenarcheal girls, almost half (32/69, 46.4%) noted heavy menstrual bleeding at menarche. Girls with von Willebrand disease were more likely to have menses lasting longer than seven days. Only 28% of girls had discussed a treatment plan for heavy menstrual bleeding before menarche. Hormonal therapy was most commonly used as initial treatment of heavy menstrual bleeding. Half (53%) of the girls failed initial treatment. Combination (hormonal and non-hormonal therapy) was more frequently used for subsequent treatment. Adolescents with bleeding disorders are at risk of heavy bleeding at and after menarche. Consultation with a pediatric gynecologist and/or hematologist prior to menarche may be helpful to outline abnormal patterns of menstrual bleeding and to discuss options of treatment in the event of heavy menstrual bleeding. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
Multigrid for Staggered Lattice Fermions

Energy Technology Data Exchange (ETDEWEB)

Brower, Richard C. [Boston U.; Clark, M. A. [Unlisted, US; Strelchenko, Alexei [Fermilab; Weinberg, Evan [Boston U.

2018-01-23

Critical slowing down in Krylov methods for the Dirac operator presents a major obstacle to further advances in lattice field theory as it approaches the continuum solution. Here we formulate a multi-grid algorithm for the Kogut-Susskind (or staggered) fermion discretization which has proven difficult relative to Wilson multigrid due to its first-order anti-Hermitian structure. The solution is to introduce a novel spectral transformation by the K\\"ahler-Dirac spin structure prior to the Galerkin projection. We present numerical results for the two-dimensional, two-flavor Schwinger model, however, the general formalism is agnostic to dimension and is directly applicable to four-dimensional lattice QCD.
Samsung Galaxy Tab S for dummies

CERN Document Server

Gookin, Dan

2015-01-01

Explore your Galaxy Tab S with an expert tour guide at your side Samsung Galaxy Tab S For Dummies is a user-friendly guide to getting the most out of your new tablet. You'll discover how different the tablet experience is from the desktop, laptop, or smartphone, and learn how to take advantage of everything your Galaxy Tab S has to offer. This entertaining guide walks you through each feature one by one, helping you learn exactly what your tablet can do for you. With everything from reading to playing games and surfing the Internet, you will learn how to be productive and have fun, too! Nav

Calculation of cell face velocity of non-staggered grid system

KAUST Repository

Li, Wang; Yu, Bo; Wang, Xinran; Sun, Shuyu

2012-01-01

In this paper, the cell face velocities in the discretization of the continuity equation, the momentum equation, and the scalar equation of a non-staggered grid system are calculated and discussed. Both the momentum interpolation and the linear
Blockspin and multigrid for staggered fermions in non-abelian gauge fields

International Nuclear Information System (INIS)

Kalkreuter, T.; Mack, G.; Speh, M.

1991-07-01

We discuss blockspins for staggered fermions, i.e. averaging and interpolation procedures which are needed in a real space renormalization group approach to gauge theories with staggered fermions and in a multigrid approach to the computation of gauge covariant propagators. The discussion starts from the requirement that the symmetries of the free action should be preserved by the blocking procedure in the limit of a pure gauge. A definition of an averaging kernel as a solution of a gauge covariant eigenvalue equation is proposed, and the properties of a corresponding interpolation kernel are examined in the light of general criteria for good choices of blockspins. Some results of multigrid computation of bosonic propagation in an SU(2) gauge field in 4 dimensions are also presented. (orig.)
Skew information in the XY model with staggered Dzyaloshinskii-Moriya interaction

Energy Technology Data Exchange (ETDEWEB)

Qiu, Liang, E-mail: lqiu@cumt.edu.cn [School of Physics, China University of Mining and Technology, Xuzhou, Jiangsu 221116 (China); Quan, Dongxiao [State Key Laboratory of Integrated Services Networks, Xidian University, Xi' an, Shaanxi 710071 (China); Pan, Fei; Liu, Zhi [School of Physics, China University of Mining and Technology, Xuzhou, Jiangsu 221116 (China)

2017-06-01

We study the performance of the lower bound of skew information in the vicinity of transition point for the anisotropic spin-1/2 XY chain with staggered Dzyaloshinskii-Moriya interaction by use of quantum renormalization-group method. For a fixed value of the Dzyaloshinskii-Moriya interaction, there are two saturated values for the lower bound of skew information corresponding to the spin-fluid and Néel phases, respectively. The scaling exponent of the lower bound of skew information closely relates to the correlation length of the model and the Dzyaloshinskii-Moriya interaction shifts the factorization point. Our results show that the lower bound of skew information can be a good candidate to detect the critical point of XY spin chain with staggered Dzyaloshinskii-Moriya interaction.
Bleeding during Pregnancy

Science.gov (United States)

... in pregnancy? • What problems with the placenta can cause bleeding during pregnancy? • Can bleeding be a sign of preterm labor? • ... the hospital. What problems with the placenta can cause bleeding during pregnancy? Several problems with the placenta later in pregnancy ...
A superlinearly convergent finite volume method for the incompressible Navier-Stokes equations on staggered unstructured grids

International Nuclear Information System (INIS)

Vidovic, D.; Segal, A.; Wesseling, P.

2004-01-01

A method for linear reconstruction of staggered vector fields with special treatment of the divergence is presented. An upwind-biased finite volume scheme for solving the unsteady incompressible Navier-Stokes equations on staggered unstructured triangular grids that uses this reconstruction is described. The scheme is applied to three benchmark problems and is found to be superlinearly convergent in space
Staggered Dslash Performance on Intel Xeon Phi Architecture

OpenAIRE

Li, Ruizi; Gottlieb, Steven

2014-01-01

The conjugate gradient (CG) algorithm is among the most essential and time consuming parts of lattice calculations with staggered quarks. We test the performance of CG and dslash, the key step in the CG algorithm, on the Intel Xeon Phi, also known as the Many Integrated Core (MIC) architecture. We try different parallelization strategies using MPI, OpenMP, and the vector processing units (VPUs).
Nonperturbative QCD simulations with 2+1 flavors of improved staggered quarks

International Nuclear Information System (INIS)

Bazavov, A.; Toussaint, D.; Bernard, C.; Laiho, J.; DeTar, C.; Levkova, L.; Oktay, M. B.; Gottlieb, Steven; Heller, U. M.; Hetrick, J. E.; Mackenzie, P. B.; Sugar, R.; Van de Water, R. S.

2010-01-01

Dramatic progress has been made over the last decade in the numerical study of quantum chromodynamics (QCD) through the use of improved formulations of QCD on the lattice (improved actions), the development of new algorithms, and the rapid increase in computing power available to lattice gauge theorists. In this article simulations of full QCD are described using the improved staggered quark formalism, ''asqtad'' fermions. These simulations were carried out with two degenerate flavors of light quarks (up and down) and with one heavier flavor, the strange quark. Several light quark masses, down to about three times the physical light quark mass, and six lattice spacings have been used. These enable controlled continuum and chiral extrapolations of many low energy QCD observables. The improved staggered formalism is reviewed, emphasizing both advantages and drawbacks. In particular, the procedure for removing unwanted staggered species in the continuum limit is reviewed. Then the asqtad lattice ensembles created by the MILC Collaboration are described. All MILC lattice ensembles are publicly available, and they have been used extensively by a number of lattice gauge theory groups. The physics results obtained with them are reviewed, and the impact of these results on phenomenology is discussed. Topics include the heavy quark potential, spectrum of light hadrons, quark masses, decay constants of light and heavy-light pseudoscalar mesons, semileptonic form factors, nucleon structure, scattering lengths, and more.
Piles, tabs and overlaps in navigation among documents

DEFF Research Database (Denmark)

Jakobsen, Mikkel Rønne; Hornbæk, Kasper

2010-01-01

Navigation among documents is a frequent, but ill supported activity. Overlapping or tabbed documents are widespread, but they offer limited visibility of their content. We explore variations on navigation support: arranging documents with tabs, as overlapping windows, and in piles. In an experim......Navigation among documents is a frequent, but ill supported activity. Overlapping or tabbed documents are widespread, but they offer limited visibility of their content. We explore variations on navigation support: arranging documents with tabs, as overlapping windows, and in piles....... In an experiment we compared 11 participants’ navigation with these variations and found strong task effects. Overall, overlapping windows were preferred and their structured layout worked well with some tasks. Surprisingly, tabbed documents were efficient in tasks requiring simply finding a document. Piled...... on document navigation and its support by piling....
Internal Bleeding

Science.gov (United States)

... Fractures (Part II) Additional Content Medical News Internal Bleeding By Amy H. Kaji, MD, PhD, Associate Professor, ... Emergency First Aid Priorities Cardiac Arrest Choking Internal Bleeding Severed or Constricted Limbs or Digits Soft-Tissue ...
Modeling seismic wave propagation using staggered-grid mimetic finite differences

Directory of Open Access Journals (Sweden)

Freysimar Solano-Feo

2017-04-01

Full Text Available Mimetic finite difference (MFD approximations of continuous gradient and divergence operators satisfy a discrete version of the Gauss-Divergence theorem on staggered grids. On the mimetic approximation of this integral conservation principle, an unique boundary flux operator is introduced that also intervenes on the discretization of a given boundary value problem (BVP. In this work, we present a second-order MFD scheme for seismic wave propagation on staggered grids that discretized free surface and absorbing boundary conditions (ABC with same accuracy order. This scheme is time explicit after coupling a central three-level finite difference (FD stencil for numerical integration. Here, we briefly discuss the convergence properties of this scheme and show its higher accuracy on a challenging test when compared to a traditional FD method. Preliminary applications to 2-D seismic scenarios are also presented and show the potential of the mimetic finite difference method.
Bleeding and starving: fasting and delayed refeeding after upper gastrointestinal bleeding.

Science.gov (United States)

Fonseca, Jorge; Meira, Tânia; Nunes, Ana; Santos, Carla Adriana

2014-01-01

Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. The aim of this study was obtaining objective data on refeeding after nonvariceal upper gastrointestinal bleeding. From 1 year span records of nonvariceal upper gastrointestinal bleeding patients that underwent urgent endoscopy: clinical features; rockall score; endoscopic data, including severity of lesions and therapy; feeding related records of seven days: liquid diet prescription, first liquid intake, soft/solid diet prescription, first soft/solid intake. From 133 patients (84 men) Rockall classification was possible in 126: 76 score ≥5, 50 score bleeding, eight rebled, two underwent surgery, 13 died. Ulcer was the major bleeding cause, 63 patients underwent endoscopic therapy. There was 142/532 possible refeeding records, no record 37% patients. Only 16% were fed during the first day and half were only fed on third day or later. Rockall upper gastrointestinal bleeding patients must be refed earlier, according to guidelines.
Nonvariceal upper gastrointestinal bleeding

International Nuclear Information System (INIS)

Burke, Stephen J.; Weldon, Derik; Sun, Shiliang; Golzarian, Jafar

2007-01-01

Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)
Nonvariceal upper gastrointestinal bleeding

Energy Technology Data Exchange (ETDEWEB)

Burke, Stephen J.; Weldon, Derik; Sun, Shiliang [University of Iowa, Department of Radiology, Iowa, IA (United States); Golzarian, Jafar [University of Iowa, Department of Radiology, Iowa, IA (United States); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa, IA (United States)

2007-07-15

Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)
The sequential organ failure assessment (SOFA) score is an effective triage marker following staggered paracetamol (acetaminophen) overdose.

Science.gov (United States)

Craig, D G; Zafar, S; Reid, T W D J; Martin, K G; Davidson, J S; Hayes, P C; Simpson, K J

2012-06-01

The sequential organ failure assessment (SOFA) score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, but has not been evaluated following staggered (multiple supratherapeutic doses over >8 h, resulting in cumulative dose of >4 g/day) overdoses. To evaluate the prognostic accuracy of the SOFA score following staggered paracetamol overdose. Time-course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual timed laboratory samples were correlated with corresponding clinical parameters and the daily SOFA scores were calculated. A total of 39/50 (78%) patients developed hepatic encephalopathy. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2-95.7), 94.3 (95% CI 82.5-99.1), and 98.4 (95% CI 84.3-100.0) at 0, 24 and 48 h, respectively, postadmission. A SOFA score of paracetamol overdose, is associated with a good prognosis. Both the SOFA and APACHE II scores could improve triage of high-risk staggered paracetamol overdose patients. © 2012 Blackwell Publishing Ltd.
A fast Poisson solver for unsteady incompressible Navier-Stokes equations on the half-staggered grid

Science.gov (United States)

Golub, G. H.; Huang, L. C.; Simon, H.; Tang, W. -P.

1995-01-01

In this paper, a fast Poisson solver for unsteady, incompressible Navier-Stokes equations with finite difference methods on the non-uniform, half-staggered grid is presented. To achieve this, new algorithms for diagonalizing a semi-definite pair are developed. Our fast solver can also be extended to the three dimensional case. The motivation and related issues in using this second kind of staggered grid are also discussed. Numerical testing has indicated the effectiveness of this algorithm.
Horizontally staggered lightguide solar concentrator with lateral displacement tracking for high concentration applications.

Science.gov (United States)

Ma, Hongcai; Wu, Lin

2015-07-10

We present the design of a horizontally staggered lightguide solar concentrator with lateral displacement tracking for high concentration applications. This solar concentrator consists of an array of telecentric primary concentrators, a horizontally staggered lightguide layer, and a vertically tapered lightguide layer. The primary concentrator is realized by two plano-aspheric lenses with lateral movement and maintains a high F-number over an angle range of ±23.5°. The results of the simulations show that the solar concentrator achieves a high concentration ratio of 500× with ±0.5° of acceptance angle by a single-axis tracker and dual lateral translation stages.
Entropy Stable Staggered Grid Spectral Collocation for the Burgers' and Compressible Navier-Stokes Equations

Science.gov (United States)

Carpenter, Mark H.; Parsani, Matteo; Fisher, Travis C.; Nielsen, Eric J.

2015-01-01

Staggered grid, entropy stable discontinuous spectral collocation operators of any order are developed for Burgers' and the compressible Navier-Stokes equations on unstructured hexahedral elements. This generalization of previous entropy stable spectral collocation work [1, 2], extends the applicable set of points from tensor product, Legendre-Gauss-Lobatto (LGL) to a combination of tensor product Legendre-Gauss (LG) and LGL points. The new semi-discrete operators discretely conserve mass, momentum, energy and satisfy a mathematical entropy inequality for both Burgers' and the compressible Navier-Stokes equations in three spatial dimensions. They are valid for smooth as well as discontinuous flows. The staggered LG and conventional LGL point formulations are compared on several challenging test problems. The staggered LG operators are significantly more accurate, although more costly to implement. The LG and LGL operators exhibit similar robustness, as is demonstrated using test problems known to be problematic for operators that lack a nonlinearly stability proof for the compressible Navier-Stokes equations (e.g., discontinuous Galerkin, spectral difference, or flux reconstruction operators).
Bleeding Disorders in Women

Science.gov (United States)

... might be heavy, print and use a menstrual chart to track your bleeding and talk to your ... you’re “low in iron.” Heavy bleeding after dental surgery, other surgery, or childbirth. Prolonged bleeding episodes ...
Vaginal bleeding in pregnancy

Science.gov (United States)

Pregnancy - vaginal bleeding; Maternal blood loss - vaginal ... Up to 1 in 4 women have vaginal bleeding at some time during their pregnancy. Bleeding is more common in the first 3 months (first trimester), especially with twins.
B→D*lν and B→Dlν form factors in staggered chiral perturbation theory

International Nuclear Information System (INIS)

Laiho, Jack; Water, Ruth S. van de

2006-01-01

We calculate the B→D and B→D* form factors at zero recoil in staggered chiral perturbation theory. We consider heavy-light mesons in which only the light (u, d, or s) quark is staggered; current lattice simulations generally use a highly improved action such as the Fermilab or nonrelativistic QCD action for the heavy (b or c) quark. We work to lowest nontrivial order in the heavy-quark expansion and to one-loop order in the chiral expansion. We present results for a partially quenched theory with three sea quarks in which there are no mass degeneracies (the ''1+1+1'' theory) and for a partially quenched theory in which the u and d sea quark masses are equal (the ''2+1'' theory). We also present results for full (2+1) QCD, along with a numerical estimate of the size of staggered discretization errors. Finally, we calculate the finite volume corrections to the form factors and estimate their numerical size in current lattice simulations

Upper gastrointestinal bleeding.

Science.gov (United States)

Feinman, Marcie; Haut, Elliott R

2014-02-01

Upper gastrointestinal (GI) bleeding remains a commonly encountered diagnosis for acute care surgeons. Initial stabilization and resuscitation of patients is imperative. Stable patients can have initiation of medical therapy and localization of the bleeding, whereas persistently unstable patients require emergent endoscopic or operative intervention. Minimally invasive techniques have surpassed surgery as the treatment of choice for most upper GI bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.
Bleeding from gastrointestinal angioectasias is not related to bleeding disorders - a case control study

Directory of Open Access Journals (Sweden)

Lärfars Gerd

2010-09-01

Full Text Available Abstract Background Angioectasias in the gastrointestinal tract can be found in up to 3% of the population. They are typically asymptomatic but may sometimes result in severe bleeding. The reasons for why some patients bleed from their angioectasias are not fully understood but it has been reported that it may be explained by an acquired von Willebrand syndrome (AVWS. This condition has similar laboratory findings to congenital von Willebrand disease with selective loss of large von Willebrand multimers. The aim of this study was to find out if AVWS or any other bleeding disorder was more common in patients with bleeding from angioectasias than in a control group. Methods We compared bleeding tests and coagulation parameters, including von Willebrand multimers, from a group of 23 patients with anemia caused by bleeding from angioectasias, with the results from a control group lacking angioectasias. Results No significant differences between the two groups were found in coagulation parameters, bleeding time or von Willebrand multimer levels. Conclusion These results do not support a need for routine bleeding tests in cases of bleeding from angioectasias and do not show an overall increased risk of AVWS among these patients.
Tool kit for staggered fermions

International Nuclear Information System (INIS)

Kilcup, G.W.; Sharpe, S.R.

1986-01-01

The symmetries of staggered fermions are analyzed both discrete and continuous. Tools are presented that allow a simple decomposition of representations of the continuum symmetries into representations of the discrete lattice symmetries, both at zero and non-zero spatial momenta. These tools are used to find the lattice transcriptions of the operators that appear in the weak interaction Hamiltonian. The lattice Ward Identities are derived that follow from the single partially conserved axial symmetry. Using these identities, the lattice equivalents of the continuum PCAC relations are found. Combining all these tools, Ward Identities are obtained, for the matrix elements of the weak interaction Hamiltonian, from which the behavior of the matrix elements as the pion and kaon masses vanish are derived. The same behavior as in the continuum is found
Minor Bleeds Alert for Subsequent Major Bleeding in Patients Using Vitamin K Antagonists.

OpenAIRE

Veeger , Nic J.G.M.; Piersma-Wichers , Margriet; Meijer , Karina; Hillege , Hans L.

2011-01-01

Abstract Vitamin K antagonists (VKA) have shown to be effective in primary and secondary prevention of thromboembolism, but the associated risk of bleeding is an important limitation. The majority of the bleeds are clinically mild. In this study, we assessed whether these minor bleeds are associated with major bleeding, when controlling for other important risk indicators, including the achieved quality of anticoagulation. For this, 5898 patients of a specialised anticoagulation cl...
A subzone reconstruction algorithm for efficient staggered compatible remapping

Energy Technology Data Exchange (ETDEWEB)

Starinshak, D.P., E-mail: starinshak1@llnl.gov; Owen, J.M., E-mail: mikeowen@llnl.gov

2015-09-01

Staggered-grid Lagrangian hydrodynamics algorithms frequently make use of subzonal discretization of state variables for the purposes of improved numerical accuracy, generality to unstructured meshes, and exact conservation of mass, momentum, and energy. For Arbitrary Lagrangian–Eulerian (ALE) methods using a geometric overlay, it is difficult to remap subzonal variables in an accurate and efficient manner due to the number of subzone–subzone intersections that must be computed. This becomes prohibitive in the case of 3D, unstructured, polyhedral meshes. A new procedure is outlined in this paper to avoid direct subzonal remapping. The new algorithm reconstructs the spatial profile of a subzonal variable using remapped zonal and nodal representations of the data. The reconstruction procedure is cast as an under-constrained optimization problem. Enforcing conservation at each zone and node on the remapped mesh provides the set of equality constraints; the objective function corresponds to a quadratic variation per subzone between the values to be reconstructed and a set of target reference values. Numerical results for various pure-remapping and hydrodynamics tests are provided. Ideas for extending the algorithm to staggered-grid radiation-hydrodynamics are discussed as well as ideas for generalizing the algorithm to include inequality constraints.
The International Bleeding Risk Score

DEFF Research Database (Denmark)

Laursen, Stig Borbjerg; Laine, L.; Dalton, H.

2017-01-01

The International Bleeding Risk Score: A New Risk Score that can Accurately Predict Mortality in Patients with Upper GI-Bleeding.......The International Bleeding Risk Score: A New Risk Score that can Accurately Predict Mortality in Patients with Upper GI-Bleeding....
Re: Penetration Behavior of Opposed Rows of Staggered Secondary Air Jets Depending on Jet Penetration Coefficient and Momentum Flux Ratio

Science.gov (United States)

Holdeman, James D.

2016-01-01

The purpose of this article is to explain why the extension of the previously published C = (S/Ho)sqrt(J) scaling for opposed rows of staggered jets wasn't directly successful in the study by Choi et al. (2016). It is not surprising that staggered jets from opposite sides do not pass each other at the expected C value, because Ho/D and sqrt(J) are much larger than the maximum in previous studies. These, and large x/D's, tend to suggest development of 2-dimensional flow. Although there are distinct optima for opposed rows of in-line jets, single-side injection, and opposed rows of staggered jets based on C, opposed rows of staggered jets provide as good or better mixing performance, at any C value, than opposed rows of in-line jets or jets from single-side injection.
Pairing correlations. II. Microscopic analysis of odd-even mass staggering in nuclei

International Nuclear Information System (INIS)

Duguet, T.; Bonche, P.; Heenen, P.-H.; Meyer, J.

2002-01-01

The odd-even mass staggering in nuclei is analyzed in the context of self-consistent mean-field calculations, for spherical as well as for deformed nuclei. For these nuclei, the respective merits of the energy differences Δ (3) and Δ (5) to extract both the pairing gap and the time-reversal symmetry breaking effect at the same time are extensively discussed. The usual mass formula Δ (3) is shown to contain additional mean-field contributions when realistic pairing is used in the calculation. A simple tool is proposed in order to remove the time-reversal symmetry breaking effects from Δ (5) . Extended comparisons with the odd-even mass staggering obtained in the zero-pairing limit (schematic model and self-consistent calculations) show the nonperturbative contribution of pairing correlations on this observable
Lattice Boltzmann simulation of flow across a staggered tube bundle array

Energy Technology Data Exchange (ETDEWEB)

Tiftikçi, A.; Kocar, C., E-mail: ckocar@hacettepe.edu.tr

2016-04-15

Highlights: • Large eddy simulation of the cross-flow in a staggered tube bundle array in 3D was made. • LBM and FVM are used separately as numerical solvers and the results of each method compared with experimental data. • Effect of lattice model is studied for tube bundle flow. • Filter size effects, mesh size effects are studied for VLES turbulence model. - Abstract: The decision on the magnitude of the grid size is a crucial problem in large eddy simulations. Finer mesh requires excessive memory and causes long simulation time. Large eddy simulation model becomes inefficient when the extent of the flow geometry to be simulated with the lattice-Boltzmann method is large. Thus, in this study, it is proposed to investigate the capabilities of three turbulence models, namely, very large eddy simulation, Van Driest and Smagorinsky–Lilly. As a test case, a staggered tube bundle flow experiment is used for the validation and comparison purposes. Sensitivity analyses (including mesh and filter size) have been made. Furthermore, the effect of lattice model is investigated and it is showed that the D3Q27 and D3Q19 models do not differ significantly in lattice-Boltzmann method for this type of flow. The results of turbulence model comparisons for staggered tube bundle flow showed that very large eddy simulation is superior at low resolution. This paper might be considered as a good validation of the lattice-Boltzmann method. In turbulent flow conditions, the code successfully captures the velocity and stress profiles even if the flow is quite complicated.
Adhesive-Bonded Tab Attaches Thermocouples to Titanium

Science.gov (United States)

Cook, C. F.

1982-01-01

Mechanical strength of titanium-alloy structures that support thermocouples is preserved by first spotwelding thermocouples to titanium tabs and then attaching tabs to titanium with a thermosetting adhesive. In contrast to spot welding, a technique previously used for thermocouples, fatigue strength of the titanium is unaffected by adhesive bonding. Technique is also gentler than soldering or attaching thermocouples with a tap screw.
Singlet vs Nonsinglet Perturbative Renormalization factors of Staggered Fermion Bilinears

Science.gov (United States)

Panagopoulos, Haralambos; Spanoudes, Gregoris

2018-03-01

In this paper we present the perturbative computation of the difference between the renormalization factors of flavor singlet (Σfψ¯fΓψf', f : flavor index) and nonsinglet (ψ¯f1Γψf2,f1 ≠ f2) bilinear quark operators (where Γ = 𝟙, γ5, γ µ, γ5 γ µ, γ5 σµv on the lattice. The computation is performed to two loops and to lowest order in the lattice spacing, using Symanzik improved gluons and staggered fermions with twice stout-smeared links. The stout smearing procedure is also applied to the definition of bilinear operators. A significant part of this work is the development of a method for treating some new peculiar divergent integrals stemming from the staggered formalism. Our results can be combined with precise simulation results for the renormalization factors of the nonsinglet operators, in order to obtain an estimate of the renormalization factors for the singlet operators. The results have been published in Physical Review D [1].
Risk Factors for Post-TAVI Bleeding According to the VARC-2 Bleeding Definition and Effect of the Bleeding on Short-Term Mortality: A Meta-analysis.

Science.gov (United States)

Wang, Jiayang; Yu, Wenyuan; Jin, Qi; Li, Yaqiong; Liu, Nan; Hou, Xiaotong; Yu, Yang

2017-04-01

In this study we investigated the effect of post-transcatheter aortic valve implantation (TAVI) bleeding (per Valve Academic Research Consortium-2 [VARC-2] bleeding criteria) on 30-day postoperative mortality and examined the correlation between pre- or intraoperative variables and bleeding. Multiple electronic literature databases were searched using predefined criteria, with bleeding defined per Valve Academic Research Consortium-2 criteria. A total of 10 eligible articles with 3602 patients were included in the meta-analysis. The meta-analysis revealed that post-TAVI bleeding was associated with a 323% increase in 30-day postoperative mortality (odds risk [OR]; 4.23, 95% confidence interval [CI], 2.80-6.40; P logistic regression analysis revealed that atrial fibrillation (AF) was independently correlated with TAVI-associated bleeding (OR, 2.63; 95% CI, 1.33-5.21; P = 0.005). Meta-regression showed that potential modifiers like the Society of Thoracic Surgeons (STS) score, mortality, the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), aortic valve area, mean pressure gradient, left ventricular ejection fraction, preoperative hemoglobin and platelet levels, and study design had no significant effects on the results of the meta-analysis. Post-TAVI bleeding, in particular, major bleeding/life-threatening bleeding, increased 30-day postoperative mortality. Transapical access was a significant bleeding risk factor. Preexisting AF independently correlated with TAVI-associated bleeding, likely because of AF-related anticoagulation. Recognition of the importance and determinants of post-TAVI bleeding should lead to strategies to improve outcomes. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
MILC staggered conjugate gradient performance on Intel KNL

OpenAIRE

DeTar, Carleton; Doerfler, Douglas; Gottlieb, Steven; Jha, Ashish; Kalamkar, Dhiraj; Li, Ruizi; Toussaint, Doug

2016-01-01

We review our work done to optimize the staggered conjugate gradient (CG) algorithm in the MILC code for use with the Intel Knights Landing (KNL) architecture. KNL is the second gener- ation Intel Xeon Phi processor. It is capable of massive thread parallelism, data parallelism, and high on-board memory bandwidth and is being adopted in supercomputing centers for scientific research. The CG solver consumes the majority of time in production running, so we have spent most of our effort on it. ...
Bleeding esophageal varices

Science.gov (United States)

... this page: //medlineplus.gov/ency/article/000268.htm Bleeding esophageal varices To use the sharing features on ... veins in the esophagus to balloon outward. Heavy bleeding can occur if the veins break open. Any ...
GI bleeding - slideshow

Science.gov (United States)

... page: //medlineplus.gov/ency/presentations/100162.htm GI bleeding - series—Normal anatomy To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Gastrointestinal Bleeding A.D.A.M., Inc. is accredited by ...
Scintigraphic evaluation of gastrointestinal bleeding

International Nuclear Information System (INIS)

Park, Yong Tai; Lee, Choon Keun; Lee, Sun Wha; Choi, Woo Suk; Yoon, Yup; Lim, Jae Hoon

1988-01-01

Gastrointestinal bleeding remains a major diagnostic problem. Although advances have been made in the medical and surgical methods of managing gastrointestinal bleeding, the commonly employed techniques of barium radiography, endoscopy, and angiography may not successfully localize the site and define the cause of gastrointestinal bleeding. Two widely available technetium-99m-labeled radiopharmaceuticals, sulfur colloid and red blood cells are currently used in the evaluation of patients who are bleeding from the gastrointestinal tract. Surgically confirmed 19 patients with use of 99m Tc-sulfur colloid (7 cases) and 99m Tc-RBC (12 cases) were retrospectively evaluated. The overall sensitivity of scintigraphy in detection of bleeding and localization of bleeding site was 68% and 84%, respectively. The authors conclude that bleeding scintigraphy is a safe, sensitive, and non-invasive method as an effective screening test before performing angiography or surgery.
Continuum symmetry restoration in lattice models with staggered fermions

International Nuclear Information System (INIS)

Morel, A.

1986-09-01

This talk is a report on results obtained by T. Jolicoeur, R. Lacaze, B. Petersson and the author: staggered fermions can be consistently interpreted as flavoured quarks in the continuum limit of asymptotically free theories on the lattice. This statement is supported by analytical results for the Gross-Neveu model at large N and for a QCD two point function, and by a numerical simulation of SU(2) quenched QCD
Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol-induced hepatotoxicity

Science.gov (United States)

Craig, Darren G N; Bates, Caroline M; Davidson, Janice S; Martin, Kirsty G; Hayes, Peter C; Simpson, Kenneth J

2012-01-01

AIMS Paracetamol (acetaminophen) poisoning remains the major cause of severe acute hepatotoxicity in the UK. In this large single centre cohort study we examined the clinical impact of staggered overdoses and delayed presentation following paracetamol overdose. RESULTS Between 1992 and 2008, 663 patients were admitted with paracetamol-induced severe liver injury, of whom 161 (24.3%) had taken a staggered overdose. Staggered overdose patients were significantly older and more likely to abuse alcohol than single time point overdose patients. Relief of pain (58.2%) was the commonest rationale for repeated supratherapeutic ingestion. Despite lower total ingested paracetamol doses and lower admission serum alanine aminotransferase concentrations, staggered overdose patients were more likely to be encephalopathic on admission, require renal replacement therapy or mechanical ventilation and had higher mortality rates compared with single time point overdoses (37.3% vs. 27.8%, P = 0.025), although this overdose pattern did not independently predict death. The King's College poor prognostic criteria had reduced sensitivity (77.6, 95% CI 70.8, 81.5) for this pattern of overdose. Of the 396/450 (88.0%) single time point overdoses in whom accurate timings could be obtained, 178 (44.9%) presented to medical services >24 h following overdose. Delayed presentation beyond 24 h post overdose was independently associated with death/liver transplantation (OR 2.25, 95% CI 1.23, 4.12, P = 0.009). CONCLUSIONS Both delayed presentation and staggered overdose pattern are associated with adverse outcomes following paracetamol overdose. These patients are at increased risk of developing multi-organ failure and should be considered for early transfer to specialist liver centres. PMID:22106945
Clinical utility of new bleeding criteria: a prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention.

Science.gov (United States)

Choi, Jae-Hyuk; Seo, Jeong-Min; Lee, Dong Hyun; Park, Kyungil; Kim, Young-Dae

2015-04-01

The aim of this study was to evaluate the clinical utility of the new bleeding criteria, proposed by the Bleeding Academic Research Consortium (BARC), compared with the old criteria for determining the action of physicians in contact with bleeding events, after percutaneous coronary intervention (PCI). The BARC criteria were independently associated with an increased risk of 1-year mortality after PCI, and provided a predictive value, in regard to 1-year mortality. The standardized bleeding definitions will be expected to help the physician to correctly analyze the bleeding events, to select an optimal treatment, and to objectively compare the results of multiple trials and registries. All the patients undergoing PCI from June to September 2012 were prospectively enrolled. Patients who experienced a bleeding event were further classified, based on three different bleeding severity criteria: BARC, Thrombolysis In Myocardial Infarction (TIMI), and Global Use of Strategies To Open coronary arteries (GUSTO). The primary outcome was the occurrence of bleeding events requiring interruption of antiplatelet therapy (IAT) by physicians. A total of 376 consecutive patients were included in this study. Total bleeding events occurred in 46 patients (12.2%). BARC type ≥2 bleeding occurred in 30 patients (8.0%); however, TIMI major or minor bleeding, and GUSTO moderate or severe bleeding occurred in 6 (1.6%) and 11 patients (2.9%), respectively. Of the 46 patients, 28 (60.9% of patients) required IAT. On receiver-operating characteristic curve analysis, bleeding defined BARC type ≥2 effectively predicted IAT, with a sensitivity of 89.3%, and a specificity of 98.5% (pdefinition may be a more useful tool for the detection of bleeding with clinical relevance, for patients undergoing PCI. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Projection of the rotation form Navier-Stokes equation onto the half-staggered grid

Energy Technology Data Exchange (ETDEWEB)

Cho, Ji Ryong [Inje University, Kimhae (Korea, Republic of)

2016-07-15

A projection method for computing incompressible fluid flow is proposed. For the method, the rotation form Navier-Stokes equation (NSE), for which the velocity and the total pressure are employed, is discretized on the half-staggered, finite difference spatial grid. The total pressure couples the static pressure gradient and the convection of momentum in the continuous NSE while the half-staggered grid provides weak pressure-velocity coupling in discrete space. These two features interact synergistically for the discretized NSE to produce smooth pressure fields without additional numerical artifacts such as the momentum interpolation. The method preserves the kinetic energy at the inviscid limit condition. Numerical solutions of the decaying Taylor vortex, the inviscid Taylor vortex, the sudden expansion channel and the square-prism wake are presented.

Vaginal or uterine bleeding - overview

Science.gov (United States)

... and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding ... There are many causes of abnormal vaginal bleeding. HORMONES ... Doctors call the problem abnormal uterine bleeding (AUB) . AUB ...
Finite micro-tab system for load control on a wind turbine

International Nuclear Information System (INIS)

Bach, A B; Lennie, M; Nayeri, C N; Paschereit, C O; Pechlivanoglou, G

2014-01-01

Finite micro-tabs have been investigated experimentally to evaluate the potential for load control on wind turbines. Two dimensional full span, as well as multiple finite tabs of various aspect ratios have been studied on an AH93W174 airfoil at different chord wise positions. A force balance was used to measure the aerodynamic loads. Furthermore, the wake vortex system consisting of the Karman vortex street as well as the tab tip vortices was analyzed with a 12-hole probe and hot wire anemometry. Finally, conventional oil paint as well as a quantitative digital flow analysis technique called SMARTviz were used to visualize the flow around the finite tab configurations. Results have shown that the devices are an effective solution to alleviate the airfoils overall load. The influence of the tab height, tab position as well as the finite tab aspect ratio on the lift and lift to drag ratio have been evaluated. It could be shown, that the lift difference can either be varied by changing the tab height as well as by altering the aspect ratio of the finite tabs. The drag of a two-dimensional flap is directly associated with the vortex street, while in the case of the finite tab, the solidity ratio of the tabs has the strongest effect on the drag. Therefore, the application of a finite tab system showed to improve the lift to drag ratio
Compact lattice QED with staggered fermions and chiral symmetry breaking

International Nuclear Information System (INIS)

Hoferichter, A.; Mitrjushkin, V.K.; Mueller-Preussker, M.

1994-07-01

Different formulations of the 4d compact lattice QED with staggered fermions (standard Wilson and modified by suppression of lattice artifacts) are investigated by Monte Carlo simulations within the quenched approximation. We show that after suppressing lattice artifacts the system undergoes a phase transition from the Coulomb phase into a presumably weakly chirally broken phase only at (unphysical) negative β-values. (orig.)
Kinetics of full scrum and staggered scrum engagement in under 19 ...

African Journals Online (AJOL)

Two hundred and eight male Rugby Union players from 13 high schools, whose ages ranged from 16 to 19 years, were used to examine the kinetics of the full scrum versus staggered scrum engagement techniques. Telemetric pressure transducers were used to measure the engagement and sustained forces acting on the ...
Energy Stability Analysis of Some Fully Discrete Numerical Schemes for Incompressible Navier–Stokes Equations on Staggered Grids

KAUST Repository

Chen, Huangxin

2017-09-01

In this paper we consider the energy stability estimates for some fully discrete schemes which both consider time and spatial discretizations for the incompressible Navier–Stokes equations. We focus on three kinds of fully discrete schemes, i.e., the linear implicit scheme for time discretization with the finite difference method (FDM) on staggered grids for spatial discretization, pressure-correction schemes for time discretization with the FDM on staggered grids for the solutions of the decoupled velocity and pressure equations, and pressure-stabilization schemes for time discretization with the FDM on staggered grids for the solutions of the decoupled velocity and pressure equations. The energy stability estimates are obtained for the above each fully discrete scheme. The upwind scheme is used in the discretization of the convection term which plays an important role in the design of unconditionally stable discrete schemes. Numerical results are given to verify the theoretical analysis.
Upper GI Bleeding in Children

Science.gov (United States)

Upper GI Bleeding in Children What is upper GI Bleeding? Irritation and ulcers of the lining of the esophagus, stomach or duodenum can result in upper GI bleeding. When this occurs the child may vomit blood ...
Scale effect and value criterion of the permeability of the interlayer staggered zones in the basalt of Jinsha River basin, China

Science.gov (United States)

Zhou, Zhifang; Lin, Mu; Guo, Qiaona; Chen, Meng

2018-05-01

The hydrogeological characteristics of structural planes are different to those of the associated bedrock. The permeability, and therefore hydraulic conductivity (K), of a structural plane can be significantly different at different scales. The interlayer staggered zones in the Emeishan Basalt of early Late Permian were studied; this formation is located in the Baihetan hydropower project area in Jinsha River Basin, China. The seepage flow distribution of a solid model and two generalized models (A and B) were computed using COMSOL. The K values of the interlayer staggered zones for all three models were calculated by both simulation and analytical methods. The results show that the calculated K results of the generalized models can reflect the variation trend of permeability in each section of the solid model, and the approximate analytical calculation of K can be taken into account in the calculation of K in the generalized models instead of that found by simulation. Further studies are needed to investigate permeability variation in the interlayer staggered zones under the condition of different scales, considering the scaling variation in each section of an interlayer staggered zone. The permeability of each section of an interlayer staggered zone presents a certain degree of dispersivity at small scales; however, the permeability values tends to converge to a similar value as the scale of each section increases. The regularity of each section of the interlayer staggered zones under the condition of different scales can provide a scientific basis for reasonable selection of different engineering options.
How Does a Staggered Board Provision Affect Corporate Strategic Change?—Evidence from China’s Listed Companies

Directory of Open Access Journals (Sweden)

Kai Wang

2018-05-01

Full Text Available As China’s capital market has become more and more developed, listed companies have begun to establish some anti-takeover provisions to protect their controlling right. Existing studies have examined the consequences of the establishment of such provisions. However, few studies have explored how these provisions affect corporate strategic change. Based on agency theory and prospect theory, this paper proposes two channels through which one of the anti-takeover provisions, staggered board provision, impacts strategic change. Using the data of China’s listed companies which issue A-shares in Shenzhen and Shanghai stock exchanges from 2007 to 2014, these two channels are tested. We find that the existence of a staggered board provision negatively affects the extent of strategic change. In addition, if governance mechanisms restrict directors’ power, the relationship between staggered board provision and strategic change will be weakened, which supports the agency theory. If the listed company is faced with a more dynamic external environment, the relationship between staggered board provision and strategic change will be stronger, which supports the prospect theory. These results are robust after we use a different method to measure strategic change. Our conclusions not only enrich literature about strategic change and anti-takeover provisions, but also are helpful for improving corporate governance in China and other developing countries.
Gamma band odd-even staggering in some deformed nuclei

International Nuclear Information System (INIS)

Khairy, M.K.; Talaat, SH.M.; Morsy, M.

2005-01-01

A complete investigation was carried out in studying the odd-even staggering (OES) of gamma bands energy levels in some deformed nuclei up to angular momentum L=13 . With the help of Minkov treatment in the framework of a collective Vector Boson Model (VBM) with broken SU (3) symmetry. The OES behavior of deformed isotopes 162 E r, 164 E r, 166 E r, 156 G d, 170 Y b and 232 T h was studied and discussed
Dysfunctional Uterine Bleeding (DUB) (For Teens)

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Abnormal Uterine Bleeding (AUB) KidsHealth / For Teens / Abnormal Uterine Bleeding (AUB) ... Print en español Sangrado uterino anormal What Is Abnormal Uterine Bleeding? Abnormal uterine bleeding (AUB) is the name doctors ...
Salmonella Dublin kan give store tab

DEFF Research Database (Denmark)

Nielsen, Torben Dahl; Nielsen, Liza Rosenbaum; Kudahl, Anne Margrethe Braad

2012-01-01

Store besætninger lider størst økonomisk tab ved infektion med Salmonella Dublin. Selv i en veldrevet besætning kan tabet løbe op i mellem 1,3 og 3,3 millioner kr. over en tiårs periode. Ved uhensigtsmæssige hygiejne- og managementrutiner kan tabet nemt blive meget højere.......Store besætninger lider størst økonomisk tab ved infektion med Salmonella Dublin. Selv i en veldrevet besætning kan tabet løbe op i mellem 1,3 og 3,3 millioner kr. over en tiårs periode. Ved uhensigtsmæssige hygiejne- og managementrutiner kan tabet nemt blive meget højere....
Analysis of the influence of the interlayer staggered zone in the basalt of Jinsha River Basin on the main buildings

Science.gov (United States)

Guo, Qiaona; Huang, Jiangwei

2018-02-01

In this paper, the finite element software FEFLOW is used to simulate the seepage field of the interlayer staggered zone C2 in the basalt of Jinsha River Basin. The influence of the interlayer staggered zone C2 on the building is analyzed. Combined with the waterproof effect of current design scheme of anti-seepage curtain, the seepage field in the interlayer staggered zone C2 is discussed under different design schemes. The optimal design scheme of anti-seepage curtain is put forward. The results showed that the case four can effectively reduce the head and hydraulic gradient of underground powerhouse area, and improve the groundwater seepage field in the plant area.
ΔI = 2 Nuclear Staggering in Superdeformed Rotational Bands

Directory of Open Access Journals (Sweden)

Okasha M. D.

2014-01-01

Full Text Available A four parameters model including collective rotational en ergies to fourth order is ap- plied to reproduce the ∆ I = 2 staggering in transition energies in four selected super deformed rotational bands, namely, 148 Gd (SD6, 194 Hg (SD1, SD2, SD3. The model parameters and the spin of the bandhead have been extracted a ssuming various val- ues to the lowest spin of the bandhead at nearest integer, in o rder to obtain a minimum root mean square deviation between calculated and the exper imental transition energies. This allows us to suggest the spin values for the energy level s which are experimentally unknown. For each band a staggering parameter represent the deviation of the transition energies from a smooth reference has been determined by calc ulating the fourth order derivative of the transition energies at a given spin. The st aggering parameter contains five consecutive transition energies which is denoted here a s the five-point formula. In order to get information about the dynamical moment of ine rtia, the two point for- mula which contains only two consecutive transition energi es has been also considered. The dynamical moment of inertia decreasing with increasing rotational frequency for A ∼ 150, while increasing for A ∼ 190 mass regions.
Management of severe perioperative bleeding

DEFF Research Database (Denmark)

Kozek-Langenecker, Sibylle A; Ahmed, Aamer B; Afshari, Arash

2017-01-01

: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia...... and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide...
Accuracy of rockall score for in hospital re bleeding among cirrhotic patients with variceal bleed

International Nuclear Information System (INIS)

Asgher, S.; Saleem, M.K.

2015-01-01

To assess the diagnostic accuracy of Roc kall scoring system for predicting in-hospital re-ble- eding in cirrhotic patients presenting with variceal bleed. Material and Methods: This descriptive case series study was conducted at Department of Medicine Combined Military Hospital Lahore from December 2013 to May 2014. We included patients with liver cirrhosis who presented with upper GI bleeding and showed varices as the cause of bleeding on endoscopy. Clinical and endoscopic features were noted to calculate Rockall score. Patients with score < 2 and > 8 were included. After treating with appropriate pharmacological and endoscopic therapy, patients were followed for re-bleeding for 10 days. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive values using 2 x 2 tables. Results: In the study, 175 patients were included. Mean age was 51.5 ± 1.22 years. Male to female ratio was 1.5 to 1.0 out of 175 patients, 157 patients (89.7%) were of low risk group (score = 2) while 18 patients (10.3%) were in high risk group (score > 8). In low risk group, re-bleeding occurred only in 2 patients (1.2%) while in high risk group, re-bleeding occurred in 14 patients (78%). Rockall score was found to have good diagnostic accuracy with sensitivity of 87.5%, specificity of 97.48%, positive predictive value of 77.8% and negative predictive value of 98.7%. Conclusion: In cases of variceal bleed, frequency of re-bleed is less in patients who are in low risk category with lower Rockall score and high in high risk patients with higher rockall score. The Rockall score has a good diagnostic accuracy in prediction of re-bleed in variceal bleeding. (author)
To Bleed or Not to Bleed: That is the Question. The Side Effects of Apixaban.

Science.gov (United States)

Ciccone, Marco Matteo; Zito, Annapaola; Devito, Fiorella; Maiello, Maria; Palmiero, Pasquale

2018-01-01

Apixaban is a new oral anticoagulant (NOACs: Novel Oral Anticoagulant), like dabigatran, rivaroxaban, and edoxaban. All of them are prescribed to patients with non valvular atrial fibrillation or venous thromboembolism, to replace warfarin, because of the lower probability of bleeding, however they can cause bleeding by themselves. Bleeding is an adverse event in patients taking anticoagulants. It is associated with a significant increase of morbidity and risk of death. However, these drugs should be used only for the time when anticoagulation is strictly required, especially when used for preventing deep vein thrombosis. Prolonged use increases the risk of bleeding. In the ARISTOTLE Trial Apixaban, compared with warfarin, was associated with a lower rate of intracranial hemorrhages and less adverse consequences following extracranial hemorrhage. Many physicians still have limited experience with new oral anticoagulants and about bleeding risk managment. We reviewed the available literature on extracranial and intracranial bleeding concerning apixaban. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.
Simulation of turbulent flow over staggered tube bundles using multi-relaxation time lattice Boltzmann method

International Nuclear Information System (INIS)

Park, Jong Woon; Choi, Hyun Gyung

2014-01-01

A turbulent fluid flow over staggered tube bundles is of great interest in many engineering fields including nuclear fuel rods, heat exchangers and especially a gas cooled reactor lower plenum. Computational methods have evolved for the simulation of such flow for decades and lattice Boltzmann method (LBM) is one of the attractive methods due to its sound physical basis and ease of computerization including parallelization. In this study to find computational performance of the LBM in turbulent flows over staggered tubes, a fluid flow analysis code employing multi-relaxation time lattice Boltzmann method (MRT-LBM) is developed based on a 2-dimensional D2Q9 lattice model and classical sub-grid eddy viscosity model of Smagorinsky. As a first step, fundamental performance MRT-LBM is investigated against a standard problem of a flow past a cylinder at low Reynolds number in terms of drag forces. As a major step, benchmarking of the MRT-LBM is performed over a turbulent flow through staggered tube bundles at Reynolds number of 18,000. For a flow past a single cylinder, the accuracy is validated against existing experimental data and previous computations in terms of drag forces on the cylinder. Mainly, the MRT-LBM computation for a flow through staggered tube bundles is performed and compared with experimental data and general purpose computational fluid dynamic (CFD) analyses with standard k-ω turbulence and large eddy simulation (LES) equipped with turbulence closures of Smagrinsky-Lilly and wall-adapting local eddy-viscosity (WALE) model. The agreement between the experimental and the computational results from the present MRT-LBM is found to be reasonably acceptable and even comparable to the LES whereas the computational efficiency is superior. (orig.)
Simulation of turbulent flow over staggered tube bundles using multi-relaxation time lattice Boltzmann method

Energy Technology Data Exchange (ETDEWEB)

Park, Jong Woon; Choi, Hyun Gyung [Dongguk Univ., Gyeongju (Korea, Republic of). Nuclear and Energy Engineering Dept.

2014-02-15

A turbulent fluid flow over staggered tube bundles is of great interest in many engineering fields including nuclear fuel rods, heat exchangers and especially a gas cooled reactor lower plenum. Computational methods have evolved for the simulation of such flow for decades and lattice Boltzmann method (LBM) is one of the attractive methods due to its sound physical basis and ease of computerization including parallelization. In this study to find computational performance of the LBM in turbulent flows over staggered tubes, a fluid flow analysis code employing multi-relaxation time lattice Boltzmann method (MRT-LBM) is developed based on a 2-dimensional D2Q9 lattice model and classical sub-grid eddy viscosity model of Smagorinsky. As a first step, fundamental performance MRT-LBM is investigated against a standard problem of a flow past a cylinder at low Reynolds number in terms of drag forces. As a major step, benchmarking of the MRT-LBM is performed over a turbulent flow through staggered tube bundles at Reynolds number of 18,000. For a flow past a single cylinder, the accuracy is validated against existing experimental data and previous computations in terms of drag forces on the cylinder. Mainly, the MRT-LBM computation for a flow through staggered tube bundles is performed and compared with experimental data and general purpose computational fluid dynamic (CFD) analyses with standard k-ω turbulence and large eddy simulation (LES) equipped with turbulence closures of Smagrinsky-Lilly and wall-adapting local eddy-viscosity (WALE) model. The agreement between the experimental and the computational results from the present MRT-LBM is found to be reasonably acceptable and even comparable to the LES whereas the computational efficiency is superior. (orig.)
Bleeding into the skin

Science.gov (United States)

... this page: //medlineplus.gov/ency/article/003235.htm Bleeding into the skin To use the sharing features on this page, please enable JavaScript. Bleeding into the skin can occur from broken blood ...
Improving the quark number susceptibilities for staggered fermions

International Nuclear Information System (INIS)

Gavai, Rajiv V.

2003-01-01

Quark number susceptibilities approach their ideal gas limit at sufficiently high temperatures. As in the case of other thermodynamic quantities, this limit itself is altered substantially on lattices with small temporal extent, N t = 4-8, making it thus difficult to check the validity of perturbation theory. Unlike other observables, improving susceptibilities or number densities is subject to constraints of current conservation and absence of chemical potential (μ) dependent divergences. We construct such an improved number density and susceptibility for staggered fermions and show that they approximate the continuum ideal gas limit better on small temporal lattices

Major bleeding and intracranial hemorrhage risk prediction in patients with atrial fibrillation: Attention to modifiable bleeding risk factors or use of a bleeding risk stratification score? A nationwide cohort study.

Science.gov (United States)

Chao, Tze-Fan; Lip, Gregory Y H; Lin, Yenn-Jiang; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Tuan, Ta-Chuan; Liao, Jo-Nan; Chung, Fa-Po; Chen, Tzeng-Ji; Chen, Shih-Ann

2018-03-01

While modifiable bleeding risks should be addressed in all patients with atrial fibrillation (AF), use of a bleeding risk score enables clinicians to 'flag up' those at risk of bleeding for more regular patient contact reviews. We compared a risk assessment strategy for major bleeding and intracranial hemorrhage (ICH) based on modifiable bleeding risk factors (referred to as a 'MBR factors' score) against established bleeding risk stratification scores (HEMORR 2 HAGES, HAS-BLED, ATRIA, ORBIT). A nationwide cohort study of 40,450 AF patients who received warfarin for stroke prevention was performed. The clinical endpoints included ICH and major bleeding. Bleeding scores were compared using receiver operating characteristic (ROC) curves (areas under the ROC curves [AUCs], or c-index) and the net reclassification index (NRI). During a follow up of 4.60±3.62years, 1581 (3.91%) patients sustained ICH and 6889 (17.03%) patients sustained major bleeding events. All tested bleeding risk scores at baseline were higher in those sustaining major bleeds. When compared to no ICH, patients sustaining ICH had higher baseline HEMORR 2 HAGES (p=0.003), HAS-BLED (pbleeding scores, c-indexes were significantly higher compared to MBR factors (pbleeding. C-indexes for the MBR factors score was significantly lower compared to all other scores (De long test, all pbleeding risk scores for major bleeding (all pbleeding risk scores had modest predictive value for predicting major bleeding but the best predictive value and NRI was found for the HAS-BLED score. Simply depending on modifiable bleeding risk factors had suboptimal predictive value for the prediction of major bleeding in AF patients, when compared to the HAS-BLED score. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Heavy Menstrual Bleeding (Menorrhagia)

Science.gov (United States)

... Us Information For… Media Policy Makers Blood Disorders Heavy Menstrual Bleeding Recommend on Facebook Tweet Share Compartir ... It can also be bleeding that is very heavy. How do you know if you have heavy ...
Haploinsufficiency of TAB2 causes congenital heart defects in humans

DEFF Research Database (Denmark)

Thienpont, Bernard; Zhang, Litu; Postma, Alex V

2010-01-01

. To definitively confirm the role of this candidate gene in CHDs, we performed mutation analysis of TAB2 in 402 patients with a CHD, which revealed two evolutionarily conserved missense mutations. Finally, a balanced translocation was identified, cosegregating with familial CHD. Mapping of the breakpoints...... demonstrated that this translocation disrupts TAB2. Taken together, these data clearly demonstrate a role for TAB2 in human cardiac development....
Comparing Bleeding Risk Assessment Focused on Modifiable Risk Factors Only Versus Validated Bleeding Risk Scores in Atrial Fibrillation

DEFF Research Database (Denmark)

Guo, Yutao; Zhu, Hang; Chen, Yundai

2018-01-01

BACKGROUNDThere is uncertainty whether a focus on modifiable bleeding risk factors offers better prediction of major bleeding than other existing bleeding risk scores.METHODSThis study compared a score based on numbers of the modifiable bleeding risk factors recommended in the 2016 European...... guidelines ("European risk score") versus other published bleeding risk scores that have been derived and validated in atrial fibrillation subjects (HEMORR2HAGES, HAS-BLED, ATRIA, and ORBIT) in a large hospital-based cohort of Chinese inpatients with atrial fibrillation.RESULTSThe European score had modest...... predictive ability for major bleeding (c-index 0.63, 95% confidence interval 0.56-0.69) and intracranial hemorrhage (0.72, 0.65-0.79) but nonsignificantly (and poorly) predicted extracranial bleeding (0.55, 0.54-0.56; P = .361). The HAS-BLED score was superior to predict bleeding events compared...
The use of 111In-labelled platelets for scintigraphic localization of gastrointestinal bleeding with special reference to occult bleeding

International Nuclear Information System (INIS)

Gjerloeff Schmidt, K.; Waever Rasmussen, J.; Grove, O.; Andersen, D.

