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Sample records for strictly selected patients

  1. Runaway selection for cooperation and strict-and-severe punishment.

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    Nakamaru, Mayuko; Dieckmann, Ulf

    2009-03-07

    Punishing defectors is an important means of stabilizing cooperation. When levels of cooperation and punishment are continuous, individuals must employ suitable social standards for defining defectors and for determining punishment levels. Here we investigate the evolution of a social reaction norm, or psychological response function, for determining the punishment level meted out by individuals in dependence on the cooperation level exhibited by their neighbors in a lattice-structured population. We find that (1) cooperation and punishment can undergo runaway selection, with evolution towards enhanced cooperation and an ever more demanding punishment reaction norm mutually reinforcing each other; (2) this mechanism works best when punishment is strict, so that ambiguities in defining defectors are small; (3) when the strictness of punishment can adapt jointly with the threshold and severity of punishment, evolution favors the strict-and-severe punishment of individuals who offer slightly less than average cooperation levels; (4) strict-and-severe punishment naturally evolves and leads to much enhanced cooperation when cooperation without punishment would be weak and neither cooperation nor punishment are too costly; and (5) such evolutionary dynamics enable the bootstrapping of cooperation and punishment, through which defectors who never punish gradually and steadily evolve into cooperators who punish those they define as defectors.

  2. Lyme Neuroborreliosis: Preliminary Results from an Urban Referral Center Employing Strict CDC Criteria for Case Selection

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    David S. Younger

    2010-01-01

    Full Text Available Lyme neuroborreliosis or “neurological Lyme disease” was evidenced in 2 of 23 patients submitted to strict criteria for case selection of the Centers for Disease Control and Prevention employing a two-tier test to detect antibodies to Borrelia burgdorferi at a single institution. One patient had symptomatic polyradiculoneuritis, dysautonomia, and serological evidence of early infection; and another had symptomatic small fiber sensory neuropathy, distal polyneuropathy, dysautonomia, and serological evidence of late infection. In the remaining patients symptoms initially ascribed to Lyme disease were probably unrelated to B. burgdorferi infection. Our findings suggest early susceptibility and protracted involvement of the nervous system most likely due to the immunological effects of B. burgdorferi infection, although the exact mechanisms remain uncertain.

  3. Clinical impact of strict criteria for selectivity and lateralization in adrenal vein sampling.

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    Gasparetto, Alessandro; Angle, John F; Darvishi, Pasha; Freeman, Colbey W; Norby, Ray G; Carey, Robert M

    2015-04-01

    Selectivity index (SI) and lateralization index (LI) thresholds determine the adequacy of adrenal vein sampling (AVS) and the degree of lateralization. The purpose of this study was investigate the clinical outcome of patients whose adrenal vein sampling was interpreted using "strict criteria" (SC) (SIpre-stimuli≥3, SIpost-stimuli≥5 and LIpre-stimuli≥4, LIpost-stimuli≥4). A retrospective review of 73 consecutive AVS procedures was performed and 67 were technically successful. Forty-three patients showed lateralization and underwent surgery, while 24 did not lateralize and were managed conservatively. Systolic blood pressure (SBP), diastolic blood pressure (DBP), kalemia (K(+)), and the change in number of blood pressure (BP) medications were recorded for each patient before and after AVS and potential surgery were performed. In the surgery group, BP and K(+) changed respectively from 160±5.3/100±2.0 mmHg to 127±3.3/80±1.9 (p blood pressure medications were six (14.0%) in the lateralized group and 22 (91.7%) in the non-lateralized group (p <0.001). AVS interpretation with SC leads to significant clinical improvement in both patients who underwent surgery and those managed conservatively.

  4. Strict Criteria for Selection of Laparoscopy for Women with Adnexal Mass

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    Sallum, Luis Felipe; Sarian, Luis Otávio; Bastos, Joana Fróes Bragança; Derchain, Sophie

    2014-01-01

    Objectives: We compared the indication of laparoscopy for treatment of adnexal masses based on the risk scores and tumor diameters with the indication based on gynecology-oncologists' experience. Methods: This was a prospective study of 174 women who underwent surgery for adnexal tumors (116 laparotomies, 58 laparoscopies). The surgeries begun and completed by laparoscopy, with benign pathologic diagnosis, were considered successful. Laparoscopic surgeries that required conversion to laparotomy, led to a malignant diagnosis, or facilitated cyst rupture were considered failures. Two groups were defined for laparoscopy indication: (1) absence of American College of Obstetrics and Gynecology (ACOG) guideline for referral of high-risk adnexal masses criteria (ACOG negative) associated with 3 different tumor sizes (10, 12, and 14 cm); and (2) Index of Risk of Malignancy (IRM) with cutoffs at 100, 200, and 300, associated with the same 3 tumor sizes. Both groups were compared with the indication based on the surgeon's experience to verify whether the selection based on strict rules would improve the rate of successful laparoscopy. Results: ACOG-negative and tumors ≤10 cm and IRM with a cutoff at 300 points and tumors ≤10cm resulted in the same best performance (78% success = 38/49 laparoscopies). However, compared with the results of the gynecology-oncologists' experience, those were not statistically significant. Discussion: The selection of patients with adnexal mass to laparoscopy by the use of the ACOG guideline or IRM associated with tumor diameter had similar performance as the experience of gynecology-oncologists. Both methods are reproducible and easy to apply to all women with adnexal masses and could be used by general gynecologists to select women for laparoscopic surgery; however, referral to a gynecology-oncologist is advisable when there is any doubt. PMID:25392617

  5. The Effect of Strict Segregation on Pseudomonas aeruginosa in Cystic Fibrosis Patients

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    van Mansfeld, Rosa; de Vrankrijker, Angelica; Brimicombe, Roland; Heijerman, Harry; Teding van Berkhout, Ferdinand; Spitoni, Cristian|info:eu-repo/dai/nl/304625957; Grave, Sanne; van der Ent, Cornelis; Wolfs, Tom; Willems, Rob; Bonten, Marc

    2016-01-01

    INTRODUCTION: Segregation of patients with cystic fibrosis (CF) was implemented to prevent chronic infection with epidemic Pseudomonas aeruginosa strains with presumed detrimental clinical effects, but its effectiveness has not been carefully evaluated. METHODS: The effect of strict segregation on

  6. Selections of the metric projection operator and strict solarity of sets with continuous metric projection

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    Alimov, A. R.

    2017-07-01

    In a broad class of finite-dimensional Banach spaces, we show that a closed set with lower semicontinuous metric projection is a strict sun, admits a continuous selection of the metric projection operator onto it, has contractible intersections with balls, and its (nonempty) intersection with any closed ball is a retract of this ball. For sets with continuous metric projection, a number of new results relating the solarity of such sets to the stability of the operator of best approximation are obtained. Bibliography 25 titles.

  7. Strict versus liberal insulin therapy in the cardiac surgery patient: An evidence-based practice development, implementation and evaluation project.

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    Gordon, Jacqueline M; Lauver, Lori S; Buck, Harleah G

    2018-02-01

    Hyperglycemia post-cardiac surgery is associated with poor clinical outcomes. Recent studies suggest maintaining liberal glycemic control (liberal CII protocol. Retrospective review of 144 strict CII patient records and 147 liberal CII patient records. Mean blood glucose was 159.8mg/dL (liberal CII) compared to 143.3mg/dL (strict CII) (p≤0.001). No surgical site infections occurred in either group. Mean ICU length of stay was 4.5days (liberal) versus 4.4days (strict) (p=0.74). Two 30-day mortalities occurred for the liberal cohort compared to no deaths in the strict group (p=0.49). Hypoglycemia incidence within 24h after surgery was 0.1% (liberal) compared to 0.3% (strict) compared to (p=0.16). Use of a nurse managed liberal CII resulted in similar outcomes with fewer incidents of hypoglycemia. Copyright © 2017. Published by Elsevier Inc.

  8. The Effect of Strict Segregation on Pseudomonas aeruginosa in Cystic Fibrosis Patients.

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    Rosa van Mansfeld

    Full Text Available Segregation of patients with cystic fibrosis (CF was implemented to prevent chronic infection with epidemic Pseudomonas aeruginosa strains with presumed detrimental clinical effects, but its effectiveness has not been carefully evaluated.The effect of strict segregation on the incidence of P. aeruginosa infection in CF patients was investigated through longitudinal protocolized follow-up of respiratory tract infection before and after segregation. In two nested cross-sectional studies in 2007 and 2011 the P. aeruginosa population structure was investigated and clinical parameters were determined in patients with and without infection with the Dutch epidemic P. aeruginosa clone (ST406.Of 784 included patients 315 and 382 were at risk for acquiring chronic P. aeruginosa infection before and after segregation. Acquisition rates were, respectively, 0.14 and 0.05 per 1,000 days at risk (HR: 0.66, 95% CI [0.2548-1.541]; p = 0.28. An exploratory subgroup analysis indicated lower acquisition after segregation in children < 15 years of age (HR: 0.43, 95% CI[0.21-0.95]; p = 0.04. P. aeruginosa population structure did not change after segregation and ST406 was not associated with lung function decline, death or lung transplantation.Strict segregation was not associated with a statistically significant lower acquisition of chronic P. aeruginosa infection and ST406 was not associated with adverse clinical outcome. After segregation there were no new acquisitions of ST406. In an unplanned exploratory analysis chronic acquisition of P. aeruginosa was lower after implementation of segregation in patients under 15 years of age.

  9. Selvester scoring in patients with strict LBBB using the QUARESS software.

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    Xia, Xiaojuan; Chaudhry, Uzma; Wieslander, Björn; Borgquist, Rasmus; Wagner, Galen S; Strauss, David G; Platonov, Pyotr; Ugander, Martin; Couderc, Jean-Philippe

    2015-01-01

    Estimation of the infarct size from body-surface ECGs in post-myocardial infarction patients has become possible using the Selvester scoring method. Automation of this scoring has been proposed in order to speed-up the measurement of the score and improving the inter-observer variability in computing a score that requires strong expertise in electrocardiography. In this work, we evaluated the quality of the QuAReSS software for delivering correct Selvester scoring in a set of standard 12-lead ECGs. Standard 12-lead ECGs were recorded in 105 post-MI patients prescribed implantation of an implantable cardiodefibrillator (ICD). Amongst the 105 patients with standard clinical left bundle branch block (LBBB) patterns, 67 had a LBBB pattern meeting the strict criteria. The QuAReSS software was applied to these 67 tracings by two independent groups of cardiologists (from a clinical group and an ECG core laboratory) to measure the Selvester score semi-automatically. Using various level of agreement metrics, we compared the scores between groups and when automatically measured by the software. The average of the absolute difference in Selvester scores measured by the two independent groups was 1.4±1.5 score points, whereas the difference between automatic method and the two manual adjudications were 1.2±1.2 and 1.3±1.2 points. Eighty-two percent score agreement was observed between the two independent measurements when the difference of score was within two point ranges, while 90% and 84% score agreements were reached using the automatic method compared to the two manual adjudications. The study confirms that the QuAReSS software provides valid measurements of the Selvester score in patients with strict LBBB with minimal correction from cardiologists. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Generalized mechanical pain sensitivity over nerve tissues in patients with strictly unilateral migraine.

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    Fernández-de-las-Peñas, César; Arendt-Nielsen, Lars; Cuadrado, María Luz; Pareja, Juan A

    2009-06-01

    No study has previously analyzed pressure pain sensitivity of nerve trunks in migraine. This study aimed to examine the differences in mechanical pain sensitivity over specific nerves between patients with unilateral migraine and healthy controls. Blinded investigators assessed pressure pain thresholds (PPT) over the supra-orbital nerves (V1) and peripheral nerve trunks of both upper extremities (median, radial, and ulnar nerves) in 20 patients with strictly unilateral migraine and 20 healthy matched controls. Pain intensity after palpation over both supra-orbital nerves was also assessed. A pressure algometer was used to quantify PPT, whereas a 10-point numerical pain rate scale was used to evaluate pain to palpation over the supra-orbital nerve. The analysis of covariance revealed that pain to palpation over the supra-orbital nerve was significantly higher (P0.6). In patients with unilateral migraine, we found increased mechano-sensitivity of the supra-orbital nerve on the symptomatic side of the head. Outside the head, the same patients showed increased mechano-sensitivity of the main peripheral nerves of both upper limbs, without asymmetries. Such diffuse hypersensitivity of the peripheral nerves lends further evidence to the presence of a state of hyperexcitability of the central nervous system in patients with unilateral migraine.

  11. Divergent changes in serum sterols during a strict uncooked vegan diet in patients with rheumatoid arthritis.

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    Agren, J J; Tvrzicka, E; Nenonen, M T; Helve, T; Hänninen, O

    2001-02-01

    The effects of a strict uncooked vegan diet on serum lipid and sterol concentrations were studied in patients with rheumatoid arthritis. The subjects were randomized into a vegan diet group (n 16), who consumed a vegan diet for 2-3 months, or into a control group (n 13), who continued their usual omnivorous diets. Serum total and LDL-cholesterol and -phospholipid concentrations were significantly decreased by the vegan diet. The levels of serum cholestanol and lathosterol also decreased, but serum cholestanol:total cholesterol and lathosterol:total cholesterol did not change. The effect of a vegan diet on serum plant sterols was divergent as the concentration of campesterol decreased while that of sitosterol increased. This effect resulted in a significantly greater sitosterol:campesterol value in the vegan diet group than in the control group (1.48 (SD 0.39) v. 0.72 (SD 0.14); P vegan diet changes the relative absorption rates of these sterols and/or their biliary clearance.

  12. Is it necessary to strictly diagnose fibromyalgia syndrome in patients with chronic widespread pain?

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    On, Arzu Yagiz; Aykanat, Dilek; Atamaz, Funda Calis; Eyigor, Can; Kocanogullari, Hayriye; Oksel, Fahrettin

    2015-08-01

    The applicability of the American College of Rheumatology (ACR) 1990 and 2010 criteria for the diagnosis of fibromyalgia syndrome (FMS) was determined in 284 patients with chronic widespread pain (CWP) including those with regional and systemic painful disorders. On the basis of initial evaluation, patients were classified into three groups. Group 1, those without any comorbid disease (N = 105), group 2, those having regional non-inflammatory painful disorders (N = 104), and group 3, those with a diagnosis of an inflammatory rheumatic disease (N = 75). Overall, 65 % of the patients fulfilled the 1990 criteria, while 94 % of them fulfilled the 2010 criteria. Almost all of the patients (97 %) with CWP did meet at least one of the criteria set, regardless of whether they have accompanying painful disorders. Widespread pain index (WPI), symptom severity scale (SS), and fibromyalgia impact questionnaire (FIQ) scores were found to be significantly higher in the patients who satisfied the 1990 criteria than those who did not (P classification of CWP to provide guidance to clinicians in selecting effective therapies.

  13. Strict versus liberal target range for perioperative glucose in patients undergoing coronary artery bypass grafting: a prospective randomized controlled trial.

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    Desai, Shalin P; Henry, Linda L; Holmes, Sari D; Hunt, Sharon L; Martin, Chidima T; Hebsur, Shrinivas; Ad, Niv

    2012-02-01

    The purpose of this study was to test the hypothesis that a liberal blood glucose strategy (121-180 mg/dL) is not inferior to a strict blood glucose strategy (90-120 mg/dL) for outcomes in patients after first-time isolated coronary artery bypass grafting and is superior for glucose control and target blood glucose management. A total of 189 patients undergoing coronary artery bypass grafting were investigated in this prospective randomized study to compare 2 glucose control strategies on patient perioperative outcomes. Three methods of analyses (intention to treat, completer, and per protocol) were conducted. Observed power was robust (>80%) for significant results. The groups were similar on preoperative hemoglobin A(1c) and number of diabetic patients. The liberal group was found to be noninferior to the strict group for perioperative complications and superior on glucose control and target range management. The liberal group had significantly fewer patients with hypoglycemic events (liberal range after coronary artery bypass grafting led to similar outcomes compared with a strict target range and was superior in glucose control and target range management. On the basis of the results of this study, a target blood glucose range of 121 to 180 mg/dL is recommended for patients after coronary artery bypass grafting as advocated by the Society of Thoracic Surgeons. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  14. Response of molars and non-molars to a strict supragingival control in periodontal patients

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    Patrícia Daniela Melchiors Angst

    2013-02-01

    Full Text Available The posterior position in the arches is one of the factors that underlies the poor prognosis of molar teeth (M. It is speculated that M do not benefit from the oral hygiene routine as well as non-molars (NM do. This study evaluated the response of M and NM to supragingival control during a 6-month period in 25 smokers (S and 25 never-smokers (NS with moderate-to-severe periodontitis. One calibrated examiner assessed visible plaque (VPI and gingival bleeding (GBI indexes, periodontal probing depth (PPD, bleeding on probing (BOP, and clinical attachment loss (CAL at days 0 (baseline, 30 and 180. At baseline, M showed significantly higher mean values of VPI (p = 0.017 and PPD (p < 0.001 compared with NM; CAL was also greater in M (p < 0.001 and was affected by smoking (p = 0.007. The reductions obtained for periodontal indicators at day 180 showed similar responses between M and NM. For CAL, M (NS 0.57 ± 0.50; S 0.67 ± 0.64 and NM (NS 0.38 ± 0.23; S 0.50 ± 0.33 reached an almost significant difference (p = 0.05. Smoking did not influence the response to treatment. Multilevel analysis revealed that, only for PDD reductions, the interaction between sites, teeth and patient was significant (p < 0.001. It was concluded that M benefit from an adequate regimen of supragingival biofilm control; therefore, supragingival condition should be considered in the prognosis of molar teeth.

  15. Lenient vs. strict rate control in patients with atrial fibrillation and heart failure: a post-hoc analysis of the RACE II study

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    Mulder, Bart A.; van Veldhuisen, Dirk J.; Crijns, Harry J. G. M.; Tijssen, Jan G. P.; Hillege, Hans L.; Alings, Marco; Rienstra, Michiel; Groenveld, Hessel F.; van den Berg, Maarten P.; van Gelder, Isabelle C.

    2013-01-01

    It is unknown whether lenient rate control is an acceptable strategy in patients with AF and heart failure. We evaluated differences in outcome in patients with AF and heart failure treated with lenient or strict rate control. This post-hoc analysis of the RACE II trial included patients with an

  16. Effect of strict metabolic control on regulation of subcutaneous blood flow in insulin-dependent diabetic patients

    DEFF Research Database (Denmark)

    Kastrup, J; Mathiesen, E R; Saurbrey, Nina

    1987-01-01

    washout technique. Mean arterial blood pressure was reduced by a maximum of 23 mmHg by elevating the limb above heart level and elevated to a maximum of 65 mmHg by head-up tilt; in the latter position venous pressure was kept constantly low by activation of the leg muscle vein pump (heel raising......The effect of 10 weeks of improved metabolic control on the impaired autoregulation of the subcutaneous blood flow was studied at the level of the lateral malleolus in eight long-term insulin-dependent diabetic patients with clinical microangiopathy. Blood flow was measured by the local 133-Xenon......). Improved metabolic control was achieved using either continuous subcutaneous insulin infusion or multiple insulin injections. The blood glucose concentration declined from (median) 12.7 to 6.8 mmol/l and the HbA1C level from 10.1 to 7.5% during strict metabolic control (p less than 0.01 and p less than 0...

  17. Changes in Frequency Intake of Foods in Patients Undergoing Sleeve Gastrectomy and Following a Strict Dietary Control.

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    Ruiz-Tovar, Jaime; Bozhychko, Maryana; Del-Campo, Jone Miren; Boix, Evangelina; Zubiaga, Lorea; Muñoz, Jose Luis; Llavero, Carolina

    2017-12-17

    Dietary intake and food preferences change after bariatric surgery, secondary to gastrointestinal symptoms and dietitian counseling. The aim of this study was to evaluate the changes in the frequency intake of different foods in patients undergoing sleeve gastrectomy and following a strict dietary control. A prospective observational study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between 2007 and 2012 was performed. Dietary assessment was performed using the Alimentary Frequency Questionnaire 1991-2002, developed and validated by the Department of Epidemiology of Miguel Hernandez University (Elche, Alicante Spain). Ninety-three patients were included for analysis, 73 females and 20 males, with a mean preoperative BMI of 46.4 ± 7.9 kg/m 2 . One year after surgery, excess weight loss was 81.1 ± 8.3% and 5 years after surgery, 79.9 ± 6.4%. Total weight loss at 1 year was 38.8 ± 5.3% and at 5 years, 35.4 ± 4.9%. Postoperatively, a reduction in the intake of dairy products, red meat, deli meat products, shellfish, fried potatoes, sweets, rice, pasta, beer, and processed foods was observed. Vegetables, fruits, and legumes intake increased after surgery. In the first postoperative year, there was a slight intolerance to red meat, fruits, vegetables and legumes, dairy products, pasta, and rice that mostly disappeared 5 years after surgery. One year after sleeve gastrectomy, calibrated with a 50-French bougie, there are not important problems in the intake of foods a priori difficult to digest. These problems mostly disappeared 5 years after surgery. The decrease intake of other unhealthy foods is mostly based on the dietary counseling.

  18. Strict confluent drawing

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    David Eppstein

    2016-01-01

    Full Text Available We define strict confluent drawing, a form of confluent drawing in which the existence of an edge is indicated by the presence of a smooth path through a system of arcs and junctions (without crossings, and in which such a path, if it exists, must be unique. We prove that it is NP-complete to determine whether a given graph has a strict confluent drawing but polynomial to determine whether it has an outerplanar strict confluent drawing with a fixed vertex ordering (a drawing within a disk, with the vertices placed in a given order on the boundary.

  19. Strictly convex renormings

    Czech Academy of Sciences Publication Activity Database

    Moltó, A.; Orihuela, J.; Troyanski, S.; Zizler, Václav

    2007-01-01

    Roč. 75, č. 3 (2007), s. 647-658 ISSN 0024-6107 R&D Projects: GA AV ČR IAA100190502 Institutional research plan: CEZ:AV0Z10190503 Keywords : strictly convex norms * lattice norm * quasi-diagonal sets Subject RIV: BA - General Mathematics Impact factor: 0.733, year: 2007

  20. Quine's "Strictly Vegetarian" Analyticity

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    Decock, L.B.

    2017-01-01

    I analyze Quine’s later writings on analyticity from a linguistic point of view. In Word and Object Quine made room for a “strictly vegetarian” notion of analyticity. In later years, he developed this notion into two more precise notions, which I have coined “stimulus analyticity” and “behaviorist

  1. Mapping clinical journeys of Asian patients presenting to the Emergency Department with syncope: Strict adoption of international guidelines does not reduce hospitalisations.

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    Kojodjojo, Pipin; Boey, Elaine; Elangovan, Anita; Chen, Xianyi; Tan, Yuquan; Singh, Devinder; Yeo, Wee Tiong; Lim, Toon Wei; Seow, Swee Chong; Sim, Tiong Beng

    2016-09-01

    Limited data exists about management of syncope in Asia. The American College of Emergency Physicians (ACEP) and European Society of Cardiology (ESC) guidelines have defined the high-risk syncope patient. This study aims to determine the effectiveness of managing syncope in an Asian healthcare system and whether strict adherence of international guidelines would reduce hospitalizations. Patients attending the Emergency Department of a Singaporean tertiary hospital with syncope were identified. Clinical journeys of all patients were meticulously mapped by interrogation of a comprehensive electronic medical record system and linkages with national datasets. Primary endpoint was hospitalization. Secondary endpoints were recurrent syncope within 1year and all-cause mortality. Expected admission rates based on application of ACEP/ESC guidelines were calculated. 638 patients (43.8±22.4years, 49.0% male) presented with syncope. 48.9% were hospitalized for 2.9±3.2days. Yields of common investigations ranged from 0 to 11.5% and no diagnosis was reached in 51.5% of patients. Diuretics use (HR 5.1, p=0.01) and prior hospitalization for syncope (HR 6.9, psyncope. Over 2.8 SD 0.3years of follow-up, 40 deaths occurred. 24 patients who died within 12months of presentation were admitted or had a firm diagnosis upon discharge. Application of guidelines did not significantly reduce hospitalisations, with limited agreement which patients warrant admission. (Actual 376, ACEP 354, ESC 391 admissions, p=NS). Unstructured management of syncope results in nearly half of patients being admitted and substantial healthcare expenditures, yet with limited diagnostic yield. Strict adoption of ACEP or ESC guidelines does not reduce admissions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Kidney function during 12 months of strict metabolic control in insulin-dependent diabetic patients with incipient nephropathy

    DEFF Research Database (Denmark)

    Feldt-Rasmussen, B; Mathiesen, E R; Hegedüs, L

    1986-01-01

    Thirty-six patients with insulin-dependent diabetes mellitus who had Albustix-negative urine but elevated urinary albumin excretion (30 to 300 mg per 24 hours) were matched in pairs according to their urinary albumin level, blood glycosylated hemoglobin level, and sex and assigned randomly...... in all patients during insulin infusion, but no consistent change was observed in the control group. No significant change was observed in the glomerular filtration rate. Our data suggest that the pathologic processes causing microalbuminuria in early renal disease are not reversed during 12 months...

  3. Pneumatic retinopexy: patient selection and specific factors.

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    Stewart, Stephen; Chan, Wing

    2018-01-01

    Pneumatic retinopexy is a minimally invasive, non-incisional procedure for repairing retinal detachment. This procedure is associated with reduced morbidity, reduced cost and faster postoperative recovery compared to pars plana vitrectomy and scleral buckling. Superior visual acuity outcomes have also been reported. Intraoperative complications are primarily related to the intraocular pressure rise caused by gas injection, or the misdirection of the gas. There is a low rate of postoperative complications. Anatomic success rates of over 90% can be achieved when strict selection criteria are applied. However, a number of studies have revealed good outcomes in cases with expanded clinical indications. Pneumatic retinopexy is currently underutilized. With appropriate patient selection, a high success rate can be achieved, and therefore, this procedure has an important role in the armamentarium of the vitreoretinal surgeon.

  4. The Success Rate of Initial {sup 131I} Ablation in Differentiated Thyroid Cancer: Comparison Between Less strict and Very Strict Low Iodine Diets

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    Yoo, Ik Dong; Kim, Sung Hoon; Seo, Ye Young; Oh, Jin Kyoung; O, Joo Hyun; Chung, Soo Kyo [The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2012-03-15

    To decrease the risk of recurrence or metastasis in differentiated thyroid cancer (DTC), selected patients receive radioactive iodine ablation of remnant thyroid tissue or tumor. A low iodine diet can enhance uptake of radioactive iodine. We compared the success rates of radioactive iodine ablation therapy in patients who followed two different low iodine diets (LIDs). The success rates of postsurgical radioactive iodine ablation in DTC patients receiving empiric doses of 150 mCi were retrospectively reviewed. First-time radioactive iodine ablation therapy was done in 71 patients following less strict LID. Less strict LID restricted seafood, iodized salt, egg yolk, dairy products, processed meat, instant prepared meals, and multivitamins. Very strict LID additionally restricted rice, freshwater fish, spinach, and soybean products. Radioactive iodine ablation therapy was considered successful when follow up {sup 123I} whole body scan was negative and stimulated serum thyroglobulin level was less than 2.0 ng/mL. The success rate of patients following less strict LID was 80.3% and for very strict LID 75.6%. There was no statistically significant difference in the success rates between the two LID groups (P=0.48). Very strict LID may not contribute to improving the success rate of initial radioactive iodine ablation therapy at the cost of great inconvenience to the patient.

  5. Efficient Strictness Analysis of Haskell

    DEFF Research Database (Denmark)

    Jensen, Kristian Damm; Hjæresen, Peter; Rosendahl, Mads

    1994-01-01

    Strictness analysis has been a living field of investigation since Mycroft's original work in 1980, and is getting increasingly significant with the still wider use of lazy functional programming languages. This paper focuses on an actual implementation of a strictness analyser for Haskell...

  6. Species Protection in the European Union : How Strict is Strict?

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    Schoukens, Hendrik; Bastmeijer, Kees; Born et al., Charles-Hubert

    2015-01-01

    European Union law to protect wild species of plants and animals is generally considered as ‘strict’. Opponents of nature conservation law often pick the species protection components of the EU Bird Directive and Habitat Directive as a prime example of an unnecessary strict regulatory scheme that

  7. Strictness Analysis for Attribute Grammars

    DEFF Research Database (Denmark)

    Rosendahl, Mads

    1992-01-01

    interpretation of attribute grammars. The framework is used to construct a strictness analysis for attribute grammars. Results of the analysis enable us to transform an attribute grammar such that attributes are evaluated during parsing, if possible. The analysis is proved correct by relating it to a fixpoint...... semantics for attribute grammars. An implementation of the analysis is discussed and some extensions to the analysis are mentioned....

  8. Surgical patient selection and counseling

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    Ziegelmann, Matt; Köhler, Tobias S.; Bailey, George C.; Miest, Tanner; Alom, Manaf

    2017-01-01

    The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures. The process of appropriate patient selection is determined by the integration of patient and surgeon factors, including psychological capacity to handle unsatisfactory results, baseline expectations, complexity of case, and surgeon volume and experience. Using this model, a high-risk scenario includes one in which a low-volume surgeon performs a complex case in a patient with limited psychological capacity and high expectations. In contrast, a high-volume surgeon performing a routine case in a male with low expectations and abundant psychiatric reserve is more likely to achieve a successful outcome. To further help identify patients who are at high risk for dissatisfaction, a previously published mnemonic is recommended: CURSED Patient (compulsive/obsessive, unrealistic, revision, surgeon shopping, entitled, denial, and psychiatric). Appropriate patient counseling includes setting appropriate expectations, reviewing the potential and anticipated risks of surgery, post-operative instruction to limit complications, and long-term follow-up. As thorough counseling is often a time-consuming endeavor, busy practices may elect to utilize various resources including educational materials, advanced practice providers, or group visits, among others. The consequences for poor patient selection and counseling may range from poor surgical outcomes and patient dissatisfaction to lawsuits, loss of

  9. Flexible or Strict Taxonomic Organization?

    DEFF Research Database (Denmark)

    Glückstad, Fumiko Kano; Mørup, Morten

    2012-01-01

    This work compares methods for constructing feature-based ontologies that are supposed to be used for culturally-specific knowledge transfer. The methods to be compared are the Terminological Ontology (TO) [1], a method of constructing ontology based on strict principles and rules, and the Infinite...... Relational Model (IRM) [2], a novel unsupervised machine learning method that learns multi-dimensional relations among concepts and features from loosely structured datasets. These methods are combined with a novel cognitive model, the Bayesian Model of Generalization (BMG) [3] that maps culturally...

  10. Extremely strict ideals in Banach spaces

    Indian Academy of Sciences (India)

    Motivated by the notion of an ideal introduced by Godefroy {\\it et al.} ({\\it Studia Math.} {\\bf 104} (1993) 13–59), in this article, we introduce and study the notion of an extremely strict ideal. For a Poulsen simplex K , we show that the space of affine continuous functions on K is an extremely strict ideal in the space of continuous ...

  11. Hyperbolic spaces are of strictly negative type

    DEFF Research Database (Denmark)

    Hjorth, Poul G.; Kokkendorff, Simon L.; Markvorsen, Steen

    2002-01-01

    We study finite metric spaces with elements picked from, and distances consistent with, ambient Riemannian manifolds. The concepts of negative type and strictly negative type are reviewed, and the conjecture that hyperbolic spaces are of strictly negative type is settled, in the affirmative...

  12. Extremely strict ideals in Banach spaces

    Indian Academy of Sciences (India)

    Abstract. Motivated by the notion of an ideal introduced by Godefroy et al. (Stu- dia Math. 104 (1993) 13–59), in this article, we introduce and study the notion of an extremely strict ideal. For a Poulsen simplex K, we show that the space of affine contin- uous functions on K is an extremely strict ideal in the space of continuous ...

  13. Finite Metric Spaces of Strictly negative Type

    DEFF Research Database (Denmark)

    Hjorth, Poul G.

    If a finite metric space is of strictly negative type then its transfinite diameter is uniquely realized by an infinite extent (“load vector''). Finite metric spaces that have this property include all trees, and all finite subspaces of Euclidean and Hyperbolic spaces. We prove that if the distance...... matrix of a finite metric space is both hypermetric and regular, then it is of strictly negative type. We show that the strictly negative type finite subspaces of spheres are precisely those which do not contain two pairs of antipodal points....

  14. Hyperbolic spaces are of strictly negative type

    DEFF Research Database (Denmark)

    Hjorth, Poul G.; Kokkendorff, Simon L.; Markvorsen, Steen

    2002-01-01

    We study finite metric spaces with elements picked from, and distances consistent with, ambient Riemannian manifolds. The concepts of negative type and strictly negative type are reviewed, and the conjecture that hyperbolic spaces are of strictly negative type is settled, in the affirmative....... The technique of the proof is subsequently applied to show that every compact manifold of negative type must have trivial fundamental group, and to obtain a necessary criterion for product manifolds to be of negative type....

  15. Strictly convex functions on complete Finsler manifolds

    Indian Academy of Sciences (India)

    ... Refresher Courses · Symposia · Live Streaming. Home; Journals; Proceedings – Mathematical Sciences; Volume 126; Issue 4. Strictly convex functions on complete Finsler manifolds. YOE ITOKAWA KATSUHIRO SHIOHAMA BANKTESHWAR TIWARI. Research Article Volume 126 Issue 4 October 2016 pp 623-627 ...

  16. Finite Metric Spaces of Strictly Negative Type

    DEFF Research Database (Denmark)

    Hjorth, Poul; Lisonek, P.; Markvorsen, Steen

    1998-01-01

    We prove that, if a finite metric space is of strictly negative type, then its transfinite diameter is uniquely realized by the infinite extender (load vector). Finite metric spaces that have this property include all spaces on two, three, or four points, all trees, and all finite subspaces of Eu...

  17. Patient selection criteria for outpatient joint arthroplasty.

    Science.gov (United States)

    Kort, Nanne P; Bemelmans, Yoeri F L; van der Kuy, P Hugo M; Jansen, Jacqueline; Schotanus, Martijn G M

    2017-09-01

    General consensus of patient selection criteria for outpatient joint arthroplasty is lacking, which is paramount to prevent prolonged hospital stay, adverse events and/or readmissions. This review highlights patient selection criteria for OJA based on the current literature and expert opinion. A search of the English and International electronic healthcare databases including MEDLINE/PubMed, EMBASE, AMED and the Cochrane library was performed in November 2015 to include studies published during the last 10 years. Furthermore, a survey of physicians from different specialties was performed. Fourteen studies described results regarding outpatient joint arthroplasty. Studies on outpatient hip and/or knee arthroplasty resulted in similar outcome in preselected patients. Patients who are able and willing to participate, with a low ASA classification (II), bleeding disorders, poorly controlled and/or severe cardiac (e.g. heart failure, arrhythmia) or pulmonary (e.g. embolism, respiratory failure) comorbidities, uncontrolled DM (type I or II), a high BMI (>30 m 2 /kg), chronic opioid consumption, functional neurological impairments, dependent functional status, chronic/end-stage renal disease and/or reduced preoperative cognitive capacity should be excluded from outpatient joint arthroplasty. The expert opinion-based selection criteria were comparable to literature with a further extension of exclusion for patients with practical issue's, urologic medical history and/or severe mobility disorders. Based on the current literature, the presented patient selection criteria provide a basis for outpatient joint arthroplasty and can be useful when selecting patients. Together with a change in mindset, a multidisciplinary approach and literature-based protocols, outpatient joint arthroplasty can be applied in daily orthopaedic practice while ensuring patients' safety. Clinical review, Level III.

  18. Extremely strict ideals in Banach spaces

    Indian Academy of Sciences (India)

    the space of regular Borel measures, it is easy to see that with respect to the projection μ → μ|(0, 1), M is an extremely strict ideal in C([0, 1]) but as the Lebesgue measure is non-atomic, M. ∗. 1 is not the norm closed ..... (Grenoble) 28 (1978) 35–65. [10] Rao T S S R K, On ideals in Banach spaces, Rocky Mountain J. Math.

  19. Validation of an automatic diagnosis of strict left bundle branch block criteria using 12-lead electrocardiograms

    DEFF Research Database (Denmark)

    Xia, Xiaojuan; Ruwald, Anne-Christine; Ruwald, Martin H

    2017-01-01

    AIMS: Strict left bundle branch block (LBBB) criteria were recently proposed to identify LBBB patients to benefit most from cardiac resynchronization therapy (CRT). The aim of our study was to automate identification of strict LBBB in order to facilitate its broader application. METHODS: We devel...

  20. Strictness Analysis and Denotational Abstract Interpretation

    DEFF Research Database (Denmark)

    Nielson, Flemming

    1988-01-01

    there and this sufices to make the framework applicable to strictness analysis for the lambda-calculus. This shows the possibility of a general theory for the analysis of functional programs and it gives more insight into the relative precision of the various analyses. In particular it is shown that a collecting (static......A theory of abstract interpretation () is developed for a typed lambda-calculus. The typed lambda-calculus may be viewed as the ''static'' part of a two-level denotational metalanguage for which abstract interpretation was developed by ). The present development relaxes a condition imposed...

  1. 7 CFR 28.441 - Strict Middling Yellow Stained Color.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Middling Yellow Stained Color. 28.441 Section... Strict Middling Yellow Stained Color. Strict Middling Yellow Stained Color is color which is deeper than that of Strict Middling Tinged Color. [57 FR 34498, Aug. 5, 1992] ...

  2. 7 CFR 28.412 - Strict Middling Light Spotted Color.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Middling Light Spotted Color. 28.412 Section 28... Light Spotted Color. Strict Middling Light Spotted Color is color which in spot or color, or both, is between Strict Middling Color and Strict Middling Spotted Color. ...

  3. Improved patient selection for TAH implantation.

    Science.gov (United States)

    Loisance, D; Dubois Rande, J L; Deleuze, P; Benvenuti, C; Dervanian, P; Brunet, S; Hillion, M L; Castaigne, A; Cachera, J P

    1989-01-01

    Patient selection and optimal timing for implantation are unsettled issues in candidates for a bridge to cardiac transplantation. A prospective evaluation of a strategy based on enoximone (E) given IV, in addition to sympathomimetic drugs, permitting to buy time, and delay by hours or days the decisions, has been performed from 1985 to 1988. Thirty-four patients in cardiogenic shock with hemodynamical criteria for TAH implantation have been included: Cl was 1.8 +/- 0.2 L/min/m2 PCWP 29 +/- 7 mmHg, diuresis less than 20 ml/hr. The protocol permitted to postpone decisions of implantation in 30 cases. The 4 unresponsive patients were implanted immediately with TAH (3) or VAD (1). Three were transplanted, two successfully. For 30, time given permitted discovery of hidden contraindications to transplantation in 17 patients. In 13, indication for transplantation was confirmed and performed in 11 within 6 hrs to 8 days (survival 64%). In two, sudden deterioration led to an unsuccessful TAH implantation. Multifactorial analysis showed that a 50% rise in Cl together with a 50% drop in PCWP, a 50% drop in PVR 30 min after IV E has a high predictive value of survival. These data suggest that enoximone IV bolus given in addition to maximal sympathomimetics to patients in cardiogenic shock reduces by 88% the need for TAH or VAD. It also permits a better selection of the candidates.

  4. Patient selection for subcutaneous versus sublingual immunotherapy.

    Science.gov (United States)

    Larenas-Linnemann, Désirée

    2015-12-01

    With the Food and Drug Administration's approval of sublingual allergen-specific immunotherapy (SL-AIT) tablets for grass and ragweed pollen, SL-AIT is progressively gathering importance not only in Europe, but also in the United States and other parts of the world. We reviewed issues related to the selection of patients for the sublingual or the subcutaneous route for allergic patients, based on what has been published since January 2014 on subcutaneous-versus-SL-AIT efficacy, safety and other issues. (Figure is included in full-text article.) As patient's adherence seems one of the major problems in real-life AIT, investigators have sought how to enhance AIT simplicity by changing the route to home-administrated SL-AIT, and by shortening the subcutaneous-allergen-specific immunotherapy (SC-AIT) build-up or maintenance phase. The latter was safe with several hypoallergenic extracts. As for SL-AIT, double blind placebo-controlled large trials in patients with allergic rhinitis and asthma have shown the efficacy and safety of ragweed pollen and house dust mite SLIT tablets and highly concentrated liquid formulations, primarily in adults. A large trial with SLIT in 3-year-old children was effective. With the improvement of SL-AIT efficacy, the selection of SC-versus-SL-AIT will probably increasingly be based not on efficacy, but on practical aspects, without losing sight of which SL-AIT products have proven efficacy.

  5. Geometrical optimization for strictly localized structures

    Science.gov (United States)

    Mo, Yirong

    2003-07-01

    Recently we proposed the block localized wavefunction (BLW) approach which takes the advantages of valence bond theory and molecular orbital theory and defines the wavefunctions for resonance structures based on the assumption that all electrons and orbitals are partitioned into a few subgroups. In this work, we implement the geometrical optimization of the BLW method based on the algorithm proposed by Gianinetti and coworkers. Thus, we can study the conjugation effect on not only the molecular stability, but also the molecular geometry. With this capability, the π conjugation effect in trans-polyenes C2nH2n+2 (n=2-5) as well as in formamide and its analogs are studied by optimizing their delocalized and strictly localized forms with the 6-31G(d) and 6-311+G(d,p) basis sets. Although it has been well presumed that the π resonance shortens the single bonds and lengthens the double bonds with the delocalization of π electrons across the whole line in polyenes, our optimization of the strictly localized structures quantitatively shows that when the conjugation effect is "turned off," the double bond lengths will be identical to the CC bond length in ethylene and the single Csp2-Csp2 bond length will be about 1.513-1.517 Å. In agreement with the classical Hückel theory, the resonance energies in polyenes are approximately in proportion to the number of double bonds. Similarly, resonance is responsible not only for the planarity of formamide, thioformamide, and selenoformamide, but also for the lengthening of the CX (X=O,S,Se) double bond and the shortening of the CN bonds. Although it is assumed that the CX bond polarization decreases in the order of O>S>Se, the π electronic delocalization increases in the opposite order, i.e., formamide

  6. Liver Transplantation: Evolving Patient Selection Criteria

    Directory of Open Access Journals (Sweden)

    Andy S Yu

    2001-01-01

    Full Text Available The widespread recognition of the success of liver transplantation as a treatment for most types of acute and chronic liver failure has led to increased referrals for transplantation in the setting of a relatively fixed supply of cadaver donor organs. These events have led to a marked lengthening of the waiting time for liver transplantation, resulting in increased deaths of those on the waiting list and sicker patients undergoing transplantation. Nearly 5000 liver transplantations were performed in the United States in 2000, while the waiting list grew to over 17,000 patients. The mounting disparity between the number of liver transplant candidates and the limited supply of donor organs has led to reassessment of the selection and listing criteria for liver transplantation, as well as revision of organ allocation and distribution policies for cadaver livers. The development of minimal listing criteria for patients with chronic liver disease based on a specific definition for decompensation of cirrhosis has facilitated the more uniform listing of patients at individual centres across the United States. The United Network for Organ Sharing, under pressure from transplant professionals, patient advocacy groups and the federal government, has continuously revised allocation and distribution policies based on the ethical principles of justice for the individual patient versus optimal utility of the limited organ supply available annually. Beginning in 2002, it is likely that the Model for End-stage Liver Disease (MELD score will be implemented to determine disease severity and direct donor organs to the sickest patients rather than to those with the longest waiting times.

  7. From Regular to Strictly Locally Testable Languages

    Directory of Open Access Journals (Sweden)

    Stefano Crespi Reghizzi

    2011-08-01

    Full Text Available A classical result (often credited to Y. Medvedev states that every language recognized by a finite automaton is the homomorphic image of a local language, over a much larger so-called local alphabet, namely the alphabet of the edges of the transition graph. Local languages are characterized by the value k=2 of the sliding window width in the McNaughton and Papert's infinite hierarchy of strictly locally testable languages (k-slt. We generalize Medvedev's result in a new direction, studying the relationship between the width and the alphabetic ratio telling how much larger the local alphabet is. We prove that every regular language is the image of a k-slt language on an alphabet of doubled size, where the width logarithmically depends on the automaton size, and we exhibit regular languages for which any smaller alphabetic ratio is insufficient. More generally, we express the trade-off between alphabetic ratio and width as a mathematical relation derived from a careful encoding of the states. At last we mention some directions for theoretical development and application.

  8. 7 CFR 28.404 - Strict Low Middling Color.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Low Middling Color. 28.404 Section 28.404... for the Color Grade of American Upland Cotton § 28.404 Strict Low Middling Color. Strict Low Middling Color is color which is within the range represented by a set of samples in the custody of the United...

  9. 7 CFR 28.406 - Strict Good Ordinary Color.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Good Ordinary Color. 28.406 Section 28.406... for the Color Grade of American Upland Cotton § 28.406 Strict Good Ordinary Color. Strict Good Ordinary Color is color which is within the range represented by a set of samples in the custody of the...

  10. 7 CFR 28.402 - Strict Middling Color.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Middling Color. 28.402 Section 28.402... for the Color Grade of American Upland Cotton § 28.402 Strict Middling Color. Strict Middling Color is color which is within the range represented by a set of samples in the custody of the United States...

  11. Mammalian evolution may not be strictly bifurcating.

    Science.gov (United States)

    Hallström, Björn M; Janke, Axel

    2010-12-01

    The massive amount of genomic sequence data that is now available for analyzing evolutionary relationships among 31 placental mammals reduces the stochastic error in phylogenetic analyses to virtually zero. One would expect that this would make it possible to finally resolve controversial branches in the placental mammalian tree. We analyzed a 2,863,797 nucleotide-long alignment (3,364 genes) from 31 placental mammals for reconstructing their evolution. Most placental mammalian relationships were resolved, and a consensus of their evolution is emerging. However, certain branches remain difficult or virtually impossible to resolve. These branches are characterized by short divergence times in the order of 1-4 million years. Computer simulations based on parameters from the real data show that as little as about 12,500 amino acid sites could be sufficient to confidently resolve short branches as old as about 90 million years ago (Ma). Thus, the amount of sequence data should no longer be a limiting factor in resolving the relationships among placental mammals. The timing of the early radiation of placental mammals coincides with a period of climate warming some 100-80 Ma and with continental fragmentation. These global processes may have triggered the rapid diversification of placental mammals. However, the rapid radiations of certain mammalian groups complicate phylogenetic analyses, possibly due to incomplete lineage sorting and introgression. These speciation-related processes led to a mosaic genome and conflicting phylogenetic signals. Split network methods are ideal for visualizing these problematic branches and can therefore depict data conflict and possibly the true evolutionary history better than strictly bifurcating trees. Given the timing of tectonics, of placental mammalian divergences, and the fossil record, a Laurasian rather than Gondwanan origin of placental mammals seems the most parsimonious explanation.

  12. The potential benefits from respiratory gating for breast cancer patients regarding target coverage and dose to organs at risk when applying strict dose limits to the heart: results from the DBCG HYPO trial

    DEFF Research Database (Denmark)

    Berg, Martin; Lorenzen, Ebbe L; Jensen, Ingelise

    2018-01-01

    PURPOSE: The potential benefits from respiratory gating (RG) compared to free-breathing (FB) regarding target coverage and dose to organs at risk for breast cancer patients receiving post-operative radiotherapy (RT) in the DBCG HYPO multicentre trial are reported. MATERIAL AND METHODS: Patients i...

  13. Nutritional assessment of selected patients with cancer.

    Science.gov (United States)

    Surwillo, Agnieszka; Wawrzyniak, Agata

    2013-01-01

    It is recognised that both nutritional status and an improper diet have significant effects on weakening the outcomes of treatment in cancer patients. As a result, a lowered response to therapy and an increase in untoward side effects is often observed leading to a deteriorating quality of life. The role of an adequately balanced diet is thus regarded as being vital in supporting recovery. To assess the dietary consumption of calories, macro-elements and selected vitamins and minerals for subjects diagnosed with cancers of the breast, lungs and bones or soft tissue. A survey was performed on 100 subjects diagnosed with various tumours between the September and December months of 2011 consisting of 34 with breast cancer, 33 lung cancer and 33 with bone or soft tissue cancer. The questionnaire was devised in-house, which included a three day dietary record. Results. The average daily calorific intake was found to be inadequate at 1608 kcal. In addition, abnormal proportions of energy derived from macro-elements was seen, where the contributions made by fats and proteins were somewhat high at respectively 35.1% and 16.5%, but too low in the case of carbohydrates at 52.1%. Up to 78% subjects had insufficient protein intakes, 88% showed deficiencies in consuming carbohydrates, as were 89% for fibre, 85% vitamin C, 99% calcium, 98% magnesium and 81% for iron. Many dietary shortcomings were observed in the studied subjects. There is therefore a need to educate persons suffering from cancer to adopt an adequate and balanced diet as means of providing vital support for treatment to be more effective.