1986-01-01

Gamma-camera imaging of the abdomen after injection of autologous 111 In-labelled platelets was applied for localization of gastrointestinal bleeding in a study of 22 patients. In 15 studies showing scintigraphic signs of bleeding, the clinical presentation included occult bleeding in 6, melaena in 4, and bloody stools in 5 patients. Scintigraphy could be done repeatedly for up to 1 week after a single tracer injection. The time interval between the injection and scintigraphic visualization of bleeding ranged from 10 min to 68 h, being longest in cases of occult bleeding. In most cases the scintigraphic findings were supported by other diagnostic modalities, including surgical removal of presumed sources of bleeding. In seven studies without scintigraphic signs of bleeding, a probable source of bleeding was identified by other means in one patient. The 111 In-platelet method seems to be a promising method for localization of gastrointestinal bleeding which may prove particularly useful in cases of occult or recurrent bleeding
Vaginal bleeding between periods

Science.gov (United States)

... this page: //medlineplus.gov/ency/article/003156.htm Vaginal bleeding between periods To use the sharing features ... this page, please enable JavaScript. This article discusses vaginal bleeding that occurs between a woman's monthly menstrual ...
Pengaruh Penempatan Sirip Berbentuk Segitiga Yang Dipasang Secara Aligned Dan Staggered Terhadap Performansi Kolektor Surya Pelat Datar

Directory of Open Access Journals (Sweden)

Ketut Astawa

2016-07-01

Full Text Available Abstrak: Energi surya adalah jenis energi terbarukan yang umum digunakan karena ketersediaannya yang sangat besar. Teknologi pengolah energi surya, salah satunya adalah kolektor surya. Kolektor surya pada umumnya, menggunakan laju aliran massa udara yang secara parallel melewati pelat penyerap. Udara yang masuk inlet akan melewati pelat penyerap dan langsung keluar melalui outlet. Penelitian ini dilakukan untuk membandingkan pengaruh penempatan sirip berbentuk segitiga yang dipasang secara alignedyang mengarah ke atas pada bagian atas pelat penyerap dan staggeredyang mengarah ke bawah pada bagian bawah dari pelat penyerap sehingga akan terjadi aliran udara secara turbulen di dalam kolektor dan dengan penambahan sirip segitiga ini juga dapat memperluas daerah penyerapan panas pada pelat penyerap kolektor surya yang secara langsung memperluas permukaan perpindahan panas dari pelat penyerap ke fluida kerja yang nantinya diharapkan mampu menghasilkan temperatur keluar kolektor yang lebih tinggi dan meningkatkan performansi kolektor surya pelat datar.Penelitian ini dilakukan secara eksperimen, sebagai variable bebas dalam penelitian ini adalah intensitas radiasi matahari dan variabel terikatnya adalah energi berguna dan efisiensi kolektor surya pelat datar.Dari hasil pembahasan penempatan sirip berbentuk segitiga pada kolektor surya pelat datar yang dipasang secara staggered menghasilkan energi berguna dan efisiensi yang lebih besar dibandingkan dengan kolektor surya yang dipasang secara aligned. Dilihat dari rata-rata hariannya energi berguna untuk kolektor bersirip aligned adalah 153.01 Watt dan untuk kolektor bersirip staggered sebesar 157.42 Watt, sedangkan untuk efesiensinya pada kolektor surya bersirip aligned adalah 37.94% dan untuk kolektor bersirip staggered42.12 %.Kata kunci : Performansi kolektor surya pelat datar, sirip segitiga aligned, sirip segitiga staggered Abstract: Solar energy is a type of renewable energy that is commonly used
Role of deformation in odd-even staggering in reaction cross sections for 30,31,32Ne and 36,37,38Mg isotopes

Science.gov (United States)

Urata, Y.; Hagino, K.; Sagawa, H.

2017-12-01

We discuss the role of pairing antihalo effect in the observed odd-even staggering in reaction cross sections for 30,31,32Ne and 36,37,38Mg isotopes by taking into account the ground-state deformation of these nuclei. To this end, we construct the ground-state density for the Ne,3130 and Mg,3736 nuclei based on a deformed Woods-Saxon potential, while for the 32Ne and 38Mg nuclei we also take into account the pairing correlation using the Hartree-Fock-Bogoliubov method. We demonstrate that, when the one-neutron separation energy is small for the odd-mass nuclei, a significant odd-even staggering still appears even with finite deformation, although the degree of staggering is somewhat reduced compared to the spherical case. This implies that the pairing antihalo effect in general plays an important role in generating the odd-even staggering in reaction cross sections for weakly bound nuclei.
Value of Adjusted Blood Requirement Index in determining failure to control bleed in patients with variceal bleeding.

Science.gov (United States)

Abid, Shahab; Khalid, Abdullah B; Awan, Safia; Shah, Hasnain A; Hamid, Saeed; Jafri, Wasim

2015-03-01

Variceal bleeding is a serious complication in patients with cirrhosis. Among the criteria that were proposed in Baveno conferences, the Adjusted Blood Requirement Index (ABRI) has not been validated prospectively in clinical practice. We therefore aim to evaluate the measurement of ABRI as a marker of failure to control bleeding and to evaluate the consistency of ABRI in relation to other criteria of failure to control variceal bleeding. All patients with variceal bleeding who presented to Aga Khan University Hospital from January 2010 to December 2012 who were administered transfusion of packed red blood cells were included after obtaining informed consent. All patients were managed as per the standard protocol with intravenous terlipressin along with band ligation and injection of cyanoacrylate in cases of esophageal and fundal varices, respectively. Hemoglobin and hematocrit were measured every 6 h for 48 h and then every 12 h until 5 days of index bleed in each patient. Packed cells were transfused if hemoglobin decreased below 8 g/dl. The number of blood units transfused, change in hemoglobin values, and ABRI were calculated after each unit of blood transfusion till 120 h. In patients in whom bleed could not be controlled, an ABRI value of 0.75 or more was compared with other Baveno IV-based parameters that define failure to control variceal bleeding. During the study period, 137 eligible patients with variceal bleed were admitted. The mean age of the patients was 52±12 years. The majority of patients (50.4%) were in Child-Pugh class B, followed by 38% in Child-Pugh class C. According to the Baveno IV criteria, overall failure to control acute variceal bleeding occurred in 52 (37.9%) patients. Excluding ABRI, failure to control bleeding was found in 22/137 (16%) patients, whereas ABRI-based criteria showed that in 34/137 (24.8%) patients, bleeding could not be controlled. There were only four (2.9%) patients with variceal bleeding in whom ABRI and
Abnormal Uterine Bleeding FAQ

Science.gov (United States)

... acid —This medication treats heavy menstrual bleeding. • Nonsteroidal anti-inflammatory drugs—These drugs, which include ibuprofen, may help control heavy bleeding and relieve menstrual cramps. • Antibiotics—If you have an infection, you may be ...
Traffic design and signal timing of staggered intersections based on a sorting strategy

Directory of Open Access Journals (Sweden)

Zhengyi Cai

2016-04-01

Full Text Available A staggered intersection is a special type of intersection in a road network. Its geographical characteristics consist of two T-legged intersections that cause the lost time per cycle to become longer than at cross intersections under conventional signal control, thus leading to low intersection efficiency. This article shows that the problem can be eliminated at the left–right type of staggered intersection by channelization and signal phasing, based on a sorting strategy and pre-signal, which reduce the amount of lost time during the signal cycle using the split distance as the sorting area. VISSIM was used to model and analyze the proposed method as well as the conventional method for comparison purposes. The simulation revealed that the proposed method reduced the average delays and maximum queue lengths in each movement and for the entire intersection, both in the peak hours and in the off-peak hour.
Diagrammatic Monte Carlo simulations of staggered fermions at finite coupling

CERN Document Server

Vairinhos, Helvio

2016-01-01

Diagrammatic Monte Carlo has been a very fruitful tool for taming, and in some cases even solving, the sign problem in several lattice models. We have recently proposed a diagrammatic model for simulating lattice gauge theories with staggered fermions at arbitrary coupling, which extends earlier successful efforts to simulate lattice QCD at finite baryon density in the strong-coupling regime. Here we present the first numerical simulations of our model, using worm algorithms.
Automated registration of tail bleeding in rats.

Science.gov (United States)

Johansen, Peter B; Henriksen, Lars; Andresen, Per R; Lauritzen, Brian; Jensen, Kåre L; Juhl, Trine N; Tranholm, Mikael

2008-05-01

An automated system for registration of tail bleeding in rats using a camera and a user-designed PC-based software program has been developed. The live and processed images are displayed on the screen and are exported together with a text file for later statistical processing of the data allowing calculation of e.g. number of bleeding episodes, bleeding times and bleeding areas. Proof-of-principle was achieved when the camera captured the blood stream after infusion of rat whole blood into saline. Suitability was assessed by recording of bleeding profiles in heparin-treated rats, demonstrating that the system was able to capture on/off bleedings and that the data transfer and analysis were conducted successfully. Then, bleeding profiles were visually recorded by two independent observers simultaneously with the automated recordings after tail transection in untreated rats. Linear relationships were found in the number of bleedings, demonstrating, however, a statistically significant difference in the recording of bleeding episodes between observers. Also, the bleeding time was longer for visual compared to automated recording. No correlation was found between blood loss and bleeding time in untreated rats, but in heparinized rats a correlation was suggested. Finally, the blood loss correlated with the automated recording of bleeding area. In conclusion, the automated system has proven suitable for replacing visual recordings of tail bleedings in rats. Inter-observer differences can be eliminated, monotonous repetitive work avoided, and a higher through-put of animals in less time achieved. The automated system will lead to an increased understanding of the nature of bleeding following tail transection in different rodent models.
Management of acute gastric varices bleeding

Directory of Open Access Journals (Sweden)

Chen-Jung Chang

2013-10-01

Full Text Available Gastroesophageal varices bleeding is a major complication in patients with cirrhosis. Gastric varices (GVs occur in approximately 20% of patients with portal hypertension. However, GV bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV bleeding. The best strategy for managing acute GV bleeding is similar to that of acute EV bleeding, which involves airway protection, hemodynamic stabilization, and intensive care. Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as terlipressin or somatostatin should be used when GV bleeding is suspected. Routine use of prophylactic antibiotics reduces bacterial infection and lowers rebleeding rates. By administering endoscopic cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV bleeding is approximately 10–30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of cyanoacrylate is superior to sclerotherapy and band ligation, and has remained the treatment of choice for treating acute GV bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as thrombin injection, transjugular intrahepatic portosystemic shunts, or balloon-occluded retrograde transvenous obliteration, have shown promising results for acute GV bleeding. However, randomized controlled trials are needed to compare the efficacy of these therapies with cyanoacrylate.
Experimental study of induced staggered magnetic fields in dysprosium gallium garnet (DGG)

International Nuclear Information System (INIS)

Steiner, M.; Corliss, L.M.; Hastings, J.M.; Blume, M.; Giordano, N.; Wolf, W.P.

1979-01-01

Neutron diffraction techniques have been used to study induced staggered magnetic field effects in DGG. The application of a uniform magnetic field at temperatures much greater than the Neel temperature induces a significant amount of antiferromagnetic order. The temperature and field dependences of this effect are in good agreement with recent theoretical predicions
Provocative Endoscopy to Identify Bleeding Site in Upper Gastrointestinal Bleeding: A Novel Approach in Transarterial Embolization.

Science.gov (United States)

Kamo, Minobu; Fuwa, Sokun; Fukuda, Katsuyuki; Fujita, Yoshiyuki; Kurihara, Yasuyuki

2016-07-01

This report describes a novel approach to endoscopically induce bleeding by removing a clot from the bleeding site during angiography for upper gastrointestinal (UGI) hemorrhage. This procedure enabled accurate identification of the bleeding site, allowing for successful targeted embolization despite a negative initial angiogram. Provocative endoscopy may be a feasible and useful option for angiography of obscure bleeding sites in patients with UGI arterial hemorrhage. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.
Severe Bleeding: First Aid

Science.gov (United States)

... 12, 2017. Jevon P, et al. Part 5 — First-aid treatment for severe bleeding. Nursing Times. 2008;104:26. Oct. 19, 2017 Original article: http://www.mayoclinic.org/first-aid/first-aid-severe-bleeding/basics/ART-20056661 . Mayo ...
Recurrent Bleeding After Perimesencephalic Hemorrhage.

Science.gov (United States)

Kauw, Frans; Velthuis, Birgitta K; Kizilates, Ufuk; van der Schaaf, Irene C; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

2017-12-01

Perimesencephalic hemorrhage (PMH) is a type of subarachnoid hemorrhage with excellent long-term outcomes. Only 1 well-documented case of in-hospital rebleeding after PMH is described in the literature, which occurred after initiating antithrombotic treatment because of myocardial ischemia. We describe a patient with PMH without antithrombotic treatment who had 2 episodes of recurrent bleeding on the day of ictus. To validate the radiologic findings, we conducted a case-control study. Six neuroradiologists and 2 neuroradiology fellows performed a blinded assessment of serial unenhanced head computed tomography (CT) scans of 8 patients with a perimesencephalic bleeding pattern (1 index patient, 6 patients with PMH, 1 patient with perimesencephalic bleeding pattern and basilar artery aneurysm) to investigate a potential increase in amount of subarachnoid blood. A 56-year-old woman with a perimesencephalic bleeding pattern and negative CT angiography had 2 episodes after the onset headache with a sudden increase of the headache. Blinded assessment of serial head CT scans of 8 patients with a perimesencephalic bleeding pattern identified the patient who was clinically suspected to have 2 episodes of recurrent bleeding to have an increased amount of subarachnoid blood on 2 subsequent CT scans. Recurrent bleeding after PMH may also occur in patients not treated with antithrombotics. Even after early rebleeding, the prognosis of PMH is excellent. Copyright © 2017 Elsevier Inc. All rights reserved.
The Office for Technology Assessment with the German Parliament (TAB)

International Nuclear Information System (INIS)

Grunwald, A.; Petermann, T.

2004-01-01

TAB was created in 1990 with the aim of providing contributions to the improvement of the information base, particularly for parliamentary decision-making concerning science and technology. Among TAB's tasks are above all the conception and execution of technology assessment projects and the monitoring and analysis of important scientific and technological trends and related societal developments. TAB is managed by the Institute for Technology Assessment and Systems Analysis (ITAS) of the Karlsruhe Research Center. (orig.)
Parametric modeling and stagger angle optimization of an axial flow fan

International Nuclear Information System (INIS)

Li, M X; Zhang, C H; Liu, Y; Zheng, S Y

2013-01-01

Axial flow fans are widely used in every field of social production. Improving their efficiency is a sustained and urgent demand of domestic industry. The optimization of stagger angle is an important method to improve fan performance. Parametric modeling and calculation process automation are realized in this paper to improve optimization efficiency. Geometric modeling and mesh division are parameterized based on GAMBIT. Parameter setting and flow field calculation are completed in the batch mode of FLUENT. A control program is developed in Visual C++ to dominate the data exchange of mentioned software. It also extracts calculation results for optimization algorithm module (provided by Matlab) to generate directive optimization control parameters, which as feedback are transferred upwards to modeling module. The center line of the blade airfoil, based on CLARK y profile, is constructed by non-constant circulation and triangle discharge method. Stagger angles of six airfoil sections are optimized, to reduce the influence of inlet shock loss as well as gas leak in blade tip clearance and hub resistance at blade root. Finally an optimal solution is obtained, which meets the total pressure requirement under given conditions and improves total pressure efficiency by about 6%

Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

International Nuclear Information System (INIS)

Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M.; Al-Wafai, I.; Vallgren, S.

1989-01-01

The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of 99m Tc-DTPA, 99m Tc-RBCs and 99m Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both 99m Tc-DTPA and 99m Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only 99m Tc-DTPA was successful in detecting the bleeding site. The results indicate that 99m Tc-DTPA is the most useful 99m Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.) [de
[Antithrombotic therapy and nonvariceal upper gastrointestinal bleeding].

Science.gov (United States)

Belanová, Veronika; Gřiva, Martin

2015-12-01

The incidence of acute upper gastrointestinal bleeding is about 85-108/100,000 inhabitants per year, nonvariceal bleeding accounts for 80-90%. Antiplatelet and anticoagulation treatment are the significant risk factors for upper gastrointestinal bleeding. To evaluate the occurrence of upper gastrointestinal bleeding in the general community of patients in a county hospital. And to compare the role played by antiplatelet and anticoagulation drugs and other risk medication. Retrospective analysis of patients over 18 years of age who underwent endoscopy for acute upper gastrointestinal bleeding or anaemia (haemoglobinupper gastrointestinal tract during a hospital stay in 2013 (from January to June). We included 111 patients of average age 69±15 years, men 60%. Nonvariceal bleeding accounted for 90% of the cases. None of the patients with variceal bleeding (10% of patients) took antiplatelet or anticoagulation therapy. There were 100 patients with nonvariceal bleeding of average age 70±15, 61% men. With the symptoms of acute bleeding (hematemesis, melena) presented in 73% of patients. The most frequent cause of bleeding was gastric and duodenal ulcer (54%). 32% of patients with nonvariceal bleeding had antiplatelets, 19% anticoagulants and 10% used nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors or corticosteroids. 30-days mortality of patients with nonvariceal bleeding was 11%, annual mortality was 23%. There was no significant difference in mortality, blood transfusion requirements or surgical intervention between the patients with antithrombotic agents and without them. 25% of patients (8 patients) using acetylsalicylic acid did not fulfil the indication for this treatment. Among the patients examined by endoscopy for symptomatic nonvariceal bleeding and/or anaemia (haemoglobingastrointestinal bleeding. With regard to that, it is alarming, that there still exists a nonnegligible percentage of patients taking acetylsalicylic acid even
Prospective analysis of delayed colorectal post-polypectomy bleeding.

Science.gov (United States)

Park, Soo-Kyung; Seo, Jeong Yeon; Lee, Min-Gu; Yang, Hyo-Joon; Jung, Yoon Suk; Choi, Kyu Yong; Kim, Hungdai; Kim, Hyung Ook; Jung, Kyung Uk; Chun, Ho-Kyung; Park, Dong Il

2018-01-17

Although post-polypectomy bleeding is the most frequent complication after colonoscopic polypectomy, only few studies have investigated the incidence of bleeding prospectively. The aim of this study was to investigate the incidence of delayed post-polypectomy bleeding and its associated risk factors prospectively. Patients who underwent colonoscopic polypectomy at Kangbuk Samsung Hospital from January 2013 to December 2014 were prospectively enrolled in this study. Trained nurses contacted patients via telephone 7 and 30 days after polypectomy and completed a standardized questionnaire regarding the development of bleeding. Delayed post-polypectomy bleeding was categorized as minor or major and early or late bleeding. Major delayed bleeding was defined as a > 2-g/dL drop in the hemoglobin level, requiring hospitalization for control of bleeding or blood transfusion; late delayed bleeding was defined as bleeding occurring later than 24 h after polypectomy. A total of 8175 colonoscopic polypectomies were performed in 3887 patients. Overall, 133 (3.4%) patients developed delayed post-polypectomy bleeding. Among them, 90 (2.3%) and 43 (1.1%) patients developed minor and major delayed bleeding, respectively, and 39 (1.0%) patients developed late delayed bleeding. In the polyp-based multivariate analysis, young age ( 10 mm (OR 2.45; 95% CI 1.38-4.36) were significant risk factors for major delayed bleeding, while young age (< 50 years; OR 2.6; 95% CI 1.35-5.12) and immediate bleeding (OR 3.3; 95% CI 1.49-7.30) were significant risk factors for late delayed bleeding. Young age, aspirin use, polyp size, and immediate bleeding were found to be independent risk factors for delayed post-polypectomy bleeding.
Identification and functional characterization of the TAB2 gene from Litopenaeus vannamei.

Science.gov (United States)

Wang, Sheng; Li, Haoyang; Qian, Zhe; Song, Xuan; Zhang, Zijian; Zuo, Hongliang; Xu, Xiaopeng; Weng, Shaoping; He, Jianguo; Li, Chaozheng

2015-10-01

In Drosophila, TAB2, an important intermediate in the IMD signaling pathway, plays critical roles in the innate immune response in response to bacterial and viral infection. However, the role of TAB-related proteins in the immune response of shrimp has not yet been established. Here, we reported the identification of a TAB2-like gene in Litopenaeus vannamei designated as LvTAB2. The full-length cDNA of LvTAB2 was 2160 bp with an open reading frame of 1827 bp, which encoded a putative protein of 608 amino acids including a ubiquitin binding domain (CUE) at the N-terminal and a Zinc Finger domain (ZnF) at the C-terminus. Real-time RT-PCR analysis showed that LvTAB2 was expressed in all tested tissues and the expression levels of LvTAB2 in gills and hemocytes were positively induced in response to LPS, Vibrio parahemolyticus and White Spot Syndrome Virus (WSSV) challenges. Dual luciferase reporter assays demonstrated that LvTAB2 was able to induce the expression of antimicrobial peptide (AMP) genes, including Drosophila Attacin A and shrimp Penaeidins. Interestingly, over-expression of LvTAB2 could up-regulate the promoter activities of L. vannamei Vago1, Vago3 and Vago4 genes in S2 cells. To our knowledge, it was the first report that TAB2 participated in innate immune signaling to regulate the expression of Vago genes in invertebrates. Moreover, RNAi-mediated knockdown of LvTAB2 enhanced sensitivity of L. vannamei to Vibrio parahaemolyticus infection and caused elevated virus loads after WSSV infection. We suggested that the LvTAB2 may play important roles in the shrimp innate immunity. Copyright © 2015 Elsevier Ltd. All rights reserved.
Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

NARCIS (Netherlands)

Cooper, Natalie A. M.; Barton, Pelham M.; Breijer, Maria; Caffrey, Orla; Opmeer, Brent C.; Timmermans, Anne; Mol, Ben W. J.; Khan, Khalid S.; Clark, T. Justin

2014-01-01

Heavy menstrual bleeding (HMB) and post-menopausal bleeding (PMB) together constitute the commonest gynaecological presentation in secondary care and impose substantial demands on health service resources. Accurate diagnosis is of key importance to realising effective treatment, reducing morbidity
Diffraction of love waves by two staggered perfectly weak half-planes

International Nuclear Information System (INIS)

Asghar, S.; Zaman, F.D.; Sajida Asghar

1989-01-01

Love wave travelling in a layer of uniform thickness overlying a half-space is assumed to be incident on two parallel but staggered perfectly weak half-planes lying in the upper layer. The diffracted fields is calculated using the modified Wiener-Hopf technique and contour integration method. The diffracted waves satisfy the dispersion relations appropriate to different regions formed by the perfectly weak half-planes
Propagator of the lattice domain wall fermion and the staggered fermion

International Nuclear Information System (INIS)

Furui, S.

2009-01-01

We calculate the propagator of the domain wall fermion (DWF) of the RBC/UKQCD collaboration with 2 + 1 dynamical flavors of 16 3 x 32 x 16 lattice in Coulomb gauge, by applying the conjugate gradient method. We find that the fluctuation of the propagator is small when the momenta are taken along the diagonal of the 4-dimensional lattice. Restricting momenta in this momentum region, which is called the cylinder cut, we compare the mass function and the running coupling of the quark-gluon coupling a s,g1 (q) with those of the staggered fermion of the MILC collaboration in Landau gauge. In the case of DWF, the ambiguity of the phase of the wave function is adjusted such that the overlap of the solution of the conjugate gradient method and the plane wave at the source becomes real. The quark-gluon coupling a s,g1 (q) of the DWF in the region q > 1.3 GeV agrees with ghost-gluon coupling a s (q) that we measured by using the configuration of the MILC collaboration, i.e., enhancement by a factor (1 + c/q 2 ) with c ∼ 2.8 GeV 2 on the pQCD result. In the case of staggered fermion, in contrast to the ghost-gluon coupling a s (q) in Landau gauge which showed infrared suppression, the quark-gluon coupling a s,g1 (q) in the infrared region increases monotonically as q → 0. Above 2 GeV, the quark-gluon coupling a s,g1 (q) of staggered fermion calculated by naive crossing becomes smaller than that of DWF, probably due to the complex phase of the propagator which is not connected with the low energy physics of the fermion taste. An erratum to this article can be found at http://dx.doi.org/10.1007/s00601-009-0053-4. (author)
Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

Energy Technology Data Exchange (ETDEWEB)

Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M. (Kuwait Univ. (Kuwait). Dept. of Nuclear Medicine); Al-Wafai, I.; Vallgren, S. (Kuwait Univ. (Kuwait). Dept. of Surgery)

1989-06-01

The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of {sup 99m}Tc-DTPA, {sup 99m}Tc-RBCs and {sup 99m}Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both {sup 99m}Tc-DTPA and {sup 99m}Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only {sup 99m}Tc-DTPA was successful in detecting the bleeding site. The results indicate that {sup 99m}Tc-DTPA is the most useful {sup 99m}Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.).
Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium-99m-labeled red blood cells in an experimental model

International Nuclear Information System (INIS)

Thorne, D.A.; Datz, F.L.; Remley, K.; Christian, P.E.

1987-01-01

Proponents of [/sup 99m/Tc]sulfur colloid for GI bleeding studies argue that, although labeled red blood cells are useful for intermittent bleeding, they are not capable of detecting low bleeding rates. Studies of dogs with experimental GI bleeding have indicated bleeding rates of 0.05 ml/min can be detected with [/sup 99m/Tc]sulfur colloid. Since similar data in the dog model were unavailable for /sup 99m/Tc-labeled red blood cells, we undertook this study. To simulate lower GI bleeding, catheters were inserted into the bowel lumen. Each dog's blood was labeled with /sup 99m/Tc using an in vitro technique. Venous blood was then withdrawn and re-infused into the lumen of the bowel using a Harvard pump. Fourteen dogs were studied, ten receiving a bleeding rate from 4.6-0.02 ml/min in the descending colon and four with proximal jejunal bleeds of 0.20-0.02 ml/min. Bleeding rates of 4.6-0.2 ml/min were detected within 10 min in the colon and bleeding rates as low as 0.04 ml/min were seen by 55 min. Slower bleeding rates were not detected. Similar findings were noted for proximal jejunal bleeds. Based on the time of appearance, a minimum volume of approximately 2-3 ml labeled blood was necessary to detect bleeding. We conclude that /sup 99m/Tc-labeled RBCs are sensitive for low bleeding rates in the dog model. The rates are comparable to those described for [/sup 99m/Tc]sulfur colloid in this experimental setting. The time of appearance of activity is related to the bleeding rate
Postpartum bleeding: efficacy of endovascular management

International Nuclear Information System (INIS)

Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki

2003-01-01

To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12 th and 13 th day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding
Postpartum bleeding: efficacy of endovascular management

Energy Technology Data Exchange (ETDEWEB)

Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki [Asan Medical Center, Seoul (Korea, Republic of)

2003-06-01

To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12{sup th} and 13{sup th} day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding.
New 2D adaptive mesh refinement algorithm based on conservative finite-differences with staggered grid

Science.gov (United States)

Gerya, T.; Duretz, T.; May, D. A.

2012-04-01

We present new 2D adaptive mesh refinement (AMR) algorithm based on stress-conservative finite-differences formulated for non-uniform rectangular staggered grid. The refinement approach is based on a repetitive cell splitting organized via a quad-tree construction (every parent cell is split into 4 daughter cells of equal size). Irrespective of the level of resolution every cell has 5 staggered nodes (2 horizontal velocities, 2 vertical velocities and 1 pressure) for which respective governing equations, boundary conditions and interpolation equations are formulated. The connectivity of the grid is achieved via cross-indexing of grid cells and basic nodal points located in their corners: four corner nodes are indexed for every cell and up to 4 surrounding cells are indexed for every node. The accuracy of the approach depends critically on the formulation of the stencil used at the "hanging" velocity nodes located at the boundaries between different levels of resolution. Most accurate results are obtained for the scheme based on the volume flux balance across the resolution boundary combined with stress-based interpolation of velocity orthogonal to the boundary. We tested this new approach with a number of 2D variable viscosity analytical solutions. Our tests demonstrate that the adaptive staggered grid formulation has convergence properties similar to those obtained in case of a standard, non-adaptive staggered grid formulation. This convergence is also achieved when resolution boundary crosses sharp viscosity contrast interfaces. The convergence rates measured are found to be insensitive to scenarios when the transition in grid resolution crosses sharp viscosity contrast interfaces. We compared various grid refinement strategies based on distribution of different field variables such as viscosity, density and velocity. According to these tests the refinement allows for significant (0.5-1 order of magnitude) increase in the computational accuracy at the same
Upper gastrointestinal bleeding in patients with CKD.

Science.gov (United States)

Liang, Chih-Chia; Wang, Su-Ming; Kuo, Huey-Liang; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Lin, Hsin-Hung; Wang, I-Kuan; Yang, Ya-Fei; Lu, Yueh-Ju; Chou, Che-Yi; Huang, Chiu-Ching

2014-08-07

Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (Pupper gastrointestinal bleeding risk. In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin. Copyright © 2014 by the American Society of Nephrology.
High‐order rotated staggered finite difference modeling of 3D elastic wave propagation in general anisotropic media

KAUST Repository

Chu, Chunlei

2009-01-01

We analyze the dispersion properties and stability conditions of the high‐order convolutional finite difference operators and compare them with the conventional finite difference schemes. We observe that the convolutional finite difference method has better dispersion properties and becomes more efficient than the conventional finite difference method with the increasing order of accuracy. This makes the high‐order convolutional operator a good choice for anisotropic elastic wave simulations on rotated staggered grids since its enhanced dispersion properties can help to suppress the numerical dispersion error that is inherent in the rotated staggered grid structure and its efficiency can help us tackle 3D problems cost‐effectively.
The usefulness of MDCT in acute intestinal bleeding

International Nuclear Information System (INIS)

Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Chang, Jay Chun; Jang, Han Won

2006-01-01

We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 or 17), whereas that of angiography was 46% (6 or 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiography did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted
Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study.

Science.gov (United States)

Wada, Tomoki; Hagiwara, Akiyoshi; Uemura, Tatsuki; Yahagi, Naoki; Kimura, Akio

2016-08-01

Not all patients with upper gastrointestinal bleeding (UGIB) require emergency endoscopy. Lactate clearance has been suggested as a parameter for predicting patient outcomes in various critical care settings. This study investigates whether lactate clearance can predict active bleeding in critically ill patients with UGIB. This single-center, retrospective, observational study included critically ill patients with UGIB who met all of the following criteria: admission to the emergency department (ED) from April 2011 to August 2014; had blood samples for lactate evaluation at least twice during the ED stay; and had emergency endoscopy within 6 h of ED presentation. The main outcome was active bleeding detected with emergency endoscopy. Classification and regression tree (CART) analyses were performed using variables associated with active bleeding to derive a prediction rule for active bleeding in critically ill UGIB patients. A total of 154 patients with UGIB were analyzed, and 31.2 % (48/154) had active bleeding. In the univariate analysis, lactate clearance was significantly lower in patients with active bleeding than in those without active bleeding (13 vs. 29 %, P bleeding is derived, and includes three variables: lactate clearance; platelet count; and systolic blood pressure at ED presentation. The rule has 97.9 % (95 % CI 90.2-99.6 %) sensitivity with 32.1 % (28.6-32.9 %) specificity. Lactate clearance may be associated with active bleeding in critically ill patients with UGIB, and may be clinically useful as a component of a prediction rule for active bleeding.
The role of endoscopy in pediatric gastrointestinal bleeding

Science.gov (United States)

Franke, Markus; Geiß, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-Jürgen; Bausch, Dirk; Fischer, Andreas

2016-01-01

Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm. Results: The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena. Conclusions: Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no
Endoscopic management of bleeding peptic ulcers

International Nuclear Information System (INIS)

Farooqi, J.I.; Farooqi, R.J.

2001-01-01

Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)
Scintigraphic detection and localization of gastrointestinal bleeding sites

International Nuclear Information System (INIS)

Alavi, A.

1988-01-01

Successful management of acute gastrointestinal (GI) bleeding usually depends on accurate localization of the bleeding site. History and clinical findings are often misleading in determination of the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provide accurate diagnoses for the majority of patients bleeding from the upper GI tract, but lower GI bleeding still poses a serious diagnostic challenge. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases (3-5), has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding at a rate greater than 0.5 ml/min, and since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. The diagnosis of lower GI bleeding is usually easy to make. In contrast, localizing the site of bleeding may be extremely difficult. Using the techniques described the nuclear physician may be able to detect the bleeding site precisely. However, if the cautions detailed are not observed, the tracer studies will show GI bleeding, but not at the true bleeding site. This must be carefully understood and avoided. Done correctly, these tests can have a major impact on patient care
Synergistic shortening of the bleeding time by desmopressin and ethamsylate in patients with various constitutional bleeding disorders.

Science.gov (United States)

Kobrinsky, N L; Israels, E D; Bickis, M G

1991-01-01

Desmopressin and ethamsylate were evaluated for possible synergistic effects on the bleeding time. The drugs were administered individually and together to 12 patients with markedly prolonged bleeding times known to be relatively or absolutely unresponsive to desmopressin alone. The bleeding disorders studied included Glanzmann's thrombasthenia (one), other disorders of platelet function (four), pseudo-von Willebrand disease (one), and von Willebrand disease type I (three), type II (two), and type III (one). Desmopressin alone shortened the bleeding time from 23.9 +/- 1.5 to 19.5 +/- 2.3 min (p = 0.03). Ethamsylate alone was without effect. Desmopressin and ethamsylate together shortened the bleeding time to 11.2 +/- 1.4 min (p less than 0.01 compared to baseline, p = 0.02 compared to desmopressin alone). The combination was ineffective in three patients, with Glanzmann's thrombasthenia (one), and von Willebrand disease type I (one) and type III (one). Toxic effects of the drugs were not observed. Five patients received desmopressin and ethamsylate prior to dental work with mandibular block (one), heart surgery requiring cardiopulmonary bypass (two), and adenotonsillectomy surgery (two). Normal hemostasis was achieved in each case. A synergistic shortening of the bleeding time was observed with the combination of desmopressin and ethamsylate in a wide range of bleeding disorders.

Helical CT in acute lower gastrointestinal bleeding

International Nuclear Information System (INIS)

Ernst, Olivier; Leroy, Christophe; Sergent, Geraldine; Bulois, Philippe; Saint-Drenant, Sophie; Paris, Jean-Claude

2003-01-01

The purpose of this study was to assess the usefulness of helical CT in depicting the location of acute lower gastrointestinal bleeding. A three-phase helical CT of the abdomen was performed in 24 patients referred for acute lower gastrointestinal bleeding. The diagnosis of the bleeding site was established by CT when there was at least one of the following criteria: spontaneous hyperdensity of the peribowel fat; contrast enhancement of the bowel wall; vascular extravasation of the contrast medium; thickening of the bowel wall; polyp or tumor; or vascular dilation. Diverticula alone were not enough to locate the bleeding site. The results of CT were compared with the diagnosis obtained by colonoscopy, enteroscopy, or surgery. A definite diagnosis was made in 19 patients. The bleeding site was located in the small bowel in 5 patients and the colon in 14 patients. The CT correctly located 4 small bowel hemorrhages and 11 colonic hemorrhages. Diagnosis of the primary lesion responsible for the bleeding was made in 10 patients. Our results suggest that helical CT could be a good diagnostic tool in acute lower gastrointestinal bleeding to help the physician to diagnose the bleeding site. (orig.)
Vaginal bleeding in late pregnancy

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000627.htm Vaginal bleeding in late pregnancy To use the sharing ... JavaScript. One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it ...
Cas9-catalyzed DNA Cleavage Generates Staggered Ends: Evidence from Molecular Dynamics Simulations

Science.gov (United States)

Zuo, Zhicheng; Liu, Jin

2016-11-01

The CRISPR-associated endonuclease Cas9 from Streptococcus pyogenes (spCas9) along with a single guide RNA (sgRNA) has emerged as a versatile toolbox for genome editing. Despite recent advances in the mechanism studies on spCas9-sgRNA-mediated double-stranded DNA (dsDNA) recognition and cleavage, it is still unclear how the catalytic Mg2+ ions induce the conformation changes toward the catalytic active state. It also remains controversial whether Cas9 generates blunt-ended or staggered-ended breaks with overhangs in the DNA. To investigate these issues, here we performed the first all-atom molecular dynamics simulations of the spCas9-sgRNA-dsDNA system with and without Mg2+ bound. The simulation results showed that binding of two Mg2+ ions at the RuvC domain active site could lead to structurally and energetically favorable coordination ready for the non-target DNA strand cleavage. Importantly, we demonstrated with our simulations that Cas9-catalyzed DNA cleavage produces 1-bp staggered ends rather than generally assumed blunt ends.
Lattice QCD with mixed action - Borici-Creutz valence quark on staggered sea

Science.gov (United States)

Basak, Subhasish; Goswami, Jishnu; Chakrabarti, Dipankar

2018-03-01

Mixed action lattice QCD with Borici-Creutz valence quarks on staggered sea is investigated. The counter terms in Borici-Creutz action are fixed nonperturbatively to restore the broken symmetries. On symmetry restoration, the usual signatures of partial quenching / unitarity violation like negative scalar correlator are observed. The size of unitarity violation due to different discretization of valence and sea quark is determined by measuring Δmix.
On the spectrum of the staggered Dirac operator at finite chemical potential

International Nuclear Information System (INIS)

Vink, J.C.; Nationaal Inst. voor Kernfysica en Hoge-Energiefysica

1988-12-01

The spectrum of the staggered Dirac operator in two-dimensional QEDF is investigated at finite chemical potential. In the quenced model, it is shown that lattice artefacts cause a spurious scattering of eigenvalues. This scattering disappears when lattice distance is taken to zero. In the unquenced model, a new approach is used to show that similar effects are absent. (author). 17 refs.; 6 figs
Staggering of angular momentum distribution in fission

Science.gov (United States)

Tamagno, Pierre; Litaize, Olivier

2018-03-01

We review here the role of angular momentum distributions in the fission process. To do so the algorithm implemented in the FIFRELIN code [?] is detailed with special emphasis on the place of fission fragment angular momenta. The usual Rayleigh distribution used for angular momentum distribution is presented and the related model derivation is recalled. Arguments are given to justify why this distribution should not hold for low excitation energy of the fission fragments. An alternative ad hoc expression taking into account low-lying collectiveness is presented as has been implemented in the FIFRELIN code. Yet on observables currently provided by the code, no dramatic impact has been found. To quantify the magnitude of the impact of the low-lying staggering in the angular momentum distribution, a textbook case is considered for the decay of the 144Ba nucleus with low excitation energy.
Treatment of acute variceal bleeding

DEFF Research Database (Denmark)

Bendtsen, Flemming; Krag, Aleksander Ahm; Møller, Søren

2008-01-01

The management of variceal bleeding remains a clinical challenge with a high mortality. Standardisation in supportive and new therapeutic treatments seems to have improved survival within the last 25 years. Although overall survival has improved in recent years, mortality is still closely related...... to failure to control initial bleeding or early re-bleeding occurring in up to 30-40% of patients. Initial procedures are to secure and protect the airway, and administer volume replacement to stabilize the patient. Treatment with vasoactive drugs should be started as soon as possible, since a reduction...... in portal pressure is associated with a better control of bleeding and may facilitate later endoscopic procedures. Vasopressin and its analogues Terlipressin and somatostatin and analogues are the two types of medicine, which has been evaluated. In meta-analysis, only Terlipressin have demonstrated effects...
Calculation of cell face velocity of non-staggered grid system

KAUST Repository

Li, Wang

2012-07-28

In this paper, the cell face velocities in the discretization of the continuity equation, the momentum equation, and the scalar equation of a non-staggered grid system are calculated and discussed. Both the momentum interpolation and the linear interpolation are adopted to evaluate the coefficients in the discretized momentum and scalar equations. Their performances are compared. When the linear interpolation is used to calculate the coefficients, the mass residual term in the coefficients must be dropped to maintain the accuracy and convergence rate of the solution. © Shanghai University and Springer-Verlag Berlin Heidelberg 2012.
Postprandial effects of consuming a staggered meal on gut peptide and glycemic responses in obese women and men.

Science.gov (United States)

Griffith, Lisa; Haddad, Ella H; Tonstad, Serena

2016-01-01

Eating slowly by staggering a meal may reduce energy intake. Our aim was to examine the effect of eating a portion of beans 15min before the rest of the meal, on gastrointestinal (GI) peptides, glucose and insulin concentrations and subsequent energy intake in obese adults. This was a randomised crossover design study with 28 obese subjects. Participants consumed a standardised breakfast on test days followed by test meals: (1) control meal containing 86g (0.5 cup) of beans, and (2) staggered meal in which 86g (0.5 cup) of beans were consumed 15min before the rest of the meal. Blood obtained prior to and at 30, 60, and 120min following the meals was analysed for acylated ghrelin, unacylated ghrelin, glucagon-like peptide-1 (GLP-1), peptide YY, oxyntomodulin, glucose and insulin. Feelings of hunger and satiety were assessed using analog visual scales. Energy intake following the test meal was obtained by computer assisted dietary recalls. Mixed model statistical analysis of data showed time effects for unacylated ghrelin, GLP-1, glucose, insulin, hunger and fullness, however, meal effects were not shown for any of the parameters. GLP-1 area under the curve from baseline to 120min (AUC0-120) decreased by 19% (P=0.024) and that of glucose increased by 7% (P=0.046) following the staggered compared to the control bean meal. Energy intake subsequent to the test meals did not differ between treatments. In conclusion, lengthening meal times by staggering eating did not benefit hormonal, metabolic or appetite control in obese individuals. Copyright © 2015 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Entropy Stable Staggered Grid Discontinuous Spectral Collocation Methods of any Order for the Compressible Navier--Stokes Equations

KAUST Repository

Parsani, Matteo

2016-10-04

Staggered grid, entropy stable discontinuous spectral collocation operators of any order are developed for the compressible Euler and Navier--Stokes equations on unstructured hexahedral elements. This generalization of previous entropy stable spectral collocation work [M. H. Carpenter, T. C. Fisher, E. J. Nielsen, and S. H. Frankel, SIAM J. Sci. Comput., 36 (2014), pp. B835--B867, M. Parsani, M. H. Carpenter, and E. J. Nielsen, J. Comput. Phys., 292 (2015), pp. 88--113], extends the applicable set of points from tensor product, Legendre--Gauss--Lobatto (LGL), to a combination of tensor product Legendre--Gauss (LG) and LGL points. The new semidiscrete operators discretely conserve mass, momentum, energy, and satisfy a mathematical entropy inequality for the compressible Navier--Stokes equations in three spatial dimensions. They are valid for smooth as well as discontinuous flows. The staggered LG and conventional LGL point formulations are compared on several challenging test problems. The staggered LG operators are significantly more accurate, although more costly from a theoretical point of view. The LG and LGL operators exhibit similar robustness, as is demonstrated using test problems known to be problematic for operators that lack a nonlinear stability proof for the compressible Navier--Stokes equations (e.g., discontinuous Galerkin, spectral difference, or flux reconstruction operators).
Management of patients with ulcer bleeding.

Science.gov (United States)

Laine, Loren; Jensen, Dennis M

2012-03-01

This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes. Upper endoscopy is generally performed within 24h. The endoscopic features of ulcers direct further management. Patients with active bleeding or non-bleeding visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, heater probe, sclerosant, clips) and those with an adherent clot may receive endoscopic therapy; these patients then receive intravenous PPI with a bolus followed by continuous infusion. Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken. Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1-3 days). Patients with idiopathic ulcers receive long-term anti-ulcer therapy.
Serendipity in scintigraphic gastrointestinal bleeding studies

International Nuclear Information System (INIS)

Goergen, T.G.

1983-01-01

A retrospective review of 80 scintigraphic bleeding studies performed with Tc-99m sulfur colloid or Tc-99m labeled red blood cells showed five cases where there were abnormal findings not related to bleeding. In some cases, the abnormalities were initially confused with bleeding or could obscure an area of bleeding, while in other cases, the abnormalities represented additional clinical information. These included bone marrow replacement related to tumor and radiation therapy, hyperemia related to a uterine leiomyoma and a diverticular abscess, and a dilated abdominal aorta (aneurysm). Recognition of such abnormalities should prevent an erroneous diagnosis and the additional information may be of clinical value
Management of Patients with Acute Lower Gastrointestinal Bleeding

Science.gov (United States)

Strate, Lisa L.; Gralnek, Ian M.

2016-01-01

This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal hemorrhage. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based upon clinical parameters should be performed to help distinguish patients at high and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper GI bleeding source and thus warrants an upper endoscopy. In the majority of patients, colonoscopy should be the initial diagnostic procedure and should be performed within 24 hours of patient presentation after adequate colon preparation. Endoscopic hemostasis therapy should be provided to patients with high risk endoscopic stigmata of bleeding including active bleeding, non-bleeding visible vessel, or adherent clot. The endoscopic hemostasis modality used (mechanical, thermal, injection or combination) is most often guided by the etiology of bleeding, access to the bleeding site, and endoscopist experience with the various hemostasis modalities. Repeat colonoscopy, with endoscopic hemostasis performed if indicated, should be considered for patients with evidence of recurrent bleeding. Radiographic interventions (tagged red blood cell scintigraphy, CT angiography, angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation, and who are unlikely to tolerate bowel preparation and colonoscopy. Strategies to prevent recurrent bleeding should be considered. NSAID use should be avoided in patients with a history of acute lower GI bleeding particularly if secondary to diverticulosis or angioectasia. In patients with established cardiovascular disease who require aspirin (secondary prophylaxis), aspirin should not be discontinued. The exact timing depends on the severity of bleeding, perceived adequacy of hemostasis and the risk of a thromboembolic event. Surgery
Vitamin K deficiency bleeding of the newborn

Science.gov (United States)

Vitamin K deficiency bleeding of the newborn (VKDB) is a bleeding disorder in babies. It most often ... A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting. Babies often ...
Risk of bleeding with dabigatran in atrial fibrillation.

Science.gov (United States)

Hernandez, Inmaculada; Baik, Seo Hyon; Piñera, Antonio; Zhang, Yuting

2015-01-01

It remains unclear whether dabigatran etexilate mesylate is associated with higher risk of bleeding than warfarin sodium in real-world clinical practice. To compare the risk of bleeding associated with dabigatran and warfarin using Medicare data. In this retrospective cohort study, we used pharmacy and medical claims in 2010 to 2011 from a 5% random sample of Medicare beneficiaries. We identified participants as those newly diagnosed as having atrial fibrillation from October 1, 2010, through October 31, 2011, and who initiated dabigatran or warfarin treatment within 60 days of initial diagnosis. We followed up patients until discontinued use or switch of anticoagulants, death, or December 31, 2011. Dabigatran users (n = 1302) and warfarin users (n = 8102). We identified any bleeding events and categorized them as major and minor bleeding by anatomical site. Major bleeding events included intracranial hemorrhage, hemoperitoneum, and inpatient or emergency department stays for hematuria, gastrointestinal, or other hemorrhage. We used a propensity score weighting mechanism to balance patient characteristics between 2 groups and Cox proportional hazards regression models to evaluate the risk of bleeding. We further examined the risk of bleeding for 4 subgroups of high-risk patients: those 75 years or older, African Americans, those with chronic kidney disease, and those with more than 7 concomitant comorbidities. Dabigatran was associated with a higher risk of bleeding relative to warfarin, with hazard ratios of 1.30 (95% CI, 1.20-1.41) for any bleeding event, 1.58 (95% CI, 1.36-1.83) for major bleeding, and 1.85 (95% CI, 1.64-2.07) for gastrointestinal bleeding. The risk of intracranial hemorrhage was higher among warfarin users, with a hazard ratio of 0.32 (95% CI, 0.20-0.50) for dabigatran compared with warfarin. Dabigatran was consistently associated with an increased risk of major bleeding and gastrointestinal hemorrhage for all subgroups analyzed. The risk of
Causes of lower gastrointestinal bleeding on colonoscopy

International Nuclear Information System (INIS)

Rehman, A.U.; Gul, R.; Khursheed, L.; Hadayat, R.

2017-01-01

Background: Bleeding from anus is usually referred as rectal bleeding but actually rectal bleeding is defined as bleeding from lower colon or rectum, which means bleeding from a place distal to ligament of Treitz. This study was conducted to determine the frequency of different causes of rectal bleeding in patients at Ayub Teaching Hospital, Abbottabad. Methods: One hundred and seventy-five patients with evidence of rectal bleed, without gender discrimination were selected by non-probability convenient sampling from the out-patient department and general medical wards. Patients with suspected upper GI source of bleeding; acute infectious bloody diarrhoea and any coagulopathy were excluded from the study. All patients were subjected to fibre optic colonoscopy after preparation of the gut and findings were recorded. Where necessary, biopsy samples were also taken. Diagnosis was based on colonoscopic findings. Results: A total of 175 patients (92 males and 83 females) with mean age 35.81±9.18 years were part of the study. Colonoscopy showed abnormal findings in 150 (85.7%) patients. The commonest diagnosis was haemorrhoids, which was found in 39 (22.3%) patients. It was followed by inflammatory bowel disease (IBD) in 30 (17.1%) patients, solitary rectal ulcer in 13 (7.4%) patients and polyps in 25 (14.3%) patients. Other less frequent findings were non-specific inflammation and fungating growths in rectum. Conclusion: Haemorrhoids was the leading cause of bleeding per rectum in this study, followed by evidence of IBD while infrequent findings of polyps and diverticuli indicate that these are uncommon in this region. (author)
Scintigraphic pattern of small bowel bleeding

International Nuclear Information System (INIS)

Anshu Rajnish Sharma; Charan, S.; Silva, I.

2004-01-01

Introduction: Small intestine is the longest part of gastrointestinal tract. Intra-luminal haemorrhage occurring anywhere in its long and tortuous course is difficult to trace. It is relatively inaccessible to endoscopic evaluation. Upper GI endoscopy can see only up to distal duodenum, whereas colonoscope can view maximum of 30 centimeters of terminal ileum after negotiating the scope through ileo-caecal valve. Hence, localization of bleeding source from small bowel remains a difficult clinical problem. This group of patients can be evaluated with scintigraphy for localizing the site of bleeding before undergoing either angiography or surgery. To our best of knowledge, there is no study, which has utilized scintigraphy for evaluation of small bowel bleed exclusively. The present study has been designed to know the efficacy of 99mTc-RBC scintigraphy in detecting small bowel bleed and to know whether it can differentiate between jejunal and ileal bleeding ? Materials and methods: Thirteen patients presenting with lower gastrointestinal bleeding (malena) were enrolled for the study. In all cases, upper GI endoscopy (UGIE) was unremarkable. Colonoscopic examination was either negative or suspected bleeding occurring proximal to ileo-caecal valve. Thus, in these patients, it is presumed clinically that bleeding is originating from small bowel. Barium meal follow through (BMFT) studies, however, could not delineate any etiological lesion in these patients. There were 8 men and 5 women (mean age 48 years). All patients were anemic (Hb- 6 gm%) and mean 3 units of blood were transfused.These patients were subjected to Tc-99m labeled red blood cells scintigraphy (15 mci, in-vivo method) for localization of source of bleeding. The scintiscan was acquired in two phases. A first pass phase acquired at a rate of 2 seconds per frame for 60 seconds followed by acquisition of static abdominal images (500 K, 256 x 256 matrix) at 5 minutes intervals up to 90 minutes on LFOV gamma
Mortality in high-risk patients with bleeding Mallory-Weiss syndrome is similar to that of peptic ulcer bleeding. Results of a prospective database study.

Science.gov (United States)

Ljubičić, Neven; Budimir, Ivan; Pavić, Tajana; Bišćanin, Alen; Puljiz, Zeljko; Bratanić, Andre; Troskot, Branko; Zekanović, Dražen

2014-04-01

The aim of this study was to identify the predictive factors influencing mortality in patients with bleeding Mallory-Weiss syndrome in comparison with peptic ulcer bleeding. Between January 2005 and December 2009, 281 patients with endoscopically confirmed Mallory-Weiss syndrome and 1530 patients with peptic ulcer bleeding were consecutively evaluated. The 30-day mortality and clinical outcome were related to the patients' demographic data, endoscopic, and clinical characteristics. The one-year cumulative incidence for bleeding Mallory-Weiss syndrome was 7.3 cases/100,000 people and for peptic ulcer bleeding 40.4 cases/100,000 people. The age-standardized incidence for both bleeding Mallory-Weiss syndrome and peptic ulcer bleeding remained unchanged during the observational five-year period. The majority of patients with bleeding Mallory-Weiss syndrome were male patients with significant overall comorbidities (ASA class 3-4). Overall 30-day mortality rate was 5.3% for patients with bleeding Mallory-Weiss syndrome and 4.6% for patients with peptic ulcer bleeding (p = 0.578). In both patients with bleeding Mallory-Weiss syndrome and peptic ulcer bleeding, mortality was significantly higher in patients over 65 years of age and those with significant overall comorbidities (ASA class 3-4). The incidence of bleeding Mallory-Weiss syndrome and peptic ulcer bleeding has not changed over a five-year observational period. The overall 30-day mortality was almost equal for both bleeding Mallory-Weiss syndrome and peptic ulcer bleeding and was positively correlated to older age and underlying comorbid illnesses.
Staggered multi-field inflation

International Nuclear Information System (INIS)

Battefeld, Diana; Battefeld, Thorsten; Davis, Anne-Christine

2008-01-01

We investigate multi-field inflationary scenarios with fields that drop out of the model in a staggered fashion. This feature is natural in certain multi-field inflationary setups within string theory; for instance, it can manifest itself when fields are related to tachyons that condense, or inter-brane distances that become meaningless when branes annihilate. Considering a separable potential, and promoting the number of fields to a smooth time dependent function, we derive the formalism to deal with these models at the background and perturbed level, providing general expressions for the scalar spectral index and the running. We recover known results of e.g. a dynamically relaxing cosmological constant in the appropriate limits. We further show that isocurvature perturbations are suppressed during inflation, and so perturbations are adiabatic and nearly Gaussian. The resulting setup might be interpreted as a novel type of warm inflation, readily implemented within string theory and without many of the shortcomings associated with warm inflation. To exemplify the applicability of the formalism we consider three concrete models: assisted inflation with exponential potentials as a simple toy model (a graceful exit becomes possible), inflation from multiple tachyons (a constant decay rate of the number of fields and negligible slow roll contributions turns out to be in good agreement with observations) and inflation from multiple M5-branes within M-theory (a narrow stacking of branes yields a consistent scenario)
Beverage can stay-tabs: still a source for inadvertently ingested foreign bodies in children

Energy Technology Data Exchange (ETDEWEB)

Donnelly, Lane F. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States); University of Cincinnati, College of Medicine, Departments of Radiology and Pediatrics, Cincinnati, OH (United States)

2010-09-15

In the 1970s in part to avoid inadvertent ingestion, the beverage-can industry changed can construction from pull-tabs to the stay-tabs (remain attached to can after opening) used today. Our purpose is to identify the number of inadvertent ingestions of beverage-can stay-tabs by children recognized at our institution. The medical information system of a children's hospital was searched with key terms to identify cases in which a witnessed or self-reported inadvertent ingestion of a beverage-can stay-tab resulted in a radiograph to rule out presence of a foreign body. Demographics, identification of stay-tab on radiographs, associated abnormalities, and patient management were reviewed. Nineteen cases of stay-tab ingestion were identified over 16 years. Mean age of ingesters was 8.5 years with the majority being teenagers and 15 (79%) >5 years of age. The stay-tab could be seen radiographically only in 4 (21%) cases - all with the stay-tab identified in the stomach. The identification of 19 children who inadvertently ingested beverage-can stay-tabs at a single children's hospital suggests that such ingestions still occur. Radiologists should be aware that stay-tabs are radiographically visible in the minority (21%) of cases. (orig.)

Beverage can stay-tabs: still a source for inadvertently ingested foreign bodies in children

International Nuclear Information System (INIS)

Donnelly, Lane F.

2010-01-01

In the 1970s in part to avoid inadvertent ingestion, the beverage-can industry changed can construction from pull-tabs to the stay-tabs (remain attached to can after opening) used today. Our purpose is to identify the number of inadvertent ingestions of beverage-can stay-tabs by children recognized at our institution. The medical information system of a children's hospital was searched with key terms to identify cases in which a witnessed or self-reported inadvertent ingestion of a beverage-can stay-tab resulted in a radiograph to rule out presence of a foreign body. Demographics, identification of stay-tab on radiographs, associated abnormalities, and patient management were reviewed. Nineteen cases of stay-tab ingestion were identified over 16 years. Mean age of ingesters was 8.5 years with the majority being teenagers and 15 (79%) >5 years of age. The stay-tab could be seen radiographically only in 4 (21%) cases - all with the stay-tab identified in the stomach. The identification of 19 children who inadvertently ingested beverage-can stay-tabs at a single children's hospital suggests that such ingestions still occur. Radiologists should be aware that stay-tabs are radiographically visible in the minority (21%) of cases. (orig.)
[Related factors to re-bleeding and mortality in cirrhotic patients with acute variceal bleeding at Hipolito Unanue Hospital, Lima, Peru].

Science.gov (United States)

Parra Pérez, Víctor Felipe; Raymundo Cajo, Roxana Magali; Gutiérrez de Aranguren, Constantino Fernando

2013-01-01

To determine related factors to 5 days re-bleeding and 6 week-mortality of an episode of variceal bleeding in cirrhotic patients. Observational, descriptive, co relational, retrospective study. In this study were included the cirrhotic patients who entered to Hipolito Unanue Hospital, Lima, Peru, between January 2006 and February 2012 with suspicion of variceal bleeding. Were excluded patients who bled from nonvariceal origin, or that did not have the data in clinical history to calculate the Child Pugh score, the Model for terminal diseases of the liver (MELD), or the endoscopic report detailing the bleeding source and the presence of esophageal and/or gastric varices. We include 63 patients, 35 (55.6%) were men. The median of age was of 64 years. 26 of them (41.3%) were Child Pugh C, where as the median of MELD score was 9. The multivariate analysis found that the Child Pugh score was related to 6 weeks-mortality (p=0,003), where as the presence of active bleeding during endoscopy (p=0.012) and the value of creatinine (p=0.012) were related to 5 days re-bleeding. The Child Pugh score was related to 6 weeks-mortality in cirrhotic patients with variceal bleeding. Active bleeding during endoscopy and the value of creatinine were related to 5 days re-bleeding.
Angiographic diagnosis and treatment of gastrointestinal bleeding

International Nuclear Information System (INIS)

Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung

1986-01-01

Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.
Angiographic diagnosis and treatment of gastrointestinal bleeding

Energy Technology Data Exchange (ETDEWEB)

Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1986-02-15

Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.
Power module assemblies with staggered coolant channels

Science.gov (United States)

Herron, Nicholas Hayden; Mann, Brooks S; Korich, Mark D

2013-07-16

A manifold is provided for supporting a power module assembly with a plurality of power modules. The manifold includes a first manifold section. The first face of the first manifold section is configured to receive the first power module, and the second face of the first manifold section defines a first cavity with a first baseplate thermally coupled to the first power module. The first face of the second manifold section is configured to receive the second power module, and the second face of the second manifold section defines a second cavity with a second baseplate thermally coupled to the second power module. The second face of the first manifold section and the second face of the second manifold section are coupled together such that the first cavity and the second cavity form a coolant channel. The first cavity is at least partially staggered with respect to second cavity.
Staggering of angular momentum distribution in fission

Directory of Open Access Journals (Sweden)

Tamagno Pierre

2018-01-01

Full Text Available We review here the role of angular momentum distributions in the fission process. To do so the algorithm implemented in the FIFRELIN code [?] is detailed with special emphasis on the place of fission fragment angular momenta. The usual Rayleigh distribution used for angular momentum distribution is presented and the related model derivation is recalled. Arguments are given to justify why this distribution should not hold for low excitation energy of the fission fragments. An alternative ad hoc expression taking into account low-lying collectiveness is presented as has been implemented in the FIFRELIN code. Yet on observables currently provided by the code, no dramatic impact has been found. To quantify the magnitude of the impact of the low-lying staggering in the angular momentum distribution, a textbook case is considered for the decay of the 144Ba nucleus with low excitation energy.
The use of staggered scheme and an absorbing buffer zone for computational aeroacoustics

Science.gov (United States)

Nark, Douglas M.

1995-01-01

Various problems from those proposed for the Computational Aeroacoustics (CAA) workshop were studied using second and fourth order staggered spatial discretizations in conjunction with fourth order Runge-Kutta time integration. In addition, an absorbing buffer zone was used at the outflow boundaries. Promising results were obtained and provide a basis for application of these techniques to a wider variety of problems.
Radiological diagnosis of gastrointestinal bleeding

International Nuclear Information System (INIS)

Neufang, K.F.R.; Gross-Fengels, W.; Lorenz, R.

1990-01-01

In the diagnosis of acute gastrointestinal bleeding, endoscopy holds the first place today. Radiological investigations are indispensable whenever endoscopy cannot precisely localise the bleeding site, whenever a tumour is present or suspected, in all cases of lower gastrointestinal bleeding, and in haemobilia. A tailored radiological approach is recommended. The radiological basis programme should be at least a complete abdominal ultrasound study and plain abdominal radiograms. CT and ERCP scans may become necessary in selected cases. As a rule, angiographical localisation of the bleeding site will be successful only in the acute stage; selective visceral arteriograms have to be obtained, which may be executed in the digital subtraction technique in patients who are cooperating and clinically stable. Angiodysplasias and aneurysms, however, may be demonstrated angiographically in the interval as well. Upper and/or lower G.I. tract studies with barium or water-soluble contrast media may be indicated in the interval in order to demonstrate tumours, metastatic lesions, diverticula and gut malformations. (orig.) [de
A rare case of bleeding disorder: Glanzmann's thrombasthenia.

Science.gov (United States)

Swathi, Jami; Gowrishankar, A; Jayakumar, S A; Jain, Karun

2017-01-01

Glanzmann's thrombasthenia (GT) is a rare bleeding disorder, which is characterized by a lack of platelet aggregation. It is characterized by qualitative or quantitative abnormalities of the platelet membrane glycoprotein IIb/IIIa. Physiologically, this platelet receptor normally binds several adhesive plasma proteins, and this facilitates attachment and aggregation of platelets to ensure thrombus formation at sites of vascular injury. The lack of resultant platelet aggregation in GT leads to mucocutaneous bleeding whose manifestation may be clinically variable, ranging from easy bruising to severe and potentially life-threatening hemorrhages. To highlight this rare but potentially life-threating disorder, GT. We report a case of GT that was first detected because of the multiple episodes of gum bleeding. The patient was an 18-year-old girl who presented with a history of repeated episodes of gum bleeding since childhood. Till the first visit to our hospital, she had not been diagnosed with GT despite a history of bleeding tendency, notably purpura in areas of easy bruising, gum bleeding, and prolonged bleeding time after abrasions and insect stings. GT was diagnosed on the basis of prolonged bleeding time, lack of platelet aggregation with adenosine di phosphate, epinephrine and collagen. GT should always be considered as differential diagnosis while evaluating any case of bleeding disorder.
Photocoagulation in the treatment of bleeding peptic ulcer

Science.gov (United States)

Otto, Wlodzimierz; Paczkowski, Pawel M.

1996-03-01

The authors present their experience in the endoscopic laser photocoagulation of bleeding peptic ulcer. From 1991 to June 1995, 203 patients admitted for UGI bleeding from peptic ulcer have been treated by this method. The source of bleeding was confirmed by endoscopy. The patients were divided into two groups: actively bleeding peptic ulcer (group IA and IB according to Forrest's classification) and ulcer with stigmata of recent bleeding (group IIA/IIB). The former group consisted of 106 patients, among whom over 40 percent (45 patients) presented signs of hypovolemic shock on admission. Nd:YAG laser (Surgical Laser Technologies) was used in a continuous mode with a contact (8 - 20 watts) or non-contact (over 50 watts) method of coagulation. In actively bleeding patients photocoagulation resulted in stopping the hemorrhage in 95 (90%). Recurrent bleeding occurred in 16 cases; in 9 of them it was stopped by repeated photocoagulation. In this group 18 patients required surgical intervention. The mortality was of 10.3% (11 patients). In 97 patients with recent bleeding stigmata photocoagulation provoked heavy hemorrhage in 3 (in 2 cases stopped by prolonged coagulation). In 9 of the remaining 94 patients recurrent bleeding occurred. Nine patients required surgical intervention. Mortality in this group was of 6%.
Development of mathematical model and optimal control system of internal temperatures of hot-blast stove process in staggered parallel operation; Netsufuro sushiki model to parallel sofu ni okeru ronai ondo saiteki seigyo system no kaihatsu

Energy Technology Data Exchange (ETDEWEB)

Matoba, Y. [Sumitomo Metal Industries, Ltd., Osaka (Japan); Otsuka, K.

1998-07-01

A mathematical model and an optimal control system of hot-blast stove process are described. A precise mathematical simulation model of the hot-blast stove was developed and the accuracy of the model has been confirmed. An optimal control system of the thermal conditions of the hot-blast stoves in staggered parallel operation was also developed. By the use of the multivariable optimal regulator and the feedforward compensations for the change of the aimed blast temperature and blast volume, the system is able to control the hot blast temperature and the brick temperature efficiently. The system has been applied to Kashima works. The variations of the blast temperature and the silica brick temperature have been decreased. The ultimate low heat level operations have been realized and the thermal efficiency furthermore has been raised by about 1%. 8 refs., 14 figs., 1 tab.
Towards an understanding of staggering effects in dissipative binary collisions

International Nuclear Information System (INIS)

D'Agostino, M.; Bruno, M.; Gulminelli, F.; Morelli, L.; Baiocco, G.; Bardelli, L.; Barlini, S.; Cannata, F.; Casini, G.; Geraci, E.; Gramegna, F.; Kravchuk, V.L.; Marchi, T.; Moroni, A.; Ordine, A.; Raduta, Ad.R.

2012-01-01

The reactions 32 S+ 58,64 Ni are studied at 14.5 A MeV. Evidence is found for important odd–even effects in isotopic observables of selected peripheral collisions corresponding to the decay of a projectile-like source. The influence of secondary decays on the staggering is studied with a correlation function technique. It is shown that this method is a powerful tool to get experimental information on the evaporation chain, in order to constrain model calculations. Specifically, we show that odd–even effects are due to interplay between pairing effects in the nuclear masses and in the level densities.
The analysis of the causes of uterine bleeding occurred after cesarean section and the evaluation of interventional therapy for bleeding

International Nuclear Information System (INIS)

Hu Peng; Li Yuwei; Li Yunhui; Luo Bin; Wen Wen; Yang Bo

2011-01-01

Objective: to analyze the causes of uterine hemorrhage occurred after cesarean section and to investigate the value of angiography and transcatheter artery embolization (TAE) in the diagnosis and treatment of postpartum hemorrhage after cesarean section. Methods: During the period from Jan. 2001 to Dec. 2011, a total of 65 cases suffering from uterine bleeding after cesarean section had underwent uterine arteriography to clarify the diagnosis, which was followed by transcatheter uterine artery embolization (TUAE). The clinical data, the causes of bleeding and the angiographic features were retrospectively analyzed. Results: The causes of uterine bleeding after cesarean section included uterine artery pseudoaneurysm (n=26), uterine atony (n=18), placental factors (n=11), gestational hypertension (n=8), coexisting uterine fibroids (n=1) and uterine bleeding of unknown reason (n=1). Uterine artery angiography revealed contrast extravasation in all patients except one patient. The angiographic findings confirmed the diagnosis of uterine artery bleeding after cesarean section. The bleeding stopped after TUAE, and the patients were in stable condition. No serious complications occurred. Conclusion: Pseudoaneurysm is the primary cause of postpartum uterine hemorrhage after cesarean section. Transcatheter uterine artery angiography can promptly and reliably determine the causes of bleeding, and, at the same time, embolization therapy can be carried out to effectively stop the bleeding. (authors)
THROMBIN GENERATION AND BLEEDING IN HEMOPHILIA A

Science.gov (United States)

Brummel-Ziedins, Kathleen E.; Whelihan, Matthew F.; Gissel, Matthew; Mann, Kenneth G.; Rivard, Georges E.

2012-01-01

Introduction Hemophilia A displays phenotypic heterogeneity with respect to clinical severity. Aim To determine if tissue factor (TF)-initiated thrombin generation profiles in whole blood in the presence of corn trypsin inhibitor (CTI) are predictive of bleeding risk in hemophilia A. Methods We studied factor(F) VIII deficient individuals (11 mild, 4 moderate and 12 severe) with a well-characterized five-year bleeding history that included hemarthrosis, soft tissue hematoma and annual FVIII concentrate usage. This clinical information was used to generate a bleeding score. The bleeding scores (range 0–32) were separated into three groups (bleeding score groupings: 0, 0 and ≤9.6, >9.6), with the higher bleeding tendency having a higher score. Whole blood collected by phlebotomy and contact pathway suppressed by 100μg/mL CTI was stimulated to react by the addition of 5pM TF. Reactions were quenched at 20min by inhibitors. Thrombin generation, determined by ELISA for thrombin – antithrombin was evaluated in terms of clot time (CT), maximum level (MaxL) and maximum rate (MaxR) and compared to the bleeding score. Results Data are shown as the mean±SD. MaxL was significantly different (phemophilia A. PMID:19563500
Monitoring and treatment of acute gastrointestinal bleeding.

Science.gov (United States)

Lenjani, Basri; Zeka, Sadik; Krasniqi, Salih; Bunjaku, Ilaz; Jakupi, Arianit; Elshani, Besni; Xhafa, Agim

2012-01-01

Acute gastrointestinal bleeding-massive acute bleeding from gastrointestinal section is one of the most frequent forms of acute abdomen. The mortality degree in emergency surgery is about 10%. It's very difficult to identify the place of bleeding and etiology. The important purpose of this research is to present the cases of acute gastrointestinal bleeding from the patients which were monitored and treated at The University Clinical Center of Kosova-Emergency Center in Pristina. These inquests included 137 patients with acute gastrointestinal bleeding who were treated in emergency center of The University Clinical Center in Pristina for the period from January 2005 until December 2006. From 137 patients with acute gastrointestinal bleeding 41% or 29% was female and 96% or 70.1% male. Following the sex we gained a high significant difference of statistics (p < 0.01). The gastrointestinal bleeding was two times more frequent in male than in female. Also in the age-group we had a high significant difference of statistics (p < 0.01) 63.5% of patients were over 55 years old. The mean age of patients with an acute gastrointestinal bleeding was 58.4 years SD 15.8 age. The mean age for female patients was 56.4 age SD 18.5 age. The patients with arterial systolic pressure under 100 mmHg have been classified as patients with hypovolemic shock. They participate with 17.5% in all prevalence of acute gastrointestinal bleeding. From the number of prevalence 2 {1.5%} patients have been diagnosed with peptic ulcer, 1 {0.7%} as gastric perforation and 1 {0.7%} with intestine ischemia. Abdominal Surgery and Intensive Care 2 or 1.5% died, 1 at intensive care unit and 1 at nephrology. As we know the severe condition of the patients with gastrointestinal bleeding and etiology it is very difficult to establish, we need to improve for the better conditions in our emergency center for treatment and initiation base of clinic criteria.
Theoretical investigation of GaAsBi/GaAsN tunneling field-effect transistors with type-II staggered tunneling junction

Science.gov (United States)

Wang, Yibo; Liu, Yan; Han, Genquan; Wang, Hongjuan; Zhang, Chunfu; Zhang, Jincheng; Hao, Yue

2017-06-01

We investigate GaAsBi/GaAsN system for the design of type-II staggered hetero tunneling field-effect transistor (hetero-TFET). Strain-symmetrized GaAsBi/GaAsN with effective lattice match to GaAs exhibits a type-II band lineup, and the effective bandgap EG,eff at interface is significantly reduced with the incorporation of Bi and N elements. The band-to-band tunneling (BTBT) rate and drive current of GaAsBi/GaAsN hetero-TFETs are boosted due to the utilizing of the type-II staggered tunneling junction with the reduced EG,eff. Numerical simulation shows that the drive current and subthreshold swing (SS) characteristics of GaAsBi/GaAsN hetero-TFETs are remarkably improved by increasing Bi and N compositions. The dilute content GaAs0.85Bi0.15/GaAs0.92N0.08 staggered hetero-nTFET achieves 7.8 and 550 times higher ION compared to InAs and In0.53Ga0.47As homo-TFETs, respectively, at the supply voltage of 0.3 V. GaAsBi/GaAsN heterostructure is a potential candidate for high performance TFET.
The Powerful Antitakeover Force of Staggered Boards: Theory, Evidence and Policy

OpenAIRE

Lucian Arye Bebchuk; John C. Coates IV; Guhan Subramanian

2002-01-01

Staggered boards, which a majority of public companies now have, provide a powerful antitakeover defense, stronger than is commonly recognized. They provide antitakeover protection both by (i) forcing any hostile bidder, no matter when it emerges, to wait at least one year to gain control of the board and (ii) requiring such a bidder to win two elections far apart in time rather than a one-time referendum on its offer. Using a new data set of hostile bids in the five-year period 1996-2000, we...
Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

Science.gov (United States)

Biecker, Erwin

2013-01-01

Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828
[The causes of recurrent ulcerative gastroduodenal bleeding].

Science.gov (United States)

Lipnitsky, E M; Alekberzade, A V; Gasanov, M R

To explore microcirculatory changes within the first 48 hours after admission, to compare them with clinical manifestations of bleeding and to define the dependence of recurrent bleeding from the therapy. The study included 108 patients with ulcerative gastroduodenal bleeding who were treated at the Clinical Hospital #71 for the period 2012-2014. There were 80 (74.1%) men and 28 (25.9%) women. Age ranged 20-87 years (mean 54.4±16.8 years). Patients younger than 45 years were predominant (33.4%). J. Forrest classification (1974) was used in endoscopic characterization of bleeding. Roccal Prognostic Scale for gastroduodenal bleeding was applied in all patients at admission to assess the risk of possible recurrence. Patients were divided into 2 groups. Group 1 included 53 (49.1%) patients without recurrent bleeding; group 2-55 (50.1%) patients who had recurrent bleeding within the first two days of treatment. Investigation of microcirculation showed the role of vegetative component including blood circulation centralization, blood flow slowing, blood cells redistribution providing sufficient blood oxygenation. By the end of the first day we observed pronounced hemodilution, decreased blood oxygenation, blood flow restructuring with its acceleration above 1 ml/s, violation of tissue oxygenation, signs of hypovolemia. These changes were significantly different from group 2 and associated with circulatory decentralization with possible pulmonary microcirculation disturbances and interstitial edema. This processes contribute to disruption of tissue oxygenation. We assume that recurrent bleeding in group 2 was caused by fluid therapy in larger volumes than it was necessary in this clinical situation. Infusion therapy should be significantly reduced for the debut of gastroduodenal ulcerative bleeding. Sedative therapy is advisable to reduce the influence of central nervous system.
Transcatheter arterial embolization for traumatic bleeding control

International Nuclear Information System (INIS)

Ryu, Choon Wook; Lee, Sang Kwon; Suh, Kyung Jin; Kim, Tae Heon; Kim, Yong Joo; Kang, Duck Sik

1989-01-01

Angiography is essential for the detection of bleeding vessels in traumatic vascular injury. Immediately after the diagnosis, transcatheter embolization can be performed for the control of bleeding effectively and easily with proper use of embolic materials. Transcatheter embolization is believed to be the treatment of choice when emergency control is needed, where surgical approach is difficult and in those who are poor candidate for surgery. We have tried bleeding control in 18 cases of trauma over recent 4 years. The results were as follows; 1. Causes of bleeding(cases): Blunt or penetrating trauma (10), latrogenic trauma (8), (Postoperative (5), Needle biopsy (2), Percutaneous hepatic procedure (1)) 2. Embolized vessels: Renal artery branches (8), Hepatic artery branches (2), Arteries supplying chest wall (2), External carotid artery branches (3), Internal carotid artery (1), Circumflex humeral artery (1), Internal iliac artery branches (1). 3. Embolic agents: Gelfoam cubes (16), Stainless steel coils (3), Detachable latex balloon (1). 4. Successful bleeding control was achieved in 17 cases and reduction of the amount of bleeding in one case without significant complications

Transcatheter emboilization therapy of massive colonic bleeding

International Nuclear Information System (INIS)

Shin, G. H.; Oh, J. H.; Yoon, Y.

1996-01-01

To evaulate the efficacy and safety of emergent superselective transcatheter embolization for controlling massive colonic bleeding. Six of the seven patients who had symptom of massive gastrointestinal bleeding underwent emergent transcatheter embolization for control of the bleeding. Gastrointestinal bleeding in these patients was originated from various colonic diseases: rectal cancer(n=1), proctitis(n=1), benign ulcer(n=1), mucosal injury by ventriculoperitoneal shunt(n=1), and unknown(n=2). All patients except one with rectal cancer were critically ill. Superselective embolization were done by using Gelfoam particles and/or coils. The vessels embolized were ileocolic artery(n=1). superior rectal artery(n=2), inferior rectal artery (n=1), and middle and inferior rectal arteries(n=1). Hemostasis was successful immediately in all patients. Two underwnet surgery due to recurrent bleeding developed 3 days after the procedure(n=1) or in associalion with underlying rectal cancer(n=1). On surgical specimen of two cases, there was no mucosal ischemic change. Transcatheter embolization is a safe and effective treatment of method for the control of massive colonic bleeding
ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

Directory of Open Access Journals (Sweden)

Daniela Benedeto-Stojanov

2015-06-01

Full Text Available Upper gastrointestinal bleeding (UGB is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%. Bleeding most commonly occurred in patients older than 60 years (84.29%. Statistically, female patients were significantly older than patients of male gender (p=0.001. The most common cause of bleeding was peptic ulcer (65.71%. The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis.
Enhancement of Radiative Efficiency with Staggered InGaN Quantum Well Light Emitting Diodes

Energy Technology Data Exchange (ETDEWEB)

Tansu, Nelson; Dierolf, Volkmar; Huang, Gensheng; Penn, Samson; Zhao, Hongping; Liu, Guangyu; Li, Xiaohang; Poplawsky, Jonathan

2011-07-14

The technology on the large overlap InGaN QWs developed in this program is currently implemented in commercial technology in enhancing the internal quantum efficiency in major LED industry in US and Asia. The scientific finding from this work supported by the DOE enabled the implementation of this step-like staggered quantum well in the commercial LEDs.
Managing Chemotherapy Side Effects: Bleeding Problems

Science.gov (United States)

... C ancer I nstitute Managing Chemotherapy Side Effects Bleeding Problems “My nurse said that chemotherapy could make ... with a clean cloth. Keep pressing until the bleeding stops. If you bruise: Put ice on the ...
Bleeding in cancer patients and its treatment: a review.

Science.gov (United States)

Johnstone, Candice; Rich, Shayna E

2017-12-18

Bleeding is a common problem in cancer patients, related to local tumor invasion, tumor angiogenesis, systemic effects of the cancer, or anti-cancer treatments. Existing bleeds can also be exacerbated by medications such as bevacizumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticoagulants. Patients may develop acute catastrophic bleeding, episodic major bleeding, or low-volume oozing. Bleeding may present as bruising, petechiae, epistaxis, hemoptysis, hematemesis, hematochezia, melena, hematuria, or vaginal bleeding. Therapeutic intervention for bleeding should start by establishing goals of care, and treatment choice should be guided by life expectancy and quality of life. Careful thought should be given to discontinuation of medications and reversal of anticoagulation. Interventions to stop or slow bleeding may include systemic agents or transfusion of blood products. Noninvasive local treatment options include applied pressure, dressings, packing, and radiation therapy. Invasive local treatments include percutaneous embolization, endoscopic procedures, and surgical treatment.
Postpolypectomy lower GI bleeding: descriptive analysis

NARCIS (Netherlands)

Sorbi, D.; Norton, I.; Conio, M.; Balm, R.; Zinsmeister, A.; Gostout, C. J.

2000-01-01

BACKGROUND: Postpolypectomy hemorrhage may warrant intensive care monitoring, transfusions, and surgery. We sought factors predicting significant bleeding requiring blood transfusion and the benefits of critical care monitoring. METHODS: Patients with postpolypectomy bleeding between April 1989 and
What to do when she's bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents.

Science.gov (United States)

Bennett, Alyssa R; Gray, Susan H

2014-08-01

This article reviews the current understanding and management of abnormal uterine bleeding (AUB) in adolescents. The readers will learn a practical approach to the evaluation and treatment of mild-to-severe uterine bleeding. In 2011, a new classification system was proposed to standardize the terminology used to describe AUB. This system is based on the pattern and etiology of bleeding and has been adopted by other organizations. The term dysfunctional uterine bleeding has been replaced by AUB. The negative effect of AUB on adolescents' quality of life is now well established. The levonorgestrel-releasing intrauterine system is considered a first-line treatment for heavy menstrual bleeding and should be considered, especially in those adolescents who may also need contraception. AUB is a common adolescent complaint that can vary from mild to life-threatening if not recognized and treated promptly. This article reviews the appropriate assessment and management of AUB and proposes a practical algorithm that can be used in an office or hospital setting.
Scintigraphic demonstration of acute gastrointestinal bleeding

Energy Technology Data Exchange (ETDEWEB)

Alavi, A.

1980-01-01

Acute gastrointestinal bleeding may be localized using noninvasive radionuclide methods. We have favored the use of technetium-99m sulfur colloid with sequential imaging because of the rapid clearance of background activity. Definition of the site of upper gastrointestinal bleeding, however, may be obscured by intense uptake of radioactivity by liver and spleen. The sensitivity of the method is such that the bleeding rates of 0.05-0.1 ml/min can be detected compared to a sensitivity of 0.5 ml/min for angiography.
HTLV-1 Tax-mediated TAK1 activation involves TAB2 adapter protein

International Nuclear Information System (INIS)

Yu Qingsheng; Minoda, Yasumasa; Yoshida, Ryoko; Yoshida, Hideyuki; Iha, Hidekatsu; Kobayashi, Takashi; Yoshimura, Akihiko; Takaesu, Giichi

2008-01-01

Human T cell leukemia virus type 1 (HTLV-1) Tax is an oncoprotein that plays a crucial role in the proliferation and transformation of HTLV-1-infected T lymphocytes. It has recently been reported that Tax activates a MAPKKK family, TAK1. However, the molecular mechanism of Tax-mediated TAK1 activation is not well understood. In this report, we investigated the role of TAK1-binding protein 2 (TAB2) in Tax-mediated TAK1 activation. We found that TAB2 physically interacts with Tax and augments Tax-induced NF-κB activity. Tax and TAB2 cooperatively activate TAK1 when they are coexpressed. Furthermore, TAK1 activation by Tax requires TAB2 binding as well as ubiquitination of Tax. We also found that the overexpression of TRAF2, 5, or 6 strongly induces Tax ubiquitination. These results suggest that TAB2 may be critically involved in Tax-mediated activation of TAK1 and that NF-κB-activating TRAF family proteins are potential cellular E3 ubiquitin ligases toward Tax
Abnormal Uterine Bleeding: American College of Nurse-Midwives.

Science.gov (United States)

2016-07-01

Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach. © 2016 by the American College of Nurse-Midwives.
Accelerating staggered-fermion dynamics with the rational hybrid Monte Carlo algorithm

International Nuclear Information System (INIS)

Clark, M. A.; Kennedy, A. D.

2007-01-01

Improved staggered-fermion formulations are a popular choice for lattice QCD calculations. Historically, the algorithm used for such calculations has been the inexact R algorithm, which has systematic errors that only vanish as the square of the integration step size. We describe how the exact rational hybrid Monte Carlo (RHMC) algorithm may be used in this context, and show that for parameters corresponding to current state-of-the-art computations it leads to a factor of approximately seven decrease in cost as well as having no step-size errors
Calculation of the Nucleon Axial Form Factor Using Staggered Lattice QCD

Energy Technology Data Exchange (ETDEWEB)

Meyer, Aaron S. [Fermilab; Hill, Richard J. [Perimeter Inst. Theor. Phys.; Kronfeld, Andreas S. [Fermilab; Li, Ruizi [Indiana U.; Simone, James N. [Fermilab

2016-10-14

The nucleon axial form factor is a dominant contribution to errors in neutrino oscillation studies. Lattice QCD calculations can help control theory errors by providing first-principles information on nucleon form factors. In these proceedings, we present preliminary results on a blinded calculation of $g_A$ and the axial form factor using HISQ staggered baryons with 2+1+1 flavors of sea quarks. Calculations are done using physical light quark masses and are absolutely normalized. We discuss fitting form factor data with the model-independent $z$ expansion parametrization.
Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

DEFF Research Database (Denmark)

Olesen, J B; Lip, G Y H; Hansen, P R

2011-01-01

Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme...
[Hysteroscopic polypectomy, treatment of abnormal uterine bleeding].

Science.gov (United States)

de Los Rios, P José F; López, R Claudia; Cifuentes, P Carolina; Angulo, C Mónica; Palacios-Barahona, Arlex U

2015-07-01

To evaluate the effectiveness of the hysteroscopic polypectomy in terms of the decrease of the abnormal uterine bleeding. A cross-sectional and analytical study was done with patients to whom a hysteroscopic polypectomy was done for treating the abnormal uterine bleeding, between January 2009 and December 2013. The response to the treatment was evaluated via a survey given to the patients about the behavior of the abnormal uterine bleeding after the procedure and about overall satisfaction. The results were obtained after a hysteroscopic polypectomy done to 128 patients and were as follows. The average time from the polypectomy applied until the survey was 30.5 months, with a standard deviation of 18 months. 67.2% of the patients reported decreased abnormal uterine bleeding and the 32.8% reported a persistence of symptoms. On average 82.8% of the. patients were satisfied with the treatment. Bivariate and multivariate analysis showed no association between the variables studied and no improvement of abnormal uterine bleeding after surgery (polypectomy). There were no complications. Hysteroscopic polypectomy is a safe surgical treatment, which decreases on two of three patients the abnormal uterine bleeding in the presence of endometrial polyps, with an acceptable level of satisfaction.
Bleeding spectrum in children with moderate or severe von Willebrand disease: Relevance of pediatric-specific bleeding

NARCIS (Netherlands)

Sanders, Yvonne V.; Fijnvandraat, Karin; Boender, Johan; Mauser-Bunschoten, Evelien P.; van der Bom, Johanna G.; de Meris, Joke; Smiers, Frans J.; Granzen, Bernd; Brons, Paul; Tamminga, Rienk Y. J.; Cnossen, Marjon H.; Leebeek, Frank W. G.

2015-01-01

The bleeding phenotype of children with von Willebrand disease (VWD) needs to be characterized in detail to facilitate diagnosis during childhood and aid in the planning and assessment of treatment strategies. The objective was to evaluate the occurrence, type, and severity of bleeding in a large
Pseudo-spectral method using rotated staggered grid for elastic wave propagation in 3D arbitrary anisotropic media

KAUST Repository

Zou, Peng; Cheng, Jiubing

2017-01-01

-difference method, we propose a modified pseudo-spectral method for wave propagation in arbitrary anisotropic media. Compared with an existing remedy of staggered-grid pseudo-spectral method based on stiffness matrix decomposition and a possible alternative using
A Study of the Transient Response of Duct Junctions: Measurements and Gas-Dynamic Modeling with a Staggered Mesh Finite Volume Approach

Directory of Open Access Journals (Sweden)

Antonio J. Torregrosa

2017-05-01

Full Text Available Duct junctions play a major role in the operation and design of most piping systems. The objective of this paper is to establish the potential of a staggered mesh finite volume model as a way to improve the description of the effect of simple duct junctions on an otherwise one-dimensional flow system, such as the intake or exhaust of an internal combustion engine. Specific experiments have been performed in which different junctions have been characterized as a multi-port, and that have provided precise and reliable results on the propagation of pressure pulses across junctions. The results obtained have been compared to simulations performed with a staggered mesh finite volume method with different flux limiters and different meshes and, as a reference, have also been compared with the results of a more conventional pressure loss-based model. The results indicate that the staggered mesh finite volume model provides a closer description of wave dynamics, even if further work is needed to establish the optimal calculation settings.
The role of nuclear medicine in acute gastrointestinal bleeding

International Nuclear Information System (INIS)

Robinson, P.

1993-01-01

In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. 99 Tc m -sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. 99 Tc m -labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author)
The role of nuclear medicine in acute gastrointestinal bleeding

Energy Technology Data Exchange (ETDEWEB)

Robinson, P. (Saint James' s Hospital, Leeds (United Kingdom). Dept. of Radiology)

1993-10-01

In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. [sup 99]Tc[sup m]-sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. [sup 99]Tc[sup m]-labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author).
The capsule endoscopy "suspected blood indicator" (SBI) for detection of active small bowel bleeding: no active bleeding in case of negative SBI.

Science.gov (United States)

Tal, Andrea Oliver; Filmann, Natalie; Makhlin, Konstantin; Hausmann, Johannes; Friedrich-Rust, Mireen; Herrmann, Eva; Zeuzem, Stefan; Albert, Jörg G

2014-09-01

Capsule endoscopy (CE) is the gold standard to diagnose small bowel bleeding. The "suspected blood indicator" (SBI) offers an automated detection of active small bowel bleeding but validity of this technique is unknown. The objective was to analyze specificity and sensitivity of the SBI using the second small bowel capsule generation for the detection of active bleeding. This is a retrospective analysis of all patients (199) who attended our clinic for CE from June 2008 through March 2013. The second-generation PillCam SB 2 capsule was used for detection of (1) luminal blood content and (2) potentially responsible small bowel lesions. The findings of an independent investigator were correlated to SBI findings and a number of SBI markings were analyzed by a receiver operating characteristic (ROC). In 157/199 cases, no sign of active bleeding or altered blood was detected. One hundred and thirty-seven of these 157 cases provided at least one SBI marking and a mean of 18.4 positive SBI markings per record were found. In 20 cases, neither SBI nor the human investigator detected abnormalities. Thirteen patients showed investigator-detected minor bleeding with mean SBI findings of 36 positive screenshots per record. When major bleeding was diagnosed by the investigator (n = 29), SBI detected a mean of 46.6 SBI-positive markings. SBI turned positive in 179 patients, whereas the investigator detected active bleeding in 42 cases. All patients with active bleeding were detected by SBI (sensitivity 100%, specificity 13%). ROC analysis revealed 51.0 SBI markings being the optimal cutoff for active versus no bleeding (sensitivity 79.1%, specificity 90.4%, misclassification of 15.3%). The new SBI software is a reliable tool to exclude active bleeding and/or major lesions but analysis of the CE video by a trained investigator is still important for the detection of lesions responsible for past bleeding.

Assessment of the forced air-cooling performance for cylindrical lithium-ion battery packs: A comparative analysis between aligned and staggered cell arrangements

International Nuclear Information System (INIS)

Yang, Naixing; Zhang, Xiongwen; Li, Guojun; Hua, Dong

2015-01-01

An appropriate cell arrangement plays significant role to design a highly efficient cooling system for the lithium-ion battery pack. This paper performs a comparative analysis of thermal performances on different arrangements of cylindrical cells for a LiFePO 4 battery pack. A thermal model for the battery pack is developed and is solved in couple with the governing equations of fluid flow in the numerical simulations. The experiments for model validation are conducted on a single cell of the battery pack with forced-air cooling system. The effects of longitudinal and transverse spacing on the cooling performances are analyzed for the battery pack with the aligned and the staggered arrays. Under a specified flow rate of cooling air, the maximum temperature rise is proportional to the longitudinal interval for the staggered arrays, while it is in inverse for the aligned arrangement. Increasing the transverse interval leads to the increase of the battery temperature rise for both aligned and staggered arrangements. By trade-off the design requirements (maximum temperature rise, temperature uniformity, power requirement and cooling index), an appropriate solution in term of the optimal combination of the longitudinal interval, transverse interval, and air inlet width is obtained for the aligned arrangement. - Highlights: • Forced air-cooling performance for cylindrical lithium-ion battery is evaluated. • Thermal performances for aligned and staggered cell arrangements are compared. • Geometric optimization is investigated for the battery air-cooling system
Transfusion strategy for acute upper gastrointestinal bleeding.

Science.gov (United States)

Handel, James; Lang, Eddy

2015-09-01

Clinical question Does a hemoglobin transfusion threshold of 70 g/L yield better patient outcomes than a threshold of 90 g/L in patients with acute upper gastrointestinal bleeding? Article chosen Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21. Study objectives The authors of this study measured mortality, from any cause, within the first 45 days, in patients with acute upper gastrointestinal bleeding, who were managed with a hemoglobin threshold for red cell transfusion of either 70 g/L or 90 g/L. The secondary outcome measures included rate of further bleeding and rate of adverse events.
The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities

NARCIS (Netherlands)

Knol, H. Marieke; Mulder, Andre; Bogchelman, Dick H.; Kluin-Nelemans, Hanneke C.; van der Zee, Ate G. J.; Meijer, Karina

OBJECTIVE: The purpose of this study was to assess the prevalence of underlying bleeding disorders in women with heavy menstrual bleeding (HMB) with and without gynecologic abnormalities. STUDY DESIGN: We performed a single-center prospective cohort study of 112 consecutive patients who were
Intracranial hemorrhage in congenital bleeding disorders.

Science.gov (United States)

Tabibian, Shadi; Motlagh, Hoda; Naderi, Majid; Dorgalaleh, Akbar

2018-01-01

: Intracranial hemorrhage (ICH), as a life-threatening bleeding among all kinds of congenital bleeding disorders (CBDs), is a rare manifestation except in factor XIII (FXIII) deficiency, which is accompanied by ICH, early in life, in about one-third of patients. Most inherited platelet function disorders (IPFDs) are mild to moderate bleeding disorders that can never experience a severe bleeding as in ICH; however, Glanzmann's thrombasthenia, a common and severe inherited platelet function disorder, can lead to ICH and occasional death. This bleeding feature can also be observed in grey platelet syndrome, though less frequently than in Glanzmann's thrombasthenia. In hemophilia, intracerebral hemorrhage is affected by various risk factors one of which is the severity of the disease. The precise prevalence of ICH in these patients is not clear but an estimated incidence of 3.5-4% among newborns with hemophilia is largely ascertained. Although ICH is a rare phenomenon in CBDs, it can be experienced by every patient with severe hemophilia A and B, FXIII deficiency (FXIIID), FVIID, FXD, FVD, FIID, and afibrinogenemia. Upon observing the general signs and symptoms of ICH such as vomiting, seizure, unconsciousness, and headache, appropriate replacement therapies and cranial ultrasound scans must be done to decrease ICH-related morbidity and mortality.
A staggered conservative scheme for every Froude number in rapidly varied shallow water flows

Science.gov (United States)

Stelling, G. S.; Duinmeijer, S. P. A.

2003-12-01

This paper proposes a numerical technique that in essence is based upon the classical staggered grids and implicit numerical integration schemes, but that can be applied to problems that include rapidly varied flows as well. Rapidly varied flows occur, for instance, in hydraulic jumps and bores. Inundation of dry land implies sudden flow transitions due to obstacles such as road banks. Near such transitions the grid resolution is often low compared to the gradients of the bathymetry. In combination with the local invalidity of the hydrostatic pressure assumption, conservation properties become crucial. The scheme described here, combines the efficiency of staggered grids with conservation properties so as to ensure accurate results for rapidly varied flows, as well as in expansions as in contractions. In flow expansions, a numerical approximation is applied that is consistent with the momentum principle. In flow contractions, a numerical approximation is applied that is consistent with the Bernoulli equation. Both approximations are consistent with the shallow water equations, so under sufficiently smooth conditions they converge to the same solution. The resulting method is very efficient for the simulation of large-scale inundations.
SBP-SAT finite difference discretization of acoustic wave equations on staggered block-wise uniform grids

KAUST Repository

Gao, Longfei

2018-02-16

We consider the numerical simulation of the acoustic wave equations arising from seismic applications, for which staggered grid finite difference methods are popular choices due to their simplicity and efficiency. We relax the uniform grid restriction on finite difference methods and allow the grids to be block-wise uniform with nonconforming interfaces. In doing so, variations in the wave speeds of the subterranean media can be accounted for more efficiently. Staggered grid finite difference operators satisfying the summation-by-parts (SBP) property are devised to approximate the spatial derivatives appearing in the acoustic wave equation. These operators are applied within each block independently. The coupling between blocks is achieved through simultaneous approximation terms (SATs), which impose the interface condition weakly, i.e., by penalty. Ratio of the grid spacing of neighboring blocks is allowed to be rational number, for which specially designed interpolation formulas are presented. These interpolation formulas constitute key pieces of the simultaneous approximation terms. The overall discretization is shown to be energy-conserving and examined on test cases of both theoretical and practical interests, delivering accurate and stable simulation results.
An SU(2) x SU(2) symmetric Higgs-Fermion model with staggered fermions

International Nuclear Information System (INIS)

Berlin, J.; Heller, U.M.

1991-01-01

We have simulated on SU(2)xSU(2) symmetric Higgs-Fermion model with a four component scalar field coupled with a Yukawa type coupling to two flavours of staggered fermions. The results show two qualitatively different behaviours in the broken phase. One for weak coupling where the fermion masses obey the perturbative tree level relation M F =y , and one for strong coupling where the behaviour agrees with a 1/d expansion. (orig.)
Pelvic artery embolization in gynecological bleeding

International Nuclear Information System (INIS)

Hausegger, K.A.; Schreyer, H.; Bodhal, H.

2002-01-01

The most common reasons for gynecological bleeding are pregnancy-related disorders, fibroids of the uterus, and gynecological malignances. Transarterial embolization is an effective treatment modality for gynecological bleeding regardless of its etiology. Depending on the underlying disease, a different technique of embolization is applied. In postpartal bleeding a temporary effect of embolization is desired, therefore gelatine sponge is used as embolizing agent. In fibroids and malignant tumors the effect should permanent, therefore PVA particles are used. Regardless the etiology, the technical and clinical success of transarterial embolization is at least 90%. In nearly every patient a post-embolization syndrome can be observed, represented by local pain and fever. This post-embolization syndrome usually does not last longer than 3 days. If embolization is performed with meticulous attention to angiographic technique and handling of embolic material, ischemic damage of adjacent organs is rarely observed. Transarterial embolization should be an integrative modality in the treatment of gynecological bleeding. (orig.) [de
Upper gastrointestinal bleeding in irbid, jordan

International Nuclear Information System (INIS)

Banisalamah, A.A.; Mraiat, Z.M.

2007-01-01

To define the various causes of nonvariceal upper gastrointestinal bleeding, to outline management modalities and to determine the final outcome of patients. A retrospective analysis of patients presenting with upper gastrointestinal (UGI) bleeding from January 2003 to December 2006 (4 years) was conducted. Patients with endoscopically proven variceal bleeding were excluded. Out of the 120 patients, most of the patients belonged to an age group of more than 50 years (mean 48.5 years). Haematemesis was the most common presentation and Acute Gastric Mucosal Lesion (AGML) was the most frequently encountered lesion. The cause of bleeding was not identified in 10 patients (undetermined group). Twenty-two (18.3%) underwent surgery and we had an overall mortality of 15.8%. AGML being the leading cause can be managed conservatively most of the time. There is a male preponderance and the incidence and mortality increases with advancing age. The undetermined group remains a diagnostic problem. (author)
Climate classification for the simulation of thermally activated building systems (TABS)

DEFF Research Database (Denmark)

Behrendt, Benjamin; Christensen, Jørgen Erik

2013-01-01

alternative (sustainable) energy sources that would otherwise be insufficient. The design of TABS is however challenging and most often requires a complete simulation of the building. The standard ISO 11855-4 (2011) suggests a simplified sizing method for TABS. The results however omit condensation risk...... entirely. The proposed climate classification should fill this gap by providing the missing data in a simple manner....
Acquired bleeding disorders

African Journals Online (AJOL)

B one marrow aplasia ... Laboratory approach to a suspected acquired bleeding disorder. (LER = leuko- .... lymphocytic leukaemia, and lymphoma). ... cells), a bone marrow aspirate and trephine biopsy (BMAT) is not ..... transplantation.
Immunosuppressive agents are associated with peptic ulcer bleeding.

Science.gov (United States)

Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Shirai, Yoshinori; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

2017-05-01

Peptic ulcer bleeding can be fatal. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and immunosuppressive agents are administered for long-term usage. The present study assessed the association between peptic ulcer bleeding and administration of NSAIDs, corticosteroids and immunosuppressive agents. Furthermore, the efficacy of lowering the risk of peptic ulcer bleeding with proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) was evaluated. Medical records were retrospectively analyzed for patients subjected to an upper gastrointestinal (GI) endoscopy performed at the National Hospital Organization Shimoshizu Hospital (Yotsukaido, Japan) from October 2014 to September 2015. During this period, a total of 1,023 patients underwent an upper GI endoscopy. A total of 1,023 patients, including 431 males (age, 68.1±12.9 years) and 592 females (age, 66.4±12.3 years), who had been administered NSAIDs, corticosteroids, immunosuppressive agents, PPIs and H2RAs, were respectively enrolled. Endoscopic findings of the patients were reviewed and their data were statistically analyzed. Logistic regression analysis was used to determine the odds ratio of peptic ulcer bleeding for each medication; immunosuppressive agents had an odds ratio of 5.83, which was larger than that for NSAIDs (4.77). The Wald test was applied to confirm the correlation between immunosuppressive agents and peptic ulcer bleeding. Furthermore, χ 2 tests were applied to the correlation between peptic ulcer bleeding and administration of PPIs or H2RAs. Immunosuppressive agents had the largest χ 2 , and the P-value was 0.03. Administration of PPIs was significantly correlated with non-peptic ulcer bleeding (P=0.02); furthermore, a tendency toward non-peptic ulcer bleeding with administration of H2RA was indicated, but it was not statistically significant (P=0.12). In conclusion, immunosuppressive agents were correlated with peptic ulcer bleeding and PPIs were effective at
Lowrank seismic-wave extrapolation on a staggered grid

KAUST Repository

Fang, Gang

2014-05-01

© 2014 Society of Exploration Geophysicists. We evaluated a new spectral method and a new finite-difference (FD) method for seismic-wave extrapolation in time. Using staggered temporal and spatial grids, we derived a wave-extrapolation operator using a lowrank decomposition for a first-order system of wave equations and designed the corresponding FD scheme. The proposed methods extend previously proposed lowrank and lowrank FD wave extrapolation methods from the cases of constant density to those of variable density. Dispersion analysis demonstrated that the proposed methods have high accuracy for a wide wavenumber range and significantly reduce the numerical dispersion. The method of manufactured solutions coupled with mesh refinement was used to verify each method and to compare numerical errors. Tests on 2D synthetic examples demonstrated that the proposed method is highly accurate and stable. The proposed methods can be used for seismic modeling or reverse-time migration.
Lowrank seismic-wave extrapolation on a staggered grid

KAUST Repository

Fang, Gang; Fomel, Sergey; Du, Qizhen; Hu, Jingwei

2014-01-01

© 2014 Society of Exploration Geophysicists. We evaluated a new spectral method and a new finite-difference (FD) method for seismic-wave extrapolation in time. Using staggered temporal and spatial grids, we derived a wave-extrapolation operator using a lowrank decomposition for a first-order system of wave equations and designed the corresponding FD scheme. The proposed methods extend previously proposed lowrank and lowrank FD wave extrapolation methods from the cases of constant density to those of variable density. Dispersion analysis demonstrated that the proposed methods have high accuracy for a wide wavenumber range and significantly reduce the numerical dispersion. The method of manufactured solutions coupled with mesh refinement was used to verify each method and to compare numerical errors. Tests on 2D synthetic examples demonstrated that the proposed method is highly accurate and stable. The proposed methods can be used for seismic modeling or reverse-time migration.
Evaluation of rectal bleeding factors associated with prostate brachytherapy

International Nuclear Information System (INIS)

Aoki, Manabu; Miki, Kenta; Sasaki, Hiroshi; Kido, Masato; Shirahama, Jun; Takagi, Sayako; Kobayashi, Masao; Honda, Chikara; Kanehira, Chihiro

2009-01-01

The purpose of this study was to analyze rectal bleeding prognostic factors associated with prostate brachytherapy (PB) or in combination with external-beam radiation therapy (EBRT) and to examine dosimetric indications associated with rectal bleeding. The study included 296 patients followed up for >36 months (median, 48 months). PB was performed alone in 252 patients and in combination with EBRT in 44 patients. PB combined with EBRT is indicated for patients with a Gleason score >6. The prescribed dose was 144 Gy for monotherapy and 110 Gy for PB+EBRT (44-46 Gy). Although 9.1% who received monotherapy had 2.3% grade 2 rectal bleeding, 36.3% who received combined therapy had 15.9% grade 2 rectal bleeding. Combined therapy was associated with higher incidence of rectal bleeding (P=0.0049) and higher percentage of grade 2 bleeding (P=0.0005). Multivariate analysis revealed that R-150 was the only significant factor for rectal bleeding, and modified Radiation Therapy Oncology Group (RTOG) grade in monotherapy and biologically equivalent dose (BED) were significant for combined therapy. Moreover, grade 2 rectal bleeding increased significantly at D90 >130 Gy. Although R-150 was the significant prognostic factor for rectal bleeding and modified RTOG rectal toxicity grade, BED was the significant prognostic factor for modified RTOG rectal toxicity grade. (author)
Two observable features of the staggered-flux phase at nonzero doping

International Nuclear Information System (INIS)

Hsu, T.C.; Marston, J.B.; Affleck, I.

1991-01-01

We investigate whether the staggered-flux phase (SFP) is realized in slightly doped phases of the Cu-O high-T c superconductors. Using a mean-field solution of the t-J model, we calculate the size of circulating currents in the CuO 2 planes. For realistic parameters we find nonzero currents when the doping δ 2-x Sr x CuO 4 samples but additional structure along the (Q x ,0) and (0,Q y ) directions has not been seen. The absence of magnetic fields when δ>0.12 is consistent with the limits set by the muon experiments on superconducting samples
Treatment Modalities in Adolescents Who present With Heavy Menstrual Bleeding.