  14. Rate Control Efficacy in Permanent Atrial Fibrillation : Successful and Failed Strict Rate Control Against a Background of Lenient Rate Control

    NARCIS (Netherlands)

    Groenveld, Hessel F.; Tijssen, Jan G. P.; Crijns, Harry J. G. M.; Van den Berg, Maarten P.; Hillege, Hans L.; Alings, Marco; Van Veldhuisen, Dirk J.; Van Gelder, Isabelle C.

    2013-01-01

    Objectives This study sought to investigate differences in outcome between patients treated with successful strict, failed strict, and lenient rate control. Background The RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation) study showed no difference in outcome between lenient and

  15. Modal Inclusion Logic: Being Lax is Simpler than Being Strict

    DEFF Research Database (Denmark)

    Hella, Lauri; Kuusisto, Antti Johannes; Meier, Arne

    2015-01-01

    We investigate the computational complexity of the satisfiability problem of modal inclusion logic. We distinguish two variants of the problem: one for strict and another one for lax semantics. The complexity of the lax version turns out to be complete for EXPTIME, whereas with strict semantics...

  16. 7 CFR 28.431 - Strict Middling Tinged Color.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Middling Tinged Color. 28.431 Section 28.431 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Tinged Color is color which is better than Middling Tinged Color. ...

  17. 7 CFR 28.433 - Strict Low Middling Tinged Color.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Low Middling Tinged Color. 28.433 Section 28.433 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Tinged Color. Strict Low Middling Tinged Color is color which is within the range represented by a set of...

  18. 7 CFR 28.424 - Strict Low Middling Spotted Color.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Low Middling Spotted Color. 28.424 Section 28.424 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Low Middling Spotted Color is color which is within the range represented by a set...

  19. 7 CFR 28.426 - Strict Good Ordinary Spotted Color.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Good Ordinary Spotted Color. 28.426 Section 28.426 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Good Ordinary Spotted Color is color which is within the range represented by a set...

  20. 7 CFR 28.422 - Strict Middling Spotted Color.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Middling Spotted Color. 28.422 Section 28.422 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Spotted Color is color which is within the range represented by a set of samples...

  1. Strictly-regular number system and data structures

    DEFF Research Database (Denmark)

    Elmasry, Amr Ahmed Abd Elmoneim; Jensen, Claus; Katajainen, Jyrki

    2010-01-01

    We introduce a new number system that we call the strictly-regular system, which efficiently supports the operations: digit-increment, digit-decrement, cut, concatenate, and add. Compared to other number systems, the strictly-regular system has distinguishable properties. It is superior to the re...

  2. Strategy and Aspects of Monitoring / Control Strictly in Coordinated Subsystems

    Directory of Open Access Journals (Sweden)

    William José Borges

    2012-06-01

    Full Text Available This paper aims to discuss the approach structures of the strictly coordinated theoretical framework developed by Zylbersztajn and Farina (1999 as an expanded perspective of the firm, taking into account the food supply chains as an extension of the nexus of contracts proposed by Coase (1937 and taken up by Williamson (1985. The structures stand out as strictly coordinated. Zylbersztajn and Farina (1999 turn to identifying points of common interests that encourage firms to promote contracts between themselves in a strictly coordinated way, considering the degree of asset specificity involved in the transaction and the competitive forces that determine the search for strategic positioning organizations to achieve sustainable superior results.

  3. Effectiveness of L2 spinal nerve infiltration for selective discogenic low back pain patients

    International Nuclear Information System (INIS)

    Ohtori, Seiji; Nakamura, Shinichiro; Koshi, Takana

    2010-01-01

    It has been reported that rat L5/6 lumbar discs are innervated mainly by L2 dorsal root ganglion neurons. We previously reported that L2 spinal nerve infiltration was effective for discogenic low back pain (DLBP) patients, although the diagnosis was based only on the results of physical examination, plain films, and magnetic resonance imaging (MRI). The purpose of the current study was to evaluate L2 spinal nerve block for DLBP patients retrospectively based on MRI findings and surgical results. A total of 62 patients with only LBP and no accompanying radicular pain were investigated. Patients had only one level of disc degeneration on MRI. When pain was provoked during discography, we performed surgery at the next stage (40 patients). In all, 22 patients were excluded owing to negative discography results. Of the 40 patients, we evaluated 25 strictly selected patients suffering from DLBP. DLBP was diagnosed when the patient experienced pain relief at least 2 years after anterior lumbar interbody fusion. Fifteen patients who did not show pain relief after surgery were used for the non-DLBP group. L2 spinal nerve infiltration using 1.5 ml of lidocaine was performed in all 40 patients before surgery. The visual analogue scale (VAS) score after L2 spinal nerve infiltration was recorded, and an association of L2 spinal nerve infiltration and DLBP was explored. Low back pain scores assessed using the VAS score, the Japanese Orthopedic Association score, and the Oswestry Disability Index score in the two groups were not significantly different. L2 spinal nerve infiltration was effective for 27 patients but not effective for 13 patients; the VAS score after 15 min and 2 h improved in the DLBP group compared with that of the non-DLBP group (P<0.05). L2 spinal nerve infiltration was more effective in DLBP patients (21 patients, 84%) than in the non-DLBP group (6 patients, 40%) (P<0.05). In the current study, L2 spinal nerve infiltration was effective in 84% of selected DLBP

  4. The role of magnetic resonance imaging to select patients for preoperative treatment in rectal cancer

    International Nuclear Information System (INIS)

    Roedel, Claus; Sauer, Rolf; Fietkau, Rainer

    2009-01-01

    Background: Traditionally, the decision to apply preoperative treatment for rectal cancer patients has been based on the T- and N-category. Recently, the radial distance of the tumor to the circumferential resection margin (CRM) has been identified as an important risk factor for local failure. By magnetic resonance imaging (MRI) this distance can be measured preoperatively with high reliability. Thus, selected groups have started to limit the indication for preoperative therapy to tumors extending to - or growing within 1 mm from - the mesorectal fascia (CRM+). Methods: Pros and cons of this selected approach for preoperative treatment and first clinical results are presented. Prerequisites are the availability of modern high-resolution thin-section MRI technology as well as strict quality control of MRI and surgical quality of total mesorectal excision (TME). Results: By selecting patients with CRM-positive tumors on MRI for preoperative therapy, only approximately 35% patients will require preoperative radiotherapy (RT) or radiochemotherapy (RCT). However, with histopathologic work-up of the resected specimen after primary surgery, the indication for postoperative RCT is given for a rather large percentage of patients, i.e., for pCRM+ (5-10%), intramesorectal or intramural excision (30-40%), pN+ (30-40%). Postoperative RCT, however, is significantly less effective and more toxic than preoperative RCT. A further point of concern is the assertion that patients, in whom a CRM-negative status is achieved by surgery alone, do not benefit from additional RT. Data of the Dutch TME trial and the British MRC (Medical Research Council) CR07 trial, however, suggest the reverse. Conclusion: To omit preoperative RT/RCT for CRM-negative tumors on MRI needs to be further investigated in prospective clinical trials. The German guidelines for the treatment of colorectal cancer 2008 continue to indicate preoperative RT/RCT based on the T- and N-category. (orig.)

  5. [The role of magnetic resonance imaging to select patients for preoperative treatment in rectal cancer].

    Science.gov (United States)

    Rödel, Claus; Sauer, Rolf; Fietkau, Rainer

    2009-08-01

    Traditionally, the decision to apply preoperative treatment for rectal cancer patients has been based on the T- and N-category. Recently, the radial distance of the tumor to the circumferential resection margin (CRM) has been identified as an important risk factor for local failure. By magnetic resonance imaging (MRI) this distance can be measured preoperatively with high reliability. Thus, selected groups have started to limit the indication for preoperative therapy to tumors extending to - or growing within 1 mm from - the mesorectal fascia (CRM+). Pros and cons of this selected approach for preoperative treatment and first clinical results are presented. Prerequisites are the availability of modern high-resolution thin-section MRI technology as well as strict quality control of MRI and surgical quality of total mesorectal excision (TME). By selecting patients with CRM-positive tumors on MRI for preoperative therapy, only approximately 35% patients will require preoperative radiotherapy (RT) or radiochemotherapy (RCT). However, with histopathologic work-up of the resected specimen after primary surgery, the indication for postoperative RCT is given for a rather large percentage of patients, i.e., for pCRM+ (5-10%), intramesorectal or intramural excision (30-40%), pN+ (30-40%). Postoperative RCT, however, is significantly less effective and more toxic than preoperative RCT. A further point of concern is the assertion that patients, in whom a CRM-negative status is achieved by surgery alone, do not benefit from additional RT. Data of the Dutch TME trial and the British MRC (Medical Research Council) CR07 trial, however, suggest the reverse. To omit preoperative RT/RCT for CRM-negative tumors on MRI needs to be further investigated in prospective clinical trials. The German guidelines for the treatment of colorectal cancer 2008 continue to indicate preoperative RT/RCT based on the T- and N-category.

  6. Strict finitism and the logic of mathematical applications

    CERN Document Server

    Ye, Feng

    2011-01-01

    Exploring the logic behind applied mathematics to the physical world, this volume illustrates how radical naturalism, nominalism and strict finitism can account for the applications of classical mathematics in current theories about natural phenomena.

  7. Strict monotonicity and unique continuation of the biharmonic operator

    Directory of Open Access Journals (Sweden)

    Najib Tsouli

    2012-01-01

    Full Text Available In this paper, we will show that the strict monotonicity of the eigenvalues of the biharmonic operator holds if and only if some unique continuation property is satisfied by the corresponding eigenfunctions.

  8. Two examples of non strictly convex large deviations

    OpenAIRE

    De Marco, Stefano; Jacquier, Antoine; Roome, Patrick

    2016-01-01

    We present two examples of a large deviations principle where the rate function is not strictly convex. This is motivated by a model used in mathematical finance (the Heston model), and adds a new item to the zoology of non strictly convex large deviations. For one of these examples, we show that the rate function of the Cramer-type of large deviations coincides with that of the Freidlin-Wentzell when contraction principles are applied.

  9. Strictly contractive quantum channels and physically realizable quantum computers

    International Nuclear Information System (INIS)

    Raginsky, Maxim

    2002-01-01

    We study the robustness of quantum computers under the influence of errors modeled by strictly contractive channels. A channel T is defined to be strictly contractive if, for any pair of density operators ρ, σ in its domain, parallel Tρ-Tσ parallel 1 ≤k parallel ρ-σ parallel 1 for some 0≤k 1 denotes the trace norm). In other words, strictly contractive channels render the states of the computer less distinguishable in the sense of quantum detection theory. Starting from the premise that all experimental procedures can be carried out with finite precision, we argue that there exists a physically meaningful connection between strictly contractive channels and errors in physically realizable quantum computers. We show that, in the absence of error correction, sensitivity of quantum memories and computers to strictly contractive errors grows exponentially with storage time and computation time, respectively, and depends only on the constant k and the measurement precision. We prove that strict contractivity rules out the possibility of perfect error correction, and give an argument that approximate error correction, which covers previous work on fault-tolerant quantum computation as a special case, is possible

  10. Selection of paediatric patients for intensive care

    African Journals Online (AJOL)

    illness, particularly near-drowning, cardiomyopathy, gastro- enteritis and complicated infectious illness (Table Ill). Cardiorespiratory resuscitation prior to ICU admission was associated with increased mortality (7/11 v. 27/106,. P < 0,05, two-tailed Fisher's exact test). There were no deaths in patients with polytrauma without ...

  11. Improved patient selection by stratified surgical intervention

    DEFF Research Database (Denmark)

    Wang, Miao; Bünger, Cody E; Li, Haisheng

    2015-01-01

    BACKGROUND CONTEXT: Choosing the best surgical treatment for patients with spinal metastases remains a significant challenge for spine surgeons. There is currently no gold standard for surgical treatments. The Aarhus Spinal Metastases Algorithm (ASMA) was established to help surgeons choose...... the most appropriate surgical intervention for patients with spinal metastases. PURPOSE: The purpose of this study was to evaluate the clinical outcome of stratified surgical interventions based on the ASMA, which combines life expectancy and the anatomical classification of patients with spinal metastases...... survival times in the five surgical groups determined by the ASMA were 2.1 (TS 0-4, TC 1-7), 5.1 (TS 5-8, TC 1-7), 12.1 (TS 9-11, TC 1-7 or TS 12-15, TC 7), 26.0 (TS 12-15, TC 4-6), and 36.0 (TS 12-15, TC 1-3) months. The 30-day mortality rate was 7.5%. Postoperative neurological function was maintained...

  12. Individual patient information to select patients for different radiation techniques

    NARCIS (Netherlands)

    Quik, E. H.; Feenstra, T. L.; Postmus, D.; Slotman, B. J.; Leemans, C. R.; Krabbe, P. F. M.; Langendijk, J. A.

    Background and purpose: Proton therapy is an emerging technique in radiotherapy which results in less dose to the normal tissues with similar target dose than photon therapy, the current standard. Patient-level simulation models support better decision making on which patients would benefit most.

  13. Individual patient information to select patients for different radiation techniques

    NARCIS (Netherlands)

    Quik, E. H.; Feenstra, T. L.; Postmus, D.; Slotman, B. J.; Leemans, C. R.; Krabbe, P. F M; Langendijk, J. A.

    BACKGROUND AND PURPOSE: Proton therapy is an emerging technique in radiotherapy which results in less dose to the normal tissues with similar target dose than photon therapy, the current standard. Patient-level simulation models support better decision making on which patients would benefit most.

  14. Convergence theorems for strictly hemi-contractive maps

    International Nuclear Information System (INIS)

    Chidume, C.E.; Osilike, M.O.

    1992-04-01

    It is proved that each of two well-known fixed point iteration methods (the Mann and the Ishikawa iteration methods) converges strongly to the fixed point of strictly hemi-contractive map in real Banach spaces with property (U, λ, m+1,m), λ is an element of R, m is an element of IN. The class of strictly hemi-contractive maps includes all strictly pseudo-contractive maps with nonempty fixed point sets; and Banach spaces with property (U, λ, m+1, m), λ is an element of R, m is an element of IN include the L p (or l p ) spaces, p≥2. Our theorems generalize important known results. (author). 22 refs

  15. Appropriate selection for omalizumab treatment in patients with severe asthma?

    DEFF Research Database (Denmark)

    Nygaard, Leo; Henriksen, Daniel Pilsgaard; Madsen, Hanne

    2017-01-01

    Background: Omalizumab improves asthma control in patients with uncontrolled severe allergic asthma; however, appropriate patient selection is crucial. Information in this field is sparse. Objective: We aimed to estimate whether potential omalizumab candidates were appropriately selected according...... to guidelines, and the clinical effect of omalizumab treatment over time. Design: We performed a retrospective observational study on adult patients with asthma treated with omalizumab during 2006-2015 at the Department of Respiratory Medicine at Odense University Hospital (OUH), Denmark. Data were obtained...... from the Electronic Patient Journal of OUH and Odense Pharmaco-Epidemiological Database. Guideline criteria for omalizumab treatment were used to evaluate the appropriateness of omalizumab candidate selection, and the Asthma Control Test (ACT) to assess the clinical effects of omalizumab at weeks 16...

  16. Mann iteration with errors for strictly pseudo-contractive mappings ...

    African Journals Online (AJOL)

    It is well known that any fixed point of a Lipschitzian strictly pseudo-contractive self mapping of a nonempty closed convex and bounded subset K of a Banach space X is unique [6] and may be norm approximated by an iterative procedure. In this paper, we show that Mann iteration with errors can be used to approximate the ...

  17. Dominated operators, absolutely summing operators and the strict ...

    African Journals Online (AJOL)

    b(X;E) be the space of all E-valued bounded continuous functions on X, equipped with the strict topology β. We study dominated and absolutely summing operators T : Cb(X;E) → F. We derive that if X is a locally compact Hausdorff space and E ...

  18. Convergence of GAOR Iterative Method with Strictly Diagonally Dominant Matrices

    Directory of Open Access Journals (Sweden)

    Guangbin Wang

    2011-01-01

    Full Text Available We discuss the convergence of GAOR method for linear systems with strictly diagonally dominant matrices. Moreover, we show that our results are better than ones of Darvishi and Hessari (2006, Tian et al. (2008 by using three numerical examples.

  19. Dominance on Strict Triangular Norms and Mulholland Inequality

    Czech Academy of Sciences Publication Activity Database

    Petrík, Milan

    2018-01-01

    Roč. 335, 15 March (2018), s. 3-17 ISSN 0165-0114 R&D Projects: GA ČR GJ15-07724Y Institutional support: RVO:67985807 Keywords : dominance relation * Mulholland inequality * strict triangular norm * transitivity Subject RIV: BA - General Mathematics Impact factor: 2.718, year: 2016

  20. Strategy selection in Alzheimer patients: a study in arithmetic.

    Science.gov (United States)

    Lemaire, Patrick; Leclère, Mariel

    2014-01-01

    We compared Alzheimer's disease (AD) patients' and elderly controls' abilities to select the best strategy on each item and determined whether AD patients tended to repeat the same strategy across consecutive items more often than controls. A total of 60 participants (30 healthy older adults, HOA; 30 AD patients) were asked to select the best rounding strategy to estimate products of multiplication problems (e.g., estimating 42 × 76 by rounding operands down or up, like doing 40 × 70 = 2800 or 50 × 80 = 3200). We identified strategies used on each problem and measured solution latencies and percentage errors with each strategy as a function of problem characteristics. Older adults and AD patients were able to use both available strategies. However, AD patients were less able to select the best strategy than HOA, especially on problems for which selecting the best strategy was most difficult. Moreover, AD patients significantly repeated the preceding strategies across successive problems more often than HOA. Our findings have important implications for further our understanding of dementia-related differences in strategic aspects of cognitive performance.

  1. Benefit of Selective Inspiratory Muscles Training on Respiratory Failure Patients

    Directory of Open Access Journals (Sweden)

    Ahmed Abdelmoniem Ibrahim

    2017-05-01

    Full Text Available The purpose of this research was to detect the effect of training of inspiratory muscle on respiratory failure patients. Method: Thirty patients with respiratory failure were selected from Cairo university hospital (critical care department. These patients were divided equally into two groups, study Group A and control Group B. Each patient of Group A received inspiratory muscles training using threshold inspiratory muscle trainer (IMT, while patients of Group B received only chest physiotherapy. Oxygen level and respiratory muscles strength for each group were measured. Result revealed significant improvement in both groups, improvement was higher in Group A more than Group B regarding oxygen level and respiratory muscles strength. Conclusion: Training of respiratory muscles using threshold inspiratory muscle trainer could be a useful in improving oxygen level and respiratory muscles power in patients with respiratory failure, this study revealed that, respiratory muscles training could be a helpful tool to improve oxygen level and inspiratory muscle strength for respiratory failure patients.

  2. Selecting Patients With Small Renal Masses For Active Surveillance.

    Science.gov (United States)

    Johnson, Michael H; Allaf, Mohamad E; Pierorazio, Phillip M

    2017-11-13

    The incidentally discovered, clinically-localized, small renal mass (clinical stage T1aN0M0, ≤4cm) is the most commonly diagnosed entity in renal cell carcinoma (RCC) - now accounting for at least 40% of newly diagnosed renal tumors. Given the above argument, active surveillance (AS) has emerged as a viable management strategy for SRM. This review will examine and discuss the existing literature regarding selection criteria for AS. AS of clinical T1a renal masses is emerging as a safe and effective management strategy in selected patients, yet appropriate patient selection and counseling remains an area of great interest. Long-term clinical outcomes are just beginning to be reported, thus much of the supporting evidence on AS and patient selection is based on retrospective data of heterogeneous quality. Nevertheless, there are certain conclusions that can be a made, despite these current limitations. First, appropriate selection of candidates should include a comprehensive evaluation of competing health risks, tumor characteristics, and patient preferences. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  3. Endoscopic bronchial valve treatment: patient selection and special considerations

    Directory of Open Access Journals (Sweden)

    Eberhardt R

    2015-10-01

    Full Text Available Ralf Eberhardt,1,2 Daniela Gompelmann,1,2 Felix JF Herth,1,2 Maren Schuhmann1 1Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, 2Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany Abstract: As well as lung volume reduction surgery, different minimally invasive endoscopic techniques are available to achieve lung volume reduction in patients with severe emphysema and significant hyperinflation. Lung function parameters and comorbidities of the patient, as well as the extent and distribution of the emphysema are factors to be considered when choosing the patient and the intervention. Endoscopic bronchial valve placement with complete occlusion of one lobe in patients with heterogeneous emphysema is the preferred technique because of its reversibility. The presence of high interlobar collateral ventilation will hinder successful treatment; therefore, endoscopic coil placement, polymeric lung volume reduction, or bronchoscopic thermal vapor ablation as well as lung volume reduction surgery can be used for treating patients with incomplete fissures. The effect of endoscopic lung volume reduction in patients with a homogeneous distribution of emphysema is still unclear and this subgroup should be treated only in clinical trials. Precise patient selection is necessary for interventions and to improve the outcome and reduce the risk and possible complications. Therefore, the patients should be discussed in a multidisciplinary approach prior to determining the most appropriate treatment for lung volume reduction. Keywords: lung emphysema, valve treatment, collateral ventilation, patient selection, outcome

  4. Phenotypes selected during chronic lung infection in cystic fibrosis patients

    DEFF Research Database (Denmark)

    Ciofu, Oana; Mandsberg, Lotte F; Wang, Hengzhuang

    2012-01-01

    During chronic lung infection of patients with cystic fibrosis, Pseudomonas aeruginosa can survive for long periods of time under the challenging selective pressure imposed by the immune system and antibiotic treatment as a result of its biofilm mode of growth and adaptive evolution mediated...... the importance of biofilm prevention strategies by early aggressive antibiotic prophylaxis or therapy before phenotypic diversification during chronic lung infection of patients with cystic fibrosis....

  5. Factors Influencing Patient Selection of an Orthopaedic Sports Medicine Physician.

    Science.gov (United States)

    Manning, Blaine T; Bohl, Daniel D; Saltzman, Bryan M; Cotter, Eric J; Wang, Kevin C; Epley, Chad T; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R

    2017-08-01

    The rise in consumer-centric health insurance plans has increased the importance of the patient in choosing a provider. There is a paucity of studies that examine how patients select an orthopaedic sports medicine physician. To evaluate factors that patients consider when choosing an orthopaedic sports medicine physician. Case series; Level of evidence, 4. A total of 1077 patients who sought treatment by 3 sports medicine physicians were administered an anonymous questionnaire. The questionnaire included 19 questions asking respondents to rate the importance of specific factors regarding the selection of orthopaedic sports medicine physicians on a scale of 1 (not important at all) to 10 (very important). The remaining 6 questions were multiple-choice and regarded the following criteria: preferred physician age, appointment availability, clinic waiting room times, travel distance, and medical student/resident involvement. Of the 1077 consecutive patients administered the survey, 382 (35%) responded. Of these, 59% (n = 224) were male, and 41% (n = 158) were female. In ranking the 19 criteria in terms of importance, patients rated board certification (9.12 ± 1.88), being well known for a specific area of expertise (8.27 ± 2.39), and in-network provider status (8.13 ± 2.94) as the 3 most important factors in selecting an orthopaedic sports medicine physician. Radio, television, and Internet advertisements were rated the least important. Regarding physician age, 63% of patients would consider seeking a physician who is ≤65 years old. Approximately 78% of patients would consider seeking a different physician if no appointments were available within 4 weeks. The study results suggest that board certification, being well known for a specific area of expertise, and health insurance in-network providers may be the most important factors influencing patient selection of an orthopaedic sports medicine physician. Advertisements were least important to patients. Patient

  6. Cardiac resynchronization therapy : advances in optimal patient selection

    NARCIS (Netherlands)

    Bleeker, Gabe Berend

    2007-01-01

    Despite the impressive results of cardiac resynchronization theraphy (CRT) in recent large randomized trials a consistent number of patients fails to improve following CRT implantation when the established CRT selection criteria (NYHA class III-IV heart failure, LV ejection fraction ≤35 % and QRS

  7. Prosthetic aortic valve selection: current patient experience, preferences and knowledge

    Science.gov (United States)

    Korteland, Nelleke M; Bras, Frans J; van Hout, Fabienne M A; Kluin, Jolanda; Klautz, Robert J M; Bogers, Ad J J C; Takkenberg, Johanna J M

    2015-01-01

    Objective Current clinical practice guidelines advocate shared decision-making (SDM) in prosthetic valve selection. This study assesses among adult patients accepted for aortic valve replacement (AVR): (1) experience with current clinical decision-making regarding prosthetic valve selection, (2) preferences for SDM and risk presentation and (3) prosthetic valve knowledge and numeracy. Methods In a prospective multicentre cohort study, AVR patients were surveyed preoperatively and 3 months postoperatively. Results 132 patients (89 males/43 females; mean age 67 years (range 23–86)) responded preoperatively. Decisional conflict was observed in 56% of patients, and in 25% to such an extent that it made them feel unsure about the decision. 68% wanted to be involved in decision-making, whereas 53% agreed that they actually were. 69% were able to answer three basic knowledge questions concerning prosthetic valves correctly. 56% were able to answer three basic numeracy questions correctly. Three months postsurgery, 90% (n=110) were satisfied with their aortic valve prosthesis, with no difference between mechanical and bioprosthetic valve recipients. Conclusions In current clinical practice, many AVR patients experience decisional conflict and suboptimal involvement in prosthetic valve selection, and exhibit impaired knowledge concerning prosthetic valves and numeracy. Given the broad support for SDM among AVR patients and the obvious need for understandable information, to-be-developed tools to support SDM in the setting of prosthetic valve selection will help to improve quality of decision-making, better inform and actively involve patients, and reduce decisional conflict. Trial registration number NTR3618. PMID:25893105

  8. [Selection of patients for transcatheter aortic valve implantation].

    Science.gov (United States)

    Tron, Christophe; Godin, Matthieu; Litzler, Pierre-Yves; Bauer, Fabrice; Caudron, Jérome; Dacher, Jean-Nicolas; Borz, Bogdan; Canville, Alexandre; Kurtz, Baptiste; Bessou, Jean-Paul; Cribier, Alain; Eltchaninoff, Hélène

    2012-06-01

    A good selection of patients is a crucial step before transcatheter aortic valve implantation (TAVI) in order to select the good indications and choose the access route. TAVI should be considered only in patients with symptomatic severe aortic stenosis and either contraindication or high surgical risk. Indication for TAVI should be discussed in a multidisciplinary team meeting. Echocardiography and/or CT scan are mandatory to evaluate the aortic annulus size and select the good prosthesis size. The possibility of transfemoral implantation is evaluated by angiography and CT scan, and based on the arterial diameters, but also on the presence of tortuosities and arterial calcifications. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  9. [Selection of treatment modalities in patients with spasticity].

    Science.gov (United States)

    Ota, Tetsuo

    2014-09-01

    Spasticity is the most common abnormality of muscle tone. Typically, oral antispastic drugs, phenol blocks, motor-point blocks, selective dorsal rhizotomies, and selective peripheral neurotomies are used to reduce muscle tone and/or improve ranges of motion. Recently, botulinum toxin injections and intrathecal baclofen have been used as treatment modalities. The selection of the most appropriate treatment modality by doctors treating patients with spasticity is critical. Furthermore, rehabilitation techniques, such as physiotherapy, occupational therapy, therapeutic electrical nerve stimulation, and orthosis, are useful as combination therapy for the treatment of spasticity. The purpose of this study was to outline the various modalities that are currently used for the treatment of spasticity. Regardless of the modality selected, it is imperative that treatment goals are carefully identified. The reduction of spasticity is not an appropriate treatment goal. Appropriate goals include improving gait, activities of daily living, and the quality of life.

  10. Guidelines for implant abutment selection for partially edentulous patients.

    Science.gov (United States)

    Drago, Carl; Lazzara, Richard J

    2010-01-01

    Dental implant treatments have changed dramatically since the introduction of osseointegration in the 1970s. Placement and restoration of dental implants now are considered to be a basic, important component of dental practices around the world. During the past several decades, there has been a significant increase in the number of dental implant manufacturers and implant restorative components available for clinicians and dental laboratory technicians treating partially edentulous patients. While the increase in components has improved the esthetic and functional results obtainable with dental implants, clinicians also have reported difficulties and confusion in treatment planning dental implant restorations for partially edentulous patients. This article introduces a protocol for implant abutment selection in partially edentulous patients undergoing dental implant treatment by describing a clinical/laboratory protocol for abutment selection in implant dentistry for implant surgeons, restorative dentists, and dental laboratory technicians.

  11. The effect of 8 days of strict bed rest on the incretin effect in healthy volunteers

    DEFF Research Database (Denmark)

    Nielsen, Signe Tellerup; Harder-Lauridsen, Nina Majlund; Benatti, Fabiana Braga

    2016-01-01

    in the levels of GLP-1 and Glucagon. Bed rest led to a mean loss of 2.4 kg of fat-free mass, and induced insulin resistance evaluated by the Matsuda index, but did not affect the incretin effect (P = 0.6). In conclusion, 8 days of bed rest induces insulin resistance, but we did not see evidence of an associated......Bed rest and physical inactivity are the consequences of hospital admission for many patients. Physical inactivity induces changes in glucose metabolism, but its effect on the incretin effect, which is reduced in, e.g., Type 2 diabetes, is unknown. To investigate how 8 days of strict bed rest...... affects the incretin effect, 10 healthy nonobese male volunteers underwent 8 days of strict bed rest. Before and after the intervention, all volunteers underwent an oral glucose tolerance test (OGTT) followed by an intravenous glucose infusion (IVGI) on the following day to mimic the blood glucose profile...

  12. Relaxation Methods for Strictly Convex Regularizations of Piecewise Linear Programs

    International Nuclear Information System (INIS)

    Kiwiel, K. C.

    1998-01-01

    We give an algorithm for minimizing the sum of a strictly convex function and a convex piecewise linear function. It extends several dual coordinate ascent methods for large-scale linearly constrained problems that occur in entropy maximization, quadratic programming, and network flows. In particular, it may solve exact penalty versions of such (possibly inconsistent) problems, and subproblems of bundle methods for nondifferentiable optimization. It is simple, can exploit sparsity, and in certain cases is highly parallelizable. Its global convergence is established in the recent framework of B -functions (generalized Bregman functions)

  13. Non-strictly black body spectrum from the tunnelling mechanism

    International Nuclear Information System (INIS)

    Corda, Christian

    2013-01-01

    The tunnelling mechanism is widely used to explain Hawking radiation. However, in many cases the analysis used to obtain the Hawking temperature only involves comparing the emission probability for an outgoing particle with the Boltzmann factor. Banerjee and Majhi improved this approach by explicitly finding a black body spectrum associated with black holes. Their result, obtained using a reformulation of the tunnelling mechanism, is in contrast to that of Parikh and Wilczek, who found an emission probability that is compatible with a non-strictly thermal spectrum. Using the recently identified effective state for a black hole, we solve this contradiction via a slight modification of the analysis by Banerjee and Majhi. The final result is a non-strictly black body spectrum from the tunnelling mechanism. We also show that for an effective temperature, we can express the corresponding effective metric using Hawking’s periodicity arguments. Potential important implications for the black hole information puzzle are discussed. -- Highlights: •We review an important result by Banerjee and Majhi on the tunnelling mechanism in the framework of Hawking radiation. •This result is in contrast to another result reported by Parikh and Wilczek. •We introduce the effective state of a black hole. •We explain the contrast via a slight modification of the analysis by Banerjee and Majhi. •We discuss potential important implications for the black hole information puzzle

  14. Autoimmunity in patients with selective IgA deficiency.

    Science.gov (United States)

    Abolhassani, H; Gharib, B; Shahinpour, S; Masoom, S N; Havaei, A; Mirminachi, B; Arandi, N; Torabi-Sagvand, B; Khazaei, H A; Mohammadi, J; Rezaei, N; Aghamohammadi, A

    2015-01-01

    Selective immunoglobulin A deficiency (SIgAD) is the most common primary antibody deticiency. Patients with SIgAD have a greater risk of concomitant autoimmune disorders than healthy individuals. The exact mechanism underlying the relationship between autoimmunity and SIgAD is not fully understood. The aim of this study was to evaluate potential associations between autoimmunity and specific clinical or immunological findings in patients with SIgAD. The study population comprised 57 symptomatic patients (65% males) with confirmed SIgAD who were referred to our center. Demographic data and history of autoimmunity were recorded both for patients and for their relatives. Comprehensive clinical and laboratory examinations were performed to investigate autoimmune complications in all the patients. Autoimmune disorders were documented in 17 cases (29.8%; 9 males and 8 females). The most common manifestations were thyroiditis, vitiligo, and hemolytic anemia (3 cases each). Ten patients (17.5%) had a family history of autoimmunity. Significant associations were detected between autoimmunity and increased duration of follow-up (P = .003), serum level of IgM (P = .01), regulatory T-cell count (P = .03), and class-switched memory B-cell count (P = .01). Four cases of autoimmune SIgAD (23.5%) progressed to common variable immunodeficiency during the follow-up period (P = .006). Autoimmune disorders, autoimmune cytopenia, and Ig subclass deficiency can lead to severe clinical manifestations in patients with SIgAD. Therefore, immunologists and pediatricians should be aware of these conditions.

  15. Selecting a provider: what factors influence patients' decision making?

    Science.gov (United States)

    Abraham, Jean; Sick, Brian; Anderson, Joseph; Berg, Andrea; Dehmer, Chad; Tufano, Amanda

    2011-01-01

    Each year consumers make a variety of decisions relating to their healthcare. Some experts argue that stronger consumer engagement in decisions about where to obtain medical care is an important mechanism for improving efficiency in healthcare delivery and financing. Consumers' ability and motivation to become more active decision makers are affected by several factors, including financial incentives and access to information. This study investigates the set of factors that consumers consider when selecting a provider, including attributes of the provider and the care experience and the reputation of the provider. Additionally, the study evaluates consumers awareness and use of formal sources of provider selection information. Our results from analyzing data from a survey of 467 patients at four clinics in Minnesota suggest that the factors considered of greatest importance include reputation of the physician and reputation of the healthcare organization. Contractual and logistical factors also play a role, with respondents highlighting the importance of seeing a provider affiliated with their health plan and appointment availability. Few respondents indicated that advertisements or formal sources of quality information affected their decision making. The key implication for provider organizations is to carefully manage referral sources to ensure that they consistently meet the needs of referrers. Excellent service to existing patients and to the network of referring physicians yields patient and referrer satisfaction that is critical to attracting new patients. Finally, organizations more generally may want to explore the capabilities of new media and social networking sites for building reputation.

  16. Acromioplasty in patients selected for operation by national guidelines.

    Science.gov (United States)

    Jacobsen, Jón Rói; Jensen, Carsten M; Deutch, Søren R

    2017-10-01

    Shoulder impingement syndrome is the most common shoulder disorder. Even though conservative treatment is the primary treatment of choice, surgery has increased substantially in several countries during the last 20 years. This has resulted in recommended clinical guidelines for treatment of shoulder impingement syndrome in countries such as The Netherlands and Denmark during recent years. The aim of this study was to investigate the effectiveness of an arthroscopic subacromial decompression in 244 patients selected for surgery according to national clinical guidelines. Patients were included from an Internet-based shoulder and elbow database. They were asked to complete 2 questionnaires consisting of the Oxford Shoulder Score (OSS) and the EuroQol 5-Dimension 3-Level and visual analog scale preoperatively and at 6-month follow-up. All patients were carefully selected for surgery according to the national guidelines, with symptoms persisting for at least 6 months. Furthermore, subgroups related to the OSS were formed to assess the clinical outcome according to preoperative status and age. For the complete study group, an OSS change of 10 (8.8-11.2; P = .0001) was found at 6-month follow-up. No significant difference was found between the genders (P = .17). The largest clinical effect from the intervention was found in the low preoperative OSS (pre-OSS) group, in which a mean change of 17 was found. The moderate and high pre-OSS groups had mean changes of 13 and 5, respectively. Similarly, according to the EuroQol 5-Dimension 3-Level and visual analog scale, the largest improvements were seen in the low and moderate pre-OSS groups. Arthroscopic subacromial decompression is a valid treatment, reducing pain and improving quality of life for patients selected for surgery according to the Danish national guidelines. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  17. Effects of a strict cutoff on Quantum Field Theory

    International Nuclear Information System (INIS)

    Sturnfield, J.F.

    1987-01-01

    Standard Quantum Field Theory has a number of integrals which are infinite. Although these are eliminated for some cases by renormalization, this aspect of the theory is not fully satisfactory. A number of theories with fundamental lengths have been introduced as alternatives and it would be useful to be able to distinguish between them. In particular, the effects that a strict cutoff would have on Quantum Field Theory is studied. It is noted that care must be taken in the method used to apply a strict cutoff. This lead to considering a theory where the cutoffs are defined by restricting each internal line. This theory is only piece-wise analytic. The resulting scattering matrix is frame dependent, yet the theory still satisfies the special relativity view that all frames are subjectively identical. The renormalization of this theory is finite. The change in mass from the electron self-energy will be a spinor operator. The main distinctions of this theory from standard theory will occur at super high energies. New poles and resonances which arise from new endpoint singularities will be found. The locations of these singularities will be frame dependent. Some of these singularities will correspond to creations or interactions of the normal particles with tachyons. It will be shown that for the one loop diagram, the form of the cutoff singularities are closely related to the standard singularities. When there is more than one loop, there can appear some new type of behavior. In particular, a cube root type of behavior in the two loop self-energy diagram will be found. Also the asymptotic behavior of the ladder diagram is studied

  18. Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review.

    Science.gov (United States)

    Gillman, Anna; Winkler, Renata; Taylor, Nicholas F

    2017-06-01

    The Frazier Free Water Protocol was developed with the aim of providing patients with dysphagia an option to consume thin (i.e. unthickened) water in-between mealtimes. A systematic review was conducted of research published in peer-reviewed journals. An electronic search of the EMBASE, CINAHL and MEDLINE databases was completed up to July 2016. A total of 8 studies were identified for inclusion: 5 randomised controlled trials, 2 cohort studies with matched cases and 1 single group pre-post intervention prospective study. A total of 215 rehabilitation inpatients and 30 acute patients with oropharyngeal dysphagia who required thickened fluids or were to remain 'nil by mouth', as determined by bedside swallow assessment and/or videofluoroscopy/fiberoptic endoscopic evaluation of swallowing, were included. Meta-analyses of the data from the rehabilitation studies revealed (1) low-quality evidence that implementing the protocol did not result in increased odds of having lung complications and (2) low-quality evidence that fluid intake may increase. Patients' perceptions of swallow-related quality of life appeared to improve. This review has found that when the protocol is closely adhered to and patients are carefully selected using strict exclusion criteria, including an evaluation of their cognition and mobility, adult rehabilitation inpatients with dysphagia to thin fluids can be offered the choice of implementing the Free Water Protocol. Further research is required to determine if the Free Water Protocol can be implemented in settings other than inpatient rehabilitation.

  19. Selection of patients for sublingual versus subcutaneous immunotherapy.

    Science.gov (United States)

    Larenas Linnemann, Désirée E S; Blaiss, Michael S

    2014-01-01

    Allergen immunotherapy is the sole treatment for IgE-mediated allergic diseases directed at the underlying mechanism. The two widely accepted administration routes are sublingual (SLIT) and subcutaneous (SCIT). We reviewed how patients should best be selected for immunotherapy and how the optimal administration route can be defined. Before deciding SCIT or SLIT, appropriate selection of patients for allergen immunotherapy (AIT) is mandatory. To be eligible for AIT, subjects must have a clear medical history of allergic disease, with exacerbation of symptoms on exposure to one or more allergens and a corresponding positive skin or in vitro test. Then the route of administration should be based on: published evidence of clinical and immunologic efficacy (which varies per allergic disease and per allergen); mono- or multi-allergen immunotherapy, for SLIT multi-allergen immunotherapy was not effective; safety: adverse events with SLIT are more frequent, but less severe; and, costs and patient preferences, closely related to adherence issues. All these are discussed in the article.

  20. [Indications and contraindications to lung transplant: patient selection].

    Science.gov (United States)

    Kanaan, R

    2010-02-01

    Lung transplant (LT) is a valid treatment for patients with end-stage lung disease such as cystic fibrosis, emphysema, pulmonary fibrosis and pulmonary arterial hypertension (85% of indications) and for selected candidates. The "good recipient" was introduced early to a specialised center, has had complete pre-LT assessment and complete information. At the end of this assessment, the absolute contraindications were eliminated (cardiovascular pathologies, recent neoplasia, active viral diseases, severe psychiatric disorders), advanced age risks were discussed, co-morbidities to treat were listed and an individualised therapeutic pre-LT program has been decided (based on exercise and muscle rehabilitation, nutritional support, anti-infectious treatments, active management of co-morbidities such as diabetes, hypertension, gastro-esophageal reflux…) with a psychological follow-up if necessary. Timely inscription on waiting list must be decided, early enough to avoid extreme handicap or risk pre-LT death, but not too early to have a survival benefit linked to LT. Death without LT prognosis criteria are still studied, and even if they do not fully define the risk of death of an individualised patient, they are taken into account by the recommendations of the societies; since 2006, LT indications are based on severity criteria of the selected patient, defined for each recipient diagnosis. LT aims to improve survival and quality of life of the patient, and this is especially true when the patient is referred, prepared and monitored early enough by the transplant team; the aim is to limit the risk of death before LT (before listing and on waiting list) and early post-LT morbimortality. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  1. Holmium Laser Enucleation of the Prostate: Patient Selection and Outcomes.

    Science.gov (United States)

    Kuebker, Joseph M; Miller, Nicole L

    2017-10-19

    Holmium laser enucleation of the prostate (HoLEP) is a proven technique to alleviate bladder outlet obstruction (BOO) from benign prostatic hyperplasia (BPH). Herein, we review factors relevant to selecting patients who will benefit from this procedure and expected outcomes. New randomized trials have validated the excellent outcomes achieved by HoLEP in the management of BOO from BPH. Its success has been reproduced in a diverse array of patients including those on anticoagulation, with detrusor underactivity/acontractility, prostate cancer, and in the retreatment setting. HoLEP can be applied to the majority of patients with BOO from BPH regardless of prostate size, previous operations, or the condition of the detrusor. HoLEP can also be carefully considered in patients requiring anticoagulation or who are undergoing active surveillance for low-risk prostate cancer. Immediate complication rate is low and incontinence is rare. Retrograde ejaculation occurs in approximately 75% patients. Furthermore, the retreatment rate for HoLEP is lower than reported for other endoscopic BPH procedures demonstrating its durability.

  2. Patient-based radiographic exposure factor selection: a systematic review

    International Nuclear Information System (INIS)

    Ching, William; Robinson, John; McEntee, Mark

    2014-01-01

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system

  3. Patient-based radiographic exposure factor selection: a systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Ching, William; Robinson, John; McEntee, Mark, E-mail: mark.mcentee@sydney.edu.au [Discipline of Medical Radiation Sciences, University of Sydney, Lidcombe, New South Wales (Australia)

    2014-09-15

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system.

  4. Patient Selection and Activity Planning Guide for Selective Internal Radiotherapy With Yttrium-90 Resin Microspheres

    Energy Technology Data Exchange (ETDEWEB)

    Lau, Wan-Yee, E-mail: josephlau@surgery.cuhk.edu.hk [Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories (Hong Kong); Kennedy, Andrew S. [Wake Radiology Oncology, Cary, NC (United States); Department of Biomedical Engineering, North Carolina State University, Raleigh, NC (United States); Kim, Yun Hwan [Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Lai, Hee Kit [Nuclear Medicine and PET Centre, Mount Elizabeth Hospital, Singapore (Singapore); Lee, Rheun-Chuan [Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China); Leung, Thomas W.T. [Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital (Hong Kong); Liu, Ching-Sheng [Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (China); Salem, Riad [Division of Interventional Radiology, Northwestern University, Chicago, IL (United States); Sangro, Bruno [Liver Unit, Clinica Universitaria de Navarra and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona (Spain); Shuter, Borys [Department of Diagnostic Imaging, National University Hospital, Singapore (Singapore); Wang, Shih-Chang [Parker-Hughes Professor of Diagnostic Radiology, University of Sydney, Sydney, NSW (Australia)

    2012-01-01

    Purpose: Selective internal radiotherapy (SIRT) with yttrium-90 ({sup 90}Y) resin microspheres can improve the clinical outcomes for selected patients with inoperable liver cancer. This technique involves intra-arterial delivery of {beta}-emitting microspheres into hepatocellular carcinomas or liver metastases while sparing uninvolved structures. Its unique mode of action, including both {sup 90}Y brachytherapy and embolization of neoplastic microvasculature, necessitates activity planning methods specific to SIRT. Methods and Materials: A panel of clinicians experienced in {sup 90}Y resin microsphere SIRT was convened to integrate clinical experience with the published data to propose an activity planning pathway for radioembolization. Results: Accurate planning is essential to minimize potentially fatal sequelae such as radiation-induced liver disease while delivering tumoricidal {sup 90}Y activity. Planning methods have included empiric dosing according to degree of tumor involvement, empiric dosing adjusted for the body surface area, and partition model calculations using Medical Internal Radiation Dose principles. It has been recommended that at least two of these methods be compared when calculating the microsphere activity for each patient. Conclusions: Many factors inform {sup 90}Y resin microsphere SIRT activity planning, including the therapeutic intent, tissue and vasculature imaging, tumor and uninvolved liver characteristics, previous therapies, and localization of the microsphere infusion. The influence of each of these factors has been discussed.

  5. Effects of growth temperature and strictly anaerobic recovery on the survival of Listeria monocytogenes during pasteurization.

    Science.gov (United States)

    Knabel, S J; Walker, H W; Hartman, P A; Mendonca, A F

    1990-02-01

    Listeria monocytogenes F5069 was suspended in either Trypticase soy broth-0.6% yeast extract (TSBYE) or sterile, whole milk and heated at 62.8 degrees C in sealed thermal death time tubes. Severely heat-injured cells were recovered in TSBYE within sealed thermal death time tubes because of the formation of reduced conditions in the depths of the TSBYE. Also, the use of strictly anaerobic Hungate techniques significantly increased recovery in TSBYE containing 1.5% agar compared with aerobically incubated controls. The exogenous addition of catalase, but not superoxide dismutase, slightly increased the recovery of heat-injured cells in TSBYE containing 1.5% agar incubated aerobically. Growth of cells at 43 degrees C caused a greater increase in heat resistance as compared with cells heat shocked at 43 degrees C or cells grown at lower temperatures. Growth of L. monocytogenes at 43 degrees C and enumeration by the use of strictly anaerobic Hungate techniques resulted in D62.8 degrees C values that were at least sixfold greater than those previously obtained by using cells grown at 37 degrees C and aerobic plating. Results indicate that, under the conditions of the present study, high levels of L. monocytogenes would survive the minimum low-temperature, long-time treatment required by the U.S. Food and Drug Administration for pasteurizing milk. The possible survival of low levels of L. monocytogenes during high-temperature, short-time pasteurization and enumeration of injured cells by recovery on selective media under strictly anaerobic conditions are discussed.

  6. Effect of cryopreservation and lyophilization on viability and growth of strict anaerobic human gut microbes.

    Science.gov (United States)

    Bircher, Lea; Geirnaert, Annelies; Hammes, Frederik; Lacroix, Christophe; Schwab, Clarissa

    2018-04-17

    Strict anaerobic gut microbes have been suggested as 'next-generation probiotics' for treating several intestinal disorders. The development of preservation techniques is of major importance for therapeutic application. This study investigated cryopreservation (-80°C) and lyophilization survival and storage stability (4°C for 3 months) of the strict anaerobic gut microbes Bacteroides thetaiotaomicron, Faecalibacterium prausnitzii, Roseburia intestinalis, Anaerostipes caccae, Eubacterium hallii and Blautia obeum. To improve preservation survival, protectants sucrose and inulin (both 5% w/v) were added for lyophilization and were also combined with glycerol (15% v/v) for cryopreservation. Bacterial fitness, evaluated by maximum growth rate and lag phase, viability and membrane integrity were determined using a standardized growth assay and by flow cytometry as markers for preservation resistance. Lyophilization was more detrimental to viability and fitness than cryopreservation, but led to better storage stability. Adding sucrose and inulin enhanced viability and the proportion of intact cells during lyophilization of all strains. Viability of protectant-free B. thetaiotaomicron, A. caccae and F. prausnitzii was above 50% after cryopreservation and storage and increased to above 80% if protectants were present. The addition of glycerol, sucrose and inulin strongly enhanced the viability of B. obeum, E. hallii and R. intestinalis from 0.03-2% in protectant-free cultures to 11-37%. This is the first study that quantitatively compared the effect of cryopreservation and lyophilization and the addition of selected protectants on viability and fitness of six strict anaerobic gut microbes. Our results suggest that efficiency of protectants is process- and species-specific. © 2018 The Authors. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.