Science.gov (United States)

Alaqzam, Tasneem S; Stanley, Angela C; Simpson, Pippa M; Flood, Veronica H; Menon, Seema

2018-03-07

This study sought to determine the relationship of bleeding disorders to iron deficiency anemia. Additionally, this study was undertaken to examine all current treatment modalities used in a menorrhagia clinic with respect to heavy menstrual bleeding management to identify the most effective options for menstrual management in the setting of an underlying bleeding disorder. DESIGN, SETTING, PARTICIPANT, INTERVENTION, AND MAIN OUTCOME MEASURES: Retrospective chart review of adolescent <21 years with heavy menstrual bleeding attending a multidisciplinary hematology-adolescent gynecology clinic. Information included demographics, bleeding diathesis, hematologic parameters, treatment, and the diagnosis was extracted from each chart. Subjects were grouped into two categories based on the diagnosis of a bleeding disorder. Hemoglobin level, iron deficiency anemia, and need for transfusion were compared between a bleeding disorder and no bleeding disorder group. Subjects were grouped into categories depending on hormonal modality and treatment success of the groups were compared. 73 subjects tested for a bleeding disorder. Of the subjects completing testing, 34 (46%) were diagnosed with a bleeding disorders. 39 (54%) subjects had heavy menstrual bleeding due to other causes. There was no significant difference in hemoglobin between those with and without a bleeding disorder. Iron deficiency anemia was significantly higher in subjects without bleeding disorder. When comparing hormone therapy success, the levonorgestrel IUD (LNG-IUD) (89%) had the highest rate of menstrual suppression followed by norethindrone acetate 5-10mg/day (83%), and the transdermal patch (80%). All subjects using both tranexamic acid and hormonal therapy had 100% achievement of menstrual suppression. A high frequency of bleeding disorder was found in those tested. Subjects with a bleeding disorder were less likely to present with severe anemia requiring blood transfusion and less likely to have iron
Gastric ulcer bleeding: diagnosis by computed tomography

Energy Technology Data Exchange (ETDEWEB)

Voloudaki, Argyro; Tsagaraki, Kaliopi; Mouzas, John; Gourtsoyiannis, Nickolas

1999-06-01

A case of CT demonstration of a bleeding gastric ulcer is presented, in a patient with confusing clinical manifestations. Abdominal CT was performed without oral contrast medium administration, and showed extravasation of intravenous contrast into a gastric lumen distended with material of mixed attenuation. It is postulated that if radiopaque oral contrast had been given, peptic ulcer bleeding would probably have been masked. CT demonstration of gastric ulcer bleeding, may be of value in cases of differential diagnostic dilemmas.
Gastric ulcer bleeding: diagnosis by computed tomography

International Nuclear Information System (INIS)

Voloudaki, Argyro; Tsagaraki, Kaliopi; Mouzas, John; Gourtsoyiannis, Nickolas

1999-01-01

A case of CT demonstration of a bleeding gastric ulcer is presented, in a patient with confusing clinical manifestations. Abdominal CT was performed without oral contrast medium administration, and showed extravasation of intravenous contrast into a gastric lumen distended with material of mixed attenuation. It is postulated that if radiopaque oral contrast had been given, peptic ulcer bleeding would probably have been masked. CT demonstration of gastric ulcer bleeding, may be of value in cases of differential diagnostic dilemmas
EM reconstruction of dual isotope PET using staggered injections and prompt gamma positron emitters

International Nuclear Information System (INIS)

Andreyev, Andriy; Sitek, Arkadiusz; Celler, Anna

2014-01-01

Purpose: The aim of dual isotope positron emission tomography (DIPET) is to create two separate images of two coinjected PET radiotracers. DIPET shortens the duration of the study, reduces patient discomfort, and produces perfectly coregistered images compared to the case when two radiotracers would be imaged independently (sequential PET studies). Reconstruction of data from such simultaneous acquisition of two PET radiotracers is difficult because positron decay of any isotope creates only 511 keV photons; therefore, the isotopes cannot be differentiated based on the detected energy. Methods: Recently, the authors have proposed a DIPET technique that uses a combination of radiotracer A which is a pure positron emitter (such as 18 F or 11 C) and radiotracer B in which positron decay is accompanied by the emission of a high-energy (HE) prompt gamma (such as 38 K or 60 Cu). Events that are detected as triple coincidences of HE gammas with the corresponding two 511 keV photons allow the authors to identify the lines-of-response (LORs) of isotope B. These LORs are used to separate the two intertwined distributions, using a dedicated image reconstruction algorithm. In this work the authors propose a new version of the DIPET EM-based reconstruction algorithm that allows the authors to include an additional, independent estimate of radiotracer A distribution which may be obtained if radioisotopes are administered using a staggered injections method. In this work the method is tested on simple simulations of static PET acquisitions. Results: The authors’ experiments performed using Monte-Carlo simulations with static acquisitions demonstrate that the combined method provides better results (crosstalk errors decrease by up to 50%) than the positron-gamma DIPET method or staggered injections alone. Conclusions: The authors demonstrate that the authors’ new EM algorithm which combines information from triple coincidences with prompt gammas and staggered injections

EM reconstruction of dual isotope PET using staggered injections and prompt gamma positron emitters

Energy Technology Data Exchange (ETDEWEB)

Andreyev, Andriy, E-mail: andriy.andreyev-1@philips.com [Philips Healthcare, Highland Heights, Ohio 44143 (United States); Sitek, Arkadiusz [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114 (United States); Celler, Anna [Department of Radiology, University of British Columbia, Vancouver V5Z 1M9 (Canada)

2014-02-15

Purpose: The aim of dual isotope positron emission tomography (DIPET) is to create two separate images of two coinjected PET radiotracers. DIPET shortens the duration of the study, reduces patient discomfort, and produces perfectly coregistered images compared to the case when two radiotracers would be imaged independently (sequential PET studies). Reconstruction of data from such simultaneous acquisition of two PET radiotracers is difficult because positron decay of any isotope creates only 511 keV photons; therefore, the isotopes cannot be differentiated based on the detected energy. Methods: Recently, the authors have proposed a DIPET technique that uses a combination of radiotracer A which is a pure positron emitter (such as{sup 18}F or {sup 11}C) and radiotracer B in which positron decay is accompanied by the emission of a high-energy (HE) prompt gamma (such as {sup 38}K or {sup 60}Cu). Events that are detected as triple coincidences of HE gammas with the corresponding two 511 keV photons allow the authors to identify the lines-of-response (LORs) of isotope B. These LORs are used to separate the two intertwined distributions, using a dedicated image reconstruction algorithm. In this work the authors propose a new version of the DIPET EM-based reconstruction algorithm that allows the authors to include an additional, independent estimate of radiotracer A distribution which may be obtained if radioisotopes are administered using a staggered injections method. In this work the method is tested on simple simulations of static PET acquisitions. Results: The authors’ experiments performed using Monte-Carlo simulations with static acquisitions demonstrate that the combined method provides better results (crosstalk errors decrease by up to 50%) than the positron-gamma DIPET method or staggered injections alone. Conclusions: The authors demonstrate that the authors’ new EM algorithm which combines information from triple coincidences with prompt gammas and
Tight-binding electrons on triangular and kagome lattices under staggered modulated magnetic fields: quantum Hall effects and Hofstadter butterflies

International Nuclear Information System (INIS)

Li Juan; Wang Yifei; Gong Changde

2011-01-01

We consider the tight-binding models of electrons on a two-dimensional triangular lattice and kagome lattice under staggered modulated magnetic fields. Such fields have two components: a uniform-flux part with strength φ, and a staggered-flux part with strength Δφ. Various properties of the Hall conductances and Hofstadter butterflies are studied. When φ is fixed, variation of Δφ leads to the quantum Hall transitions and Chern numbers of Landau subbands being redistributed between neighboring pairs. The energy spectra with nonzero Δφs have similar fractal structures but quite different energy gaps compared with the original Hofstadter butterflies of Δφ = 0. Moreover, the fan-like structure of Landau levels in the low magnetic field region is also modified appreciably by Δφ.
Tight-binding electrons on triangular and kagome lattices under staggered modulated magnetic fields: quantum Hall effects and Hofstadter butterflies

Energy Technology Data Exchange (ETDEWEB)

Li Juan; Wang Yifei; Gong Changde, E-mail: yfwang_nju@hotmail.com [Center for Statistical and Theoretical Condensed Matter Physics, and Department of Physics, Zhejiang Normal University, Jinhua 321004 (China)

2011-04-20

We consider the tight-binding models of electrons on a two-dimensional triangular lattice and kagome lattice under staggered modulated magnetic fields. Such fields have two components: a uniform-flux part with strength {phi}, and a staggered-flux part with strength {Delta}{phi}. Various properties of the Hall conductances and Hofstadter butterflies are studied. When {phi} is fixed, variation of {Delta}{phi} leads to the quantum Hall transitions and Chern numbers of Landau subbands being redistributed between neighboring pairs. The energy spectra with nonzero {Delta}{phi}s have similar fractal structures but quite different energy gaps compared with the original Hofstadter butterflies of {Delta}{phi} = 0. Moreover, the fan-like structure of Landau levels in the low magnetic field region is also modified appreciably by {Delta}{phi}.
Bleeding disorders in dental practice: A diagnostic overview

Directory of Open Access Journals (Sweden)

Abhirup Goswami

2014-01-01

Full Text Available Dental health care workers are increasingly called upon to provide quality dental care to individuals whose bleeding and clotting mechanisms have been altered by inherited or acquired diseases. This provides an opportunity for the dentist who is trained in the recognition of oral and systemic signs of altered hemostasis to assist in the diagnosis of the underlying condition. A number of dental procedures result in the risk of bleeding that can have serious consequences, such as severe hemorrhage or possibly death, for the patient with a bleeding disorder. Oral care providers must be aware of the impact of bleeding disorders on the management of their patients. These disorders must be recognized from history, clinical examinations, and laboratory investigations, if indicated, prior to surgical procedures including those in dental surgery to prevent bleeding related complications. Safe dental care may require consultation with the patient′s physician, systemic management, and dental treatment modifications. The purpose of this article is how to identify these patients with bleeding disorders.
Abnormal Bleeding during Menopause Hormone Therapy: Insights for Clinical Management

Directory of Open Access Journals (Sweden)

Sebastião Freitas De Medeiros

2013-01-01

Full Text Available Objective Our objective was to review the involved mechanisms and propose actions for controlling/treating abnormal uterine bleeding during climacteric hormone therapy. Methods A systemic search of the databases SciELO, MEDLINE, and Pubmed was performed for identifying relevant publications on normal endometrial bleeding, abnormal uterine bleeding, and hormone therapy bleeding. Results Before starting hormone therapy, it is essential to exclude any abnormal organic condition, identify women at higher risk for bleeding, and adapt the regimen to suit eachwoman's characteristics. Abnormal bleeding with progesterone/progestogen only, combined sequential, or combined continuous regimens may be corrected by changing the progestogen, adjusting the progestogen or estrogen/progestogen doses, or even switching the initial regimen to other formulation. Conclusion To diminish the occurrence of abnormal bleeding during hormone therapy (HT, it is important to tailor the regimen to the needs of individual women and identify those with higher risk of bleeding. The use of new agents as adjuvant therapies for decreasing abnormal bleeding in women on HT awaits future studies.
Timing of onset of gastrointestinal bleeding in the ICU

DEFF Research Database (Denmark)

Granholm, A; Lange, T; Anthon, C T

2018-01-01

BACKGROUND: Critically ill patients are at risk of gastrointestinal bleeding, but clinically important gastrointestinal bleeding is rare. The majority of intensive care unit (ICU) patients receive stress ulcer prophylaxis (SUP), despite uncertainty concerning the balance between benefit and harm....... For approximately half of ICU patients with gastrointestinal bleeding, onset is early, ie within the first two days of the ICU stay. The aetiology of gastrointestinal bleeding and consequently the balance between benefit and harm of SUP may differ between patients with early vs late gastrointestinal bleeding...... will describe baseline characteristics and assess the time to onset of the first clinically important episode of GI bleeding accounting for survival status and allocation to SUP or placebo. In addition, we will describe differences in therapeutic and diagnostic procedures used in patients with clinically...
Partially quenched gauge theories and an application to staggered fermions

International Nuclear Information System (INIS)

Bernard, C.W.; Golterman, M.F.L.

1994-01-01

We extend our Lagrangian technique for chiral perturbation theory for quenched QCD to include theories in which only some of the quarks are quenched. We discuss the relationship between the partially quenched theory and a theory in which only the unquenched quarks are present. We also investigate the peculiar infrared divergences associated with the η' in the quenched approximation, and find the conditions under which such divergences can appear in a partially quenched theory. We then apply our results to staggered fermion QCD in which the square root of the fermion determinant is taken, using the observation that this should correspond to a theory with four quarks, two of which are quenched
Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding.

Directory of Open Access Journals (Sweden)

Wei-Chen Lin

Full Text Available Post-endoscopic sphincterotomy bleeding is a common complication of biliary sphincterotomy, and the incidence varies from 1% to 48%. It can be challenging to localize the bleeder or to administer various interventions through a side-viewing endoscope. This study aimed to evaluate the risk factors of post-endoscopic sphincterotomy bleeding and the outcome of endoscopic intervention therapies. We retrospectively reviewed the records of 513 patients who underwent biliary sphincterotomy in Mackay Memorial Hospital between 2011 and 2016. The blood biochemistry, comorbidities, indication for sphincterotomy, severity of bleeding, endoscopic features of bleeder, and type of endoscopic therapy were analyzed. Post-endoscopic sphincterotomy bleeding occurred in 65 (12.6% patients. Forty-five patients had immediate bleeding and 20 patients had delayed bleeding. The multivariate analysis of risk factors associated with post-endoscopic sphincterotomy bleeding were liver cirrhosis (P = 0.029, end-stage renal disease (P = 0.038, previous antiplatelet drug use (P<0.001, and duodenal ulcer (P = 0.023. The complications of pancreatitis and cholangitis were higher in the bleeding group, with statistical significance. Delayed bleeding occurred within 1 to 7 days (mean, 2.5 days, and 60% (12/20 of the patients received endoscopic evaluation. In the delayed bleeding group, the successful hemostasis rate was 71.4% (5/7, and 65% (13/20 of the patients had ceased bleeding without endoscopic hemostasis therapy. Comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray (P = 0.042 and pancreatitis was higher in patients who received epinephrine injection and electrocoagulation (P = 0.041 and P = 0.039 respectively. Clinically, post-endoscopic sphincterotomy bleeding and further endoscopic hemostasis therapy increase the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each
ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

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Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

2015-09-01

Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended
[Management of intractable epistaxis and bleeding points localization].

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Yang, Da-Zhang; Cheng, Jing-Ning; Han, Jun; Shu, Ping; Zhang, Hua

2005-05-01

To investigate the common nasal bleeding points and the management of intractable epistaxis. The bleeding points and its correlation with age distribution, surgical techniques as well as its effects were studied retrospectively in 92 patients, in whom the bleeding points were not found by routine nasal endoscopy and the hemorrhage was not controlled with standard nasal packing. The bleeding points were found in the following different sites: superior wall of inferior nasal meatus (56.5%, 52/92), olfactory cleft of nasal septum (27.2%, 25/92), posterosuperior wall of middle nasal meatus (8.7%, 8/92) and uncertain (7.6%, 7/92). The results showed that the bleeding points had correlation with age. Epistaxis was well controlled by electrocoagulation in 83 cases, gelfoam packing in 8 cases, and transcatheter maxillary artery embolization in 1 case. There were no complications during a followed-up for 1 - 3 months after management. Among the 92 cases, the numbers of treatment needed to stop bleeding were 82 cases (89.1%) after 1 time of treatment, 9 cases (9.8%) after 2 times and in one case (1.1%) after 4 times. Endoscopy combined with displacement of the middle and inferior turbinate gives good visualization and direct management of the deeply-sited bleeding points, which were difficult in localization. The combined method provides an effective and safe way to control intractable epistaxis.
Clinically significant bleeding in incurable cancer patients: effectiveness of hemostatic radiotherapy

International Nuclear Information System (INIS)

Cihoric, Nikola; Crowe, Susanne; Eychmüller, Steffen; Aebersold, Daniel M; Ghadjar, Pirus

2012-01-01

This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients. Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = petechial bleeding, 2 = clinically significant bleeding, 3 = bleeding requiring transfusion, 4 = bleeding associated with fatality). The primary endpoint was bleeding at the end of RT. Key secondary endpoints included overall survival (OS) and acute toxicity. The bleeding score before and after RT were compared using the Wilcoxon signed rank test. Time to event endpoints were estimated using the Kaplan Meier method. Overall 62 patients were analyzed including 1 patient whose benign cause of bleeding was pseudomyxoma peritonei. Median age was 66 (range, 37–93) years. Before RT, bleeding was graded as 2 and 3 in 24 (39%) and 38 (61%) patients, respectively. A median dose of 20 (range, 5–45) Gy of hemostatic RT was applied to the bleeding site. At the end of RT, there was a statistically significant difference in bleeding (p < 0.001); it was graded as 0 (n = 39), 1 (n = 12), 2 (n = 6), 3 (n = 4) and 4 (n = 1). With a median follow-up of 19.3 (range, 0.3-19.3) months, the 6-month OS rate was 43%. Forty patients died (65%); 5 due to bleeding. No grade 3 or above acute toxicity was observed. Hemostatic RT seems to be a safe and effective treatment for clinically and statistically significantly reducing bleeding in incurable cancer patients
Scoring Systems for Estimating the Risk of Anticoagulant-Associated Bleeding.

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Parks, Anna L; Fang, Margaret C

2017-07-01

Anticoagulant medications are frequently used to prevent and treat thromboembolic disease. However, the benefits of anticoagulants must be balanced with a careful assessment of the risk of bleeding complications that can ensue from their use. Several bleeding risk scores are available, including the Outpatient Bleeding Risk Index, HAS-BLED, ATRIA, and HEMORR 2 HAGES risk assessment tools, and can be used to help estimate patients' risk for bleeding on anticoagulants. These tools vary by their individual risk components and in how they define and weigh clinical factors. However, it is not yet clear how best to integrate bleeding risk tools into clinical practice. Current bleeding risk scores generally have modest predictive ability and limited ability to predict the most devastating complication of anticoagulation, intracranial hemorrhage. In clinical practice, bleeding risk tools should be paired with a formal determination of thrombosis risk, as their results may be most influential for patients at the lower end of thrombosis risk, as well as for highlighting potentially modifiable risk factors for bleeding. Use of bleeding risk scores may assist clinicians and patients in making informed and individualized anticoagulation decisions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Universal definition of perioperative bleeding in adult cardiac surgery

NARCIS (Netherlands)

Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J.; Sellke, Frank W.; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

2014-01-01

Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and
Abnormal Uterine Bleeding

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... especially the progestin-only pill (also called the “mini-pill”) can actually cause abnormal bleeding for some ... Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality ...
Thermo Active Building Systems(TABS) - Performance in practice and possibilities for optimization

DEFF Research Database (Denmark)

Kolarik, Jakub

The project “Thermo Active Building Systems (TABS) – Performance in practice and possibilities for optimization” was carried out at DTU Byg in the period form 1.9.2012 until 31.12.2014. The aim of the project was to conduct field measurements in modern office buildings equipped with TABS systems...
Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal.

Science.gov (United States)

Lirio, Richard A

2016-01-01

Upper gastrointestinal (UGI) bleeding is generally defined as bleeding proximal to the ligament of Treitz, which leads to hematemesis. There are several causes of UGI bleeding necessitating a detailed history to rule out comorbid conditions, medications, and possible exposures. In addition, the severity, timing, duration, and volume of the bleeding are important details to note for management purposes. Despite the source of the bleeding, acid suppression with a proton-pump inhibitor has been shown to be effective in minimizing rebleeding. Endoscopy remains the interventional modality of choice for both nonvariceal and variceal bleeds because it can be diagnostic and therapeutic. Copyright © 2016 Elsevier Inc. All rights reserved.
Scintigraphy in gastrointestinal bleeding in the pediatric population

International Nuclear Information System (INIS)

Hall, T.R.; Miller, J.H.; Sty, J.R.

1986-01-01

Gastrointestinal (GI) tract bleeding in the pediatric population is not uncommon, especially in chronically ill patients. A total of 29 patients with GI tract bleeding were studied scintigraphically using Tc-99m-labeled red blood cells (RBCs) or sulfur colloid (SC). The patients ranged in age from 3 weeks to 20 years, with an equal sex distribution. Of 19 patients studied with Tc-99m-labeled RBCs using an in vitro labeling technique, evidence of GI tract bleeding was documented scintigraphically in 15. Tc-99m-labeled SC scans in the remaining ten patients demonstrated GI tract bleeding in six. The Tc-99m RBC method was slightly more sensitive than the Tc-99m SC method. Advantages of using labeled RBCs include increased sensitivity in detecting upper abdominal bleeding, ability to delay imaging for up to 18-24 hours, and the use of provocative testing
Duodenal diverticular bleeding: an endoscopic challenge

Directory of Open Access Journals (Sweden)

Eduardo Valdivielso-Cortázar

Full Text Available Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.
Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients.

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Pingleton, S K; Hadzima, S K

1983-01-01

The incidence of upper gastrointestinal (GI) bleeding in mechanically ventilated ICU patients receiving enteral alimentation was reviewed and compared to bleeding occurring in ventilated patients receiving prophylactic antacids or cimetidine. Of 250 patients admitted to our ICU during a 1-yr time period, 43 ventilated patients were studied. Patients in each group were comparable with respect to age, respiratory diagnosis, number of GI hemorrhage risk factors, and number of ventilator, ICU, and hospital days. Twenty-one patients had evidence of GI bleeding. Fourteen of 20 patients receiving antacids and 7 of 9 patients receiving cimetidine had evidence of GI bleeding. No bleeding occurred in 14 patients receiving enteral alimentation. Complications of enteral alimentation were few and none required discontinuation of enteral alimentation. Our preliminary data suggest the role of enteral alimentation in critically ill patients may include not only protection against malnutrition but also protection against GI bleeding.
Gastrointestinal bleeding after intracerebral hemorrhage: a retrospective review of 808 cases.

Science.gov (United States)

Yang, Tie-Cheng; Li, Jian-Guo; Shi, Hong-Mei; Yu, Dong-Ming; Shan, Kai; Li, Li-Xia; Dong, Xiao-Yan; Ren, Tian-Hua

2013-10-01

This study examined the incidence and risk factors for gastrointestinal (GI) bleeding after spontaneous intracerebral hemorrhage (ICH). The available medical records of patients with ICH admitted from June 2008 to December 2009 for any episode of GI bleeding, possible precipitating factors and administration of ulcer prophylaxis were reviewed. The prevalence of GI bleeding was 26.7%, including 3 cases of severe GI bleeding (0.35%). Patients with GI bleeding had significantly longer hospital stay and higher in-hospital mortality compared with patients without GI bleeding. Multivariate logistic regression analyses showed that age, Glasgow Coma Scale scores, sepsis and ICH volume were independent predictors of GI bleeding. About 63.4% of patients with ICH received stress ulcer prophylaxis. GI bleeding occurred frequently after ICH, but severe events were rare. Age, Glasgow Coma Scale score, sepsis and ICH volume were independent predictors of GI bleeding occurring after ICH.

Thermodynamics of spin ice in staggered and direct (along the [111] axis) fields in the cluster approximation

Energy Technology Data Exchange (ETDEWEB)

Zinenko, V. I., E-mail: zvi@iph.krasn.ru; Pavlovskii, M. S. [Russian Academy of Sciences, Kirensky Institute of Physics, Siberian Branch (Russian Federation)

2017-02-15

We have analyzed the low-temperature thermodynamic properties of spin ice in the staggered and direct (acting along the [111] axis) fields for rare-earth oxides with the chalcolamprite structure and general formula Re{sub 2}{sup 3+}Me{sub 2}{sup 4+}O{sub 7}{sup 2-}. Calculations have been performed in the cluster approximation. The results have been compared with experimental temperature dependences of heat capacity and entropy for Dy{sub 2}Ti{sub 2}O{sub 7} compound for different values of the external field in the [111] direction. The experimental data and calculated results have also been compared for the Pr{sub 2}Ru{sub 2}O{sub 7} compound with the antiferromagnetic ordering of magnetic moments of ruthenium ions, which gives rise to the staggered field acting on the system of rare-earth ions. The calculated temperature dependences of heat capacity and entropy are in good agreement with experimental data.
Upper gastrointestinal bleeding - state of the art.

Science.gov (United States)

Szura, Mirosław; Pasternak, Artur

2014-01-01

Upper gastrointestinal (GI) bleeding is a condition requiring immediate medical intervention, with high associated mortality exceeding 10%. The most common cause of upper GI bleeding is peptic ulcer disease, which largely corresponds to the intake of NSAIDs and Helicobacter pylori infection. Endoscopy is the essential tool for the diagnosis and treatment of active upper GI hemorrhage. Endoscopic therapy together with proton pump inhibitors and eradication of Helicobacter pylori significantly reduces rebleeding rates, mortality and number of emergency surgical interventions. This paper presents contemporary data on the diagnosis and treatment of upper gastrointestinal bleeding.
Abnormal uterine bleeding in perimenopause.

Science.gov (United States)

Goldstein, S R; Lumsden, M A

2017-10-01

Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office or primary-care setting. The wider availability of diagnostic tools has allowed prompt diagnosis and treatment of an increasing number of menstrual disorders in an office setting. This White Paper reviews the advantages and disadvantages of transvaginal ultrasound, blind endometrial sampling and diagnostic hysteroscopy. Once a proper diagnosis has been established, appropriate therapy may be embarked upon. Fortunately, only a minority of such patients will have premalignant or malignant disease. When bleeding is sufficient to cause severe anemia or even hypovolemia, prompt intervention is called for. In most of the cases, however, the abnormal uterine bleeding will be disquieting to the patient and significantly affect her 'quality of life'. Sometimes, reassurance and expectant management will be sufficient in such patients. Overall, however, in cases of benign disease, some intervention will be required. The use of oral contraceptive pills especially those with a short hormone-free interval, the insertion of the levonorgestrel intrauterine system, the incorporation of newer medical therapies including antifibrinolytic drugs and selective progesterone receptor modulators and minimally invasive treatments have made outpatient therapy increasingly effective. For others, operative hysteroscopy and endometrial ablation are proven therapeutic tools to provide both long- and short-term relief of abnormal uterine bleeding, thus avoiding, or deferring, hysterectomy.
Reliability measures in managing GI bleeding.

Science.gov (United States)

Sonnenberg, Amnon

2012-06-01

Multiple procedures and devices are used in a complex interplay to diagnose and treat GI bleeding. To model how a large variety of diagnostic and therapeutic components interact in the successful management of GI bleeding. The analysis uses the concept of reliability block diagrams from probability theory to model management outcome. Separate components of the management process are arranged in a serial or parallel fashion. If the outcome depends on the function of each component individually, such components are modeled to be arranged in series. If components complement each other and can mutually compensate for each of their failures, such components are arranged in a parallel fashion. General endoscopy practice. Patients with GI bleeding of unknown etiology. All available endoscopic and radiographic means to diagnose and treat GI bleeding. Process reliability in achieving hemostasis. Serial arrangements tend to reduce process reliability, whereas parallel arrangements increase it. Whenever possible, serial components should be bridged and complemented by additional alternative (parallel) routes of operation. Parallel components with low individual reliability can still contribute to overall process reliability as long as they function independently of other pre-existing alternatives. Probability of success associated with individual components is partly unknown. Modeling management of GI bleeding by a reliability block diagram provides a useful tool in assessing the impact of individual endoscopic techniques and administrative structures on the overall outcome. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Pattern recognition in menstrual bleeding diaries by statistical cluster analysis

Directory of Open Access Journals (Sweden)

Wessel Jens

2009-07-01

Full Text Available Abstract Background The aim of this paper is to empirically identify a treatment-independent statistical method to describe clinically relevant bleeding patterns by using bleeding diaries of clinical studies on various sex hormone containing drugs. Methods We used the four cluster analysis methods single, average and complete linkage as well as the method of Ward for the pattern recognition in menstrual bleeding diaries. The optimal number of clusters was determined using the semi-partial R2, the cubic cluster criterion, the pseudo-F- and the pseudo-t2-statistic. Finally, the interpretability of the results from a gynecological point of view was assessed. Results The method of Ward yielded distinct clusters of the bleeding diaries. The other methods successively chained the observations into one cluster. The optimal number of distinctive bleeding patterns was six. We found two desirable and four undesirable bleeding patterns. Cyclic and non cyclic bleeding patterns were well separated. Conclusion Using this cluster analysis with the method of Ward medications and devices having an impact on bleeding can be easily compared and categorized.
Experimental study of thermal–hydraulic performance of cam-shaped tube bundle with staggered arrangement

International Nuclear Information System (INIS)

Bayat, Hamidreza; Lavasani, Arash Mirabdolah; Maarefdoost, Taher

2014-01-01

Highlights: • Thermal–hydraulic performance of a non-circular tube bundle has been investigated experimentally. • Tubes were mounted in staggered arrangement with two longitudinal pitch ratios 1.5 and 2. • Drag coefficient and Nusselt number of tubes in second row was measured. • Friction factor of this tube bundle is lower than circular tube bundle. • Thermal–hydraulic performance of this tube bundle is greater than circular tube bundle. - Abstract: Flow and heat transfer from cam-shaped tube bank in staggered arrangement is studied experimentally. Tubes were located in test section of an open loop wind tunnel with two longitudinal pitch ratios 1.5 and 2. Reynolds number varies in range of 27,000 ⩽ Re D ⩽ 42,500 and tubes surface temperature is between 78 and 85 °C. Results show that both drag coefficient and Nusselt number depends on position of tube in tube bank and Reynolds number. Tubes in the first column have maximum value of drag coefficient, while its Nusselt number is minimum compared to other tubes in tube bank. Moreover, pressure drop from this tube bank is about 92–93% lower than circular tube bank and as a result thermal–hydraulic performance of this tube bank is about 6 times greater than circular tube bank
TabSQL: a MySQL tool to facilitate mapping user data to public databases.

Science.gov (United States)

Xia, Xiao-Qin; McClelland, Michael; Wang, Yipeng

2010-06-23

With advances in high-throughput genomics and proteomics, it is challenging for biologists to deal with large data files and to map their data to annotations in public databases. We developed TabSQL, a MySQL-based application tool, for viewing, filtering and querying data files with large numbers of rows. TabSQL provides functions for downloading and installing table files from public databases including the Gene Ontology database (GO), the Ensembl databases, and genome databases from the UCSC genome bioinformatics site. Any other database that provides tab-delimited flat files can also be imported. The downloaded gene annotation tables can be queried together with users' data in TabSQL using either a graphic interface or command line. TabSQL allows queries across the user's data and public databases without programming. It is a convenient tool for biologists to annotate and enrich their data.
Rectal bleeding after hypofractionated radiotherapy for prostate cancer: Correlation between clinical and dosimetric parameters and the incidence of grade 2 or worse rectal bleeding

International Nuclear Information System (INIS)

Akimoto, Tetsuo; Muramatsu, Hiroyuki; Takahashi, Mitsuhiro; Saito, Jun-ichi; Kitamoto, Yoshizumi; Harashima, Koichi; Miyazawa, Yasushi; Yamada, Masami; Ito, Kazuto; Kurokawa, Kouhei; Yamanaka, Hidetoshi; Nakano, Takashi; Mitsuhashi, Norio; Niibe, Hideo

2004-01-01

Purpose: To investigate the incidence and severity of rectal bleeding after high-dose hypofractionated radiotherapy (RT) for prostate cancer, and to explore the factors affecting the incidence of Grade 2 or worse rectal bleeding. Methods and materials: The data of 52 patients who had been treated by external beam RT for localized prostate cancer between 1999 and 2002 were analyzed. All the patients had received hypofractionated external beam RT to a total dose of 69 Gy in 3-Gy fractions, three fractions weekly. The clinical and dosimetric factors affecting the incidence of Grade 2 or worse late rectal bleeding were analyzed by univariate and multivariate analyses. The effect of the percentage of the whole rectal volume receiving 30%, 50%, 80%, and 90% of the prescribed radiation dose (V 30 , V 50 , V 80 , and V 90 , respectively) on the incidence of rectal bleeding was evaluated. Results: Of the 52 patients, 13 (25%) developed Grade 2 or worse rectal bleeding. One patient who needed laser coagulation and blood transfusion for the treatment of rectal bleeding was classified as having Grade 3 rectal bleeding. The median time to the development of Grade 2 or worse rectal bleeding was 11 months. The results of the univariate analysis revealed that the presence of a history of diabetes mellitus (p 30 ≥ 60%, V 50 ≥ 40% (p 80 ≥ 25%, and V 90 ≥ 15% (p < 0.001) were statistically significant risk factors for the occurrence of Grade 2 or worse rectal bleeding. The results of the multivariate analysis revealed that a history of diabetes mellitus was the most statistically significant risk factor for the occurrence of rectal bleeding after hypofractionated RT for prostate cancer (p < 0.05). Conclusion: A history of diabetes mellitus was the most statistically significant risk factor for the occurrence of Grade 2 or worse rectal bleeding after high-dose hypofractionated RT, although dosimetric factors were also closely associated with the risk of rectal bleeding
Outcomes of Propofol Sedation During Emergency Endoscopy Performed for Upper Gastrointestinal Bleeding.

Science.gov (United States)

Park, Chan Hyuk; Han, Dong Soo; Jeong, Jae Yoon; Eun, Chang Soo; Yoo, Kyo-Sang; Jeon, Yong Cheol; Sohn, Joo Hyun

2016-03-01

Although propofol-based sedation can be used during emergency endoscopy for upper gastrointestinal bleeding (UGIB), there is a potential risk of sedation-related adverse events, especially in patients with variceal bleeding. We compared adverse events related to propofol-based sedation during emergency endoscopy between patients with non-variceal and variceal bleeding. Clinical records of patients who underwent emergency endoscopy for UGIB under sedation were reviewed. Adverse events, including shock, hypoxia, and paradoxical reaction, were compared between the non-variceal and variceal bleeding groups. Of 703 endoscopies, 539 and 164 were performed for non-variceal and variceal bleeding, respectively. Shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding (12.2 vs. 3.5%, P bleeding (non-variceal bleeding vs. variceal bleeding: hypoxia, 3.5 vs. 1.8%, P = 0.275; paradoxical reaction interfering with the procedure, 4.1 vs. 5.5%, P = 0.442). Although shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding, most cases could be controlled without procedure interruption. Paradoxical reaction, rather than shock or hypoxia, was the most common cause of procedure interruption in patients with variceal bleeding, but the rate did not differ between patients with non-variceal and variceal bleeding.
Posterior epistaxis: Common bleeding sites and prophylactic electrocoagulation.

Science.gov (United States)

Liu, Juan; Sun, Xicai; Guo, Limin; Wang, Dehui

2016-01-01

Posterior epistaxis is a frequent emergency, and the key to efficient management is identification of the bleeding point. We performed a retrospective study of 318 patients with posterior epistaxis treated with endoscopic bipolar electrocautery during a 4-year period. Distribution of the bleeding sites was recorded. Patients with no definite bleeding sites in the first operation were assigned to Group A (n = 39) and Group B (n = 34). Patients in Group A were only observed in the ward. Patients in Group B were given prophylactic electrocoagulation at the common bleeding points. Of the 318 patients, bleeding sites were successfully identified and coagulated in 263 patients. All of them were located posteriorly, with 166 on the lateral nasal wall, 86 on the septum, and 11 on the anterior face of the sphenoid sinus. The rebleeding rate of Group B (8.8%) was lower than that of Group A (38.5%) (p < 0.01).
Spontaneous bleeding from liver after open heart surgery.

Science.gov (United States)

Mir, Najeeb H; Shah, Mian T; Obeid, Mahmoud Ali; Gallo, Ricardo; Aliter, Hashem

2013-01-01

Intra-abdominal hemorrhage after open heart surgery is very uncommon in routine clinical practice. There are case reports of having bleeding from spleen or liver after starting low molecular weight heparin (LMWH) postoperatively. Our patient is a 58-year-old man with mitral valve regurgitation, who underwent mitral valve repair and developed intra-abdominal hemorrhage 8h after open heart surgery. The exploratory laparotomy revealed the source of bleeding from ruptured sub-capsular liver hematoma and oozing from raw areas of the liver surface. Liver packing was done to control the bleeding. The gastrointestinal complications after open heart surgery are rare and spontaneous bleeding from spleen has been reported. This is the first case from our hospital to have intra-abdominal hemorrhage after open heart surgery. Spontaneous bleeding from liver is a possible complication after open heart surgery. We submit the case for the academic interest and to discuss the possible cause of hemorrhage. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.
Resin bleed improvement on surface mount semiconductor device

Science.gov (United States)

Rajoo, Indra Kumar; Tahir, Suraya Mohd; Aziz, Faieza Abdul; Shamsul Anuar, Mohd

2018-04-01

Resin bleed is a transparent layer of epoxy compound which occurs during molding process but is difficult to be detected after the molding process. Resin bleed on the lead on the unit from the focused package, SOD123, can cause solderability failure at end customer. This failed unit from the customer will be considered as a customer complaint. Generally, the semiconductor company has to perform visual inspection after the plating process to detect resin bleed. Mold chase with excess hole, split cavity & stepped design ejector pin hole have been found to be the major root cause of resin bleed in this company. The modifications of the mold chase, changing of split cavity to solid cavity and re-design of the ejector pin proposed were derived after a detailed study & analysis conducted to arrive at these solutions. The solutions proposed have yield good results during the pilot run with zero (0) occurrence of resin bleed for 3 consecutive months.
The role of endoscopy in pediatric gastrointestinal bleeding

OpenAIRE

Franke, Markus; Gei?, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-J?rgen; Bausch, Dirk; Fischer, Andreas

2016-01-01

Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20?% of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediat...
Analysis and Optimization of a Novel 2-D Magnet Array with Gaps and Staggers for a Moving-Magnet Planar Motor

Science.gov (United States)

Chen, Xuedong; Zeng, Lizhan

2018-01-01

This paper presents a novel 2-D magnet array with gaps and staggers, which is especially suitable for magnetically levitated planar motor with moving magnets. The magnetic flux density distribution is derived by Fourier analysis and superposition. The influences of gaps and staggers on high-order harmonics and flux density were analyzed, and the optimized design is presented. Compared with the other improved structures based on traditional Halbach magnet arrays, the proposed design has the lowest high-order harmonics percentage, and the characteristics of flux density meet the demand of high acceleration in horizontal directions. It is also lightweight and easy to manufacture. The proposed magnet array was built, and the calculation results have been verified with experiment. PMID:29300323
Increased bleeding risk during percutaneous coronary interventions by arterial hypertension.

Science.gov (United States)

Ndrepepa, Gjin; Groha, Philipp; Lahmann, Anna L; Lohaus, Raphaela; Cassese, Salvatore; Schulz-Schüpke, Stefanie; Kufner, Sebastian; Mayer, Katharina; Bernlochner, Isabell; Byrne, Robert A; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan

2016-08-01

We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI). The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown. This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI. Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018). Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
Bleeding tendency in dual antiplatelet therapy with aspirin/clopidogrel: rescue of the template bleeding time in a single-center prospective study

Directory of Open Access Journals (Sweden)

Altman Raul

2012-01-01

Full Text Available Abstract Background Patients with heightened platelet reactivity in response to antiplatelet agents are at an increased risk of recurrent ischemic events. However, there is a lack of diagnostic criteria for increased response to combined aspirin/clopidogrel therapy. The challenge is to identify patients at risk of bleeding. This study sought to characterize bleeding tendency in patients treated with aspirin and clopidogrel. Patients/methods In a single-center prospective study, 100 patients under long-term aspirin/clopidogrel treatment, the effect of therapy was assayed by template bleeding time (BT and the inhibition of platelet aggregation (IPA by light transmission aggregometry (LTA. Arachidonic acid (0.625 mmol/L and adenosine diphosphate (ADP; 2, 4, and 8 μmol/L were used as platelet agonists. Results Bleeding episodes (28 nuisance, 2 hematuria [1 severe], 1 severe proctorrhagia, 1 severe epistaxis were significantly more frequent in patients with longer BT. Template BT ≥ 24 min was associated with bleeding episodes (28 of 32. Risk of bleeding increased 17.4% for each 1 min increase in BT. Correlation was found between BT and IPAmax in response to ADP 2 μmol/L but not to ADP 4 or 8 μmol/L. Conclusion In patients treated with dual aspirin/clopidogrel therapy, nuisance and internal bleeding were significantly associated with template BT and with IPAmax in response to ADP 2 μmol/L but not in response to ADP 4 μmol/L or 8 μmol/L.
Rectal bleeding in children: endoscopic evaluation revisited

NARCIS (Netherlands)

de Ridder, Lissy; van Lingen, Anna V.; Taminiau, Jan A. J. M.; Benninga, Marc A.

2007-01-01

Objectives Rectal bleeding is an alarming event both for the child and parents. It is hypothesized that colonoscopy instead of sigmoidoscopy and adding esophago-gastro-duodenoscopy in case of accompanying complaints, improves the diagnostic accuracy in children with prolonged rectal bleeding. Study
HÃ¡bitos tabÃ¡gicos em alunos do 6.Âº ano de Medicina e medidas anti-tabÃ¡gicas

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AndrÃ© Borges

2008-05-01

Full Text Available Resumo: Objectivos: Estudar os hÃ¡bitos tabÃ¡gicos, caracterizar o conhecimento, aceitaÃ§Ã£o de medidas anti-tabÃ¡gicas e as expectativas em relaÃ§Ã£o ao impacto destas na saÃºde pÃºblica em alunos do 6.Âº ano de Medicina, em Portugal.Material e mÃ©todos: Foi realizado um estudo descritivo transversal, cuja populaÃ§Ã£o alvo foram os alunos de Medicina do sexto ano, em Portugal. Foi utilizado um questionÃ¡rio auto-preenchido, anÃ³nimo, dispo-nibilizado numa pÃ¡gina online, que divulgÃ¡mos por correio electrÃ³nico. Para a anÃ¡lise de algumas variÃ¡-veis utilizamos tabelas de contingÃªncia e a prova do Ï2, com nÃvel de significÃ¢ncia de 0,05.Resultados: Obtivemos 255 questionÃ¡rios vÃ¡lidos. A taxa de fumadores foi de 18,04%. O consumo de cigarros mais frequente foi entre 1-10 cigarros, sendo mais elevado entre os homens. A idade de inÃcio da maioria foi entre 13-18 anos, com as mulheres a co-meÃ§arem mais tarde. Dos fumadores, 36,96% jÃ¡ fize-ram uma tentativa de cessaÃ§Ã£o tabÃ¡gica. A maioria dos inquiridos concorda com as medidas anti-tabÃ¡gicas inquiridas e considera que irÃ£o diminuir o consumo e a morbimortalidade da populaÃ§Ã£o em geral. A formaÃ§Ã£o sobre cessaÃ§Ã£o tabÃ¡gica foi considerada suficiente por 34,90%.ConclusÃµes: Os resultados obtidos estÃ£o de acordo com as caracterÃsticas da populaÃ§Ã£o em geral, nomea-damente quanto Ã prevalÃªncia de fumadores, idade de inÃcio do consumo de tabaco e elevada prevalÃªncia de mulheres fumadoras. As medidas anti-tabÃ¡gicas parecem reunir consenso, segundo a nossa amostra, que tambÃ©m espera uma reduÃ§Ã£o do consumo geral e individual, assim como da morbimortalidade.Rev Port Pneumol 2008; XIV (3: 379-390 Abstract: Objectives: To study the smoking habits of 6th year Portuguese medical students and assess their knowledge and acceptance of anti-smoking measures and how they felt these
HÃ¡bitos tabÃ¡gicos em alunos do 6.Âº ano de Medicina e medidas anti-tabÃ¡gicas

Directory of Open Access Journals (Sweden)

AndrÃ© Borges

2008-03-01

Full Text Available Resumo: Objectivos: Estudar os hÃ¡bitos tabÃ¡gicos, caracterizar o conhecimento, a aceitaÃ§Ã£o de medidas anti-tabÃ¡gicas e as expectativas em relaÃ§Ã£o ao impacto destas na saÃºde pÃºblica em alunos do 6.Âº ano de Medicina, em Portugal.Material e mÃ©todos: Foi realizado um estudo descritivo transversal, cuja populaÃ§Ã£o-alvo foram os alunos de Medicina do sexto ano em Portugal. Foi utilizado um questionÃ¡rio auto-preenchido, anÃ³nimo, disponibilizado numa pÃ¡gina online, que divulgÃ¡mos por correio electrÃ³nico. Para a anÃ¡lise de algumas variÃ¡veis, utilizÃ¡mos tabelas de contingÃªncia e a prova do Ï2, com nÃvel de significÃ¢ncia de 0,05.Resultados: Obtivemos 255 questionÃ¡rios vÃ¡lidos. A taxa de fumadores foi de 18,04%. O consumo de cigarros mais frequente foi entre 1-10, sendo mais elevado entre os homens. A idade de inÃcio da maioria foi entre 13-18 anos, com as mulheres a comeÃ§arem mais tarde. Dos fumadores, 36,96% jÃ¡ fizeram uma tentativa de cessaÃ§Ã£o tabÃ¡gica. A maioria dos inquiridos concorda com as medidas anti-tabÃ¡gicas inquiridas e considera que irÃ£o diminuir o consumo e a morbimortalidade da populaÃ§Ã£o em geral. A formaÃ§Ã£o sobre cessaÃ§Ã£o tabÃ¡gica foi considerada suficiente por 34,90%.ConclusÃµes: Os resultados obtidos estÃ£o de acordo com as caracterÃsticas da populaÃ§Ã£o em geral, nomeadamente quanto Ã prevalÃªncia de fumadores, idade de inÃcio do consumo de tabaco e elevada prevalÃªncia de mulheres fumadoras. As medidas anti-tabÃ¡gicas parecem reunir consenso, segundo a nossa amostra, que tambÃ©m espera uma reduÃ§Ã£o do consumo geral e individual, assim como da morbimortalidade.Rev Port Pneumol 2007; XIV (2: 219-230 Abstract: Objectives: To study the smoking habits of 6th year Portuguese medical students and assess their knowledge and acceptance of anti-smoking measures and how they felt these would
Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

Energy Technology Data Exchange (ETDEWEB)

Shin, Ji Hoon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2012-02-15

Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

Pseudoxanthoma elasticum: A rare cause of gastrointestinal bleed

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Ishrat H Dar

2015-01-01

Full Text Available Causes of obscure gastrointestinal (GI bleed are diverse and rare. The most common cause for GI bleeding of small bowel origin is angiodysplasia, followed by tumors of the small intestine, and various other causes, including small bowel ulcers and aortienteric fistulas. Pseudoxanthoma elasticum (PXE is a rare cause of GI bleed. It is an inherited elastic tissue disorder with degeneration of elastic fibers involving mainly skin, eyes and the cardiovascular system. Upper GI hemorrhage occurs in 13% of cases and is often resistant to nonsurgical methods of treatment. Presented herein is a case of GI bleed in a 65-year-old woman who had PXE and hyperplastic polyps in the stomach.
Use of heparin in the investigation of obscure gastrointestinal bleeding

International Nuclear Information System (INIS)

Mernagh, J.R.; O'Donovan, N.; Somers, S.; Gill, G.; Sridhar, S.

2001-01-01

To determine if the administration of heparin improves the predictive value of angiography in the investigation of obscure gastrointestinal (GI) bleeding. 18 patients with a history of chronic GI bleeding were investigated with angiography. For 6 patients, the cause of GI bleeding was established with angiography; the 12 patients who had negative results were given heparin for 24 h and were reassessed with angiography. After heparin administration, the source of GI bleeding was determined with angiography for 6 of the remaining 12 patients. Thus, heparinization increased diagnostic yield from 33% (6 of 18) to 67% (12 of 18). No significant complications, such as uncontrolled GI bleeding, occurred. Heparinization improves the diagnostic yield of angiography when obscure GI bleeding is being investigated. (author)
Small Bowel Bleeding

Science.gov (United States)

... pouchings in the wall of the colon), or cancer. Upper GI (esophagus, stomach, or duodenum) bleeding is most often due ... begins transmitting images of the inside of the esophagus, stomach, and small bowel to a ... Bowel Disease Irritable Bowel Syndrome ...
Objectives and Design of BLEEDS: A Cohort Study to Identify New Risk Factors and Predictors for Major Bleeding during Treatment with Vitamin K Antagonists.

Science.gov (United States)

van Rein, Nienke; Lijfering, Willem M; Bos, Mettine H A; Herruer, Martien H; Vermaas, Helga W; van der Meer, Felix J M; Reitsma, Pieter H

2016-01-01

Risk scores for patients who are at high risk for major bleeding complications during treatment with vitamin K antagonists (VKAs) do not perform that well. BLEEDS was initiated to search for new biomarkers that predict bleeding in these patients. To describe the outline and objectives of BLEEDS and to examine whether the study population is generalizable to other VKA treated populations. A cohort was created consisting of all patients starting VKA treatment at three Dutch anticoagulation clinics between January-2012 and July-2014. We stored leftover plasma and DNA following analysis of the INR. Of 16,706 eligible patients, 16,570 (99%) were included in BLEEDS and plasma was stored from 13,779 patients (83%). Patients had a mean age of 70 years (SD 14), 8713 were male (53%). The most common VKA indications were atrial fibrillation (10,876 patients, 66%) and venous thrombosis (3920 patients, 24%). 326 Major bleeds occurred during 17,613 years of follow-up (incidence rate 1.85/100 person years, 95%CI 1.66-2.06). The risk for major bleeding was highest in the initial three months of VKA treatment and increased when the international normalized ratio increased. These results and characteristics are in concordance with results from other VKA treated populations. BLEEDS is generalizable to other VKA treated populations and will permit innovative and unbiased research of biomarkers that may predict major bleeding during VKA treatment.
Acquired Inhibitors: A Special Case of Bleeding in Older Adults

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Richard G. Stefanacci

2012-01-01

Full Text Available This literature review is intended to familiarize physicians and healthcare providers of older adults with the potential causes of acute bleeding in older adults and to review diagnostic approaches that can produce prompt identification of acute bleeding and facilitate timely treatment. Adverse events from anticoagulant treatment and nonsteroidal anti-inflammatory drug (NSAID and aspirin use and abuse are among the most common causes of bleeding in older adults. Diagnoses infrequently considered—mild congenital hemophilia, acquired hemophilia, von Willebrand disease, and platelet dysfunction—can contribute to acute bleeding in older adults. The approach to management of bleeding varies. Management of acute bleeding in older adults can be challenging because these patients often have chronic comorbidity and have been prescribed long-term concomitant medications that can complicate diagnosis and treatment. Prompt recognition of acquired hemophilia, referral to an expert hematologist, and timely initiation of treatment could improve outcome in older patients who experience bleeding episodes resulting from this condition.
Endometrial biopsy findings in postmenopausal bleeding

International Nuclear Information System (INIS)

Sarfraz, T.; Tariq, H.

2007-01-01

To study endometrial histopathology in women presenting with postmenopausal bleeding. A two-year study from January 2003 to December 2004 of 100 cases of postmenopausal bleeding was conducted at Combined Military Hospital, Sialkot. The histopathology of endometrial biopsy specimens was done to find out the causes of postmenopausal bleeding in these ladies. All these 100 patients had confirmed menopause and the average age was 55 years and above. The most common histopathological diagnosis was senile endometrial atrophy (27%), followed by simple cystic hyperplasia in (17%). Three cases of simple cystic hyperplasia had coexistent ovarian tumors. Glandular hyperplasia without atypia was seen in 6% and with atypia in 4%. Other causes were endometritis (13%), endometrial polyps (8%), proliferative phase endometrium (6%) and secretary phase endometrium (5%). Endometrial carcinoma was seen in (6%) cases, (8%) biopsy specimens were non-representative. Although senile endometrial atrophy was most commonly found in these ladies but a significant percentage of endometrial hyperplasia and endometrial cancer implies the need for investigating all cases of postmenopausal bleeding. Bimanual examination and pelvic ultrasonography should be combined with endometrial sampling so that rare pelvic pathologies may not be missed. (author)
Structural and aerodynamic considerations of an active piezoelectric trailing-edge tab on a helicopter rotor

Science.gov (United States)

Murray, Gabriel Jon

This dissertation is concerned with an active tab for use on a rotorcraft for noise and vibration reduction. The tab is located at the trailing edge of the airfoil. The tab consists of a shim sandwiched by layers of the piezoelectric actuators, macro fiber composites, of varying length. This configuration is similar to a bimorph. The modus operandi is similar to that of a trailing edge flap. The actuators deform the tab, bending it to achieve a tip displacement. This provides a change in the lift, moment, and drag coefficients of the airfoil. By actuating the system at 3/rev to 5/rev, reductions in noise and vibration can be realized. The system was examined and designed around using the UH-60 Blackhawk as the model rotorcraft. The tab is envisioned to operate between 65% to 85% of the main rotor span. The tab's chordwise dimensions considered were 20% and 15% of the blade chord. In order to assess the potential of the tab to change the lift and moment coefficients of the airfoil-tab system, a steady computational fluid dynamics study was conducted. The results were generated via the University of Maryland's Transonic Unsteady Navier-Stokes code. Various tab deflection angles, Mach numbers, and angle-of-attack values were computed. These results were compared to a trailing edge flap of similar size. The comparison shows that the tab produces lift and moment increments similar to that of the trailing edge flap. The design of the tab---composed of both active piezoelectric actuators and passive materials---was conducted using finite element analysis. The objectives were to maximize the tip deflection due to the actuators, while minimizing the deformation due to inertial and aerodynamic forces and loads. The inertial loads (acceleration terms) come from both blade motion, such as flapping and pitch, as well as the rotation of the rotor (centrifugal force). All of these previously mentioned terms cause the tab to undergo undesirable deflections. The original concept
Radiotherapy Can Cause Haemostasis in Bleeding Skin Malignancies

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Helena Sung-In Jang

2012-01-01

Full Text Available Radiotherapy (RT can cause haemostasis in select cases of malignant bleeding. We present two cases where RT was used to prevent fatal exsanguination from bleeding skin malignancies. Treatment was with radical intent in one case and palliative intent in the other. The dose used in both cases was 20 Gray (Gy in 5 fractions. To our knowledge, this is the first report of radiation-induced haemostasis in bleeding skin malignancies.
Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention

Science.gov (United States)

Pham, Phuong-Anh; Pham, Phuong-Thu; Pham, Phuong-Chi; Miller, Jeffrey M; Pham, Phuong-Mai; Pham, Son V

2011-01-01

The advent of potent antiplatelet and antithrombotic agents over the past decade has resulted in significant improvement in reducing ischemic events in acute coronary syndrome (ACS). However, the use of antiplatelet and antithrombotic combination therapy, often in the settings of percutaneous coronary intervention (PCI), has led to an increase in the risk of bleeding. In patients with non-ST elevation myocardial infarction treated with antithrombotic agents, bleeding has been reported to occur in 0.4%–10% of patients, whereas in patients undergoing PCI, periprocedural bleeding occurs in 2.2%–14% of cases. Until recently, bleeding was considered an intrinsic risk of antithrombotic therapy, and efforts to reduce bleeding have received little attention. There have been increasing data demonstrating that bleeding is associated with adverse outcomes, including myocardial infarction, stroke, and death. Therefore, it is imperative to optimize patient outcomes by adopting pharmacological and nonpharmacological strategies to minimize bleeding while maximizing treatment efficacy. In this paper, we present a review of the bleeding classifications used in large-scale clinical trials in patients with ACS and those undergoing PCI treated with antiplatelets and antithrombotic agents, adverse outcomes, particularly mortality associated with bleeding complications, and suggested predictive risk factors. Potential mechanisms of the association between bleeding and mortality and strategies to reduce bleeding complications are also discussed. PMID:21915172
Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

Science.gov (United States)

Fujishiro, Mitsuhiro; Iguchi, Mikitaka; Kakushima, Naomi; Kato, Motohiko; Sakata, Yasuhisa; Hoteya, Shu; Kataoka, Mikinori; Shimaoka, Shunji; Yahagi, Naohisa; Fujimoto, Kazuma

2016-05-01

Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. © 2016 Japan Gastroenterological Endoscopy Society.
Prothrombin complex concentrate for reversal of vitamin K antagonist treatment in bleeding and non-bleeding patients

DEFF Research Database (Denmark)

Johansen, Mathias; Wikkelsø, Anne; Lunde, Jens

2015-01-01

BACKGROUND: Treatment with vitamin K antagonists is associated with increased morbidity and mortality. Reversal therapy with prothrombin complex concentrate (PCC) is used increasingly and is recommended in the treatment of patients with bleeding complications undertaking surgical interventions......, as well as patients at high risk of bleeding. Evidence is lacking regarding indication, dosing, efficacy and safety. OBJECTIVES: We assessed the benefits and harms of PCC compared with fresh frozen plasma in the acute medical and surgical setting involving vitamin K antagonist-treated bleeding and non...... finding a beneficial effect of PCC in reducing the volume of fresh frozen plasma (FFP) transfused to reverse the effect of vitamin K antagonist treatment. The number of new occurrences of transfusion of red blood cells (RBCs) did not seem to be associated with the use of PCC (RR 1.08, 95% CI 0.82 to 1...
Upper gastrointestinal bleeding caused by severe esophagitis: a unique clinical syndrome.

Science.gov (United States)

Guntipalli, Prathima; Chason, Rebecca; Elliott, Alan; Rockey, Don C

2014-12-01

We have recognized a unique clinical syndrome in patients with upper gastrointestinal bleeding who are found to have severe esophagitis. We aimed to more clearly describe the clinical entity of upper gastrointestinal bleeding in patients with severe esophagitis. We conducted a retrospective matched case-control study designed to investigate clinical features in patients with carefully defined upper gastrointestinal bleeding and severe esophagitis. Patient data were captured prospectively via a Gastrointestinal Bleeding Healthcare Registry, which collects data on all patients admitted with gastrointestinal bleeding. Patients with endoscopically documented esophagitis (cases) were matched with randomly selected controls that had upper gastrointestinal bleeding caused by other lesions. Epidemiologic features in patients with esophagitis were similar to those with other causes of upper gastrointestinal bleeding. However, hematemesis was more common in patients with esophagitis 86% (102/119) than in controls 55% (196/357) (p bleeding than those without cirrhosis. We have described a unique clinical syndrome in patients with upper gastrointestinal bleeding who have erosive esophagitis. This syndrome is manifest by typical clinical features and is associated with favorable outcomes.
Long-term bleeding risk prediction in 'real world' patients with atrial fibrillation: Comparison of the HAS-BLED and ABC-Bleeding risk scores. The Murcia Atrial Fibrillation Project.

Science.gov (United States)

Esteve-Pastor, María Asunción; Rivera-Caravaca, José Miguel; Roldan, Vanessa; Vicente, Vicente; Valdés, Mariano; Marín, Francisco; Lip, Gregory Y H

2017-10-05

Risk scores in patients with atrial fibrillation (AF) based on clinical factors alone generally have only modest predictive value for predicting high risk patients that sustain events. Biomarkers might be an attractive prognostic tool to improve bleeding risk prediction. The new ABC-Bleeding score performed better than HAS-BLED score in a clinical trial cohort but has not been externally validated. The aim of this study was to analyze the predictive performance of the ABC-Bleeding score compared to HAS-BLED score in an independent "real-world" anticoagulated AF patients with long-term follow-up. We enrolled 1,120 patients stable on vitamin K antagonist treatment. The HAS-BLED and ABC-Bleeding scores were quantified. Predictive values were compared by c-indexes, IDI, NRI, as well as decision curve analysis (DCA). Median HAS-BLED score was 2 (IQR 2-3) and median ABC-Bleeding was 16.5 (IQR 14.3-18.6). After 6.5 years of follow-up, 207 (2.84 %/year) patients had major bleeding events, of which 65 (0.89 %/year) had intracranial haemorrhage (ICH) and 85 (1.17 %/year) had gastrointestinal bleeding events (GIB). The c-index of HAS-BLED was significantly higher than ABC-Bleeding for major bleeding (0.583 vs 0.518; p=0.025), GIB (0.596 vs 0.519; p=0.017) and for the composite of ICH-GIB (0.593 vs 0.527; p=0.030). NRI showed a significant negative reclassification for major bleeding and for the composite of ICH-GIB with the ABC-Bleeding score compared to HAS-BLED. Using DCAs, the use of HAS-BLED score gave an approximate net benefit of 4 % over the ABC-Bleeding score. In conclusion, in the first "real-world" validation of the ABC-Bleeding score, HAS-BLED performed significantly better than the ABC-Bleeding score in predicting major bleeding, GIB and the composite of GIB and ICH.
RESEARCH Endoscopic injection sclerotherapy for bleeding varices ...

African Journals Online (AJOL)

Portal hypertension due to intrahepatic disease or extrahepatic portal vein obstruction (EHPVO) is an important cause of upper gastro- intestinal bleeding in children. About 50% of children with EHPVO present with bleeding from oesophageal varices.1-3 Improvements in the management of children with intrahepatic ...
Breast cancer recurrence after reoperation for surgical bleeding

DEFF Research Database (Denmark)

Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

2017-01-01

BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from.......i. 0·89 to 1·26). The estimates did not vary by site of breast cancer recurrence. CONCLUSION: In this large cohort study, there was no evidence of an association between reoperation for bleeding and breast cancer recurrence....
Tamoxifen treatment of bleeding irregularities associated with Norplant use.

Science.gov (United States)

Abdel-Aleem, Hany; Shaaban, Omar M; Amin, Ahmed F; Abdel-Aleem, Aly M

2005-12-01

To evaluate the possible role of tamoxifen (selective estrogen receptor modulators, SERM) in treating bleeding irregularities associated with Norplant contraceptive use. Randomized clinical trial including 100 Norplant users complaining of vaginal bleeding irregularities. The trial was conducted in the Family Planning Clinic of Assiut University Hospital. Women were assigned at random to receive tamoxifen tablets (10 mg) twice daily for 10 days or similar placebo. Women were followed-up for 3 months. The end points were percentage of women who stopped bleeding during treatment, bleeding/spotting days during the period of follow-up, effect of treatment on their lifestyle, and side effects and discontinuation of contraception. There was good compliance with treatment. At the end of treatment, a significantly higher percentage of tamoxifen users stopped bleeding in comparison to the control group (88% vs. 68%, respectively; p=.016). Women who used tamoxifen had significantly less bleeding and/or spotting days than women who used placebo, during the first and second months. During the third month, there were no significant differences between the two groups. Women who used tamoxifen reported improvement in performing household activities, religious duties and in sexual life, during the first 2 months. In the third month, there were no differences between the two groups. There were no significant differences between tamoxifen and placebo groups in reporting side effects. In the group who used tamoxifen, two women discontinued Norplant use because of bleeding vs. nine women in the placebo group. Tamoxifen use at a dose of 10 mg twice daily orally, for 10 days, has a beneficial effect on vaginal bleeding associated with Norplant use. In addition, the bleeding pattern was better in women who used tamoxifen for the following 2 months after treatment. However, these results have to be confirmed in a larger trial before advocating this line of treatment.
21 CFR 864.6100 - Bleeding time device.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bleeding time device. 864.6100 Section 864.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Manual Hematology Devices § 864.6100 Bleeding time device...
Upper gastrointestinal bleeding: Five-year experience from one centre

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Jovanović Ivan

2008-01-01

Full Text Available Introduction Acute upper gastrointestinal bleeding is the commonest emergency managed by gastroenterologists. Objective To assess the frequency of erosive gastropathy and duodenal ulcer as a cause of upper gastrointestinal (GI bleeding as well as its relation to age, gender and known risk factors. METHOD We conducted retrospective observational analysis of emergency endoscopy reports from the records of the Emergency Department of Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, during the period from 2000 to 2005. Data consisted of patients' demographics, endoscopic findings and potential risk factors. Results During the period 2000-2005, three thousand nine hundred and fifty four emergency upper endoscopies were performed for acute bleeding. In one quarter of cases, acute gastric erosions were the actual cause of bleeding. One half of them were associated with excessive consumption of salicylates and NSAIDs. In most of the examined cases, bleeding stopped spontaneously, while 7.6% of the cases required endoscopic intervention. Duodenal ulcer was detected as a source of bleeding in 1320 (33.4% patients and was significantly associated with a male gender (71.8% and salicylate or NSAID abuse (59.1% (χ2-test; p=0.007. Conclusion Erosive gastropathy and duodenal ulcer represent a significant cause of upper gastrointestinal bleeding accounting for up to 60% of all cases that required emergency endoscopy during the 5- year period. Consumption of NSAIDs and salicylates was associated more frequently with bleeding from a duodenal ulcer than with erosive gastropathy leading to a conclusion that we must explore other causes of erosive gastropathy more thoroughly. .
Dosimetric Analysis of Radiation-induced Gastric Bleeding

Energy Technology Data Exchange (ETDEWEB)

Feng, Mary, E-mail: maryfeng@umich.edu [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Normolle, Daniel [Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Pan, Charlie C. [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Dawson, Laura A. [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Amarnath, Sudha [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Ensminger, William D. [Department of Internal Medicine, Division of Hematology Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Lawrence, Theodore S.; Ten Haken, Randall K. [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)

2012-09-01

Purpose: Radiation-induced gastric bleeding has been poorly understood. In this study, we described dosimetric predictors for gastric bleeding after fractionated radiation therapy. Methods and Materials: The records of 139 sequential patients treated with 3-dimensional conformal radiation therapy (3D-CRT) for intrahepatic malignancies were reviewed. Median follow-up was 7.4 months. The parameters of a Lyman normal tissue complication probability (NTCP) model for the occurrence of {>=}grade 3 gastric bleed, adjusted for cirrhosis, were fitted to the data. The principle of maximum likelihood was used to estimate parameters for NTCP models. Results: Sixteen of 116 evaluable patients (14%) developed gastric bleeds at a median time of 4.0 months (mean, 6.5 months; range, 2.1-28.3 months) following completion of RT. The median and mean maximum doses to the stomach were 61 and 63 Gy (range, 46-86 Gy), respectively, after biocorrection of each part of the 3D dose distributions to equivalent 2-Gy daily fractions. The Lyman NTCP model with parameters adjusted for cirrhosis predicted gastric bleed. Best-fit Lyman NTCP model parameters were n=0.10 and m=0.21 and with TD{sub 50} (normal) = 56 Gy and TD{sub 50} (cirrhosis) = 22 Gy. The low n value is consistent with the importance of maximum dose; a lower TD{sub 50} value for the cirrhosis patients points out their greater sensitivity. Conclusions: This study demonstrates that the Lyman NTCP model has utility for predicting gastric bleeding and that the presence of cirrhosis greatly increases this risk. These findings should facilitate the design of future clinical trials involving high-dose upper abdominal radiation.
Dosimetric Analysis of Radiation-induced Gastric Bleeding

International Nuclear Information System (INIS)

Feng, Mary; Normolle, Daniel; Pan, Charlie C.; Dawson, Laura A.; Amarnath, Sudha; Ensminger, William D.; Lawrence, Theodore S.; Ten Haken, Randall K.

2012-01-01

Purpose: Radiation-induced gastric bleeding has been poorly understood. In this study, we described dosimetric predictors for gastric bleeding after fractionated radiation therapy. Methods and Materials: The records of 139 sequential patients treated with 3-dimensional conformal radiation therapy (3D-CRT) for intrahepatic malignancies were reviewed. Median follow-up was 7.4 months. The parameters of a Lyman normal tissue complication probability (NTCP) model for the occurrence of ≥grade 3 gastric bleed, adjusted for cirrhosis, were fitted to the data. The principle of maximum likelihood was used to estimate parameters for NTCP models. Results: Sixteen of 116 evaluable patients (14%) developed gastric bleeds at a median time of 4.0 months (mean, 6.5 months; range, 2.1-28.3 months) following completion of RT. The median and mean maximum doses to the stomach were 61 and 63 Gy (range, 46-86 Gy), respectively, after biocorrection of each part of the 3D dose distributions to equivalent 2-Gy daily fractions. The Lyman NTCP model with parameters adjusted for cirrhosis predicted gastric bleed. Best-fit Lyman NTCP model parameters were n=0.10 and m=0.21 and with TD 50 (normal) = 56 Gy and TD 50 (cirrhosis) = 22 Gy. The low n value is consistent with the importance of maximum dose; a lower TD 50 value for the cirrhosis patients points out their greater sensitivity. Conclusions: This study demonstrates that the Lyman NTCP model has utility for predicting gastric bleeding and that the presence of cirrhosis greatly increases this risk. These findings should facilitate the design of future clinical trials involving high-dose upper abdominal radiation.

Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

International Nuclear Information System (INIS)

Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo

2012-01-01

Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.
Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

Energy Technology Data Exchange (ETDEWEB)

Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

2012-03-15

Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.
Obscure bleeding colonic duplication responds to proton pump inhibitor therapy.

Science.gov (United States)

Jacques, Jérémie; Projetti, Fabrice; Legros, Romain; Valgueblasse, Virginie; Sarabi, Matthieu; Carrier, Paul; Fredon, Fabien; Bouvier, Stéphane; Loustaud-Ratti, Véronique; Sautereau, Denis

2013-09-21

We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy. This showed long tubular duplication of the right colon, with fresh blood in the duplicated colon. Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening. The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy. Obscure gastrointestinal bleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel's diverticulum or gastrointestinal duplication, and gastroenterologists should be aware of this potential medical situation.
Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery.

Science.gov (United States)

Coppola, Antonio; Windyga, Jerzy; Tufano, Antonella; Yeung, Cindy; Di Minno, Matteo Nicola Dario

2015-02-09

In people with haemophilia or other congenital bleeding disorders undergoing surgical interventions, haemostatic treatment is needed in order to correct the underlying coagulation abnormalities and minimise the bleeding risk. This treatment varies according to the specific haemostatic defect, its severity and the type of surgical procedure. The aim of treatment is to ensure adequate haemostatic coverage for as long as the bleeding risk persists and until wound healing is complete. To assess the effectiveness and safety of different haemostatic regimens (type, dose and duration, modality of administration and target haemostatic levels) administered in people with haemophilia or other congenital bleeding disorders for preventing bleeding complications during and after surgical procedures. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of the last search: 20 November 2014. Randomised and quasi-randomised controlled trials comparing any hemostatic treatment regimen to no treatment or to another active regimen in children and adults with haemophilia or other congenital bleeding disorders undergoing any surgical intervention. Two authors independently assessed trials (eligibility and risks of bias) and extracted data. Meta-analyses were performed on available and relevant data. Of the 16 identified trials, four (112 participants) were eligible for inclusion.Two trials evaluated 59 people with haemophilia A and B undergoing 63 dental extractions. Trials compared the use of a different type (tranexamic acid or epsilon-aminocaproic acid) and regimen of antifibrinolytic agents as haemostatic support to the initial replacement treatment. Neither trial specifically addressed mortality (one of this review's primary outcomes); however, in the frame
CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

International Nuclear Information System (INIS)

Jain, T.P.; Gulati, M.S.; Makharia, G.K.; Bandhu, S.; Garg, P.K.

2007-01-01

Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding
CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

Energy Technology Data Exchange (ETDEWEB)

Jain, T.P. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Gulati, M.S. [Department of Imaging, Queen Elizabeth Hospital NHS Trust, London (United Kingdom); Makharia, G.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)]. E-mail: govindmakharia@aiims.ac.in; Bandhu, S. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Garg, P.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)

2007-07-15

Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding.
First trimester bleeding and maternal cardiovascular morbidity

DEFF Research Database (Denmark)

Lykke, Jacob A; Langhoff-Roos, Jens

2012-01-01

First trimester bleeding without miscarriage is a risk factor for complications later in the pregnancy, such as preterm delivery. Also, first trimester miscarriage has been linked to subsequent maternal ischemic heart disease. We investigated the link between maternal cardiovascular disease prior...... to and subsequent to first trimester bleeding without miscarriage....
Especificaciones del servicio de cesación tabáquica

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Mendoza A

2016-03-01

Full Text Available En abril de 2013, la Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC presentó su propuesta sobre servicios profesionales farmacéuticos (SPF cuyo fin es cubrir las necesidades relacionadas tanto con la atención de los pacientes que utilizan medicamentos, como con la salud pública. Esta propuesta ofrece un planteamiento sobre la implantación y desarrollo de los SPF con el objetivo de impulsar su prestación por las farmacias comunitarias en los próximos años. De acuerdo con dicha propuesta todos los SPF que constituyen el catálogo de servicios contarán con un documento de especificaciones. El objeto de este documento de especificaciones, aprobado por la Junta Directiva de SEFAC el 20 de abril de 2014, es definir y caracterizar el servicio de cesación tabáquica con una doble finalidad: • Ayudar al farmacéutico comunitario y a sus representantes en el ofrecimiento, prestación, difusión, financiación y concertación de este servicio. • Servir de guía a los farmacéuticos comunitarios que desean implantar un servicio de cesación tabáquica en la farmacia o elaborar un procedimiento normalizado de trabajo para su realización. Este documento se complementa con el programa CESAR de formación en cesación tabáquica, y el Documento de intervención en Cesación tabáquica en farmacia comunitaria elaborado y avalado por SEFAC y validado por SEFAC, la Sociedad Española de Neumología y Patología Torácica (SEPAR, la Sociedad Española de Especialistas en Tabaquismo (SEDET y las sociedades médicas de atención primaria (semFYC, SEMG y SEMERGEN.
Risk of Gastrointestinal Bleeding with Rivaroxaban: A Comparative Study with Warfarin

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Muhammed Sherid

2016-01-01

Full Text Available Introduction. The risk of gastrointestinal (GI bleeding with rivaroxaban has not been studied extensively. The aim of our study was to assess this risk in comparison to warfarin. Methods. We examined the medical records for patients who were started on rivaroxaban or warfarin from April 2011 to April 2013. Results. We identified 300 patients (147 on rivaroxaban versus 153 on warfarin. GI bleeding occurred in 4.8% patients with rivaroxaban when compared to 9.8% patients in warfarin group (p=0.094. GI bleeding occurred in 8% with therapeutic doses of rivaroxaban (>10 mg/d compared to 9.8% with warfarin (p=0.65. Multivariate analysis showed that patients who were on rivaroxaban for ≤40 days had a higher incidence of GI bleeding than those who were on it for >40 days (OR = 2.8, p=0.023. Concomitant use of dual antiplatelet agents was associated with increased risk of GI bleeding in the rivaroxaban group (OR = 7.4, p=0.0378. Prior GI bleeding was also a risk factor for GI bleeding in rivaroxaban group (OR = 15.5. Conclusion. The incidence of GI bleeding was similar between rivaroxaban and warfarin. The risk factors for GI bleeding with rivaroxaban were the first 40 days of taking the drug, concomitant dual antiplatelet agents, and prior GI bleeding.
The medical management of abnormal uterine bleeding in reproductive-aged women.

Science.gov (United States)

Bradley, Linda D; Gueye, Ndeye-Aicha

2016-01-01

In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the first-line approach. Determining the acuity of the bleeding, the patient's medical history, assessing risk factors, and establishing a diagnosis will individualize their medical regimen. In acute abnormal uterine bleeding with a normal uterus, parenteral estrogen, a multidose combined oral contraceptive regimen, a multidose progestin-only regimen, and tranexamic acid are all viable options, given the appropriate clinical scenario. Heavy menstrual bleeding can be treated with a levonorgestrel-releasing intrauterine system, combined oral contraceptives, continuous oral progestins, and tranexamic acid with high efficacy. Nonsteroidal antiinflammatory drugs may be utilized with hormonal methods and tranexamic acid to decrease menstrual bleeding. Gonadotropin-releasing hormone agonists are indicated in patients with leiomyoma and abnormal uterine bleeding in preparation for surgical interventions. In women with inherited bleeding disorders all hormonal methods as well as tranexamic acid can be used to treat abnormal uterine bleeding. Women on anticoagulation therapy should consider using progestin-only methods as well as a gonadotropin-releasing hormone agonist to treat their heavy menstrual bleeding. Given these myriad options for medical treatment of abnormal uterine bleeding, many patients may avoid surgical intervention. Copyright © 2016 Elsevier Inc. All rights reserved.
Systematic review: tranexamic acid for upper gastrointestinal bleeding

DEFF Research Database (Denmark)

Klingenberg, S.L.; Langholz, S.E.; Gluud, Lise Lotte

2008-01-01

BACKGROUND: Tranexamic acid may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments. AIM: To review randomized trials on tranexamic acid for upper gastrointestinal bleeding. METHODS: Manual and electronic searches of The Cochrane Library, MEDLINE, EMBASE...... and Science Citation Index were combined. Intention-to-treat random effect meta-analyses were performed and results presented as RRs with 95% confidence intervals. RESULTS: Seven double-blind randomized trials on tranexamic acid vs. placebo were included. Of 1754 patients randomized, 21% were excluded. Only...... one trial included endoscopic treatments or proton pump inhibitors. Five per cent of patients on tranexamic acid and 8% of controls died (RR: 0.61, 95% CI: 0.42-0.89). No significant differences were found on bleeding, bleeding-related mortality, surgery or transfusion requirements. Adverse events...
Anode reactive bleed and injector shift control strategy

Science.gov (United States)

Cai, Jun [Rochester, NY; Chowdhury, Akbar [Pittsford, NY; Lerner, Seth E [Honeoye Falls, NY; Marley, William S [Rush, NY; Savage, David R [Rochester, NY; Leary, James K [Rochester, NY

2012-01-03

A system and method for correcting a large fuel cell voltage spread for a split sub-stack fuel cell system. The system includes a hydrogen source that provides hydrogen to each split sub-stack and bleed valves for bleeding the anode side of the sub-stacks. The system also includes a voltage measuring device for measuring the voltage of each cell in the split sub-stacks. The system provides two levels for correcting a large stack voltage spread problem. The first level includes sending fresh hydrogen to the weak sub-stack well before a normal reactive bleed would occur, and the second level includes sending fresh hydrogen to the weak sub-stack and opening the bleed valve of the other sub-stack when the cell voltage spread is close to stack failure.
Rectal bleeding and its management after irradiation for cervix cancer

International Nuclear Information System (INIS)

Chun, Mi Son; Kang, Seung Hee; Kil, Hoon Jong; Oh, Young Taek; Sohn, Jeong Hye; Ryu, Hee Suk; Lee, Kwang Jae; Jung, Hye Young

2002-01-01

Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. The study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. A total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The point A dose from the HDR brachytherapy was 28 Gy to 30 Gy (4 Gy x 7, or 5 Gy x 6). The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months (12 ∼ 86 months). The incidence of rectal bleeding was 12.7% (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was 8.5%. Most complications (92.6%) developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding: an icruCRBED greater than 100 Gy (19.7% vs. 4.2%), an EBRT dose to the parametrium over 55 Gy (22.1% vs. 5.1%) and higher stages of III and IV (31.8% vs. 10.5%). In the multivariate analysis, the icruCRBED was the only significant factor (ρ > 0.0432). The total
Medical treatment for heavy menstrual bleeding

Directory of Open Access Journals (Sweden)

Yi-Jen Chen

2015-10-01

Full Text Available Heavy menstrual bleeding, or menorrhagia, is subjectively defined as a “complaint of a large amount of bleeding during menstrual cycles that occurs over several consecutive cycles” and is objectively defined as menstrual blood loss of more than 80 mL per cycle that is associated with an anemia status (defined as a hemoglobin level of <10 g/dL. During their reproductive age, more than 30% of women will complain of or experience a heavy amount of bleeding, which leads to a debilitating health outcome, including significantly reduced health-related quality of life, and a considerable economic burden on the health care system. Although surgical treatment might be the most important definite treatment, especially hysterectomy for those women who have finished bearing children, the uterus is still regarded as the regulator and controller of important physiological functions, a sexual organ, a source of energy and vitality, and a maintainer of youth and attractiveness. This has resulted in a modern trend in which women may reconsider the possibility of organ preservation. For women who wish to retain the uterus, medical treatment may be one of the best alternatives. In this review, recent trends in the management of women with heavy menstrual bleeding are discussed.
No increased systemic fibrinolysis in women with heavy menstrual bleeding

NARCIS (Netherlands)

Wiewel-Verschueren, S.; Knol, H. M.; Lisman, T.; Bogchelman, D. H.; Kluin-Nelemans, J. C.; van der Zee, A.G.J.; Mulder, A.B.; Meijer, K.

BackgroundBleeding disorders have been recognized as important etiologic or contributory factors in women with heavy menstrual bleeding. Fibrinolysis in the endometrium plays a role in heavy menstrual bleeding. It is unknown whether increased systemic fibrinolysis might also increase the risk of
[High risk factors of upper gastrointestinal bleeding after neurosurgical procedures].

Science.gov (United States)

Zheng, Kang; Wu, Gang; Cheng, Neng-neng; Yao, Cheng-jun; Zhou, Liang-fu

2005-12-21

To analyze high risk factors of postoperative upper gastrointestinal (GI) bleeding after neurosurgery so as to give guidance for prevention of GI bleeding. A questionnaire was developed to investigate the medical records of 1500 patients who were hospitalized and underwent neurosurgical operations in 1997. Logistic regression analysis was made. 1430 valid questionnaires were obtained. Postoperative upper GI bleeding occurred in 75 patients (5.24%). The incidence of upper GI bleeding were 6.64% (54/813) in the male patients and 3.40% (21/617) in the female persons (P = 0.007); 9.88% (41/415) in those aged > 50 and 3.35% in those aged hematoma, intraventricular hemorrhage, subdural hematoma, and extradural hematoma were 15.7%, 10.0%, 6.00%, and 2.94% respectively (P = 0.02). The incidence of upper GI bleeding of the patients with tumors of fourth ventricle of cerebrum, brainstem, cerebral hemisphere, and sellar hypothalamus were 15.79% (3/19), 7.89%, 5.71%, and 3.74% respectively. In the emergent cases, the incidence of upper GI bleeding was higher in those with hypertension. The incidence of upper GI bleeding was 5.46% in the patients undergoing adrenocortical hormone treatment, significantly higher than that in those who did not receive such treatment (2.13%). Patients who are at high risk of developing postoperative upper GI bleeding including that: age greater than 50 years; male; Glasgow Coma Score less than 10 pre and post operation; The lesion was located in brain stem and forth ventricle; Hypertensive cerebral hemorrhage; Intracerebral and intraventricular hemorrhagic brain trauma; Postoperative pneumonia, brain edema, encephalic high pressure, pyogenic infection of the central nervous system and other postoperative complications. The mortality of patients with postoperative upper GI bleeding was evidently higher than that of the patients without postoperative upper GI bleeding.
Agonist-induced platelet reactivity correlates with bleeding in haemato-oncological patients.

Science.gov (United States)

Batman, B; van Bladel, E R; van Hamersveld, M; Pasker-de Jong, P C M; Korporaal, S J A; Urbanus, R T; Roest, M; Boven, L A; Fijnheer, R

2017-11-01

Prophylactic platelet transfusions are administered to prevent bleeding in haemato-oncological patients. However, bleeding still occurs, despite these transfusions. This practice is costly and not without risk. Better predictors of bleeding are needed, and flow cytometric evaluation of platelet function might aid the clinician in identifying patients at risk of bleeding. This evaluation can be performed within the hour and is not hampered by low platelet count. Our objective was to assess a possible correlation between bleeding and platelet function in thrombocytopenic haemato-oncological patients. Inclusion was possible for admitted haemato-oncology patients aged 18 years and above. Furthermore, an expected need for platelet transfusions was necessary. Bleeding was graded according to the WHO bleeding scale. Platelet reactivity to stimulation by either adenosine diphosphate (ADP), cross-linked collagen-related peptide (CRP-xL), PAR1- or PAR4-activating peptide (AP) was measured using flow cytometry. A total of 114 evaluations were available from 21 consecutive patients. Platelet reactivity in response to stimulation by all four studied agonists was inversely correlated with significant bleeding. Odds ratios (OR) for bleeding were 0·28 for every unit increase in median fluorescence intensity (MFI) [95% confidence interval (CI) 0·11-0·73] for ADP; 0·59 [0·40-0·87] for CRP-xL; 0·59 [0·37-0·94] for PAR1-AP; and 0·43 [0·23-0·79] for PAR4-AP. The platelet count was not correlated with bleeding (OR 0·99 [0·96-1·02]). Agonist-induced platelet reactivity was significantly correlated to bleeding. Platelet function testing could provide a basis for a personalized transfusion regimen, in which platelet transfusions are limited to those at risk of bleeding. © 2017 International Society of Blood Transfusion.
Helping mothers survive bleeding after birth

DEFF Research Database (Denmark)

Nelissen, Ellen; Ersdal, Hege; Ostergaard, Doris

2014-01-01

OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants, and ambul......OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants...
Breast cancer recurrence after reoperation for surgical bleeding

DEFF Research Database (Denmark)

Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

2017-01-01

BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from...
Importance of histopathological examination of endometrium in Dysfunctional Uterine Bleeding.

Directory of Open Access Journals (Sweden)

Dr. Yaminee Rana

2017-12-01

Full Text Available Introduction: Abnormal uterine bleeding is a common condition affecting women of reproductive age that has significant social and economic impact. Dysfunctional uterine bleeding (DUB is defined as abnormal uterine bleeding in the absence of organic disease. Dysfunctional uterine bleeding is one of the most commonly encountered gynaecological problems. Objectives: This study is done to evaluate the histopathological pattern of the endometrial biopsies of patients with dysfunctional uterine bleeding and its correlation with clinical data. Methods: The present prospective study included evaluation of 208 cases of dysfunctional uterine bleeding in the Department of Pathology, B. J. Medical College, Ahmedabad over a period of 10 months, from January 2017 to October 2017. Women presenting with abnormal uterine bleeding were included in the study. Those women in which bleeding is secondary to systemic causes, organic causes and due to cervical and vaginal causes were excluded. The specimens were processed, embedded and cut into sections of 3-4 microns. The histopathological patterns were studied. Results: Age distribution varied from 18 years to 70 years, majority of the patients were between 21 to 30 years. Among the cases of DUB, proliferative phase accounted for 66.3% and secretory phase accounted for 21.3%. 18 cases (8.6% of atrophic endometrium, four cases (1.9% of irregular shedding and two cases of luteal phase insufficiency were received. Conclusion: Dysfunctional uterine bleeding is a common and debilitating condition in women of reproductive age. Endometrial biopsy could be effectively used as the first diagnostic step in DUB and thus ensures correct management.

Spontaneous emission spectra from a staggered-array undulator

International Nuclear Information System (INIS)

Shimada, Shigeki; Okada, Kouji; Masuda, Kai; Sobajima, Masaaki; Yoshikawa, Kiyoshi; Ohnishi, Masami; Yamamoto, Yasushi; Toku, Hisayuki

1997-01-01

A staggered-array undulator set inside the superconducting solenoid coils is shown to be able to provide high undulator fields larger than the longitudinal magnetic fields, a small undulator period, easy tunability through the solenoid coil current, and compact and easy fabrication. The overall performance characteristics of this undulator were studied mainly with respect to iron and aluminum disk widths, and spontaneous emission spectra through the numerical calculations. The maximum undulator field is found to be obtained for the ratio of the aluminum disk width to the undulator period of 0.45. The line widths (FWHM) of the spontaneous emission spectra, however, do not show N w -1 dependence on the number of the undulator period N w for practical beams with a Gaussian distribution, compared with for a single electron. The energy spread among various parameters is seen to play an important role in reducing the FWHM with increase of N w . The large tunability of the wavelength is proved to cover 6-10 mm by changing the solenoid magnetic field from 0.4 T to 1.6 T. (author)
X-ray imaging bilinear staggered GaAs detectors

Energy Technology Data Exchange (ETDEWEB)

Achmadullin, R.A.; Dvoryankin, V.F. E-mail: vfd217@ire216.msk.su; Dvoryankina, G.G.; Dikaev, Y.M.Yu.M.; Krikunov, A.I.; Kudryashov, A.A.; Panova, T.M.; Petrov, A.G.; Telegin, A.A

2004-09-21

The multichannel bilinear X-ray detector based on epitaxial GaAs structures is developed to obtain a digital X-ray image. Each detector operates in photovoltaic mode without reverse bias that enables almost complete elimination of detector noise arising due to leakage currents. The sensitivity range of the epitaxial GaAs photovoltaic X-ray detector covers the effective energies from 8 to 120 keV. A maximum response of the detector operating in the short-circuit mode was observed at an energy of 35 keV and amounted to 30 {mu}A min/(Gy cm{sup 2}). The multichannel detector was made of 1024 pixels with pitch of 0.8 mm. The spatial resolution of double staggered sensor row is twice as high as the resolution of that of single sensor row with the same pitch. Measured spatial resolution is 1.2 line-pairs/mm, contrast sensitivity not worse 1% and dynamic range defined as the ratio of maximum detectable X-ray signal to electronic noise level more than 2000 are received.
X-ray imaging bilinear staggered GaAs detectors

International Nuclear Information System (INIS)

Achmadullin, R.A.; Dvoryankin, V.F.; Dvoryankina, G.G.; Dikaev, Y.M.Yu.M.; Krikunov, A.I.; Kudryashov, A.A.; Panova, T.M.; Petrov, A.G.; Telegin, A.A.

2004-01-01

The multichannel bilinear X-ray detector based on epitaxial GaAs structures is developed to obtain a digital X-ray image. Each detector operates in photovoltaic mode without reverse bias that enables almost complete elimination of detector noise arising due to leakage currents. The sensitivity range of the epitaxial GaAs photovoltaic X-ray detector covers the effective energies from 8 to 120 keV. A maximum response of the detector operating in the short-circuit mode was observed at an energy of 35 keV and amounted to 30 μA min/(Gy cm 2 ). The multichannel detector was made of 1024 pixels with pitch of 0.8 mm. The spatial resolution of double staggered sensor row is twice as high as the resolution of that of single sensor row with the same pitch. Measured spatial resolution is 1.2 line-pairs/mm, contrast sensitivity not worse 1% and dynamic range defined as the ratio of maximum detectable X-ray signal to electronic noise level more than 2000 are received
Diagnosis and management of upper gastrointestinal bleeding in children.

Science.gov (United States)

Owensby, Susan; Taylor, Kellee; Wilkins, Thad

2015-01-01

Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. © Copyright 2015 by the American Board of Family Medicine.
Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

Science.gov (United States)

Kim, Young-Il

2015-01-01

Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated. PMID:25844339
Development of Non-staggered, semi-implicit ICE numerical scheme for a two-fluid, three-field model

Energy Technology Data Exchange (ETDEWEB)

Jeong, Jae Jun; Yoon, H. Y.; Bae, S. W

2007-11-15

A pilot code for one-dimensional, transient, two-fluid, three-field model has been developed. In this code, the semi-implicit ICE numerical scheme has been adapted to a 'non-staggered' grid. Using several conceptual problems, the numerical scheme has been verified. The results of the verifications are summarized below: - It was confirmed that the basic pilot code can simulate various flow conditions (such as single-phase liquid flow, two-phase mixture flow, and single-phase vapor flow) and transitions of the flow conditions. A mist flow was not simulated, but it seems that the basic pilot code can simulate mist flow conditions. - The mass and energy conservation was confirmed for single-phase liquid and single-phase vapor flows. - It was confirmed that the inlet pressure and velocity boundary conditions work properly. - It was confirmed that, for single- and two-phase flows, the velocity and temperature of non-existing phase are calculated as intended. The non-staggered, semi-implicit ICE numerical scheme, which has been developed in this study, will be a starting point of a new code development that adopts an unstructured finite volume method.
Bleeding Peptic Ulcer - Tertiary Center Experience: Epidemiology, Treatment and Prognosis.

Science.gov (United States)

Budimir, Ivan; Stojsavljević, Sanja; Hrabar, Davor; Kralj, Dominik; Bišćanin, Alen; Kirigin, Lora Stanka; Zovak, Mario; Babić, Žarko; Bohnec, Sven; Budimir, Ivan

2017-12-01

The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute upper gastrointestinal bleeding (UGIB) with special reference to peptic ulcer bleeding (PUB). The study included 2198 consecutive patients referred to our emergency department due to acute UGIB from January 2008 to December 2012. All patients underwent urgent upper GI endoscopy within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed-up. The cumulative incidence of UGIB was 126/100,000 in the 5-year period. Two out of five patients had a bleeding peptic ulcer; in total, 440 (52.3%) had bleeding gastric ulcer, 356 (42.3%) had bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers, and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomoses. PUB was more common in men. The mean patient age was 65.9 years. The majority of patients (57%) with PUB were taking agents that attenuate the cytoprotective function of gastric and duodenal mucosa. Rebleeding occurred in 77 (9.7%) patients and 47 (5.9%) patients required surgical intervention. The 30-day morality was 5.2% and 10% of patients died from uncontrolled bleeding and concomitant diseases. In conclusion, PUB is the main cause of UGIB, characterized by a significant rebleeding rate and mortality.
Intracranial hemorrhage after blunt head trauma in children with bleeding disorders.

Science.gov (United States)

Lee, Lois K; Dayan, Peter S; Gerardi, Michael J; Borgialli, Dominic A; Badawy, Mohamed K; Callahan, James M; Lillis, Kathleen A; Stanley, Rachel M; Gorelick, Marc H; Dong, Li; Zuspan, Sally Jo; Holmes, James F; Kuppermann, Nathan

2011-06-01

To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders. We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8) , compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery. In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders. Copyright © 2011 Mosby, Inc. All rights reserved.
DSA diagnosis and interventional management of postoperative bleeding

International Nuclear Information System (INIS)

Li Yuwei; Zhang Fuqiang; Li Yunhui; Yuan Liang; Si Guangyan; Liu Lili

2009-01-01

Objective: To discuss the clinical application of DSA and interventional management in diagnosing and treating the bleeding after surgery. Methods: The clinical data and the interventional management of 14 patients with DSA-proved postoperative bleeding, encountered during the period of Aug. 2005-Jan. 2008, were retrospectively analyzed. The surgeries included subtotal gastrectomy (n=4), pancreatoduodenectomy (n=3), cesarean section (n=2), nephrolithotomy (n=3), heminephrectomy (n=1), internal hemorrhoidectomy (n=1). Results: Seventeen arterial bleeding sites were demonstrated, including gastroduodenal (n=2), left gastric (n=4), phrenic (n=1), short gastric (n=1), superior mesenteric (n=2), renal (n=4), uterine (n=2) and internal pudendal (n=1) artery. The diagnosis was confirmed with DSA in all 14 patients, of which embolization was successfully carried out in 13 in one session (92.8%). The remaining one case had to be operated again to stop the bleeding because of the failure of the superselective catheterization. No serious complications, such as organ necrosis or visceral dysfunction, occurred. Conclusion: As a safe, minimally-invasive and effective technique, DSA and interventional management are very helpful in diagnosing and treating the bleeding after surgery. (authors)
Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

International Nuclear Information System (INIS)

Ramon Banos Madrid; Fernando Alberca de las Parras; Angel Vargas Acosta and others

2006-01-01

The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosions and the varicose veins in oesophagus and stomach. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach, the habitual is to diagnose this entity of accidental form in the course of endoscopic procedures, radiological or surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first
Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

International Nuclear Information System (INIS)

Banos Madrid, Ramon; Alberca de las Parras, Fernando; Vargas Acosta, Angel and others

2006-01-01

The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosion and the varicose veins in oesophagus and stomachs. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach the habitual is to diagnose this entity of occidental form in the course of endoscopic procedures, radiological of surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first
Bottleneck congestion and distribution of work start times: The economics of staggered work hours revisited

OpenAIRE

Takayama, Yuki

2014-01-01

Since the seminal work of Henderson (1981), a number of studies examined the effect of staggered work hours by analyzing models of work start time choice that consider the trade-off between negative congestion externalities and positive production externalities. However, these studies described traffic congestion using flow congestion models. This study develops a model of work start time choice with bottleneck congestion and discloses the intrinsic properties of the model. To this end, this ...
Bleeding stomal varices in portal hypertension

Directory of Open Access Journals (Sweden)

Karen Tran-Harding, MD

2018-04-01

Full Text Available We report a case of a 50-year-old man with a history of liver cirrhosis and colon cancer post end colostomy presenting to the emergency department with stomal bleeding and passage of clots into the colostomy bag. The patient was treated with transjugular intrahepatic portosystemic shunt (TIPS and concomitant embolization of the stomal varices via the TIPS shunt using N-butyl cyanoacrylate mixed with ethiodol. Although stomal variceal bleeding is uncommon, this entity can have up to 40% mortality upon initial presentation, given the challenges in diagnosis and management. Currently, there are no established standard treatments for stomal variceal bleeding. In addition, to the best of our knowledge, there are no cases in the current literature in which treatment of this entity is performed with a combination of TIPS shunt placement and N-butyl cyanoacrylate variceal embolization. Keywords: Stomal varices, TIPS, Cirrhosis, Colon cancer, Embolization, NBCA
Appendiceal hemorrhage – An uncommon cause of lower gastrointestinal bleeding

Directory of Open Access Journals (Sweden)

Ching-Chung Chiang

2011-06-01

Full Text Available Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn’s disease, neoplasms, inflammatory bowel disease, hemorrhoids, and ischemic colitis. Lower gastrointestinal bleeding arising from the appendix is an extremely rare condition. We report a case of appendiceal hemorrhage in a young male. Diagnosis was made by multidetector computerized tomography during survey for hematochezia. The patient recovered well after appendectomy. The histological finding revealed focal erosion of appendix mucosa with bleeding.
Therapeutic options to manage bleeding in a dentist’s office

Science.gov (United States)

Rostetter, Claudio; Finkenstädt, Tim; Rücker, Martin; Lübbers, Heinz-Theo

2018-06-18

This manuscript provides an overview of therapeutic options for the problem of bleeding in a dentist’s office. Bleeding after tooth extraction is a very common finding in dental medicine and persistent blood in the mouth is obviously uncomfortable and sometimes terrifying for the patient. Most bleedings can be stopped simply with compression, in some cases a homeostatic therapy is necessary. For local compression, a swab with tranexamic acid is useful. If local compression is not sufficient, sutures are often an option. A very effective therapy would also be Tabotamp®, a local hemostypticum which is placed onto the bleeding and should increase the thrombocytic aggregation. In the worst case Floseal®, a human Thrombin, can be placed locally. It stops the bleeding very fast and sufficiently.
Non-Local Sparse Image Inpainting for Document Bleed-Through Removal

Directory of Open Access Journals (Sweden)

Muhammad Hanif

2018-05-01

Full Text Available Bleed-through is a frequent, pervasive degradation in ancient manuscripts, which is caused by ink seeped from the opposite side of the sheet. Bleed-through, appearing as an extra interfering text, hinders document readability and makes it difficult to decipher the information contents. Digital image restoration techniques have been successfully employed to remove or significantly reduce this distortion. This paper proposes a two-step restoration method for documents affected by bleed-through, exploiting information from the recto and verso images. First, the bleed-through pixels are identified, based on a non-stationary, linear model of the two texts overlapped in the recto-verso pair. In the second step, a dictionary learning-based sparse image inpainting technique, with non-local patch grouping, is used to reconstruct the bleed-through-contaminated image information. An overcomplete sparse dictionary is learned from the bleed-through-free image patches, which is then used to estimate a befitting fill-in for the identified bleed-through pixels. The non-local patch similarity is employed in the sparse reconstruction of each patch, to enforce the local similarity. Thanks to the intrinsic image sparsity and non-local patch similarity, the natural texture of the background is well reproduced in the bleed-through areas, and even a possible overestimation of the bleed through pixels is effectively corrected, so that the original appearance of the document is preserved. We evaluate the performance of the proposed method on the images of a popular database of ancient documents, and the results validate the performance of the proposed method compared to the state of the art.
Double blind, placebo-controlled trial of Tranexamic acid on recent internal hemorrhoid bleeding

Directory of Open Access Journals (Sweden)

Abdul A. Rani

2002-12-01

Full Text Available Double blind randomized placebo controlled trial was conducted to evaluate the efficacy of Tranexamic acid in 54 patients with recent hemorrhoid bleeding. Age, gender, body weight, height, grade of hemorrhoid, time of onset of recent bleeding were comparable between two groups. Analysis of haemostatic effect or stop bleeding as an immediate outcome of this study revealed that in the grade 2 patients, 23/23 (100% of tranexamic group and 18/23(78.26% of placebo group the bleeding stop. After 3 days of observation, there was statistically significant different for the rate of stop bleeding as well as at the end of observation. Bleeding stop earlier in the Tranexamic group with median 4 days (3-5 days, compare to placebo, median 11(9.55-12.45. Analysis of recurrent bleeding as an outcome of this study revealed that in the placebo group 9/18(50% of grade 2 patients and all grade 3 (100%patients suffered from recurrent bleeding. Since the days 4, both group have significant different time for recurrent bleeding and at the end of observation, cumulative probability of free of bleeding between two groups significantly different. Median still stop bleeding in the placebo group was 36 days, and the tranexamic group never reaches the median until the end of observation. Conclusion: tranexamic acid was an effective drug to stop recent hemorrhoid bleeding and prevent further recurrent bleeding, significantly better than placebo. (Med J Indones 2002;11: 215-21Keywords: Tranexamic acid, hemorrhoid bleeding, haemostatic effect, recurrent bleeding.
Excitation spectrum and staggering transformations in lattice quantum models.

Science.gov (United States)

Faria da Veiga, Paulo A; O'Carroll, Michael; Schor, Ricardo

2002-08-01

We consider the energy-momentum excitation spectrum of diverse lattice Hamiltonian operators: the generator of the Markov semigroup of Ginzburg-Landau models with Langevin stochastic dynamics, the Hamiltonian of a scalar quantum field theory, and the Hamiltonian associated with the transfer matrix of a classical ferromagnetic spin system at high temperature. The low-lying spectrum consists of a one-particle state and a two-particle band. The two-particle spectrum is determined using a lattice version of the Bethe-Salpeter equation. In addition to the two-particle band, depending on the lattice dimension and on the attractive or repulsive character of the interaction between the particles of the system, there is, respectively, a bound state below or above the two-particle band. We show how the existence or nonexistence of these bound states can be understood in terms of a nonrelativistic single-particle lattice Schrödinger Hamiltonian with a delta potential. A staggering transformation relates the spectra of the attractive and the repulsive cases.
Detection and localization of lower gastrointestinal bleeding site with scintigraphic techniques

International Nuclear Information System (INIS)

Alavi, A.

1988-01-01

Successful management of acute gastrointestinal (GI) bleeding frequently depends on accurate localization of the bleeding site. History and clinical findings are often misleading in localizing the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provides accurate diagnoses for the majority of patients with upper GI tract hemorrhage, but lower GI bleeding still is a serious diagnostic problem. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases, has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding. Since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. Repeated angiography to pursue recurrent episodes of bleeding is impractical. Because of these shortcomings, in the past decade several noninvasive scintigraphic techniques have been developed to detect and localize sites of GI bleeding. In this chapter the authors discuss details related to the technetium 99m sulfur colloid (Tc-SC) and technetium 99m-labeled red blood cell (Tc-RBC) techniques
Prediction of Outcome in Acute Lower Gastrointestinal Bleeding Using Gradient Boosting.

Directory of Open Access Journals (Sweden)

Lakshmana Ayaru

Full Text Available There are no widely used models in clinical care to predict outcome in acute lower gastro-intestinal bleeding (ALGIB. If available these could help triage patients at presentation to appropriate levels of care/intervention and improve medical resource utilisation. We aimed to apply a state-of-the-art machine learning classifier, gradient boosting (GB, to predict outcome in ALGIB using non-endoscopic measurements as predictors.Non-endoscopic variables from patients with ALGIB attending the emergency departments of two teaching hospitals were analysed retrospectively for training/internal validation (n=170 and external validation (n=130 of the GB model. The performance of the GB algorithm in predicting recurrent bleeding, clinical intervention and severe bleeding was compared to a multiple logic regression (MLR model and two published MLR-based prediction algorithms (BLEED and Strate prediction rule.The GB algorithm had the best negative predictive values for the chosen outcomes (>88%. On internal validation the accuracy of the GB algorithm for predicting recurrent bleeding, therapeutic intervention and severe bleeding were (88%, 88% and 78% respectively and superior to the BLEED classification (64%, 68% and 63%, Strate prediction rule (78%, 78%, 67% and conventional MLR (74%, 74% 62%. On external validation the accuracy was similar to conventional MLR for recurrent bleeding (88% vs. 83% and therapeutic intervention (91% vs. 87% but superior for severe bleeding (83% vs. 71%.The gradient boosting algorithm accurately predicts outcome in patients with acute lower gastrointestinal bleeding and outperforms multiple logistic regression based models. These may be useful for risk stratification of patients on presentation to the emergency department.

Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

DEFF Research Database (Denmark)

Kjeldsen, A D; Kjeldsen, J

2000-01-01

Gastrointestinal bleeding occurs in a number of patients with hereditary hemorrhagic telangiectasia (HHT) and may lead to a high transfusion need. The aim of this study was to estimate the occurrence and severity of gastrointestinal bleeding in a geographically well defined HHT population....
Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

International Nuclear Information System (INIS)

Uflacker, R.

1987-01-01

Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries in an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation. (orig.)
Gastrointestinal Bleeding Secondary to Calciphylaxis

Science.gov (United States)

Gupta, Nancy; Haq, Khwaja F.; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

2015-01-01

Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. Case Report: A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. Conclusions: Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938
Prognostic Significance of Bleeding Location and Severity Among Patients With Acute Coronary Syndromes

Science.gov (United States)

Vavalle, John P.; Clare, Robert; Chiswell, Karen; Rao, Sunil V.; Petersen, John L.; Kleiman, Neal S.; Mahaffey, Kenneth W.; Wang, Tracy Y.

2013-01-01

Objectives This study sought to determine if there is an association between bleed location and clinical outcomes in acute coronary syndromes (ACS) patients. Background The prognostic significance of bleeding location among ACS patients undergoing cardiac catheterization is not well known. Methods We analyzed in-hospital bleeding events among 9,978 patients randomized in the SYNERGY (Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors) study. Bleeding events were categorized by location as access site, systemic, surgical, or superficial, and severity was graded using the GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definition. We assessed the association of each bleeding location and severity with 6-month risk of death or myocardial infarction using a multicovariate-adjusted Cox proportional hazard model. Results A total of 4,900 bleeding events were identified among 3,694 ACS patients with in-hospital bleeding. Among 4,679 GUSTO mild/moderate bleeding events, only surgical and systemic bleeds were associated with an increased risk of 6-month death or myocardial infarction (adjusted hazard ratio [HR]: 2.52 [95% confidence interval (CI): 2.16 to 2.94, and 1.40 [95% CI: 1.16 to 1.69], respectively). Mild/moderate superficial and access-site bleeds were not associated with downstream risk (adjusted HR: 1.17 [95% CI: 0.97 to 1.40], and 0.96 [95% CI: 0.82 to 1.12], respectively). Among 221 GUSTO severe bleeds, surgical bleeds were associated with the highest risk (HR: 5.27 [95% CI: 3.80 to 7.29]), followed by systemic (HR: 4.48 [95% CI: 2.98 to 6.72]), and finally access-site bleeds (HR: 3.57 [95% CI: 2.35 to 5.40]). Conclusions Among ACS patients who develop in-hospital bleeding, systemic and surgical bleeding are associated with the highest risks of adverse outcomes regardless of bleeding severity. Although the most frequent among bleeds, GUSTO mild/moderate access-site bleeding is not
WWER-440 reactor emergency cooling using `feed and bleed` procedure; Avarijnoe raskholazhivanie reaktora WWER-440 s pomoshtyu protsedury `podpitka-produvka`

Energy Technology Data Exchange (ETDEWEB)

Marinov, M; Dimitrov, B; Popov, E; Avdzhiev, K [Energoproekt, Sofia (Bulgaria)

1996-12-31

A procedure for emergency cooling in the case of total loss of coolant water is proposed. `Feed and bleed` procedure is applied by the operator and its main goal is to maintain a predefined level in the primary circuit and low pressure and temperature in the reactor. Two extreme cases are considered: 1. the loss of coolant is combined with a blackout; 2. the loss of feeding water is due to a general failure in the control room. The accidents are simulated and the relevant time intervals are estimated. After a simulated operator action following the procedure the reactor temperature is evaluated to 147{sup o} C and the primary circuit pressure to 10 bar. 1 ref., 4 figs., 2 tabs.
Treatment and prognosis in peptic ulcer bleeding.

Science.gov (United States)

Laursen, Stig Borbjerg

2014-01-01

Peptic ulcer bleeding is a frequent cause of admission. Despite several advances in treatment the 30-day mortality seems unchanged at a level around 11%. Use of risk scoring systems is shown to be advantageous in the primary assessment of patients presenting with symptoms of peptic ulcer bleeding. Studies performed outside Denmark have demonstrated that use of risk scoring systems facilitates identification of low-risk patients suitable for outpatient management. Nevertheless, these systems have not been implemented for routine use in Denmark. This is mainly explained by concerns about the external validity due to considerable inter-country variation in patients' characteristics. In recent years, transcatheter arterial embolization (TAE) has become increasingly used for achievement of hemostasis in patients with peptic ulcer bleeding not responding to endoscopic therapy. As rebleeding is associated with poor outcome TAE could, in theory, also be beneficial as a supplementary treatment in patients with ulcer bleeding responding to endoscopic therapy. This has not been examined previously. Several studies have concluded that peptic ulcer bleeding is associated with excess long-term mortality. These findings are, however, questioned as the studies were based on life-table analysis, unmatched control groups, or did not perform adequate adjustment for comorbidity. Treatment with blood transfusion is, among patients undergoing cardiac bypass surgery, shown to increase the long-term mortality. Despite frequent use of blood transfusion in treatment of peptic ulcer bleeding a possible adverse effect of on long-term survival has not been examined in these patients. The aims of the present thesis were: 1. To examine which risk scoring system is best at predicting need of hospital-based intervention, rebleeding, and mortality in patients presenting with upper gastrointestinal bleeding (Study I) 2. To evaluate if supplementary transcatheter arterial embolization (STAE) after
Common management issues in pediatric patients with mild bleeding disorders.

Science.gov (United States)

O'Brien, Sarah H

2012-10-01

Type 1 von Willebrand disease and mild platelet function defects are among the most common disorders seen by pediatric hematologists. The management and prevention of bleeding in these patients can be challenging, as there are limited published data to guide clinical practice, and a complete lack of randomized clinical trials. Desmopressin (DDAVP) and antifibrinolytics are the mainstays of treatment in these patients, yet the optimal dosing and timing of these agents to prevent or resolve bleeding, while minimizing adverse side effects, is sometimes unclear. DDAVP-induced hyponatremia is a particularly under-recognized complication in children with bleeding disorders who undergo surgery. Clinicians need to be aware of local measures that are equally important in treating problems such as epistaxis and surgical bleeding. This review will discuss the published literature and provide practical suggestions regarding four common management issues in the care of children and adolescents with mild bleeding disorders: epistaxis, heavy menstrual bleeding, dental extractions, and tonsillectomy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Prediction of bleeding and prophylactic platelet transfusions in cancer patients with thrombocytopenia

DEFF Research Database (Denmark)

Vinholt, Pernille J; Alnor, Anne; Nybo, Mads

2016-01-01

Studies on markers for bleeding risk among thrombocytopenic cancer patients are lacking. This prospective observational cohort study investigated whether platelet parameters and a standardised bleeding questionnaire predicted bleeding or prophylactic platelet transfusions in patients with cancer ...... platelet transfusion but not bleeding. Bleeding risk factors were previous haematuria or gastrointestinal bleeding, infection, antiplatelet or anticoagulant treatment, high urea nitrogen, low haemoglobin or high creatinine....... or warfarin OR = 2.34, 95% CI 1.23–4.48; urea nitrogen OR = 1.15, 95% CI 1.07–1.25; creatinine OR = 1.01, 95% CI 1.01–1.01; and haemoglobin OR = 0.62, 95% CI 0.41–0.93. Specific information regarding previous gastrointestinal bleeding OR = 3.33, 95% CI 1.19–9.34 and haematuria OR = 3.00, 95% CI 1...
Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

Energy Technology Data Exchange (ETDEWEB)

So, Young Ho; Choi, Young Ho [Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of); Song, Soon Young [Hanyang University Hospital, Seoul (Korea, Republic of)

2012-01-15

The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. We reviewed the records of 10 patients (3%; M:F 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; {+-} 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.
Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

International Nuclear Information System (INIS)

So, Young Ho; Choi, Young Ho; Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung; Song, Soon Young

2012-01-01

The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. We reviewed the records of 10 patients (3%; M:F 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; ± 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.
Focal intestinal lymphangiectasia: An unusual cause of acute overt obscure gastrointestinal bleeding

Directory of Open Access Journals (Sweden)

Ashish Kumar Jha

2014-01-01

Full Text Available Detection of bleeding lesion in a patient of acute overt obscure gastrointestinal bleeding is a real challenge. Recently, authors have showed superiority of urgent capsule endoscopy (CE over angiography in patients with acute overt obscure gastrointestinal bleeding. Focal type of intestinal lymphangiectasia is a rare cause of acute gastrointestinal bleeding. Here, we describe a case of focal lymphangiectasia who presented to us with acute overt obscure gastrointestinal bleeding and diagnosed by urgent CE.
Risk Factors for and Management of MPN-Associated Bleeding and Thrombosis.