  7. Drainage of malignant ascites: patient selection and perspectives

    Directory of Open Access Journals (Sweden)

    Stukan M

    2017-04-01

    Full Text Available Maciej Stukan Department of Gynecologic Oncology, Gdynia Oncology Center, Szpitale Wojewodzkie w Gdyni Sp. z o.o., Gdynia, Poland Abstract: Malignant ascites (MA is a sign of advanced cancer and poor prognosis. MA can result in impairment in quality of life (QOL and significant symptoms. As a supportive treatment, ascites can be drained by paracentesis (PC, percutaneously implanted catheters (tunneled, untunneled, central venous catheters, or peritoneal ports, or peritoneovenous shunts. The aim of this study was to evaluate the effectiveness, safety, and patient-reported outcomes (PRO of different drainage methods for the management of MA. A systematic review of the literature was performed, and 32 original articles met the inclusion criteria. Patients selected for permanent drain insertion demonstrated symptoms related to MA and had undergone repeated PC. The primary focus of the reviewed articles was procedural safety issues. The rate of technical success of drainage device installation was 100%. Most patients experienced improvements in symptom control after ascites drainage. When analyzed together, 19.7% (255/1297 of patients experienced any complication and 6.2% (81/1297 experienced serious adverse events during MA drainage. Complications were reported for every drainage method; however, the least occurred after PC or central venous catheter, while the most serious occurred after peritoneovenous shunts. Adverse events were as follows: catheter obstruction: 4.4%, infection: 4.1%, leakage: 3.5%, catheter dislodgment: 2.3%, hypotension: 0.6%, injuries during device insertion: 0.6%, renal impairment: 0.5%, electrolyte imbalance: 0.2%, other: 3.6%. PRO and QOL endpoints were available for 12 studies. When PRO were measured using an interview, a significant improvement in symptom control and QOL was reported in almost all patients. Once standardized questionnaires were used, improvements in symptomatic scores and role functioning were observed

  8. 7 CFR 28.414 - Strict Low Middling Light Spotted Color.

    Science.gov (United States)

    2010-01-01

    ... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.414 Strict Low Middling Light Spotted Color. Strict Low Middling Light Spotted Color is color which in spot or...

  9. Two-level cervical disc replacement: perspectives and patient selection

    Directory of Open Access Journals (Sweden)

    Narain AS

    2017-02-01

    Full Text Available Ankur S Narain, Fady Y Hijji, Daniel D Bohl, Kelly H Yom, Krishna T Kudaravalli, Kern Singh Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA Introduction: Cervical disc replacement (CDR is an emerging treatment option for cervical degenerative disease. Postulated benefits of cervical disc replacement compared to anterior cervical discectomy and fusion include preserved motion at the operative segments and decreased motion at adjacent levels. Multiple studies have been performed investigating the outcomes of CDR in single-level pathology. The investigation of the use of CDR in two-level pathology is an emerging topic within the literature.Purpose: To critically evaluate the literature regarding two-level CDR in order to determine its utility compared to two-level cervical arthrodesis. Patient selection factors including indications and contraindications will also be explored.Methods: The PubMed database was searched for all articles published on the subject of two-level CDR up until October 2016. Studies were classified by publication year, study design, sample size, follow-up interval, and conflict of interest. Outcomes were recorded from each study, and included data on patient-reported outcomes, radiographic measurements, range of motion, peri- and postoperative complications, heterotopic ossification, adjacent segment disease, reoperation rate, and total intervention cost. Results: Fourteen studies were included in this review. All studies demonstrated at least noninferiority of two-level CDR compared to both two-level arthrodesis and single-level CDR. Patient selection in two-level CDR is driven by the inclusion and exclusion criteria presented in prospective, randomized controlled trials. The most common indication is subaxial degenerative disc disease over two contiguous levels presenting with radiculopathy or myelopathy. Furthermore, costs analyses trended toward at least noninferiority of two

  10. On N. Chomsky’s strict subcategorization of verbs

    Directory of Open Access Journals (Sweden)

    Janez Orešnik

    1966-12-01

    Full Text Available This paper studies the so-called strict subcategorization rules, and the theory associated with them, in the transformational grammar of. Erigl·ish as proposed by Noarn Chomsky in his Aspects. The syntactic component of English transformational grammar consists of two mutually ordered parts, viz., the base and the transformational subcomponents. The initial part of the base are the so-called categorial rules, which are of almost exclusive interest to us here. Their primary task is to generate what are usually called basic sentence patterns, and will here, with Chomsky (Aspects, p.ll3, be designated with the expression, frames of category symbols.- The rules of the transformational subcomponent modify, in various ways, the frames generated by the base. For several reasons - one of them being that the correct work of the transformational subcomponent quite often depends on the kind of lexical items with which the syntactic positions in the frames of category symbols have been filled, the lexical items must be introduced from the lexicon into the empty positions in the frames before the rules of the transformational subcomponent can be allowed to modify the frames.

  11. Managing Hanford Site solid waste through strict acceptance criteria

    International Nuclear Information System (INIS)

    Jasen, W.G.; Pierce, R.D.; Willis, N.P.

    1993-02-01

    Various types of waste have been generated during the 50-year history of the Hanford Site. Regulatory changes in the last 20 years have provided the emphasis for better management of these wastes. Interpretations of the Atomic Energy Act of 1954 (AEA) and the Resource Conservation and Recovery Act of 1976 (RCRA) have led to the definition of a group of wastes called radioactive mixed wastes (RMW). As a result of the radioactive and hazardous properties of these wastes, strict management programs have been implemented for the management of these wastes. Solid waste management is accomplished through a systems performance approach to waste management that used best-demonstrated available technology (BDAT) and best management practices. The solid waste program at the Hanford Site strives to integrate all aspects of management relative to the treatment, storage and disposal (TSD) of solid waste. Often there are many competing and important needs. It is a difficult task to balance these needs in a manner that is both equitable and productive. Management science is used to help the process of making decisions. Tools used to support the decision making process include five-year planning, cost estimating, resource allocation, performance assessment, waste volume forecasts, input/output models, and waste acceptance criteria. The purpose of this document is to describe how one of these tools, waste acceptance criteria, has helped the Hanford Site manage solid wastes

  12. Effects of strict prolonged bed rest on cardiorespiratory fitness

    DEFF Research Database (Denmark)

    Ried-Larsen, Mathias; Aarts, Hugo M; Joyner, Michael J

    2017-01-01

    with larger declines in V̇o2max). Furthermore, the systematic review revealed a gap in the knowledge about the cardiovascular response to extreme physical inactivity, particularly in older subjects and women of any age group. In addition to its relevance to spaceflight, this lack of data has significant....... Since 1949, 80 studies with a total of 949 participants (>90% men) have been published with data on strict bed rest and V̇o2max The studies were conducted mainly in young participants [median age (interquartile range) 24.5 (22.4-34.0) yr]. The duration of bed rest ranged from 1 to 90 days. V̇o2max...... declined linearly across bed rest duration. No statistical difference in the decline among studies reporting V̇o2max as l/min (-0.3% per day) compared with studies reporting V̇o2max normalized to body weight (ml·kg-1·min-1; -0.43% per day) was observed. Although both total body weight and lean body mass...

  13. Fixed point iterations for strictly hemi-contractive maps in uniformly smooth Banach spaces

    International Nuclear Information System (INIS)

    Chidume, C.E.; Osilike, M.O.

    1993-05-01

    It is proved that the Mann iteration process converges strongly to the fixed point of a strictly hemi-contractive map in real uniformly smooth Banach spaces. The class of strictly hemi-contractive maps includes all strictly pseudo-contractive maps with nonempty fixed point sets. A related result deals with the Ishikawa iteration scheme when the mapping is Lipschitzian and strictly hemi-contractive. Our theorems generalize important known results. (author). 29 refs

  14. Readmissions for Selected Infections Due to Medical Care: Expanding the Definition of a Patient Safety Indicator

    National Research Council Canada - National Science Library

    Gallagher, Brian; Cen, Liyi; Hannan, Edward L

    2005-01-01

    Objective: Evaluate the Agency for Healthcare Research and Quality's Patient Safety Indicator that identifies patients with selected infections that result from medical care during hospital inpatient treatment...

  15. Selective decontamination of the oropharynx and the digestive tract in ICU patients

    NARCIS (Netherlands)

    de Smet, A.M.G.A.

    2009-01-01

    Background: Selective Digestive tract Decontamination (SDD) and Selective Oropharyngeal Decontamination (SOD) are effective infection prevention measures in intensive care patients, but reported effects on patient outcome are conflicting and the effects on infections and respiratory tract

  16. Helicobacter pylori infection in patients with selective immunoglobulin a deficiency.

    Science.gov (United States)

    Magen, E; Waitman, D-A; Goldstein, N; Schlesinger, M; Dickstein, Y; Kahan, N R

    2016-06-01

    Selective immunoglobulin A (IgA) deficiency (IgAD) is the most common primary immunodeficiency in the western world. The aim of the study was to investigate the prevalence and clinical characteristics of Helicobacter pylori-infected dyspeptic patients with IgAD. Case samples were drawn from all subjects ≥ 12 years of age (n = 104729) who had undergone serum total IgA measurements during 2004-14 for any reason at Leumit Healthcare Services (Israel) and had serum total IgA < 0·07 g/l. The control group was comprised of a random sample of remaining patients with a case-control ratio of 10 controls for each case. The dyspeptic diseases were identified and retrieved from Leumit Health Care Services electronic database using specific ICD-9-CM diagnostic codes. The case group included 347 subjects and the control group 3470 subjects. There were no significant differences in the prevalence of patients with dyspepsia [84 (24·2%) versus 821 (23·6%) for cases and controls, respectively]. Additionally, there was no difference in a proportion of dyspeptic H. pylori-positive subjects [59 (17·1%) versus 524 (15·1%)] between the case and control groups. Only 59 (17%) among the 347 IgAD patients underwent gastroscopy. A significantly larger proportion of case subjects experienced several forms of gastritis [13 (61·9%) versus 38 (21·6%), P < 0·001), duodenal ulcers [seven (33·3%) versus 19 (10·8%); P = 0·01] and nodular lymphoid hyperplasia (NLH) [two (9·5%) versus none; P = 0·011]. IgAD is not associated with increased prevalence of H. pylori-associated dyspepsia; nevertheless, H. pylori-infected dyspeptic IgAD subjects experience more EGD-proved gastritis, duodenal ulcers and NLH. © 2016 British Society for Immunology.

  17. Alcohol septal ablation: patient selection and rationality of its application

    Directory of Open Access Journals (Sweden)

    М. Г. Каштанов

    2017-04-01

    Full Text Available The article looks at some aspects of selecting patients with obstructive hypertrophic cardiomyopathy for alcohol septal ablation (ASA procedure. Based on the world’s experience and in the context of evidence-based medicine, the current positions of ASA in complex treatment of obstructive hypertrophic cardiomyopathy are described. Received 29 September 2016. Accepted 9 January 2017.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsData collection and analysis: Kashtanov M.G. Drafting the article: Kashtanov M.G. Critical revision: Kashtanov M.G., Idov E.M., Chernyshev S.D., Kardapoltsev L.V., Berdnikov S.V.

  18. Strategies for selecting effective patient nutrition education materials.

    Science.gov (United States)

    Clayton, Laura H

    2010-10-01

    Nutrition and diet therapy are at the center of health promotion activities and self-management of chronic diseases. To assist an individual in making informed decisions regarding his or her diet and increase adherence to dietary recommendations or treatments, healthcare professionals must select health information that is appropriate to the client's level of understanding. A systematic approach in the evaluation of patient education material, whether in print or on the World Wide Web, must focus on the information's content, literacy level, graphical displays, layout and typography, motivating principles, cultural relevance, and feasibility. Additional criteria should be evaluated when accessing Web sites and include source, site credibility, conflict of interest, disclaimer, disclosure, navigation, and interactivity information.

  19. Strict or graduated punishment? Effect of punishment strictness on the evolution of cooperation in continuous public goods games.

    Directory of Open Access Journals (Sweden)

    Hajime Shimao

    Full Text Available Whether costly punishment encourages cooperation is one of the principal questions in studies on the evolution of cooperation and social sciences. In society, punishment helps deter people from flouting rules in institutions. Specifically, graduated punishment is a design principle for long-enduring common-pool resource institutions. In this study, we investigate whether graduated punishment can promote a higher cooperation level when each individual plays the public goods game and has the opportunity to punish others whose cooperation levels fall below the punisher's threshold. We then examine how spatial structure affects evolutionary dynamics when each individual dies inversely proportional to the game score resulting from the social interaction and another player is randomly chosen from the population to produce offspring to fill the empty site created after a player's death. Our evolutionary simulation outcomes demonstrate that stricter punishment promotes increased cooperation more than graduated punishment in a spatially structured population, whereas graduated punishment increases cooperation more than strict punishment when players interact with randomly chosen opponents from the population. The mathematical analysis also supports the results.

  20. Strict or Graduated Punishment? Effect of Punishment Strictness on the Evolution of Cooperation in Continuous Public Goods Games

    Science.gov (United States)

    Shimao, Hajime; Nakamaru, Mayuko

    2013-01-01

    Whether costly punishment encourages cooperation is one of the principal questions in studies on the evolution of cooperation and social sciences. In society, punishment helps deter people from flouting rules in institutions. Specifically, graduated punishment is a design principle for long-enduring common-pool resource institutions. In this study, we investigate whether graduated punishment can promote a higher cooperation level when each individual plays the public goods game and has the opportunity to punish others whose cooperation levels fall below the punisher’s threshold. We then examine how spatial structure affects evolutionary dynamics when each individual dies inversely proportional to the game score resulting from the social interaction and another player is randomly chosen from the population to produce offspring to fill the empty site created after a player’s death. Our evolutionary simulation outcomes demonstrate that stricter punishment promotes increased cooperation more than graduated punishment in a spatially structured population, whereas graduated punishment increases cooperation more than strict punishment when players interact with randomly chosen opponents from the population. The mathematical analysis also supports the results. PMID:23555826

  1. In search of patient characteristics that may guide empirically based treatment selection for personality disorder patients - a concept map approach

    NARCIS (Netherlands)

    van Manen, J.G.; Kamphuis, J.H.; Goossensen, A.; Timman, R.; Busschbach, J.J.V.; Verheul, R.

    2012-01-01

    Using the concept map method, this study aimed to summarize and describe patient characteristics pertinent to treatment selection for patients with personality disorders (PDs). Initial patient characteristics were derived from the research literature and a survey among Dutch expert clinicians.

  2. Towards patient-specific tumor antigen selection for vaccination.

    Science.gov (United States)

    Rammensee, Hans-Georg; Weinschenk, Toni; Gouttefangeas, Cécile; Stevanović, Stefan

    2002-10-01

    In this review, we discuss the possibilities for combining the power of molecular analysis of the antigens expressed in a given individual tumor with the design of a tailored vaccine containing defined antigens. Step 1 is a differential gene expression analysis of tumor and corresponding normal tissue. Step 2 is the analysis of human leukocyte antigen (HLA) ligands on tumor cells. Step 3 is data mining with the aim to select those antigens that might be suitable for tumor attack by the adaptive immune system. Step 4 is the on-the-spot clinical grade production of the constituents of the patient tailored vaccine, e.g. peptides. Step 5 is then vaccination and monitoring. Although it will not be possible to cover all relevant antigens expressed in a tumor, the antigens that can be identified with our present technical possibilities might be enough for improved immunotherapy. The scope of the present review is to explore the possibilities and the formidable technical and logistical challenge for such individual patient-oriented antigen definition to be used for therapeutic immunization.

  3. Can We Select Patients for Colorectal Cancer Prevention with Aspirin?

    Science.gov (United States)

    Kraus, Sarah; Sion, Daniel; Arber, Nadir

    2015-01-01

    Aspirin has been extensively investigated in the context of the prevention of cardiovascular disease. It has one of the strongest cumulative evidence supporting its use in colorectal cancer (CRC) chemoprevention. Epidemiological, clinical, and observational studies have demonstrated that aspirin and non-steroidal antiinflammatory drugs (NSAIDs), including COX-2 inhibitors, can protect against CRC and significantly reduce its incidence. Moreover, prospective randomized controlled trials of colorectal polyp recurrence and in patients with hereditary CRC syndromes have shown that aspirin can produce regression of existing colorectal adenomas and prevent the formation of new polyps. However, the lowest effective doses, treatment duration, target populations, and the effects on survival are not entirely clear. Although not common serious side effects and in particular gastrointestinal and intracerebral hemorrhage do occur, better selection of individuals who might benefit the most from aspirin use must be carefully performed in order to maximize their risk/benefit ratio. In the era of precision medicine, genetic information, blood and/or urinary biomarkers, could potentially help in tailoring chemopreventive therapeutic strategies, based on aspirin use, while limiting adverse toxic effects. The current review will cover the use of aspirin for the prevention of colorectal adenomas and CRC, potential markers for chemoprevention, and patient stratification.

  4. Bevacizumab in the treatment of NSCLC: patient selection and perspectives

    Directory of Open Access Journals (Sweden)

    Russo AE

    2017-12-01

    well tolerated even in those patients subpopulations excluded from pivotal trials. This review outlines the current state-of-the-art on bev use in advanced NSCLC. It also describes patient selection and future perspectives on this antiangiogenic agent. Keywords: bevacizumab, nonsquamous NSCLC, eligibility, safety, subpopulations 

  5. Vasectomy as a reversible form of contraception for select patients.

    Science.gov (United States)

    Samplaski, Mary K; Daniel, Ariande; Jarvi, Keith

    2014-04-01

    To provide an effective form of birth control, men may choose a reversible or permanent form of contraception. Vasectomy is presently offered as a permanent option for male contraception. We have had patients who were interested in vasectomy and reversal as a temporary birth control option. The purpose of this paper is to determine if vasectomy should be offered for selected couples as a temporary form of contraception and under which circumstances. A literature review was conducted to determine the available reversible contraceptive options, risks, failure rates and contraindications to each, and the risks and success rates of vasectomy and vasectomy reversal. Reversible contraceptives include hormonally based methods for women, non-hormonal anatomic barrier devices and spermatocidal agents. Hormone based therapies may be contraindicated in women with cardiovascular disease, hypertension, and some cancers. Non-hormonal contraceptives are generally less effective and may be unacceptable for some couples due to higher failure rates, difficulty of use and lack of acceptance. Both vasectomy and vasectomy reversal are low risk procedures. Reversal may be performed with a high degree of success, particularly with a short obstructive interval (97% patency if performed contraception.

  6. Evaluating the Influence of Motor Control on Selective Attention through a Stochastic Model: The Paradigm of Motor Control Dysfunction in Cerebellar Patient

    Directory of Open Access Journals (Sweden)

    Giacomo Veneri

    2014-01-01

    Full Text Available Attention allows us to selectively process the vast amount of information with which we are confronted, prioritizing some aspects of information and ignoring others by focusing on a certain location or aspect of the visual scene. Selective attention is guided by two cognitive mechanisms: saliency of the image (bottom up and endogenous mechanisms (top down. These two mechanisms interact to direct attention and plan eye movements; then, the movement profile is sent to the motor system, which must constantly update the command needed to produce the desired eye movement. A new approach is described here to study how the eye motor control could influence this selection mechanism in clinical behavior: two groups of patients (SCA2 and late onset cerebellar ataxia LOCA with well-known problems of motor control were studied; patients performed a cognitively demanding task; the results were compared to a stochastic model based on Monte Carlo simulations and a group of healthy subjects. The analytical procedure evaluated some energy functions for understanding the process. The implemented model suggested that patients performed an optimal visual search, reducing intrinsic noise sources. Our findings theorize a strict correlation between the “optimal motor system” and the “optimal stimulus encoders.”

  7. Weight of fitness deviation governs strict physical chaos in replicator dynamics

    Science.gov (United States)

    Pandit, Varun; Mukhopadhyay, Archan; Chakraborty, Sagar

    2018-03-01

    Replicator equation—a paradigm equation in evolutionary game dynamics—mathematizes the frequency dependent selection of competing strategies vying to enhance their fitness (quantified by the average payoffs) with respect to the average fitnesses of the evolving population under consideration. In this paper, we deal with two discrete versions of the replicator equation employed to study evolution in a population where any two players' interaction is modelled by a two-strategy symmetric normal-form game. There are twelve distinct classes of such games, each typified by a particular ordinal relationship among the elements of the corresponding payoff matrix. Here, we find the sufficient conditions for the existence of asymptotic solutions of the replicator equations such that the solutions—fixed points, periodic orbits, and chaotic trajectories—are all strictly physical, meaning that the frequency of any strategy lies inside the closed interval zero to one at all times. Thus, we elaborate on which of the twelve types of games are capable of showing meaningful physical solutions and for which of the two types of replicator equation. Subsequently, we introduce the concept of the weight of fitness deviation that is the scaling factor in a positive affine transformation connecting two payoff matrices such that the corresponding one-shot games have exactly same Nash equilibria and evolutionary stable states. The weight also quantifies how much the excess of fitness of a strategy over the average fitness of the population affects the per capita change in the frequency of the strategy. Intriguingly, the weight's variation is capable of making the Nash equilibria and the evolutionary stable states, useless by introducing strict physical chaos in the replicator dynamics based on the normal-form game.

  8. Differential Medical Aerosol Device and Interface Selection in Patients during Spontaneous, Conventional Mechanical and Noninvasive Ventilation.

    Science.gov (United States)

    Ari, Arzu; Fink, James B

    2016-04-01

    Many aerosol delivery devices are available on the market that have different features, characteristics, and operating requirements that need to be considered for the effective treatment of patients with pulmonary diseases. Device selection in aerosol medicine is largely patient dependent. Since there is no aerosol device that suits all patient populations, device selection and successful integration of the prescribed aerosol device to patients is essential. This article explores key issues in differential device selection in spontaneously breathing adults with or without artificial airways, as well as critically ill patients receiving invasive and noninvasive ventilation, with discussion of considerations for integration of aerosol devices to each of these patient populations.

  9. Reduced selective learning in fibromyalgia patients versus healthy controls

    NARCIS (Netherlands)

    Meulders, Ann; Boddez, Yannick; Blanco, Fernando; Van Den Houte, Maaike; Vlaeyen, Johan W S

    2018-01-01

    Impaired selective fear learning has been advanced as a core mechanism involved in excessive spreading of protective responses such as pain-related fear and avoidance leading to disability in chronic pain conditions. Using the litmus test for selective learning effects, the blocking procedure, we

  10. 7 CFR 28.416 - Strict Good Ordinary Light Spotted Color.

    Science.gov (United States)

    2010-01-01

    ... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.416 Strict Good Ordinary Light Spotted Color. Strict Good Ordinary Light Spotted Color is color which in spot or... Cotton Source: 57 FR 34498, Aug. 5, 1992, unless otherwise noted. ...

  11. Therapeutic management of stoma complications in selected patients.

    Science.gov (United States)

    Trzciński, Radzisław; Kresińska-Kaba, Teresa; Dziki, Adam

    2013-09-01

    Stoma complications occur in 21-75% of patients, and 30% of them require redo surgery within 10 years after previous surgical treatment. Medical treatment is successful in most cases with no need for surgery. However, severe stoma complications are the real challenge for medical team and require an individual approach to each patient. The aim of the study was to report stoma patients with severe complications of both ileo- and/or colostomy and present different options of medical treatment. Between March 2005 and April 2007 we treated 8 patients with severe stoma complications at the Department of General and Colorectal Surgery, Medical University of Łódź. There were 4 patients with colostomy, 3 patients with ileostomy and one patient with both ileo- and colostomy. The mean age of patients was 56,7 years (range 30-68 years). In all patients we achieved either complete stoma-related wound healing or we observed substantial progress of wound healing with medical treatment. No patient required surgery for stoma complications. Stoma complications still occur in spite of adherence to rules of stoma care and surgical technique. Most of them can be treated conservatively. Much emphasis is put on close team work comprising doctors and nurses in the treatment of severe stoma complications.

  12. The use of the waiting list in a fair selection of patients for nursing home care

    NARCIS (Netherlands)

    Meiland, F. J.; Danse, J. A.; Hoos, A. M.; Wendte, J. F.; Gunning-Schepers, L. J.

    1996-01-01

    When health care resources are scarce, waiting lists may be used as a distribution measure in order to enhance the fair allocation of resources through selection of patients. In this study, the structure and use of a waiting list for a fair selection of patients for nursing home admission was

  13. Patient Selection in Plastic Surgery: Recognizing Body Dysmorphic Disorder

    Directory of Open Access Journals (Sweden)

    Cihan Sahin

    2013-04-01

    Full Text Available Plastic surgery is a branch of medicine that provides significant improvements to the people with positive changes. But first of all, this branch has a characteristic which requires analysing patients' psychological situation very carefully. Plastic surgeons are often confronted by patients with mental disorders seeking aesthetic surgery. It is imperative for surgeons to recognize possible underlying psychiatric illnesses. Common psychiatric conditions seen in cosmetic surgery patients include body dysmorphic disorder (BDD, narcissistic personality disorder and histrionic personality disorders. BDD is of particular importance to plastic surgeons. Because outrageous dissatisfaction with one's appearance may conceal psychopathologic traits that are not always easily recognizable, and which, if neglected, may result in serious iatrogenic and medicolegal consequences, we hope that this paper will help plastic surgeons in ultimately preventing patient and surgeon dissatisfaction within the population of patients with psychiatric disorders, and should recognize the diagnostic features of body dysmorphic disorder and screen psychologically unstable patients who may never be satisfied with surgery. [Arch Clin Exp Surg 2013; 2(2.000: 109-115

  14. Selection of oncoplastic surgical technique in Asian breast cancer patients

    Directory of Open Access Journals (Sweden)

    Eui Sun Shin

    2018-01-01

    Full Text Available Background Oncoplastic surgery is being increasingly performed in Korean women; however, unlike Westerners, Korean women usually have small to moderate-sized breasts. To achieve better outcomes in reconstructed breasts, several factors should be considered to determine the optimal surgical method. Methods A total of 108 patients who underwent oncoplastic surgery from January 2013 to December 2016 were retrospectively investigated. We used various methods, including glandular tissue reshaping, latissimus dorsi (LD flap transposition, and reduction oncoplasty, to restore the breast volume and symmetry. Results The mean weight of the tumor specimens was 40.46 g, and the ratio of the tumor specimen weight to breast volume was 0.12 g/mL in the patients who underwent glandular tissue reshaping (n=59. The corresponding values were 101.47 g and 0.14 g/mL, respectively, in the patients who underwent reduction oncoplasty (n=17, and 82.54 g and 0.20 g/mL, respectively, in those treated with an LD flap (n=32. Glandular tissue reshaping was mostly performed in the upper outer quadrant, and LD flap transposition was mostly performed in the lower inner quadrant. No major complications were noted. Most patients were satisfied with the aesthetic results. Conclusions We report satisfactory outcomes of oncoplastic surgical procedures in Korean patients. The results regarding specimen weight and the tumor-to-breast ratio of Asian patients will be a helpful reference point for determining the most appropriate oncoplastic surgical technique.

  15. Synchronization control of cross-strict feedback hyperchaotic system based on cross active backstepping design

    International Nuclear Information System (INIS)

    Wang Jing; Gao Jinfeng; Ma Xikui

    2007-01-01

    This Letter presents a novel cross active backstepping design method for synchronization control of cross-strict feedback hyperchaotic system, in which the ordinary backstepping design is unavailable. The proposed control method, combining backstepping design and active control approach, extends the application of backstepping technique in chaos control. Based on this method, different combinations of controllers can be designed to meet the needs of different applications. The proposed method is applied to achieve chaos synchronization of two identical cross-strict feedback hyperchaotic systems. Also it is used to implement synchronization between cross-strict feedback hyperchaotic system and Roessler hyperchaotic system. Numerical examples illustrate the validity of the control method

  16. Successful selective arterial thrombolysis in patient with acute abdominal thromboembolism

    Directory of Open Access Journals (Sweden)

    Christo Tsekov

    2016-06-01

    Full Text Available The paper reports successful thrombolysis conducted in 64 years old woman admitted to the clinic with clinical and angiographic data for acute surgical abdomen caused by acute tromboembolia of arteria mesenterica superior (AMS. The therapeutic approach required to undertake lifesaving decision on i.e. surgical vs. invasive treatment in conditions of emergency. Finally, it was decided to undertake invasive treatment with successful restoration of blood flow in the related artery. The patient was discharged from the clinic with considerable clinical improvement on the fifth day of her stay. The case report includes discussion on issues relating the consequence of the diagnostic and interventional procedures in such patients, opportunities for conducting emergency thrombolysis in acute embolia of AMS and preventive measures in patients with high tromboembolic risk. Keywords: Mesenterial circulation, Abdominal thromboembolism, Arterial thrombolysis

  17. Selective use of diagnostic laparoscopy in patients with suspected appendicitis

    NARCIS (Netherlands)

    van den Broek, W. T.; Bijnen, A. B.; van Eerten, P. V.; de Ruiter, P.; Gouma, D. J.

    2000-01-01

    BACKGROUND: Diagnostic laparoscopy has been introduced as a new diagnostic tool for patients with acute appendicitis. We performed diagnostic laparoscopy when the clinical diagnosis of appendicitis was in doubt. The aims of this study were to evaluate this strategy and to analyze the efficacy of

  18. Strict deformation quantization for actions of a class of symplectic lie groups

    International Nuclear Information System (INIS)

    Bieliavsky, Pierre; Massar, Marc

    2002-01-01

    We present explicit universal strict deformation quantization formulae for actions of Iwasawa subgroups AN of SN(1, n). This answers a question raised by Rieffel in [Contemp. Math. 228 (1998), 315]. (author)

  19. Strict optical orthogonal codes for purely asynchronous code-division multiple-access applications

    Science.gov (United States)

    Zhang, Jian-Guo

    1996-12-01

    Strict optical orthogonal codes are presented for purely asynchronous optical code-division multiple-access (CDMA) applications. The proposed code can strictly guarantee the peaks of its cross-correlation functions and the sidelobes of any of its autocorrelation functions to have a value of 1 in purely asynchronous data communications. The basic theory of the proposed codes is given. An experiment on optical CDMA systems is also demonstrated to verify the characteristics of the proposed code.

  20. Metabolic complications of endogenous Cushing: patient selection for screening

    Directory of Open Access Journals (Sweden)

    Zh E Belaya

    2013-03-01

    Full Text Available Aims: this study evaluates the most common associations of symptoms and complications in patients with Cushing’s syndrome (CS in order to choose a potential population to be screened for CS and estimates the diagnostic accuracy of first line screening tests (cortisol, ACTH to differentiate ACTH-ectopic CS from Cushing’s disease. Materials and Methods: The clinical data of 259 patients with proven CS during 2001–2011 was analyzed. The clinical presentations of 197 patients (159 Cushing’s disease, 28 ACTH-ectopic CS and 10 cases of benign cortisol-secreting adrenal adenoma were compared according to the cause of hypercortisolism. ROC-analysis was performed to estimate the diagnostic accuracy of the first line tests (cortisol, ACTH to suggest ACTH-ectopic CS. A threshold for the test with the highest area under the curves was chosen based on the maximum sum of the sensitivity and specificity. Results: The most frequent complaints were related to fatigue, muscle weakness, weight gain and changes in appearance (facial plethora and fullness, striae. Among the complications of CS the most frequent were being overweight or obese (71%, hypertension (63%, dislipoproteinemia (41%, low traumatic fractures (43% and steroid-induced diabetes (31%. In women, 16% were older than 50, in those who were younger amenorrhea was registered in 43%. The patients with ACTH-ectopic CS had higher rate of low traumatic fractures (p=0.04, increased serum late-night cortisol, 24 hours urinary free cortisol, morning and evening ACTH and lower levels of potassium (p<0.01 for all parameters. Plasma late-night ACTH measurements showed the highest AUC (0,811 (95% CI 0,712–0,909 to differentiate ACTH-ectopic CS from Cushing’s disease. A cut off value of 108.9 pg/ml for late-night ACTH yielded a sensitivity of 60,7% and a specificity of 79%. Conclusions: patients with a coexistence of obesity, muscle weakness, fatigue, some components of metabolic syndrome and especially

  1. Immediate effect of instrumentation on the subgingival microflora in deep inflamed pockets under strict plaque control.

    Science.gov (United States)

    Rhemrev, G E; Timmerman, M F; Veldkamp, I; Van Winkelhoff, A J; Van der Velden, U

    2006-01-01

    To investigate (1) reduction in the number of microorganisms obtained directly after subgingival instrumentation, (2) rate of bacterial re-colonization during 2 weeks, under supragingival plaque-free conditions. Effects of subgingival instrumentation were measured at one deep pocket in 22 patients (11 smokers and 11 non-smokers). Immediately after initial therapy, experimental sites, under strict plaque control, were instrumented subgingivally. Microbiological evaluation was performed at pre-instrumentation, immediate post-instrumentation and 1 and 2 weeks post-instrumentation. Mean total anaerobic colony forming units (CFUs) dropped from 3.9 x 10(6) before to 0.09 x 10(6) immediately following instrumentation. Significant reductions were found for Tannerella forsythia, Micromonas micros, Fusobacterium nucleatum and spirochetes. Significant reductions were not observed for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Campylobacter rectus. Except for spirochetes, no reduction in prevalence of specific periodontal bacteria was found immediately after instrumentation. During follow-up, mean total CFU tended to increase. Prevalence of periodontal bacteria further reduced. No effect of smoking was found. Results indicate that subgingival mechanical cleaning in itself, has a limited effect, in actually removing bacteria. The subsequent reduction in prevalence of specific periodontal bacteria shows that it is apparently difficult for these species to survive in treated pockets.

  2. SELECTIVE INTESTINAL DECONTAMINATION FOR PREVENTION OF WOUND COLONIZATION IN SEVERELY BURNED PATIENTS - A RETROSPECTIVE ANALYSIS

    NARCIS (Netherlands)

    MANSON, WL; KLASEN, HJ; SAUER, EW; OLIEMAN, A

    In this study the effect of selective intestinal decontamination of the digestive tract (SDD) on wound colonization was investigated. Ninety-one patients with at least 25 per cent total burned surface area (TBSA) were included in this study. All patients received oral polymyxin. In 63 patients oral

  3. Plant use in the medicinal practices known as "strict diets" in Chazuta valley (Peruvian Amazon).

    Science.gov (United States)

    Sanz-Biset, Jaume; Cañigueral, Salvador

    2011-09-01

    Strict diets are traditional medicinal practices where plant remedies are consumed with nearly fasting and with some sort of social seclusion. The aim of this work was to describe these practices of Chazuta and the use of plants within, as well as to analyse the possible functions of the last. The information was obtained through interviews to the 6.3% of the district rural adult population (140 individuals, 75% of which was considered Quechua). In total, 122 strict diets were recorded and 106 different plant species were reported to be used. Strict diets present a characteristic structure and plant use. The main effects reported in strict diets were antinflammatory, antiinfective, brain function alteration and depuration. Strict diets are well structured traditional medicinal practices, also with a symbolic significance in the life cycle of chazutian men. Plants used in strict diets can contribute to the main effects through antinflammation, antiinfective actions, psychoactivity and depurative related activities. The correlation between literature evidence of activity of most used plants and effects reported for the correspondent diet (i.e. in which the plant was used) are 36% for antinflammatory activity, 29% for antimicrobial activity, 18% for psychoactivity and 5% for depurative related activities. The percentages go to 77%, 64%, 73% and 32%, respectively, when literature evidences on related taxa are also considered. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  4. Taking a history in aesthetic surgery: SAGA--the surgeon's tool for patient selection.

    Science.gov (United States)

    Blackburn, V F; Blackburn, A V

    2008-07-01

    Most patient dissatisfaction in Aesthetic surgery is based on failures of communication and patient selection criteria, and not on technical faults [Ward CM. Consenting and consulting for cosmetic surgery. Br J Plast Surg 1998;51:547-50; Gorney M. (2004) Essentials of malpractice claims prevention for the plastic surgeon. eMedicine; Jan 5, 2004]. Litigation leaves the surgeon perplexed when the operation has been performed to his or her satisfaction. Taking a history of Aesthetic Distress is critical in understanding the patient's complaint and postoperative expectation. It is often overlooked. This valuable information influences patient selection for surgery and shapes the operation to be performed. If a carefully selected patient has a surgical result that addresses their complaint and meets their expectation, the rate of dissatisfaction is reduced and litigation is avoided or more easily defended. An historical literature review of patient selection for aesthetic surgery is offered. It confirms that the need for establishing a rapport with the patient has been recognised and, indeed, stressed for many years. However, while we have found negative lists of the types of patient to avoid, and aspersions of psychiatric conditions in dissatisfied patients, we have been unable to find any structure or template for eliciting the required history, which is all important in determining patient selection. SAGA is a simple template for questioning, during consultation. It provides the surgeon with a systematic tool for recording the history of the complaint of appearance, whilst establishing rapport with the patient. It gives insight into the patient's personality and complaint, thus aiding patient selection for surgery and shaping the operation performed. Finally it provides a record for "rebuttal" in the postoperative period, should this be necessary. It has served the senior author well for twenty-five years.

  5. Assessment and selection considerations: ESRD patient and family education materials and media.

    Science.gov (United States)

    Szczepanik, M E

    1995-07-01

    Education has long been an integral component of the care of end-stage renal disease patients and their families. The health care environment of the 1990s led to increase in the numbers and acuity of patients and a decrease in professional staff and reimbursement. A basic understanding of the patient education process, assessment of educational materials, adult learning principles, and empowerment is essential for the health care professional responsible for assessing and selecting patient education materials and media. This article provides an overview of the education process, assessment of materials and media (content, scope and depth, readability, clarity and design features), and selection of materials and media based on learner needs and characteristics. The features of four types of materials and media that affect selection and purchasing decisions for the individual patient or for an agency or group of patients are also presented. Special considerations about developing in-house materials are addressed throughout the article.

  6. Tiotropium for the Treatment of Asthma: Patient Selection and Perspectives

    Directory of Open Access Journals (Sweden)

    V. Madhu Chari

    2018-01-01

    Full Text Available Asthma is a chronic disease of airway inflammation with a large global burden. Despite established, guideline-based stepwise therapy, a significant proportion of patients remain symptomatic and poorly controlled. As such, there is a need for additional safe, effective, convenient, and cost-effective therapies that can be broadly applied across a range of asthma phenotypes. Tiotropium is a long-acting muscarinic antagonist (LAMA that leads to bronchodilation by blocking endogenous acetylcholine receptors in the airways. Tiotropium has long been approved for the treatment of chronic obstructive pulmonary disease, and it has recently been recognized for its safety and efficacy in improving lung function and controlling asthma. Evidence from several Phase III trials in the adult and paediatric population has shown that tiotropium is well tolerated and significantly improves a range of endpoints as an add-on treatment to ICS therapy, regardless of baseline characteristics and clinical phenotypes. Consequently, regulatory authorities worldwide have recently licensed tiotropium as the only LAMA approved for the treatment of asthma. This review provides an overview of safety and efficacy data and discusses the use of tiotropium in patients across the range of asthma severities, ages, and phenotypes.

  7. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study

    NARCIS (Netherlands)

    Smet, A.M. de; Kluytmans, J.A.; Blok, H.E.; Mascini, E.M.; Benus, R.F.; Bernards, A.T.; Kuijper, E.J.; Leverstein-van Hall, M.A.; Jansz, A.R.; Jongh, B.M. de; Asselt, G.J. van; Frenay, I.H.; Thijsen, S.F.; Conijn, S.N.; Kaan, J.A.; Arends, J.P.; Sturm, P.D.J.; Bootsma, M.C.; Bonten, M.J.

    2011-01-01

    BACKGROUND: Previously, we assessed selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) on survival and prevention of bacteraemia in patients in intensive-care units. In this analysis, we aimed to assess effectiveness of these interventions for

  8. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units : an open-label, clustered group-randomised, crossover study

    NARCIS (Netherlands)

    de Smet, Anne Marie G. A.; Kluytmans, Jan A. J. W.; Blok, Hetty E. M.; Mascini, Ellen M.; Benus, Robin F. J.; Bernards, Alexandra T.; Kuijper, Ed J.; Leverstein-van Hall, Maurine A.; Jansz, Arjan R.; de Jongh, Bartelt M.; van Asselt, Gerard J.; Frenay, Ine H. M. E.; Thijsen, Steven F. T.; Conijn, Simon N. M.; Kaan, Jan A.; Arends, Jan P.; Sturm, Patrick D. J.; Bootsma, Martin C. J.; Bonten, Marc J. M.

    Background Previously, we assessed selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) on survival and prevention of bacteraemia in patients in intensive-care units. In this analysis, we aimed to assess effectiveness of these interventions for prevention

  9. Diagnostic value of urodynamic bladder outlet obstruction to select patients for transurethral surgery of the prostate: Systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Myong Kim

    Full Text Available To investigate the diagnostic value of urodynamic bladder outlet obstruction (BOO in the selection of patients for transurethral surgery of the prostate.We systematically searched online PubMed, Embase, and Cochrane Library databases from January 1989 to June 2014.A total of 19 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 2321 patients with a median number of 92 patients per study (range: 12-437. Of the 19 studies, 15 conducted conventional transurethral prostatectomy (TURP, and 7 used other or multiple modalities. In urodynamic bladder outlet obstruction (BOO positive patients, the pooled mean difference (MD was significant for better improvement of the International Prostate Symptom Score (IPSS (pooled MD, 3.48; 95% confidence interval [CI], 1.72-5.24; p < 0.01; studies, 16; participants, 1726, quality of life score (QoL (pooled MD, 0.56; 95% CI, 0.14-1.02; p = 0.010; studies, 9; participants, 1052, maximal flow rate (Qmax (pooled MD, 3.86; 95% CI, 2.17-5.54; p < 0.01; studies, 17; participants, 1852, and post-void residual volume (PVR (pooled MD, 32.46; 95% CI, 23.34-41.58; p < 0.01; studies, 10; participants, 1219 compared with that in non-BOO patients. Some comparisons showed between-study heterogeneity despite the strict selection criteria of the included studies. However, there was no clear evidence of publication bias in this meta-analysis.Our meta-analysis results showed a significant association between urodynamic BOO and better improvements in all treatment outcome parameters. Preoperative UDS may add insight into postoperative outcomes after surgical treatment of benign prostatic hyperplasia.

  10. Patient selection and treatment planning for implant restorations.

    Science.gov (United States)

    Bryington, Matthew; De Kok, Ingeborg J; Thalji, Ghadeer; Cooper, Lyndon F

    2014-01-01

    Dental implants are an indispensible tool for the restoration of missing teeth. Their use has elevated the practice of dentistry by improving both our technical ability to rehabilitate patients and general quality of life. To routinely achieve the associated high expectations, diligent attention to details must be observed and addressed from the outset. Of central concern is the attainment of osseointegration and the location of implants to ideally support the intended restoration. The pivotal point in treatment planning for dental implants occurs when the location of bone is viewed radiographically in the context of the planned prosthesis. This most often requires diagnostic waxing or tooth arrangement using mounted diagnostic casts. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Selecting the optimal oral antihistamine for patients with allergic rhinitis.

    Science.gov (United States)

    Lehman, Jeffrey M; Blaiss, Michael S

    2006-01-01

    Allergic rhinitis (AR) is now recognised as a global health problem that affects 10-30% of adults and up to 40% of children. Each year, millions of patients seek treatment from their healthcare provider. However, the prevalence of AR maybe significantly underestimated because of misdiagnosis, under diagnosis and failure of patients to seek medical attention. In addition to the classical symptoms such as sneezing, nasal pruritus, congestion and rhinorrhoea, it is now recognised that AR has a significant impact on quality of life (QOL). This condition can lead to sleep disturbance as a result of nasal congestion, which leads to significant impairment in daily activities such as work and school. Traditionally, AR has been subdivided into seasonal AR (SAR) or perennial AR (PAR). SAR symptoms usually appear during a specific season in which aeroallergens are present in the outdoor air such as tree and grass pollen in the spring and summer and weed pollens in the autumn (fall); and PAR symptoms are present year-round and are triggered by dust mite, animal dander, indoor molds and cockroaches. Oral histamine H(1)-receptor antagonists (H(1) antihistamines) are one of the most commonly prescribed medications for the treatment of AR. There are several oral H(1) antihistamines available and it is important to know the pharmacology, such as administration interval, onset of action, metabolism and conditions that require administration adjustments. When prescribing oral H(1) antihistamines, the healthcare provider must take into account the clinical efficacy and weigh this against the risk of adverse effects from the agent. In addition to the clinical efficacy, potential for improvement in QOL with a particular treatment should also be considered.

  12. Psychosocial and Patient Education Needs of Prostate Cancers Selecting Watchful Waiting

    National Research Council Canada - National Science Library

    Knight, Sara J; Latini, David M

    2006-01-01

    ... of this approach to disease management. We propose to gather data from prostate cancer patients selecting watchful waiting in lieu of an active treatment for their cancer in order to understand the psychosocial and symptom management...

  13. Cost effectiveness of selective decontamination of the digestive tract in liver transplant patients

    NARCIS (Netherlands)

    van Enckevort, PJ; Zwaveling, JH; Bottema, JT; Maring, JK; Klompmaker, IJ; Slooff, MJH; TenVergert, EM

    2001-01-01

    Objective: To assess the cost effectiveness of selective decontamination of the digestive tract (SDD) in liver transplant patients. Design: Randomised, placebo-controlled, double-blind trial with an integrated economic evaluation. Setting: Two university hospitals in The Netherlands. Cost

  14. Effectiveness of strict vs. multiple use protected areas in reducing tropical forest fires: a global analysis using matching methods.

    Directory of Open Access Journals (Sweden)

    Andrew Nelson

    Full Text Available Protected areas (PAs cover a quarter of the tropical forest estate. Yet there is debate over the effectiveness of PAs in reducing deforestation, especially when local people have rights to use the forest. A key analytic problem is the likely placement of PAs on marginal lands with low pressure for deforestation, biasing comparisons between protected and unprotected areas. Using matching techniques to control for this bias, this paper analyzes the global tropical forest biome using forest fires as a high resolution proxy for deforestation; disaggregates impacts by remoteness, a proxy for deforestation pressure; and compares strictly protected vs. multiple use PAs vs indigenous areas. Fire activity was overlaid on a 1 km map of tropical forest extent in 2000; land use change was inferred for any point experiencing one or more fires. Sampled points in pre-2000 PAs were matched with randomly selected never-protected points in the same country. Matching criteria included distance to road network, distance to major cities, elevation and slope, and rainfall. In Latin America and Asia, strict PAs substantially reduced fire incidence, but multi-use PAs were even more effective. In Latin America, where there is data on indigenous areas, these areas reduce forest fire incidence by 16 percentage points, over two and a half times as much as naïve (unmatched comparison with unprotected areas would suggest. In Africa, more recently established strict PAs appear to be effective, but multi-use tropical forest protected areas yield few sample points, and their impacts are not robustly estimated. These results suggest that forest protection can contribute both to biodiversity conservation and CO2 mitigation goals, with particular relevance to the REDD agenda. Encouragingly, indigenous areas and multi-use protected areas can help to accomplish these goals, suggesting some compatibility between global environmental goals and support for local livelihoods.

  15. Hydroxycinnamic acids used as external acceptors of electrons: an energetic advantage for strictly heterofermentative lactic acid bacteria.

    Science.gov (United States)

    Filannino, Pasquale; Gobbetti, Marco; De Angelis, Maria; Di Cagno, Raffaella

    2014-12-01

    The metabolism of hydroxycinnamic acids by strictly heterofermentative lactic acid bacteria (19 strains) was investigated as a potential alternative energy route. Lactobacillus curvatus PE5 was the most tolerant to hydroxycinnamic acids, followed by strains of Weissella spp., Lactobacillus brevis, Lactobacillus fermentum, and Leuconostoc mesenteroides, for which the MIC values were the same. The highest sensitivity was found for Lactobacillus rossiae strains. During growth in MRS broth, lactic acid bacteria reduced caffeic, p-coumaric, and ferulic acids into dihydrocaffeic, phloretic, and dihydroferulic acids, respectively, or decarboxylated hydroxycinnamic acids into the corresponding vinyl derivatives and then reduced the latter compounds to ethyl compounds. Reductase activities mainly emerged, and the activities of selected strains were further investigated in chemically defined basal medium (CDM) under anaerobic conditions. The end products of carbon metabolism were quantified, as were the levels of intracellular ATP and the NAD(+)/NADH ratio. Electron and carbon balances and theoretical ATP/glucose yields were also estimated. When CDM was supplemented with hydroxycinnamic acids, the synthesis of ethanol decreased and the concentration of acetic acid increased. The levels of these metabolites reflected on the alcohol dehydrogenase and acetate kinase activities. Overall, some biochemical traits distinguished the common metabolism of strictly heterofermentative strains: main reductase activity toward hydroxycinnamic acids, a shift from alcohol dehydrogenase to acetate kinase activities, an increase in the NAD(+)/NADH ratio, and the accumulation of supplementary intracellular ATP. Taken together, the above-described metabolic responses suggest that strictly heterofermentative lactic acid bacteria mainly use hydroxycinnamic acids as external acceptors of electrons. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  16. Plan selection strategy for rectum cancer patients: An interobserver study to assess clinical feasibility.