Science.gov (United States)

Martin, Karlyn

2017-10-01

The Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) are characterized by both thrombotic and bleeding complications. The purpose of this review is to describe the risk factors associated with bleeding and thrombosis in MPN, as well as to review prevention strategies and management of these complications. Well-described risk factors for thrombotic complications include older age and history of prior thrombosis, along with traditional cardiovascular and venous thromboembolic risk factors. More recently, JAK2 V617F mutation has been found to carry an increased risk of thrombotic complications, whereas CALR has a lower risk than JAK2 mutation. Factors associated with an increased risk of bleeding in MPN include a prior history of bleeding, acquired von Willebrand syndrome, and primary myelofibrosis. Recent findings suggest that thrombocytosis carries a higher risk of bleeding than thrombosis in MPN, and aspirin may exacerbate this risk of bleeding, particularly in CALR-mutated ET. Much of the management of MPN focuses on predicting risk of bleeding and thrombosis and initiating prophylaxis to prevent complications in those at high risk of thrombosis. Emerging evidence suggests that sub-populations may have bleeding risk that outweighs thrombotic risk, particularly in setting of antiplatelet therapy. Future work is needed to better characterize this balance. At present, a thorough assessment of the risks of bleeding and thrombosis should be undertaken for each patient, and herein, we review risk factors for and management of these complications.
The bleeding time may be longer in children than in adults.

Science.gov (United States)

Sanders, J M; Holtkamp, C A; Buchanan, G R

1990-01-01

The bleeding time, the most frequently performed test reflecting in vivo platelet function, is the duration of blood flow from a standardized incision on the volar surface of the forearm. Normal values have been determined in adult subjects, but with the exception of neonates, data on the range of bleeding time values in pediatric patients are unavailable. Standard hematology textbooks imply that bleeding time values in children are similar to those of adults. We have reviewed our 9 years of experience with 137 children (mean age 6.5 years) who were referred for diagnostic evaluation of a bleeding disorder but whose history and physical examination were felt by us to be inconsistent with an abnormality of hemostasis. Bleeding time values in these individuals (mean 6.0 min, 95th percentile 9.0 min) were compared with those of 85 normal adult volunteers (mean 4.4 min, 95th percentile 6.5 min). The Simplate-I disposable device and vertical (perpendicular to elbow crease) incision direction were used in both groups. This difference between the pediatric and adult bleeding time values is statistically significant (p less than 0.0001). Neither age nor sex had a significant effect on the pediatric bleeding time measurements. We conclude that the bleeding time, when performed as described, is longer in children than in adults and that pediatric standards for bleeding time should be used in order to avoid a spurious diagnosis of a primary hemostatic disorder in some normal children.
Ileal polypoid lymphangiectasia bleeding diagnosed and treated by double balloon enteroscopy.

Science.gov (United States)

Park, Min Seon; Lee, Beom Jae; Gu, Dae Hoe; Pyo, Jeung-Hui; Kim, Kyeong Jin; Lee, Yun Ho; Joo, Moon Kyung; Park, Jong-Jae; Kim, Jae Seon; Bak, Young-Tae

2013-12-07

Intestinal lymphangiectasia is a rare disease characterized by focal or diffuse dilated enteric lymphatics with impaired lymph drainage. It causes protein-losing enteropathy and may lead to gastrointestinal bleeding. Commonly, lymphangiectasia presents as whitish spots or specks. To our knowledge, small bowel bleeding resulting from polypoid intestinal lymphangiectasia has not been reported. Here, we report a rare case of active bleeding from the small bowel caused by polypoid lymphangiectasia with a review of the relevant literature. An 80-year-old woman was hospitalized for melena. Esophagogastroduodenoscopy could not identify the source of bleeding. Subsequent colonoscopy showed fresh bloody material gushing from the small bowel. An abdominal-pelvic contrast-enhanced computed tomography scan did not reveal any abnormal findings. Video capsule endoscopy showed evidence of active and recent bleeding in the ileum. To localize the bleeding site, we performed double balloon enteroscopy by the anal approach. A small, bleeding, polypoid lesion was found in the distal ileum and was successfully removed using endoscopic snare electrocautery. © 2013 Baishideng Publishing Group Co., Limited. All rights reserved.
Trends in Acute Nonvariceal Upper Gastrointestinal Bleeding in Dialysis Patients

Science.gov (United States)

Yang, Ju-Yeh; Lee, Tsung-Chun; Montez-Rath, Maria E.; Paik, Jane; Chertow, Glenn M.; Desai, Manisha

2012-01-01

Impaired kidney function is a risk factor for upper gastrointestinal (GI) bleeding, an event associated with poor outcomes. The burden of upper GI bleeding and its effect on patients with ESRD are not well described. Using data from the US Renal Data System, we quantified the rates of occurrence of and associated 30-day mortality from acute, nonvariceal upper GI bleeding in patients undergoing dialysis; we used medical claims and previously validated algorithms where available. Overall, 948,345 patients contributed 2,296,323 patient-years for study. The occurrence rates for upper GI bleeding were 57 and 328 episodes per 1000 person-years according to stringent and lenient definitions of acute, nonvariceal upper GI bleeding, respectively. Unadjusted occurrence rates remained flat (stringent) or increased (lenient) from 1997 to 2008; after adjustment for sociodemographic characteristics and comorbid conditions, however, we found a significant decline for both definitions (linear approximation, 2.7% and 1.5% per year, respectively; Pupper GI bleeding episodes and were more likely to receive blood transfusions during an episode. Overall 30-day mortality was 11.8%, which declined significantly over time (relative declines of 2.3% or 2.8% per year for the stringent and lenient definitions, respectively). In summary, despite declining trends worldwide, crude rates of acute, nonvariceal upper GI bleeding among patients undergoing dialysis have not decreased in the past 10 years. Although 30-day mortality related to upper GI bleeding declined, perhaps reflecting improvements in medical care, the burden on the ESRD population remains substantial. PMID:22266666
EPIDEMIOLOGICAL CORRELATES OF POSTMENOPAUSAL BLEEDING IN A TERTIARY CARE HOSPITAL

Directory of Open Access Journals (Sweden)

Sonia Arora

2012-06-01

Full Text Available Background: A woman is considered menopausal after 12 months of amenorrhea. The most feared symptom during menopause is postmenopausal bleeding which unless proved otherwise indicates genital malignancy. Objectives: To study Socio-demographic factors related to postmenopausal bleeding and to find time lapse between bleeding and reporting of these cases. Material and Methods: This cross sectional was done in the Department of Obstetrics & Gynecology, Pt. J. N. M. Medical College & DR. B. R. Ambedkar Memorial, Hospital, Raipur (C. G. The participants were 146 women who came with the complaint of postmenopausal bleeding. A detailed, preceded, pre-tested, structured, close ended questionnaire was used to collect the data. By interviewing these women, information was collected about different demographic factors like age, socio-economic status, parity etc. The collected data was put in the master chart and analyzed. Results: The proportion of postmenopausal bleeding cases was 3.5% .Maximum cases(50% with postmenopausal bleeding were found in the age group of 45-54yrs . 60 % of patients were from rural areas and 62% were illiterate. 65% of the patients were grand multipara (Parity4. Most of the patients belonged to lower socioeconomic strata. Almost half (48% of patients presented after, more than 6 months since the first episode of bleeding . Conclusions: The proportion of postmenopausal bleeding is high, requiring immediate investigation. Lack of awareness led to very late presentation of most of the patients, so education at community level is required to reduce this time lapse for earlier diagnosis and management
Microcoil Embolization for Acute Lower Gastrointestinal Bleeding

International Nuclear Information System (INIS)

D'Othee, Bertrand Janne; Surapaneni, Padmaja; Rabkin, Dmitry; Nasser, Imad; Clouse, Melvin

2006-01-01

Purpose. To assess outcomes after microcoil embolization for active lower gastrointestinal (GI) bleeding. Methods. We retrospectively studied all consecutive patients in whom microcoil embolization was attempted to treat acute lower GI bleeding over 88 months. Baseline, procedural, and outcome parameters were recorded following current Society of Interventional Radiology guidelines. Outcomes included technical success, clinical success (rebleeding within 30 days), delayed rebleeding (>30 days), and major and minor complication rates. Follow-up consisted of clinical, endoscopic, and pathologic data. Results. Nineteen patients (13 men, 6 women; mean age ± 95% confidence interval = 70 ± 6 years) requiring blood transfusion (10 ± 3 units) had angiography-proven bleeding distal to the marginal artery. Main comorbidities were malignancy (42%), coagulopathy (28%), and renal failure (26%). Bleeding was located in the small bowel (n = 5), colon (n 13) or rectum (n = 1). Technical success was obtained in 17 patients (89%); 2 patients could not be embolized due to vessel tortuosity and stenoses. Clinical follow-up length was 145 ± 75 days. Clinical success was complete in 13 (68%), partial in 3 (16%), and failed in 2 patients (11%). Delayed rebleeding (3 patients, 27%) was always due to a different lesion in another bowel segment (0 late rebleeding in embolized area). Two patients experienced colonic ischemia (11%) and underwent uneventful colectomy. Two minor complications were noted. Conclusion. Microcoil embolization for active lower GI bleeding is safe and effective in most patients, with high technical and clinical success rates, no procedure-related mortality, and a low risk of bowel ischemia and late rebleeding
Percutaneous transsplenic varices embolization for upper gastrointestinal bleeding

International Nuclear Information System (INIS)

Zhang Qiang; Li Jingyu; Lu Junliang; Xu Liyang; Liu Tao

2010-01-01

Objective: To investigate the value of percutaneous transsplenic varices embolization (PTSVE) for treatment of upper gastrointestinal bleeding. Methods: Twenty cases with liver cirrhosis and portal hypertension suffered upper gastrointestinal bleeding. PTSVE was administered to them with hardener and coils. Among them, 8 cases had massive hepatocellular carcinoma (HCC) in right lobe; 10 cases with hepatocellular carcinoma had portal vein tumor thrombus and occlusion; the other two cases with liver cirrhosis had portal vein thrombosis. All of these cases were not suitable for percutaneous transhepatic varices embolization (PTHVE). PTSVE was performed under the guidance of fluoroscopy. Results: Technical success was achieved in 18 patients. A total of 35 gastric coronary veins were embolized. In all these cases, upper gastrointestinal bleeding stopped after PTSVE. There was no recurrence within 1 month follow-up. No serious complication occurred. Conclusion: PTSVE is a safe and efficient alternative treatment for upper gastrointestinal bleeding, especially for cases with portal vein occlusion or with massive HCC in right lobe of liver. (authors)
Agonist-induced platelet reactivity correlates with bleeding in haemato-oncological patients

NARCIS (Netherlands)

Batman, B.; van Bladel, E. R.; van Hamersveld, M.; Pasker-De Jong, Pieternel C M; Korporaal, S. J.A.; Urbanus, R. T.; Roest, M.; Boven, Leonie A; Fijnheer, R.

2017-01-01

Background and objective: Prophylactic platelet transfusions are administered to prevent bleeding in haemato-oncological patients. However, bleeding still occurs, despite these transfusions. This practice is costly and not without risk. Better predictors of bleeding are needed, and flow cytometric
Gynaecological and obstetric management of women with inherited bleeding disorders.

Science.gov (United States)

Demers, Christine; Derzko, Christine; David, Michèle; Douglas, Joanne

2006-10-01

The prevalence of bleeding disorders, notably von Willebrand disease (vWD), among adult women with objectively documented menorrhagia is consistently reported to be 10% to 20% and is even higher in adolescents presenting with menorrhagia. This consensus document has been developed by a multidisciplinary committee consisting of an anesthesiologist, 2 hematologists, and an obstetrician/gynaecologist and has been endorsed by their relevant specialty bodies. It has been prepared with the express purpose of providing guidelines for both women with inherited bleeding disorders and for their caregivers regarding the gynaecological and obstetric management of these women, including appropriate anesthesia support where indicated. Diagnostic tools and specific medical and, where appropriate, surgical alternatives to management are reviewed and evidence-based recommendations presented. A MEDLINE search of the English literature between January 1975 and November 2003 was performed using the following key words: menorrhagia, uterine bleeding, pregnancy, von Willebrand, congenital bleeding disorder, desmopressin/DDAVP, tranexamic acid, oral contraceptives, medroxyprogesterone, therapy, hysterectomy, anesthesia, epidural, spinal. Recommendations from other society guidelines were reviewed. 1. Inherited bleeding disorders should be considered in the differential diagnosis of all patients presenting with menorrhagia (II-2B). The graphical scoring system presented is a validated tool which offers a simple yet practical method that can be used by patients to quantify their blood loss (II-2B). 2. Because underlying bleeding disorders are frequent in women with menorrhagia, physicians should consider performing a hemoglobin/hematocrit, platelet count, ferritin, PT (INR) and APTT in women with menorrhagia. In women who have a personal history of other bleeding or a family history of bleeding, further investigation should be considered, including a vWD workup (factor VIII, vWF antigen

Bleed water testing program for controlled low strength material

International Nuclear Information System (INIS)

Langton, C.A.

1996-01-01

Bleed water measurements for two Controlled Low Strength Material (CLSM) mixes were conducted to provide engineering data for the Tank 20F closure activities. CLSM Mix 1 contained 150 pounds of cement per cubic yard whereas CLSM Mix 2 contained 50 pounds per cub yard. SRS currently used CLSM Mix 2 for various applications. Bleed water percentages and generation rates were measured along with flow and compressive strength. This information will be used to select a mix design for the Tank 20F closure activities and to establish the engineering requirements, such as, lift height, time required between lifts and quantity of bleed water to be removed from the tank during the placement activities. Mix 1 is recommended for placement within Tank 20F because it has better flow characteristics, less segregation, lower percentage of bleed water and slightly higher strength. Optimization of Mix 1 was beyond the scope of this study. However, further testing of thickening additives, such as clays (bentonite), sodium silicate or fine silicas maybe useful for decreasing or eliminating bleed water
Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration.

Science.gov (United States)

Singh, Pratibha

2018-01-01

Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB), especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn) was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic) were used to retrieve data. One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41-45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C) in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Endometrial aspiration is a simple, safe, and effective method to sample endometrium in cases of AUB avoiding risk of
Recombinant activated factor VII in the treatment of bleeds and for the prevention of surgery-related bleeding in congenital haemophilia with inhibitors.

Science.gov (United States)

Santagostino, Elena; Escobar, Miguel; Ozelo, Margareth; Solimeno, Luigi; Arkhammar, Per; Lee, Hye Youn; Rosu, Gabriela; Giangrande, Paul

2015-06-01

The availability of recombinant activated factor VII (rFVIIa, eptacog alfa activated) has greatly advanced the care of patients with haemophilia A or B who have developed inhibitors against the infused replacement factor. Recombinant FVIIa is licensed for the on-demand treatment of bleeding episodes and the prevention of bleeding in surgery or invasive procedures in patients with congenital haemophilia with inhibitors. This article attempts to review in detail the extensive evidence of rFVIIa in congenital haemophilia patients with inhibitors. Patients with acute bleeding episodes are best treated on demand at home, to achieve the short- and long-term benefits of rapid bleed control. Key prospective studies have shown that rFVIIa achieves consistently high efficacy rates in the management of acute (including joint) bleeds in inhibitor patients in the home treatment setting. Substantial post-approval data from key registries also support the on-demand efficacy profile of rFVIIa established by the prospective clinical trials. The availability of rFVIIa has allowed major surgery to become a reality for inhibitor patients. Studies in key surgery, including orthopaedic procedures, have found that rFVIIa provides consistently high efficacy rates. Importantly, the wealth of data does not raise any unexpected safety concerns surrounding rFVIIa use; this is likely because rFVIIa is a recombinant product with a localised mechanism of action at the site of vascular injury. In summary, rFVIIa is established as an effective and well-tolerated first-line treatment for on-demand bleeding control and bleed prevention during minor and major (including elective orthopaedic) surgery in inhibitor patients. Use of rFVIIa has been a major step towards narrowing the gap in outcomes between inhibitor patients and non-inhibitor patients. Copyright © 2015 Elsevier Ltd. All rights reserved.
Red blood cell transfusion is associated with further bleeding and fresh-frozen plasma with mortality in nonvariceal upper gastrointestinal bleeding.

Science.gov (United States)

Subramaniam, Kavitha; Spilsbury, Katrina; Ayonrinde, Oyekoya T; Latchmiah, Faye; Mukhtar, Syed A; Semmens, James B; Leahy, Michael F; Olynyk, John K

2016-04-01

Blood products are commonly transfused for patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). While concerns exist about further bleeding and mortality in subsets of patients receiving red blood cell (RBC) transfusion, the impact of non-RBC blood products has not previously been systematically investigated. The aim of the study was to investigate the associations between blood products transfusion, further bleeding, and mortality after acute NVUGIB. A retrospective cohort study examined further bleeding and 30-day and 1-year mortality in adult patients who underwent gastroscopy for suspected acute NVUGIB between 2008 and 2010 in three tertiary hospitals in Western Australia. Survival analysis was performed. A total of 2228 adults (63% male) with 2360 hospital admissions for NVUGIB met the inclusion criteria. Median age at presentation was 70 years (range, 19-99 years). Thirty-day mortality was 4.9% and 1-year mortality was 13.9%. Transfusion of 4 or more units of RBCs was associated with greater than 10 times the odds of further bleeding in patients with a hemoglobin level of more than 90 g/L (odds ratio, 11.9; 95% confidence interval [CI], 3.1-45.7; p ≤ 0.001), but was not associated with mortality. Administration of 5 or more units of fresh-frozen plasma (FFP) was associated with increased 30-day (hazard ratio, 2.8; 95% CI, 1.3-5.9; p = 0.008) and 1-year (hazard ratio, 2.6; 95% CI, 1.3-5.0; p = 0.005) mortality after adjusting for coagulopathy, comorbidity, Rockall score, and other covariates. In this large, multicenter study of NVUGIB, RBC transfusion was associated with further bleeding but not mortality, while FFP transfusion was associated with increased mortality in a subset of patients. © 2015 AABB.
Mitos y tabúes en la sexualidad humana

Directory of Open Access Journals (Sweden)

Ignacio González Labrador

2002-06-01

Full Text Available Se realizan consideraciones muy generales sobre el origen de los géneros y cómo esta formación favorece la presencia de mitos y tabúes en la expresión de la sexualidad de la pareja humana.Very general considerations are presented on the origin of genders and how this formation has favored myths and taboos in the expression of the human couple's sexuality.
Photovoltaic sheathing element with one or more tabs

Energy Technology Data Exchange (ETDEWEB)

Keenihan, James R; Langmaid, Joseph A; Lopez, Leonardo C.

2017-02-07

The present invention is premised upon an assembly that includes at least a photovoltaic sheathing element capable of being affixed on a building structure. The shingle including at least a photovoltaic cell assembly, a body portion attached to one or more portions of the photovoltaic cell assembly. Wherein the body portion includes one or more top peripheral tabs each capable of fitting under one or more vertically adjoining devices.
Bleeding gastrointestinal stromal tumour of the stomach complicated ...

African Journals Online (AJOL)

Inferior vena cava filter insertion was not possible due to non-availability. Coexistence of DVT needing anticoagulation and bleeding gastric GIST requiring urgent resection presented a management dilemna. Despite the risk, the patient was taken for an emergency tumor resection primarily to stop the bleeding and facilitate ...
Endovascular management of acute bleeding arterioenteric fistulas

DEFF Research Database (Denmark)

Leonhardt, H.; Mellander, S.; Snygg, J.

2008-01-01

follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed....... All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...
Fibrinogen concentrate for bleeding - a systematic review

DEFF Research Database (Denmark)

Lunde, J; Stensballe, J; Wikkelsø, A

2014-01-01

Fibrinogen concentrate as part of treatment protocols increasingly draws attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the potential to reduce bleeding, transfusion requirement and subsequently reduce morbidity and mortality. A systematic search for randomised controlled...... trials (RCTs) and non-randomised studies investigating fibrinogen concentrate in bleeding patients was conducted up to November 2013. We included 30 studies of 3480 identified (7 RCTs and 23 non-randomised). Seven RCTs included a total of 268 patients (165 adults and 103 paediatric), and all were...... determined to be of high risk of bias and none reported a significant effect on mortality. Two RCTs found a significant reduction in bleeding and five RCTs found a significant reduction in transfusion requirements. The 23 non-randomised studies included a total of 2825 patients, but only 11 of 23 studies...
Premenopausal abnormal uterine bleeding and risk of endometrial cancer.

Science.gov (United States)

Pennant, M E; Mehta, R; Moody, P; Hackett, G; Prentice, A; Sharp, S J; Lakshman, R

2017-02-01

Endometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear. To conduct a systematic literature review to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with abnormal uterine bleeding. Search of PubMed, Embase and the Cochrane Library from database inception to August 2015. Studies reporting rates of endometrial cancer and/or atypical hyperplasia in women with premenopausal abnormal uterine bleeding. Data were independently extracted by two reviewers and cross-checked. For each outcome, the risk and a 95% CI were estimated using logistic regression with robust standard errors to account for clustering by study. Sixty-five articles contributed to the analysis. Risk of endometrial cancer was 0.33% (95% CI 0.23-0.48%, n = 29 059; 97 cases) and risk of endometrial cancer or atypical hyperplasia was 1.31% (95% CI 0.96-1.80, n = 15 772; 207 cases). Risk of endometrial cancer was lower in women with heavy menstrual bleeding (HMB) (0.11%, 95% CI 0.04-0.32%, n = 8352; 9 cases) compared with inter-menstrual bleeding (IMB) (0.52%, 95% CI 0.23-1.16%, n = 3109; 14 cases). Of five studies reporting the rate of atypical hyperplasia in women with HMB, none identified any cases. The risk of endometrial cancer or atypical hyperplasia in premenopausal women with abnormal uterine bleeding is low. Premenopausal women with abnormal uterine bleeding should first undergo conventional medical management. Where this fails, the presence of IMB and older age may be indicators for further investigation. Further research into the risks associated with age and the cumulative risk of co-morbidities is needed. Contrary to practice, premenopausal women with heavy periods or inter-menstrual bleeding rarely require biopsy. © 2016 The Authors BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal
Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT

Energy Technology Data Exchange (ETDEWEB)

Scheffel, Hans; Pfammatter, Thomas; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Wildi, Stefan [University Hospital Zurich, Department of Visceral and Transplant Surgery, Zurich (Switzerland); Bauerfeind, Peter [University Hospital Zurich, Division of Gastroenterology, Zurich (Switzerland)

2007-06-15

This study was conducted to determine the ability of multi-detector-row computed tomography (CT) to identify the source and etiology of acute gastrointestinal bleeding. Eighteen patients with acute upper (n = 10) and lower (n = 8) gastrointestinal bleeding underwent 4-detector-row CT (n = 6), 16-detector-row CT (n = 11), and 64-slice CT (n = 1) with an arterial and portal venous phase of contrast enhancement. Unenhanced scans were performed in nine patients. CT scans were reviewed to determine conspicuity of bleeding source, underlying etiology, and for potential causes of false-negative prospective interpretations. Bleeding sources were prospectively identified with CT in 15 (83%) patients, and three (17%) bleeding sources were visualized in retrospect, allowing the characterization of all sources of bleeding with CT. Contrast extravasation was demonstrated with CT in all 11 patients with severe bleeding, but only in 1 of 7 patients with mild bleeding. The etiology could not be identified on unenhanced CT scans in any patient, whereas arterial-phase and portal venous-phase CT depicted etiology in 15 (83%) patients. Underlying etiology was correctly identified in all eight patients with mild GI bleeding. Multi-detector-row CT enables the identification of bleeding source and precise etiology in patients with acute gastrointestinal bleeding. (orig.)
Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT

International Nuclear Information System (INIS)

Scheffel, Hans; Pfammatter, Thomas; Marincek, Borut; Alkadhi, Hatem; Wildi, Stefan; Bauerfeind, Peter

2007-01-01

This study was conducted to determine the ability of multi-detector-row computed tomography (CT) to identify the source and etiology of acute gastrointestinal bleeding. Eighteen patients with acute upper (n = 10) and lower (n = 8) gastrointestinal bleeding underwent 4-detector-row CT (n = 6), 16-detector-row CT (n = 11), and 64-slice CT (n = 1) with an arterial and portal venous phase of contrast enhancement. Unenhanced scans were performed in nine patients. CT scans were reviewed to determine conspicuity of bleeding source, underlying etiology, and for potential causes of false-negative prospective interpretations. Bleeding sources were prospectively identified with CT in 15 (83%) patients, and three (17%) bleeding sources were visualized in retrospect, allowing the characterization of all sources of bleeding with CT. Contrast extravasation was demonstrated with CT in all 11 patients with severe bleeding, but only in 1 of 7 patients with mild bleeding. The etiology could not be identified on unenhanced CT scans in any patient, whereas arterial-phase and portal venous-phase CT depicted etiology in 15 (83%) patients. Underlying etiology was correctly identified in all eight patients with mild GI bleeding. Multi-detector-row CT enables the identification of bleeding source and precise etiology in patients with acute gastrointestinal bleeding. (orig.)
Mortality caused by intracranial bleeding in non-severe hemophilia A patients.

Science.gov (United States)

Loomans, J I; Eckhardt, C L; Reitter-Pfoertner, S E; Holmström, M; van Gorkom, B Laros; Leebeek, F W G; Santoro, C; Haya, S; Meijer, K; Nijziel, M R; van der Bom, J G; Fijnvandraat, K

2017-06-01

Essentials Data on bleeding-related causes of death in non-severe hemophilia A (HA) patients are scarce. Such data may provide new insights into areas of care that can be improved. Non-severe HA patients have an increased risk of dying from intracranial bleeding. This demonstrates the need for specialized care for non-severe HA patients. Background Non-severe hemophilia (factor VIII concentration [FVIII:C] of 2-40 IU dL -1 ) is characterized by a milder bleeding phenotype than severe hemophilia A. However, some patients with non-severe hemophilia A suffer from severe bleeding complications that may result in death. Data on bleeding-related causes of death, such as fatal intracranial bleeding, in non-severe patients are scarce. Such data may provide new insights into areas of care that can be improved. Aims To describe mortality rates, risk factors and comorbidities associated with fatal intracranial bleeding in non-severe hemophilia A patients. Methods We analyzed data from the INSIGHT study, an international cohort study of all non-severe hemophilia A patients treated with FVIII concentrates during the observation period between 1980 and 2010 in 34 participating centers across Europe and Australia. Clinical data and vital status were collected from 2709 patients. We report the standardized mortality rate for patients who suffered from fatal intracranial bleeding, using a general European male population as a control population. Results Twelve per cent of the 148 deceased patients in our cohort of 2709 patients died from intracranial bleeding. The mortality rate between 1996 and 2010 for all ages was 3.5-fold higher than that in the general population (95% confidence interval [CI] 2.0-5.8). Patients who died from intracranial bleeding mostly presented with mild hemophilia without clear comorbidities. Conclusion Non-severe hemophilia A patients have an increased risk of dying from intracranial bleeding in comparison with the general population. This demonstrates the
Risk-based decision making for staggered bioterrorist attacks : resource allocation and risk reduction in "reload" scenarios.

Energy Technology Data Exchange (ETDEWEB)

Lemaster, Michelle Nicole; Gay, David M. (Sandia National Laboratories, Albuquerque, NM); Ehlen, Mark Andrew (Sandia National Laboratories, Albuquerque, NM); Boggs, Paul T.; Ray, Jaideep

2009-10-01

Staggered bioterrorist attacks with aerosolized pathogens on population centers present a formidable challenge to resource allocation and response planning. The response and planning will commence immediately after the detection of the first attack and with no or little information of the second attack. In this report, we outline a method by which resource allocation may be performed. It involves probabilistic reconstruction of the bioterrorist attack from partial observations of the outbreak, followed by an optimization-under-uncertainty approach to perform resource allocations. We consider both single-site and time-staggered multi-site attacks (i.e., a reload scenario) under conditions when resources (personnel and equipment which are difficult to gather and transport) are insufficient. Both communicable (plague) and non-communicable diseases (anthrax) are addressed, and we also consider cases when the data, the time-series of people reporting with symptoms, are confounded with a reporting delay. We demonstrate how our approach develops allocations profiles that have the potential to reduce the probability of an extremely adverse outcome in exchange for a more certain, but less adverse outcome. We explore the effect of placing limits on daily allocations. Further, since our method is data-driven, the resource allocation progressively improves as more data becomes available.
A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

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Zeytunlu Murat

2009-01-01

Full Text Available Abstract Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare. We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin. Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding.
No impact of fish oil supplements on bleeding risk

DEFF Research Database (Denmark)

Begtrup, Katrine Munk; Krag, Andreas Engel; Hvas, Anne-Mette

2017-01-01

Abstract Introduction: Fish oil supplementation may inhibit platelet aggregation and can potentially increase the risk of bleeding. The aim of the present systematic review was to evaluate the effect of fish oil supplements on haemostasis and bleeding risk, and to provide recommendations on whether...... of the included studies were randomised controlled trials or included a control group. Overall, fish oil supplements reduced platelet aggregation in healthy subjects. Fish oil exposure in surgical patients did not increase bleeding or blood transfusions either during or after surgery. Conclusion: Fish oil...... supplements reduced platelet aggregation in healthy subjects. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. Consequently, this systematic review does not support the need for discontinuation of fish oil supplements prior...
Modern issues on the treatment of peptic ulcer bleedings

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Potakhin S.N.

2014-03-01

Full Text Available Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding.
Post-biliary sphincterotomy bleeding despite covered metallic stent deployment

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Gianfranco Donatelli

2016-05-01

Full Text Available Objectives: Several endoscopic techniques have been proposed for the management of post-sphincterotomy bleeding. Lately, self-expandable metal stents deployment has gained popularity especially as a rescue therapy when other endoscopic techniques fail. Methods-results: We report the case report of a massive post-sphincterotomy bleeding in a patient with a self-expandable metal stent in the biliary tree. Despite the presence of a correctly positioned self-expandable metal stent, a new endoscopic session was required to control the bleeding. Conclusions: Self-expandable metal stent may be useful to manage post-endoscopic sphincterotomy bleeding. However, up to now there is no specifically designed self-expandable metal stent for such complication. Large new designed self-expandable metal stent may be a useful tool for biliary endoscopist.
What is the recurrence rate of postmenopausal bleeding in women who have a thin endometrium during a first episode of postmenopausal bleeding?

NARCIS (Netherlands)

van Doorn, H. C.; Timmermans, A.; Opmeer, B. C.; Kruitwagen, R. F. M. P.; Dijkhuizen, F. P. H. L. J.; Kooi, G. S.; van de Weijer, P. H. M.; Mol, B. W. J.

2008-01-01

Objective. To determine the incidence and significance of recurrent postmenopausal bleeding among women diagnosed with an endometrial thickness <= 4 mm after a first episode of postmenopausal bleeding. Methods. Consecutive patients not using hormone replacement therapy (HRT) presenting with a first
Risk factors for bleeding complications after nephrologist-performed native renal biopsy.

Science.gov (United States)

Lees, Jennifer S; McQuarrie, Emily P; Mordi, Natalie; Geddes, Colin C; Fox, Jonathan G; Mackinnon, Bruce

2017-08-01

Bleeding is a recognized complication of native percutaneous renal biopsy. This study aimed to describe the incidence of major bleeding after biopsy in a single centre over a 15-year period and examine factors associated with major bleeding. We identified consecutive adult patients undergoing ultrasound-guided native renal biopsy in the Glasgow Renal and Transplant Unit from 2000 to 2014. From the electronic patient record, we collected data pertaining to biopsy indication, pre- and post-biopsy laboratory measurements, prescribed medication and diagnosis. Aspirin was routinely continued. We defined major bleeding post-biopsy as the need for blood transfusion, surgical or radiological intervention or death. Binary logistic regression analysis was used to assess factors associated with increased risk of major bleeding. There were 2563 patients who underwent native renal biopsy (1499 elective, 1064 emergency). The average age of patients was 57 (SD 17) years and 57.4% were male. Overall, the rate of major bleeding was 2.2%. In all, 46 patients required transfusion (1.8%), 9 patients underwent embolization (0.4%), no patient required nephrectomy and 1 patient died as a result of a significant late retroperitoneal bleed. Major bleeding was more common in those undergoing emergency compared with elective renal biopsy (3.4 versus 1.1%; P 30). The risk of major bleeding following native renal biopsy in the modern era is low. Complications are more common when biopsy is conducted as an emergency, which has implications for obtaining informed consent. Our data support the strategy of not stopping aspirin before renal biopsy.

Endovascular management for significant iatrogenic portal vein bleeding.

Science.gov (United States)

Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo

2017-11-01

Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.
Congenital portosystemic shunts with and without gastrointestinal bleeding - case series

Energy Technology Data Exchange (ETDEWEB)

Gong, Ying; Chen, Jun; Chen, Qi; Ji, Min; Pa, Mier; Qiao, Zhongwei [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China); Zhu, Hui [Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai (China); Zheng, Shan [Children' s Hospital of Fudan University, Department of Surgery, Shanghai (China)

2015-12-15

The clinical presentation of congenital portosystemic shunt is variable and gastrointestinal bleeding is an uncommon presentation. To describe the imaging features of congenital portosystemic shunt as it presented in 11 children with (n = 6) and without gastrointestinal bleeding (n = 5). We performed a retrospective study on a clinical and imaging dataset of 11 children diagnosed with congenital portosystemic shunt. A total of 11 children with congenital portosystemic shunt were included in this study, 7 with extrahepatic portosystemic shunts and 4 with intrahepatic portosystemic shunts. Six patients with gastrointestinal bleeding had an extrahepatic portosystemic shunt, and the imaging results showed that the shunts originated from the splenomesenteric junction (n = 5) or splenic vein (n = 1) and connected to the internal iliac vein. Among the five cases of congenital portosystemic shunt without gastrointestinal bleeding, one case was an extrahepatic portosystemic shunt and the other four were intrahepatic portosystemic shunts. Most congenital portosystemic shunt patients with gastrointestinal bleeding had a shunt that drained portal blood into the iliac vein via an inferior mesenteric vein. This type of shunt was uncommon, but the concomitant rate of gastrointestinal bleeding with this type of shunt was high. (orig.)
Investigation on solder joint strength of nickel tin-plated and CRS tabs with PCB

International Nuclear Information System (INIS)

Luay Hussain

2002-01-01

Failure analysis on easily peels off Nickel and CRS steel tabs from PCB was carried out. Nickel Tin plated tabs, CRS steel tabs and tube were joined to the PCB using reflow/ convection soldering, in an oven. The solder paste composition is Sn36/Pb35/Ag2. Peel test was conducted and it was found that many tabs could be easily peeled off with low force. Porosities which varies from 0.4 mm to < 0.01mm in diameter, developed during soldering process and solidification was noted. It was found, the number, size and position of these porosities inside the solder layer on both parts of the tabs affect the peel strength. Scanning Electron Microscopy study and EDX analysis were carried out. It was found that the low peel strength values were due to the combination of generation and development of porosities during soldering process which act as stress concentrators and the evolution (growth) of eutectic Sn/Pb and Sn/Ni/Cu brittle grainy phase. Large eutectic microstructure with brittle Sn-Ni-Cu grainy phase enhances the failure with low peeling forces. Sample showing no feature of Sn/Ni/Cu grain gave high peeling strength value. Solder reflow, an important process, can result in strength enhancement (if it was controlled for example in a furnace). (Author)
Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding.

Science.gov (United States)

Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Shirai, Yoshinori; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

2015-05-28

To distinguish upper from lower gastrointestinal (GI) bleeding. Patient records between April 2011 and March 2014 were analyzed retrospectively (3296 upper endoscopy, and 1520 colonoscopy). Seventy-six patients had upper GI bleeding (Upper group) and 65 had lower GI bleeding (Lower group). Variables were compared between the groups using one-way analysis of variance. Logistic regression was performed to identify variables significantly associated with the diagnosis of upper vs lower GI bleeding. Receiver-operator characteristic (ROC) analysis was performed to determine the threshold value that could distinguish upper from lower GI bleeding. Hemoglobin (P = 0.023), total protein (P = 0.0002), and lactate dehydrogenase (P = 0.009) were significantly lower in the Upper group than in the Lower group. Blood urea nitrogen (BUN) was higher in the Upper group than in the Lower group (P = 0.0065). Logistic regression analysis revealed that BUN was most strongly associated with the diagnosis of upper vs lower GI bleeding. ROC analysis revealed a threshold BUN value of 21.0 mg/dL, with a specificity of 93.0%. The threshold BUN value for distinguishing upper from lower GI bleeding was 21.0 mg/dL.
The use of selective serotonin receptor inhibitors (SSRIs) is not associated with increased risk of endoscopy-refractory bleeding, rebleeding or mortality in peptic ulcer bleeding.

Science.gov (United States)

Laursen, S B; Leontiadis, G I; Stanley, A J; Hallas, J; Schaffalitzky de Muckadell, O B

2017-08-01

Observational studies have consistently shown an increased risk of upper gastrointestinal bleeding in users of selective serotonin receptor inhibitors (SSRIs), probably explained by their inhibition of platelet aggregation. Therefore, treatment with SSRIs is often temporarily withheld in patients with peptic ulcer bleeding. However, abrupt discontinuation of SSRIs is associated with development of withdrawal symptoms in one-third of patients. Further data are needed to clarify whether treatment with SSRIs is associated with poor outcomes, which would support temporary discontinuation of treatment. To identify if treatment with SSRIs is associated with increased risk of: (1) endoscopy-refractory bleeding, (2) rebleeding or (3) 30-day mortality due to peptic ulcer bleeding. A nationwide cohort study. Analyses were performed on prospectively collected data on consecutive patients admitted to hospital with peptic ulcer bleeding in Denmark in the period 2006-2014. Logistic regression analyses were used to investigate the association between treatment with SSRIs and outcome following adjustment for pre-defined confounders. Sensitivity and subgroup analyses were performed to evaluate the validity of the findings. A total of 14 343 patients were included. Following adjustment, treatment with SSRIs was not associated with increased risk of endoscopy-refractory bleeding (odds ratio [OR] [95% Confidence Interval (CI)]: 1.03 [0.79-1.33]), rebleeding (OR [95% CI]: 0.96 [0.83-1.11]) or 30-day mortality (OR [95% CI]: 1.01 [0.85-1.19]. These findings were supported by sensitivity and subgroup analyses. According to our data, treatment with SSRIs does not influence the risk of endoscopy-refractory bleeding, rebleeding or 30-day mortality in peptic ulcer bleeding. © 2017 John Wiley & Sons Ltd.
Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis

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Jan Yi-Yin

2006-01-01

Full Text Available Abstract Background A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH in managing of bleeding pseudoaneurysms associated with chronic pancreatitis. Methods The medical records of 9 patients (8 males and 1 female; age range, 28 – 71 years; median, 36 years with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78% was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7, computed tomographic (4/7, ultrasound (2/5, and surgical (2/2 findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4 – 87 months. Results Abdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%. Angiography determined correct diagnosis in 7 patients (7/7, 100%. The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4 or elective (n = 3 surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5 and 89% (8/9. Five patients developed pseudocysts before treatment (n = 3 or following intervention (n = 2. Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality
Preventive Strategies against Bleeding due to Nonvitamin K Antagonist Oral Anticoagulants

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Lessire Sarah

2014-01-01

Full Text Available Dabigatran etexilate (DE, rivaroxaban, and apixaban are nonvitamin K antagonist oral anticoagulants (NOACs that have been compared in clinical trials with existing anticoagulants (warfarin and enoxaparin in several indications for the prevention and treatment of thrombotic events. All NOACs presented bleeding events despite a careful selection and control of patients. Compared with warfarin, NOACs had a decreased risk of intracranial hemorrhage, and apixaban and DE (110 mg BID had a decreased risk of major bleeding from any site. Rivaroxaban and DE showed an increased risk of major gastrointestinal bleeding compared with warfarin. Developing strategies to minimize the risk of bleeding is essential, as major bleedings are reported in clinical practice and specific antidotes are currently not available. In this paper, the following preventive approaches are reviewed: improvement of appropriate prescription, identification of modifiable bleeding risk factors, tailoring NOAC’s dose, dealing with a missed dose as well as adhesion to switching, bridging and anesthetic procedures.
Bayesian network modelling of upper gastrointestinal bleeding

Science.gov (United States)

Aisha, Nazziwa; Shohaimi, Shamarina; Adam, Mohd Bakri

2013-09-01

Bayesian networks are graphical probabilistic models that represent causal and other relationships between domain variables. In the context of medical decision making, these models have been explored to help in medical diagnosis and prognosis. In this paper, we discuss the Bayesian network formalism in building medical support systems and we learn a tree augmented naive Bayes Network (TAN) from gastrointestinal bleeding data. The accuracy of the TAN in classifying the source of gastrointestinal bleeding into upper or lower source is obtained. The TAN achieves a high classification accuracy of 86% and an area under curve of 92%. A sensitivity analysis of the model shows relatively high levels of entropy reduction for color of the stool, history of gastrointestinal bleeding, consistency and the ratio of blood urea nitrogen to creatinine. The TAN facilitates the identification of the source of GIB and requires further validation.
A novel semi-quantitative method for measuring tissue bleeding.

Science.gov (United States)

Vukcevic, G; Volarevic, V; Raicevic, S; Tanaskovic, I; Milicic, B; Vulovic, T; Arsenijevic, S

2014-03-01

In this study, we describe a new semi-quantitative method for measuring the extent of bleeding in pathohistological tissue samples. To test our novel method, we recruited 120 female patients in their first trimester of pregnancy and divided them into three groups of 40. Group I was the control group, in which no dilation was applied. Group II was an experimental group, in which dilation was performed using classical mechanical dilators. Group III was also an experimental group, in which dilation was performed using a hydraulic dilator. Tissue samples were taken from the patients' cervical canals using a Novak's probe via energetic single-step curettage prior to any dilation in Group I and after dilation in Groups II and III. After the tissue samples were prepared, light microscopy was used to obtain microphotographs at 100x magnification. The surfaces affected by bleeding were measured in the microphotographs using the Autodesk AutoCAD 2009 program and its "polylines" function. The lines were used to mark the area around the entire sample (marked A) and to create "polyline" areas around each bleeding area on the sample (marked B). The percentage of the total area affected by bleeding was calculated using the formula: N = Bt x 100 / At where N is the percentage (%) of the tissue sample surface affected by bleeding, At (A total) is the sum of the surfaces of all of the tissue samples and Bt (B total) is the sum of all the surfaces affected by bleeding in all of the tissue samples. This novel semi-quantitative method utilizes the Autodesk AutoCAD 2009 program, which is simple to use and widely available, thereby offering a new, objective and precise approach to estimate the extent of bleeding in tissue samples.
Complex endoscopic treatment of acute gastrointestinal bleeding of ulcer origin

Directory of Open Access Journals (Sweden)

V. V. Izbitsky

2013-06-01

Full Text Available Gastrointestinal bleeding (GIB is determined in 20-30% of patients with peptic ulcer disease. Acute gastrointestinal bleeding is on the first place as the main cause of deaths from peptic ulcer ahead of the other complications. Rebleeding occurs in 30-38% of patients. Materials and Methods For getting of the objective endoscopic picture in patients with bleeding gastroduodenal ulcers we used the classification of J.A. Forrest in our study: Type I - active bleeding: • I a - pulsating jet; • I b - stream. Type II - signs of recent bleeding: • II a - visible (non-bleeding visible vessel; • II b - fixed thrombus - a clot; • II c - flat black spot (black bottom ulcers. Type III - ulcer with a clean (white down. Integrated endoscopic hemostasis included: irrigation of ulcer defect and area around it with 3% hydrogen peroxide solution in a volume of 10 - 30ml; Injection of 2-4 mL of diluted epinephrine (1:10000 for hemostasis; use of Argon plasma coagulation. Results and Discussion Integrated endoscopic stop of bleeding was performed in 57 patients who were examined and treated at the Department of Surgery from 2006 to 2012. In 16 patients bleeding was caused by gastric ulcer. Gastric ulcer type I localization according to classification (HD Johnson, 1965 was determined in 9 patients, type II - in 2 patients, type III – in 5 patients. In 31 patients bleeding was caused by duodenal peptic ulcer, in 4 patients - erosive gastritis, 1 - erosive esophagitis, and in 5 patients - gastroenteroanastomosis area peptic ulcer. Final hemostasis was achieved in 55 (96.5% patients. In 50 (87.7% patients it was sufficient to conduct a single session of complex endoscopic treatment. In 5 (8.8% patients – it was done two times. In 2 (3.5% cases operation was performed due to the recurrent bleeding. The source of major bleeding in these patients was: chronic, duodenal ulcer penetrating into the head of the pancreas in one case complicated by subcompensated
Ibrutinib-associated bleeding: pathogenesis, management and risk reduction strategies.

Science.gov (United States)

Shatzel, J J; Olson, S R; Tao, D L; McCarty, O J T; Danilov, A V; DeLoughery, T G

2017-05-01

Ibrutinib is an irreversible inhibitor of Bruton's tyrosine kinase (Btk) that has proven to be an effective therapeutic agent for multiple B-cell-mediated lymphoproliferative disorders. Ibrutinib, however, carries an increased bleeding risk compared with standard chemotherapy. Bleeding events range from minor mucocutaneous bleeding to life-threatening hemorrhage, due in large part to the effects of ibrutinib on several distinct platelet signaling pathways. There is currently a minimal amount of data to guide clinicians regarding the use of ibrutinib in patients at high risk of bleeding or on anticoagulant or antiplatelet therapy. In addition, the potential cardiovascular protective effects of ibrutinib monotherapy in patients at risk of vascular disease are unknown. Patients should be cautioned against using non-steroidal anti-inflammatory drugs, fish oils, vitamin E and aspirin-containing products, and consider replacing ibrutinib with a different agent if dual antiplatelet therapy is indicated. Patients should not take vitamin K antagonists concurrently with ibrutinib; direct oral anticoagulants should be used if extended anticoagulation is strongly indicated. In this review, we describe the pathophysiology of ibrutinib-mediated bleeding and suggest risk reduction strategies for common clinical scenarios associated with ibrutinib. © 2017 International Society on Thrombosis and Haemostasis.
Histopathological pattern of abnormal uterine bleeding in endometrial biopsies.

Science.gov (United States)

Vaidya, S; Lakhey, M; Vaidya, S; Sharma, P K; Hirachand, S; Lama, S; KC, S

2013-03-01

Abnormal uterine bleeding is a common presenting complaint in gyanecology out patient department. Histopathological evaluation of the endometrial samples plays a significant role in the diagnosis of abnormal uterine bleeding. This study was carried out to determine the histopathological pattern of the endometrium in women of various age groups presenting with abnormal uterine bleeding. Endometrial biopsies and curettings of patients presenting with abnormal uterine bleeding was retrospectively studied. A total of 403 endometrial biopsies and curettings were analyzed. The age of the patients ranged from 18 to 70 years. Normal cyclical endometrium was seen in 165 (40.94%) cases, followed by 54 (13.40%) cases of disordered proliferative endometrium and 44 (10.92%) cases of hyperplasia. Malignancy was seen in 10 (2.48%) cases. Hyperplasia and malignancy were more common in the perimenopausal and postmenopausal age groups. Histopathological examination of endometrial biopsies and curettings in patients presenting with abnormal uterine bleeding showed a wide spectrum of changes ranging from normal endometrium to malignancy. Endometrial evaluation is specially recommended in women of perimenopausal and postmenopausal age groups presenting with AUB, to rule out a possibility of any preneoplastic condition or malignancy.
ISA-TAB-Nano: A Specification for Sharing Nanomaterial Research Data in Spreadsheet-based Format

Science.gov (United States)

2013-01-01

Background and motivation The high-throughput genomics communities have been successfully using standardized spreadsheet-based formats to capture and share data within labs and among public repositories. The nanomedicine community has yet to adopt similar standards to share the diverse and multi-dimensional types of data (including metadata) pertaining to the description and characterization of nanomaterials. Owing to the lack of standardization in representing and sharing nanomaterial data, most of the data currently shared via publications and data resources are incomplete, poorly-integrated, and not suitable for meaningful interpretation and re-use of the data. Specifically, in its current state, data cannot be effectively utilized for the development of predictive models that will inform the rational design of nanomaterials. Results We have developed a specification called ISA-TAB-Nano, which comprises four spreadsheet-based file formats for representing and integrating various types of nanomaterial data. Three file formats (Investigation, Study, and Assay files) have been adapted from the established ISA-TAB specification; while the Material file format was developed de novo to more readily describe the complexity of nanomaterials and associated small molecules. In this paper, we have discussed the main features of each file format and how to use them for sharing nanomaterial descriptions and assay metadata. Conclusion The ISA-TAB-Nano file formats provide a general and flexible framework to record and integrate nanomaterial descriptions, assay data (metadata and endpoint measurements) and protocol information. Like ISA-TAB, ISA-TAB-Nano supports the use of ontology terms to promote standardized descriptions and to facilitate search and integration of the data. The ISA-TAB-Nano specification has been submitted as an ASTM work item to obtain community feedback and to provide a nanotechnology data-sharing standard for public development and adoption. PMID
Evaluation and Management of Adolescents with Abnormal Uterine Bleeding.

Science.gov (United States)

Mullins, Tanya L Kowalczyk; Miller, Rachel J; Mullins, Eric S

2015-09-01

The International Federation of Gynecology and Obstetrics and the American Congress of Obstetricians and Gynecologists support the use of new terminology for abnormal uterine bleeding (AUB) to consistently categorize AUB by etiology. The term AUB can be further classified as AUB/heavy menstrual bleeding (HMB) (replacing the term "menorrhagia") or AUB/intermenstrual bleeding (replacing the term "metrorrhagia"). Although many cases of AUB in adolescent women are attributable to immaturity of the hypothalamic-pituitary-ovarian axis, underlying bleeding disorders should be considered in women with AUB/HMB. This article reviews the new terminology for AUB, discusses important relevant features of history and examination, presents the laboratory evaluation of HMB, and describes hormonal (oral contraceptive pills, progestin-only methods, long-acting reversible contraceptives including intrauterine systems), hematologic (tranexamic acid and desmopressin), and surgical management options for AUB/HMB. Copyright 2015, SLACK Incorporated.
The wheat transcription factor, TabHLH39, improves tolerance to multiple abiotic stressors in transgenic plants.

Science.gov (United States)

Zhai, Yiqian; Zhang, Lichao; Xia, Chuan; Fu, Silu; Zhao, Guangyao; Jia, Jizeng; Kong, Xiuying

2016-05-13

Although bHLH transcription factors play important roles regulating plant development and abiotic stress response and tolerance, few functional studies have been performed in wheat. In this study, we isolated and characterized a bHLH gene, TabHLH39, from wheat. The TabHLH39 gene is located on wheat chromosome 5DL, and the protein localized to the nucleus and activated transcription. TabHLH39 showed variable expression in roots, stems, leaves, glumes, pistils and stamens and was induced by polyethylene glycol, salt and cold treatments. Further analysis revealed that TabHLH39 overexpression in Arabidopsis significantly enhanced tolerance to drought, salt and freezing stress during the seedling stage, which was also demonstrated by enhanced abiotic stress-response gene expression and changes to several physiological indices. Therefore, TabHLH39 has potential in transgenic breeding applications to improve abiotic stress tolerance in crops. Copyright © 2016 Elsevier Inc. All rights reserved.
Risk of Vascular Thrombotic Events Following Discontinuation of Antithrombotics After Peptic Ulcer Bleeding.

Science.gov (United States)

Kim, Seung Young; Hyun, Jong Jin; Suh, Sang Jun; Jung, Sung Woo; Jung, Young Kul; Koo, Ja Seol; Yim, Hyung Joon; Park, Jong Jae; Chun, Hoon Jai; Lee, Sang Woo

2016-04-01

To evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. Peptic ulcer bleeding associated with antithrombotics has increased due to the increase in the proportion of elderly population. Little is known about the long-term effects of discontinuing antithrombotics after peptic ulcer bleeding. The aim of this study was to evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. We reviewed the medical records of patients with ulcer bleeding who were taking antiplatelet agents or anticoagulants at the time of ulcer bleeding. Cox-regression model was used to adjust for potential confounders, and analyzed association between discontinuation of antithrombotic drugs after ulcer bleeding and thrombotic events such as ischemic heart disease or stroke. Of the 544 patients with ulcer bleeding, 72 patients who were taking antithrombotics and followed up for >2 months were analyzed. Forty patients discontinued antithrombotics after ulcer bleeding (discontinuation group) and 32 patients continued antithrombotics with or without transient interruption (continuation group). Thrombotic events developed more often in discontinuation group than in the continuation group [7/32 (21.9%) vs. 1/40 (2.5%), P=0.019]. Hazard ratio for thrombotic event when antithrombotics were continuously discontinued was 10.9 (95% confidence interval, 1.3-89.7). There were no significant differences in recurrent bleeding events between the 2 groups. Discontinuation of antithrombotics after peptic ulcer bleeding increases the risk of cardiovascular events. Therefore, caution should be taken when discontinuing antithrombotics after ulcer bleeding.
Knee arthroplasty and bleeding: when to remove drainages.

Science.gov (United States)

Ares, Oscar; Seijas, Roberto; Hernandez, Alberto; Castellet, Enric; Sallent, Andrea

2013-02-01

The aim of this study is an attempt to clarify the productive time of drainages as we find that the use of drains in knee arthroplasty is controversial, and there is no consensus regarding their length-time maintenance. We analysed the survival curve of bleeding within three surgical techniques for knee arthroplasty and the effect of two variables on survival curve. One hundred and eighty-eight out of 234 knees were included in the study, and patients were divided into three groups according to the surgical technique: conventional total knee arthroplasty (TKA), subvastus TKA and unicompartmental knee arthroplasty. Variables of study were type of surgery, number and placement of drains. Mean of survival curve for postoperative bleeding time was 16 h (95 % CI: 15.4; 16.6). The risk for longer bleeding increased 1.38-fold with each additional drain used (95 % CI 1.1; 1.8). According to the present study, drains can be safely removed at around 17 h postoperative. Bleeding time reduces as less drains are applied. Therapeutic study, Level III.
Transvaginal Ultrasound for the Diagnosis of Abnormal Uterine Bleeding.

Science.gov (United States)

Wheeler, Karen C; Goldstein, Steven R

2017-03-01

Transvaginal ultrasound is the first-line imaging test for the evaluation of abnormal uterine bleeding in both premenopausal and postmenopausal women. Transvaginal ultrasound can be used to diagnose structural causes of abnormal bleeding such as polyps, adenomyosis, leiomyomas, hyperplasia, and malignancy, and can also be beneficial in making the diagnosis of ovulatory dysfunction. Traditional 2-dimensional imaging is often enhanced by the addition of 3-dimension imaging with coronal reconstruction and saline infusion sonohysterography. In this article we discuss specific ultrasound findings and technical considerations useful in the diagnosis of abnormal uterine bleeding.
Clival chordoma manifesting as nasal bleeding. A case report

Energy Technology Data Exchange (ETDEWEB)

Kitai, Ryuhei; Yoshida, Kazuhiko; Kubota, Toshihiko; Sato, Kazufumi; Handa, Yuji; Kasahara, Kazuma [University of Fukui, Department of Neurosurgery, Fukui (Japan); Nakajima, Hirofumi [Tsuruga Municipal Hospital, Department of Neurosurgery, Fukui (Japan)

2005-05-01

Chordoma is a rare cartilaginous tumor, for which bleeding presentation is unusual. We report a case of rare hemorrhaged clival chordoma, which was diagnosed correctly by magnetic resonance imaging. A 32-year-old man presented with nasal bleeding. The tumor was totally removed via a trans-sphenoidal approach, from which the surgical specimen confirmed chordoma. Epistaxis seemed to be caused by the spreading of the intratumoral hemorrhage into the sphenoid sinus. This case demonstrates the importance of an exact differential diagnostic evaluation, including chordoma, by use of modern imaging techniques for nasal bleeding. (orig.)
Clival chordoma manifesting as nasal bleeding. A case report

International Nuclear Information System (INIS)

Kitai, Ryuhei; Yoshida, Kazuhiko; Kubota, Toshihiko; Sato, Kazufumi; Handa, Yuji; Kasahara, Kazuma; Nakajima, Hirofumi

2005-01-01

Chordoma is a rare cartilaginous tumor, for which bleeding presentation is unusual. We report a case of rare hemorrhaged clival chordoma, which was diagnosed correctly by magnetic resonance imaging. A 32-year-old man presented with nasal bleeding. The tumor was totally removed via a trans-sphenoidal approach, from which the surgical specimen confirmed chordoma. Epistaxis seemed to be caused by the spreading of the intratumoral hemorrhage into the sphenoid sinus. This case demonstrates the importance of an exact differential diagnostic evaluation, including chordoma, by use of modern imaging techniques for nasal bleeding. (orig.)

Hepatitis A and B immunization for individuals with inherited bleeding disorders.

Science.gov (United States)

Steele, M; Cochrane, A; Wakefield, C; Stain, A-M; Ling, S; Blanchette, V; Gold, R; Ford-Jones, L

2009-03-01

Hepatitis A and B vaccines are highly effective tools that can greatly reduce infection risk in the bleeding disorder population. Although hepatitis A and B immunization for individuals with bleeding disorders is universally recommended, various advisory bodies often differ with respect to many practical aspects of vaccination. To review the published literature and guidelines and form a practical, comprehensive and consistent approach to hepatitis A and B immunization for individuals with bleeding disorders. We reviewed published immunization guidelines from North American immunization advisory bodies and published statements from North American and international haemophilia advisory bodies. A search of the MEDLINE database was performed to find original published literature pertaining to hepatitis A or B immunization of patients with haemophilia or bleeding disorder patients that provided supporting or refuting evidence for advisory body guidelines. Various advisory bodies' immunization guidelines regarding individuals with bleeding disorders have contradictory statements and often did not clarify issues (e.g. post vaccination surveillance). Published literature addressing immunization in bleeding disorder patients is sparse and mostly examines route of vaccine administration, complications and corresponding antibody response. Although the risk of hepatitis A and B infection is low, the use of simple measures such as vaccination is reasonable and advocated by haemophilia advisory bodies. Following our review of the available literature and North American guidelines, we have developed comprehensive and practical recommendations addressing hepatitis A and B immunization for the bleeding disorder population that may be applicable in Bleeding Disorder clinics.
A STUDY ON UPPER GASTROINTESTINAL ENDOSCOPIC FINDINGS IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING

Directory of Open Access Journals (Sweden)

Salla Surya Prakasa Rao

2016-10-01

Full Text Available BACKGROUND Vomiting of blood almost always proximal to the ligament of Treitz is the upper gastrointestinal haemorrhage. The incidence of acute upper gastrointestinal haemorrhage has been estimated to be 50-100 per 1,00,000 person per year, with an annual hospitalization rate of approximately 100 per 1, 00,000 hospital admission. This study is to find out the prevalence of nature of lesion on Upper Gastrointestinal Endoscopy in patients admitted for Gastrointestinal bleeding. (UGI Bleed. MATERIALS AND METHODS Place of Study- Department of General Medicine, Andhra Medical College, Visakhapatnam, India. Type of Study- Prospective study. Period of Study- July 2015 to August 2016. RESULTS The Results Study on Endoscopic Findings in Upper Gastro Intestinal Bleed are 1. The peptic ulcer disease was the most common lesion found on endoscopy with prevalence of 54%. 2. Varices contributes second common lesion, next to peptic ulcer disease in UGI bleed with prevalence of 16%. 3. Minor UGI bleed was the commonest presentation. Majority of lesions (60% presented with minor UGI bleed, 28% lesions presented as moderate UGI bleed. Only 8% presented as major UGI bleed. 4. Varices account for the most common cause for major UGI bleed contributing 50%. 5. Gastric ulcer was commonest lesions accounting for 37 cases (37% among 72 cases having single acid peptic lesions on endoscopy. The second most common is duodenal ulcer (31%. 6. Multiple lesions were found in 10% of cases. Peptic ulcer lesions were found in 20% of total number of varices cases. CONCLUSION Peptic ulcer disease was found to be most common lesion causing UGI bleed, with most common presentation as minor UGI bleed and variceal bleed being most common cause of major UGI bleed.
Bleeding complications during anticoagulant treatment in patients with cancer

NARCIS (Netherlands)

Kamphuisen, Pieter W.; Beyer-Westendorf, Jan

Patients with cancer have an increased risk of bleeding complications, of which some are fatal. This risk is influenced by chemotherapy, cancer type and stage, thrombocytopenia, renal function, and previous bleeding. Since many cancer patients receive anticoagulant treatment for prophylaxis or
PENGARUH BRAND EQUITY TERHADAP KEPUTUSAN PEMBELIAN KONSUMEN PADA PRODUK SAMSUNG GALAXY TAB DI MAKASSAR

OpenAIRE

SYAHPUTRA, ANDY

2014-01-01

2014 Penelitian ini bertujuan untuk mengetahui pengaruh ekuitas merek (Brand Equity) terhadap keputusan pembelian konsumen pada produk Samsung Galaxy Tab di Makassar. Data penelitian ini diperoleh dari kusioner (primer) dengan pihak pengguna Samsung Galaxy Tab. Temuan penelitian menunjukkan bahwa variabel brand equity yang terdiri dari dimensi kesadaran merek (brand awareness), kesan kualitas (perceive quality), asosiasi merek (brand ...
Influence of surface layer removal of shade guide tabs on the measured color by spectrophotometer and spectroradiometer.

Science.gov (United States)

Kim, Jin-Cheol; Yu, Bin; Lee, Yong-Keun

2008-12-01

To determine the changes in color parameters of Vitapan 3D-Master shade guide tabs by a spectrophotometer (SP) or a spectroradiometer (SR), and by the removal of the surface layer of the tabs that was performed to make a flat measuring surface for the SP color measurement. Color of the shade tabs was measured before and after removing the surface layer of the tabs using SP and SR. Correlations between the color parameters between the original (OR) and the surface layer removed (RM) tabs and between the SP and the SR measurements were determined (alpha=0.05). Based on SP, the lightness, chroma, CIE a* and b* values measured after the surface layer removal were higher than those of the original tabs except a few cases. Based on SR, the chroma and CIE a* and b* values measured after surface layer removal were higher than those of the original tabs except a few cases; however, in case of the lightness, the changes varied by the shade designation. Type of instrument influenced the changes in color parameters based on paired t-test (pspectrophotometer or a spectroradiometer, measurement protocols should be specified because color difference by the surface layer removal and the instrument was high.
Using narrow-band imaging with conventional hysteroscopy increases the detection of chronic endometritis in abnormal uterine bleeding and postmenopausal bleeding.

Science.gov (United States)

Ozturk, Mustafa; Ulubay, Mustafa; Alanbay, Ibrahim; Keskin, Uğur; Karasahin, Emre; Yenen, Müfit Cemal

2016-01-01

A preliminary study was designed to evaluate whether a narrow-band imaging (NBI) endoscopic light source could detect chronic endometritis that was not identifiable with a white light hysteroscope. A total of 86 patients with endometrial pathology (71 abnormal uterine bleeding and 15 postmenopausal bleeding) were examined by NBI endoscopy and white light hysteroscopy between February 2010 and February 2011. The surgeon initially observed the uterine cavity using white light hysteroscopy and made a diagnostic impression, which was recorded. Subsequently, after pressing a button on the telescope, NBI was used to reevaluate the endometrial mucosa. The median age of the patients was 40 years (range: 30-60 years). Endometritis was diagnosed histologically. Six cases of abnormal uterine bleeding (6/71, 8.4%, 95% confidence interval [CI] 0.03-0.17) and one case of postmenopausal bleeding (1/15, 6%, 95%CI 0.01-0.29) were only diagnosed with chronic endometritis by NBI (7/86, 8.1%, 95%CI 0.04-0.15). Capillary patterns of the endometrium can be observed by NBI and this method can be used to assess chronic endometritis. © 2015 Japan Society of Obstetrics and Gynecology.
Arterial embolization of a bleeding gastric Dieulafoy lesion: a case report.

Science.gov (United States)

Mohd Rizal, M Y; Kosai, N R; Sutton, P A; Rozman, Z; Razman, J; Harunarashid, H; Das, S

2013-01-01

Dieulafoy's lesion is one of an unusual cause of upper gastrointestinal bleeding (U GIB). Endoscopic intervention has always been a preferred non-surgical method in treating UGIB including bleeding from Dieulafoy's lesion. Owing to recent advances in angiography, arterial embolization has become a popular alternative in non- variceal UGIB especially in cases with failed endoscopic treatment. However, managing bleeding Dieulafoy's with selective arterial embolization as the first line of treatment has not been exclusively practiced. We hereby, report a case of bleeding Dieulafoy lesion which had been primarily treated with arterial embolization.
Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI).

Science.gov (United States)

Stępińska, Janina; Czerwińska, Katarzyna; Witkowski, Adam; Dąbrowski, Maciej; Chmielak, Zbigniew; Kuśmierski, Krzysztof; Hryniewiecki, Tomasz; Demkow, Marcin

2013-01-01

The risk of bleedings in transcatheter aortic valve implantation (TAVI) patients increases due to age and concomitant diseases. The aim of the study was to assess the risk of bleedings, their influence on early prognosis of TAVI patients and utility of the TIMI and GUSTO scales in the evaluation of bleeding and in prediction of blood transfusion. This was a single center study of in-hospital bleedings in 56 consecutive TAVI patients. Bleedings were classified according to the GUSTO and TIMI scales. HASBLED's scale risk factors, diabetes mellitus, female sex, the route of bioprosthesis implantation and inhospital antithrombotic treatment were analyzed. Statistical analysis consisted of c2, Fisher's exact, Wilcoxon tests and logistic regression analysis. Serious bleedings occurred in 35 (62.5%) patients. There was no significant correlation with HASBLED score. History of anemia was a significant predictor of bleeding in GUSTO (p = 0.0013) and TIMI (p = 0.048) scales. No bleedings in patients receiving vitamin K antagonists (VKA) pre- and VKA plus clopidogrel post intervention were observed. Patients with bleedings according to the GUSTO scale more often required blood tranfusion than in TIMI scale (p = 0.03). History of anemia is the strongest predictor of serious bleedings. VKA before and VKA with clopidogrel after TAVI are safer than dual antiplatelet or triple therapy. The TIMI and GUSTO scales can adequately classify bleeding after TAVI, however the GUSTO better predicts transfusions.
Selective CT mesentericography in the diagnostics of obscure overt intestinal bleeding: preliminary results

International Nuclear Information System (INIS)

Schuermann, K.; Buecker, A.; Tacke, J.; Schmitz-Rode, T.; Guenther, R.W.; Jansen, M.

2002-01-01

Aim: To evaluate intra-arterial CT mesentericography (CTM) in the diagnostics of severe obscure overt intestinal bleeding in comparison with conventional mesentericography (MG) and surgery. Methods: In 8 patients (23 - 82 years, mean 59 years), CTM was performed via the catheter left in the superior mesenteric artery after MG to detect the source of bleeding. Early and late-phase spiral CT scans were acquired after administration of contrast medium. Active bleeding was considered to be present if extravasation of contrast medium into the bowel was found. The results of MG and CTM were compared with the results of surgery. Results: With MG active bleeding was found in one patient, with CTM in five patients. In three patients, both MG and CTM were negative. Six patients underwent surgery. Five cases of bleeding detected with CTM were confirmed by surgery. In one case, bleeding found with CTM was not confirmed by surgery. One patient underwent surgery although all imaging procedures were negative. The source of bleeding remained unknown. Surgically, the site of bleeding was located in the jejunum in 3 patients (jejunitis, jejunal ulcers, carcinoid), one patient had a diverticulum in the ascending colon. The colonic bleeding site was correctly localized with CTM, whereas the small bowel bleeding could only roughly be assigned to the proximal or distal jejunum or jejunoileal transition area. Conclusion: Preliminary results indicate that selective CTM is superior to MG in the evaluation of severe obscure overt intestinal bleeding. (orig.) [de
An automated database case definition for serious bleeding related to oral anticoagulant use.

Science.gov (United States)

Cunningham, Andrew; Stein, C Michael; Chung, Cecilia P; Daugherty, James R; Smalley, Walter E; Ray, Wayne A

2011-06-01

Bleeding complications are a serious adverse effect of medications that prevent abnormal blood clotting. To facilitate epidemiologic investigations of bleeding complications, we developed and validated an automated database case definition for bleeding-related hospitalizations. The case definition utilized information from an in-progress retrospective cohort study of warfarin-related bleeding in Tennessee Medicaid enrollees 30 years of age or older. It identified inpatient stays during the study period of January 1990 to December 2005 with diagnoses and/or procedures that indicated a current episode of bleeding. The definition was validated by medical record review for a sample of 236 hospitalizations. We reviewed 186 hospitalizations that had medical records with sufficient information for adjudication. Of these, 165 (89%, 95%CI: 83-92%) were clinically confirmed bleeding-related hospitalizations. An additional 19 hospitalizations (10%, 7-15%) were adjudicated as possibly bleeding-related. Of the 165 clinically confirmed bleeding-related hospitalizations, the automated database and clinical definitions had concordant anatomical sites (gastrointestinal, cerebral, genitourinary, other) for 163 (99%, 96-100%). For those hospitalizations with sufficient information to distinguish between upper/lower gastrointestinal bleeding, the concordance was 89% (76-96%) for upper gastrointestinal sites and 91% (77-97%) for lower gastrointestinal sites. A case definition for bleeding-related hospitalizations suitable for automated databases had a positive predictive value of between 89% and 99% and could distinguish specific bleeding sites. Copyright © 2011 John Wiley & Sons, Ltd.
Bleed-through correction for rendering and correlation analysis in multi-colour localization microscopy

International Nuclear Information System (INIS)

Kim, Dahan; Curthoys, Nikki M; Parent, Matthew T; Hess, Samuel T

2013-01-01

Multi-colour localization microscopy has enabled sub-diffraction studies of colocalization between multiple biological species and quantification of their correlation at length scales previously inaccessible with conventional fluorescence microscopy. However, bleed-through, or misidentification of probe species, creates false colocalization and artificially increases certain types of correlation between two imaged species, affecting the reliability of information provided by colocalization and quantified correlation. Despite the potential risk of these artefacts of bleed-through, neither the effect of bleed-through on correlation nor methods for its correction in correlation analyses have been systematically studied at typical rates of bleed-through reported to affect multi-colour imaging. Here, we present a reliable method of bleed-through correction applicable to image rendering and correlation analysis of multi-colour localization microscopy. Application of our bleed-through correction shows that our method accurately corrects the artificial increase in both types of correlation studied (Pearson coefficient and pair correlation), at all rates of bleed-through tested, in all types of correlation examined. In particular, anti-correlation could not be quantified without our bleed-through correction, even at rates of bleed-through as low as 2%. While it is demonstrated with dichroic-based multi-colour FPALM here, our presented method of bleed-through correction can be applied to all types of localization microscopy (PALM, STORM, dSTORM, GSDIM, etc), including both simultaneous and sequential multi-colour modalities, provided the rate of bleed-through can be reliably determined. (special issue article)
Successful Management of Neobladder Variceal Bleeding

Energy Technology Data Exchange (ETDEWEB)

Atwal, Dinesh; Chatterjee, Kshitij, E-mail: kchatterjee@uams.edu [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Osborne, Scott [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Kakkera, Krishna; Deas, Steven [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Li, Ruizong [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Erbland, Marcia [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States)

2016-10-15

Hematuria from a neobladder can occur due to a variety of pathologies including tumors, stones, and fistulas. Variceal bleeding in a neobladder is a very rare condition with only one case reported in literature. We present a case of a patient with cirrhosis and portal hypertension and an ileocolic orthotopic neobladder presenting with hematuria. Computed tomographic angiography showed dilated varices around the neobladder which were successfully embolized. To the best of our knowledge, this is the first report case of variceal bleeding in a neobladder successfully managed with the combination of TIPS (transjugular intrahepatic portosystemic shunt) procedure and embolization.
Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration

Directory of Open Access Journals (Sweden)

Pratibha Singh

2018-01-01

Full Text Available Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB, especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. Materials and Methods: We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic were used to retrieve data. Results: One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41–45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Discussion: Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Conclusion: Endometrial aspiration is a simple, safe, and
Cellular uptake of magnetite nanoparticles enhanced by NdFeB magnets in staggered arrangement

Science.gov (United States)

Lu, Yi-Ching; Chang, Fan-Yu; Tu, Shu-Ju; Chen, Jyh-Ping; Ma, Yunn-Hwa

2017-04-01

Magnetic force may greatly enhance uptake of magnetic nanoparticles (MNPs) by cultured cells; however, the effects of non-uniformity of magnetic field/ magnetic gradient on MNP internalization in culture has not been elucidated. Cellular uptake of polyacrylic acid coated-MNP by LN229 cells was measured with cylindrical NdFeB magnets arranged in a staggered pattern. The magnetic field generated by placing a magnet underneath (H-field) elicited a homogenous distribution of MNPs on the cells in culture; whereas the field without magnet underneath (L-field) resulted in MNP distribution along the edge of the wells. Cell-associated MNP (MNPcell) appeared to be magnetic field- and concentration-dependent. In H-field, MNPcell reached plateau within one hour of exposure to MNP with only one-min application of the magnetic force in the beginning of incubation; continuous presence of the magnet for 2 h did not further increase MNPcell, suggesting that magnetic force-induced uptake may be primarily contributed to enhanced MNP sedimentation. Although MNP distribution was much inhomogeneous in L-field, averaged MNPcell in the L-field may reach as high as 80% of that in H-field during 1-6 h incubation, suggesting high capacity of MNP internalization. In addition, no significant difference was observed in MNPcell analyzed by flow cytometry with the application of H-field of staggered plate vs. filled magnet plate. Therefore, biological variation may dominate MNP internalization even under relatively uniformed magnetic field; whereas non-uniformed magnetic field may serve as a model for tumor targeting with MNPs in vivo.
Recombinant activated factor VII for uncontrolled bleeding postcardiac surgery

Directory of Open Access Journals (Sweden)

Aly Makram Habib

2016-10-01

Conclusion: In this analysis, rFVIIa succefully reduced the chest tube bleeding and blood products transfused during severe post cardiac surgical bleeding. However, safety of rFVIIa remains unclear. Prospective controlled trials are still needed to confirm the role of rFVIIa.
[Gastrointestinal bleeding--concepts of surgical therapy in the upper gastrointestinal tract].

Science.gov (United States)

Knoefel, W T; Rehders, A

2006-02-01

Bleeding of the upper gastrointestinal tract is the main symptom of a variety of possible conditions and still results in considerable mortality. Endoscopy is the first diagnostic modality, enabling rapid therapeutic intervention. In case of intractable or relapsing bleeding, surgery is often inevitable. However, emergency operations result in significantly higher mortality rates. Therefore the option of early elective surgical intervention should be considered for patients at increased risk of relapsing bleeding. If bleeding is symptomatic due to a complex underlying condition such as hemosuccus pancreaticus or hemobilia, angiography is now recognized as the definitive investigation. Angiographic hemostasis can be achieved in most cases. Due to the underlying condition, surgical management still remains the mainstay in treating these patients. This paper reviews surgical strategy in handling upper gastrointestinal bleeding.
Hemospray application in nonvariceal upper gastrointestinal bleeding

DEFF Research Database (Denmark)

Smith, Lyn A; Stanley, Adrian J; Bergman, Jacques J

2013-01-01

BACKGROUND: Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe. GOALS: We present the operating characteristics and performance of TC-325 in the largest registry to date of patients presenting with NVUGIB in everyday...... in combination with other hemostatic modalities at the endoscopists' discretion. RESULTS: Sixty-three patients (44 men, 19 women), median age 69 (range, 21 to 98) years with NVUGIB requiring endoscopic hemostasis were treated with TC-325. There were 30 patients with bleeding ulcers and 33 with other NVUGIB...... pathology. Fifty-five (87%) were treated with TC-325 as monotherapy; 47 [85%; 95% confidence interval (CI), 76%-94%] of them achieved primary hemostasis, and rebleeding rate at 7 days was 15% (95% CI, 5%-25%). Primary hemostasis rate for TC-325 in patients with ulcer bleeds was 76% (95% CI, 59%-93%). Eight...
PALM-COEIN Nomenclature for Abnormal Uterine Bleeding.

Science.gov (United States)

Deneris, Angela

2016-05-01

Approximately 30% of women will experience abnormal uterine bleeding (AUB) during their life time. Previous terms defining AUB have been confusing and imprecisely applied. As a consequence, both clinical management and research on this common problem have been negatively impacted. In 2011, the International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Group (FMDG) published PALM-COEIN, a new classification system for abnormal bleeding in the reproductive years. Terms such as menorrhagia, menometrorrhagia, metrorrhagia, dysfunctional uterine bleeding, polymenorrhea, oligomenorrhea, and uterine hemorrhage are no longer recommended. The PALM-COEIN system was developed to standardize nomenclature to describe the etiology and severity of AUB. A brief description of the PALM-COEIN nomenclature is presented as well as treatment options for each etiology. Clinicians will frequently encounter women with AUB and should report findings utilizing the PALM-COEIN system. © 2016 by the American College of Nurse-Midwives.
Endovascular Management of Acute Bleeding Arterioenteric Fistulas

International Nuclear Information System (INIS)

Leonhardt, Henrik; Mellander, Stefan; Snygg, Johan; Loenn, Lars

2008-01-01

The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered
Abnormal Uterine Bleeding including coagulopathies and other menstrual disorders.

Science.gov (United States)

Deligeoroglou, Efthimios; Karountzos, Vasileios

2018-04-01

Abnormal Uterine Bleeding (AUB) is a frequent cause of visits to the emergency department and a major reason for concern among adolescents and their families. The most common cause of AUB, in otherwise healthy adolescents, is ovulatory dysfunction, although 5-36% of adolescents who present with heavy menstrual bleeding, have an underlying bleeding disorder (BD). The most common form of BDs is von Willebrand Disease, reflecting 13% of adolescents with AUB. Management of AUB depends on the underlying etiology, the bleeding severity, as well as the need for hospitalization. Treatment of adolescents with an underlying coagulopathy depends on the severity of the BD, while therapeutic interventions are summarized in supportive measures, hormonal treatments (e.g. Combined Oral Contraceptives), non-hormonal treatments (e.g. tranexamic acid and desmopressin), surgical options (e.g. dilatation & curettage) and treatment options in specific conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improvements of the base bleed effect using reactive particles

Energy Technology Data Exchange (ETDEWEB)

Bournot, Herve; Daniel, Eric [Polytech' Marseille, IUSTI UMR CNRS 6595, 5, rue E. Fermi, Technopole de Chateau Gombert, 13453 Marseille cedex 13 (France); Cayzac, Roxan [Giat Industries, 7, Route de Guerry, F-18023 Bourges cedex (France)

2006-11-15

A numerical study of the base drag reduction of axisymmetric body projectiles in supersonic flight using a base bleed injection is presented in this paper. Unsteady computations of compressible viscous flow have been achieved in order to investigate the coupled effect of the bleed temperature and the bleed mass flow rate on the base pressure. The idea developed in the study, consists in the addition of metallic particles in the propellant composition used to provide the additional mass injected in order to obtain the lowest base drag. Indeed, for a low mass addition, a significant increase of the mixture energy is expected due to the particles combustion. Base flow with reactive two-phase injection is then simulated. Results show the ability of the method to describe such flows and the efficiency of the particles combustion to increase the base bleed reducing drag effect. (author)
Numerical simulation of the effects of hanging sound absorbers on TABS cooling performance

DEFF Research Database (Denmark)

Rage, Nils; Kazanci, Ongun Berk; Olesen, Bjarne W.

2016-01-01

simulating a two-person office of 20 m2, with a typical cooling load of 42 W/m2. The results show that covering 60% of the ceiling surface with sound absorbers hanging at 300 mm from the ceiling active deck is expected to reduce the cooling capacity coefficient of TABS by 15.8%. This drops to 25......Recently there has been a considerable increase in the use of Thermally-Active Building Systems (TABS) in Europe as an energy-efficient and economical cooling and heating solution for buildings. However, this widespread solution requires large uncovered hard surfaces indoors, which can lead...... to a degradation of the room acoustic comfort. Therefore, challenges arise when this system has to be combined with acoustic requirements. Soffit-hanging sound absorbers embody a promising solution. This study focuses on quantifying their impact on the cooling performance of TABS, assessed by means of the cooling...
Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators.

Science.gov (United States)

D'Amico, Gennaro; De Franchis, Roberto

2003-09-01

Several treatments have been proven to be effective for variceal bleeding in patients with cirrhosis. The aim of this multicenter, prospective, cohort study was to assess how these treatments are used in clinical practice and what are the posttherapeutic prognosis and prognostic indicators of upper digestive bleeding in patients with cirrhosis. A training set of 291 and a test set of 174 bleeding cirrhotic patients were included. Treatment was according to the preferences of each center and the follow-up period was 6 weeks. Predictive rules for 5-day failure (uncontrolled bleeding, rebleeding, or death) and 6-week mortality were developed by the logistic model in the training set and validated in the test set. Initial treatment controlled bleeding in 90% of patients, including vasoactive drugs in 27%, endoscopic therapy in 10%, combined (endoscopic and vasoactive) in 45%, balloon tamponade alone in 1%, and none in 17%. The 5-day failure rate was 13%, 6-week rebleeding was 17%, and mortality was 20%. Corresponding findings for variceal versus nonvariceal bleeding were 15% versus 7% (P =.034), 19% versus 10% (P =.019), and 20% versus 15% (P =.22). Active bleeding on endoscopy, hematocrit levels, aminotransferase levels, Child-Pugh class, and portal vein thrombosis were significant predictors of 5-day failure; alcohol-induced etiology, bilirubin, albumin, encephalopathy, and hepatocarcinoma were predictors of 6-week mortality. Prognostic reassessment including blood transfusions improved the predictive accuracy. All the developed prognostic models were superior to the Child-Pugh score. In conclusion, prognosis of digestive bleeding in cirrhosis has much improved over the past 2 decades. Initial treatment stops bleeding in 90% of patients. Accurate predictive rules are provided for early recognition of high-risk patients.
Pattern not volume of bleeding predicts angiographic vasospasm in nonaneurysmal subarachnoid hemorrhage.

Science.gov (United States)

Raya, Amanda; Zipfel, Gregory J; Diringer, Michael N; Dacey, Ralph G; Derdeyn, Colin P; Rich, Keith M; Chicoine, Michael R; Dhar, Rajat

2014-01-01

Spontaneous idiopathic subarachnoid hemorrhage (SAH) with a perimesencephalic bleeding pattern is usually associated with a benign course, whereas a diffuse bleeding pattern has been associated with a higher risk of vasospasm and disability. We evaluated whether volume of bleeding explains this disparity. Pattern and amount of bleeding (by Hijdra and intraventricular hemorrhage scores) were assessed in 89 patients with nonaneurysmal SAH. Outcomes included angiographic vasospasm, delayed cerebral ischemia, and functional outcome at 1 year. Diffuse bleeding was associated with significantly higher Hijdra and intraventricular hemorrhage scores than perimesencephalic SAH, P≤0.003. Angiographic vasospasm was more likely in diffuse versus perimesencephalic SAH (45% versus 27%; odds ratio, 2.9; P=0.08), but adjustment for greater blood burden only partially attenuated this trend (adjusted odds ratio, 2.2; 95% confidence interval, 0.69-7.2; P=0.18); delayed cerebral ischemia was only seen in those with diffuse bleeding. Patients with diffuse bleeding were less likely to be discharged home (68% versus 90%; P=0.01) and tended to have more residual disability (modified Rankin scale, 3-6; 20% versus 6%; P=0.18). Nonaneurysmal SAH can still result in vasospasm and residual disability, especially in those with diffuse bleeding. This disparity is only partially accounted for by greater cisternal or intraventricular blood, suggesting that the mechanism and distribution of bleeding may be as important as the amount of hemorrhage in patients with idiopathic SAH.
Savings through the use of adaptive predictive control of thermo-active building systems (TABS): A case study

International Nuclear Information System (INIS)

Schmelas, Martin; Feldmann, Thomas; Bollin, Elmar

2017-01-01

Highlights: •An adaptive and predictive algorithm for the control of TABS (AMLR) is evaluated. •Comparison of standard TABS control and AMLR over a period of nine month each. •Thermal comfort, energy and investment savings in a passive seminar building. •Reduction of peak power of chilled beams (auxiliary system) with AMLR algorithm. •Simplification of the TABS hydraulics with AMLR algorithm. -- Abstract: The building sector is one of the main consumers of energy. Therefore, heating and cooling concepts for renewable energy sources become increasingly important. For this purpose, low-temperature systems such as thermo-active building systems (TABS) are particularly suitable. This paper presents results of the use of a novel adaptive and predictive computation method, based on multiple linear regression (AMLR) for the control of TABS in a passive seminar building. Detailed comparisons are shown between the standard TABS and AMLR strategies over a period of nine months each. In addition to the reduction of thermal energy use by approx. 26% and a significant reduction of the TABS pump operation time, this paper focuses on investment savings in a passive seminar building through the use of the AMLR strategy. This includes the reduction of peak power of the chilled beams (auxiliary system) as well as a simplification of the TABS hydronic circuit and the saving of an external temperature sensor. The AMLR proves its practicality by learning from the historical building operation, by dealing with forecasting errors and it is easy to integrate into a building automation system.
Two-color lattice QCD with staggered quarks

Energy Technology Data Exchange (ETDEWEB)

Scheffler, David

2015-07-20

The study of quantum chromodynamics (QCD) at finite temperature and density provides important contributions to the understanding of strong-interaction matter as it is present e.g. in nuclear matter and in neutron stars or as produced in heavy-ion collision experiments. Lattice QCD is a non-perturbative approach, where equations of motion for quarks and gluons are discretized on a finite space-time lattice. The method successfully describes the behavior of QCD in the vacuum and at finite temperature, however it cannot be applied to finite baryon density due to the fermion sign problem. Various QCD-like theories, that offer to draw conclusions about QCD, allow simulations also at finite densities. In this work we investigate two-color QCD as a popular example of a QCD-like theory free from the sign problem with methods from lattice gauge theory. For the generation of gauge configurations with two dynamical quark flavors in the staggered formalism with the ''rooting trick'' we apply the Rational Hybrid Monte Carlo (RHMC) algorithm. We carry out essential preparatory work for future simulations at finite density. As a start, we concentrate on the calculation of the effective potential for the Polyakov loop, which is an order parameter for the confinement-deconfinement transition, in dependence of the temperature and quark mass. It serves as an important input for effective models of QCD. We obtain the effective potential via the histogram method from local distributions of the Polyakov loop. To study the influence of dynamical quarks on gluonic observables, the simulations are performed with large quark masses and are compared to calculations in the pure gauge theory. In the second part of the thesis we examine aspects of the chiral phase transition along the temperature axis. The symmetry group of chiral symmetry in two-color QCD is enlarged to SU(2N{sub f}). Discretized two-color QCD in the staggered formalism exhibits a chiral symmetry breaking
The phase diagram of high temperature QCD with three flavors of improved staggered quarks

International Nuclear Information System (INIS)

Bernard, C.; Burch, T.; DeTar, C.E.; Gottlieb, Steven; Gregory, E.B.; Heller, U.M.; Hetrick, J.E.; Sugar, R.L.; Toussaint, D.

2004-01-01

We report on progress in our study of high temperature QCD with three flavors of improved staggered quarks. Simulations are being carried out with three degenerate quarks with masses less than or equal to the strange quark mass, m s , and with degenerate up and down quarks with masses in the range 0.1 m s ≤ m u,d ≤ 0.6 m s , and the strange quark mass fixed near its physical value. For the quark masses studied to date we find rapid crossovers, which sharpen as the quark mass is reduced, rather than bona fide phase transitions
Clinical approach to a patient with abnormal uterine bleeding

African Journals Online (AJOL)

bleeding, type, appearance, duration, cyclicity and associated ... Clinical approach. In all cases where the main complaint is that of excessive menstrual bleeding, an immediate differentiation must be made between acute severe blood loss and chronic excessive ... management rules can be implemented. In such patients ...
Computed tomography angiography in patients with active gastrointestinal bleeding

Energy Technology Data Exchange (ETDEWEB)

Reis, Fatima Regina Silva; D' Ippolito, Giuseppe, E-mail: fatima.rsreis@gmail.com [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Cardia, P.P. [Hospital Vera Cruz, Campinas, SP (Brazil)

2015-11-15

Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. (author)
Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding

International Nuclear Information System (INIS)

Chua, A. E.; Ridley, L. J.

2008-01-01

Full text: The aim of the study was to carry out a systematic review determining the accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding. A search of published work in Medline and manual searching of reference lists of articles was conducted. Studies were included if they compared CT angiography to a reference standard of upper gastrointestinal endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute gastrointestinal bleeding. Eight published studies evaluating 129 patients were included. Data were used to form 2 x2 tables. Computed tomography angiography showed pooled sensitivity of 86% (95% confidence interval 78-92%) and specificity of 95% (95% confidence interval 76-100%), without showing significant heterogeneity (x 2 = 3.5, P=0.6) and (x 2 - 5.4, P = 0.6), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.93. Computed tomography angiography is accurate in the diagnosis of acute gastrointestinal bleeding and can show the precise location and aetiology of bleeding, thereby directing further management. Strong recommendations for use of CT cannot be made from this review because of the methodological limitations and further large prospective studies are needed to define the role of CT in acute gastrointestinal bleeding.
Approach to upper gastrointestinal bleeding

African Journals Online (AJOL)

Benign ulcer. Mallory-Weiss tear .... pressure and direct thermal coagulation. Alternatively, use ... Forrest classification of peptic ulcer bleeding related to risks of rebleeding. (NBVV - non- .... esomeprazole for prevention of recurrent peptic ulcer ...
Severity and Features of Epistaxis in Children with a Mucocutaneous Bleeding Disorder

NARCIS (Netherlands)

Stokhuijzen, Eva; Segbefia, Catherine I.; Biss, Tina T.; Clark, Dewi S.; James, Paula D.; Riddel, Jim; Blanchette, Victor S.; Rand, Margaret L.

2018-01-01

Objective To use standardized bleeding questionnaires to compare the severity and patterns of epistaxis in children with a mucocutaneous bleeding disorder and control children. Study design The epistaxis sections of the Pediatric Bleeding Questionnaire (PBQ) administered to pediatric patients with
Abnormal uterine bleeding in reproductive-aged women.

Science.gov (United States)

Matthews, Michelle L

2015-03-01

Abnormal uterine bleeding is a common medical condition with several causes. The International Federation of Gynecology and Obstetrics published guidelines in 2011 to develop universally accepted nomenclature and a classification system. In addition, the American College of Obstetrics and Gynecology recently updated recommendations on evaluation of abnormal uterine bleeding and indications for endometrial biopsies. This article reviews both medical and surgical treatments, including meta-analysis reviews of the most effective treatment options. Copyright © 2015 Elsevier Inc. All rights reserved.
Bronchoscopic intratumoral injection of tranexamic acid to prevent excessive bleeding during multiple forceps biopsies of lesions with a high risk of bleeding: a prospective case series

International Nuclear Information System (INIS)

Zamani, Adil

2014-01-01

Significant bleeding may occur following endobronchial forceps biopsy or brushing of necrotic or hypervascular tumors in the airways. In some cases, methods such as endobronchial instillation of iced saline lavage and epinephrine may fail to control bleeding. The present study evaluated the efficacy and safety of a new bronchoscopic technique using intratumoral injection of tranexamic acid (IIT) for control of bleeding during forceps biopsy in patients with endobronchial tumors with a high risk of bleeding. The study was a prospective case series carried out in a single center. Bronchoscopic IIT was performed in those patients who had endoscopically visible tumoral lesions with persistent active bleeding following the first attempt at bronchoscopic sampling. Tranexamic acid (TEA) was injected through a 22-gauge Wang cytology needle into the lesion in nominal doses of 250–500 mg. After 2–3 minutes, multiple forceps biopsy specimens were obtained from the lesion. Of the 57 consecutive patients included in the study, 20 patients (35.1%) underwent bronchoscopic IIT. The first attempt in 18 patients was endobronchial forceps biopsy (EBB), and because of a high risk of bleeding, the first attempt for the remaining two patients, who were on continuous dual antiplatelet therapy (aspirin and clopidogrel), employed endobronchial needle aspiration (EBNA) as a precautionary measure. Following IIT, subsequent specimens were obtained using EBB in all patients. Multiple forceps biopsy specimens (3–10) were obtained from the lesions (8 necrotic and 12 hypervascular) without incurring active bleeding. The following histopathologic diagnoses were made: squamous cell carcinoma (n = 14), adenocarcinoma (n = 2), small-cell lung cancer (n = 3), and malignant mesenchymal tumor (n = 1). No side effects of TEA were observed. Bronchoscopic IIT is a useful and safe technique for controlling significant bleeding from a forceps biopsy procedure and can be considered as a pre
Revisiting the phylogeny of Zoanthidea (Cnidaria: Anthozoa): Staggered alignment of hypervariable sequences improves species tree inference.

Science.gov (United States)

Swain, Timothy D

2018-01-01

The recent rapid proliferation of novel taxon identification in the Zoanthidea has been accompanied by a parallel propagation of gene trees as a tool of species discovery, but not a corresponding increase in our understanding of phylogeny. This disparity is caused by the trade-off between the capabilities of automated DNA sequence alignment and data content of genes applied to phylogenetic inference in this group. Conserved genes or segments are easily aligned across the order, but produce poorly resolved trees; hypervariable genes or segments contain the evolutionary signal necessary for resolution and robust support, but sequence alignment is daunting. Staggered alignments are a form of phylogeny-informed sequence alignment composed of a mosaic of local and universal regions that allow phylogenetic inference to be applied to all nucleotides from both hypervariable and conserved gene segments. Comparisons between species tree phylogenies inferred from all data (staggered alignment) and hypervariable-excluded data (standard alignment) demonstrate improved confidence and greater topological agreement with other sources of data for the complete-data tree. This novel phylogeny is the most comprehensive to date (in terms of taxa and data) and can serve as an expandable tool for evolutionary hypothesis testing in the Zoanthidea. Spanish language abstract available in Text S1. Translation by L. O. Swain, DePaul University, Chicago, Illinois, 60604, USA. Copyright © 2017 Elsevier Inc. All rights reserved.
[sup 99m]Tc-RBC subtraction scintigraphy; Assessmet of bleeding site and rate

Energy Technology Data Exchange (ETDEWEB)

Inagaki, Syoichi; Tonami, Syuichi; Yasui, Masakazu; Kuranishi, Makoto; Sugishita, Kouki; Nakamura, Mamoru (Toyama Medical and Pharmaceutical Univ. (Japan). Hospital)

1994-03-01

Sequential abdominal scintigrams with [sup 99m]Tc-labelled red blood cells (RBC) were subtracted for observing a site of gastrointestinal bleeding and calculating the bleeding rate. This method is technically very easy and can detect the site of bleeding with the minimum rate, as low as 0.2 ml/min., in a phantom experiment. In 23 cases with final diagnosis of gastrointestinal bleeding, conventional non-subtraction scintigraphy detected only 30% (7/23), but subtraction scintigraphy detected 61% (14/23). It was concluded that subtraction scintigraphy had higher sensitivity than conventional scintigraphy for early diagnosing bleeding. A combination of non-subtraction and subtraction scintigraphy is recommended to detect a site of gastrointestinal bleeding in a clinical setting. (author).
Galaxy Tab Covers Samsung TouchWiz Interface

CERN Document Server

Gralla, Preston

2011-01-01

Galaxy Tab lets you work, play, read, and connect on the go, but mastering its TouchWiz interface and finding the best apps can be tricky-unless you have this Missing Manual. Gadget whiz Preston Gralla provides crystal-clear explanations and step-by-step instructions to get you up to speed quickly, whether you have the 3G/4G or Wi-Fi version of this amazing device. The important stuff you need to know: Design your experience. Add interactive widgets and mini-apps to your screen with TouchWiz.Satisfy your appetite. Download thousands of games and apps from the Android Market.Keep in touch. Ch
Post-partum hemorrhage in women with rare bleeding disorders.

Science.gov (United States)

Peyvandi, Flora; Menegatti, Marzia; Siboni, Simona Maria

2011-02-01

Post-partum hemorrhage (PPH) accounts for a substantial fraction of maternal deaths in the general population. Among all women, however, those affected with rare bleeding disorders (RBDs) represent a particular group since to usual bleeding symptoms, they are likely to experience bleedings associated to obstetrical and gynaecological problems. Pregnancy and childbirth, two important stages in the life of a woman, pose a special clinical challenge in women with RBDs, since information about these issues are really scarce and limited to few case reports. These data show that all women with RBDs, except for FXI deficiency, have to be considered potentially at risk for developing PPH, therefore they should be monitored carefully during and immediately after pregnancy. The implication is that women with bleeding disorders may require prophylaxis and/or close observation for several weeks and should be followed by a multidisciplinary team including expertises such as laboratory haematologist, obstetrician-gynaecologist, anaesthesiologist, family physician, and laboratory technician. © 2011 Elsevier Ltd. All rights reserved.
Management of bleeding gastroduodenal ulcers

DEFF Research Database (Denmark)

Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

2012-01-01

Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved by the D......Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved......) again as soon as cardiovascular risks outweigh gastrointestinal risks. Patients in need of continued treatment with ASA or a nonsteroidal anti-inflammatory drug should be put on prophylactic treatment with PPI at standard dosage. The combination of 75mg ASA and PPI should be preferred to monotherapy...
Factors associated with delayed bleeding after resection of large nonpedunculated colorectal polyps.

Science.gov (United States)

Elliott, Timothy R; Tsiamoulos, Zacharias P; Thomas-Gibson, Siwan; Suzuki, Noriko; Bourikas, Leonidas A; Hart, Ailsa; Bassett, Paul; Saunders, Brian P

2018-04-06

Delayed bleeding is the most common significant complication after piecemeal endoscopic mucosal resection (p-EMR) of large nonpedunculated colorectal polyps (NPCPs). Risk factors for delayed bleeding are incompletely defined. We aimed to determine risk factors for delayed bleeding following p-EMR. Data were analyzed from a prospective tertiary center audit of patients with NPCPs ≥ 20 mm who underwent p-EMR between 2010 and 2012. Patient, polyp, and procedure-related data were collected. Four post p-EMR defect factors were evaluated for interobserver agreement and included in analysis. Delayed bleeding severity was reported in accordance with guidelines. Predictors of bleeding were identified. Delayed bleeding requiring hospitalization occurred after 22 of 330 procedures (6.7 %). A total of 11 patients required blood transfusion; of these, 4 underwent urgent colonoscopy, 1 underwent radiological embolization, and 1 required surgery. Interobserver agreement for identification of the four post p-EMR defect factors was moderate (kappa range 0.52 - 0.57). Factors associated with delayed bleeding were visible muscle fibers ( P = 0.03) and the presence of a "cherry red spot" ( P = 0.05) in the post p-EMR defect. Factors not associated with delayed bleeding were American Association of Anesthesiologists class, aspirin use, polyp size, site, and use of argon plasma coagulation. Visible muscle fibers and the presence of a "cherry red spot" in the resection defect were associated with delayed bleeding after p-EMR. These findings suggest evaluation and photodocumentation of the post p-EMR defect is important and, when considered alongside other patient and procedural factors, may help to reduce the incidence and severity of delayed bleeding. © Georg Thieme Verlag KG Stuttgart · New York.

Transvaginal sonography in abnormal uterine bleeding and correlation to hysteroscopy

International Nuclear Information System (INIS)

Saeed, S.; Shah, S.; Ali, H.; Khan, S.; Ehsan, N.; Ahmed, S.Z.

2017-01-01

To correlate results of Transvaginal sonography with those of hysteroscopy and biopsy in abnormal uterine bleeding to estimate the accuracy and analytical values of non-invasive transvaginal sonography in abnormal uterine bleeding. Methodology: This cross-sectional Study was carried out at BMCH, Quetta, Balochistan, Pakistan from March 2013 to February 2014 and included 200 patients of abnormal uterine bleeding. Exclusion criteria were pregnancy, virginity, local bleeding of perineal or vaginal origin. Hysteroscopy and biopsy and Transvaginal Ultrasound (TVS) were performed in all. Result: The most common type of bleeding was found to be menorrhagia in 39% while the least common type was postmenopausal bleeding in 9%. Mean endometrial thickness was 11.64 mm and it was noted that at less than 14mm thickness no serious pathology was found. Sensitivity of TVS for endometrial hyperplasia was found to be 66.66% while specificity was 100%. Positive analytical value was 100% while negative value was 100%. Overall sensitivity calculated for TVS was 94.44%, specificity 98.55%, PPV was 81.93% and NPV 98.55%. Conclusion: Sensitivity and specificity of TVS were lower than hysteroscopy and biopsy but the difference was not significant. TVS can be used as first line investigation while hysteroscopy and biopsy may be left for cases of high risk or in those cases where some positive findings could be found on TVS. (author)
Individualized FAC on bottom tab subassemblies to minimize adhesive gap between emitter and optics

Science.gov (United States)

Sauer, Sebastian; Müller, Tobias; Haag, Sebastian; Beleke, Andreas; Zontar, Daniel; Baum, Christoph; Brecher, Christian

2017-02-01

High Power Diode Laser (HPDL) systems with short focal length fast-axis collimators (FAC) require submicron assembly precision. Conventional FAC-Lens assembly processes require adhesive gaps of 50 microns or more in order to compensate for component tolerances (e.g. deviation of back focal length) and previous assembly steps. In order to control volumetric shrinkage of fast-curing UV-adhesives shrinkage compensation is mandatory. The novel approach described in this paper aims to minimize the impact of volumetric shrinkage due to the adhesive gap between HPDL edge emitters and FAC-Lens. Firstly, the FAC is actively aligned to the edge emitter without adhesives or bottom tab. The relative position and orientation of FAC to emitter are measured and stored. Consecutively, an individual subassembly of FAC and bottom tab is assembled on Fraunhofer IPT's mounting station with a precision of +/-1 micron. Translational and lateral offsets can be compensated, so that a narrow and uniform glue gap for the consecutive bonding process of bottom tab to heatsink applies (Figure 4). Accordingly, FAC and bottom tab are mounted to the heatsink without major shrinkage compensation. Fraunhofer IPT's department assembly of optical systems and automation has made several publications regarding active alignment of FAC lenses [SPIE LASE 8241-12], volumetric shrinkage compensation [SPIE LASE 9730-28] and FAC on bottom tab assembly [SPIE LASE 9727-31] in automated production environments. The approach described in this paper combines these and is the logical continuation of that work towards higher quality of HPDLs.
A STUDY ON ENDOSCOPIC EVALUATION OF UPPER GASTROINTESTINAL BLEEDING

Directory of Open Access Journals (Sweden)

Pranaya Kumar

2016-03-01

Full Text Available CONTEXT Upper gastrointestinal bleeding (UGIB is one of the commonest gastrointestinal emergencies encountered by clinicians. Peptic ulcers are the most common cause of UGIB. Endoscopy has become the preferred method for diagnosis in patients with acute UGIB. This study is done in a diagnostic upper gastrointestinal endoscopy (UGIE setup of a tertiary care hospital to ascertain the causes of UGIB prevalent in this part of our country which might differ from other studies. AIM To ascertain prevalent causes of UGIB in patients of this part of India admitted to a Govt. Tertiary Hospital with a provisional diagnosis of UGIB. METHOD One hundred consecutive patients with UGIB were subjected to UGIE to find out the aetiology. The clinical profile and endoscopic findings were analysed and compared with the data on UGIB from other studies. RESULTS The mean age of patients was 47.03 years with male: female ratio of 2.33:1. 58% of patients were first time bleeders. Majority of patients presented with melaena. Visualisation of active bleeding achieved to 85.7% when endoscopy was done within first 24 hrs. The commonest cause of UGIB was duodenal ulcer (DU which accounted for 41% cases. Gastric ulcer was responsible in 13% of cases. Portal hypertension was responsible for bleed in only 13%. Neoplasms accounted for 25% of cases. Other less common causes were erosive gastritis (3%, gastric polyp (3%, Mallory-Weiss tear (1%, and Dieulafoy’s lesion (1%. Among bleeding peptic ulcers, 27.8% of cases were classified as Forrest IIa and 20.4% in Forrest IIb & IIc each. Acid peptic disease was past history elicited in majority (33% followed by NSAID (26% and alcohol (26%. CONCLUSION The present study has diagnosed various causes of upper gastrointestinal bleeding in this part of country. The incidence of gastric carcinoma as a cause of upper gastrointestinal bleeding is significantly high compared to those in other studies. UGI endoscopy should be done in every case
Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

International Nuclear Information System (INIS)

Jae, Hwan Jun; Chung, Jin Wook; Jung, Ah Young; Lee, Whal; Park, Jae Hyung

2007-01-01

To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy
Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

Energy Technology Data Exchange (ETDEWEB)

Jae, Hwan Jun; Chung, Jin Wook; Jung, Ah Young; Lee, Whal; Park, Jae Hyung [Seoul National University Hospital, Institute of Radiation Medicine, Seoul (Korea, Republic of)

2007-02-15

To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.
Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage: a prospective database study in Italy.

Science.gov (United States)

Marmo, Riccardo; Del Piano, Mario; Rotondano, Gianluca; Koch, Maurizio; Bianco, Maria Antonia; Zambelli, Alessandro; Di Matteo, Giovanni; Grossi, Enzo; Cipolletta, Livio; Prometeo Investigators

2012-02-01

Nonulcer causes of bleeding are often regarded as minor, ie, associated with a lower risk of mortality. To assess the risk of death from nonulcer causes of upper GI bleeding (UGIB). Secondary analysis of prospectively collected data from 3 national databases. Community and teaching hospitals. Consecutive patients admitted for acute nonvariceal UGIB. Early endoscopy, medical and endoscopic treatment as appropriate. Thirty-day mortality, recurrent bleeding, and need for surgery. A total of 3207 patients (65.8% male), mean (standard deviation) age 68.3 (16.4) years, were analyzed. Overall mortality was 4.45% (143 patients). According to the source of bleeding, mortality was 9.8% for neoplasia, 4.8% for Mallory-Weiss tears, 4.8% for vascular lesions, 4.4% for gastroduodenal erosions, 4.4% for duodenal ulcer, and 3.1% for gastric ulcer. Frequency of death was not different among benign endoscopic diagnoses (overall P = .567). Risk of death was significantly higher in patients with neoplasia compared with benign conditions (odds ratio 2.50; 95% CI, 1.32-4.46; P bleeding peptic ulcers in the clinical context of a high-risk patient. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Side Effects: Bleeding and Bruising

Science.gov (United States)

Cancer treatments, such as chemotherapy and targeted therapy, can increase patients’ risk of bleeding and bruising, also called thrombocytopenia. Learn about steps to take if you are at increased risk of a low platelet count.
[Three methods for controlling presacral massive bleeding during pelvic operations].

Science.gov (United States)

Wang, Xiaoxue; Liu, Zhimin; Xie, Shangkui; Ren, Donglin; Wu, Yin'ai

2017-12-25

To evaluate three different methods for controlling presacral massive bleeding during pelvic operations. Clinical data of 11 patients with presacral massive bleeding during pelvic operation at The Sixth Affiliated Hospital of Sun Yat-sen University and 157 Branch Hospital of Guangzhou General Hospital of Guangzhou Military Command from January 2001 to January 2016 were analyzed retrospectively. Hemostasis methods for presacral massive bleeding during operation included gauze packing (whole pressure), drawing pin (local pressure) and absorbable gauze (absorbable gauze was adhered to bleeding position with medical glue after local pressure). Efficacy of these 3 methods for controlling bleeding was evaluated and compared. Ten patients were male and 1 was female with average age of 65.2 (40 to 79) years old. Eight cases were rectal cancer, 2 were presacral malignancies and 1 was rectal benign lesion. Bleeding volume during operation was 300 to 2 500 (median 800) ml. From 2001 to 2012, 4 cases received gauze packing, of whom, 3 cases were scheduled Dixon resection before operation and then had to be referred to Hartman resection; 3 cases died of systemic failure due to postoperative chronic errhysis and infection, and 1 underwent re-operation. At the same time from 2001 to 2012, 5 cases received drawing pin, of whom, bleeding of 3 cases was successfully controlled and Dixon resection was completed. In other 2 cases with hemostasis failure, 1 case underwent re-operation following the use of gauze packing, and another 1 case received absorbable gauze hemostasis. All the 5 patients were healing. From 2013 to 2016, 2 cases completed scheduled anterior resection of rectum after successful hemostasis with absorbable gauze and were healing and discharged. Gauze packing hemostasis is a basic method for controlling presacral massive bleeding. Drawing pin and absorbable gauze hemostasis are more precise and may avoid the change of surgical procedure. But drawing pin has the
ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding.

Science.gov (United States)

Singh-Bhinder, Nimarta; Kim, David H; Holly, Brian P; Johnson, Pamela T; Hanley, Michael; Carucci, Laura R; Cash, Brooks D; Chandra, Ankur; Gage, Kenneth L; Lambert, Drew L; Levy, Angela D; Oliva, Isabel B; Peterson, Christine M; Strax, Richard; Rybicki, Frank J; Dill, Karin E

2017-05-01

Upper gastrointestinal bleeding (UGIB) remains a significant cause of morbidity and mortality with mortality rates as high as 14%. This document addresses the indications for imaging UGIB that is nonvariceal and unrelated to portal hypertension. The four variants are derived with respect to upper endoscopy. For the first three, it is presumed that upper endoscopy has been performed, with three potential initial outcomes: endoscopy reveals arterial bleeding source, endoscopy confirms UGIB without a clear source, and negative endoscopy. The fourth variant, "postsurgical and traumatic causes of UGIB; endoscopy contraindicated" is considered separately because upper endoscopy is not performed. When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable with angiography as a diagnostic next step. If endoscopy demonstrates a bleed but the endoscopist cannot identify the bleeding source, angiography or CTA can be typically performed and both are considered appropriate. In the event of an obscure UGIB, angiography and CTA have been shown to be equivalent in identifying the bleeding source; CT enterography may be an alternative to CTA to find an intermittent bleeding source. In the postoperative or traumatic setting when endoscopy is contraindicated, primary angiography, CTA, and CT with intravenous contrast are considered appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to
Packing of Renal Fossa: Useful Technique for Intractable Bleeding ...

African Journals Online (AJOL)

There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours) to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone ...
First-trimester vaginal bleeding and complications later in pregnancy

DEFF Research Database (Denmark)

Lykke, Jacob Alexander; Dideriksen, Katrine Lehrmann; Lidegaard, Øjvind

2010-01-01

To evaluate the association of first-trimester bleeding without miscarriage and complications later in the first pregnancy as well as in the next pregnancy.......To evaluate the association of first-trimester bleeding without miscarriage and complications later in the first pregnancy as well as in the next pregnancy....
A sensitive venous bleeding model in haemophilia A mice

DEFF Research Database (Denmark)

Pastoft, Anne Engedahl; Lykkesfeldt, Jens; Ezban, M.