    Science.gov (United States)

    de Jong, Rianne; Lutkenhaus, Lotte; van Wieringen, Niek; Visser, Jorrit; Wiersma, Jan; Crama, Koen; Geijsen, Debby; Bel, Arjan

    2016-08-01

    In radiotherapy for rectum cancer, the target volume is highly deformable. An adaptive plan selection strategy can mitigate the effect of these variations. The purpose of this study was to evaluate the feasibility of an adaptive strategy by assessing the interobserver variation in CBCT-based plan selection. Eleven patients with rectum cancer, treated with a non-adaptive strategy, were selected. Five CBCT scans were available per patient. To simulate the plan selection strategy, per patient three PTVs were created by varying the anterior upper mesorectum margin. For each CBCT scan, twenty observers selected the smallest PTV that encompassed the target volume. After this initial baseline measurement, the gold standard was determined during a consensus meeting, followed by a second measurement one month later. Differences between both measurements were assessed using the Wilcoxon signed-rank test. In the baseline measurement, the concordance with the gold standard was 69% (range: 60-82%), which improved to 75% (range: 60-87%) in the second measurement (p=0.01). For the second measurement, 10% of plan selections were smaller than the gold standard. With a plan selection consistency between observers of 75%, a plan selection strategy for rectum cancer patients is feasible. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Suitability of selected chromatographic columns for analysis of fatty acids in dialyzed patients.

    Science.gov (United States)

    Pazda, Magdalena; Stepnowski, Piotr; Sledzinski, Tomasz; Chmielewski, Michal; Mika, Adriana

    2017-11-01

    Gas chromatography-mass spectrometry is a preferred method for fatty acid (FA) analysis in biofluids from patients with metabolic diseases. Complex characteristics of FAs make their analysis particularly challenging. Selection of an appropriate chromatographic column is particularly important component of the process as it provides optimal separation and detection of possibly all FAs present in the sample. However, no accurate protocol for comparative evaluation of capillary columns for the analysis of whole serum FA profile in patients with chronic kidney disease (CKD) has been developed thus far. Therefore, in the present study four columns were examined to select the one providing optimal separation and determination of FA profiles in this group of patients. Moreover, serum FA profiles obtained with the selected column in CKD patients subjected to peritoneal dialysis and healthy controls were compared. Thirty-seven component FAME Mix and sera from CKD patients were used to optimize chromatographic conditions and to select the most appropriate column. The ZB-5 column turned out to be the most appropriate for the analysis of whole FA profile in CKD patients' sera. Then, this column was used to compare FA profiles in patients subjected to peritoneal dialysis and in healthy controls. The analysis demonstrated many abnormalities in the FA profile of CKD patients. Further studies involving larger groups of patients presenting with other stages of CKD are required to explain the impact of the disease progression on composition of serum FAs. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Selective Non-operative Management of Patients with Abdominal Trauma-Is CECT Scan Mandatory?

    Science.gov (United States)

    Kumar, Sunil; Prakash, Puneet; Joshi, Mohit Kumar; Rathi, Vinita

    2017-10-01

    CECT scan is considered essential for selective non-operative management (SNOM) of patients with abdominal trauma. However, CECT has its own hazards and limitations. We evaluated the safety and efficacy of selective non-operative management of patients with abdominal trauma without the mandatory use of CECT scan in a prospective study. Patients with peritonitis and ongoing intra-abdominal bleed were excluded. Consenting FAST positive, hemodynamically stable patients with blunt and penetrating abdominal trauma between 18 and 60 years of age were included and admitted for SNOM and detailed ultrasonography of the abdomen (in all) with or without CECT abdomen (selectively). Eighty-four patients with abdominal trauma were admitted during the study period. Twenty-two patients did not satisfy the inclusion criteria and 18 required immediate laparotomy based on primary survey. Remaining 44 patients were admitted for SNOM: mean ± SD age of these patients was 27 ± 8.7 years; 40 (89 %) were males. Thirty-five patients (79.54 %) sustained blunt trauma (RTI = 16, Fall = 16, others = 3) while nine patients (20.45 %) sustained penetrating trauma. SNOM without CECT was successful in 36 (81.82 %) patients. Five (11.36 %) patients underwent delayed emergency laparotomy based on clinical and detailed USG evaluation. CECT was not done in these patients. Three patients underwent CECT for various reasons; however, they were managed with SNOM. Thus, SNOM without abdominal CECT was successful in 36 (81.82 %) patients. SNOM failed in five patients but abdominal USG was sufficient. SNOM can be practised safely in patients of abdominal trauma with limited use of CECT scan.

  19. Improving patient selection for selective internal radiation therapy of intra-hepatic cholangiocarcinoma: A meta-regression study.

    Science.gov (United States)

    Cucchetti, Alessandro; Cappelli, Alberta; Mosconi, Cristina; Zhong, Jian-Hong; Cescon, Matteo; Pinna, Antonio D; Golfieri, Rita

    2017-07-01

    Selective internal radiation therapy (SIRT) is emerging as a potential therapy for unresectable intra-hepatic cholangiocarcinoma (iCCA) able to prolong life-expectancy. Aim of this study was to collect available literature meta-analyse data and results and investigate sources of heterogeneity through a meta-regression approach before suggesting SIRT as a valuable option. A systematic review of studies published until 1 September 2016 in PubMed and Scopus databases was performed. Patient survival was the primary outcome measure. Meta-analysis was performed using a random-effects model. Meta-regression was applied to investigate relationships existing between clinical and tumour features and the primary outcome. Nine observational studies were included in the analysis involving 224 patients. The 1-, 2- and 3-year pooled survival estimates were 55.7%, 33.1% and 20.2%. Clinical and tumour characteristics showed medium-to-considerable heterogeneity (I 2 >50%). Meta-regression analysis showed that determinants of best survivals were the presence of mass-forming iCCA type (median survival=19.9 months vs 8.1 months for the infiltrative type; P=.002) that also accounted for most of the heterogeneity between included studies (residual I 2 =0); SIRT as first-line therapy (median survival=24 months vs 11.5 months for non-naïve patients; P=.048) and the adoption of concomitant chemotherapy (median survival 19.5 months vs 5.5 months in patients not receiving chemotherapy; P=.042). There is considerable heterogeneity between studies highlighting that indications for SIRT are extremely varied. To ameliorate SIRT results naïve patients with mass-forming iCCA should be selected as the best candidates with the possibility of adding concomitant standard chemotherapy. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients

    Directory of Open Access Journals (Sweden)

    Han-Song Sheng

    2017-08-01

    Conclusion: Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.

  1. Patient Selection in Heart Failure With Preserved Ejection Fraction Clinical Trials

    NARCIS (Netherlands)

    Kelly, Jacob P.; Mentz, Robert J.; Mebazaa, Alexandre; Voors, Adriaan A.; Butler, Javed; Roessig, Lothar; Fiuzat, Mona; Zannad, Faiez; Pitt, Bertram; O'Connor, Christopher M.; Lam, Carolyn S. P.

    2015-01-01

    Recent clinical trials in patients with heart failure with preserved ejection fraction (HFpEF) have provided important insights into participant selection strategies. Historically, HFpEF trials have included patients with relatively preserved left ventricular ejection fraction ranging from 40% to

  2. Actions of a separately strict cpo-monoid on pointed directed complete posets

    Directory of Open Access Journals (Sweden)

    Halimeh Moghbeli Damaneh

    2015-07-01

    Full Text Available ‎ In the present article‎, ‎we study some categorical properties of the category {$bf‎ Cpo_{Sep}$-$S$} of all {separately strict $S$-cpo's}; cpo's equipped with‎ a compatible right action of a separately strict cpo-monoid $S$ which is‎ strict continuous in each component‎. ‎In particular‎, we show that this category is reflective and coreflective in the‎ category of $S$-cpo's‎, ‎find the free and cofree functors‎, characterize products and coproducts‎. ‎Furthermore‎, ‎epimorphisms and‎  monomorphisms in {$bf Cpo_{Sep}$-$S$} are studied‎, ‎and show that‎ {$bf Cpo_{Sep}$-$S$} is not cartesian closed‎.

  3. Reducing Wrong Patient Selection Errors: Exploring the Design Space of User Interface Techniques

    Science.gov (United States)

    Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

    2014-01-01

    Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients’ identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed. PMID:25954415

  4. The photon is no strict particle and nonlocality is far from being proven

    Energy Technology Data Exchange (ETDEWEB)

    Greulich, Karl Otto [Fritz Lipmann Institut, Jena (Germany)

    2010-07-01

    Two aspects of philosophical discussions on physics are the wave particle dualism and non locality including entanglement. However the strict particle aspect of the photon, in the common sense view, has never been proven. The accumulation time argument, the only experimental verification of a strictly particle like photon, has so far not yet been satisfied. Also, experiments thought to prove nonlocality have loophole which have so far not yet been safely closed, and now an even more serious loophole emerges. Thus, also nonlocality cannot be seen as proven. This demands some fine tuning of philosophical discussions on critical experiments in physics.

  5. Retrograde ureteroscopic holmium laser endopyelotomy in a selected population of patients with ureteropelvic junction obstruction

    DEFF Research Database (Denmark)

    Stilling, Nicolaj; Jung, Helene; Nørby, Bettina

    2009-01-01

    Objective. Significant controversy remains concerning the best way to treat ureteropelvic junction obstruction (UPJO). This study evaluates subjective and objective outcomes of retrograde holmium laser endopyelotomy in a selected population with UPJO. Material and methods. Forty-seven patients...... with UPJO were referred to retrograde endopyelotomy between April 2004 and March 2007. Patients with a very large pelvis, a high insertion of the ureter, a renal split function below 20% or a long (>2 cm) stenosed ureteropelvic segment, and patients younger than 18 years were not selected for endopyelotomy...... referred to retreatment owing to unchanged symptoms. Conclusion. Retrograde ureteroscopic endopyelotomy is a safe and effective treatment option in patients with primary and secondary UPJO when selected properly....

  6. Patients' selection for treatment of caliceal diverticular stones with extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Won Hong; Lee, Hee Jeong; Son, Soon Yong; Kang, Seong Ho; Cho, Cheong Chan; Ryu, Meung Sun [AMC, Seoul (Korea, Republic of); Kim, Seung Kook [Kwang-Ju Health College, Kwang-Ju (Korea, Republic of)

    2001-06-01

    Symptoms of caliceal diverticular stones are commonly associated with pain, recurrent urinary tract infection and hematuria. The aim of this study is to select the proper patient for the application of more successful extracorporeal shock wave lithotripsy(ESWL) as a treatment of caliceal diverticular stone. 16 patients with caliceal diverticular stones were treated with ESWL, and all patients had single caliceal diverticulum. The diagnosis of caliceal diverticulum with stones was made by intraveneous pyelography to all patients. On these intravenous pyelogram, we also classified diverticular type, whether the diverticular neck is connected with urinary tract patently, diverticular site and stone number and size. All patients were followed after ESWL by plain film of the kidneys, ureters and bladder and interviewed. Of all patients 44% was shown stone-free completely, also 83% was rendered symptom-free. All patients whose diverticular neck connected with urinary tract patently on the intraveneous pyelogram became stone-free. Of solitary stone 60% and multiple stones (more than 2) 17% became symptom-free. The patients with infection before ESWL 75% had residual stones, of these patients 33% had slightly flank pain, and 25% of patients with stones recurred become stone-free. We propose that more successful ESWL for patients with caliceal diverticular stones select satisfactory patients including that the diverticular neck is connected with urinary tract patently, solitary stone and no infection simultaneously.

  7. Patients' selection for treatment of caliceal diverticular stones with extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Lee, Won Hong; Lee, Hee Jeong; Son, Soon Yong; Kang, Seong Ho; Cho, Cheong Chan; Ryu, Meung Sun; Kim, Seung Kook

    2001-01-01

    Symptoms of caliceal diverticular stones are commonly associated with pain, recurrent urinary tract infection and hematuria. The aim of this study is to select the proper patient for the application of more successful extracorporeal shock wave lithotripsy(ESWL) as a treatment of caliceal diverticular stone. 16 patients with caliceal diverticular stones were treated with ESWL, and all patients had single caliceal diverticulum. The diagnosis of caliceal diverticulum with stones was made by intraveneous pyelography to all patients. On these intravenous pyelogram, we also classified diverticular type, whether the diverticular neck is connected with urinary tract patently, diverticular site and stone number and size. All patients were followed after ESWL by plain film of the kidneys, ureters and bladder and interviewed. Of all patients 44% was shown stone-free completely, also 83% was rendered symptom-free. All patients whose diverticular neck connected with urinary tract patently on the intraveneous pyelogram became stone-free. Of solitary stone 60% and multiple stones (more than 2) 17% became symptom-free. The patients with infection before ESWL 75% had residual stones, of these patients 33% had slightly flank pain, and 25% of patients with stones recurred become stone-free. We propose that more successful ESWL for patients with caliceal diverticular stones select satisfactory patients including that the diverticular neck is connected with urinary tract patently, solitary stone and no infection simultaneously

  8. Selective oropharyngeal decontamination versus selective digestive decontamination in critically ill patients: a meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Zhao D

    2015-07-01

    Full Text Available Di Zhao,1,* Jian Song,2,* Xuan Gao,3 Fei Gao,4 Yupeng Wu,2 Yingying Lu,5 Kai Hou1 1Department of Neurosurgery, The First Hospital of Hebei Medical University, 2Department of Neurosurgery, 3Department of Neurology, The Second Hospital of Hebei Medical University, 4Hebei Provincial Procurement Centers for Medical Drugs and Devices, 5Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang People’s Republic of China *These authors contributed equally to this work Background: Selective digestive decontamination (SDD and selective oropharyngeal decontamination (SOD are associated with reduced mortality and infection rates among patients in intensive care units (ICUs; however, whether SOD has a superior effect than SDD remains uncertain. Hence, we conducted a meta-analysis of randomized controlled trials (RCTs to compare SOD with SDD in terms of clinical outcomes and antimicrobial resistance rates in patients who were critically ill. Methods: RCTs published in PubMed, Embase, and Web of Science were systematically reviewed to compare the effects of SOD and SDD in patients who were critically ill. Outcomes included day-28 mortality, length of ICU stay, length of hospital stay, duration of mechanical ventilation, ICU-acquired bacteremia, and prevalence of antibiotic-resistant Gram-negative bacteria. Results were expressed as risk ratio (RR with 95% confidence intervals (CIs, and weighted mean differences (WMDs with 95% CIs. Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. Results: A total of four RCTs involving 23,822 patients met the inclusion criteria and were included in this meta-analysis. Among patients whose admitting specialty was surgery, cardiothoracic surgery (57.3% and neurosurgery (29.7% were the two main types of surgery being performed. Pooled results showed that SOD had similar effects as SDD in day-28 mortality (RR =1

  9. More strictly protected areas are not necessarily more protective: evidence from Bolivia, Costa Rica, Indonesia, and Thailand

    International Nuclear Information System (INIS)

    Ferraro, Paul J; Hanauer, Merlin M; Miteva, Daniela A; Pattanayak, Subhrendu K; Canavire-Bacarreza, Gustavo Javier; Sims, Katharine R E

    2013-01-01

    National parks and other protected areas are at the forefront of global efforts to protect biodiversity and ecosystem services. However, not all protection is equal. Some areas are assigned strict legal protection that permits few extractive human uses. Other protected area designations permit a wider range of uses. Whether strictly protected areas are more effective in achieving environmental objectives is an empirical question: although strictly protected areas legally permit less anthropogenic disturbance, the social conflicts associated with assigning strict protection may lead politicians to assign strict protection to less-threatened areas and may lead citizens or enforcement agents to ignore the strict legal restrictions. We contrast the impacts of strictly and less strictly protected areas in four countries using IUCN designations to measure de jure strictness, data on deforestation to measure outcomes, and a quasi-experimental design to estimate impacts. On average, stricter protection reduced deforestation rates more than less strict protection, but the additional impact was not always large and sometimes arose because of where stricter protection was assigned rather than regulatory strictness per se. We also show that, in protected area studies contrasting y management regimes, there are y 2 policy-relevant impacts, rather than only y, as earlier studies have implied. (letter)

  10. What Is the Role of Developmental Disability in Patient Selection for Pediatric Solid Organ Transplantation?

    Science.gov (United States)

    Kamin, D S; Freiberger, D; Daly, K P; Oliva, M; Helfand, L; Haynes, K; Harrison, C H; Kim, H B

    2016-03-01

    The National Organ Transplant Act stipulates that deceased donor organs should be justly and wisely allocated based on sound medical criteria. Allocation schemes are consistent across the country, and specific policies are publicly vetted. Patient selection criteria are largely in the hands of individual organ transplant programs, and consistent standards are less evident. This has been particularly apparent for patients with developmental disabilities (DDs). In response to concerns regarding the fairness of transplant evaluations for patients with DDs, we developed a transplant centerwide policy using a multidisciplinary, community-based approach. This publication details the particular policy of our center. All patients should receive individualized assessments using consistent standards; disability should be neither a relative nor an absolute contraindication to transplantation. External review can increase trust in the selection process. Patients in persistent vegetative states should not be listed for transplantation. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  11. Supracricoid hemilaryngopharyngectomy for selected pyriform sinus carcinoma patients – a retrospective chart review

    Directory of Open Access Journals (Sweden)

    Yiotakis Ioannis E

    2009-08-01

    Full Text Available Abstract Background The aim of this study is to assess the functional and oncologic results of supracricoid hemilaryngopharyngectomy and report our experience in the technique, local control and overall survival rates. Materials and methods 18 selected patients with pyriform sinus cancer treated by supracricoid hemilaryngopharyngectomy in a University Hospital setting. Retrospective chart review was used to assess functional and oncologic results of the procedure. Results The actuarial 5 year survival rate in our study was 55.56% and the actuarial neck recurrence rate was 16.67%. All patients were successfully decannulated. Aspiration pneumonia was the most common postoperative complication (22.23% and was treated mostly conservatively. One patient required a temporary gastrostomy but no patient needed total laryngectomy in the postoperative period. Conclusion Supracricoid hemilaryngopharyngectomy in experienced hands is a reliable technique for selected patients with pyriform sinus cancer.

  12. Clinical comparison between patients with selective immunoglobulin A deficiency and other primary immunodeficiencies.

    Science.gov (United States)

    Lozano, Natalia A; Lozano, Alejandro; Sasia, Laura V; Saranz, Ricardo J; Agresta, María Fernanda; del Pilar Bovina Martijena, María; Ianiero, Luciano; Grenat, Andrés R

    2015-04-01

    Primary immunodeficiencies (PID) are low-prevalence diseases. There are warning signs that may raise clinical suspicion. The objectives of this study were to describe the clinical characteristics and warning signs of patients with PID and to compare the clinical differences between selective immunoglobulin A (IgA) deficiency and other PIDs. Eighty-nine patients were studied; their median age at the time of diagnosis was 6 years old (4.08-11.67). Fifty-three (59.5%) patients were male. Fifty-four (60.7%) patients had selective IgA deficiency, and 35 (39.3%) had other PIDs. The main clinical manifestations were rhinopharyngitis in 65 (73.03%) patients and atopy in 39 (43.82%). Twenty- four (26.97%) patients showed warning signs, and none had selective IgA deficiency. Patients with other PIDs had a higher incidence of lower respiratory tract infection, sepsis, skin infections, mucocutaneous candidiasis, dental alterations, cardiovascular malformations, angioedema, hospitalizations and death. Ten (28.57%) patients received intravenous gammaglobulin, 15 (42.85%) antibiotic prophylaxis, and 2 (2.24%) antifungal prophylaxis.

  13. Strict Monotonicity and Unique Continuation for the Third-Order Spectrum of Biharmonic Operator

    Directory of Open Access Journals (Sweden)

    Khalil Ben Haddouch

    2012-01-01

    Full Text Available We will study the spectrum for the biharmonic operator involving the laplacian and the gradient of the laplacian with weight, which we call third-order spectrum. We will show that the strict monotonicity of the eigenvalues of the operator , where , holds if some unique continuation property is satisfied by the corresponding eigenfunctions.

  14. "Let the Master Respond": Should Schools Be Strictly Liable When Employees Sexually Abuse Children?

    Science.gov (United States)

    Fossey, Richard; DeMitchell, Todd

    Although sexual abuse against children is a problem in the public schools, school officials have generally not acted aggressively to stop it. This paper argues for a strict liability standard--the assessment of liability without fault--against a school district in cases of student sexual abuse by a school employee. Part 1 explores the principle of…

  15. Detection of low numbers of microplastics in North Sea fish using strict quality assurance criteria

    NARCIS (Netherlands)

    Hermsen, E.; Pompe, R.; Besseling, E.; Koelmans, A.A.

    2017-01-01

    We investigated 400 individual fish of four North Sea species: Atlantic Herring, Sprat, Common Dab, and Whiting on ingestion of > 20 μm microplastic. Strict quality assurance criteria were followed in order to control contamination during the study. Two plastic particles were found in only 1 (a

  16. History, administration, goals, values, and long-term data of Russia's strictly protected scientific nature reserves

    Science.gov (United States)

    Martin A. Spetich; Anna E. Kvashnina; Y.D. Nukhimovskya; Olin E. Jr. Rhodes

    2009-01-01

    One of the most comprehensive attempts at biodiversity conservation in Russia and the former Soviet Union has been the establishment of an extensive network of protected natural areas. Among all types of protected areas in Russia, zapovedniks (strictly protected scientific preserve) have been the most effective in protecting biodiversity at the ecosystem scale. Russia...

  17. The Preventive Effect of Strict Gun Control Laws on Suicide and Homicide.

    Science.gov (United States)

    Lester, David; Murrell, Mary E.

    1982-01-01

    Examined state gun control laws and used a multidimensional scaling technique to study the relationship of strictness and death rates. Results showed states with stricter laws had lower suicide rates by firearms but higher rates by other means. No effect on homicide was found. (JAC)

  18. Enterococcus faecalis colonisation and endocarditis in five intensive care patients as late sequelae of selective decontamination.

    Science.gov (United States)

    Sijpkens, Y W; Buurke, E J; Ulrich, C; van Asselt, G J

    1995-03-01

    To describe Enterococcus faecalis colonisation and endocarditis in 5 intensive care patients after treatment with selective decontamination (SDD). Intensive care unit (ICU) in a general hospital. The patients were admitted to the ICU because of adult respiratory distress syndrome, polytrauma (2 patients), abdominal aortic surgery and gastrointestinal surgery. Because these patients needed mechanical ventilation they received systemic cefotaxime and SDD (polymyxin E, amphotericin B and norfloxacin). Colonisation with E. faecalis was documented in all patients. Intravascular catheter-related infection with E. faecalis occurred in 4 patients. None of the patients received antibiotics active against, E. faecalis, because body temperature normalised after catheter removal. In the course of his ICU stay one patient died. Autopsy showed E. faecalis endocarditis. The other 4 patients recovered from their primary illness, but had to be readmitted after several months because of E. faecalis endocarditis. One of these patients died. One patient recovered of endocarditis, but one year later valve surgery was necessary. The other 2 patients needed acute valve replacement. The latter 3 patients survived. We observed 5 patients with E. faecalis endocarditis as a late and severe sequela of SDD during their ICU stay.

  19. CT perfusion-guided patient selection for endovascular recanalization in acute ischemic stroke: a multicenter study.

    Science.gov (United States)

    Turk, Aquilla S; Magarick, Jordan Asher; Frei, Don; Fargen, Kyle Michael; Chaudry, Imran; Holmstedt, Christine A; Nicholas, Joyce; Mocco, J; Turner, Raymond D; Huddle, Daniel; Loy, David; Bellon, Richard; Dooley, Gwendolyn; Adams, Robert; Whaley, Michelle; Fanale, Chris; Jauch, Edward

    2013-11-01

    The treatment of acute ischemic stroke is traditionally centered on time criteria, although recent evidence suggests that physiologic neuroimaging may be useful. In a multicenter study we evaluated the use of CT perfusion, regardless of time from symptom onset, in patients selected for intra-arterial treatment of ischemic stroke. Three medical centers retrospectively assessed stroke patients with a National Institute of Health Stroke Scale of ≥ 8, regardless of time from symptom onset. CT perfusion maps were qualitatively assessed. Patients with defined salvageable penumbra underwent intra-arterial revascularization of their occlusion. Functional outcome using the modified Rankin Score (mRS) was recorded. Two hundred and forty-seven patients were selected to undergo intra-arterial treatment based on CT perfusion imaging. The median time from symptom onset to procedure was 6 h. Patients were divided into two groups for analysis: ≤ 8 h and >8 h from symptom onset to endovascular procedure. We found no difference in functional outcome between the two groups (42.8% and 41.9% achieved 90-day mRS ≤ 2, respectively (p=1.0), and 54.9% vs 55.4% (p=1.0) achieved 90-day mRS ≤ 3, respectively). Overall, 48 patients (19.4%) had hemorrhages, of which 20 (8.0%) were symptomatic, with no difference between the groups (p=1.0). In a multicenter study, we demonstrated similar rates of good functional outcome and intracranial hemorrhage in patients with ischemic stroke when endovascular treatment was performed based on CT perfusion selection rather than time-guided selection. Our findings suggest that physiologic imaging-guided patient selection rather than time for endovascular reperfusion in ischemic stroke may be effective and safe.

  20. Recognition of genetic predisposition in pediatric cancer patients: An easy-to-use selection tool.

    Science.gov (United States)

    Jongmans, Marjolijn C J; Loeffen, Jan L C M; Waanders, Esmé; Hoogerbrugge, Peter M; Ligtenberg, Marjolijn J L; Kuiper, Roland P; Hoogerbrugge, Nicoline

    2016-03-01

    Genetic predisposition for childhood cancer is under diagnosed. Identifying these patients may lead to therapy adjustments in case of syndrome-related increased toxicity or resistant disease and syndrome-specific screening programs may lead to early detection of a further independent malignancy. Cancer surveillance might also be warranted for affected relatives and detection of a genetic mutation can allow for reproductive counseling. Here we present an easy-to-use selection tool, based on a systematic review of pediatric cancer predisposing syndromes, to identify patients who may benefit from genetic counseling. The selection tool involves five questions concerning family history, the type of malignancy, multiple primary malignancies, specific features and excessive toxicity, which results in the selection of those patients that may benefit from referral to a clinical geneticist. Copyright © 2016 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

  1. Dasatinib for the treatment of chronic myeloid leukemia: patient selection and special considerations.

    Science.gov (United States)

    Keskin, Dilek; Sadri, Sevil; Eskazan, Ahmet Emre

    2016-01-01

    Dasatinib is one of the second-generation tyrosine kinase inhibitors used in imatinib resistance and/or intolerance, as well as in the frontline setting in patients with chronic myeloid leukemia-chronic phase, and also in patients with advanced disease. It is also utilized in Philadelphia chromosome-positive acute lymphocytic leukemia. While choosing the appropriate tyrosine kinase inhibitor (ie, dasatinib) for each individual patient, comorbidities and BCR-ABL1 kinase domain mutations should always be taken into consideration, among other things. This review mainly focuses on patient selection prior to dasatinib administration in the treatment of chronic myeloid leukemia.

  2. Chemical shift selective magnetic resonance imaging of the optic nerve in patients with acute optic neuritis

    DEFF Research Database (Denmark)

    Larsson, H B; Thomsen, C; Frederiksen, J

    1988-01-01

    of the 16 patients, abnormalities were seen. In one patient with bilateral symptoms, signal hyperintensity and swelling of the right side of the chiasm were found. In another patient the optic nerve was found diffusely enlarged with only a marginally increased signal in the second echo. In the third patient......Optic neuritis is often the first manifestation of multiple sclerosis (MS). Sixteen patients with acute optic neuritis and one patient with benign intracranial hypertension (BIH) were investigated by magnetic resonance imaging, using a chemical shift selective double spin echo sequence. In 3...... an area of signal hyperintensity and swelling was seen in the left optic nerve. In the patient with BIH the subarachnoid space which surrounds the optic nerves was enlarged. Even using this refined pulse sequence, avoiding the major artefact in imaging the optic nerve, the chemical shift artefact, lesions...

  3. Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative acute kidney injury.

    Science.gov (United States)

    Mita, Naoji; Kawahito, Shinji; Soga, Tomohiro; Takaishi, Kazumi; Kitahata, Hiroshi; Matsuhisa, Munehide; Shimada, Mitsuo; Kinoshita, Hiroyuki; Tsutsumi, Yasuo M; Tanaka, Katsuya

    2017-03-01

    The aim of the present study was to evaluate the usefulness of a closed-loop system (STG-55; Nikkiso, Tokyo, Japan), a type of artificial endocrine pancreas for the continuous monitoring and control of intraoperative blood glucose, for preventing postoperative acute kidney injury (AKI) in patients undergoing hepatectomy. Thirty-eight patients were enrolled in this study. Glucose concentrations were controlled with either a manual injection of insulin based on a commonly used sliding scale (manual insulin group, n = 19) or the programmed infusion of insulin determined by the control algorithm of the artificial endocrine pancreas (programmed insulin group, n = 19). After the induction of anesthesia, a 20-G intravenous catheter was inserted into the peripheral forearm vein of patients in the programmed insulin group and connected to an artificial endocrine pancreas (STG-55). The target range for glucose concentrations was set to 100-150 mg/dL. The mean serum creatinine concentrations of preoperative, postoperative 24 and 48 h were 0.72, 0.78, and 0.79 mg/dL in the programmed insulin group, and 0.81, 0.95, and 1.03 mg/dL in the manual insulin group, respectively. Elevations in serum creatinine concentrations postoperative 48 h were significantly suppressed in the programmed insulin group. The STG-55 closed-loop system was effective for maintaining strict blood glucose control during hepatectomy with minimal variability in blood glucose concentrations and for suppressing elevations in serum creatinine concentrations. Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative AKI.

  4. Factors influencing patient interest in plastic surgery and the process of selecting a surgeon.

    Science.gov (United States)

    Galanis, Charles; Sanchez, Ivan S; Roostaeian, Jason; Crisera, Christopher

    2013-05-01

    Understanding patient interest in cosmetic surgery is an important tool in delineating the current market for aesthetic surgeons. Similarly, defining those factors that most influence surgeon selection is vital for optimizing marketing strategies. The authors evaluate a general population sample's interest in cosmetic surgery and investigate which factors patients value when selecting their surgeon. An anonymous questionnaire was distributed to 96 individuals in waiting rooms in nonsurgical clinics. Respondents were questioned on their ability to differentiate between a "plastic" surgeon and a "cosmetic" surgeon, their interest in having plastic surgery, and factors affecting surgeon and practice selection. Univariate and multivariate analyses were conducted to define any significant correlative relationships. Respondents consisted of 15 men and 81 women. Median age was 34.5 (range, 18-67) years. Overall, 20% were currently considering plastic surgery and 78% stated they would consider it in the future. The most common area of interest was a procedure for the face. The most important factors in selecting a surgeon were surgeon reputation and board certification. The least important were quality of advertising and surgeon age. The most cited factor preventing individuals from pursuing plastic surgery was fear of a poor result. Most (60%) patients would choose a private surgicenter-based practice. The level of importance for each studied attribute can help plastic surgeons understand the market for cosmetic surgery as well as what patients look for when selecting their surgeon. This study helps to define those attributes in a sample population.

  5. Analysis of antibiotics selection in patients undergoing appendectomy in a Chinese tertiary care hospital.

    Science.gov (United States)

    Xu, Shengyong; Yu, Xuezhong; Li, Yi; Shi, Donglei; Huang, Jingya; Gao, Qian; Zhang, Ting; Guo, Shigong

    2016-01-01

    To investigate the status of antibiotics use in acute appendicitis patients who undergo appendectomy in a Chinese tertiary care hospital. A retrospective analysis of 93 patients who underwent appendectomy from June 1, 2011 to May 30, 2012 and had recorded use of intravenous antibiotics. We defined simple appendicitis and suppurative appendicitis as mild appendicitis. Gangrenous appendicitis and perforated appendicitis were classified as advanced appendicitis. The occurrence of advanced appendicitis, postoperative complications and length of hospital stay were the three major end points for outcomes analysis. 100 % of the patients received antibiotics therapy before and after operation. 45 patients received Fluoroquinolones (48.4 %), 41 patients received Cephalosporins (44.1 %) and 7 patients received Carbapenems (7.5 %). We found no statistical difference between antibiotics selection and the occurrence of advanced appendicitis (P = 0.3337). Both the monovariate analysis and multivariate analysis showed no statistical difference between antibiotics selection and the postoperative complications (P > 0.05). The average stay of patients receiving Fluoroquinolones was 2.6 days shorter than patients who received Cephalosporins (P = 0.0085). It is a lack of a standardized guideline for antibiotics selection in our hospital. All the antibiotics prescription were empirical. We tended to choose high levels of antibiotics, pay insufficient attention to the anaerobic bacteria and have a long duration of antibiotics therapy. We also found that antibiotics selection bore no relationship with the occurrence of advanced appendicitis and postoperative complications. Fluoroquinolones may lead to a shorter hospital stay, but this result may also be affected by the fewer underlying diseases and lower severity of the patients.

  6. The selection of patients for breast reduction: should health commissions have a say?

    Science.gov (United States)

    Horlock, N; Cole, R P; Rossi, A R

    1999-03-01

    Selective or restrictive access policies operate for breast reduction, despite proven benefits. The rationale for these policies, in particular the requirement of psychiatric assessment prior to a plastic surgical consultation, as an aid to patient selection by the health commission, was examined in 57 general practice referrals to a plastic surgical unit. In 22 cases, these policies deterred the patient or GP from pursuing the referral further. Sixteen cases were funded by the health commission directly, 16 patients required psychiatric or orthopaedic referrals, and three patients were refused funding outright. The decision to fund, reject or refer to a non-plastic-surgical specialist was not statistically related to the patients' symptoms. Non-plastic-surgical assessment resulted in referral for a plastic surgical opinion in 15 of 16 patients. We conclude that these selective policies are unsatisfactory, since patient management is not related to symptoms and the use of non-plastic-surgical opinions by the health commission as an aid to rationing is of little benefit.

  7. ANALYSIS OF THE SECONDARY CURVES IN PATIENTS UNDERGOING SELECTIVE ARTHRODESIS LENKE I

    Directory of Open Access Journals (Sweden)

    TADEU GERVAZONI DEBOM

    2015-12-01

    Full Text Available Objective : To radiographically evaluate the behavior of the secondary curves in the coronal and sagittal planes in patients with AIS classified as Lenke I, who underwent surgical treatment of selective arthrodesis by posterior approach. Methods : Retrospective study which analyzed 40 patients with AIS, being 33 female. The measurement of the radiographic parameters used followed the recommendations by Cobb. Results : The average correction of the thoracic proximal, primary and lumbar curves was 34.73%, 75.06% and 64.64%, respectively. Conclusion : Surgical treatment by selective arthrodesis in cases of AIS Lenke type I provide correction of compensatory curves in the coronal and maintenance in the sagittal plane.

  8. Natalizumab treatment for multiple sclerosis: updated recommendations for patient selection and monitoring

    DEFF Research Database (Denmark)

    Kappos, Ludwig; Bates, David; Edan, Gilles

    2011-01-01

    Natalizumab, a highly specific a4-integrin antagonist, is approved for treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). It is generally recommended for individuals who have not responded to a currently available first-line disease-modifying therapy or who have very......, based on additional long-term follow-up of clinical studies and post-marketing observations, including appropriate patient selection and management recommendations....

  9. Natalizumab treatment for multiple sclerosis: updated recommendations for patient selection and monitoring

    DEFF Research Database (Denmark)

    Kappos, Ludwig; Bates, David; Edan, Gilles

    2011-01-01

    Natalizumab, a highly specific α4-integrin antagonist, is approved for treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). It is generally recommended for individuals who have not responded to a currently available first-line disease-modifying therapy or who have very......, based on additional long-term follow-up of clinical studies and post-marketing observations, including appropriate patient selection and management recommendations....

  10. Ventricular assist devices for heart failure: a focus on patient selection and complications

    Directory of Open Access Journals (Sweden)

    Cipriani M

    2014-09-01

    Full Text Available Manlio Cipriani, Vincenzo De Simone, Luciana D'Angelo, Enrico Perna, Marzia Lilliu, Virginia Bovolo, Fabrizio Oliva, Maria Frigerio Cardiovascular and Thoracic Department, A De Gasperis Niguarda Ca' Granda Hospital, Milan, Italy Abstract: Heart transplantation represents the “gold standard” for the treatment of patients with end-stage heart failure, but remains challenged by inadequate donor supply, finite graft survival, and long-term complications arising from immunosuppressive therapy. In addition, a lot of patients waiting for a heart transplant experience clinical deterioration, and other patients become ineligible to undergo this treatment due to their age or relevant comorbidities. Left ventricular assist devices have emerged as a valid therapeutic option for advanced heart failure. In recent years, we have seen significant advances not only in the technologies available, but also in patient selection, indications for use, and management after implantation. Consequently, there has been an increase in the number of implants and an improvement in the survival rate and quality of life for these patients. At the same time, there are new challenges on the horizon. Patient selection is a difficult process, based on clinical and imaging parameters and risk scores, and more data are needed to refine patient selection criteria and the timing of the implant. Left ventricular assist device-related complications are still a serious problem, causing adverse events and hospital readmissions. Continuous progress in the development of these implantable devices, such as a further reduction in size and hopefully the abolition of the external driveline, will probably make ventricular assist devices an option also for less advanced stages of heart failure. Here, we discuss the current indications for left ventricular assist device implantation, patient selection criteria, and the most frequent complications associated with these devices. Keywords

  11. Voxel-based dose prediction with multi-patient atlas selection for automated radiotherapy treatment planning

    Science.gov (United States)

    McIntosh, Chris; Purdie, Thomas G.

    2017-01-01

    Automating the radiotherapy treatment planning process is a technically challenging problem. The majority of automated approaches have focused on customizing and inferring dose volume objectives to be used in plan optimization. In this work we outline a multi-patient atlas-based dose prediction approach that learns to predict the dose-per-voxel for a novel patient directly from the computed tomography planning scan without the requirement of specifying any objectives. Our method learns to automatically select the most effective atlases for a novel patient, and then map the dose from those atlases onto the novel patient. We extend our previous work to include a conditional random field for the optimization of a joint distribution prior that matches the complementary goals of an accurately spatially distributed dose distribution while still adhering to the desired dose volume histograms. The resulting distribution can then be used for inverse-planning with a new spatial dose objective, or to create typical dose volume objectives for the canonical optimization pipeline. We investigated six treatment sites (633 patients for training and 113 patients for testing) and evaluated the mean absolute difference in all DVHs for the clinical and predicted dose distribution. The results on average are favorable in comparison to our previous approach (1.91 versus 2.57). Comparing our method with and without atlas-selection further validates that atlas-selection improved dose prediction on average in whole breast (0.64 versus 1.59), prostate (2.13 versus 4.07), and rectum (1.46 versus 3.29) while it is less important in breast cavity (0.79 versus 0.92) and lung (1.33 versus 1.27) for which there is high conformity and minimal dose shaping. In CNS brain, atlas-selection has the potential to be impactful (3.65 versus 5.09), but selecting the ideal atlas is the most challenging.

  12. Treatment of Prolapsing Hemorrhoids in HIV-Infected Patients with Tissue-Selecting Technique

    Directory of Open Access Journals (Sweden)

    Zhe Fan

    2017-01-01

    Full Text Available The aim of this retrospective study was to evaluate the outcome of a tissue-selecting therapy stapler (TST for prolapsing hemorrhoids in HIV-infected patients. Sixty-two patients with stage III-IV hemorrhoidal prolapse were treated with TST by a single surgeon between June and November 2014. The TST group comprised 32 patients (4 females, and the TST + HIV group comprised 30 HIV-infected patients (3 females. Age, gender, and preoperative examination as well as intraoperative and postoperative features were assessed. There was no marked difference in hemorrhoidal prolapse between the TST and HIV + TST groups, except for patient satisfaction at 12 months. TST is an effective and safe technique for treatment of prolapsing hemorrhoids in HIV-infected patients.

  13. Selective Serotonin Reuptake Inhibitor-Induced Hyponatremia and the Plastic Surgery Patient.

    Science.gov (United States)

    Levine, Steven M; Sinno, Sammy; Cannavo, Dominick; Baker, Daniel C

    2017-06-01

    Cosmetic plastic surgery procedures continue to increase in frequency, and a greater number of them now occur outside of an acute-care hospital setting. In addition, antidepressant use is also rising, with a greater number of patients taking selective serotonin reuptake inhibitors to aid in a variety of mood and anxiety disorders. Americans spend more than $86 billion each year on antidepressants, as 34 million people in the United States are taking at least one of these medications. Many side effects of selective serotonin reuptake inhibitors are well known and not clinically relevant to practicing surgeons. Hyponatremia, however, is a well-documented side effect of these medications that has received relatively little attention in the surgical literature. Postoperative hyponatremia results because of a decrease of antidiuretic hormone suppression that occurs with selective serotonin reuptake inhibitor administration. Here, the authors first review the literature reporting hyponatremia with selective serotonin reuptake inhibitor use. The authors then present two cases of severe postoperative hyponatremia after plastic surgery operations. The authors propose that patients using selective serotonin reuptake inhibitors, especially elderly patients and those undergoing procedures with expected large fluid shifts, should be tested preoperatively and postoperatively for serum sodium levels so that a diagnosis of hyponatremia may be made early and treated before a catastrophic event. Therapeutic, V.

  14. LOPES: Selective control of gait functions during the gait rehabilitation of CVA patients

    NARCIS (Netherlands)

    Ekkelenkamp, R.; Veneman, J.F.; van der Kooij, Herman

    2005-01-01

    LOPES aims for an active role of the patient by selective and partial support of gait functions during robotic treadmill training sessions. Virtual model control (VMC) was applied to the robot as an intuitive method for translating current treadmill gait rehabilitation therapy programs into robotic

  15. Neoadjuvant selective COX-2 inhibition down-regulates important oncogenic pathways in patients with esophageal adenocarcinoma

    NARCIS (Netherlands)

    Tuynman, Jurriaan B.; Buskens, Christianne J.; Kemper, Kristel; ten Kate, Fiebo J. W.; Offerhaus, G. Johan A.; Richel, Dirk J.; van Lanschot, J. Jan B.

    2005-01-01

    OBJECTIVES: To evaluate the effects of neoadjuvant therapy with the selective cyclooxygenase-2 (COX-2) inhibitor celecoxib in vitro and in patients with esophageal adenocarcinoma on COX-2 and MET expression. SUMMARY BACKGROUND DATA: High COX-2 and/or MET expression levels are negative prognostic

  16. Series: Pragmatic trials and real world evidence: Paper 3. Patient selection challenges and consequences.

    Science.gov (United States)

    Oude Rengerink, Katrien; Kalkman, Shona; Collier, Susan; Ciaglia, Antonio; Worsley, Sally D; Lightbourne, Alison; Eckert, Laurent; Groenwold, Rolf H H; Grobbee, Diederick E; Irving, Elaine A

    2017-09-01

    This paper addresses challenges of identifying, enrolling, and retaining participants in a trial conducted within a routine care setting. All patients who are potential candidates for the treatments in routine clinical practice should be considered eligible for a pragmatic trial. To ensure generalizability, the recruited sample should have a similar distribution of the treatment effect modifiers as the target population. In practice, this can be best achieved by including-within the selected sites-all patients without further selection. If relevant heterogeneity between subgroups is expected, increasing the relative proportion of the subgroup of patients in the heterogeneous trial could be considered (oversampling) or a separate trial in this subgroup can be planned. Selection will nevertheless occur. Low enrollment and loss to follow-up can introduce selection and can jeopardize validity as well as generalizability. Pragmatic trials are conducted in clinical practice rather than in a dedicated research setting, which could reduce recruitment rates. However, if a trial poses a minimal burden to the physician and the patient and routine clinical practice is maximally adhered to, the participation rate may be high and loss to follow-up will not be a specific problem for pragmatic trials. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  17. The value of surveillance cultures in neutropenic patients receiving selective intestinal decontamination

    NARCIS (Netherlands)

    de Jong, P. J.; de Jong, M. D.; Kuijper, E. J.; van der Lelie, H.

    1993-01-01

    230 neutropenic episodes in 84 patients with acute myeloid leukemia receiving selective intestinal decontamination were studied to evaluate the ability of surveillance cultures to monitor the efficacy of microbial suppression, to identify causative organisms in case of fever, and to predict

  18. 42 CFR 482.90 - Condition of participation: Patient and living donor selection.

    Science.gov (United States)

    2010-10-01

    ... patient's suitability for transplantation. If a center performs living donor transplants, the center also must use written donor selection criteria in determining the suitability of candidates for donation. (a... distribution of organs. (1) Prior to placement on the center's waiting list, a prospective transplant candidate...

  19. A Criterium for the Strict Positivity of the Density of the Law of a Poisson Process

    Directory of Open Access Journals (Sweden)

    Léandre Rémi

    2011-01-01

    Full Text Available We translate in semigroup theory our result (Léandre, 1990 giving a necessary condition so that the law of a Markov process with jumps could have a strictly positive density. This result express, that we have to jump in a finite number of jumps in a "submersive" way from the starting point to the end point if the density of the jump process is strictly positive in . We use the Malliavin Calculus of Bismut type of (Léandre, (2008;2010 translated in semi-group theory as a tool, and the interpretation in semi-group theory of some classical results of the stochastic analysis for Poisson process as, for instance, the formula giving the law of a compound Poisson process.

  20. Detection of low numbers of microplastics in North Sea fish using strict quality assurance criteria.

    Science.gov (United States)

    Hermsen, Enya; Pompe, Renske; Besseling, Ellen; Koelmans, Albert A

    2017-09-15

    We investigated 400 individual fish of four North Sea species: Atlantic Herring, Sprat, Common Dab, and Whiting on ingestion of >20μm microplastic. Strict quality assurance criteria were followed in order to control contamination during the study. Two plastic particles were found in only 1 (a Sprat) out of 400 individuals (0.25%, with a 95% confidence interval of 0.09-1.1%). The particles were identified to consist of polymethylmethacrylate (PMMA) through FTIR spectroscopy. No contamination occurred during the study, showing the method applied to be suitable for microplastic ingestion studies in biota. We discuss the low particle count for North Sea fish with those in other studies and suggest a relation between reported particle count and degree of quality assurance applied. Microplastic ingestion by fish may be less common than thought initially, with low incidence shown in this study, and other studies adhering to strict quality assurance criteria. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. A strict anaerobic extreme thermophilic hydrogen-producing culture enriched from digested household waste

    DEFF Research Database (Denmark)

    Karakashev, Dimitar Borisov; Kotay, Shireen Meher; Trably, Eric

    2009-01-01

    sources. Growth on glucose produced acetate, H-2 and carbon dioxide. Maximal H-2 production rate on glucose was 1.1 mmol l(-1) h(-1) with a maximum H-2 yield of 1.9 mole H-2 per mole glucose. 16S ribosomal DNA clone library analyses showed that the culture members were phylogenetically affiliated......The aim of this study was to enrich, characterize and identify strict anaerobic extreme thermophilic hydrogen (H-2) producers from digested household solid wastes. A strict anaerobic extreme thermophilic H-2 producing bacterial culture was enriched from a lab-scale digester treating household...... wastes at 70 degrees C. The enriched mixed culture consisted of two rod-shaped bacterial members growing at an optimal temperature of 80 degrees C and an optimal pH 8.1. The culture was able to utilize glucose, galactose, mannose, xylose, arabinose, maltose, sucrose, pyruvate and glycerol as carbon...

  2. A Hybrid P2P Overlay Network for Non-strictly Hierarchically Categorized Content

    Science.gov (United States)

    Wan, Yi; Asaka, Takuya; Takahashi, Tatsuro

    In P2P content distribution systems, there are many cases in which the content can be classified into hierarchically organized categories. In this paper, we propose a hybrid overlay network design suitable for such content called Pastry/NSHCC (Pastry for Non-Strictly Hierarchically Categorized Content). The semantic information of classification hierarchies of the content can be utilized regardless of whether they are in a strict tree structure or not. By doing so, the search scope can be restrained to any granularity, and the number of query messages also decreases while maintaining keyword searching availability. Through simulation, we showed that the proposed method provides better performance and lower overhead than unstructured overlays exploiting the same semantic information.

  3. Selecting patients with young-onset colorectal cancer for mismatch repair gene analysis

    DEFF Research Database (Denmark)

    Walker, M; O'Sullivan, B; Perakath, B

    2007-01-01

    BACKGROUND: Young patients with colorectal cancer are at increased risk of carrying a germline mutation in mismatch repair (MMR) genes. This study investigated the role of clinical criteria and immunohistochemistry for MMR proteins in selecting young patients for mutation testing. METHODS: A cohort...... of 56 consecutive patients with colorectal cancer aged less than 45 years were stratified into three groups based on clinical criteria: 'Amsterdam criteria', 'high risk' and 'young onset only'. Immunohistochemistry for four MMR proteins was carried out and the rate of compliance with clinical guidelines....... CONCLUSION: MMR immunohistochemistry should be considered routine in young-onset colorectal cancer....

  4. Headache in patients with cervical radiculopathy: a prospective study with selective nerve root blocks in 275 patients

    Science.gov (United States)

    Carlsson, Jane Y.; Anderberg, Leif

    2006-01-01

    Since many years we routinely use diagnostic selective nerve root blocks (SNRB) at our department when evaluating patients with cervical radiculopathy. Frequently patients who also presented with headache reported that the headache disappeared when the nerve root responsible for the radicular pain was blocked with local anaesthetics. Headache has been described as a companioning symptom related to cervical radiculopathy but has never before been evaluated with SNRB performed in the lower cervical spine. For this reason we added to our routine an evaluation of the response from the SNRB on headache in patients with cervical radiculopathy. The aim was to describe the frequency of headache in patients with cervical radiculopathy and its response to a selective nerve root block of the nerve root/roots responsible for the radiculopathy. Can nerve root compression in the lower cervical spine produce headache? In this consecutive series of 275 patients with cervical radiculopathy, 161 patients reported that they also suffered from daily or recurrent headache located most often unilaterally on the same side as the radiculopathy. All patients underwent a careful clinical examination by a neurosurgeon and a MRI of the cervical spine. The significantly compressed root/roots, according to the MRI, underwent SNRB with a local anaesthetic. The effect of the nerve root block on the radiculopathy and the headache was carefully noted and evaluated by a physiotherapist using visual analogue scales (VAS) before and after the SNRB. All patients with headache had tender points in the neck/shoulder region on the affected side. Patients with headache graded significantly more limitations in daily activities and higher pain intensity in the neck/shoulder/arm than patients without headache. After selective nerve root block, 59% of the patients with headache reported 50% or more reduction of headache and of these 69% reported total relief. A significant correlation was seen between reduced

  5. Weak asymptotic solution for a non-strictly hyperbolic system of conservation laws-II

    Directory of Open Access Journals (Sweden)

    Manas Ranjan Sahoo

    2016-04-01

    Full Text Available In this article we introduce a concept of entropy weak asymptotic solution for a system of conservation laws and construct the same for a prolonged system of conservation laws which is highly non-strictly hyperbolic. This is first done for Riemann type initial data by introducing $\\delta,\\delta',\\delta''$ waves along a discontinuity curve and then for general initial data by piecing together the Riemann solutions.

  6. Multiple-Set Split Feasibility Problems for κ-Strictly Pseudononspreading Mapping in Hilbert Spaces

    Directory of Open Access Journals (Sweden)

    Jing Quan

    2013-01-01

    Full Text Available The purpose of this paper is to prove some weak and strong convergence theorems for solving the multiple-set split feasibility problems for κ-strictly pseudononspreading mapping in infinite-dimensional Hilbert spaces by using the proposed iterative method. The main results presented in this paper extend and improve the corresponding results of Xu et al. (2006, of Osilike et al. (2011, and of many other authors.

  7. Multiobjective Optimization for the Forecasting Models on the Base of the Strictly Binary Trees

    OpenAIRE

    Nadezhda Astakhova; Liliya Demidova; Evgeny Nikulchev

    2016-01-01

    The optimization problem dealing with the development of the forecasting models on the base of strictly binary trees has been considered. The aim of paper is the comparative analysis of two optimization variants which are applied for the development of the forecasting models. Herewith the first optimization variant assumes the application of one quality indicator of the forecasting model named as the affinity indicator and the second variant realizes the application of two quality indicators ...

  8. Cannabis legalization with strict regulation, the overall superior policy option for public health.

    Science.gov (United States)

    Rehm, J; Fischer, B

    2015-06-01

    Cannabis is the most prevalently used drug globally, with many jurisdictions considering varying reform options to current policies to deal with this substance and associated harm. Three policy options are available: prohibition, decriminalization, and legalization, with prohibition currently the dominant model globally. This contribution gives reasons why legalization with strict regulation should be considered superior to other options with respect to public health in high income countries in North America. © 2015 ASCPT.

  9. Examination of the PCICE method in the nearly incompressible, as well as strictly incompressible, limits

    International Nuclear Information System (INIS)

    Berry, Ray A.; Martineau, Richard C.

    2007-01-01

    The conservative-form, pressure-based PCICE numerical method (Martineau and Berry, 2004) (Berry, 2006), recently developed for computing transient fluid flows of all speeds from very low to very high (with strong shocks), is simplified and generalized. Though the method automatically treats a continuous transition of compressibility, three distinct, limiting compressibility regimes are formally defined for purposes of discussion and comparison with traditional methods - the strictly incompressible limit, the nearly incompressible limit, and the fully compressible limit. The PCICE method's behavior is examined in each limiting regime. In the strictly incompressible limit the PCICE algorithm reduces to the traditional MAC-type method with velocity divergence driving the pressure Poisson equation. In the nearly incompressible limit the PCICE algorithm is found to reduce to a generalization of traditional incompressible methods, i.e. to one in which not only the velocity divergence effect, but also the density gradient effect is included as a driving function in the pressure Poisson equation. This nearly incompressible regime has received little attention, and it appears that in the past, strictly incompressible methods may have been conveniently applied to flows in this regime at the expense of ignoring a potentially important coupling mechanism. This could be significant in many important flows; for example, in natural convection flows resulting from high heat flux. In the fully compressible limit or regime, the algorithm is found to reduce to an expression equivalent to density-based methods for high-speed flow. (author)

  10. Frequency effect on p-nitrophenol degradation under conditions of strict acoustic and electric control

    Directory of Open Access Journals (Sweden)

    Chang-ping Zhu

    2011-03-01

    Full Text Available The process of decomposing p-nitrophenol (PNP with power ultrasound requires strict control of acoustic and electric conditions. In this study, the conditions, including acoustic power and acoustic intensity, but not ultrasonic frequency, were controlled strictly at constant levels. The absorbency and the COD concentrations of the samples were measured in order to show the variation of the sample concentration. The results show significant differences in the trend of the solution degradation rate as acoustic power increases after the PNP solution (with a concentration of 114 mg/L and a pH value of 5.4 is irradiated for 60 min with ultrasonic frequencies of 530.8 kHz, 610.6 kHz, 855.0 kHz, and 1 130.0 kHz. The degradation rate of the solution increases with time and acoustic power (acoustic intensity. On the other hand, the degradation rate of the solution is distinctly dependent on frequency when the acoustic power and intensity are strictly controlled and maintained at constant levels. The degradation rate of the PNP solution declines with ultrasonic frequencies of 530.8 kHz, 610.6 kHz, 855.0 kHz, and 1 130.0 kHz; the COD concentration, on the contrary, increase.

  11. TESTING STRICT HYDROSTATIC EQUILIBRIUM IN SIMULATED CLUSTERS OF GALAXIES: IMPLICATIONS FOR A1689

    International Nuclear Information System (INIS)

    Molnar, S. M.; Umetsu, K.; Chiu, I.-N.; Chen, P.; Hearn, N.; Broadhurst, T.; Bryan, G.; Shang, C.

    2010-01-01

    Accurate mass determination of clusters of galaxies is crucial if they are to be used as cosmological probes. However, there are some discrepancies between cluster masses determined based on gravitational lensing and X-ray observations assuming strict hydrostatic equilibrium (i.e., the equilibrium gas pressure is provided entirely by thermal pressure). Cosmological simulations suggest that turbulent gas motions remaining from hierarchical structure formation may provide a significant contribution to the equilibrium pressure in clusters. We analyze a sample of massive clusters of galaxies drawn from high-resolution cosmological simulations and find a significant contribution (20%-45%) from non-thermal pressure near the center of relaxed clusters, and, in accord with previous studies, a minimum contribution at about 0.1 R vir , growing to about 30%-45% at the virial radius, R vir . Our results strongly suggest that relaxed clusters should have significant non-thermal support in their core region. As an example, we test the validity of strict hydrostatic equilibrium in the well-studied massive galaxy cluster A1689 using the latest high-resolution gravitational lensing and X-ray observations. We find a contribution of about 40% from non-thermal pressure within the core region of A1689, suggesting an alternate explanation for the mass discrepancy: the strict hydrostatic equilibrium is not valid in this region.

  12. Temporary Strict Maternal Avoidance of Cow’s Milk and Infantile Colic

    Directory of Open Access Journals (Sweden)

    Firoozeh Sajedi

    2009-12-01

    Full Text Available Infant colic is a common problem characterized by excessive crying and fussing. We examined whether colic symptoms of exclusively breast-milk-fed infants would be improved by temporary strict maternal avoidance of cows milk. This study is analytic and experimental. Sixty-six subjects were recruited during winter of 2006 from a clinic in Isfahan, Iran. Breast-milk-fed in-fants with "colic", age 3-6 months and to be in otherwise good health were referred by pediatri-cians. The intervention was 1 week period of strict maternal avoidance of cows milk while they continued exclusive breast-milk-feeding. All infants showed improvement in distressed behavior (crying and fussing during intervention. The total recorded crying and fussing time was reduced by an average of 31%. A significant difference was found in cry and fuss time between first and last 2 days of intervention (P = 0.000. Cows milk proteins may play an etiologic role in colic. We propose that a brief intervention with strict maternal avoidance of cows milk may be an effective treatment for colic in some breast-milk-fed infants.

  13. Prognostic factors for prediction of survival of hepatocellular cancer patients after selective internal radiation therapy.

    Science.gov (United States)

    Soydal, Cigdem; Keskin, Onur; Kucuk, Ozlem N; Ozkan, Elgin; Bilgic, Sadik; Idilman, Ramazan; Kir, Metin K

    2015-06-01

    In this study, it was aimed to explore the prognostic factors in patients who received selective internal radiation therapy for hepatocellular cancer. A retrospective evaluation was made of 28 (24 male, 4 female, mean age 65.4 ± 6.8 years) hepatocellular cancer patients who received selective internal radiation therapy with Y-90 resin microspheres. Using Cox proportional hazards regression analysis, the relationship between age, gender, MELD score, serum albumin and AFP levels, number of liver lesions, size of the largest lesion, absence of (18)F-FDG uptake, maximum standardized uptake value and overall survival times was analyzed. Treatment was applied to the right lobe in 22 and both in 6 patients. Mean treatment dose was 1.5 ± 0.2 GBq. Number of liver lesions were 1, internal radiation therapy.

  14. Selective decontamination of the gastrointestinal tract in patients undergoing esophageal resection

    Directory of Open Access Journals (Sweden)

    Lange Jochen

    2010-12-01

    Full Text Available Abstract Background Selective decontamination of the digestive tract (SDD to eliminate gram-negative bacteria is still not widely accepted, although it reduces the incidence of nosocomial infections. In a previous retrospective study, a clear benefit to perioperative morbidity, and a reduction in nosocomial infections were found in patients who underwent an esophageal anastomosis. Thus, SDD was applied routinely for esophageal anastomoses. We report the outcome of a cohort of 81 patients who underwent this treatment. Methods From 2002, patients who underwent an esophageal anastomosis (esophagojejunostomy were prospectively recorded. Perioperatively, patients received polymyxin, tobramycin, vancomycin and nystatin by mouth four times a day. Outcome was compared to a control group that was treated before 2002 (68 patients without SDD and 53 patients with SDD. Postoperative morbidity and mortality were assessed. Results Between 2002 and 2007, 81 patients who underwent an esophageal anastomosis received SDD. Compared to a retrospective control group, patients with SDD had significantly less pneumonia (OR 0.06 (0.01-0.46, p Conclusions SDD significantly reduces perioperative morbidity and mortality in patients who undergo a distal esophageal anastomosis compared to a historical control group. In patients with an anastomotic leakage, there was a strong tendency of SDD to reduce postoperative mortality.

  15. Abdominal computed tomographic scan for patients with gunshot wounds to the abdomen selected for nonoperative management.

    Science.gov (United States)

    Velmahos, George C; Constantinou, Constantinos; Tillou, Areti; Brown, Carlos V; Salim, Ali; Demetriades, Demetrios

    2005-11-01

    Computed tomographic (CT) scanning is increasingly used in patients with abdominal gunshot wounds (AGSWs) selected for nonoperative management (NOM). Triple-contrast CT scanning (i.e., intravenous, oral, and rectal) has produced encouraging initial results. The exact role and usefulness of CT scanning with intravenous contrast only is unknown. Hemodynamically stable AGSW patients without generalized abdominal tenderness were offered a trial of NOM, underwent single-contrast (intravenous) CT scanning, and were prospectively followed from July 1, 2002, to May 31, 2004. The sensitivity and specificity of CT scanning to detect organ injuries requiring repair were calculated against the clinical results of NOM. The effect of CT scanning in management was recorded. One hundred patients with nontangential AGSWs were included. Twenty-six required laparotomy, which was nontherapeutic in five (19%). These five patients underwent operation on the basis of misleading CT findings (n = 3) or development of clinical symptoms (n = 2). Two CT scans were false-negative, and these patients were operated on at 121 and 307 minutes after arrival for hollow visceral injuries and recovered without postoperative complications. Three CT scans were false-positive and resulted in nontherapeutic laparotomies without postoperative complications. The sensitivity and specificity of CT scanning was 90.5% and 96%, respectively. CT findings resulted in a change of management in 40 patients. In nine, the decision to operate was changed to a decision to manage nonoperatively; whereas in eight, the opposite occurred. In addition, in 17, the decision to observe was changed to a decision to discharge; whereas in 1, the opposite occurred. Finally, five patients had additional tests after the findings of CT scanning. Abdominal CT scanning is a safe and useful method of selecting AGSW patients for NOM. Further exploration is needed to define the precise benefits of routine CT scanning over clinical

  16. Knee disorders in primary care: design and patient selection of the HONEUR knee cohort

    Directory of Open Access Journals (Sweden)

    Koes Bart W

    2005-08-01

    Full Text Available Abstract Background Knee complaints are a frequent reason for consultation in general practice. These patients constitute a specific population compared to secondary care patients. However, information to base treatment decisions on is generally derived from specialistic settings. Our cohort study is aimed at collecting knowledge about prognosis and prognostic factors of knee complaints presented in a primary care setting. This paper describes the methods used for data collection, and discusses potential selectiveness of patient recruitment. Methods This is a descriptive prospective cohort study with one-year follow-up. 40 Dutch GPs recruited consecutive patients with incident knee complaints aged 12 years and above from October 2001 to October 2003. Patients were assessed with questionnaires and standardised physical examinations. Additional measurements of subgroups included MRI for recent knee traumas and device assessed function measurements for non-traumatic patients. After the inclusion period we retrospectively searched the computerized medical files of participating GPs to obtain a sample to determine possible selective recruitment. We assessed differences in proportions of gender, traumatic onset of injury and age groups between participants and non-participants using Odds Ratios (OR and 95% confidence intervals. Results We recruited 1068 patients. In a sample of 310 patients visiting the GP, we detected some selective recruitment, indicating an underrepresentation of patients aged 12 to 35 years (OR 1.70; 1.15–2.77, especially among men (OR 2.16; 1.12–4.18. The underrepresentation of patients with traumatic onset of injury was not statistically significant. Conclusion This cohort is unique in its size, setting, and its range of both age and type of knee complaints. We believe the detected selective recruitment is unlikely to introduce significant bias, as the cohort will be divided into subgroups according to age group or traumatic

  17. Patient Selection and Surgical Management of High-Risk Patients with Morbid Obesity.

    Science.gov (United States)

    Daniel Guerron, A; Portenier, Dana D

    2016-08-01

    Bariatric surgery is the most effective way to improve comorbidities related to obesity. Since the introduction of minimally invasive laparoscopic surgery in the bariatric surgery techniques, the number of procedures has increased substantially; advances in techniques and the transition from open to minimally invasive procedures have decreased morbidity and mortality. Multidisciplinary teams in charge of the operative planning, surgical act, and postoperative recovery are determinant in the success of the management of high-risk bariatric patients; careful identification and preoperative management of these higher-risk patients is crucial in decreasing complications after weight loss surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease.

    Science.gov (United States)

    Liang, C-H; Yang, C-Y; Lu, K-C; Chu, P; Chen, C-H; Chang, Y-S; O'Brien, A P; Bloomer, M; Chou, K-R

    2011-12-01

    Taiwan has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world with 55,499 ESRD patients on long-term dialysis. Nevertheless, 90.96% of these patients are managed on maintenance haemodialysis (HD), with only 9.03% enrolled in a peritoneal dialysis (PD) programme. The study aim was to identify the factors affecting Taiwanese patient's selection of PD in preference to HD for chronic kidney disease. A cross-sectional research design was utilized with 130 chronic renal failure (CRF) patients purposively selected from outpatient nephrology clinics at four separate Taiwan hospitals. Logistic regression was used to identify the main factors affecting the patient's choice of dialysis type. Single-factor logistic regression found significant differences in opinion related to age, education level, occupation type, disease characteristics, lifestyle modifications, self-care ability, know-how of dialysis modality, security considerations and findings related to the decisions made by medical personnel (P self-care ability and dialysis modality know-how were the two main factors affecting the person's selection of dialysis type. Self-care ability and the person's knowledge of the different types of dialysis modality and how they function were the major determinants for selection of dialysis type in Taiwan based on the results from this study. The results indicate that the education of CRF patients about the types of dialysis available is essential to enable them to understand the benefits or limitations of both types of dialysis. © 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.

  19. Medical management of aortic coarctation is feasible & durable in selected patients: a case report & literature review.

    Science.gov (United States)

    Khan, Asif N; Carter, William; Mousa, Albeir Y

    2015-01-01

    Long-term survival in patients with complete aortic coarctation (AC) without surgical repair has not been well characterized and is rarely documented. We report a case of an 84 year old male with complete aortic coarctation with history of hypertension for more than 40 years. Since the diagnosis was made in early 1950's medical treatment to control hypertension was initiated as patient was deemed high risk for surgical intervention. He has survived to the age of 84 years with minimal medical problems. This report also reviews the few documented cases of prolonged survival in patients with aortic coarctation. This report demonstrates that prolonged survival is possible in patients with documented complete coarctation and awareness of this report may influence the decision to use medical treatment for selected elderly patients with high risk of mortality associated with surgical repair.

  20. Real-time 3D echo in patient selection for cardiac resynchronization therapy.

    Science.gov (United States)

    Kapetanakis, Stamatis; Bhan, Amit; Murgatroyd, Francis; Kearney, Mark T; Gall, Nicholas; Zhang, Qing; Yu, Cheuk-Man; Monaghan, Mark J

    2011-01-01

    this study investigated the use of 3-dimensional (3D) echo in quantifying left ventricular mechanical dyssynchrony (LVMD), its interhospital agreement, and potential impact on patient selection. assessment of LVMD has been proposed as an improvement on conventional criteria in selecting patients for cardiac resynchronization therapy (CRT). Three-dimensional echo offers a reproducible assessment of left ventricular (LV) structure, function, and LVMD and may be useful in selecting patients for this intervention. we studied 187 patients at 2 institutions. Three-dimensional data from baseline and longest follow-up were quantified for volume, left ventricular ejection fraction (LVEF), and systolic dyssynchrony index (SDI). New York Heart Association (NYHA) functional class was assessed independently. Several outcomes from CRT were considered: 1) reduction in NYHA functional class; 2) 20% relative increase in LVEF; and 3) 15% reduction in LV end-systolic volume. Sixty-two cases were shared between institutions to analyze interhospital agreement. there was excellent interhospital agreement for 3D-derived LV end-diastolic and end- systolic volumes, EF, and SDI (variability: 2.9%, 1%, 7.1%, and 7.6%, respectively). Reduction in NYHA functional class was found in 78.9% of patients. Relative improvement in LVEF of 20% was found in 68% of patients, but significant reduction in LV end-systolic volume was found in only 41.5%. The QRS duration was not predictive of any of the measures of outcome (area under the curve [AUC]: 0.52, 0.58, and 0.57 for NYHA functional class, LVEF, and LV end-systolic volume), whereas SDI was highly predictive of improvement in these parameters (AUC: 0.79, 0.86, and 0.66, respectively). For patients not fulfilling traditional selection criteria (atrial fibrillation, QRS duration <120 ms, or undergoing device upgrade), SDI had similar predictive value. A cutoff of 10.4% for SDI was found to have the highest accuracy for predicting improvement following

  1. Use of selective media for detection of cephalothin-resistant bacteria in surgical patients

    Directory of Open Access Journals (Sweden)

    Sérgio A.C. Melo

    Full Text Available Bacterial colonization in hospitalized patients is an important step in nosocomial infections. Frequent employment of antimicrobials can modify patients' normal microbiota, favoring colonization and infection by antimicrobial-resistant microorganisms. First-generation cephalosporins are frequently used as prophylactic antibiotics in surgery. Intestinal, oropharyngeal and skin colonization by cephalothin-resistant microorganisms were studied in 60 pre-operative patients at the Hospital Universitário Pedro Ernesto. Feces were cultured in Eosin-methylene blue medium containing 32 µg/mL of cephalothin. Swabs obtained from the oropharynx and from skin were inoculated in cistein-lactose electrolytes-deficient medium containing 32 µg/mL of cephalothin. Isolated strains were identified and tested for susceptibility to antimicrobials by disk diffusion. Cephalothin-resistant strains were isolated from the feces of 59 patients (98%, from the oropharynx of 13 patients (22% and from skin in 10 patients (17%. Enterobacter cloacae was predominant in feces (68% of the patients and oropharynx (13%. Acinetobacter spp. was the most frequent microorganism isolated from the skin (10%. Antimicrobial multiresistant strains were isolated from at least one of the sites in 38 patients (63%. The employment of selective medium containing antimicrobials is a relatively simple and efficient method, being useful to evaluate microorganisms from hospitalized patients' microbiota that are relevant as potential pathogens in nosocomial infections.

  2. A selected controlled trial of supplementary vitamin E for treatment of muscle cramps in hemodialysis patients.

    Science.gov (United States)

    El-Hennawy, Adel S; Zaib, Salwat

    2010-01-01

    Muscle cramps are not uncommon complications of hemodialysis (HD) treatments and lead to early termination of HD sessions and are therefore a significant cause of under-dialysis. The etiology of cramps in dialysis patients remains a matter of debate. Many reports suggested that vitamin E (vit. E) may be effective for the prevention of HD-associated cramps. We decided to perform a selected controlled trial of supplementary vit. E for treatment of patients on HD who experience frequent attacks during and between HD sessions. The goal was to compare the number of attacks of muscle cramps with the patient's baseline over a specific period of time. In this study, 19 HD patients were randomly selected of different age groups and ethnicity. Patient must have had at least 60 attacks of muscle cramps during and between HD sessions over a 12-week period. All selected patients received vit. E at a dose of 400 international units daily for 12 weeks, and the number of attacks of muscle cramps was recorded. The frequency of muscle cramps decreased significantly during vit. E therapy, and, at the end of the trial, vit. E led to cramp reductions of 68.3%. The reduction in number of attacks of muscle cramps had no significant correlation with age, sex, etiology of end-stage renal disease, serum electrolytes, or HD duration, and it showed a statistically positive correlation (P = 0.0001) with vit. E therapy. No vit. E-related adverse effects were encountered during the trial. Short-term treatment with vit. E is safe and effective in reducing number of attacks of muscle cramps in HD patients, as shown in our study.

  3. Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Francisco Flávio Costa Filho

    2015-11-01

    Full Text Available AbstractBackground:Guidelines recommend that in suspected stable coronary artery disease (CAD, a clinical (non-invasive evaluation should be performed before coronary angiography.Objective:We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD.Methods:We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests.Results:A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77, age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26, diabetes (OR, 2.01; CI 95%, 1.40 - 2.90, dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07, typical angina (OR, 2.92; CI 95%, 1.77 - 4.83 and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27.Conclusions:In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.

  4. Optimising the dichotomy limit for left ventricular ejection fraction in selecting patients for defibrillator therapy after myocardial infarction

    DEFF Research Database (Denmark)

    Yap, Yee Guan; Duong, Trinh; Bland, J Martin

    2007-01-01

    BACKGROUND: The selection of patients for prophylactic implantable cardioverter-defibrilator (ICD) treatment after myocardial infarction (MI) remains controversial. AIM: To determine the optimum left ventricular ejection fraction (LVEF) dichotomy limit for ICD treatment in patients with a history...

  5. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Saulino M

    2014-11-01

    Full Text Available Michael Saulino,1,2 Philip S Kim,3,4 Erik Shaw5 1MossRehab, Elkins Park, PA, USA; 2Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA, USA; 3Helen F Graham Cancer Center, Christiana Care Health System, Newark, DE, USA; 4Center for Interventional Pain Spine, LLC., Bryn Mawr, PA, USA; 5Shepherd Pain Institute, Shepherd Center, Atlanta, GA, USA Abstract: Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of “last resort”, intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents – morphine and ziconotide – are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been

  6. Foregut symptoms, somatoform tendencies, and the selection of patients for antireflux surgery.

    Science.gov (United States)

    Fuchs, K-H; Musial, F; Ulbricht, F; Breithaupt, W; Reinisch, A; Babic, B; Fuchs, H; Varga, G

    2017-07-01

    A large variety of foregut symptoms can occur in patients with gastroesophageal reflux disease (GERD), which can overlap with other disorders such as somatoform disorders and dyspepsia. Due to unclear diagnostic situations, these patients are often not adequately treated. The aim of this study was the evaluation of patients with foregut symptoms, referred for possible antireflux surgery, regarding their relationship with GERD and somatization tendencies based on control data from an unselected population. Symptom evaluation and somatization screening were initiated both in volunteers and in patients with foregut symptoms and GERD. Unselected volunteers from a village population were also evaluated by symptom analysis and for somatisation tendency. In addition, patients with foregut symptoms were diagnosed for GERD, and symptom analysis and psychodiagnostic evaluation were performed. There is no major significant difference in the symptom-spectrum in patients with foregut symptoms, whether they have a proven pathologic acid exposure from GERD or not. The probability for the risk of somatization was 5.6% in the unselected population of nonpatient volunteers (n = 267). In patients with foregut symptoms (n = 750), the probability for the presence of somatoform tendencies was approximately 20%, independent whether these patients had a documented GERD or a normal esophageal acid exposure, implicating further diagnostic work-up for the selection of patients for antireflux surgery. There is a remarkable symptom load and variety in patients with GERD, in patients with foregut symptoms, and in an unselected population of volunteers. There is no difference in the risk for somatization between patients with foregut symptoms and those with documented GERD. Therapeutic decision making especially prior to antireflux surgery requires an awareness of mental and emotional challenges. © The Authors 2017. Published by Oxford University Press on behalf of International Society for

  7. Is selective internal radioembolization safe and effective for patients with inoperable hepatocellular carcinoma and venous thrombosis?

    Science.gov (United States)

    Woodall, Charles E; Scoggins, Charles R; Ellis, Susan F; Tatum, Clifton M; Hahl, Michael J; Ravindra, Kadiyala V; McMasters, Kelly M; Martin, Robert C G

    2009-03-01

    The goal of this study was to examine the safety and efficacy of selective internal radioembolization (SIR) for hepatocellular carcinoma (HCC) with portal vein or caval thrombosis (VT), or both. Recent reports have demonstrated that SIR is safe for patients with HCC, but the impact on efficacy of venous thrombosis is unknown. Prospective single-arm study of the use of Therasphere in patients with unresectable HCC enrolled from January 2004 to June 2007. Patients were categorized into three groups based on VT status and therapy. Fifty-two patients were enrolled: 20 patients without VT who received SIR, 15 patients with VT who were treated, and 17 patients (10 with VT) who were not treated because of preprocedure screening failure. Fifty-eight treatments were administered, with a median of two treatments per patient (range of one to three treatments). Child's score was different between groups. Of the VT patients treated, 67% had portal VT, 7% had cava VT, and 26% had both. There were no treatment-related deaths. There was no difference in complications among groups (p = 0.34). Treated patients without thrombosis had a median overall survival of 13.9 months versus 2.7 months for those treated with thrombosis and 5.2 months for the untreated group given best supportive care only (p = 0.01). SIR is safe in patients with HCC. Although SIR can be delivered with minimal morbidity, there might be no benefit for patients with VT. Continued emphasis on multimodality therapy in this population is needed to improve survival.

  8. Plasma cytokine profiles in depressed patients who fail to respond to selective serotonin reuptake inhibitor therapy.

    LENUS (Irish Health Repository)

    O'Brien, Sinead M

    2012-02-03

    OBJECTIVE: Approximately 30% of patients with depression fail to respond to a selective serotonin reuptake inhibitor (SSRI). Few studies have attempted to define these patients from a biological perspective. Studies suggest that overall patients with depression show increased production of proinflammatory cytokines. We examined pro- and anti-inflammatory cytokine levels in patients who were SSRI resistant. METHODS: Plasma concentrations of IL-6, IL-8, IL-10, TNF-alpha and sIL-6R were measured with enzyme linked immunosorbent assays (ELISA) in DSM-1V major depressives who were SSRI resistant, in formerly SSRI resistant patients currently euthymic and in healthy controls. RESULTS: Patients with SSRI-resistant depression had significantly higher production of the pro-inflammatory cytokines IL-6 (p=0.01) and TNF-alpha (p=0.004) compared to normal controls. Euthymic patients who were formerly SSRI resistant had proinflammatory cytokine levels which were similar to the healthy subject group. Anti-inflammatory cytokine levels did not differ across the 3 groups. CONCLUSION: Suppression of proinflammatory cytokines does not occur in depressed patients who fail to respond to SSRIs and is necessary for clinical recovery.

  9. Neutrophil/lymphocyte ratio helps select metastatic pancreatic cancer patients benefitting from oxaliplatin.

    Science.gov (United States)

    Formica, Vincenzo; Morelli, Cristina; Ferroni, Patrizia; Nardecchia, Antonella; Tesauro, Manfredi; Pellicori, Stefania; Cereda, Vittore; Russo, Antonio; Riondino, Silvia; Guadagni, Fiorella; Roselli, Mario

    2016-09-26

    High Neutrophil/Lymphocyte ratio (NLR), as a measure of enhanced inflammatory response, has been negatively associated with prognosis in patients with localized pancreatic ductal adenocarcinoma (PDA). In the present study, we aimed at investigating the prognostic value of NLR in two homogeneous groups of chemotherapy-naïve metastatic PDA patients. Patients were treated with either gemcitabine (GEM) or gemcitabine/oxaliplatin (GEMOXA). We also assessed whether NLR could identify patients benefiting from the use of oxaliplatin. Consecutive PDA patients treated at the Medical Oncology Unit of Tor Vergata University Hospital of Rome with either GEM or GEMOXA were included (n= 103). NLR was assessed before and during chemotherapy and correlated with outcome together with common clinical and biochemical variables. Among 17 analyzed variables NLR, Karhofsky Perfomance Status (KPS), d-dimer and erythrocyte sedimentation rate were found to be significantly associated with median Overall Survival (mOS) at the univariate analysis. Only NLR and KPS were independent prognosticator at multivariate analysis, with NLR displaying the highest statistical significance. NLR was also predictive of oxaliplatin activity, as only patients with NLR > 2.5 (cutoff determined upon ROC analysis) derived benefit from GEMOXA over GEM. NLR is both an independent prognostic and predictive factor in metastatic PDA, since only patients with high NLR seem to benefit from the addition of oxaliplatin. NLR may help select patients for whom a particularly poor prognosis might justify more intensive, yet less tolerable, combination regimens.

  10. Neuropsychiatric and psychosocial issues of patients with hepatitis C infection: a selective literature review.

    Science.gov (United States)

    Modabbernia, Amirhossein; Poustchi, Hossein; Malekzadeh, Reza

    2013-01-01

    We briefly reviewed the evidence on the association of hepatitis C (HCV) infection with several aspects of mental and psychosocial health. Medline was searched with appropriate keywords. The primary sources were the systematic reviews. If systematic reviews were not available for a subject, then the most relevant and methodologically sound original studies were selected. HCV infection is associated with poorer health-related quality of life, and physical, mental, and social health. A part of impaired health of these patients is related to cirrhosis, intravenous drug use, co morbid psychiatric disorders, stigmatization, poor social support, alcohol abuse, and interferon treatment. However, HCV itself is also associated with poorer health status particularly in the physical and cognitive domains, which might be related to brain alterations induced by the virus. Interferon treatment is an important cause of depression in HCV patients and sometimes is associated with irritability, manic episode, or acute confusional state. Social health of HCV patients is significantly impaired by stigmatization, poor social support, psychiatric comorbidties, and impaired coping. Psychosocial impairment of HCV patients significantly impairs their treatment adherence. A supportive and nonjudgmental multidisciplinary team is required for optimal management of these patients. Patients with HCV infection had complex neuropsychiatric and psychosocial problems. These problems are challenges for management of HCV infection, affect the patient's care significantly, and might alter the course of the disease. A multidisciplinary approach, a supportive environment, and a nonjudgmental healthcare team are required for optimal medical and psychosocial management of patients with HCV.

  11. Non-invasive examinations successfully select patients with medial temporal lobe epilepsy for anterior temporal lobectomy

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    Morioka, Takato; Nishio, Shunji; Kawamura, Tadao; Fukui, Kimiko; Sasaki, Masayuki; Fukui, Masashi [Kyushu Univ., Fukuoka (Japan). Graduate School of Medical Sciences

    2001-06-01

    We retrospectively analyzed 8 patients with intractable medial temporal lobe epilepsy (MTLE) who underwent the anterior temporal lobectomy with hippocampectomy (ATL) without invasive examinations such as chronic subdural electrode recording. Five patients had a history of febrile convulsion. While all 8 patients had oral automatism, automatism of ipsilateral limbs with dystonic posture of contralateral limbs was demonstrated in 2 patients. Bilateral temporal paroxysmal activities on interictal EEG was observed in 4 patients and all patients had clear ictal onset zone on unilateral anterior temporal region. MRI demonstrated unilateral hippocampal sclerosis in 5 cases. Interictal FDG-PET depicted hypometabolism of the unilateral temporal lobe in all cases, however, ECD-SPECT failed to reveal the hypoperfusion of the unilateral temporal lobe in a case. Postoperatively, 7 cases became seizure free, and one had rare seizure. Non-invasive examinations, especially ictal EEG and concordant FDG-PET findings, in patients with oral automatism in seizure semiology, successfully select patients with MTLE for ATL. (author)

  12. Alternatives for OSAHS treatment: selection of patients for upper airway surgery and oral appliances

    Directory of Open Access Journals (Sweden)

    A. Boudewyns

    2007-12-01

    Full Text Available Although continuous positive airway pressure (CPAP is considered to represent the standard treatment for patients with moderate-to-severe obstructive sleep apnoea/hypopnoea syndrome (OSAHS, poor treatment compliance and/or refusal is an issue in 20–30% of these patients. As an alternative to life-long CPAP treatment, conservative procedures exist with dental appliances for mandibular advancement, as well as curative surgical techniques. Surgical treatment of OSAHS can be divided into the following two main groups: 1 upper airway surgery by soft tissue resection (uvulopalatopharyngoplasty, etc., and 2 skeletal procedures, such as maxillo-mandibular advancement. Proper selection of patients for the different treatment modalities is the key for full treatment success. Patient-related factors, such as the site of upper airway collapse, craniofacial characteristics, dental health, obesity, age, profession and positional dependence, as well as treatment-related factors, should be evaluated before a final proposal for these treatment alternatives is formulated.

  13. Appropriateness guidelines and predictive rules to select patients for upper endoscopy: a nationwide multicenter study.

    Science.gov (United States)

    Buri, Luigi; Hassan, Cesare; Bersani, Gianluca; Anti, Marcello; Bianco, Maria Antonietta; Cipolletta, Livio; Di Giulio, Emilio; Di Matteo, Giovanni; Familiari, Luigi; Ficano, Leonardo; Loriga, Pietro; Morini, Sergio; Pietropaolo, Vincenzo; Zambelli, Alessandro; Grossi, Enzo; Intraligi, Marco; Buscema, Massimo

    2010-06-01

    Selecting patients appropriately for upper endoscopy (EGD) is crucial for efficient use of endoscopy. The objective of this study was to compare different clinical strategies and statistical methods to select patients for EGD, namely appropriateness guidelines, age and/or alarm features, and multivariate and artificial neural network (ANN) models. A nationwide, multicenter, prospective study was undertaken in which consecutive patients referred for EGD during a 1-month period were enrolled. Before EGD, the endoscopist assessed referral appropriateness according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines, also collecting clinical and demographic variables. Outcomes of the study were detection of relevant findings and new diagnosis of malignancy at EGD. The accuracy of the following clinical strategies and predictive rules was compared: (i) ASGE appropriateness guidelines (indicated vs. not indicated), (ii) simplified rule (>or=45 years or alarm features vs. <45 years without alarm features), (iii) logistic regression model, and (iv) ANN models. A total of 8,252 patients were enrolled in 57 centers. Overall, 3,803 (46%) relevant findings and 132 (1.6%) new malignancies were detected. Sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) of the simplified rule were similar to that of the ASGE guidelines for both relevant findings (82%/26%/0.55 vs. 88%/27%/0.52) and cancer (97%/22%/0.58 vs. 98%/20%/0.58). Both logistic regression and ANN models seemed to be substantially more accurate in predicting new cases of malignancy, with an AUC of 0.82 and 0.87, respectively. A simple predictive rule based on age and alarm features is similarly effective to the more complex ASGE guidelines in selecting patients for EGD. Regression and ANN models may be useful in identifying a relatively small subgroup of patients at higher risk of cancer.

  14. Interferon and ribavarin associated depression in hcv patients and role of selective serotonin reuptake inhibitors

    International Nuclear Information System (INIS)

    Bashir, K.; Hussain, C.A.; Amer, K.

    2013-01-01

    Objective: To determine the frequency and severity of depression associated with antiviral therapy of Hepatitis C Virus (HCV) infection and effect of selective serotonin reuptake Inhibitors (SSRIs) to treat these depressive symptoms. Type of Study: Observational Analytical study. Place of Study and Duration: The study was conducted at Psychiatry, Medicine and Pathology department of Combined Military Hospital Sialkot Pakistan from February 2009 to July 2010. Subjects and Methods: All the patients in this study were suffering from HCV infection and were managed with Interferon (3 m.i.u. s/c thrice weekly) and Cap Ribavirin (400 mg bid) for six months. Patients were assessed by Hospital Anxiety and Depression Scale (HADS) - Urdu Version and Beck's Depressive Inventory (BDI) Scores after twelve weeks of antiviral therapy. Depressed patients were managed with selective serotonin reuptake inhibitors (SSRIs) for six weeks and again evaluated on HADS and BDI Scores. Response to SSRIs was defined as complete response, partial response and no response. Results: A total of 105 patients were studied out of which 75 were male and 30 were female with mean age 29.4 years. Out of these 54 (51.43%) patients developed depression and this tendency to develop depression was not related with the age and sex of the patients. The mean HADS and BDI scores before and after treatments with SSRIs were compared for significance and it was quite significant. There was not a single patient who did not show response to SSRIs. Conclusion: Depression is frequently associated with antiviral therapy of HCV RNA viraemia with interferon and SSRIs have proved an effective and safe remedy in these patients. (author)

  15. Opportunities for inhaler device selection in elderly patients with asthma or COPD

    Directory of Open Access Journals (Sweden)

    Barrons R

    2015-12-01

    Full Text Available Robert Barrons,1 James Wheeler,2 J Andrew Woods1 1Wingate University School of Pharmacy, Wingate, NC, USA; 2University of Tennessee Health Science Center, Nashville, TN, USA Abstract: An anticipated surge in the elderly population will be accompanied by a rise in aging patients with asthma or COPD. Clinician selection of inhalers needs to address the unique challenges to elderly patients. These challenges to the use of inhalers include diminished physical and cognitive abilities, as well as cost reimbursement issues associated with polypharmacy and the Medicare gap. Clinicians should consider patient preferences for an inhaler device that provides ease of administration, and addresses conveniences such as portability, visual, and auditory indicators of dosing completion. The addition of spacer devices resolves hand-breath coordination difficulty with pressurized metered dose inhalers, but reduces overall inhaler convenience. Soft mist inhalers (Respimat® improve ease of administration, but use may be limited by cost and formulary availability. Multiple dose dry powder inhalers provide convenience and simplified use by requiring only one to two steps prior to administration, but concerns of peak inspiratory flow requirements remain among patients with advanced age and severity of COPD. If unaddressed, these challenges to inhaler selection contribute to inappropriate use of inhalers in 41% to 69% of patients, accompanied by at least 51% non-adherence to treatment. Clinicians must first avail themselves of reputable educational resources regarding new inhaler developments and administration, for competent patient instruction. Patient education should include a checklist of inhaler technique, with physical demonstration of each device by the patient and provider. Device demonstration significantly improves inhaler technique and identifies the need for nebulization therapy. Clinician and patient knowledge of available inhalers and their

  16. Selective Attention and Drug Related Attention Bias in Methadone Maintenance Patients

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    Majid Nejati

    2011-12-01

    Full Text Available One of the main problems of the drug abusers is drug related attention bias, which causes craving, and as a result drive the drug abusers to take narcotics. Methadone is used as a maintenance treatment for drug abusers. The purpose of this study is evaluation of the effect of Methadone maintenance therapy (MMT on selective attention and drug related attention bias. This study investigated drug cue-related attention bias and selective attention in 16 methadone-maintained patients before and 45 days after methadone therapy period. Stroop color-word test and addiction Stroop test were used as measurement methods. Results show less reaction time and higher accuracy in Color-Word Stroop Test after MMT and less delay for addict related word in addiction Stroop test. It is concluded that methadone can improve selective attention capability and reduce drug related attention bias.

  17. E Actitrode: The new selective stimulation interface for functional movements in hemiplegics patients

    Directory of Open Access Journals (Sweden)

    Bijelić Goran

    2004-01-01

    Full Text Available We describe the new multi-contact electrode-array for surface electrical stimulation, and the corresponding interface device that allows on-line selection of the conductive fields during the application of the system. This new device has a specific value for therapeutic applications of electrical stimulation since it allows effective generation of desired functional movements. The user-friendly interface also allows patients at home to select the optimal electrode array; thereby, to receive therapies out of the clinical environment. The electrode was tested in three post-stroke hemiplegics patients. The pilot experiments showed that system works sufficiently good for control of fingers during grasp and release functions without the interference of the wrist movement. The use of electrode is also envisioned for many other applications (foot-drop fitness, shoulder subluxation, etc.

  18. RelTime Rates Collapse to a Strict Clock When Estimating the Timeline of Animal Diversification.

    Science.gov (United States)

    Lozano-Fernandez, Jesus; Dos Reis, Mario; Donoghue, Philip C J; Pisani, Davide

    2017-05-01

    Establishing an accurate timescale for the history of life is crucial to understand evolutionary processes. For this purpose, relaxed molecular clock models implemented in a Bayesian MCMC framework are generally used. However, these methods are time consuming. RelTime, a non-Bayesian method implementing a fast, ad hoc, algorithm for relative dating, was developed to overcome the computational inefficiencies of Bayesian software. RelTime was recently used to investigate the timing of origin of animals, yielding results consistent with early strict clock studies from the 1980s and 1990s, estimating metazoans to have a Mesoproterozoic origin-over a billion years ago. RelTime results are unexpected and disagree with the largest majority of modern, relaxed, Bayesian molecular clock analyses, which suggest animals originated in the Tonian-Cryogenian (less that 850 million years ago). Here, we demonstrate that RelTime-inferred divergence times for the origin of animals are spurious, a consequence of the inability of RelTime to relax the clock along the internal branches of the animal phylogeny. RelTime-inferred divergence times are comparable to strict-clock estimates because they are essentially inferred under a strict clock. Our results warn us of the danger of using ad hoc algorithms making implicit assumptions about rate changes along a tree. Our study roundly rejects a Mesoproterozoic origin of animals; metazoans emerged in the Tonian-Cryogenian, and diversified in the Ediacaran, in the immediate prelude to the routine fossilization of animals in the Cambrian associated with the emergence of readily preserved skeletons. © The Author 2017. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

  19. Effects of growth temperature and strictly anaerobic recovery on the survival of Listeria monocytogenes during pasteurization.

    OpenAIRE

    Knabel, S J; Walker, H W; Hartman, P A; Mendonca, A F

    1990-01-01

    Listeria monocytogenes F5069 was suspended in either Trypticase soy broth-0.6% yeast extract (TSBYE) or sterile, whole milk and heated at 62.8 degrees C in sealed thermal death time tubes. Severely heat-injured cells were recovered in TSBYE within sealed thermal death time tubes because of the formation of reduced conditions in the depths of the TSBYE. Also, the use of strictly anaerobic Hungate techniques significantly increased recovery in TSBYE containing 1.5% agar compared with aerobicall...

  20. The Dirichlet problem for the Monge-Ampere equation in convex (but not strictly convex domains

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    David Hartenstine

    2006-10-01

    Full Text Available It is well-known that the Dirichlet problem for the Monge-Amp`ere equation $det D^2 u = mu$ in a bounded strictly convex domain $Omega$ in $mathbb{R}^n$ has a weak solution (in the sense of Aleksandrov for any finite Borel measure $mu$ on $Omega$ and for any continuous boundary data. We consider the Dirichlet problem when $Omega$ is only assumed to be convex, and give a necessary and sufficient condition on the boundary data for solvability.

  1. Transplanting Diseases from Organ Donors in Western Europe: Fault Liability or Strict Liability?

    Science.gov (United States)

    Broeckx, Nils; Verhoeven, Dimitri

    2015-06-01

    This article will examine the problem of disease transmission through organ transplantation from a civil liability perspective. Both fault liability and strict product liability might be possible. These two types of liability will be compared, while applying them to the actions of the central parties involved in organ donation and transplantation, namely the physician/hospital, the donor and the organ exchange organisation. While product liability is generally an easier way to obtain compensation than fault liability, it might nevertheless place too heavy a burden on the transplant professionals.

  2. Single molecule experiments challenge the strict wave-particle dualism of light.

    Science.gov (United States)

    Greulich, Karl Otto

    2010-01-21

    Single molecule techniques improve our understanding of the photon and light. If the single photon double slit experiment is performed at the "single photon limit" of a multi-atom light source, faint light pulses with more than one photon hamper the interpretation. Single molecules, quantum dots or defect centres in crystals should be used as light source. "Single photon detectors" do not meet their promise-only "photon number resolving single photon detectors" do so. Particularly, the accumulation time argument, the only safe basis for the postulate of a strictly particle like photon, has so far not yet been verified.

  3. Single Molecule Experiments Challenge the Strict Wave-Particle Dualism of Light

    Directory of Open Access Journals (Sweden)

    Karl Otto Greulich

    2010-01-01

    Full Text Available Single molecule techniques improve our understanding of the photon and light. If the single photon double slit experiment is performed at the “single photon limit” of a multi-atom light source, faint light pulses with more than one photon hamper the interpretation. Single molecules, quantum dots or defect centres in crystals should be used as light source. “Single photon detectors” do not meet their promise―only “photon number resolving single photon detectors” do so. Particularly, the accumulation time argument, the only safe basis for the postulate of a strictly particle like photon, has so far not yet been verified.

  4. Determination of Selected Amino Acids in Serum of Patients with Liver Disease.

    Science.gov (United States)

    Kanďár, Roman; Drábková, Petra; Toiflová, Tereza; Čegan, Alexander

    2016-01-01

    The determination of amino acids can be a reliable approach for extended diagnosis of liver diseases. This is because liver disease can be a cause of impaired amino acid metabolism. Therefore, a method for the determination of serum amino acids, applicable for clinical purposes, is necessary. The aim of this study was to find differences in the levels of selected amino acids between patients with liver disease and a control group. Samples of peripheral venous blood were obtained from a group of patients with liver disease (n = 131, 59 women at an average age of 60 years and 72 men at an average age of 52 years) and a control group (n = 105, 47 women at an average age of 62 years and 58 men at an average age of 58 years). Before the separation, the amino acids were derivatized with naphthalene-2,3-dicarboxaldehyde. For the separation, reverse phase column was used. The effluent was monitored with a fluorescence detector. There were significant differences in the concentrations of some amino acids between the patients and the control group, but also between women and men. Correlations between some amino acids and markers of liver blood tests and lipid metabolism were observed. A simple, relatively rapid and selective HPLC method with fluorescence detection for the determination of selected amino acids in serum has been developed.

  5. Diffusion-weighted MRI and selection of patients for fibrinolytic therapy of acute cerebral ischaemia

    International Nuclear Information System (INIS)

    Ezura, M.; Takahashi, A.; Shimizu, H.; Yoshimoto, T.

    2000-01-01

    Treatment of patients with acute cerebral ischaemic events remains controversial. We investigated the reversibility of high signal intensity on diffusion-weighted (DW) MRI after acute local intra-arterial fibrinolysis (LIF) and the feasibility of DW MRI for selecting patients for acute LIF. Nine patients with acute middle cerebral artery embolic occlusion underwent single-photon emission computed tomography (SPECT) and DW MRI followed by acute LIF using tissue plasminogen activator. Recanalisation was observed in all patients, and eight improved clinically. The area of high signal intensity on pretreatment DW MRI was smaller than the low-uptake area on SPECT in all patients, and went on to infarction, as detected by MRI or CT 3 days after onset in all patients. It appears to correlate, at least clinically, with irreversible brain damage. Therefore, acute LIF should not be performed in patients with areas of high signal intensity in the cortex responsible for the symptoms. SPECT remains important, because areas normal on DW MRI with low uptake on SPECT often contribute to functional prognosis. (orig.)