2012-01-01

Haemostatic effect of compounds for treating haemophilia can be evaluated in various bleeding models in haemophilic mice. However, the doses of factor VIII (FVIII) for normalizing bleeding used in some of these models are reported to be relatively high. The aim of this study was to establish a se...
Aminaphtone in the control of gingival bleeding in children

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Pereira de Godoy JM

2014-09-01

Full Text Available José Maria Pereira de Godoy,1,2 Mara Lucia Macedo Paizan3 1Department of Cardiology and Cardiovascular Surgery, Faculdade de Medicina de São José do Rio Preto (FAMERP, São José do Rio Preto, 2Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, Brasília, 3FAMERP, São José do Rio Preto, Brazil Aim: The objective of the current study was to evaluate the efficacy of aminaphtone to control gum bleeding.Patients and methods: Fifteen male and 15 female children, aged between 10 and 18 years with a mean age of 13.4 years and with gingival bleeding, were enrolled in this randomized, double-blind, placebo-controlled, Phase IV clinical trial. The inclusion criterion was gingivitis with gingival bleeding. Participants were prescribed either aminaphtone or placebo. Thirty identical boxes containing blister packs of identical pills of either aminaphtone or placebo were produced and coded with unique numbers by the manufacturer (Baldacci Laboratory, Brazil and donated for this trial. A research assistant administered aminaphtone (Capilarema 75 mg to fifteen patients or placebo to fifteen patients twice daily for 5 days. Intraoral clinical evaluations of bleeding were made before starting medication/placebo and then at 3 and 5 days after administration.Results: On comparing the number of bleeding points before and after treatment between the aminaphtone and placebo groups, we found significantly higher reductions with the medication (P<0.0001.Conclusion: Aminaphtone reduces gum bleeding in gingivitis, and may have a supportive role in the control of bleeding. Keywords: periodontitis, bleeding, treatment
Risk of bleeding related to antithrombotic treatment in cardiovascular disease

DEFF Research Database (Denmark)

Sørensen, Rikke; Olesen, Jonas B; Charlot, Mette

2012-01-01

Antithrombotic therapy is a cornerstone of treatment in patients with cardiovascular disease with bleeding being the most feared complication. This review describes the risk of bleeding related to different combinations of antithrombotic drugs used for cardiovascular disease: acute coronary...... syndrome (ACS), atrial fibrillation (AF), cerebrovascular (CVD) and peripheral arterial disease (PAD). Different risk assessment schemes and bleeding definitions are compared. The HAS-BLED risk score is recommended in patients with AF and in ACS patients with AF. In patients with ACS with or without...... a stent dual antiplatelet therapy with a P2Y12 receptor antagonist and acetylsalicylic acid (ASA) is recommended for 12 months, preferable with prasugrel or ticagrelor unless there is an additional indication of warfarin or increased risk of bleeding. In patients with AF, warfarin is recommended...
Association of bleeding and thrombosis with outcome in Extracorporeal Life Support

Science.gov (United States)

Dalton, Heidi J.; Garcia-Filion, Pamela; Holubkov, Richard; Moler, Frank W.; Shanley, Thomas; Heidemann, Sabrina; Meert, Kathy; Berg, Robert A.; Berger, John; Carcillo, Joseph; Newth, Christopher; Harrison, Richard; Doctor, Allan; Rycus, Peter; Dean, J Michael; Jenkins, Tammara; Nicholson, Carol

2015-01-01

Objective Changes in technology and increased reports of successful extracorporeal life support (ECLS) use in patient populations such as influenza, cardiac arrest and adults are leading to expansion of ECLS. Major limitations to ECLS expansion remain bleeding and thrombosis. These complications are the most frequent causes of death and morbidity. As a pilot project to provide baseline data for a detailed evaluation of bleeding and thrombosis in the current era, ECLS patients were analyzed from eight centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). Study design Retrospective analysis of patients (50 mg/dL) (10%; n=177). Among patients with CDH, bleeding and thrombosis occurred in, respectively, 45% (n=118) and 60% (n=159), Bleeding events were associated with reduced survival (RR 0.62; 95%CI: 0.46, 0.86) although thrombotic events were not (RR 0.92; 95%CI: 0.67, 1.26). Conclusions Bleeding and thrombosis remain common complications in patients undergoing ECLS. Further research to reduce or eliminate bleeding and thrombosis is indicated to help improve patient outcome. PMID:25647124
[Epidemiology of upper gastrointestinal bleeding in Gabon].

Science.gov (United States)

Gaudong Mbethe, G L; Mounguengui, D; Ondounda, M; Magne, C; Bignoumbra, R; Ntsoumou, S; Moussavou Kombila, J-B; Nzenze, J R

2014-01-01

The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.
[Massive hookworm infection as a cause of intestinal bleeding and severe anemia].

Science.gov (United States)

Nair, Gayatri V; Cazorla, Ernesto; Choque, Henry; White, A Clinton; Cabada, Miguel M

2016-01-01

Overt gastrointestinal bleeding caused by hookworm infection is rarely reported. We present a 34 year old male with lower gastrointestinal bleeding with evidence of massive hookworm infection on colonoscopy and discuss the need to consider hookworm infection as a possible etiology of gastrointestinal bleed in endemic areas.
The use of selective serotonin receptor inhibitors (SSRIs) is not associated with increased risk of endoscopy-refractory bleeding, rebleeding or mortality in peptic ulcer bleeding

DEFF Research Database (Denmark)

Laursen, S B; Leontiadis, Grigorios I; Stanley, Adrian J

2017-01-01

in patients with peptic ulcer bleeding. However, abrupt discontinuation of SSRIs is associated with development of withdrawal symptoms in one-third of patients. Further data are needed to clarify whether treatment with SSRIs is associated with poor outcomes, which would support temporary discontinuation...... of treatment. AIM: To identify if treatment with SSRIs is associated with increased risk of: (1) endoscopy-refractory bleeding, (2) rebleeding or (3) 30-day mortality due to peptic ulcer bleeding. METHODS: A nationwide cohort study. Analyses were performed on prospectively collected data on consecutive...... patients admitted to hospital with peptic ulcer bleeding in Denmark in the period 2006-2014. Logistic regression analyses were used to investigate the association between treatment with SSRIs and outcome following adjustment for pre-defined confounders. Sensitivity and subgroup analyses were performed...
Risk of bleeding related to antithrombotic treatment in cardiovascular disease

DEFF Research Database (Denmark)

Sørensen, Rikke; Olesen, Jonas B; Charlot, Mette

2012-01-01

Antithrombotic therapy is a cornerstone of treatment in patients with cardiovascular disease with bleeding being the most feared complication. This review describes the risk of bleeding related to different combinations of antithrombotic drugs used for cardiovascular disease: acute coronary...... syndrome (ACS), atrial fibrillation (AF), cerebrovascular (CVD) and peripheral arterial disease (PAD). Different risk assessment schemes and bleeding definitions are compared. The HAS-BLED risk score is recommended in patients with AF and in ACS patients with AF. In patients with ACS with or without...
Risk factors for nasal bleeding in patients undergoing transnasal gastrointestinal endoscopy

Directory of Open Access Journals (Sweden)

Mitsuyo Mieda

2018-05-01

Full Text Available Transnasal endoscopy is widely used in screening for upper gastrointestinal lesions because of less associated pain. Nasal bleeding is the most severe adverse effect, but specific risk factors have not been identified. The aim of this study is to identify risk factors for nasal bleeding during transnasal endoscopy. Nasal bleeding occurred in 160/3035 (5.3% of patients undergoing transnasal endoscopy as part of health checkups. Patient data were retrospectively evaluated including anthropometric, medical, and life-style parameters with multiple logistic regression analysis. Multiple logistic regression revealed that nasal bleeding was significantly associated with age in decades [odds ratio/10 years 0.78, 95% confidence interval (CI 0.63–0.97, p = 0.027], female gender (2.15, 95% CI 1.48–3.12, p < 0.001, a history of previous upper gastrointestinal endoscopy (0.55, 95% CI 0.36–0.82, p = 0.004, and chronic/allergic rhinitis (0.60, 95% CI 0.36–0.98, p = 0.043. Other factors including the use of antiplatelet and/or anticoagulant drugs were not significantly associated with nasal bleeding. Female and young patients are significantly associated with an increased risk of bleeding from transnasal endoscopy, but antiplatelet and/or anticoagulant medications and a history of chronic/allergic rhinitis may not be associated. Keywords: Transnasal endoscopy, Nasal bleeding, Risk factors

Upper gastrointestinal bleeding: audit of a single center experience in Western India

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Jignesh B. Rathod

2011-11-01

Full Text Available Upper gastrointestinal (GI bleeding is defined as bleeding proximal to the ligament of Treitz. The most important aspect of management of GI bleeding is to locate the site and cause of bleeding. The aim of the study is to find out the common etiology, presentation and management, including the role of upper GI endoscopy. Recent advances have meant that endoscopic hemostatic methods are now associated with a reduced rate of re-bleeding, cost, blood transfusion, length of hospital stay and mortality. A prospective study of 50 cases was carried out between August 2001 and July 2003. Patients with signs and symptoms suggestive of upper GI bleeding (UGIB such as hematemesis, melena, aspirated blood from nasogastric tubes, profuse hematochezia, etc., were included in the study. The patients were selected randomly. The most common cause of UGIB in the present study was acute erosive gastritis (34% followed by portal hypertension (24% and peptic ulcer (22%. All 50 patients underwent upper GI endoscopy, of whom 39 patients were treated conservatively and 11 patients underwent endotherapy to control bleeding. Out of 39 patients treated non-endoscopically, 6 cases required laparotomy to control UGIB. 8 of 50 cases had past history of UGIB, 5 of whom had a previous history of endotherapy. One case was treated with devascularization as routine hemostatic methods failed. So, initial method of choice to control the bleeding was endotherapy and surgery was undertaken if an endoscopic method failed. The most common cause of hematemesis in our setting was acute erosive gastritis followed by portal hypertension. Endoscopy is a valuable minimal invasive method to diagnose and treat upper GI bleeding.
Transarterial embolization for management of severe postcoital bleeding

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Armen Eskandari

2016-08-01

Full Text Available Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management. Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion. Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils. Conclusion: Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.
Short-term use of serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding.

Science.gov (United States)

Wang, Yen-Po; Chen, Yung-Tai; Tsai, Chia-Fen; Li, Szu-Yuan; Luo, Jiing-Chyuan; Wang, Shuu-Jiun; Tang, Chao-Hsiun; Liu, Chia-Jen; Lin, Han-Chieh; Lee, Fa-Yauh; Chang, Full-Young; Lu, Ching-Liang

2014-01-01

The association between selective serotonin receptor inhibitors (SSRIs) and risk of upper gastrointestinal bleeding remains controversial. Previous studies have generally evaluated the issue for approximately 3 months, even though the SSRI-mediated inhibition of platelet serotonin concentrations occurs within 7-14 days. The authors explored the risk of upper gastrointestinal bleeding after short-term SSRI exposure by a case-crossover design. The records of psychiatric inpatients with upper gastrointestinal bleeding were retrieved from the Taiwan National Health Insurance Database (1998-2009). Rates of antidepressant use were compared for case and control periods with time windows of 7, 14, and 28 days. The adjusted self-matched odds ratios from a conditional logistic regression model were used to determine the association between SSRI use and upper gastrointestinal bleeding. A total of 5,377 patients with upper gastrointestinal bleeding were enrolled. The adjusted odds ratio for the risk of upper gastrointestinal bleeding after SSRI exposure was 1.67 (95% CI=1.23-2.26) for the 7-day window, 1.84 (95% CI=1.42-2.40) for the 14-day window, and 1.67 (95% CI=1.34-2.08) for the 28-day window. SSRIs with high and intermediate, but not low, affinity for serotonin transporter were associated with upper gastrointestinal bleeding. An elevated risk of upper gastrointestinal bleeding after SSRI exposure was seen in male but not female patients. Short-term SSRI use (7-28 days) is significantly associated with upper gastrointestinal bleeding. Gender differences may exist in the relationship between SSRI use and upper gastrointestinal bleeding. Physicians should carefully monitor signs of upper gastrointestinal bleeding even after short-term exposure to SSRIs, as is done with nonsteroidal anti-inflammatory drugs and aspirin.
Portal hypertension in children: High-risk varices, primary prophylaxis and consequences of bleeding.

Science.gov (United States)

Duché, Mathieu; Ducot, Béatrice; Ackermann, Oanez; Guérin, Florent; Jacquemin, Emmanuel; Bernard, Olivier

2017-02-01

Primary prophylaxis of bleeding is debated for children with portal hypertension because of the limited number of studies on its safety and efficacy, the lack of a known endoscopic pattern carrying a high-risk of bleeding for all causes, and the assumption that the mortality of a first bleed is low. We report our experience with these issues. From 1989 to 2014, we managed 1300 children with portal hypertension. Endoscopic features were recorded; high-risk varices were defined as: grade 3 esophageal varices, grade 2 varices with red wale markings, or gastric varices. Two hundred forty-six children bled spontaneously and 182 underwent primary prophylaxis. The results of primary prophylaxis were reviewed as well as bleed-free survival, overall survival and life-threatening complications of bleeding. High-risk varices were found in 96% of children who bled spontaneously and in 11% of children who did not bleed without primary prophylaxis (pportal hypertension. Life-threatening complications of bleeding were recorded in 19% of children with cirrhosis and high-risk varices who bled spontaneously. Ten-year probabilities of bleed-free survival after primary prophylaxis in children with high-risk varices were 96% and 72% for non-cirrhotic causes and cirrhosis respectively. Ten-year probabilities of overall survival after primary prophylaxis were 100% and 93% in children with non-cirrhotic causes and cirrhosis respectively. In children with portal hypertension, bleeding is linked to the high-risk endoscopic pattern reported here. Primary prophylaxis of bleeding based on this pattern is fairly effective and safe. In children with liver disease, the risk of bleeding from varices in the esophagus is linked to their large size, the presence of congestion on their surface and their expansion into the stomach but not to the child's age nor to the cause of portal hypertension. Prevention of the first bleed in children with high-risk varices can be achieved by surgery or endoscopic
Post-tonsillectomy hemorrhagic outcomes in children with bleeding disorders at a single institution.

Science.gov (United States)

Patel, Priyesh N; Arambula, Alexandra M; Wheeler, Allison P; Penn, Edward B

2017-09-01

To report on the post-tonsillectomy bleeding outcomes and factors associated with hemorrhage among children with pre- or post-operatively diagnosed bleeding disorders treated with an institutional protocol. Retrospective cohort study of patients with hematologic disorders who underwent tonsillectomy between 2003 and 2016 and were treated with perioperative desmopressin or factor replacement and/or aminocaproic acid. Postoperative outcomes were compared to controls matched for age, sex, and indication for surgery. Analysis of factors associated with hemorrhage was performed in patients with bleeding disorders using Mann-Whitney U or chi-squared tests. 45 patients with hematologic disorders met inclusion criteria. Platelet dysfunction, including von Willebrand Disease (vWD), was the most common diagnosis (77.8%). Most patients had a preoperative diagnosis of a bleeding disorder and received perioperative hematologic medications (86.7%). Compared to matched controls, patients with hematologic disorders experienced more postoperative bleeding (15.5%; 12 bleeds, 7 patients vs. 1.7%; 1 bleed, 1 patient, p = 0.05) and had longer postoperative stays (1.3 days vs. 0.4 days, p bleed were significantly more likely to have a factor deficiency (e.g. Hemophilia over vWD) and have a postoperative diagnosis (compared to preoperative diagnosis) for which they did not receive perioperative hematologic medication. Of patients with a postoperative bleed, all those diagnosed postoperatively required at least one surgical intervention to control bleeding compared to 33% of patients with a preoperative diagnosis. A history of post-surgical bleeding, male sex, age at surgery, and pharyngitis as surgical indication were not associated with higher hemorrhage rates in this group. This study suggests a clinically important magnitude of increased bleeding risk in patients with hematologic disease. This risk appears to decrease with the use of an institutional protocol consisting of
Fibrinogen concentrate in bleeding patients

DEFF Research Database (Denmark)

Wikkelsø, Anne; Lunde, Jens; Johansen, Mathias

2013-01-01

Hypofibrinogenaemia is associated with increased morbidity and mortality, but the optimal treatment level, the use of preemptive treatment and the preferred source of fibrinogen remain disputed. Fibrinogen concentrate is increasingly used and recommended for bleeding with acquired haemostatic...
Examining the bleeding incidences associated with targeted therapies used in metastatic renal cell carcinoma.

Science.gov (United States)

Crist, MacKenzie; Hansen, Elizabeth; Chablani, Lipika; Guancial, Elizabeth

2017-12-01

A systematic review was conducted to illustrate the bleeding risks associated with targeted therapies used in the treatment of metastatic renal cell carcinoma (mRCC). Eligible studies included phase II, III, or IV clinical trials using pazopanib, sunitinib, cabozantinib, lenvatinib, everolimus, temsirolimus, bevacizumab, axitinib, and/or sorafenib in the setting of mRCC. Types of bleeding event(s), bleeding event frequency, and incidence of thrombocytopenia were collected from the relevant articles. ClinicalTrials.gov was also searched for incidence of "Serious bleeding adverse effects" reported in these trials. The incidences of bleeding events ranged from 1 to 36%, and incidences of thrombocytopenia ranged from 2 to 78%. Available serious bleeding adverse events ranged from 1 to 7%. The highest percentage of bleeding incidences were seen with bevacizumab, while the lowest percentage of bleeding incidences were seen with axitinib. All of the included trials were of high quality per Jadad scoring. Copyright © 2017 Elsevier B.V. All rights reserved.
Thermal analysis of mass concrete embedded with double-layer staggered heterogeneous cooling water pipes

International Nuclear Information System (INIS)

Yang Jian; Hu Yu; Zuo Zheng; Jin Feng; Li Qingbin

2012-01-01

Removal of hydration heat from mass concrete during construction is important for the quality and safety of concrete structures. In this study, a three-dimensional finite element program for thermal analysis of mass concrete embedded with double-layer staggered heterogeneous cooling water pipes was developed based on the equivalent equation of heat conduction including the effect of cooling water pipes and hydration heat of concrete. The cooling function of the double-layer staggered heterogeneous cooling pipes in a concrete slab was derived from the principle of equivalent cooling. To improve the applicability and precision of the equivalent heat conduction equation under small flow, the cooling function was revised according to its monotonicity and empirical formulas of single-phase forced-convection heat transfer in tube flow. Considering heat hydration of concrete at later age, a double exponential function was proposed to fit the adiabatic temperature rise curve of concrete. Subsequently, the temperature variation of concrete was obtained, and the outlet temperature of cooling water was estimated through the energy conservation principle. Comparing calculated results with actual measured data from a monolith of an arch dam in China, the numerical model was proven to be effective in sufficiently simulating accurate temperature variations of mass concrete. - Highlights: ► Three-dimensional program is developed to model temperature history of mass concrete. ► Massive concrete is embedded with double-layer heterogeneous cooling pipes. ► Double exponential function is proposed to fit the adiabatic temperature rise curve. ► Outlet temperature of cooling water is estimated. ► A comparison is made between the calculated and measured data.
Current understanding of bleeding with ibrutinib use: a systematic review and meta-analysis.

Science.gov (United States)

Caron, François; Leong, Darryl P; Hillis, Christopher; Fraser, Graeme; Siegal, Deborah

2017-05-09

Ibrutinib therapy was associated with an increased risk of bleeding in previous trials. In this systematic review and meta-analysis of published trials including patients treated with ibrutinib, the relative risk (95% confidence interval [CI]) of overall bleeding was significantly higher in ibrutinib recipients (2.72 [1.62-6.58]), but major bleeding did not show a significant difference (1.66 [0.96-2.85]). The incidences (95% CI) of major bleeding and any bleeding were 3.0 (2.3-3.7) and 20.8 (19.1-22.1) per 100 patient-years, respectively. This analysis is limited by reporting bias from variable ascertainment of bleeding and lack of allocation concealment in some studies and differing exposures between groups, leading to potential overestimation of event rates in the ibrutinib group.
Management of abnormal uterine bleeding – focus on ambulatory hysteroscopy

Directory of Open Access Journals (Sweden)

Kolhe S

2018-03-01

Full Text Available Shilpa Kolhe Ambulatory Gynaecology Unit, Royal Derby Hospital, Derby, UK Abstract: The rapid evolution in ambulatory hysteroscopy (AH has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB. The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting. Keywords: abnormal uterine bleeding, ambulatory hysteroscopy, endometrial polyps, one-stop clinic, vaginoscopic approach
Sonographic cervical length, vaginal bleeding, and the risk of preterm birth.

Science.gov (United States)

Ramaeker, Devon M; Simhan, Hyagriv N

2012-03-01

We sought to evaluate the contributions of vaginal bleeding and cervical length to the risk of preterm birth. This was a secondary analysis of a cohort study designed to study predictors of preterm birth. The study included 2988 women with singleton gestations. Women underwent midtrimester transvaginal ultrasound assessment of cervical length and were queried regarding first- and second-trimester vaginal bleeding. There was a significant second-order relation between cervical length and preterm birth (P birth (odds ratio, 1.5; 95% confidence interval, 1.3-2.0). There was a significant interaction between cervical length and vaginal bleeding (P = .015). After accounting for cervical length and interaction, the adjusted odds ratio for vaginal bleeding and preterm birth was 4.8 (95% confidence interval, 1.89-12.4; P = .001). The magnitude of risk of preterm birth associated with sonographic cervical length depends on a woman's history of first- and second-trimester vaginal bleeding. Copyright © 2012 Mosby, Inc. All rights reserved.
The Biocarbon vascular access device (DiaTAB) for haemodialysis.

Science.gov (United States)

Smits, P J; Slooff, M J; Lichtendahl, D H; van der Hem, G K

1985-01-01

The Biocarbon vascular access device (DiaTAB) is a relatively new method in secondary access surgery. Punctures, often the cause of complications can be avoided because it is a no-needle method of dialysis. However thrombosis due to stenosis of the venous anastomosis or of the efferent vein is a continuing problem. A new experience is the fibrin flap formation under the plug of the device, which can be removed easily.
Localized hypothermia aggravates bleeding in the collagenase model of intracerebral hemorrhage.

Science.gov (United States)

John, Roseleen F; Williamson, Michael R; Dietrich, Kristen; Colbourne, Frederick

2015-03-01

Animal studies testing whether therapeutic hypothermia is neuroprotective after intracerebral hemorrhage (ICH) have been inconclusive. In rodents, ICH is often produced in the striatum by infusing collagenase, which causes prolonged hemorrhaging from multiple vessels. Our previous data shows that this bleeding (hematoma) is worsened by systemic hypothermia given soon after collagenase infusion. In this study we hypothesized that localized brain hypothermia would also aggravate bleeding in this model (0.2 U of collagenase in 1.2 μL of saline). We also evaluated cooling after intrastriatal thrombin infusion (1 U in 30 μL of saline)-a simplified model of ICH thought to cause bleeding. Focal hypothermia was achieved by flushing cold water through an implanted cooling device attached to the skull underneath the temporalis muscle of adult rats. Previous work and data at this time shows this method cools the striatum to ∼33°C, whereas the body remains normothermic. In comparison to normothermic groups, cooling significantly worsened bleeding when instituted at 6 hours (∼94 vs. 42 μL, p=0.018) and 12 hours (79 vs. 61 μL, p=0.042) post-ICH (24-hour survival), but not after a 24-hour delay (36-hour survival). Rats were cooled until euthanasia when hematoma size was determined by a hemoglobin-based spectrophotometry assay. Cooling did not influence cerebral blood volume after just saline or thrombin infusion. The latter is explained by the fact that thrombin did not cause bleeding beyond that caused by saline infusion. In summary, local hypothermia significantly aggravates bleeding many hours after collagenase infusion suggesting that bleeding may have confounded earlier studies with hypothermia. Furthermore, these findings serve as a cautionary note on using cooling even many hours after cerebral bleeding.
On the donor states in double InxGa1−xN/InyGa1−yN/GaN staggered quantum wells

International Nuclear Information System (INIS)

Yıldırım, Hasan; Aslan, Bulent

2013-01-01

We have calculated the binding energies of the donor states, 1s and 2p ± , with respect to the lowest sub-band energy in a double quantum well composed of wurtzite InGaN staggered quantum wells with GaN barriers. All the energies and the wavefunctions were calculated by applying the variational methods. We have found that the binding energies of donors placed in the right quantum well are larger and independent of the middle barrier width of up to 40 Å. This is because of the strong built-in electric field which brings more confinement to the donor wavefunctions in the right staggered quantum well. The binding energies are found to be strong functions of the donor position in the double quantum well system which is the consequence of the large asymmetry introduced by the built-in electric field. (paper)
Use of a Stent Graft for Bleeding Hepatic Artery Pseudoaneurysm Following Pancreaticoduodenectomy

Directory of Open Access Journals (Sweden)

Leoncio L. Kaw, Jr

2006-10-01

Full Text Available Although uncommon, bleeding following pancreaticoduodenectomy is associated with high mortality. Management generally includes surgical reexploration or, alternatively, transarterial embolization. We report the case of a 62-year-old man who presented with massive upper gastrointestinal bleeding 3 weeks after pancreaticoduodenectomy. Selective coeliac angiography revealed a large pseudoaneurysm involving the proper hepatic artery. This was treated successfully with a stent graft. There was no recurrence of bleeding at the 6-month follow-up. To our knowledge, this is the first report of stent graft repair of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.
Risk Stratification for Bleeding Complications in Patients With Venous Thromboembolism

DEFF Research Database (Denmark)

Brown, Joshua D; Goodin, Amie J; Lip, Gregory Y H

2018-01-01

BACKGROUND: The Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile International Normalized Ratio (INR), Elderly, Drugs or alcohol use (HAS-BLED) score has strong predictive validity for major bleeding complications, but limited validation has been conducted in venous thromboem...
Replacement therapy for bleeding episodes in factor VII deficiency. A prospective evaluation.

Science.gov (United States)

Mariani, Guglielmo; Napolitano, Mariasanta; Dolce, Alberto; Pérez Garrido, Rosario; Batorova, Angelika; Karimi, Mehran; Platokouki, Helen; Auerswald, Günter; Bertrand, Anne-Marie; Di Minno, Giovanni; Schved, Jean F; Bjerre, Jens; Ingerslev, Jorgen; Sørensen, Benny; Ruiz-Saez, Arlette

2013-02-01

Patients with inherited factor VII (FVII) deficiency display different clinical phenotypes requiring ad hoc management. This study evaluated treatments for spontaneous and traumatic bleeding using data from the Seven Treatment Evaluation Registry (STER). One-hundred one bleeds were analysed in 75 patients (41 females; FVII coagulant activity <1-20%). Bleeds were grouped as haemarthroses (n=30), muscle/subcutaneous haematomas (n=16), epistaxis (n=12), gum bleeding (n=13), menorrhagia (n=16), central nervous system (CNS; n=9), gastrointestinal (GI; n=2) and other (n=3). Of 93 evaluable episodes, 76 were treated with recombinant, activated FVII (rFVIIa), eight with fresh frozen plasma (FFP), seven with plasma-derived FVII (pdFVII) and two with prothrombin-complex concentrates. One-day replacement therapy resulted in very favourable outcomes in haemarthroses, and was successful in muscle/subcutaneous haematomas, epistaxis and gum bleeding. For menorrhagia, single- or multiple-dose schedules led to favourable outcomes. No thrombosis occurred; two inhibitors were detected in two repeatedly treated patients (one post-rFVIIa, one post-pdFVII). In FVII deficiency, most bleeds were successfully treated with single 'intermediate' doses (median 60 µg/kg) of rFVIIa. For the most severe bleeds (CNS, GI) short- or long-term prophylaxis may be optimal.
Ten-year study of postoperative complications following dental extractions in patients with inherited bleeding disorders.

Science.gov (United States)

Hsieh, J-T; Klein, K; Batstone, M

2017-09-01

Dental extractions challenge the body's haemostatic mechanism. Postoperative bleeding from dental extraction can be prolonged, or even life threatening in patients with inherited bleeding disorders. Pre- and postoperative clotting factor replacements or systemic desmopressin (ddAVP) have been advocated at our institution to prevent bleeding complications in these patients. This study aimed to assess the postoperative bleeding rate in patients with inherited bleeding disorders that underwent dental extractions at our institution between 2003 and 2012. Patients with inherited bleeding disorders such as haemophilia A, haemophilia B, and von Willebrand's disease were included. Retrospective chart review was conducted. The result showed 53 extraction events occurred in 45 patients over the 10-year period. Ten out of 53 extraction events (18.9%) had postoperative bleeding requiring further factor replacement or ddAVP. Postoperative bleeding in one patient with mild haemophilia A was complicated by the development of inhibitors. Type and severity of bleeding disorder, bone removal, and use of a local haemostatic agent did not have any significant effect on postoperative bleeding. Despite the use of perioperative factors and desmopressin, the postoperative bleeding rates remain high for patients with inherited bleeding disorders. More studies are required to assess the safety and effectiveness of using local haemostatic control to achieve haemostasis following extractions. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
Virological failure of staggered and simultaneous treatment interruption in HIV patients who began Efavirenz-based regimens after allergic reactions to nevirapine

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Siripassorn Krittaecho

2013-01-01

Full Text Available Abstract Objective The objective of this work was to study the virological outcomes associated with two different types of treatment interruption strategies in patients with allergic reactions to nevirapine (NVP. We compared the virological outcomes of (1 HIV-1-infected patients who discontinued an initial NVP-based regimen because of cutaneous allergic reactions to NVP; different types of interruption strategies were used, and second-line regimen was based on efavirenz (EFV; and (2 HIV-1-infected patients who began an EFV-based regimen as a first-line therapy (controls. Methods This retrospective cohort included patients who began an EFV-based regimen, between January 2002 and December 2008, as either an initial regimen or as a subsequent regimen after resolving a cutaneous allergic reaction against an initial NVP-based regimen. The study ended in March 2010. The primary outcome was virological failure, which was defined as either (a two consecutive plasma HIV-1 RNA levels >400 copies/mL or (b a plasma HIV-1 RNA level >1,000 copies/mL plus any genotypic resistance mutation. Results A total of 559 patients were stratified into three groups: (a Simultaneous Interruption, in which the subjects simultaneously discontinued all the drugs in an NVP-based regimen following an allergic reaction (n=161; (b Staggered Interruption, in which the subjects discontinued NVP treatment while continuing nucleoside reverse transcriptase inhibitor (NRTI backbone therapy for a median of 7 days (n=82; and (c Control, in which the subjects were naïve to antiretroviral therapy (n=316. The overall median follow-up time was 43 months. Incidence of virological failure in Simultaneous Interruption was 12.9 cases per 1,000 person-years, which trended toward being higher than the incidences in Staggered Interruption (5.4 and Control (6.6. However, differences were not statistically significant. Conclusions Among the patients who had an acute allergic reaction to first
BLEEDING AND STARVING: fasting and delayed refeeding after upper gastrointestinal bleeding

OpenAIRE

FONSECA,Jorge; MEIRA,Tânia; NUNES,Ana; SANTOS,Carla Adriana

2014-01-01

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. See more: http://creativecommons.org/licenses/by-nc/3.0//deed.en "Context - Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. Objective - The aim of this study was obtain...

Transrectal ultrasound-guided biopsy of the prostate: aspirin increases the incidence of minor bleeding complications

International Nuclear Information System (INIS)

Halliwell, O.T.; Yadegafar, G.; Lane, C.; Dewbury, K.C.

2008-01-01

Aim: To assess whether patients taking aspirin were more likely to experience bleeding complications after transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and methods: Three hundred and eighty-seven patients taking aspirin who underwent prostate biopsy over a 3.5 year period and 731 patients not taking aspirin over a 2 year period returned a questionnaire assessing the incidence and severity of bleeding complications. Results: Patients taking aspirin had a significantly higher cumulative incidence of haematuria and rectal bleeding, but not of haemospermia. They also had a longer mean duration of bleeding, but no increase in bleeding severity. Severe bleeding was very uncommon in both groups and no patients required intervention for bleeding complications. Conclusion: Aspirin exacerbates minor bleeding complications in patients undergoing TRUS guided biopsy of the prostate, but in this large group of aspirin-taking patients no dangerous bleeding complications were encountered. It may be that the risks associated with aspirin cessation outweigh the risks of haemorrhagic complications
Transrectal ultrasound-guided biopsy of the prostate: aspirin increases the incidence of minor bleeding complications

Energy Technology Data Exchange (ETDEWEB)

Halliwell, O.T. [Department of Radiology, Southampton General Hospital, Southampton (United Kingdom)], E-mail: hallo99@doctors.org.uk; Yadegafar, G. [Public Health Sciences and Medical Statistics Division, School of Medicine, Southampton General Hospital, Southampton University, Southampton (United Kingdom); Lane, C.; Dewbury, K.C. [Department of Radiology, Southampton General Hospital, Southampton (United Kingdom)

2008-05-15

Aim: To assess whether patients taking aspirin were more likely to experience bleeding complications after transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and methods: Three hundred and eighty-seven patients taking aspirin who underwent prostate biopsy over a 3.5 year period and 731 patients not taking aspirin over a 2 year period returned a questionnaire assessing the incidence and severity of bleeding complications. Results: Patients taking aspirin had a significantly higher cumulative incidence of haematuria and rectal bleeding, but not of haemospermia. They also had a longer mean duration of bleeding, but no increase in bleeding severity. Severe bleeding was very uncommon in both groups and no patients required intervention for bleeding complications. Conclusion: Aspirin exacerbates minor bleeding complications in patients undergoing TRUS guided biopsy of the prostate, but in this large group of aspirin-taking patients no dangerous bleeding complications were encountered. It may be that the risks associated with aspirin cessation outweigh the risks of haemorrhagic complications.
Acute upper GI bleeding: Did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000

NARCIS (Netherlands)

van Leerdam, M. E.; Vreeburg, E. M.; Rauws, E. A. J.; Geraedts, A. A. M.; Tijssen, J. G. P.; Reitsma, J. B.; Tytgat, G. N. J.

2003-01-01

OBJECTIVES: The aim of this study was to examine recent time trends in incidence and outcome of upper GI bleeding. METHODS: Prospective data collection on all patients presenting with acute upper GI bleeding from a defined geographical area in the period 1993/1994 and 2000. RESULTS: Incidence
Empiric transcatheter arterial embolization for massive bleeding from duodenal ulcers: efficacy and complications.

Science.gov (United States)

Ichiro, Ikushima; Shushi, Higashi; Akihiko, Ishii; Yasuhiko, Iryo; Yasuyuki, Yamashita

2011-07-01

To evaluate the efficacy and safety of empiric transcatheter arterial embolization (TAE) for patients with massive bleeding from duodenal ulcers. During January 2000 and December 2009, 59 patients with duodenal ulcer bleeding in whom TAE was attempted after endoscopic therapy failed were retrospectively analyzed. The patients were divided into empiric TAE (n = 36) and identifiable TAE (n = 23) groups according to angiographic findings with or without identification of the bleeding sites. The technical and clinical success rate, recurrent bleeding rate, procedure-related complications, and clinical outcomes were evaluated. The technical and clinical success rates of TAE were 100% and 83%. The recurrent bleeding rate, clinical success, duodenal stenosis, and 30-day mortality after TAE were not significantly different between the empiric and identifiable TAE groups. A high rate of technical and clinical success was obtained with empiric TAE comparable to identifiable TAE in patients with massive bleeding from duodenal ulcers. There were no severe complications. Empiric TAE is an effective and safe method when a bleeding site cannot determined by angiography. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.
Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study.

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Atsushi Kimura

Full Text Available Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was performed just before the operation. Volumes of perioperative blood loss were compared with the results of detailed laboratory tests assessing primary hemostasis, secondary hemostasis, and fibrinolysis. Platelet aggregations induced by several agonists correlated with each other, and only two latent factors determined inter-individual difference. Platelet aggregability independently determined perioperative bleeding. We also identified low levels of plasminogen-activator inhibitor-1 (PAI-1 and α2-plasmin inhibitor to be independent risk factors for intraoperative and postoperative bleeding, respectively. Most important independent factor to determine postoperative bleeding was body weight. Of note, obese patients with low levels of PAI-1 became high-risk patients for bleeding during surgery. Our data suggest that bleeding after surgical procedure may be influenced by inter-individual differences of hemostatic function including platelet function and fibrinolysis, even in the patients without bleeding diathesis.
Severe bleeding events in adults and children with primary immune thrombocytopenia: a systematic review.

Science.gov (United States)

Neunert, C; Noroozi, N; Norman, G; Buchanan, G R; Goy, J; Nazi, I; Kelton, J G; Arnold, D M

2015-03-01

The burden of severe bleeding in adults and children with immune thrombocytopenia (ITP) has not been established. To describe the frequency and severity of bleeding events in patients with ITP, and the methods used to measure bleeding in ITP studies. We performed a systematic review of all prospective ITP studies that enrolled 20 or more patients. Two reviewers searched Medline, Embase, CINAHL and the Cochrane registry up to May 2014. Overall weighted proportions were estimated using a random effects model. Measurement properties of bleeding assessment tools were evaluated. We identified 118 studies that reported bleeding (n = 10 908 patients). Weighted proportions for intracerebral hemorrhage (ICH) were 1.4% for adults (95% confidence interval [CI], 0.9-2.1%) and 0.4% for children (95% CI, 0.2-0.7%; P bleeding was 9.6% for adults (95% CI, 4.1-17.1%) and 20.2% for children (95% CI, 10.0-32.9%; P bleeding were highly variable in primary studies. Two bleeding assessment tools (Buchanan 2002 for children; Page 2007 for adults) demonstrated adequate inter-rater reliability and validity in independent assessments. ICH was more common in adults and tended to occur during chronic ITP; other severe bleeds were more common in children and occurred at all stages of disease. Reporting of non-ICH bleeding was variable across studies. Further attention to ITP-specific bleeding measurement in clinical trials is needed to improve standardization of this important outcome for patients. © 2014 International Society on Thrombosis and Haemostasis.
Frequency of endometrial carcinoma in patients with postmenopausal bleeding

International Nuclear Information System (INIS)

Yousaf, S.; Shaheen, M.; Rana, T.

2010-01-01

Introduction: Postmenopausal bleeding (PMB) is defined as bleeding that occurs after 1 year of amenorrhea in a woman who is not receiving hormone replacement therapy (HRT). About 10% of women with postmenopausal bleeding have a primary or secondary malignancy. Common malignancies among them are endometrial cancer (80%), cervical cancer or an ovarian tumour. Endometrial cancer is the second most common cancer associated with hereditary non-polyposis colorectal cancer. Ninety percent of patients have benign causes. Objective: The objective of this study was to determine the frequency of endometrial carcinoma in patients with post-menopausal bleeding. Study Design: Descriptive case series study. Setting: Department of obstetrics and gynaecology, Lady Willingdon, Lahore. Duration of Study: This study was conducted over a period of six months from January, 1 2009 to June 30, 2009. Subjects and Methods: 50 cases with postmenopausal bleeding. Results: During the period of this study a total number of 50 consecutive patients who met inclusion criteria were enrolled in the study. Ages of the patients who presented with PMB ranged between 48 years and 80 years with a mean age of 59 years. Malignancy was found in 18 out of 50 cases (36%).Cases with endometrial CA were 14 out of 50 cases (28%) and CA cervix constituted 4 out of 50 cases (8%). Benign pathology was more frequent (64%). 13 of 50 cases (26%) had hyperplasia out of which 1 case (2%) was of atypical hyperplasia. Endometrial polyp was found in 4 of 50 cases (8%). 3 of 50 cases (6%) had chronic endometritis. 5 of 50 cases (10%) had chronic cervicitis. While 7 cases (14%) had postmenopausal bleeding due to decubitus ulcer of uterovaginal prolapse. Among malignancies (36%), endometrial cancer is the most frequent malignancy in women with postmenopausal bleeding with mean age of 65 years. Conclusion: In this study it was concluded that the majority of cases of PMB would be expected to be suffering from benign problems
Argon plasma coagulation for rectal bleeding after prostate brachytherapy

International Nuclear Information System (INIS)

Smith, Stephen; Wallner, Kent; Dominitz, Jason A.; Han, Ben; True, Lawrence; Sutlief, Steven; Billingsley, Kevin

2001-01-01

Purpose: To better define the efficacy and safety of argon plasma coagulation (APC), specifically for brachytherapy-related proctitis, we reviewed the clinical course of 7 patients treated for persistent rectal bleeding. Approximately 2-10% of prostate cancer patients treated with 125 I or 103 Pd brachytherapy will develop radiation proctitis. The optimum treatment for patients with persistent bleeding is unclear from the paucity of available data. Prior reports lack specific dosimetric information, and patients with widely divergent forms of radiation were grouped together in the analyses. Methods and Materials: Seven patients were treated with APC at the Veterans Affairs Puget Sound Health Care System and the University of Washington from 1997 to 1999 for persistent rectal bleeding due to prostate brachytherapy-related proctitis. Four patients received supplemental external beam radiation, delivered by a four-field technique. A single gastroenterologist at the Veterans Affairs Puget Sound Health Care System treated 6 of the 7 patients. If the degree of proctitis was limited, all sites of active bleeding were coagulated in symptomatic patients. An argon plasma coagulator electrosurgical system was used to administer treatments every 4-8 weeks as needed. The argon gas flow was set at 1.6 L/min, with an electrical power setting of 40-45 W. Results: The rectal V100 (the total rectal volume, including the lumen, receiving the prescription dose or greater) for the 7 patients ranged from 0.13 to 4.61 cc. Rectal bleeding was first noticed 3-18 months after implantation. APC (range 1-3 sessions) was performed 9-22 months after implantation. Five patients had complete resolution of their bleeding, usually within days of completing APC. Two patients had only partial relief from bleeding, but declined additional APC therapy. No patient developed clinically evident progressive rectal wall abnormalities after APC, (post-APC follow-up range 4-13 months). Conclusions: Most
Costs of treating bleeding and perforated peptic ulcers in The Netherlands.

Science.gov (United States)

de Leest, Helena; van Dieten, Hiske; van Tulder, Maurits; Lems, Willem F; Dijkmans, Ben A C; Boers, Maarten

2004-04-01

Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs includes perforations and bleeds. Several preventive strategies are being tested for cost-effectiveness, but little is known about the costs of the complications they are trying to prevent. We estimated the direct costs of hospital treatment of bleeding and perforated ulcers in a university hospital, from data in discharge letters and the hospital management information system. Eligible patients had been treated in the VU University Medical Center between January 1997 and August 2000 for an ulcer bleed or perforation (International Classification of Diseases code 531-4). Resource use comprised hospitalization days and diagnostic and therapeutic interventions. Insurance claim prices determined the costs from the payers' perspective. In a secondary analysis we excluded resource use that was clearly related to the treatment of comorbid illness. Fifty-three patients with a bleeding (n = 35) or perforated ulcer (n = 15) or both (n = 3) were studied, including 14 with comorbidity; 22 complications occurred in the stomach, 29 in the duodenum, one in both stomach and duodenum, and one after partial gastrectomy. A simultaneous bleed and perforation was most expensive (26,000 euro), followed by perforation (19,000 euro) and bleeding (12,000 euro). A bleed in the duodenum was more expensive than in the stomach (13,000 euro vs 10,000 euro), while the opposite was seen for perforations (13,000 euro vs 21,000 euro). Comorbidity increased costs substantially: even after correction for procedures unrelated to the ulcer complication, comorbidity more than doubled the costs of treatment. Treatment of complicated ulcers is expensive, especially in patients with comorbid conditions.
A feasibility study on feed and bleed for pressurized water reactors

International Nuclear Information System (INIS)

Yi-Shung Chen; Shimeck, D.J.; Sullivan, L.H.

1983-01-01

By injecting coolant with a high pressure emergency core cooling system, and removing the heated/ vaporized fluid by way of the pressurizer power operated relief valve, primary feed and bleed cooling denotes an operation whereby reactor core cooling is maintained. This paper presents the results from an experimental and analytical study that includes a simplified analysis of mass and energy balances associated with the feed and bleed, examination of test data from the Semiscale system, RELAP5 code analyses of both Semiscale and a four-loop Westinghouse plant, and the primary coolant system behavior for a transient that leads to the need for feed and bleed. Examination of the parameters that govern a stable feed and bleed operation identifies four key parameters such as: core decay heat, cooling water injection capacity, power operated relief valve (PORV) energy removal rate, and PORV mass removal rate. A simplified analytical approach to determining if stable feed and bleed is feasible, has been developed and corroborated by experimental data and computer code calculations. The Semiscale tests have not only provided test data for code assessment, but also have identified the factors influencing the PORV discharge, which is the most variable of the boundary conditions influencing feed and bleed. The RELAP5 computer code has demonstrated the capability of predicting the Semiscale experiments, and when applied to a four-loop Westinghouse plant has indicated that primary feed and bleed is a viable cooling mechanism. This has also been shown by using the simplified analytical method
Selective serotonin reuptake inhibitors and gastrointestinal bleeding: a case-control study.

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Alfonso Carvajal

Full Text Available BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs have been associated with upper gastrointestinal (GI bleeding. Given their worldwide use, even small risks account for a large number of cases. This study has been conducted with carefully collected information to further investigate the relationship between SSRIs and upper GI bleeding. METHODS: We conducted a case-control study in hospitals in Spain and in Italy. Cases were patients aged ≥18 years with a primary diagnosis of acute upper GI bleeding diagnosed by endoscopy; three controls were matched by sex, age, date of admission (within 3 months and hospital among patients who were admitted for elective surgery for non-painful disorders. Exposures to SSRIs, other antidepressants and other drugs were defined as any use of these drugs in the 7 days before the day on which upper gastrointestinal bleeding started (index day. RESULTS: 581 cases of upper GI bleeding and 1358 controls were considered eligible for the study; no differences in age or sex distribution were observed between cases and controls after matching. Overall, 4.0% of the cases and 3.3% of controls used an SSRI antidepressant in the week before the index day. No significant risk of upper GI bleeding was encountered for SSRI antidepressants (adjusted odds ratio, 1.06, 95% CI, 0.57-1.96 or for whichever other grouping of antidepressants. CONCLUSIONS: The results of this case-control study showed no significant increase in upper GI bleeding with SSRIs and provide good evidence that the magnitude of any increase in risk is not greater than 2.
Secondary Bleedings in Oral Surgery Emergency Service: A Cross-Sectional Study

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Sebastian Igelbrink

2018-01-01

Full Text Available Introduction. Bleeding after dental surgery is still a common cause for emergency presentation in patients using anticoagulants. Our aim was to analyze pertinent characteristic features on the one hand and to bare existing problems in handling on the other. Materials and Methods. The study included 76 patients. We documented basic data, anticoagulant medication, type of surgery, and tooth socket sutures in respective patients. Results. The vast majority of patients took a coumarin derivative (41 and acetylsalicylic acid (27. Nine (12% of the patients had to be hospitalized due to ongoing bleeding despite local haemostyptic steps and/or circulatory dysregulation. Most patients could be successfully treated in outpatient settings. No statistically significant correlation between bleeding, level of INR value, number of extracted teeth, and sewed alveoli could be shown. Sixty-five percent of cases with tooth extractions did not have suture of tooth sockets. Eighty-seven percent of the patients denied being informed about possible self-treatment options by their surgeon/dentist, and none of the patients got presurgical-fabricated bandage plate(s. Conclusions. Patients taking coumarin derivative currently, furthermore, represent the biggest anticoagulant after-bleeding group in dentoalveolar surgery. The major part of after-bleedings (90% can be handled in an outpatient setting with simplest surgical interventions. Unfortunately, the biggest part of the patient collective got no suture, no prefabricated dental bandage plate(s, and no explanation by their dentist how to handle in case of after-bleeding. Therefore, dental practitioners should furthermore get enlightenment on how to prevent after-bleeding situations.
TAB2 Is Essential for Prevention of Apoptosis in Fetal Liver but Not for Interleukin-1 Signaling

Science.gov (United States)

Sanjo, Hideki; Takeda, Kiyoshi; Tsujimura, Tohru; Ninomiya-Tsuji, Jun; Matsumoto, Kunihiro; Akira, Shizuo

2003-01-01

The proinflammatory cytokine interleukin-1 (IL-1) transmits a signal via several critical cytoplasmic proteins such as MyD88, IRAKs and TRAF6. Recently, serine/threonine kinase TAK1 and TAK1 binding protein 1 and 2 (TAB1/2) have been identified as molecules involved in IL-1-induced TRAF6-mediated activation of AP-1 and NF-κB via mitogen-activated protein (MAP) kinases and IκB kinases, respectively. However, their physiological functions remain to be clarified. To elucidate their roles in vivo, we generated TAB2-deficient mice. The TAB2 deficiency was embryonic lethal due to liver degeneration and apoptosis. This phenotype was similar to that of NF-κB p65-, IKKβ-, and NEMO/IKKγ-deficient mice. However, the IL-1-induced activation of NF-κB and MAP kinases was not impaired in TAB2-deficient embryonic fibroblasts. These findings demonstrate that TAB2 is essential for embryonic development through prevention of liver apoptosis but not for the IL-1 receptor-mediated signaling pathway. PMID:12556483
Severe upper gastrointestinal bleeding in extraluminal diverticula in the third part of the duodenum

DEFF Research Database (Denmark)

Wilhelmsen, Michael; Andersen, Johnny Fredsbo; Lauritsen, Morten Laksafoss

2014-01-01

The successful management of upper gastrointestinal (GI) bleeding requires identification of the source of bleeding and when this is achieved the bleeding can often be treated endoscopically. However, the identification of the bleeding can be challenging due to the location of the bleeding...... or technical aspects. Therefore it might be necessary to use other measures than endoscopy such as CT angiography. Duodenal diverticula is a rare cause of upper GI bleeding and can be challenging to diagnose as they often require specialised endoscopy procedures such as endoscopy with a side-viewing scope....... This case describes the first successful management of this rare condition with an upper GI endoscopy with a colonoscope and afterwards intravascular coiling....
Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

International Nuclear Information System (INIS)

Kim, Jin Hyoung; Shin, Ji Hoon; Yoon, Hyun Ki; Chae, Eun Young; Myung, Seung Jae; Ko, Gi Young; Gwon, Dong Il; Sung, Kyu Bo

2009-01-01

To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 ± 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition
Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

Energy Technology Data Exchange (ETDEWEB)

Kim, Jin Hyoung; Shin, Ji Hoon; Yoon, Hyun Ki; Chae, Eun Young; Myung, Seung Jae; Ko, Gi Young; Gwon, Dong Il; Sung, Kyu Bo [Asan Medical Center, Seoul (Korea, Republic of)

2009-08-15

To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 {+-} 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.
Evaluation and management of abnormal uterine bleeding in premenopausal women.

Science.gov (United States)

Sweet, Mary Gayle; Schmidt-Dalton, Tarin A; Weiss, Patrice M; Madsen, Keith P

2012-01-01

Up to 14 percent of women experience irregular or excessively heavy menstrual bleeding. This abnormal uterine bleeding generally can be divided into anovulatory and ovulatory patterns. Chronic anovulation can lead to irregular bleeding, prolonged unopposed estrogen stimulation of the endometrium, and increased risk of endometrial cancer. Causes include polycystic ovary syndrome, uncontrolled diabetes mellitus, thyroid dysfunction, hyperprolactinemia, and use of antipsychotics or antiepileptics. Women 35 years or older with recurrent anovulation, women younger than 35 years with risk factors for endometrial cancer, and women with excessive bleeding unresponsive to medical therapy should undergo endometrial biopsy. Treatment with combination oral contraceptives or progestins may regulate menstrual cycles. Histologic findings of hyperplasia without atypia may be treated with cyclic or continuous progestin. Women who have hyperplasia with atypia or adenocarcinoma should be referred to a gynecologist or gynecologic oncologist, respectively. Ovulatory abnormal uterine bleeding, or menorrhagia, may be caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease), endometrial polyps, and submucosal fibroids. Transvaginal ultrasonography or saline infusion sonohysterography may be used to evaluate menorrhagia. The levonorgestrel-releasing intrauterine system is an effective treatment for menorrhagia. Oral progesterone for 21 days per month and nonsteroidal anti-inflammatory drugs are also effective. Tranexamic acid is approved by the U.S. Food and Drug Administration for the treatment of ovulatory bleeding, but is expensive. When clear structural causes are identified or medical management is ineffective, polypectomy, fibroidectomy, uterine artery embolization, and endometrial ablation may be considered. Hysterectomy is the most definitive treatment.
In vitro and clinical evaluation of DSA in acute gastrointestinal bleeding

International Nuclear Information System (INIS)

Rees, C.R.; Palmaz, J.C.; Alvarado, R.; Tyrrel, R.; Ciaravino, V.; Register, T.; Reuter, S.R.

1987-01-01

In an in vitro model of gastrointestinal (GI) bleeding, digital subtraction angiography (DSA) was found to be more accurate, more sensitive, and equally specific in the detection of extravasation compared to conventional screen-film angiography /sub chi//sup 2/, P < .05), DSA was used in the diagnosis and/or therapeutic management of 35 patients with GI bleeding (in the upper tract in 30, in the lower tract in five). When DSA results were negative (13 cases), results of conventional angiography were also negative. Upper GI bleeding episodes could be managed solely with DSA, which shortened examination times by 20% - 35%. The usefulness of DSA in lower GI bleeding was limited in the authors' series by a 9-inch image intensifier and misregistration caused by bowel motion
Increased Bleeding Risk With Concurrent Use of Selective Serotonin Reuptake inhibitors and Coumarins

NARCIS (Netherlands)

Schalekamp, Tom; Klungel, Olaf H; Souverein, Patrick C; de Boer, Anthonius

2008-01-01

BACKGROUND: Treatment with vitamin K antagonists (coumarins) is associated with an increased risk of bleeding. Because use of selective serotonin reuptake inhibitors (SSRIs) is also associated with an increased risk of bleeding, we assessed the odds ratio (OR) of abnormal bleeding associated with
Novel, high incidence exercise-induced muscle bleeding model in hemophilia B mice

DEFF Research Database (Denmark)

Tranholm, M.; Kristensen, Annemarie Thuri; Broberg, M. L.

2015-01-01

INTRODUCTION: Muscle hematomas are the second most common complication of hemophilia and insufficient treatment may result in serious and even life-threatening complications. Hemophilic dogs and rats do experience spontaneous muscle bleeding, but currently, no experimental animal model is available...... specifically investigating spontaneous muscle bleeds in a hemophilic setting. AIM: The objective of this study was to develop a model of spontaneous muscle bleeds in hemophilia B mice. We hypothesized that treadmill exercise would induce muscle bleeds in hemophilia B mice but not in normal non-hemophilic mice...... and that treatment with recombinant factor IX (rFIX) before treadmill exercise could prevent the occurrence of pathology. METHODS: A total of 203 mice (123 F9-KO and 80 C57BL/6NTac) were included in three separate studies: (i) the model implementation study investigating the bleeding pattern in hemophilia B mice...

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