  6. Oesophageal ulceration after selective internal radiation therapy in a patient with carcinoma of unknown primary.

    Science.gov (United States)

    Kubisch, C H; Beigel, F; Ihrler, S; Goke, B; Reiser, M F; Hoffmann, R T

    2010-05-01

    Cancer of unknown primary (CUP) is defined as histologically confirmed metastases in the absence of an identifiable primary tumor. Patients with solely liver metastases from adenocarinomas represent the most frequent subgroup with an unfavourable prognosis. The medium survival averages 6 to 9 months. No chemotherapheutic standard has been established. We present a patient with hepatic CUP. After cycles of chemotherapy and hemihepatectomy the tumor returned and showed hepatic progression. The patient was evaluated for selective internal radiation therapy (SIRT). Three years after diagnosis she is still alive and tumorfree. Despite a good result and disease control our patient suffered radiation-induced ulceration in the oesophagus, stomach, and duodenum. This side effect appears in up to 12 % of patients, often very late after treatment, is refractory to pharmacotherapy and persistent over a long time. SIRT is a new, effective treatment in patients with hepatic CUP. Because of the anticipated increase of this therapy, adverse side effects such as ulcerations in the upper-GI tract secondary to ectopic implantation of microspheres may be seen more commonly. Awareness of this and the recognition of microspheres in biopsies is cardinal for appropriate management and maintenance of the patient's quality of life.

  7. Update on prescription extended-release opioids and appropriate patient selection

    Directory of Open Access Journals (Sweden)

    Brennan MJ

    2013-07-01

    Full Text Available Michael J Brennan The Pain Center of Fairfield, Fairfield, CT, USA Abstract: Chronic pain is largely underdiagnosed, often undertreated, and expected to increase as the American population ages. Many patients with chronic pain require long-term treatment with analgesic medications, and pain management may involve use of prescription opioids for patients whose pain is inadequately controlled through other therapies. Yet because of the potential for abuse and addiction, many clinicians hesitate to treat their patients with pain with potentially beneficial agents. Finding the right opioid for the right patient is the first – often complicated – step. Ensuring that patients continue to properly use the medication while achieving therapeutic analgesic effects is the long-term goal. Combined with careful patient selection and ongoing monitoring, new formulations using extended-release technologies incorporating tamper-resistant features may help combat the growing risk of abuse or misuse, which will hopefully reduce individual suffering and the societal burden of chronic pain. The objective of this manuscript is to provide an update on extended-release opioids and to provide clinicians with a greater understanding of which patients might benefit from these new opioid formulations and how to integrate the recommended monitoring for abuse potential into clinical practice. Keywords: chronic pain, opioid analgesics, extended release, abuse prevention

  8. Feature selection and classification model construction on type 2 diabetic patients' data.

    Science.gov (United States)

    Huang, Yue; McCullagh, Paul; Black, Norman; Harper, Roy

    2007-11-01

    Diabetes affects between 2% and 4% of the global population (up to 10% in the over 65 age group), and its avoidance and effective treatment are undoubtedly crucial public health and health economics issues in the 21st century. The aim of this research was to identify significant factors influencing diabetes control, by applying feature selection to a working patient management system to assist with ranking, classification and knowledge discovery. The classification models can be used to determine individuals in the population with poor diabetes control status based on physiological and examination factors. The diabetic patients' information was collected by Ulster Community and Hospitals Trust (UCHT) from year 2000 to 2004 as part of clinical management. In order to discover key predictors and latent knowledge, data mining techniques were applied. To improve computational efficiency, a feature selection technique, feature selection via supervised model construction (FSSMC), an optimisation of ReliefF, was used to rank the important attributes affecting diabetic control. After selecting suitable features, three complementary classification techniques (Naïve Bayes, IB1 and C4.5) were applied to the data to predict how well the patients' condition was controlled. FSSMC identified patients' 'age', 'diagnosis duration', the need for 'insulin treatment', 'random blood glucose' measurement and 'diet treatment' as the most important factors influencing blood glucose control. Using the reduced features, a best predictive accuracy of 95% and sensitivity of 98% was achieved. The influence of factors, such as 'type of care' delivered, the use of 'home monitoring', and the importance of 'smoking' on outcome can contribute to domain knowledge in diabetes control. In the care of patients with diabetes, the more important factors identified: patients' 'age', 'diagnosis duration' and 'family history', are beyond the control of physicians. Treatment methods such as 'insulin', 'diet

  9. Exploring Visual Selective Attention towards Novel Stimuli in Alzheimer's Disease Patients

    Directory of Open Access Journals (Sweden)

    Sarah A. Chau

    2015-12-01

    Full Text Available Background: Alzheimer's disease (AD is associated with selective attention impairments, which could contribute to cognitive and functional deficits. Selective attention can be explored through examination of novelty preference. Aims: In this study, we quantified novelty preference in AD patients by measuring visual scanning behaviour using an eye tracking paradigm. Methods: Mild-to-moderate AD patients and elderly controls viewed slides containing novel and repeated images simultaneously. The outcome measure was time spent on specific images, with novelty preference defined by greater relative fixation time (RFT on novel versus repeated images. Cognitive status (Standardized Mini-Mental State Examination, SMMSE and attention (Digit Span, DS were also measured. Results: AD patients (age 79.2 ± 6.7 years, SMMSE 22.2 ± 4.0, n = 41 and controls (age 76.2 ± 6.4 years, SMMSE 28.1 ± 2.0, n = 24 were similar in age, education and sex. Compared with controls, AD patients had lower RFT on novel than on repeated images (F1,63 = 11.18, p = 0.001. Further, reduced RFT was associated with lower scores on SMMSE (r63 = 0.288, p = 0.020 and DS (r63 = 0.269, p = 0.030. Within individuals, novelty preference was detected in 92.3% of patients and in 100% of controls. Conclusion: These findings suggest that novelty preference, measured by visual scanning behaviour, can differentiate cognitively healthy and impaired people and may offer a nonverbal, less cognitively demanding method of assessing selective attention.

  10. Use of select medications prior to duloxetine initiation among commercially-insured patients

    Directory of Open Access Journals (Sweden)

    Bernauer M

    2012-08-01

    Full Text Available Mark Bernauer,1 Ning Wu,2 Shih-Yin Chen,2 Xiaomei Peng,1 Luke Boulanger,2 Yang Zhao11Eli Lilly and Company, Indianapolis, IN, 2United BioSource Corporation, Lexington, MA, USABackground: The purpose of this study was to assess select medication utilization prior to duloxetine initiation among patients with major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia, and musculoskeletal pain associated with osteoarthritis or low back pain.Methods: Commercially insured duloxetine initiators between January 1, 2007 and March 31, 2010 were identified from a large US administrative claims database. Disease subgroups were constructed based on diagnosis from medical claims during the 12 months prior to duloxetine initiation. Prior use of antidepressants, anticonvulsants, opioids, nonsteroidal anti-inflammatory drugs, and muscle relaxants was assessed during the 12-month preinitiation period.Results: This study identified 56,845 (2007, 44,838 (2008, and 65,840 (January 2009 to March 2010 duloxetine initiators. Among the 2009 initiators, utilization patterns were similar for patients with major depressive disorder and generalized anxiety disorder, with antidepressants being the most used (84% and 80%, respectively, followed by opioids (58% and 55%, respectively. Patients across pain-related conditions also had similar utilization patterns, with opioid use being the highest (76%–82%, followed by antidepressants (65%–72%. Use of other medication classes was common (29%–63% but less frequent, and over 50% of the patients used any antidepressants, 70% used any antidepressants or anticonvulsants, and 90% used any antidepressants, anticonvulsants, or opioids. Trends in the use of these select medications were similar between 2007 and 2009.Conclusion: Patients used several types of medications over the 12 months prior to initiating duloxetine across disease states, with antidepressants and opioids being the

  11. Selective patient experience with the Blom-Singer Dual Valve voice prosthesis.

    Science.gov (United States)

    Brownlee, Ben; Ahmad, Saniya; Grammer, Tracy; Krempl, Greg

    2018-02-01

    This study compares the overall durability, phonation effort, and speech quality achieved by the Blom-Singer Dual Valve prosthesis to the same characteristics achieved by the single-valve prosthesis used in a select population of total laryngectomy patients who have demonstrated single-valve prosthesis failure within 3 months of placement. Prospective phase IV study. Fourteen patients who had previously experienced early valve failure using a single-valve prosthesis had a Dual Valve placed by a speech language pathologist. A total of seventeen Dual Valves were inserted during routine clinical visits for valve replacement. Time intervals from insertion to replacement of the Dual Valve, as well as the average lifespan of patients' three previous single valves were collected. Subjective, categorical responses to speech quality and phonation effort for the Dual Valve compared to the single valve were collected on a questionnaire upon failure of the device. The mean duration of the single valve was 60 days, with a median of 51 days, whereas the mean duration of the Dual Valve was 164 days, with a median duration of 84 days. Both sets of data were statistically significant, with a P value of .0131. Valve life was increased in 86% of patients, with 43% experiencing greater than 150 days improvement in valve duration when using the Dual Valve. Phonation effort was increased in 14% of patients, and speech quality was not significantly affected in any patients. In this select population, the Dual Valve offers improved durability over the single valve without sacrificing speech quality, making it a preferred prosthesis option for patients experiencing single-valve failure in less than 3 months. 4. Laryngoscope, 128:422-426, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Patient Selection for Drip and Ship Thrombolysis in Acute Ischemic Stroke.

    Science.gov (United States)

    Lyerly, Michael J; Albright, Karen C; Boehme, Amelia K; Shahripour, Reza Bavarsad; Donnelly, John P; Houston, James T; Rawal, Pawan V; Kapoor, Niren; Alvi, Muhammad; Sisson, April; Alexandrov, Anne W; Alexandrov, Andrei V

    2015-07-01

    The drip and ship model is a method used to deliver thrombolysis to acute stroke patients in facilities lacking onsite neurology coverage. We sought to determine whether our drip and ship population differs from patients treated directly at our stroke center (direct presenters). We retrospectively reviewed consecutive patients who received thrombolysis at an outside facility with subsequent transfer to our center between 2009 and 2011. Patients received thrombolysis after telephone consultation with a stroke specialist. We examined demographics, vascular risk factors, laboratory values, and stroke severity in drip and ship patients compared with direct presenters. Ninety-six patients were identified who received thrombolysis by drip and ship compared with 212 direct presenters. The two groups did not differ with respect to sex, ethnicity, vascular risk factors, or admission glucose. The odds ratio (OR) of arriving at our hospital as a drip and ship for someone 80 years or older was 0.31 (95% confidence interval [CI] 0.15-0.61, P < 0.001). Only 21% of drip and ship patients were black versus 38% of direct presenters (OR 0.434, 95% CI 0.25-0.76, P = 0.004). Even after stratifying by age (<80 vs ≥80), a smaller proportion of drip and ship patients were black (OR 0.44, 95% CI 0.24-0.81, P = 0.008). Furthermore, we found that fewer black patients with severe strokes arrived by drip and ship (OR 0.33, 95% CI 0.11-0.98, P = 0.0028). Our study showed that a smaller proportion of blacks and older adults arrived at our center by the drip and ship model. This may reflect differences in how patients are selected for thrombolysis and transfer to a higher level of care.

  13. What are the parameters for predictive selection of patients requiring anesthesia for extracorporeal shockwave lithotripsy?

    Science.gov (United States)

    Weber, A; Koehrmann, K U; Denig, N; Michel, M S; Alken, P

    1998-08-01

    Additional anesthesia is required to minimize the tolerable pain level in efficiently performed extracorporeal shockwave lithotripsy (ESWL) with electrohydraulic and electromagnetic sources. In order to assess optimum anesthesia for each patient undergoing a standardized ESWL protocol, pain measurement and scoring were carried out. We attempted to determine the individual type and amount of analgesia prior to treatment. Patients (n = 95) with urolithiasis underwent pain measurement and scoring prior to ESWL. 'Threshold of pain' (TP) and 'maximal tolerable pain (MTP) were assessed by inducing ischemia pain with the submaximum effort tourniquet technique. Pain intensity was assessed by a verbal rating scale (VRS). The results of pain measurement and amount of analgosedation were correlated in two phases. Patients were administered an oral premedication of 0.1 mg/kg midazolam. Phase 1: 60 patients were randomized into three groups: (1) piritramide (0.1-0.3 mg/kg) and midazolam (1-3 mg) i.v. (2) Lidocaine/prilocaine cream topically (30 g) to skin and diclofenac supp. 100 mg. (3) No analgesia. Phase 2: Based on the data of phase 1, cut-off points for TP and MTP were set for female and male patients. In accordance with these results, 35 patients comprised group 1 for anesthesia with piritramide/midazolam, group 2 with lidocaine/prilocaine cream and diclofenac supp. and group 3 for no analgesia at all. The electromagnetic shockwave sources Modulith SLX and Lithostar Plus were utilized. Phase 1: All patients randomized for group 1 (intravenous analgosedation) were treated in accordance with the protocol. 65% of group 2 (cream/suppository) tolerated treatment as planned. 35% of patients selected for ESWL without analgesia (group 3) remained within this group. Patients requiring additional analgosedation displayed lower TP and MTP. The cut-off points for females and males were TP >/=25/35 s and MTP >/=45/60 s, respectively. Phase 2: 20/35 patients were preselected for a

  14. Preoperative testing and risk assessment: perspectives on patient selection in ambulatory anesthetic procedures

    Directory of Open Access Journals (Sweden)

    Stierer TL

    2015-08-01

    Full Text Available Tracey L Stierer,1,2 Nancy A Collop3,41Department of Anesthesiology, 2Department of Critical Care Medicine, Otolaryngology Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, USA; 3Department of Medicine, 4Department of Neurology, Emory University, Emory Sleep Center, Wesley Woods Center, Atlanta, GA, USAAbstract: With recent advances in surgical and anesthetic technique, there has been a growing emphasis on the delivery of care to patients undergoing ambulatory procedures of increasing complexity. Appropriate patient selection and meticulous preparation are vital to the provision of a safe, quality perioperative experience. It is not unusual for patients with complex medical histories and substantial systemic disease to be scheduled for discharge on the same day as their surgical procedure. The trend to “push the envelope” by triaging progressively sicker patients to ambulatory surgical facilities has resulted in a number of challenges for the anesthesia provider who will assume their care. It is well known that certain patient diseases are associated with increased perioperative risk. It is therefore important to define clinical factors that warrant more extensive testing of the patient and medical conditions that present a prohibitive risk for an adverse outcome. The preoperative assessment is an opportunity for the anesthesia provider to determine the status and stability of the patient’s health, provide preoperative education and instructions, and offer support and reassurance to the patient and the patient’s family members. Communication between the surgeon/proceduralist and the anesthesia provider is critical in achieving optimal outcome. A multifaceted approach is required when considering whether a specific patient will be best served having their procedure on an outpatient basis. Not only should the patient's comorbidities be stable and optimized, but details regarding the planned procedure and the resources available

  15. Customized acrylic implants for reconstruction of extensive skull defects: an exception approach for selected patients

    Directory of Open Access Journals (Sweden)

    RAFAEL DENADAI PIGOZZI DA SILVA

    Full Text Available ABSTRACT Objective: to present our experience in the surgical treatment of extensive skullcap defects with customized acrylic implants. Methods: we conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between 2004 and 2013. We carefully selected all patients and classified surgical results based on three scales (craniofacial esthetics, improvement of facial symmetry and need for additional surgery. Results: fifteen patients underwent cranioplasty with intraoperative acrylic implants, whether manually customized (46.67% or made with prototyped three-dimensional biomodels (53.33%. There were two (13.33% complications (one infection with implant withdrawal and one seroma. We considered the craniofacial aesthetics excellent (50%, the degree of improvement of craniofacial symmetry satisfactory (57.14%, and the overall mean of surgical results according to the need for new surgeries was 1.5±0.52. Conclusion: cranioplasties of patients with extensive skullcap defects should obey careful and predetermined criteria, both for selection and for the acrylic implant customization method.

  16. Scurvy in the present times: vitamin C allergy leading to strict fast food diet.

    Science.gov (United States)

    Shaath, Tarek; Fischer, Ryan; Goeser, Megan; Rajpara, Anand; Aires, Daniel

    2016-01-15

    Scurvy results from a deficiency of vitamin C, a nutrient otherwise known as ascorbic acid. Today, scurvy is rare yet emerges in select patients. The patient reported herein developed scurvy secondary to deliberate avoidance of vitamin C-rich foods. Classic cutaneous manifestations of scurvy include follicular hyperkeratosis and perifollicular hemorrhage encompassing coiled "corkscrew" hairs and hairs bent into "swan-neck" deformities. Ecchymoses, purpura, and petechiae are also characteristically prominent. Classic oral abnormalities include erythematous, swollen gingivae that hemorrhage from subtle microtrauma.Subungual linear splinter hemorrhages may also manifest as a sign of the disease. To establish the diagnosis requirements include characteristic physical exam findings, evidence of inadequate dietary intake, and rapid reversal of symptoms upon supplementation. Although unnecessary for diagnosis, histological findings demonstrate perifollicular inflammation and hemorrhage, fibrosis, and hyperkeratosis, amongst dilated hair follicles and keratin plugging. Although citrus fruit allergies have been historically documented, ascorbic acid has not been previously reported as an allergen. Although lacking absolute certainty, this report suggests a presumed case of ascorbic acid allergy based on patient history and favorable response to ascorbic acid desensitization therapy.

  17. Economic considerations and patients' preferences affect treatment selection for patients with rheumatoid arthritis: a discrete choice experiment among European rheumatologists.

    Science.gov (United States)

    Hifinger, M; Hiligsmann, M; Ramiro, S; Watson, V; Severens, J L; Fautrel, B; Uhlig, T; van Vollenhoven, R; Jacques, P; Detert, J; Canas da Silva, J; Scirè, C A; Berghea, F; Carmona, L; Péntek, M; Keat, A; Boonen, A

    2017-01-01

    To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis. In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with moderate disease activity. Treatments differed in five attributes: efficacy (improvement and achieved state on disease activity), safety (probability of serious adverse events), patient's preference (level of agreement), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). A Bayesian efficient design defined 14 choice sets, and a random parameter logit model was used to estimate relative preferences for rheumatologists across countries. Cluster analyses and latent class models were applied to understand preference patterns across countries and among individual rheumatologists. Responses of 559 rheumatologists from 12 European countries were included in the analysis (49% females, mean age 48 years). In all countries, efficacy dominated treatment decisions followed by economic considerations and patients' preferences. Across countries, rheumatologists avoided selecting a treatment that patients disliked. Latent class models revealed four respondent profiles: one traded off all attributes except safety, and the remaining three classes disregarded ICER. Among individual rheumatologists, 57% disregarded ICER and these were more likely from Italy, Romania, Portugal or France, whereas 43% disregarded uncommon/rare side effects and were more likely from Belgium, Germany, Hungary, the Netherlands, Norway, Spain, Sweden or UK. Overall, European rheumatologists are willing to trade between treatment efficacy, patients' treatment preferences and economic considerations. However, the degree of trade-off differs between countries and among individuals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  18. Fuzzy Adaptive Decentralized Optimal Control for Strict Feedback Nonlinear Large-Scale Systems.

    Science.gov (United States)

    Sun, Kangkang; Sui, Shuai; Tong, Shaocheng

    2018-04-01

    This paper considers the optimal decentralized fuzzy adaptive control design problem for a class of interconnected large-scale nonlinear systems in strict feedback form and with unknown nonlinear functions. The fuzzy logic systems are introduced to learn the unknown dynamics and cost functions, respectively, and a state estimator is developed. By applying the state estimator and the backstepping recursive design algorithm, a decentralized feedforward controller is established. By using the backstepping decentralized feedforward control scheme, the considered interconnected large-scale nonlinear system in strict feedback form is changed into an equivalent affine large-scale nonlinear system. Subsequently, an optimal decentralized fuzzy adaptive control scheme is constructed. The whole optimal decentralized fuzzy adaptive controller is composed of a decentralized feedforward control and an optimal decentralized control. It is proved that the developed optimal decentralized controller can ensure that all the variables of the control system are uniformly ultimately bounded, and the cost functions are the smallest. Two simulation examples are provided to illustrate the validity of the developed optimal decentralized fuzzy adaptive control scheme.

  19. Selective screening of 650 high risk Iranian patients for detection of inborn error of metabolism

    Directory of Open Access Journals (Sweden)

    Narges Pishva

    2015-02-01

    Full Text Available Objective: Although metabolic diseases individually are rare ,but overall have an incidence of 1/2000 and can cause devastating and irreversible effect if not diagnosed early and treated promptly. selective screening is an acceptable method for detection of these multi presentation diseases.Method: using panel neonatal screening for detection of metabolic diseases in 650 high risk Iranian patients in Fars province. The following clinical features were used as inclusion criteria for investigation of the patients.Lethargy, poor feeding ,persistent vomiting, cholestasis, intractable seizure ,decreased level of consciousness ,persistent hypoglycemia, unexplained acid base disturbance and unexplained neonatal death.Result: Organic acidemia with 40 cases (42% was the most frequent disorder diagnosed in our high risk populations, followed by disorder of galactose metabolism(30%, 15 patient had classic galactosemia(GALT

  20. Motor-evacuatory gastric function in patients with duodenal cancer after selective proximal vagotomy

    Energy Technology Data Exchange (ETDEWEB)

    Aliev, M.A.; Kabdrakhmanov, T.K.; Kashkin, K.A.; Darmenov, O.K.; Kuspangaljeva, Sh.U. (Kazakhskij Inst. Klinicheskoj i Ehksperimental' noj Khirurgii Minzdrava Kazakhskoj SSR, Alma-Ata)

    1983-06-01

    Motor-evacuatory stomach function by using continuous radiogastrography was studied in patients with duodenal ulcers. Radiogastrograms were analyzed before operation, on the 7th-15th day after selective proximal vagotomy performed either independently or in combination with draining operations. A faster evacuation of food from the stomach prevailed in an uncomplicated form of duodenal ulcer and compensated stenosis of the pyloroduodenal zone, evacuatory stomach function was retarded or absent in subcompensated and decompensated stenosis. Discoordinated gastric peristalsis and a reverse food input were noted in patients with subcompensated stenosis. At early time after operations temporary inhibition of evacuatory stomach function occurred in 94.2% of the patients; it could be corrected with conservative therapeutic measures.

  1. Selective screening of 650 high risk Iranian patients for detection of inborn error of metabolism

    Directory of Open Access Journals (Sweden)

    Narges Pishva

    2015-02-01

    Full Text Available Objective: Although metabolic diseases individually are rare ,but overall have an incidence of 1/2000 and can cause devastating and irreversible effect if not diagnosed early and treated promptly. selective screening is an acceptable method for detection of these multi presentation diseases. Method: using panel neonatal screening for detection of metabolic diseases in 650 high risk Iranian patients in Fars province. The following clinical features were used as inclusion criteria for investigation of the patients. Lethargy, poor feeding ,persistent vomiting, cholestasis, intractable seizure ,decreased level of consciousness ,persistent hypoglycemia, unexplained acid base disturbance and unexplained neonatal death. Result: Organic acidemia with 40 cases (42% was the most frequent disorder diagnosed in our high risk populations, followed by disorder of galactose metabolism(30%, 15 patient had classic galactosemia(GALT

  2. Motor-evacuatory gastric function in patients with duodenal cancer after selective proximal vagotomy

    International Nuclear Information System (INIS)

    Aliev, M.A.; Kabdrakhmanov, T.K.; Kashkin, K.A.; Darmenov, O.K.; Kuspangaljeva, Sh.U.

    1983-01-01

    Motor-evacuatory stomach function by using continuous radiogastrography was studied in patients with duodenal ulcers. Radiogastrograms were analyzed before operation, on the 7th-15th day after selective proximal vagotomy performed either independently or in combination with draining operations. A faster evacuation of food from the stomach prevailed in an uncomplicated form of duodenal ulcer and compensated stenosis of the pyloroduodenal zone, evacuatory stomach function was retarded or absent in subcompensated and decompensated stenosis. Discoordinated gastric peristalsis and a reverse food input were noted in patients with subcompensated stenosis. At early time after operations temporary inhibition of evacuatory stomach function occurred in 94.2% of the patients; it could be corrected with conservative therapeutic measures

  3. Selective nonoperative management in 1106 patients with abdominal gunshot wounds: conclusions on safety, efficacy, and the role of selective CT imaging in a prospective single-center study.

    Science.gov (United States)

    Navsaria, Pradeep H; Nicol, Andrew J; Edu, Sorin; Gandhi, Rajiv; Ball, Chad G

    2015-04-01

    The primary aim of this study was to delineate the role of computed tomography (CT) in patients undergoing NOM for AGSW. Nonoperative management (NOM) of abdominal gunshot wounds (AGSWs) remains controversial. This prospective study included all patients with abdominal gunshot injuries admitted to our trauma center from April 1, 2004 to September 30, 2009. Exclusion criteria included patients with peritonitis, hemodynamic instability, unreliable physical examination, head and spinal cord injury with an AGSW underwent immediate laparotomy. The remaining patients were selected for NOM. Nonperitonitic stable patients with right-sided thoracoabdominal/right upper quadrant gunshots and/or hematuria underwent mandatory CT with intravenous contrast. CT to detect missile trajectory was optional. The primary outcome measure was failure of NOM. Secondary outcomes were unnecessary laparotomy rates and mortality. A total of 1106 patients with abdominal gunshot injuries were admitted. Of these, 834 (75.4%) underwent immediate laparotomy, whereas 272 (24.6%) were selected for NOM. In the former group, there were 56 (6.7%) deaths and 29 (3.5%) unnecessary laparotomies, whereas in the latter NOM group, 82 (30.1%) patients were managed by serial clinical examination alone, whereas 190 (69.9%) patients underwent abdominal CT scanning, in addition to serial clinical examination. The overall NOM success rate was 95.2%. Of the 13 patients undergoing delayed laparotomy, there were 10 therapeutic, 2 nontherapeutic, and 1 negative laparotomy. The NOM of appropriately selected patients with AGSW with selective use of CT scanning is feasible, safe, and effective, but largely based on findings from serial clinical examinations.

  4. EVALUATION OF N-RATIO IN SELECTING PATIENTS FOR ADJUVANT CHEMORADIOTHERAPY AFTER D2-GASTRECTOMY

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    Wilson Luiz da COSTA JUNIOR

    2013-12-01

    Full Text Available Context Whether adjuvant chemoradiotherapy may contribute to improve survival outcomes after D2-gastrectomy remains controvertial. Objective To explore the clinical utility of N-Ratio in selecting gastric cancer patients for adjuvant chemoradiotherapy after D2-gastrectomy. Methods A retrospective cohort study was carried out on gastric cancer patients who underwent D2-gastrectomy alone or D2-gastrectomy plus adjuvant chemoradiotherapy (INT-0116 protocol at the Hospital A. C. Camargo from September 1998 to December 2008. Statistical analysis were performed using multiple conventional methods, such as c-statistic, adjusted Cox's regression and stratified survival analysis. Results Our analysis involved 128 patients. According to c-statistic, the N-Ratio (i.e., as a continuous variable presented “area under ROC curve” (AUC of 0.713, while the number of metastatic nodes presented AUC of 0.705. After categorization, the cut-offs provide by Marchet et al. displayed the highest discriminating power – AUC value of 0.702. This N-Ratio categorization was confirmed as an independent predictor of survival using multivariate analyses. There also was a trend of better survival by adding of adjuvant chemoradiotherapy only for patients with milder degrees of lymphatic spread – 5-year survival of 23.1% vs 66.9%, respectively (HR = 0.426, 95% CI 0.150–1.202; P = 0.092. Conclusions This study confirms the N-Ratio as a tool to improve the lymph node metastasis staging in gastric cancer and suggests the cut-offs provided by Marchet et al. as the best way for its categorization after a D2-gastrectomy. In these settings, the N-Ratio appears a useful tool to select patients for adjuvant chemoradiotherapy, and the benefit of adding this type of adjuvancy to D2-gastrectomy is suggested to be limited to patients with milder degrees of lymphatic spread (i.e., NR2, 10%–25%.

  5. Selective dorsal rhizotomy for spastic diplegia secondary to stroke in an adult patient.

    Science.gov (United States)

    Eppinger, Melissa Ann; Berman, Casey Melissa; Mazzola, Catherine Anne

    2015-01-01

    Selective dorsal rhizotomy (SDR) is often recommended for children with spastic paraparesis and cerebral palsy. SDR reduces spasticity in the lower extremities for these children with spastic paraplegia. However, SDR is infrequently recommended for adults with spasticity. Spastic diplegia in adult patients can be due to stroke, brain or spinal cord injury from trauma, infection, toxic-metabolic disorders, and other causes. Although rarely considered, SDR is an option for adult patients with spastic diplegia as well. The authors describe a patient who underwent a SDR with a successful postoperative outcome. This man suffered a hypertensive and hemorrhagic stroke secondary to intravenous drug abuse at age 46. A SDR was performed after two failed intrathecal baclofen pump placements due to recurrent infections, likely resulting from his immunocompromised status. The patient underwent lumbar laminectomies and dorsal rhizotomies at levels L1-S1 bilaterally. Postoperatively, the patient's spasticity was significantly reduced. His Ashworth spasticity score decreased from 4/5 to 1/5, and the reduction in tone has been durable over 3 years. SDR in older patients with spastic paraparesis may be considered as a treatment option.

  6. Home blood pressure monitoring and self-titration of antihypertensive medications: Proposed patient selection criteria.

    Science.gov (United States)

    Hill, James R

    2016-05-01

    Recent studies have demonstrated that home blood pressure monitoring (HBPM), coupled with self-titration of medications is a viable intervention to control hypertension. There are currently no established criteria to evaluate patients for inclusion in such a program. The purpose of this discussion is to propose criteria for determining if a patient is appropriate to participate in a program of HBPM and self-titration. Inclusion criteria for two self-titration trials were examined, and additional factors in clinical practice were identified and discussed. Additional selection criteria were proposed to support the decision to enroll a patient in an antihypertensive self-titration program. Inclusion criteria from self-titration trials provide a reasonable starting point for choosing appropriate patients in clinical practice, but additional research is necessary. Adaptation of these criteria and consideration of the identified factors can be used to develop decision support instruments. Such instruments should be evaluated for effectiveness and reliability prior to use in clinical practice. HBPM combined with self-titration is an effective patient-centered approach for hypertension management. Decision support instruments to determine appropriate patients are necessary for safe and effective use in clinical practice. ©2015 American Association of Nurse Practitioners.

  7. A technology selection framework for supporting delivery of patient-oriented health interventions in developing countries.

    Science.gov (United States)

    Chan, Connie V; Kaufman, David R

    2010-04-01

    Health information technologies (HIT) have great potential to advance health care globally. In particular, HIT can provide innovative approaches and methodologies to overcome the range of access and resource barriers specific to developing countries. However, there is a paucity of models and empirical evidence informing the technology selection process in these settings. We propose a framework for selecting patient-oriented technologies in developing countries. The selection guidance process is structured by a set of filters that impose particular constraints and serve to narrow the space of possible decisions. The framework consists of three levels of factors: (1) situational factors, (2) the technology and its relationship with health interventions and with target patients, and (3) empirical evidence. We demonstrate the utility of the framework in the context of mobile phones for behavioral health interventions to reduce risk factors for cardiovascular disease. This framework can be applied to health interventions across health domains to explore how and whether available technologies can support delivery of the associated types of interventions and with the target populations. Published by Elsevier Inc.

  8. Survival Prediction and Feature Selection in Patients with Breast Cancer Using Support Vector Regression

    Directory of Open Access Journals (Sweden)

    Shahrbanoo Goli

    2016-01-01

    Full Text Available The Support Vector Regression (SVR model has been broadly used for response prediction. However, few researchers have used SVR for survival analysis. In this study, a new SVR model is proposed and SVR with different kernels and the traditional Cox model are trained. The models are compared based on different performance measures. We also select the best subset of features using three feature selection methods: combination of SVR and statistical tests, univariate feature selection based on concordance index, and recursive feature elimination. The evaluations are performed using available medical datasets and also a Breast Cancer (BC dataset consisting of 573 patients who visited the Oncology Clinic of Hamadan province in Iran. Results show that, for the BC dataset, survival time can be predicted more accurately by linear SVR than nonlinear SVR. Based on the three feature selection methods, metastasis status, progesterone receptor status, and human epidermal growth factor receptor 2 status are the best features associated to survival. Also, according to the obtained results, performance of linear and nonlinear kernels is comparable. The proposed SVR model performs similar to or slightly better than other models. Also, SVR performs similar to or better than Cox when all features are included in model.

  9. Should breast density influence patient selection for breast-conserving surgery?

    Science.gov (United States)

    Kapoor, Nimmi S; Eaton, Anne; King, Tari A; Patil, Sujata; Stempel, Michelle; Morris, Elizabeth; Brogi, Edi; Morrow, Monica

    2013-02-01

    In a previous study of the relationship between breast density and primary tumor features, we observed a higher mastectomy rate in patients with extremely dense breasts. Here we examine possible reasons for this finding. Data were obtained from a prospectively maintained database of 1,056 invasive breast cancer patients from January 2005 to June 2007. Mammographic density was assigned by Breast Imaging-Reporting and Data System (BI-RADS) classification. Initial and final surgical procedures, and patient and tumor variables were recorded. Breast-conserving surgery (BCS) was attempted in 758 patients (72 %), 385 (51 %) of whom had preoperative magnetic resonance imaging (MRI). Initial BCS was less common among patients with the highest (BI-RADS 4) breast density compared to patients with less-dense breasts (52 vs. 74 %; p mastectomy compared to patients with less-dense breasts. After initial BCS, 387 patients (51 %) had positive shaved margins, 96 (25 %) of whom converted to mastectomy. MRI did not correlate with the rate of positive margins overall or among those with dense breasts. Adjusting for clinical and pathologic variables, density did not predict margin status or conversion to mastectomy. In a multivariate model, age, histologic grade, extensive intraductal component, and multicentricity/multifocality were independently associated with conversion to mastectomy. Density alone seems to influence the decision to proceed with initial mastectomy. When BCS was attempted, breast density was not associated with positive margins or conversion to mastectomy. A benefit of MRI in decreasing positive margins was not observed. These data do not support the use of breast density as a selection criterion for BCS.

  10. Study on Environment Performance Evaluation and Regional Differences of Strictly-Environmental-Monitored Cities in China

    Directory of Open Access Journals (Sweden)

    Ji Guo

    2017-12-01

    Full Text Available With the rapid economic growth and development, the problem of environmental pollution in China’s cities is becoming increasingly serious, and environmental pollution takes on a regional difference. There is, however, little comprehensive evaluation on the environmental performance and the regional difference of strictly-environmental-monitored cities in China. In this paper, the environmental performance of 109 strictly-environmental-monitored cities in China is evaluated in terms of natural performance, management performance, and scale performance by Data Envelopment Analysis (DEA, incorporating PM2.5 and PM10 as undesirable outputs. The empirical results show that: (1 At present, the natural performance is quite high, while the management performance is noticeably low for most cities. (2 The gap between the level of economic development and environmental protection among cities in China is large, and the scale efficiency of big cities is better than that of smaller cities. The efficiency value of large-scale cities such as Beijing, Shanghai, Guangzhou, Shenzhen, etc. is high, equaling 1; the value of smaller cities such as Sanmenxia, Baoding, Mudanjiang, and Pingdingshan is low, close to 0, indicating that big cities are characterized by high environmental efficiency. (3 From the perspective of region, the level of environmental performance in China is very uneven. For example, the environmental efficiency level of the Pan-Pearl River Delta region is superior to that of the Pan-Yangtze River region and the Bahia Rim region, whose values of environmental efficiency are 0.858, 0.658, and 0.622 respectively. The average efficiency of the Southern Coastal Economic Zone, Eastern Coastal Comprehensive Economic Zone, and the Comprehensive Economic Zone in the middle reaches of the Yangtze River is higher than that of other regions. Finally, corresponding countermeasures and suggestions are put forward. The method used in this paper is applicable

  11. Disordered strictly jammed binary sphere packings attain an anomalously large range of densities

    Science.gov (United States)

    Hopkins, Adam B.; Stillinger, Frank H.; Torquato, Salvatore

    2013-08-01

    Previous attempts to simulate disordered binary sphere packings have been limited in producing mechanically stable, isostatic packings across a broad spectrum of packing fractions. Here we report that disordered strictly jammed binary packings (packings that remain mechanically stable under general shear deformations and compressions) can be produced with an anomalously large range of average packing fractions 0.634≤ϕ≤0.829 for small to large sphere radius ratios α restricted to α≥0.100. Surprisingly, this range of average packing fractions is obtained for packings containing a subset of spheres (called the backbone) that are exactly strictly jammed, exactly isostatic, and also generated from random initial conditions. Additionally, the average packing fractions of these packings at certain α and small sphere relative number concentrations x approach those of the corresponding densest known ordered packings. These findings suggest for entropic reasons that these high-density disordered packings should be good glass formers and that they may be easy to prepare experimentally. We also identify an unusual feature of the packing fraction of jammed backbones (packings with rattlers excluded). The backbone packing fraction is about 0.624 over the majority of the α-x plane, even when large numbers of small spheres are present in the backbone. Over the (relatively small) area of the α-x plane where the backbone is not roughly constant, we find that backbone packing fractions range from about 0.606 to 0.829, with the volume of rattler spheres comprising between 1.6% and 26.9% of total sphere volume. To generate isostatic strictly jammed packings, we use an implementation of the Torquato-Jiao sequential linear programming algorithm [Phys. Rev. EPLEEE81539-375510.1103/PhysRevE.82.061302 82, 061302 (2010)], which is an efficient producer of inherent structures (mechanically stable configurations at the local maxima in the density landscape). The identification and

  12. Disordered strictly jammed binary sphere packings attain an anomalously large range of densities.

    Science.gov (United States)

    Hopkins, Adam B; Stillinger, Frank H; Torquato, Salvatore

    2013-08-01

    Previous attempts to simulate disordered binary sphere packings have been limited in producing mechanically stable, isostatic packings across a broad spectrum of packing fractions. Here we report that disordered strictly jammed binary packings (packings that remain mechanically stable under general shear deformations and compressions) can be produced with an anomalously large range of average packing fractions 0.634≤φ≤0.829 for small to large sphere radius ratios α restricted to α≥0.100. Surprisingly, this range of average packing fractions is obtained for packings containing a subset of spheres (called the backbone) that are exactly strictly jammed, exactly isostatic, and also generated from random initial conditions. Additionally, the average packing fractions of these packings at certain α and small sphere relative number concentrations x approach those of the corresponding densest known ordered packings. These findings suggest for entropic reasons that these high-density disordered packings should be good glass formers and that they may be easy to prepare experimentally. We also identify an unusual feature of the packing fraction of jammed backbones (packings with rattlers excluded). The backbone packing fraction is about 0.624 over the majority of the α-x plane, even when large numbers of small spheres are present in the backbone. Over the (relatively small) area of the α-x plane where the backbone is not roughly constant, we find that backbone packing fractions range from about 0.606 to 0.829, with the volume of rattler spheres comprising between 1.6% and 26.9% of total sphere volume. To generate isostatic strictly jammed packings, we use an implementation of the Torquato-Jiao sequential linear programming algorithm [Phys. Rev. E 82, 061302 (2010)], which is an efficient producer of inherent structures (mechanically stable configurations at the local maxima in the density landscape). The identification and explicit construction of binary packings

  13. Naltrexone HCI/bupropion HCI for chronic weight management in obese adults: patient selection and perspectives.

    Science.gov (United States)

    Tek, Cenk

    2016-01-01

    Naltrexone, an opiate antagonist, and bupropion, a noradrenergic/dopaminergic antidepressant, have many effects on the reward systems of the brain. These medications impact eating behavior, presumably via their impact on food reward. However, only bupropion induces weight loss in obese individuals, while naltrexone does not have any appreciable effect. The combination of 32 mg of naltrexone and 360 mg of bupropion in a sustained-release combination pill form has been recently approved for obesity treatment. Studies have shown that the combination of these two medications is more effective in inducing weight loss, when combined with lifestyle intervention and calorie reduction, than each individual medicine alone. The naltrexone-bupropion combination, when combined with lifestyle intervention and modest calorie reduction, seems to be quite effective for 6-month and 1-year outcomes for clinically significant weight loss (over 5% of total body weight). These medications are not devoid of serious side effects, however, and careful patient selection can reduce dramatic complications and increase positive outcomes. This paper reviews existing weight loss clinical trials with bupropion and the bupropion-naltrexone combination. Additionally, the rationale for the suggested patient selection and clinical strategies for special patient populations are discussed.

  14. A Consumer Health Information System to Assist Patients Select Quality Home Health Services

    Directory of Open Access Journals (Sweden)

    Dimitrios Zikos

    2017-11-01

    Full Text Available Patients evaluate the quality of home health agencies (HHAs using the Health Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey. This paper describes a prototype community health information system to help patients select appropriate and quality HHAs, according to the location, proprietary status, type of service, and year of HHA establishment. Five HCAHPS indicators were selected: “summary rating”, “quality of care”, “professional care”, “communication”, and “recommend agency”. Independent t-test analysis showed that agencies offering Speech Pathology, Medical-Social, or Home Health Aide services, receive significantly worse HCAHPS ratings, while mean ratings vary significantly across different US states. Multiple comparisons with post hoc ANOVA revealed differences between and within HHAs of different proprietary status (p < 0.001: governmental HHAs receiving higher ratings than private HHAs. Finally, there was observed a relationship between all five quality rating variables and the HHA year of establishment (Pearson, p < 0.001. The older the agency is, the better the HCAPS summary ratings. Findings provided the knowledge to design of a consumer health information system, to provide rankings filtered according to user criteria, comparing the quality rankings of eligible HHAs. Users can also see how a specific agency is ranked against eligible HHAs. Ultimately, the system aims to support the patient community with contextually realistic comparisons in an effort to choose optimal HH service.

  15. Recurrent Intestinal Obstruction in a Patient with Selective IgA Deficiency.

    Science.gov (United States)

    Hui, Chee-Kin

    2016-11-01

    A 32 year old woman presented with acute onset of abdominal pain and fever. An urgent computerised tomography (CT) of the whole abdomen showed dilated loop at the terminal ileum in the right lower abdomen with thickening of the wall and oedema. The CT was suggestive of distal small bowel obstruction at the ileum with surrounding wall oedema. Multiple biopsies taken from the terminal ileum and colon on colonoscopy were all unremarkable. She represented one-year later with a recurrence of intestinal obstruction. CT enteroclysis showed collapse at the distal 3 cm segment of the terminal ileum. There was no associated wall thickening, active inflammatory changes or ileitis. This was suspicious of post-inflammatory change or fibrosis. She was subsequently found to have selective IgA deficiency with recurrent infection in the terminal ileum resulting in intestinal obstruction. In conclusion, selective IgA deficiency should be considered in patients with recurrent intestinal obstruction without anatomical obstructions.

  16. Introduction of helical computed tomography affects patient selection for V/Q lung scan

    International Nuclear Information System (INIS)

    Zettinig, G.; Baudrexel, S.; Leitha, Th.

    2002-01-01

    Aim: Retrospective analysis for determination of the effect of helical computed tomography (HCT) on utilization of V/Q lung scanning to diagnose pulmonary embolism (PE) in a large general hospital. Methods: A total number of 2676 V/Q scans of in- and out-patients referred to our department between March 1992 and December 1998 and between April 1997 and December 1998 were analyzed by an identical group of nuclear physicians. Results: Neither the total number of annually performed V/Q scans (446 ± 135) nor the mean age of patients (56 years ± 17) changed significantly since the introduction of HCT. However, the referral pattern was different. The percentage of patients with high and intermediate probability for PE decreased significantly from 15.2% to 9.4% (p <0.01) and from 10.2% to 7.3% (p <0.05), respectively. Low probability scans significantly increased from 37.8% to 42.7% (p <0.05). The percentage of normal scans did not change significantly, however, there was a highly significant increase summarizing patients with normal and low probability scans (74.6% to 83.3%; p <0.01). Conclusion: The introduction of HCT affected the selection of patients referred for V/Q lung scanning since V/Q scanning was primarily used to exclude rather to confirm PE. (orig.)

  17. [Experience of using endotoxin selective adsorption in patients with severe sepsis after open-heart surgery].

    Science.gov (United States)

    Iarustovskiĭ, M B; Abramian, M V; Krotenko, N P; Popov, D A; Pliushch, M G; Nazarova, E I; Gordeev, S L

    2014-01-01

    To evaluate the safety and effectiveness of selective lipopolysaccharide (LPS)-adsorption therapy using polymyxin B immobilised fibre cartridges in adult patients complicated with severe sepsis after cardiac surgery. 105 patients received extracorporeal LPS-adsorption procedures using Toraymyxin columns--PMX (Toray, Japan) in addition to the standard treatment according to the Surviving Sepsis Campaign guideline study group. For control group we selected 40 patients, comparable by PMX group in age, body weight, severity of illness, and the duration of cardiopulmonary bypass, received only standard therapy. All patients received significant doses of vasoactive drugs for hemodynamic support, mechanical ventilation and broad-spectrum antibiotics. Mean APACHE II and SOFA scores were comparable for both groups. Inclusion criteria were: clinical signs of severe sepsis, endotoxin activity assay (EAA) > or = 0.6, elevated blood plasma procalcitonin (PCT) > 2 ng ml(-1). The inclusion criteria were clinical signs of severe sepsis, endotoxin activity assay (EAA) > or = 0.6, and blood plasma procalcitonin (PCT) > 2 ng ml(-1). Extracorporeal treatment was administered within 24 h of a severe sepsis diagnosis. Each patient in PMX group received 2 LPS-adsorption procedures and each session of hemoperfusion lasted for 120 minutes. After the LPS-adsorption course, we noted any indices of haemodynamic improvements, including an increase in mean arterial pressure on 22% (p < 0.001), mean oxygenation index (on 24.5%, p < 0.001), normalisation of leukocytosis and a decrease in mean body temperature. After the procedures of LPS-adsorption we found the statistically significant decreasing of LPS concentrations according to LAL-test and EAA. In the control group, there were no significant changes in any of the studied parameters except body temperature. Moreover, the 28-day mortality was 42% in the study group and 65% in the control group (p = 0.032). The endotoxin adsorption procedures

  18. A data mining based model for selecting type of treatment for kidney stone patients

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    Sepehri MM

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Data mining as a multidisciplinary field is rooted in the fields such as statistics, mathematics, computer science and artificial intelligence and has been gaining momentum in scientific, managerial, and executive applications in health care. Data mining can be defined as the automated extraction of valuable, practical and hidden knowledge and information from large data. Applying data mining in medical records and data is of utmost importance for health care givers and providers and brings vital and valuable outcomes. Data mining can help doctors come up with better recommendations and plans for treatment which actually in many respects have significant impact on patients' life and satisfaction In this paper we have proposed and utilized data mining methods to extract hidden information in medical records of pelvis stone patients with ureteral stone. We have tried to design a decision support system model to be applicable for selecting type of treatment for these groups of patients."n"nMethods: We gathered needed information from Shahid Hashemi Nejad hospital. In this research we have used decision tree as a data mining tool, for selecting suitable treatment for patients with ureteral stone. This

  19. Alemtuzumab in the treatment of multiple sclerosis: patient selection and special considerations

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    Dörr J

    2016-10-01

    the other are not yet available. Thus, the overall success of alemtuzumab treatment critically depends on the patient selection. The aim of this article is therefore, to characterize the significance of alemtuzumab in the treatment of MS with a focus on the selection of the optimal patient. Keywords: multiple sclerosis, treatment, safety, efficacy, selection, benefit risk relation

  20. Pembrolizumab in the treatment of metastatic non-small-cell lung cancer: patient selection and perspectives

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    Somasundaram A

    2017-01-01

    Full Text Available Ashwin Somasundaram, Timothy F Burns Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA Abstract: Lung cancer is the leading killer of both men and women in the US, and the 5-year survival remains poor. However, the approval of checkpoint blockade immunotherapy has shifted the treatment paradigm and provides hope for improved survival. The ability of non-small-cell lung cancer (NSCLC to evade the host immune system can be overcome by agents such as pembrolizumab (MK-3475/lambrolizumab, which is a monoclonal antibody targeting the programmed death 1 (PD-1 receptor. In early studies, treatment with pembrolizumab led to dramatic and durable responses in select patients (PD-L1+ tumors. This remarkable efficacy lead to approval of pembrolizumab in the second-line setting as response rates were almost doubled compared to standard of care (SOC chemotherapy. Most recently, data in the first-line setting from the KEYNOTE-024 study have redefined the SOC therapy for a selected subset of patients. In patients with ≥50% PD-L1+ tumors, pembrolizumab had a clear progression-free survival and overall survival benefit. Toxicity was mostly immune related and similar to checkpoint blockade toxicities observed in previous studies. The initial approval and subsequent studies of pembrolizumab required and utilized a companion diagnostic test, Dako’s IHC 22C3, to assess PD-L1 status of patients. The evaluation and scoring system of this assay has been used by other companies as a reference to develop their own assays, which may complicate selection of patients. Finally, the impact of pembrolizumab in NSCLC is growing as evidenced by the numerous, ongoing trials open for combinations with chemotherapy, chemoradiation, other immunotherapeutics, immunomodulators, tyrosine kinase inhibitors, PI3K inhibitors, MEK inhibitors, hypomethylating agents, and histone deacetylase inhibitors. Further studies

  1. Selective versus routine patch metal allergy testing to select bar material for the Nuss procedure in 932 patients over 10years.

    Science.gov (United States)

    Obermeyer, Robert J; Gaffar, Sheema; Kelly, Robert E; Kuhn, M Ann; Frantz, Frazier W; McGuire, Margaret M; Paulson, James F; Kelly, Cynthia S

    2018-02-01

    The aim of the study was to determine the role of patch metal allergy testing to select bar material for the Nuss procedure. An IRB-approved (11-04-WC-0098) single institution retrospective, cohort study comparing selective versus routine patch metal allergy testing to select stainless steel or titanium bars for Nuss repair was performed. In Cohort A (9/2004-1/2011), selective patch testing was performed based on clinical risk factors. In Cohort B (2/2011-9/2014), all patients were patch tested. The cohorts were compared for incidence of bar allergy and resultant premature bar loss. Risk factors for stainless steel allergy or positive patch test were evaluated. Cohort A had 628 patients with 63 (10.0%) selected for patch testing, while all 304 patients in Cohort B were tested. Over 10years, 15 (1.8%) of the 842 stainless steel Nuss repairs resulted in a bar allergy, and 5 had a negative preoperative patch test. The incidence of stainless steel bar allergy (1.8% vs 1.7%, p=0.57) and resultant bar loss (0.5% vs 1.3%, p=0.23) was not statistically different between cohorts. An allergic reaction to a stainless steel bar or a positive patch test was more common in females (OR=2.3, pmetal sensitivity. Stainless steel bar allergies occur at a low incidence with either routine or selective patch metal allergy testing. If selective testing is performed, it is advisable in females and patients with a personal or family history of metal sensitivity. A negative preoperative patch metal allergy test does not preclude the possibility of a postoperative stainless steel bar allergy. Level III Treatment Study and Study of Diagnostic Test. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. On The Integral Representation of Strictly Continuous Set-Valued Maps

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    Anaté K. Lakmon

    2015-11-01

    Full Text Available Let T be a completely regular topological space and C(T be the space of bounded, continuous real-valued functions on T. C(T is endowed with the strict topology (the topology generated by seminorms determined by continuous functions vanishing at in_nity. R. Giles ([13], p. 472, Theorem 4.6 proved in 1971 that the dual of C(T can be identi_ed with the space of regular Borel measures on T. We prove this result for positive, additive set-valued maps with values in the space of convex weakly compact non-empty subsets of a Banach space and we deduce from this result the theorem of R. Giles ([13], theorem 4.6, p.473.

  3. A Total Variation Model Based on the Strictly Convex Modification for Image Denoising

    Directory of Open Access Journals (Sweden)

    Boying Wu

    2014-01-01

    Full Text Available We propose a strictly convex functional in which the regular term consists of the total variation term and an adaptive logarithm based convex modification term. We prove the existence and uniqueness of the minimizer for the proposed variational problem. The existence, uniqueness, and long-time behavior of the solution of the associated evolution system is also established. Finally, we present experimental results to illustrate the effectiveness of the model in noise reduction, and a comparison is made in relation to the more classical methods of the traditional total variation (TV, the Perona-Malik (PM, and the more recent D-α-PM method. Additional distinction from the other methods is that the parameters, for manual manipulation, in the proposed algorithm are reduced to basically only one.

  4. Residual diffeomorphisms and symplectic soft hairs: The need to refine strict statement of equivalence principle

    Science.gov (United States)

    Sheikh-Jabbari, M. M.

    2016-09-01

    General covariance is the cornerstone of Einstein’s general relativity (GR) and implies that any two metrics related by diffeomorphisms are physically equivalent. There are, however, many examples pointing to the fact that this strict statement of general covariance needs refinement. There are a very special (measure-zero) subset of diffeomorphisms, the residual diffeomorphisms, to which one can associate well-defined conserved charges. This would hence render these diffeomorphic geometries physically distinct. We discuss that these symmetries may be appropriately called “symplectic symmetries”. Existence of residual diffeomorphisms and symplectic symmetries can be a quite general feature and not limited to the examples discussed so far in the literature. We propose that, in the context of black holes, these diffeomorphic, but distinct, geometries may be viewed as “symplectic soft hair” on black holes. We comment on how this may remedy black hole microstate problem, which in this context are dubbed as “horizon fluffs”.

  5. Reactions to terror attacks in ultra-orthodox jews: the cost of maintaining strict identity.

    Science.gov (United States)

    Ankri, Yael L E; Bachar, Eytan; Shalev, Arieh Y

    2010-01-01

    Traumatic events can shatter faith and beliefs. The responses of Ultra-Orthodox survivors of deadly terrorist attacks illustrate an effort to reconcile dreadful experiences with deeply embedded beliefs. Qualified clinicians prospectively evaluated self-reported and interviewer-generated posttraumatic stress disorder (PTSD) symptoms and cognitive appraisal in Ultra-Orthodox (n = 20) and non-Ultra-Orthodox (n = 33) survivors of suicide bus-bombing incidents in Jerusalem. Ultra-Orthodox survivors reported higher levels of PTSD symptoms and more personal guilt. Their narratives reflected an unshaken belief in Just Providence, within which being a victim of terror was perceived as a Just retribution for known or unknown wrongdoing. Survivors' reactions to trauma often reflect an effort to reconcile incongruous experiences with previously held beliefs. When treating strict believers, helpers should be sensitive to the identity-preserving function of posttraumatic cognitions.

  6. On a class of adjustable rate mortgage loans subject to a strict balance principle

    DEFF Research Database (Denmark)

    Astrup Jensen, Bjarne

    We describe the background and the basic funding mechanisms for the type of adjustable rate mortgageloans that were introduced in the Danish market in 1996. Each loan is funded separately by tap issuingpass-through mortgage bonds (`strict balance principle'). The novelty is a funding mechanism...... that usesa roll-over strategy, where long term loans are funded by sequentially issuing short term pass-throughbonds, and the first issuer of these loans obtained a patent on the funding principles in 1999. Publiclyavailable descriptions of the principles leave an impression of very complicated numerical...... algorithms.The algorithms described here show that the essentials can be reduced to a `back of an envelope' complexity.Keywords: Adjustable rate mortgages, balance principle, patent, yield curve riding...

  7. [General principles of effective communication between physician and patient with selected mental disorders].

    Science.gov (United States)

    Błaszczyk, Justyna; Bobińska, Kinga; Filip, Maria; Gałecki, Piotr

    2015-04-01

    Faced with the growing frequency of mental disorders occurrence and considering the necessity of improving the patient care, it is particularly important that physicians of different specialties knew the general principles of effective communication with patients who are mentally ill. Equally important is to spread the knowledge of the symptomatology of various mental illnesses. Studies published by the Institute of Psychiatry and Neurology involving persons between 18 and 64 years old, show that 8 millions Poles suffers or suffered from mental disorders. This represents almost 25% of Polish society. The above data confirm, that basic knowledge of criteria for diagnosing mental disorders and their treatment by primary care physicians, determines the success of the entire health care system. It must be taken into consideration that frequently patients seeing general practitioner (GP) are suffering from more than one mental illness or it is accompanied by somatic disease. Adequate communication determines effective treatment. Simple yet exact message, ability to adapt it to patient and problems reported by him, is a valuable means in daily medical practice. It reduces the risk of iatrogenic disorder, encourages the efficiency of the entire therapeutic process. Good cooperation with the patient is also determined by patience, empathy, understanding, and competence. The aim of this study is to present the principles of effective communication between doctor and patient suffering from selected mental disorders. The article defines the concept of communication. It shows symptomatology of primary psychiatric disorders. Moreover, the most common difficulties in relationship between the doctor and the patient had been pointed. © 2015 MEDPRESS.

  8. Strict Liability Versus Policy and Regulation for Environmental Protection and Agricultural Waste Management in Malaysia

    Directory of Open Access Journals (Sweden)

    Mohd Bakri Ishak

    2010-01-01

    Full Text Available Basically, strict liability is part of the mechanism for expressing judgment or sentence by using direct evidence. This principle is very useful in order to obtain remedies from any damage either directly or indirectly. The principle in Rylands v Fletcher is responsible on imposing strict liability where if something brought onto land or collected there escapes liability under this rule can include not only the owner of land but also those who control or occupation on it. However, as a matter of fact, policy and regulation are also important in taking any action against any party who are responsible for environmental pollution or damage, which may include mismanagement of waste or industrial waste or agricultural waste. There are certain policies and regulations on environmental protection such as the National Environmental Policy, certain Acts and several regulations under the Environmental Quality Act 1974 (Act 127, which are very useful for agricultural waste management inter alia: Waters Act 1920 (Act 418, Environmental Quality (Prescribed Premises (Crude Palm Oil Regulations 1977, Environmental Quality (Prescribed Premises (Raw Natural Rubber Regulations 1978, Environmental Quality (Sewage and Industrial Effluents Regulations 1979, and Environmental Quality (Compounding of Offences Rules 1978. As a matter of fact, we should realize that time is of an essence for any parties which are involved in court cases and especially in avoiding the element of externality, which is commonly suffered by the government. In making this paper, therefore, some element of comparison with certain developed jurisdiction such as in the United Kingdom and Japan could not be avoided in order to obtain better outcome and to be more practical for the purpose of environmental protection and agricultural waste management.

  9. Strict stoichiometric homeostasis of Cryptomonas pyrenoidifera (Cryptophyceae in relation to N:P supply ratios

    Directory of Open Access Journals (Sweden)

    Eloísa Ramos Rodríguez

    2016-11-01

    Full Text Available A common freshwater cryptophyte, Cryptomonas pyrenoidifera, was cultivated in batch-cultures to analyze intraspecific variation in elemental stoichiometry along a broad gradient of pulsed phosphorus (P enrichment during the early acclimation period and to determine the immediate homeostatic capacity of the nitrogen-to-phosphorus (N:P ratio of this alga when nutrients are at saturating levels. Experimental results revealed that nitrogen (N and P cell quotas significantly increased with increasing P concentration. However, despite the wide range of N:P ratios in the medium, Cryptomonas N:P ratios were highly stable at higher P-level treatments, indicating a highly conservative behavior and suggesting strict elemental homeostasis when nutrients are at saturating levels. The strictly homeostatic N:P ratio appears to be attributable to their high potential for a fast luxury consumption of both N and P after a brief and intense episode of increased resource availability and to physiological limits on their nutrient storage capacity. Most importantly, the N:P biomass ratio at nutrient saturating levels converged around 11:1, which was the observed ratio of maximum internal cell quotas for N and P (i.e. Qmax,N:Qmax,P under the prevailing experimental conditions. This value is particularly informative for C. pyrenoidifera because it represents cell storage quotients and may be a taxon-specific evolutionary optimum, providing a reference point to infer the grade of nutrient-limitation. The experimental data give ranges of variation in C. pyrenoidifera elemental composition permitting, among others, proper parameterization of cryptophyte stoichiometry models.

  10. Strict follow-up programme including CT and (18) F-FDG-PET after curative surgery for colorectal cancer

    DEFF Research Database (Denmark)

    Sørensen, N F; Jensen, A B; Wille-Jørgensen, P

    2010-01-01

    Aim  The risk of local recurrence following curative surgery for colorectal cancer (CRC) is up to 50%. A rigorous follow-up program may increase survival. Guidelines on suitable methods for scheduled follow up examinations are needed. This study evaluates a strict follow-up program including...... supported a strict follow-up program following curative surgery for colorectal cancer. FDG-PET combined with CT should be included in control programs....

  11. The Selective Impairment of the Phonological Output Buffer: Evidence From a Chinese Patient

    Directory of Open Access Journals (Sweden)

    Hua Shu

    2005-01-01

    Full Text Available We present a Chinese-speaking patient, SJ, who makes phonological errors across all tasks involving oral production. Detailed analyses of the errors across different tasks reveal that the patterns are very similar for reading, oral picture naming, and repetition tasks, which are also comparable to the error patterns of the phonological buffer deficit cases reported in the literature. The nature of the errors invites us to conclude that the patient's phonological output buffer is selectively impaired. Different from previously reported cases, SJ's deficits in oral production tasks are not accompanied by a similar impairment of writing performance. We argue that this dissociation is evidence that the phonological output buffer is not involved in writing Chinese words. Furthermore, the majority of SJ's errors occur at the onset of a syllable, indicating that the buffer has a structure that makes the onset more prone to impairment.

  12. B-lymphocyte subpopulations in patients with selective IgA deficiency.

    Science.gov (United States)

    Nechvatalova, Jana; Pikulova, Zdenka; Stikarovska, Dagmar; Pesak, Sava; Vlkova, Marcela; Litzman, Jiri

    2012-06-01

    Selective deficiency IgA (IgAD) is the most common primary abnormality of immunoglobulin production with unknown pathophysiology. It is genetically related to common variable immunodeficiency (CVID), where besides IgA also IgG and frequently IgM serum levels are decreased. In this study we focused on determination of B-lymphocyte developmental stages and searching for similarities between CVID and IgAD. Using flow cytometry we determined major lymphocyte subpopulations and B-lymphocyte subsets: naïve (CD27(-)IgD(+)), marginal zone cells (CD27(+)IgD(+)), class-switched memory cells (CD27(+)IgD(-)), "double-negative" B cells (CD27(-)IgD(-)), transitional cells (IgM(++)CD38(++)), plasmablasts (CD38(+++)IgM(+) or IgM(-)), and CD21(low)CD38(low) cells in 80 patients with IgAD, 48 patients with CVID, and 80 control persons. Compared to healthy controls, a decrease in the absolute number and frequency of CD4+ cells (both < 0.001) was observed in IgAD patients. A decrease in the frequency of switched memory cells (P < 0.001), transitional cells (P = 0.035) as well as plasmablasts (P < 0.001) and an increase in the CD21(low)CD38(low) subset (P = 0.007) was observed in IgAD patients compared to control persons. No significant differences were observed in the remaining B-cell developmental subsets. A decrease in CD27(+)IgD(-) (<0.4% of peripheral blood lymphocytes), frequently observed in CVID patients and also previously reported in IgAD, was found in only five patients (6%) with IgAD, two of them being first-degree relatives of CVID patients. Our results show a decrease of terminally differentiated B-lymphocyte subsets in patients with IgAD, similar as previously found in patients with CVID, but these results are less expressed than in CVID patients.

  13. Patient selection for incus body coupling of a totally implantable middle ear implant.

    Science.gov (United States)

    Zenner, Hans Peter; Baumann, Joachim W; Reischl, Gabriele; Plinkert, Peter; Zimmermann, Rainer; Mauz, Paul S; Limberger, Annette; Maassen, Marcus M

    2003-08-01

    To evaluate audiologic selection criteria for incus body coupling (IBC) of a totally implantable middle ear implant (TI-MEI) for the treatment of sensorineural hearing loss (SNHL). The protocol is specified in the Investigational Device Exemption of a Food and Drug Administration-approved multicenter clinical trial. The prospective study compared pre- and postoperative hearing levels using each patient as their own control. In addition, an implant on/off comparison was made. All patients had a follow-up interval of at least 6 months. Audiologic assessment tests included speech discrimination in quiet as the primary efficacy variable and pure-tone audiometry (aided thresholds), gain, speech recognition in noise and subject satisfaction using standardized questionnaires and visual analog scales (VASs) as secondary efficacy variables. The study group of patients (n = 13) was divided into 3 subgroups based on their pure-tone and speech discrimination scores: Group A consisted of 6 patients, Group B 9 patients and Group C of all 13 patients. All patients suffered from long-standing bilateral moderate to severe SNHL. Five patients were dissatisfied hearing aid (HA) users and eight subjects could not wear HAs. All patients were implanted with a TI-MEI which was coupled to the incus body. The amplification level of the device was set postoperatively using inductive digital fitting based on "most comfortable loudness" specifications. The implant produced median improvements from 30% (optimally fit bilateral HAs; n = 5) and 50% (HA non-users; n = 8) to 70% word recognition at 60 dB SPL. Average word recognition scores at 60, 80 and 90 dB SPL in Groups A and B showed increases from 42% (interquartile range +27%, -12%) to 93.5% (+3%, -5%) and 92.5% (+3%, -7%), respectively. In the presence of background noise, the sentence recognition threshold ranged from -2 to 1 dB signal-to-noise ratio. Maximum amplification was 50 dB at 3 kHz and 55 dB at 4 kHz. In Groups A and B, VASs

  14. Unspeakable motion: Selective action-verb impairments in Parkinson's disease patients without mild cognitive impairment.

    Science.gov (United States)

    Bocanegra, Yamile; García, Adolfo M; Lopera, Francisco; Pineda, David; Baena, Ana; Ospina, Paula; Alzate, Diana; Buriticá, Omar; Moreno, Leonardo; Ibáñez, Agustín; Cuetos, Fernando

    2017-05-01

    Parkinson's disease (PD) patients show marked impairments in processing action verbs, and to a lesser extent, concrete (specially, manipulable) nouns. However, it is still unclear to what extent deficits in each of these categories are influenced by more general cognitive dysfunctions, and whether they are modulated by the words' implied motility. To examine these issues, we evaluated 49 non-demented PD patients and 49 healthy volunteers in an oral production task. The patients were divided into two groups depending on the presence or absence of mild cognitive impairment (PD-MCI and PD-nMCI, respectively). Participants named pictures of actions varying in motion content (low and high) and of objects varying in manipulability (low and high). The PD-MCI group showed deficits across all four categories. However, PD-nMCI patients exhibited a selective difficulty for high-motion action verbs. This finding corroborates and refines previous results suggesting that disturbances of action-related lexico-semantic information in PD constitute a sui generis alteration manifested early in the course of the disease's physiopathology. Moreover, it suggests that the grounding of action verbs on motor circuits could depend on fine-grained intracategorical semantic distinctions. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Selective internal radiation therapy in patients with progressive neuroendocrine liver metastases.

    Science.gov (United States)

    Barbier, Charlotte Ebeling; Garske-Román, Ulrike; Sandström, Mattias; Nyman, Rickard; Granberg, Dan

    2016-07-01

    To evaluate the safety and efficacy of selective internal radiation therapy (SIRT) in patients with unresectable liver metastases from neuroendocrine tumours (NETLMs). This retrospective study included 40 patients with progressive NETLMs (22 women, 18 men, mean age 61.6 years) who underwent SIRT with (90)Y-labelled resin microspheres. Tumour response was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) on CT or MR images. Medical records were reviewed. In the 40 patients, 54 evaluable SIRT procedures were performed, 33 to the right liver lobe (mean activity 1.31 GBq), 13 to the left lobe (mean activity 0.85 GBq), and 8 to both lobes (mean activity 1.61 GBq). Late follow-up imaging (mean 20 months) was performed after 44 of the treatments. Objective tumour response and disease control rates were 54 % (29 of 54 treatments) and 94 % (51 treatments), respectively, at the early follow-up examination (mean 3 months) and 34 % (15 treatments) and 57 % (25 treatments), respectively at the late follow-up examination. Mean overall survival from the first SIRT was 34,8 months and survival rates at 1, 2, 3 and 5 years were 76 %, 59 %, 52 % and 35 % respectively. Adverse effects were generally mild and easily manageable, except in one patient who died from radiation-induced liver failure. Of the 45 patients, 18 (45 %) had received peptide receptor radionuclide therapy (PRRT) prior to SIRT. SIRT with (90)Y-labelled resin microspheres is a safe and effective treatment for patients with progressive NETLM, and also for those who have received prior PRRT.

  16. Selective laser trabeculoplasty reduces mean IOP and IOP variation in normal tension glaucoma patients

    Directory of Open Access Journals (Sweden)

    Mohammed K El Mallah

    2010-07-01

    Full Text Available Mohammed K El Mallah1, Molly M Walsh2, Sandra S Stinnett2, Sanjay G Asrani21Ocala Eye, Ocala, Florida, USA; 2Duke University Eye Center, Durham, North Carolina, USAPurpose: To evaluate the effect of selective laser trabeculoplasty (SLT in normal tension glaucoma (NTG patients.Patients and methods: A retrospective review was performed of NTG patients who had undergone SLT at the Duke University Eye Center between 12/2002 and 7/2005. For each eye of each patient at pre-laser and post-laser time points, the IOP measurements were summarized by mean, standard deviation, and range. Then for each of these descriptive statistics, the differences between pre-laser and post-laser values were obtained. Statistical analysis was performed using a random effects model. Main outcome measures: difference in mean IOP, standard deviation of IOP, and range of IOP.Results: Thirty-one eyes of 18 patients were included for analysis. The average of the mean ­pre-operative IOP measurements was 14.3 ± 2.6 mmHg compared to 12.2 ± 1.7 mmHg (P < 0.001 post-operatively. The mean pre-operative standard deviation was 1.9 ± 0.9 mmHg compared to 1.0 ± 0.6 mmHg (P = 0.002 post-operatively while the mean IOP range prior to treatment was 4.5 ± 2.5 mmHg compared to 2.5 ± 1.9 mmHg (P = 0.017 after treatment.Conclusion: In this pilot study, SLT was found to lower mean IOP and intervisit IOP ­variation in NTG patients. Given the importance of IOP variation and its association with glaucoma ­progression, measurement of IOP variation following treatment with SLT may be considered.Keywords: SLT, NTG, laser, glaucoma

  17. Health selection into neighborhoods among patients enrolled in a clinical trial

    Directory of Open Access Journals (Sweden)

    Mariana C. Arcaya

    2017-12-01

    Full Text Available Health selection into neighborhoods may contribute to geographic health disparities. We demonstrate the potential for clinical trial data to help clarify the causal role of health on locational attainment. We used data from the 20-year United Kingdom Prospective Diabetes Study (UKPDS to explore whether random assignment to intensive blood-glucose control therapy, which improved long-term health outcomes after median 10 years follow-up, subsequently affected what neighborhoods patients lived in. We extracted postcode-level deprivation indices for the 2710 surviving participants of UKPDS living in England at study end in 1996/1997. We observed small neighborhood advantages in the intensive versus conventional therapy group, although these differences were not statistically significant. This analysis failed to show conclusive evidence of health selection into neighborhoods, but data suggest the hypothesis may be worthy of exploration in other clinical trials or in a meta-analysis. Keywords: Neighborhoods, Self-selection, Health, Equity, Socioeconomic status

  18. [Indications of lung transplantation: Patients selection, timing of listing, and choice of procedure].

    Science.gov (United States)

    Morisse Pradier, H; Sénéchal, A; Philit, F; Tronc, F; Maury, J-M; Grima, R; Flamens, C; Paulus, S; Neidecker, J; Mornex, J-F

    2016-02-01

    Lung transplantation (LT) is now considered as an excellent treatment option for selected patients with end-stage pulmonary diseases, such as COPD, cystic fibrosis, idiopathic pulmonary fibrosis, and pulmonary arterial hypertension. The 2 goals of LT are to provide a survival benefit and to improve quality of life. The 3-step decision process leading to LT is discussed in this review. The first step is the selection of candidates, which requires a careful examination in order to check absolute and relative contraindications. The second step is the timing of listing for LT; it requires the knowledge of disease-specific prognostic factors available in international guidelines, and discussed in this paper. The third step is the choice of procedure: indications of heart-lung, single-lung, and bilateral-lung transplantation are described. In conclusion, this document provides guidelines to help pulmonologists in the referral and selection processes of candidates for transplantation in order to optimize the outcome of LT. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Macro-amylasemia in a patient with selective IgA deficiency and antiphospholipid antibodies.

    Science.gov (United States)

    Türkçapar, Nuran; Ozyüncü, Nil; Idilman, Ramazan; Ensari, Arzu; Soylu, Kazim; Ozden, Ali

    2006-06-01

    We report an unusual case with macro-amylasemia with coexistent selective IgA deficiency and antiphospholipid antibodies. A 16-year-old girl was referred to us with a history of episodic abdominal pain accompanied by vomiting and diarrhea. Macroamylasemia was demonstrated by precipitation of 99% amylase activity with polyethylene glycol 6000. She had high levels of anticardiolipin IgG and beta2 glycoprotein 1 IgG antibodies in the blood, but no evidence of clinical criteria of antiphospholipid syndrome. In the literature, although macro-amylasemia has been found to occur in a variety of diseases including autoimmune disorders, to our knowledge, this is the first well-documented case of macro-amylasemia associated with selective IgA deficiency and the presence of antiphospholipid antibodies. It is important that clinicians be aware of their existence in order to avoid unnecessary procedures and that the patient is informed of the macro-amylasemia; moreover, it should be stated in the patient's health record.

  20. Effect of selection of QTc formula on eligibility of cancer patients for phase I clinical trials.

    Science.gov (United States)

    Borad, Mitesh J; Soman, Arundhati D; Benjamin, Martin; Casa, Daniel; Tembe, Waibhav D; Piper, Barbara F; Ramanathan, Ramesh; Tibes, Raoul; Jameson, Gayle; Ansaldo, Karen; Von Hoff, Daniel D

    2013-08-01

    A retrospective analysis of 130 patients was conducted in a Phase I oncology clinic to assess the effect of QTc formula selection on clinical trial eligibility. QTc values were calculated from screening electrocardiograms using 7 formulae (Bazett, Fridericia, Framingham, Hodges, Mayeda, Van de Water and Wohlfart). QTc values > 470 ms for females and > 450 ms for males were used to define prolongation. Concomitant medication potential for QTc prolongation was determined using a public database (AzCert). Ineligibility rates ranged from 3.1 % to 17.7 % (Framingham: 3.1 %, Van de Water: 3.1 %, Hodges: 3.1 %, Wohlfart: 3.1 %, Fridericia: 3.9 %, Bazett: 10.8 % and Mayeda: 17.7 %). A consistent ineligibility rate was achieved by using formulae-specific thresholds. Fifty one percent of patients were taking concomitant medications with QTc prolongation potential. The proportion of concomitant medications with the potential to prolong QTc was 11.57 % (96 of 830). Uniform criteria and guidelines for selection of QTc formulae need to be developed. Formulae-specific QTc thresholds also need to be specified.

  1. Distinct quasispecies characteristics and positive selection within the core gene in chronic hepatitis B virus infected child and adult patients.

    Science.gov (United States)

    Deng, Hai-jun; Huang, Yong; Huang, Ai-long; Long, Quan-xin

    2015-05-01

    There are significant differences in clinical characteristics between chronic hepatitis B virus infected (CHB) child and adult patients. Viral quasispecies characteristics are associated with its pathogenic properties. For hepatitis B virus (HBV), its core region is the main immune recognition region for its enriched epitopes. In our study, we discuss the quasispecies characteristics and positive selection within core gene within chronic HBV infected child and adult patients. By analyzing 170 core gene sequences from child CHB patients and 121 core genes sequences from adult CHB patients, quasispecies characteristics were described by sequence complexity, diversity, non-synonymous substitution ratio (dN) and synonymous substitution ratios (dS). In addition, positive selection sites were also determined by bioinformatics tools. Then, all these parameters were compared between child and adult CHB patient groups. Compared with child patients, adult patients with CHB showed distinct quasispecies characteristics within the core region, had a higher sequence complexity and diversity and more positive selection sites, suggesting that the adult CHB patients had a higher immune selection pressure on the HBV core gene. Reduced selection pressure on the HBV core gene in hepatitis B e antigen (HBeAg)-positive CHB patients than HBeAg negative CHB patients were observed in both adult and child patient groups. The majority of the screened positive selection sites lay within human leukocyte antigens (HLA)-restricted epitopes. In conclusion, this study analyzed the quasispecies characteristics discrepancy between child and adult patients with CHB, and revealed the possible reason for the distinct clinical characteristics in the perspective of population genetics.

  2. Comparing Non-Medical Sex Selection and Saviour Sibling Selection in the Case of JS and LS v Patient Review Panel: Beyond the Welfare of the Child?

    Science.gov (United States)

    Smith, Malcolm K; Taylor-Sands, Michelle

    2018-03-01

    The national ethical guidelines relevant to assisted reproductive technology (ART) have recently been reviewed by the National Health and Medical Research Council (NHMRC). The review process paid particular attention to the issue of non-medical sex selection, although ultimately, the updated ethical guidelines maintain the pre-consultation position of a prohibition on non-medical sex selection. Whilst this recent review process provided a public forum for debate and discussion of this ethically contentious issue, the Victorian case of JS and LS v Patient Review Panel (Health and Privacy) [2011] VCAT 856 provides a rare instance where the prohibition on non-medical sex selection has been explored by a court or tribunal in Australia. This paper analyses the reasoning in that decision, focusing specifically on how the Victorian Civil and Administrative Tribunal applied the statutory framework relevant to ART and its comparison to other uses of embryo selection technologies. The Tribunal relied heavily upon the welfare-of-the-child principle under the Assisted Reproductive Treatment Act 2008 (Vic). The Tribunal also compared non-medical sex selection with saviour sibling selection (that is, where a child is purposely conceived as a matched tissue donor for an existing child of the family). Our analysis leads us to conclude that the Tribunal's reasoning fails to adequately justify the denial of the applicants' request to utilize ART services to select the sex of their prospective child.

  3. Single-donor islet transplantation in type 1 diabetes: patient selection and special considerations

    Directory of Open Access Journals (Sweden)

    Tatum JA

    2017-02-01

    Full Text Available Jacob A Tatum,* Max O Meneveau,* Kenneth L Brayman Department of Surgery, Division of Transplantation, The University of Virginia Health System, Charlottesville, VA, USA *These authors contributed equally to this work. Abstract: Type 1 diabetes mellitus is an autoimmune disorder of the endocrine pancreas that currently affects millions of people in the United States. Although the disease can be managed with exogenous insulin administration, the ultimate cure for the condition lies in restoring a patient’s ability to produce their own insulin. Islet cell allotransplantation provides a means of endogenous insulin production. Though far from perfected, islet transplants are now a proven treatment for type 1 diabetics. However, proper patient selection is critical for achieving optimal outcomes. Given the shortage of transplantable organs, selecting appropriate candidates for whom the procedure will be of greatest benefit is essential. Although many of those who receive islets do not retain insulin independence, grafts do play a significant role in preventing hypoglycemic episodes that can be quite detrimental to quality of life and potentially fatal. Additionally, islet transplant requires lifelong immunosuppression. Antibodies, both preformed and following islet infusion, may play important roles in graft outcomes. Finally, no procedure is without inherent risk and islet transfusions can have serious consequences for recipients’ livers in the form of both vascular and metabolic complications. Therefore, patient-specific factors that should be taken into account before islet transplantation include aims of therapy, sensitization, and potential increased risk for hepatic and portal-venous sequelae. Keywords: islet transplantation, diabetes mellitus type 1, brittle diabetes, single donor, patient

  4. Cost Analysis of Selected Patient Categories Within A Dermatology Department Using an ABC Approach.

    Science.gov (United States)

    Papadaki, Šárka; Popesko, Boris

    2015-11-17

    Present trends in hospital management are facilitating the utilization of more accurate costing methods, which potentially results in superior cost-related information and improved managerial decision-making. However, the Activity-Based Costing method (ABC), which was designed for cost allocation purposes in the 1980s, is not widely used by healthcare organizations. This study analyzes costs related to selected categories of patients, those suffering from psoriasis, varicose ulcers, eczema and other conditions, within a dermatology department at a Czech regional hospital. The study was conducted in a hospital department where both inpatient and outpatient care are offered. Firstly, the diseases treated at the department were identified. Further costs were determined for each activity using ABC. The study utilized data from managerial and financial accounting, as well as data obtained through interviews with departmental staff. Using a defined cost-allocation procedure makes it possible to determine the cost of an individual patient with a given disease more accurately than via traditional costing procedures. The cost analysis focused on the differences between the costs related to individual patients within the selected diagnoses, variations between inpatient and outpatient treatments and the costs of activities performed by the dermatology department. Furthermore, comparing the costs identified through this approach and the revenue stemming from the health insurance system is an option. Activity-Based Costing is more accurate and relevant than the traditional costing method. The outputs of ABC provide an abundance of additional information for managers. The benefits of this research lie in its practically-tested outputs, resulting from calculating the costs of hospitalization, which could prove invaluable to persons involved in hospital management and decision-making. The study also defines the managerial implications of the performed cost analysis for the

  5. Risk-adjusted treatment selection and outcome of patients with acute cholecystitis.

    Science.gov (United States)

    González-Muñoz, J I; Franch-Arcas, G; Angoso-Clavijo, M; Sánchez-Hernández, M; García-Plaza, A; Caraballo-Angeli, M; Muñoz-Bellvís, L

    2017-06-01

    Age and comorbidities increase the surgical risk for patients with acute cholecystitis and impact on the initial treatment selection. The aim of this article is the implementation of objective risk criteria that may be used to select the most appropriate treatment. We carried out a prospective cohort study of all patients who were admitted to the hospital with a diagnosis of acute cholecystitis during 2014. They were initially allocated to three different treatment groups according to cholecystitis grade, number of days from clinical onset, and surgical risk scores as follows: immediate surgery by sepsis (EmergS), early surgery (EarlyS), or medical treatment group (MedT). Differences in the outcomes between the treatment groups were evaluated using bivariate and logistic regression analyses. A total of 149 patients were admitted; 44 % were >80 years old and 40 % were American Society of Anesthesiologists (ASA) > II. The mortality rate of the series was 0 % in EarlyS, 17 % in MedT, and 19 % in EmergS. The mortality rate was significantly associated with a higher degree of cholecystitis, age, and worse score values in risk scales and Charlson index. Logistic regression identified that the only independent predictors of death at the time of admission were the degree of cholecystitis (OR 2.87, p = 0.018) and the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score (OR 1.14, p = 0.001). The evaluation for the initial treatment in acute cholecystitis should include a systematic determination of the degree of cholecystitis and a surgical risk assessment. Tokyo guideline recommendations should be reviewed.

  6. Value of Computed Tomographic Perfusion-Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment

    NARCIS (Netherlands)

    Borst, Jordi; Berkhemer, Olvert A.; Roos, Yvo B. W. E. M.; van Bavel, Ed; van Zwam, Wim H.; van Oostenbrugge, Robert J.; van Walderveen, Marianne A. A.; Lingsma, Hester F.; van der Lugt, Aad; Dippel, Diederik W. J.; Yoo, Albert J.; Marquering, Henk A.; Majoie, Charles B. L. M.; Fransen, Puck S. S.; Beumer, Debbie; van den Berg, Lucie A.; Schonewille, Wouter J.; Vos, Jan Albert; Nederkoorn, Paul J.; Wermer, Marieke J. H.; Staals, Julie; Hofmeijer, Jeannette; van Oostayen, Jacques A.; Lycklama à Nijeholt, Geert J.; Boiten, Jelis; Brouwer, Patrick A.; Emmer, Bart J.; de Bruijn, Sebastiaan F.; van Dijk, Lukas C.; Kappelle, L. Jaap; Lo, Rob H.; van Dijk, Ewoud J.; de Vries, Joost; de Kort, Paul L. M.; van den Berg, Jan S. P.; van Hasselt, Boudewijn A. A. M.; Aerden, Leo A. M.; Dallinga, René J.; Visser, Marieke C.; Bot, Joseph C. J.; Vroomen, Patrick C.; Eshghi, Omid; Schreuder, Tobien H. C. M. L.; Heijboer, Roel J. J.; Keizer, Koos; Tielbeek, Alexander V.; den Hertog, Heleen M.; Gerrits, Dick G.; van den Berg-Vos, Renske M.; Karas, Giorgos B.; Steyerberg, Ewout W.; Flach, H. Zwenneke; Sprengers, Marieke E. S.; Jenniskens, Sjoerd F. M.; Beenen, Ludo F. M.; van den Berg, René; Koudstaal, Peter J.; Brown, Martin M.; Liebig, Thomas; Stijnen, Theo; Andersson, Tommy; Mattle, Heinrich; Wahlgren, Nils; van der Heijden, Esther; Ghannouti, Naziha; Fleitour, Nadine; Hooijenga, Imke; Puppels, Corina; Pellikaan, Wilma; Geerling, Annet; Lindl-Velema, Annemieke; van Vemde, Gina; de Ridder, Ans; Greebe, Paut; de Bont-Stikkelbroeck, José; de Meris, Joke; Janssen, Kirsten; Struijk, Willy; Simons, Tiny; Messchendorp, Gert; van der Minne, Friedus; Bongenaar, Hester; Licher, Silvan; Boodt, Nikki; Ros, Adriaan; Venema, Esmee; Slokkers, Ilse; Ganpat, Raymie-Jayce; Mulder, Maxim; Saiedie, Nawid; Heshmatollah, Alis; Schipperen, Stefanie; Vinken, Stefan; van Boxtel, Tiemen; Koets, Jeroen; Boers, Merel; Santos, Emilie; Jansen, Ivo; Kappelhof, Manon; Lucas, Marit; Geuskens, Ralph; Barros, Renan Sales; Dobbe, Roeland; Csizmadia, Marloes

    2015-01-01

    The utility of computed tomographic perfusion (CTP)-based patient selection for intra-arterial treatment of acute ischemic stroke has not been proven in randomized trials and requires further study in a cohort that was not selected based on CTP. Our objective was to study the relationship between

  7. Intensive induction is effective in selected octogenarian acute myeloid leukemia patients: prognostic significance of karyotype and selected molecular markers used in the European LeukemiaNet classification.

    Science.gov (United States)

    Wetzler, Meir; Mrózek, Krzysztof; Kohlschmidt, Jessica; Dombret, Hervé; Döhner, Hartmut; Pilorge, Sylvain; Krug, Utz; Carroll, Andrew J; Larson, Richard A; Marcucci, Guido; Hiddemann, Wolfgang; Büchner, Thomas; Bloomfield, Clara D

    2014-02-01

    We investigated whether octogenarian patients with acute myeloid leukemia enrolled onto Cooperative Group clinical trials and treated with intensive induction therapy could be cured, and whether karyotype and selected molecular markers had any prognostic significance in these patients. Among 138 patients with cytogenetic information, normal karyotype was the most common (47.1%) followed by complex karyotype (14.5%) and sole +8 (9.4%). Among these patients, the relapse-free survival rate at 1 year was 37% and 13% at 3 years, and the respective overall survival rates were 24% and 8%. Whereas the 90 patients who survived beyond 30 days had the same relapse-free survival rates, their 1-year and 3-year overall survival rates were 36% and 11%, respectively. Of the 66 patients surviving beyond 30 days who could be classified into European LeukemiaNet genetic groups, those in the intermediate-I group had better overall survival than patients in the adverse group (P=0.01). Among patients with cytogenetically normal acute myeloid leukemia who were tested for the European LeukemiaNet-associated molecular alterations, FLT3-internal tandem duplication and NPM1 mutations, it was found that FLT3-internal tandem duplication (detected in 29% of patients) did not associate with overall survival (P=0.31), whereas NPM1 mutations (30%) were associated with a significantly longer overall survival (P=0.002). We conclude that intensive induction is effective and indicated in selected octogenarians with acute myeloid leukemia, that their overall survival varies among the European LeukemiaNet genetic groups and that NPM1 mutations may be of prognostic significance among octogenarian patients with cytogenetically normal acute myeloid leukemia.

  8. Selection and Characterization of Palmitic Acid Responsive Patients with an OXPHOS Complex I Defect

    Directory of Open Access Journals (Sweden)

    Tom E. J. Theunissen

    2017-10-01

    a clinical and biochemical level that a high fat diet can be beneficial for complex I patients and that our cell line assay will be an easy tool for the selection of patients, who might potentially benefit from this therapeutic diet.

  9. Selecting the patients for morning report sessions: case-based vs. conventional method.

    Science.gov (United States)

    Rabiei, Mehdi; Saeidi, Masumeh; Kiani, Mohammad Ali; Amin, Sakineh Mohebi; Ahanchian, Hamid; Jafari, Seyed Ali; Kianifar, Hamidreza

    2015-08-01

    One of the most important issues in morning report sessions is the number of patients. The aim of this study was to investigate and compare the number of cases reported in the morning report sessions in terms of case-based and conventional methods from the perspective of pediatric residents of Mashhad University of Medical Sciences. The present study was conducted on 24 pediatric residents of Mashhad University of Medical Sciences in the academic year 2014-2015. In this survey, the residents replied to a 20-question researcher-made questionnaire that had been designed to measure the views of residents regarding the number of patients in the morning report sessions using case-based and conventional methods. The validity of the questionnaire was confirmed by experts' views and its reliability by calculating Cronbach's alpha coefficients. Data were analyzed by t-test analysis. The mean age of the residents was 30.852 ± 2.506, and 66.6% of them were female. The results showed that there was no significant relationship among the variables of academic year, gender, and residents' perspective to choosing the number of patients in the morning report sessions (P > 0.05). T-test analysis showed a significant relationship among the average scores of residents in the selection of the case-based method in comparison to the conventional method (P case-based morning report was preferred compared to the conventional method. This method makes residents pay more attention to the details of patients' issues and therefore helps them to better plan how to address patient problems and improve their differential diagnosis skills.

  10. A novel method for laryngeal mask airway size selection in paediatric patients.

    Science.gov (United States)

    Zahoor, Abdul; Ahmad, Nauman; Sereche, Getu; Riad, Waleed

    2012-08-01

    The successful use of the laryngeal mask airway in children partly depends on the correct selection of size. Most anaesthesiologists rely on the weight-based table which is often difficult to remember. A simple method allowing an adequate choice of the correct size may be highly desirable. To test the hypothesis that the size of the external ear (pinna) of the child may be used as proxy for the required size of laryngeal mask airway. A descriptive study. King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Two hundred and ten paediatric patients aged 6 months to 15 years, of either sex, American Society of Anesthesiologists (ASA) 1-2 and scheduled for routine ophthalmological procedures from 1 March to 31 December 2010. Emergency cases, patients with a full stomach or with a history of any oropharyngeal lesion other than tonsillar hypertrophy were excluded. The size of the external ear was measured with a ruler in vertical and horizontal dimensions in the first 30 patients, and visually evaluated for the remaining patients. For all, the nearest corresponding size of partially inflated laryngeal mask airway was chosen and inserted after induction. The correct placement was assessed using predefined criteria. Insertion and good ventilation was achieved in 196 (93.3%) on first attempt. Fourteen patients (6.7%) required a second attempt and the main reason for failure was an audible leak because of smaller size. Choosing the size of the laryngeal mask airway in children according to the size of the external ear was associated with a success rate of 93% which is comparable with that reported in the literature when the tables are used. This simple method may allow a rapid choice of the correct size of laryngeal mask airway and may eliminate the need to remember different tables or formulae.

  11. General quality of life of patients with acne vulgaris before and after performing selected cosmetological treatments

    Science.gov (United States)

    Chilicka, Karolina; Maj, Joanna; Panaszek, Bernard

    2017-01-01

    Background Achieving a satisfying quality of life for a patient by applying individually matched therapy is, simultaneously, a great challenge and a priority for contemporary medicine. Patients with visible dermatological ailments are particularly susceptible to reduction in the general quality of life. Among the dermatological diseases, acne causes considerable reduction in the quality of life and changes in self-perception that lead to the worsening of a patient’s mental condition, including depression and suicidal thoughts. As a result, difficulties in contact with loved ones, as well as social and professional problems are observed, which show that acne is not a somatic problem alone. To a large extent, it becomes a part of psychodermatology, becoming an important topic of public health in social medicine practice. Pharmacological treatment of acne is a challenge for a dermatologist and often requires the necessity of cooperating with a cosmetologist. Cosmetological treatments are aimed at improving the condition of the skin and reduction or subsiding of acne skin changes. Aim The aim of this study was to assess the influence of selected cosmetological treatments on the general quality of life of patients with acne. Materials and methods The study group consisted of 101 women aged 19–29 years (x¯=22.5 years, SD =2.3 years). All subjects were diagnosed with acne vulgaris of the face. In the study group, the acne changes occurred over the course of 3–15 years (x¯=8.1 years, SD =2.7 years). Selected cosmetological treatments (intensive pulsing light, alpha-hydroxy acids, cavitation peeling, needle-free mesotherapy, diamond microdermabrasion and sonophoresis) were performed in series in the number depending on the particular patient’s chosen treatment, after excluding contraindications. General quality of life of the patients was estimated using the Skindex-29 and Dermatology Life Quality Index (DLQI) questionnaires, before and after the cosmetological

  12. Patient Education and Peritoneal Dialysis Modality Selection: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Devoe, Daniel J; Wong, Ben; James, Matthew T; Ravani, Pietro; Oliver, Matthew J; Barnieh, Lianne; Roberts, Derek J; Pauly, Robert; Manns, Braden J; Kappel, Joanne; Quinn, Robert R

    2016-09-01

    Educational interventions are increasingly used to promote peritoneal dialysis (PD), the most common form of home therapy for end-stage renal disease. A systematic review of the evidence in support of dialysis modality education is needed to inform the design of patient-targeted interventions to increase selection of PD. We performed a systematic review and meta-analysis to characterize the relationship between patient-targeted educational interventions and choosing and receiving PD. Systematic review and meta-analysis. Published original studies and abstracts. We searched MEDLINE, EMBASE, CINAHL and EBMR. We included controlled observational studies and randomized trials of educational interventions designed to increase PD selection. Predialysis educational interventions. The primary outcome was choosing PD, defined as intention to use PD regardless of whether PD was ever used. The secondary outcome, receiving PD, was defined as an individual receiving PD as his or her treatment. Of 3,540 citations, 15 studies met our inclusion criteria, including 1 randomized trial. In the single randomized trial (N=70), receipt of an educational intervention was associated with a more than 4-fold increase in the odds of choosing PD (OR, 4.60; 95% CI, 1.19-17.74). Based on results from 4 observational studies (N=7,653), patient-targeted educational interventions were associated with a 2-fold increase in the odds of choosing PD (pooled OR, 2.15; 95% CI, 1.07-4.32; I(2)=76.7%). Based on results from 9 observational studies (N=8,229), patient-targeted educational intervention was associated with a 3-fold increase in the odds of receiving PD as the initial treatment modality (OR, 3.50; 95% CI, 2.82-4.35; I(2)=24.9%). Most studies were observational studies, which can establish an association between education and choosing PD or receiving PD, but does not establish causality. This systematic review demonstrates a strong association between patient-targeted education interventions and

  13. New Criteria of Indication and Selection of Patients to Cochlear Implant

    Science.gov (United States)

    Sampaio, André L. L.; Araújo, Mercêdes F. S.; Oliveira, Carlos A. C. P.

    2011-01-01

    Numerous changes continue to occur in cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound unilateral hearing loss rather then the prior requirement of a bilateral profound loss. Furthermore, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low-frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. This paper will review the new concepts in the candidacy of cochlear implant. Medline data base was used to search articles dealing with the following topics: cochlear implant in younger children, cochlear implant and hearing preservation, cochlear implant for unilateral deafness and tinnitus, genetic hearing loss and cochlear implant, bilateral cochlear implant, neuropathy and cochlear implant and neural plasticity, and the selection of patients for cochlear implant. PMID:22013448

  14. The syntax of single words: Evidence from a patient with a selective function word reading deficit.

    Science.gov (United States)

    Druks, Judit; Froud, Karen

    2002-05-01

    We describe the reading performance of a patient who has selective deficits for reading nonwords, function words, and morphologically complex words in isolation. His reading of highly abstract nouns and verbs, however, is relatively well preserved. He can recognise and comprehend the meaning of written function words, of derivational morphology, and of most inflectional morphology. We suggest that his deficit in reading grammatical morphemes is unrelated to his problems in reading nonwords and cannot be explained by their low semanticity and imageability. The patient's speech is ungrammatical but is not devoid of grammatical morphemes and his reading of functional elements improves when these are presented within the context of sentences. We argue that syntactic information relevant to individual lexical items including information about how the word may potentially be used within a phrase must be accessed during single word reading tasks (e.g., Levelt, 1989). This is particularly difficult for function words due to their linguistic specification, which is different from that of lexical categories (Chomsky, 1995). Both linguistic theory and Garrett's (e.g., 1982) model of sentence processing account for the patient's improved reading of function words in the context of sentences.

  15. New Criteria of Indication and Selection of Patients to Cochlear Implant

    Directory of Open Access Journals (Sweden)

    André L. L. Sampaio

    2011-01-01

    Full Text Available Numerous changes continue to occur in cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound unilateral hearing loss rather then the prior requirement of a bilateral profound loss. Furthermore, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low-frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. This paper will review the new concepts in the candidacy of cochlear implant. Medline data base was used to search articles dealing with the following topics: cochlear implant in younger children, cochlear implant and hearing preservation, cochlear implant for unilateral deafness and tinnitus, genetic hearing loss and cochlear implant, bilateral cochlear implant, neuropathy and cochlear implant and neural plasticity, and the selection of patients for cochlear implant.

  16. An Assay of Selected Serum Amino Acids in Patients with Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Drábková, Petra; Šanderová, Jana; Kovařík, Jakub; kanďár, Roman

    2015-01-01

    Amino acids are the building blocks of proteins. In case of insulin resistance, which is typical for type 2 diabetes mellitus (T2DM), proteolysis is increased and protein synthesis is decreased; therefore, we can observe changes in the levels of amino acids in diabetics vs. non-diabetics. The aim of this study was to find differences in the levels of selected amino acids between patients with diabetes (type 2) and a control group. Amino acids were derivatized with naphthalene-2,3-dicarboxaldehyde in the presence of potassium cyanide to form fluorescent 1-cyanobenz(f)isoindole product. Amino acids derivatives were measured using a high-performance liquid chromatography with fluorescence detection. The serum levels of glucose were determined using an automatic biochemistry analyzer, glycated hemoglobin HbA1c was measured by cation exchange chromatography. A total of 19 serum amino acids in T2DM patients and non-diabetics were measured. There were 9 amino acids, which were significantly different in these groups (pdiabetics were found. Significant difference in metabolism of amino acids between diabetics and non-diabetics were observed. The altered levels of amino acids in diabetic patients could be a suitable predictor of diabetes.

  17. A Comparison of Relative Time to Peak and Tmax for Mismatch-Based Patient Selection

    Directory of Open Access Journals (Sweden)

    Anke Wouters

    2017-10-01

    Full Text Available Background and purposeThe perfusion-weighted imaging (PWI/diffusion-weighted imaging (DWI mismatch profile is used to select patients for endovascular treatment. A PWI map of Tmax is commonly used to identify tissue with critical hypoperfusion. A time to peak (TTP map reflects similar hemodynamic properties with the added benefit that it does not require arterial input function (AIF selection and deconvolution. We aimed to determine if TTP could substitute Tmax for mismatch categorization.MethodsImaging data of the DEFUSE 2 trial were reprocessed to generate relative TTP (rTTP maps. We identified the rTTP threshold that yielded lesion volumes comparable to Tmax > 6 s and assessed the effect of reperfusion according to mismatch status, determined based on Tmax and rTTP volumes.ResultsAmong 102 included cases, the Tmax > 6 s lesion volumes corresponded most closely with rTTP > 4.5 s lesion volumes: median absolute difference 6.9 mL (IQR: 2.3–13.0. There was 94% agreement in mismatch classification between Tmax and rTTP-based criteria. When mismatch was assessed by Tmax criteria, the odds ratio (OR for favorable clinical response associated with reperfusion was 7.4 (95% CI 2.3–24.1 in patients with mismatch vs. 0.4 (95% CI 0.1–2.6 in patients without mismatch. When mismatch was assessed with rTTP criteria, these ORs were 7.2 (95% CI 2.3–22.2 and 0.3 (95% CI 0.1–2.2, respectively.ConclusionrTTP yields lesion volumes that are comparable to Tmax and reliably identifies the PWI/DWI mismatch profile. Since rTTP is void of the problems associated with AIF selection, it is a suitable substitute for Tmax that could improve the robustness and reproducibility of mismatch classification in acute stroke.

  18. Intracerebral Hemorrhage and Outcome After Thrombolysis in Stroke Patients Using Selective Serotonin-Reuptake Inhibitors.

    Science.gov (United States)

    Scheitz, Jan F; Turc, Guillaume; Kujala, Linda; Polymeris, Alexandros A; Heldner, Mirjam R; Zonneveld, Thomas P; Erdur, Hebun; Curtze, Sami; Traenka, Christopher; Brenière, Céline; Wiest, Roland; Rocco, Andrea; Sibolt, Gerli; Gensicke, Henrik; Endres, Matthias; Martinez-Majander, Nicolas; Béjot, Yannick; Nederkoorn, Paul J; Oppenheim, Catherine; Arnold, Marcel; Engelter, Stefan T; Strbian, Daniel; Nolte, Christian H

    2017-12-01

    Selective serotonin-reuptake inhibitors (SSRIs) impair platelet function and have been linked to a higher risk of spontaneous intracerebral hemorrhage-an association that may be augmented by oral anticoagulants (OAC). We aimed to assess whether preadmission treatment with SSRIs in patients with acute ischemic stroke is associated with post-thrombolysis symptomatic intracerebral hemorrhage (sICH) and functional outcome. A multicenter retrospective analysis was conducted in prospective registries of patients treated by thrombolysis within 4.5 hours of stroke onset. The association between preadmission treatment with SSRIs and sICH (ECASS II definition [European Cooperative Acute Stroke Study]) or unfavorable 3-month outcome (modified Rankin Scale >2) was assessed by logistic regression, taking into account potential interaction with concomitant use of antithrombotics. Six thousand two hundred forty-two patients were included (mean age, 70.1±14.0 years; median National Institutes of Health Stroke Scale, 9 [5-16]). Preadmission treatment with SSRIs was present in 4.3% (n=266) of patients. Overall, SICH rate was 3.9% (95% confidence interval [CI], 3.5%-4.4%; n=244), and SSRI use was not significantly associated with sICH in unadjusted (odds ratio [OR], 1.28; 95% CI, 0.72-2.27) or adjusted (OR, 1.30; 95% CI, 0.71-2.40) analysis. However, there was a significant interaction of concomitant use of OACs (international normalized ratio <1.7) and SSRI for occurrence of sICH ( P =0.01). SICH was significantly more frequent in patients taking both OAC and SSRI (23.1%; 95% CI, 8.2%-50.3%) than in patients taking OAC but not SSRI (adjusted OR, 9.04; 95% CI, 1.95-41.89). Preadmission use of SSRI was associated with unfavorable 3-month outcome (unadjusted OR, 1.90; 95% CI, 1.48-2.46; adjusted OR, 1.59; 95% CI, 1.15-2.19). Preadmission treatment with SSRIs was not significantly associated with an increased risk of post-thrombolysis sICH in this cohort study. However, subgroup

  19. Magnetic resonance imaging quantitation of changes in muscle volume during 7 days of strict bed rest.

    Science.gov (United States)

    Ferrando, A A; Stuart, C A; Brunder, D G; Hillman, G R

    1995-10-01

    Prolonged bed rest results in a loss of leg lean body mass. Previous studies using bed rest as a model for microgravity have shown decreases in leg mass after 12 and 14 d, 5 and 17 wk. As magnetic resonance imaging (MRI) can provide a precise and non-invasive means of determining muscle volume, we sought to determine if changes in leg muscle volume could be detected in bed rest periods as short as 7 d. Five young, healthy, male volunteers were subjected to 7 d of absolute bed rest. Each subject underwent MRI quantitation of segmental muscle volumes of the calves and thighs before and after bed rest. Eleven (calf) and nine (thigh) contiguous 1-cm thick transaxial images were generated over prescribed regions using a Technicare MRI imager with a 0.6T superconducting magnet and body coil. Image processing was performed using a generalized 8-bit medical image analysis package developed at University of Texas Medical Branch. Images were analyzed for muscle and non-muscle volumes (including fat, blood vessel, and bone marrow volumes). The MRI quantitation demonstrated bed rest-induced significant decreases in segmental thigh muscle (approximately 3.0%, p image analysis of MRI images provides a sensitive tool capable of detecting leg volume changes of as little as 3.0% over a 7-d period of strict bed rest.

  20. Managing curriculum transformation within strict university governance structures: an example from Damascus University Medical School.

    Science.gov (United States)

    Kayyal, Mohammad; Gibbs, Trevor

    2012-01-01

    As the world of medical education moves forward, it becomes increasingly clear that the transformative process is not as easy a process for all. Across the globe, there appears to be many barriers that obstruct or threaten innovation and change, most of which cause almost insurmountable problems to many schools. If transformative education is to result in an equitable raising of standards across such an unlevel playing field, schools have to find ways in overcoming these barriers. One seemingly common barrier to development occurs when medical schools are trapped within strict University governance structures; rules and regulations which are frequently inappropriate and obstructive to the transformation that must occur in today's medical educational paradigm. The Faculty of Medicine at Damascus University, one of the oldest and foremost medical schools in the Middle East, is one such school where rigid rules and regulations and traditional values are obstructing transformative change. This paper describes the problems, which the authors believe to be common to many, and explores how attempts have been made to overcome them and move the school into the twenty-first century. It is the ultimate purpose of this paper to raise awareness of the issue, share the lessons learned in order to assist others who are experiencing similar problems and possibly create opportunities for dialogue between schools.

  1. On a holomorphic Lefschetz formula in strictly pseudoconvex subdomains of complex manifolds

    International Nuclear Information System (INIS)

    Kytmanov, A M; Myslivets, S G; Tarkhanov, N N

    2004-01-01

    The classical Lefschetz formula expresses the number of fixed points of a continuous map f:M→M in terms of the transformation induced by f on the cohomology of M. In 1966, Atiyah and Bott extended this formula to elliptic complexes over a compact closed manifold. In particular, they obtained a holomorphic Lefschetz formula on compact complex manifolds without boundary. Brenner and Shubin (1981, 1991) extended the Atiyah-Bott theory to compact manifolds with boundary. On compact complex manifolds with boundary the Dolbeault complex is not elliptic, therefore the Atiyah-Bott theory is not applicable. Bypassing difficulties related to the boundary behaviour of Dolbeault cohomology, Donnelly and Fefferman (1986) obtained a formula for the number of fixed points in terms of the Bergman metric. The aim of this paper is to obtain a Lefschetz formula on relatively compact strictly pseudoconvex subdomains of complex manifolds X with smooth boundary, that is, to find the total Lefschetz number for a holomorphic endomorphism f * of the Dolbeault complex and to express it in terms of local invariants of the fixed points of f.

  2. Model-Based Adaptive Event-Triggered Control of Strict-Feedback Nonlinear Systems.

    Science.gov (United States)

    Li, Yuan-Xin; Yang, Guang-Hong

    2018-04-01

    This paper is concerned with the adaptive event-triggered control problem of nonlinear continuous-time systems in strict-feedback form. By using the event-sampled neural network (NN) to approximate the unknown nonlinear function, an adaptive model and an associated event-triggered controller are designed by exploiting the backstepping method. In the proposed method, the feedback signals and the NN weights are aperiodically updated only when the event-triggered condition is violated. A positive lower bound on the minimum intersample time is guaranteed to avoid accumulation point. The closed-loop stability of the resulting nonlinear impulsive dynamical system is rigorously proved via Lyapunov analysis under an adaptive event sampling condition. In comparing with the traditional adaptive backstepping design with a fixed sample period, the event-triggered method samples the state and updates the NN weights only when it is necessary. Therefore, the number of transmissions can be significantly reduced. Finally, two simulation examples are presented to show the effectiveness of the proposed control method.

  3. DNA remodelling by Strict Partial Endoreplication in orchids, an original process in the plant kingdom.

    Science.gov (United States)

    Brown, Spencer C; Bourge, Mickaël; Maunoury, Nicolas; Wong, Maurice; Bianchi, Michele Wolfe; Lepers-Andrzejewski, Sandra; Besse, Pascale; Siljak-Yakovlev, Sonja; Dron, Michel; Satiat-Jeunemaître, Béatrice

    2017-04-13

    DNA remodelling during endoreplication appears to be a strong developmental characteristic in orchids. In this study, we analysed DNA content and nuclei in 41 species of orchids to further map the genome evolution in this plant family. We demonstrate that the DNA remodelling observed in 36 out of 41 orchids studied corresponds to strict partial endoreplication. Such process is developmentally regulated in each wild species studied. Cytometry data analyses allowed us to propose a model where nuclear states 2C, 4E, 8E, etc. form a series comprising a fixed proportion, the euploid genome 2C, plus 2 to 32 additional copies of a complementary part of the genome. The fixed proportion ranged from 89% of the genome in Vanilla mexicana down to 19% in V. pompona, the lowest value for all 148 orchids reported. Insterspecific hybridisation did not suppress this phenomenon. Interestingly, this process was not observed in mass-produced epiphytes. Nucleolar volumes grow with the number of endocopies present, coherent with high transcription activity in endoreplicated nuclei. Our analyses suggest species-specific chromatin rearrangement. Towards understanding endoreplication, V. planifolia constitutes a tractable system for isolating the genomic sequences that confer an advantage via endoreplication from those that apparently suffice at diploid level. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

  4. Strictly hyperbolic models of co-current three-phase flow withgravity

    Energy Technology Data Exchange (ETDEWEB)

    Juanes, Ruben; Patzek, Tadeusz W.

    2002-11-18

    We study the character of the equations in the traditional formulation of one-dimensional immiscible three-phase flow with gravity, in the limit of negligible capillarity. We restrict our analysis to co-current flow required for a displacement process; in cases of mixed co-current and counter-current flow, capillarity effects cannot be dropped from the formulation. The model makes use of the classical multiphase extension of Darcy's equation. It is well known that, if relative permeabilities are taken as fixed functions of saturations, the model yields regions in the saturation space where the system of equations is locally elliptic. We regard elliptic behavior as a nonphysical artifact of an incomplete formulation, and derive conditions on the relative permeabilities that ensure strict hyperbolicity of the governing equations. The key point is to acknowledge that a Darcy-type formulation is insufficient to capture all the physics of three-phase flow and that, consequently, the relative permeabilities are functionals that depend on the fluid viscosity ratio and the gravity number. The derived conditions are consistent with the type of displacements that take place in porous media. By means of an illustrative example, we show how elliptic behavior can be removed, even when using simplistic relative permeability models.

  5. Investigation of selected trace elements in hair samples of eczema patients

    International Nuclear Information System (INIS)

    Osman, N. O.

    2010-12-01

    The aim of this case-control study was to investigate the relationship between selected trace elements and skin diseases, namely eczema. Fifty five patients affected by the most frequent eczema types were recruited at the onset of disease at the hospital of dermatology in Khartoum together with thirty healthy controls. Fe, Zn, Cu, and Ni were measured in hair samples obtained from both patients and control group using Atomic Absorption Spectrometry (AAS). Data analysis was performed using the T-test. Partial correlation was used to study the relationship between the elemental concentration. Certified reference material (IAEA-85) Hair Powder) produced by the International Atomic Energy Agency (IAEA) was used as a quality control to check the accuracy and precision of the analytical technique, good agreement was achieved for all elements under investigation. Significant variations (p<0.05) in the concentrations of Fe, Zn, Cu, and Ni in the hair of the patients compared to the control group, and this difference was a decrease of iron, zinc and copper, therefore, should be given to the patient doses of these elements, while there was an increase in the nickel. So it is not included in the treatment. These interesting associations between the levels the of trace elements could be used as an indication for the disease as well as to monitor the treatment. Comparisons of the results obtained in the present study with those conducted for other population in the literature showed very close agreement. The levels of the elements under investigation are comparable with the data obtained from the literature for other populations with exception of Fe which was found to be very high in Sudanese population. (Author)

  6. Personalizing colon cancer adjuvant therapy: selecting optimal treatments for individual patients.

    Science.gov (United States)

    Dienstmann, Rodrigo; Salazar, Ramon; Tabernero, Josep

    2015-06-01

    For more than three decades, postoperative chemotherapy-initially fluoropyrimidines and more recently combinations with oxaliplatin-has reduced the risk of tumor recurrence and improved survival for patients with resected colon cancer. Although universally recommended for patients with stage III disease, there is no consensus about the survival benefit of postoperative chemotherapy in stage II colon cancer. The most recent adjuvant clinical trials have not shown any value for adding targeted agents, namely bevacizumab and cetuximab, to standard chemotherapies in stage III disease, despite improved outcomes in the metastatic setting. However, biomarker analyses of multiple studies strongly support the feasibility of refining risk stratification in colon cancer by factoring in molecular characteristics with pathologic tumor staging. In stage II disease, for example, microsatellite instability supports observation after surgery. Furthermore, the value of BRAF or KRAS mutations as additional risk factors in stage III disease is greater when microsatellite status and tumor location are taken into account. Validated predictive markers of adjuvant chemotherapy benefit for stage II or III colon cancer are lacking, but intensive research is ongoing. Recent advances in understanding the biologic hallmarks and drivers of early-stage disease as well as the micrometastatic environment are expected to translate into therapeutic strategies tailored to select patients. This review focuses on the pathologic, molecular, and gene expression characterizations of early-stage colon cancer; new insights into prognostication; and emerging predictive biomarkers that could ultimately help define the optimal adjuvant treatments for patients in routine clinical practice. © 2015 by American Society of Clinical Oncology.

  7. Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

    Directory of Open Access Journals (Sweden)

    Wearne N

    2017-01-01

    Full Text Available Nicola Wearne,1 Kajiru Kilonzo,2 Emmanuel Effa,3 Bianca Davidson,1 Peter Nourse,4 Udeme Ekrikpo,1,5 Ikechi G Okpechi1 1Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; 2Department of Medicine, Kilimanjaro Christian Medical College, Moshi, Tanzania; 3Department of Medicine, University of Calabar, Calabar, Nigeria; 4Division of Paediatric Nephrology, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; 5Department of Internal Medicine, University of Uyo, Uyo, Nigeria Abstract: Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs. There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or

  8. Customized acrylic implants for reconstruction of extensive skull defects: an exception approach for selected patients.

    Science.gov (United States)

    Silva, Rafael Denadai Pigozzi DA; Raposo-Amaral, Cesar Augusto; Guidi, Marcelo Campos; Raposo-Amaral, Cassio Eduardo; Buzzo, Celso Luiz

    2017-01-01

    to present our experience in the surgical treatment of extensive skullcap defects with customized acrylic implants. we conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between 2004 and 2013. We carefully selected all patients and classified surgical results based on three scales (craniofacial esthetics, improvement of facial symmetry and need for additional surgery). fifteen patients underwent cranioplasty with intraoperative acrylic implants, whether manually customized (46.67%) or made with prototyped three-dimensional biomodels (53.33%). There were two (13.33%) complications (one infection with implant withdrawal and one seroma). We considered the craniofacial aesthetics excellent (50%), the degree of improvement of craniofacial symmetry satisfactory (57.14%), and the overall mean of surgical results according to the need for new surgeries was 1.5±0.52. cranioplasties of patients with extensive skullcap defects should obey careful and predetermined criteria, both for selection and for the acrylic implant customization method. apresentar nossa experiência no tratamento cirúrgico dos defeitos extensos da calota craniana com implantes de acrílico customizados. análise retrospectiva de pacientes com defeitos extensos da calota craniana submetidos à cranioplastias com acrílico entre 2004 e 2013. Todos os pacientes foram criteriosamente selecionados e os resultados cirúrgicos foram classificados com base em três escalas (estética craniofacial, melhora da simetria facial e necessidade de cirurgia adicional). Quinze pacientes foram submetidos à cranioplastia com implantes de acrílico customizados manualmente no intraoperatório (46,67%) e confeccionados com base em biomodelos tridimensionais prototipados (53,33%). Mesmo respeitando critérios de seleção, houve duas (13,33%) complicações (infecção com retirada do implante e seroma). A estética craniofacial foi considerada excelente (50%), o

  9. Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders

    DEFF Research Database (Denmark)

    Gross, Douglas P; Armijo-Olivo, Susan; Shaw, William S

    2016-01-01

    Purpose We aimed to identify and inventory clinical decision support (CDS) tools for helping front-line staff select interventions for patients with musculoskeletal (MSK) disorders. Methods We used Arksey and O'Malley's scoping review framework which progresses through five stages: (1) identifying...... multiple disciplines, we searched health care, computing science and business databases. Results Our search resulted in 4605 manuscripts. Titles and abstracts were screened for relevance. The reliability of the screening process was high with an average percentage of agreement of 92.3 %. Of the located...... rapidly advancing computer technologies, are under development and of potential interest to health care providers, case management organizations and funders of care. Based on the results of this scoping review, we conclude that these tools, models and systems should be subjected to further validation...

  10. Routine versus selective antifungal administration for control of fungal infections in patients with cancer

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C; Johansen, Helle Krogh

    2014-01-01

    commonly used antifungal drugs decrease mortality in cancer patients with neutropenia. SEARCH METHODS: We searched PubMed from 1966 to 7 July 2014 and the reference lists of identified articles. SELECTION CRITERIA: Randomised clinical trials of amphotericin B, fluconazole, ketoconazole, miconazole....... Prophylactic or empirical treatment with amphotericin B significantly decreased total mortality (relative risk (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.96), whereas the estimated RRs for fluconazole, ketoconazole, miconazole, and itraconazole were close to 1.00. No eligible trials were found.......73), fluconazole (RR 0.39, 95% CI 0.27 to 0.57) and itraconazole (RR 0.53, 95% CI 0.29 to 0.97), but not with ketoconazole or miconazole. Effect estimates were similar for those 13 trials that had adequate allocation concealment and were blinded. The reporting of harms was far too variable from trial to trial...

  11. [Salmonella typhi vaccination response study reveals defective antibody production selective IgA deficiency patient].

    Science.gov (United States)

    Pleguezuelo, Daniel E; Gianelli, Carla

    2015-01-01

    Selective IgA deficiency (SIgAD) is the most prevalent immunodeficiency worldwide, progressing to common variable immunodeficiency only in few reported cases. We report the case of a Spanish female aged 22 and diagnosed of selective IgA deficiency, a long history of bronchitis, several episodes of pneumonia, bilateral bronchiectasis, normal IgG, IgM, IgG subclasses, and detectable pre-vaccination IgG antibodies against tetanus toxoid and Streptococcus pneumoniae. She was evaluated in our clinic in order to rule out common variable immunodeficiency. We observed good antibody response to tetanus toxoid, absence of circulating switched memory B cells, decreased response to pneumococcal polysaccharide antigens and a lack of response to Salmonella typhi vaccine. Most SIgAD patients presents with upper respiratory tract infections or mild diarrhea. Those with lower tract infections, pneumonia or untreatable diarrhea should follow B-cell subpopulations' study and antibody response to vaccines. Absence of response to Salmonella typhi vaccine allowed us to expose the defective antibody production.

  12. Collaborative Patient-Centered Quality Improvement: A Cross-Sectional Survey Comparing the Types and Numbers of Quality Initiatives Selected by Patients and Health Professionals.

    Science.gov (United States)

    Fradgley, Elizabeth A; Paul, Christine L; Bryant, Jamie; Collins, Nicolas; Ackland, Stephen P; Bellamy, Douglas; Levi, Christopher R

    2016-12-01

    Identification of patients' and health professionals' quality improvement preferences is an essential first step in collaborative improvement models. This includes experience-based codesign (EBCD), where service change is strategically introduced following stakeholder consultation. This study compared the number and types of improvement initiatives selected by outpatients and health professionals. Using electronic surveys designed to inform EBCD studies, 541 outpatients (71.1% consent) and 124 professionals (47.1% response) selected up to 23 general initiatives. On average, outpatients selected 2.4 (median = 1, interquartile range = 1-3) initiatives and professionals selected 10.7 (median = 10; interquartile range = 6-15) initiatives. Outpatients demonstrated a strong preference for improvements to clinic organization, such as appointment scheduling and clinic contact. Outpatients selected relatively fewer initiatives potentially reducing the complexity of service change and resources required to address preferences. Comparatively, professionals indicated a greater degree of change is needed and selected initiatives related to communication with patients and other professionals, including coordinating multidisciplinary care. Improvements to information provision were commonly selected by both groups and offered a strategic opportunity to address patients' and professionals' preferences. By quantifying the ways in which preferences differed, this study emphasizes the need for collaborative approaches to health service change and may be used to initiate an informed discussion on patients' and professionals' quality improvement preferences in tertiary care. © The Author(s) 2016.

  13. Patients' Expectations and Perceptions of Service Quality in the Selected Hospitals.

    Science.gov (United States)

    Nadi, Aliasghar; Shojaee, Jalil; Abedi, Ghassem; Siamian, Hasan; Abedini, Ehsan; Rostami, Farideh

    2016-04-01

    Hospital's success depends on patients' expectations, perceptions, and judgment on the quality of services provided by hospitals. This study was conducted to assess the patients' perceptions and expectations from the quality of inpatient health care in Vali-Asr hospital, Ghaemshahr, and Imam Khomeini and Shafa Hospitals, Sari. This study is applied regarding the objective of the study. Considering the research methodology, it is a descriptive - analytical study. The sample of this study consists of 600 patients with at least 24 hours of being hospitalized in internal, surgery, women, and children sectors of Vali-Asr, Ghaemshahr, Imam Khomeini, and Shafa Hospitals. Using random sampling method, the classifications relevant to the size of each class were selected. The data required was collected through the standard SERVQUAL questionnaire and then it was analyzed using the SPSS software. The overall mean value and standard deviation of expectations were equal to 10.4 and 28, respectively. The mean value for the field of perception was 69.2 and the relevant standard deviation was 26. In terms of patients and hospital visits in concrete cases, the highest priority is related to empathy. The second priority is related to physical appearance, the third priority is related to responsiveness, the fourth priority is related to assurance, and the lowest priority is related to the reliability of the SERVQUAL approach. Examining the gap between patients' perceptions and expectations, the widest gap was observed in the Vali-Asr Hospital with the mean and SD (-92.0±39.0) and the lowest gap was observed in Shafa Hospital with the mean value of (-39.9±44.0). According to The Kruskal-Wallis test, the difference observed in these three hospitals were significant. The results showed that patients' expectations had not been met in any of the examined dimensions and their consent has not been achieved. It seemed that necessary for managers and relevant authorities to plan and pay

  14. Selection of symptomatic patients with Crohn's disease for abdominopelvic computed tomography: role of serum C-reactive protein.

    LENUS (Irish Health Repository)

    Desmond, Alan N

    2012-11-01

    Results of previous studies have shown that repeated abdominopelvic computed tomography (CT) examinations can lead to substantial cumulative diagnostic radiation exposure in patients with Crohn\\'s disease (CD). Improved selection of patients referred for CT will reduce unnecessary radiation exposure. This study examines if serum C-reactive protein (CRP) concentration predicts which symptomatic patients with CD are likely to have significant disease activity or disease complications (such as abscess) detected on abdominopelvic CT.

  15. [INTERFACE SELECTION IN NON-INVASIVE MECHANICAL VENTILATION IN CRITICALLY ILL PATIENT].

    Science.gov (United States)

    Sánchez-Morago, Santiago García; Migallón Buitrago, Ma Elvira

    2014-11-01

    Non-invasive ventilation is used with a mechanical ventilator and an interface that is interposed between the patient and the ventilator without invading the airway. It is an alternative to the artificial airway in situations of acute respiratory insufficiency. Determine if the selection of an appropriate interface to the contour of the patient's face and the pathology involves the triumph or failure of the procedure, deeming it is a dependent variable in the success of the NIV. Research bibliographic in PubMed, with secondary search in the Cochrane Library and CUIDEN. Includes the articles published since 2000 in adults. No limitations have been imposed on study design, type of intervention or results of the publications. The articles are reviewed to determine their relevance and draw conclusions. The heterogeneity of designs prevents statistical combination of results and a review was conducted descriptive. There were 67 publications of which 28 were rejected by may not be related to the reason for this study, 12 to be made in pediatric population, 8 per language, 2 to be carried out on animals and 1 to be duplicated. The 16 included studies attest to the effectiveness of the NIV with studies not comparable between different interfaces. The consulted evidence suggests the benefits of NIV it insisting on the great importance of the interface to tolerance and successful of the technique. The studies are heterogeneous in its design but the authors suggest continue developing better interfaces, with greater tolerance and fewer complications.

  16. Reevaluating Antidepressant Selection in Patients With Bruxism and Temporomandibular Joint Disorder.

    Science.gov (United States)

    Rajan, Royce; Sun, Ye-Ming

    2017-05-01

    Temporomandibular joint disorder (TMD) is a broad pain disorder that refers to several conditions affecting the temporomandibular joint of the jaw and the muscles of mastication. As with most pain disorders, a high prevalence of depression and anxiety is associated with TMD. Research has shown that selective serotonin reuptake inhibitors (SSRIs), the first-line drug therapy for major depressive disorder, may not be suitable for TMD patients because SSRIs can induce teeth-grinding, otherwise known as bruxism. This is problematic because bruxism is believed to further exacerbate TMD. Therefore, the purpose of this literature review is to better understand the mechanism of SSRI-induced bruxism, as well as discuss alternative antidepressant options for treating depression and anxiety in patients with bruxism and TMD. Alternative classes of antidepressants reviewed include serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, and monoamine oxidase inhibitors. Findings indicate that dopamine agonists and buspirone are currently the most effective medications to treat the side effects of SSRI-induced bruxism, but results regarding the effectiveness of specific antidepressants that avoid bruxism altogether remain inconclusive.

  17. Selection and ranking of patient video cases in paediatric neurology in relation to learner levels.

    Science.gov (United States)

    Balslev, Thomas; Muijtjens, Arno M M; Maarbjerg, Sabine Frølich; de Grave, Willem

    2017-12-02

    Teaching and learning with patient video cases may add authenticity, enhance diagnostic accuracy and improve chances of early diagnosis. The aim of this study is firstly to identify selection criteria for key Patient video cases (PVCs), secondly to identify trends in relevance of PVCs for learner levels and thirdly, to rank PVCs for learner levels. Based on a literature review, we identified criteria for key PVCs for use in paediatric neurology. We then performed a multi-round Delphi analysis to obtain agreement between 28 expert clinician teachers concerning key PVCs for four learner levels. We identified two major criteria: key PVCs should demonstrate key movements, and these movements should be subtle and/or difficult to note. The expert clinician teachers subsequently assessed a list of 14 topics for key PVCs. We found a clear, increasing trend in relevance scores, from medical students to young residents to experienced residents and specialists. For medical students and residents, epileptic spasms, Down syndrome, developmental delay, cerebral palsy and absence epilepsy were highly ranked. For specialists, conditions like chorea, focal seizures or eye movement disorders topped the ranking list, although ranking was less clear for this group of advanced learners. Key PVCs should demonstrate movements that are difficult to note for learners. Ranked lists of key PVCs for teaching and learning at different learner levels are now available and may help institutions build validated local libraries of PVCs. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  18. Strict Host-Symbiont Cospeciation and Reductive Genome Evolution in Insect Gut Bacteria

    Science.gov (United States)

    Hosokawa, Takahiro; Kikuchi, Yoshitomo; Nikoh, Naruo; Shimada, Masakazu; Fukatsu, Takema

    2006-01-01

    Host-symbiont cospeciation and reductive genome evolution have been identified in obligate endocellular insect symbionts, but no such example has been identified from extracellular ones. Here we first report such a case in stinkbugs of the family Plataspidae, wherein a specific gut bacterium is vertically transmitted via “symbiont capsule.” In all of the plataspid species, females produced symbiont capsules upon oviposition and their gut exhibited specialized traits for capsule production. Phylogenetic analysis showed that the plataspid symbionts constituted a distinct group in the γ-Proteobacteria, whose sister group was the aphid obligate endocellular symbionts Buchnera. Removal of the symbionts resulted in retarded growth, mortality, and sterility of the insects. The host phylogeny perfectly agreed with the symbiont phylogeny, indicating strict host-symbiont cospeciation despite the extracellular association. The symbionts exhibited AT-biased nucleotide composition, accelerated molecular evolution, and reduced genome size, as has been observed in obligate endocellular insect symbionts. These findings suggest that not the endocellular conditions themselves but the population genetic attributes of the vertically transmitted symbionts are probably responsible for the peculiar genetic traits of these insect symbionts. We proposed the designation “Candidatus Ishikawaella capsulata” for the plataspid symbionts. The plataspid stinkbugs, wherein the host-symbiont associations can be easily manipulated, provide a novel system that enables experimental approaches to previously untouched aspects of the insect-microbe mutualism. Furthermore, comparative analyses of the sister groups, the endocellular Buchnera and the extracellular Ishikawaella, would lead to insights into how the different symbiotic lifestyles have affected their genomic evolution. PMID:17032065

  19. Onabotulinum toxin A in the treatment of chronic migraine: patient selection and special considerations

    Directory of Open Access Journals (Sweden)

    Barbanti P

    2017-09-01

    Full Text Available Piero Barbanti,1 Patrizia Ferroni2 1Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, 2Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, IRCCS San Raffaele Pisana, Rome, Italy Abstract: Discovered by serendipity, onabotulinum toxin A (BoNT-A is the only US Food and Drug Administration-approved treatment for the prevention of chronic migraine (CM, one of the most disabling and burdensome human conditions. Its efficacy, safety and tolerability, proved by the largest and longest migraine therapeutic trial (the Phase III Research Evaluating Migraine Prophylaxis Therapy program [PREEMPT], have been replicated by various real-life studies also in the presence of medication overuse. The benefit of BoNT-A prophylaxis is likely due to its ability to counteract peripheral and central nociceptive sensitization through reversible chemical denervation of pericranial sensitive afferents. Its efficacy increases considerably over time during long-term treatments, significantly varying among patients. The present review focuses on the state-of-the art of current knowledge on putative instrumental, biochemical and clinical predictors of BoNT-A responsiveness, outlining the need for a thorough characterization of the full phenotypic migraine picture when trying to predict good responders. Available evidence suggests that disentangling the BoNT-A responsiveness puzzle requires 1 a reappraisal of easy-obtainable clinical details (eg, site and quality of pain, presence of cranial autonomic symptoms, 2 a proper stratification of patients with CM according to their headache frequency, 3 the evaluation of potential synergistic effects of concomitant prophylaxis/treatment and 4 a detailed assessment of modifiable risk factors evolution during treatment. Keywords: chronic migraine, onabotulinum toxin A, prophylaxis, treatment responder, patient selection, disability

  20. Prevalence of Lactose Malabsorption and Lactose Intolerance in Pediatric Patients with Selected Gastrointestinal Diseases.

    Science.gov (United States)

    Pawłowska, Katarzyna; Umławska, Wioleta; Iwańczak, Barbara

    2015-01-01

    Lactase is an enzyme involved in the hydrolysis of lactose. Deficiency of the enzyme (hypolactasia) may be determined genetically or arise secondarily to disease of small intestine. Under this condition, lactose enters the colon where it is fermented by intestinal microflora and turns to gases and short-chain fatty acids, causing gastrointestinal symptoms known as lactose intolerance (LI). To investigate the incidence of lactose malabsorption (LM), LI and the coexistence of these two conditions in children with upper gastrointestinal tract diseases (UGTD), malabsorption syndrome, inflammatory bowel disease (IBD) and functional gastrointestinal disorders (FGID). Hydrogen breath test (HBT) was conducted in 387 pediatric patients in years 2010-2013. Two hundred thirty two children with gastrointestinal tract diseases were selected and assigned to groups - UGTD, malabsorption syndrome, IBD or FGID. For each group the frequency of LM, frequency and severity of LI and the frequency of their co-occurrence were calculated. Lactose malabsorption was observed in 37.08% of patients with gastrointestinal diseases. Positive HBT result was the most common in children with malabsorption syndrome (52.50%) and less common in UGTD (30.85%), especially in ulcer disease (23.53%). Symptoms after lactose ingestion affected 36.64% of the subjects, and were more specific to lactose malabsorbers than to lactose absorbers (72.10% vs. 15.75%). The higher frequency of LI was noted in children with FGID, especially in irritable bowel syndrome (IBS) (65.22%). The lowest incidence of symptoms was obtained in children with UGTD, especially in those with ulcer disease (27.44%). The incidence of LM with LI was noted in 27.16% of all patients and was the highest in IBS (47.83%) and the lowest in ulcer disease (15.78%). Lactose malabsorption is a common problem in children with gastrointestinal diseases, especially in children with bowel diseases. Lactose intolerance is related to LM, but does not

  1. Utilization of CT perfusion patient selection for mechanical thrombectomy irrespective of time: a comparison of functional outcomes and complications.

    Science.gov (United States)

    Turk, Aquilla S; Nyberg, Eric MacKenzie; Chaudry, M Imran; Turner, Raymond D; Magarik, Jordan Asher; Nicholas, Joyce S; Holmstedt, Christine A; Chalela, Julio Alejandro; Hays, Angela; Lazaridis, Christos; Chimowitz, Marc I; Turan, Tanya N; Adams, Robert J; Jauch, Edward C

    2013-11-01

    Patient selection for acute ischemic stroke has been largely driven by time-based criteria, although emerging data suggest that image-based criteria may be useful. The purpose of this study was to directly compare outcomes of patients treated within a traditional time window with those treated beyond this benchmark when CT perfusion (CTP) imaging was used as the primary selection tool. A prospectively collected database of all patients with acute ischemic stroke who received intra-arterial therapy at the Medical University of South Carolina was retrospectively analyzed, regardless of time from symptom onset. At presentation, CTP maps were qualitatively assessed. Selected patients underwent intra-arterial therapy. Functional outcome according to the modified Rankin scale (mRS) score at about 90 days was documented. 140 patients were included in the study. The median time from symptom onset to groin access was 7.0 h. Overall, 28 patients (20%) had bleeding complications, but only 10 (7.1%) were symptomatic. The average National Institute of Health Stroke Scale (NIHSS) score for patients treated ≤ 7 h from symptom onset was 17.3 and 30.2% had a mRS score of 0-2 at 90 days. Patients treated >7 h from symptom onset had an average NIHSS score of 15.1 and 45.5% achieved a mRS score of 0-2 at 90 days (p=0.104). Patients in the two groups had similar rates of symptomatic intracerebral hemorrhage (8.5% and 5.8%, respectively; p=0.745). No difference was found in the rates of good functional outcome between patients treated ≤ 7 h and those treated >7 h from symptom onset. These data suggest that imaging-based patient selection is a safe and viable methodology.

  2. Clinical Application of Targeted Deep Sequencing in Solid-Cancer Patients and Utility for Biomarker-Selected Clinical Trials.

    Science.gov (United States)

    Kim, Seung Tae; Kim, Kyoung-Mee; Kim, Nayoung K D; Park, Joon Oh; Ahn, Soomin; Yun, Jae-Won; Kim, Kyu-Tae; Park, Se Hoon; Park, Peter J; Kim, Hee Cheol; Sohn, Tae Sung; Choi, Dong Il; Cho, Jong Ho; Heo, Jin Seok; Kwon, Wooil; Lee, Hyuk; Min, Byung-Hoon; Hong, Sung No; Park, Young Suk; Lim, Ho Yeong; Kang, Won Ki; Park, Woong-Yang; Lee, Jeeyun

    2017-10-01

    Molecular profiling of actionable mutations in refractory cancer patients has the potential to enable "precision medicine," wherein individualized therapies are guided based on genomic profiling. The molecular-screening program was intended to route participants to different candidate drugs in trials based on clinical-sequencing reports. In this screening program, we used a custom target-enrichment panel consisting of cancer-related genes to interrogate single-nucleotide variants, insertions and deletions, copy number variants, and a subset of gene fusions. From August 2014 through April 2015, 654 patients consented to participate in the program at Samsung Medical Center. Of these patients, 588 passed the quality control process for the 381-gene cancer-panel test, and 418 patients were included in the final analysis as being eligible for any anticancer treatment (127 gastric cancer, 122 colorectal cancer, 62 pancreatic/biliary tract cancer, 67 sarcoma/other cancer, and 40 genitourinary cancer patients). Of the 418 patients, 55 (12%) harbored a biomarker that guided them to a biomarker-selected clinical trial, and 184 (44%) patients harbored at least one genomic alteration that was potentially targetable. This study demonstrated that the panel-based sequencing program resulted in an increased rate of trial enrollment of metastatic cancer patients into biomarker-selected clinical trials. Given the expanding list of biomarker-selected trials, the guidance percentage to matched trials is anticipated to increase. This study demonstrated that the panel-based sequencing program resulted in an increased rate of trial enrollment of metastatic cancer patients into biomarker-selected clinical trials. Given the expanding list of biomarker-selected trials, the guidance percentage to matched trials is anticipated to increase. © AlphaMed Press 2017.

  3. Medication withdrawal may be an option for a select group of patients in relapsing-remitting multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Guilherme Sciascia do Olival

    2013-08-01

    Full Text Available This article describes the clinical and radiological evolution of a stable group of patients with relapsing-remitting multiple sclerosis that had their disease-modifying therapy (DMT withdrawn. Forty patients, which had made continuous use of one immunomodulator and had remained free of disease for at least 5 years, had their DMT withdrawn and were observed from 13 to 86 months. Out of the followed patients, 4 (10% patients presented with new attacks. In addition to these patients, 2 (5% patients had new lesions revealed by magnetic resonance imaging that did not correspond to clinical attacks. Despite these results, the difficult decision to withdraw medication requires careful analysis. Withdrawal, however, should not be viewed as simply the suspension of treatment because these patients should be evaluated periodically, and the immunomodulators should be readily reintroduced if new attacks occur. Nonetheless, medication withdrawal is an option for a select group of patients.

  4. General quality of life of patients with acne vulgaris before and after performing selected cosmetological treatments

    Directory of Open Access Journals (Sweden)

    Chilicka K

    2017-08-01

    Full Text Available Karolina Chilicka,1 Joanna Maj,2 Bernard Panaszek3 1Department of Cosmetology, Opole Medical School, Opole, 2Department of Dermatology, Venereology and Allergology, 3Department of Internal Medicine and Allergy, Wroclaw Medical University, Wrocław, Poland Background: Achieving a satisfying quality of life for a patient by applying individually matched therapy is, simultaneously, a great challenge and a priority for contemporary medicine. Patients with visible dermatological ailments are particularly susceptible to reduction in the general quality of life. Among the dermatological diseases, acne causes considerable reduction in the quality of life and changes in self-perception that lead to the worsening of a patient’s mental condition, including depression and suicidal thoughts. As a result, difficulties in contact with loved ones, as well as social and professional problems are observed, which show that acne is not a somatic problem alone. To a large extent, it becomes a part of psychodermatology, becoming an important topic of public health in social medicine practice. Pharmacological treatment of acne is a challenge for a dermatologist and often requires the necessity of cooperating with a cosmetologist. Cosmetological treatments are aimed at improving the condition of the skin and reduction or subsiding of acne skin changes.Aim: The aim of this study was to assess the influence of selected cosmetological treatments on the general quality of life of patients with acne.Materials and methods: The study group consisted of 101 women aged 19–29 years (x̅  =22.5 years, SD =2.3 years. All subjects were diagnosed with acne vulgaris of the face. In the study group, the acne changes occurred over the course of 3–15 years (x̅ =8.1 years, SD =2.7 years. Selected cosmetological treatments (intensive pulsing light, alpha-hydroxy acids, cavitation peeling, needle-free mesotherapy, diamond microdermabrasion and sonophoresis were performed in

  5. Economic considerations and patients' preferences affect treatment selection for patients with rheumatoid arthritis: a discrete choice experiment among European rheumatologists

    NARCIS (Netherlands)

    Hifinger, M.; Hiligsmann, M.; Ramiro, S.; Watson, V.; Severens, J. L.; Fautrel, B.; Uhlig, T.; van Vollenhoven, R.; Jacques, P.; Detert, J.; Canas da Silva, J.; Scirè, C. A.; Berghea, F.; Carmona, L.; Péntek, M.; Keat, A.; Boonen, A.

    2017-01-01

    To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis. In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with

  6. Analyses des discours non strictement mathematiques accompagnant des cours de mathematiques (Analysis of Not Strictly Mathematical Discourse in Mathematics Classes).

    Science.gov (United States)

    Robert, Aline

    1995-01-01

    Examines discourse, not strictly mathematical, that teachers might adopt in a mathematics class and presents three major functions of such discourse: communication; structuring and labeling; and reflection. Develops lines for further inquiry, notably on the third function, the most likely focus for specific preparation by the teacher. (13…

  7. Properties of N-person axiomatic bargaining solutions if the Pareto frontier is twice differentiable and strictly concave

    NARCIS (Netherlands)

    Douven, R.C.M.H.; Engwerda, J.C.

    1995-01-01

    In this paper we discuss properties of N-person axiomatic bargaining problems, where the Pareto frontier of S can be described by a strictly concave and twice differentiable function. These type of problems are characteristic for the empirical policy coordination literature. In that literature the

  8. Convergence of Implicit and Explicit Schemes for an Asymptotically Nonexpansive Mapping in -Uniformly Smooth and Strictly Convex Banach Spaces

    Directory of Open Access Journals (Sweden)

    Meng Wen

    2012-01-01

    Full Text Available We introduce a new iterative scheme with Meir-Keeler contractions for an asymptotically nonexpansive mapping in -uniformly smooth and strictly convex Banach spaces. We also proved the strong convergence theorems of implicit and explicit schemes. The results obtained in this paper extend and improve many recent ones announced by many others.

  9. A non-permselective membrane reactor for chemical processes normally requiring strict stoichiometric feed rates of reactants

    NARCIS (Netherlands)

    Sloot, H.J.; Versteeg, Geert; van Swaaij, Willibrordus Petrus Maria

    1990-01-01

    A novel type of membrane reactor with separated feeding of the reactants is presented for chemical processes normally requiring strict stoichiometric feed rates of premixed reactants. The reactants are fed in the reactor to the different sides of a porous membrane which is impregnated with a

  10. Strict Fathers, Competing Culture(s), and Racialized Poverty: White South African Teachers' Conceptions of Themselves as Racialized Actors

    Science.gov (United States)

    Casey, Zachary A.

    2016-01-01

    This article focuses in particular on four white South African female practicing P-12 teachers' narratives about their own racialized understanding of their classroom practice(s) and their (racio-cultural) self-identity. Each of the four participants reported growing up with what they described as "strict fathers" and shared ways in…

  11. Preoperative accuracy of gastric cancer staging in patient selection for preoperative therapy: race may affect accuracy of endoscopic ultrasonography.

    Science.gov (United States)

    Ikoma, Naruhiko; Lee, Jeffrey H; Bhutani, Manoop S; Ross, William A; Weston, Brian; Chiang, Yi-Ju; Blum, Mariela A; Sagebiel, Tara; Devine, Catherine E; Matamoros, Aurelio; Fournier, Keith; Mansfield, Paul; Ajani, Jaffer A; Badgwell, Brian D

    2017-12-01

    Over the last 15 years, large randomized controlled studies have validated the benefit of preoperative therapy for patients with resectable gastric cancer. Computed tomography (CT) and endoscopic ultrasonography (EUS) are commonly used to select patients for preoperative treatment, but studies of preoperative staging accuracy that focus on patient selection for preoperative therapy are rare; therefore, whether CT or EUS can reliably identify patients eligible for preoperative therapy is still unclear. Our purpose was to determine the accuracy of EUS and CT for preoperative staging of gastric cancer and to identify factors that may affect their usefulness in selecting patients for preoperative therapy. We reviewed the medical records of 8,260 patients with gastric or gastroesophageal adenocarcinoma treated at our institution from 1995 to 2013, identifying those who underwent gastrectomy without preoperative treatment. We compared T stage and N status from preoperative EUS and CT reports with those drawn from surgical pathology reports. Clinicopathologic and demographic variables associated with incorrect preoperative staging were investigated using univariate and multivariate analyses. We identified 187 patients who underwent preoperative staging by EUS (n=145) and/or CT (n=134) before gastrectomy. The accuracy, sensitivity, and specificity of EUS in distinguishing stage T1 from more advanced tumors were 82%, 78%, and 85%, respectively. Variables associated with underestimation of EUS T stage were lymphovascular invasion [odds ratio (OR), 7.51; 95% confidence interval (CI), 1.91-29.50; Ppreoperative therapy.

  12. Solving a More Flexible Home Health Care Scheduling and Routing Problem with Joint Patient and Nursing Staff Selection

    Directory of Open Access Journals (Sweden)

    Jamal Abdul Nasir

    2018-01-01

    Full Text Available Development of an efficient and effective home health care (HHC service system is a quite recent and challenging task for the HHC firms. This paper aims to develop an HHC service system in the perspective of long-term economic sustainability as well as operational efficiency. A more flexible mixed-integer linear programming (MILP model is formulated by incorporating the dynamic arrival and departure of patients along with the selection of new patients and nursing staff. An integrated model is proposed that jointly addresses: (i patient selection; (ii nurse hiring; (iii nurse to patient assignment; and (iv scheduling and routing decisions in a daily HHC planning problem. The proposed model extends the HHC problem from conventional scheduling and routing issues to demand and capacity management aspects. It enables an HHC firm to solve the daily scheduling and routing problem considering existing patients and nursing staff in combination with the simultaneous selection of new patients and nurses, and optimizing the existing routes by including new patients and nurses. The model considers planning issues related to compatibility, time restrictions, contract durations, idle time and workload balance. Two heuristic methods are proposed to solve the model by exploiting the variable neighborhood search (VNS approach. Results obtained from the heuristic methods are compared with a CPLEX based solution. Numerical experiments performed on different data sets, show the efficiency and effectiveness of the solution methods to handle the considered problem.

  13. Energy and nutritional value of diets used in patients alimentation and their assessment by patients of selected clinical department in the Military Medical Institute in Warsaw.

    Science.gov (United States)

    Kłos, Krzysztof; Bertrandt, Jerzy; Jałocha, Lukasz; Matuszewski, Tomasz; Abramowicz, Michał

    2007-01-01

    The aim of the work was laboratory assessment of energy and nutritional value of general and light diets used in patients of selected clinical department in the Military Medical Institute in Warsaw alimentation. Using questionnaire method the assessment of diets was done by patients too. Meals given to patients in hospital not always fulfilled nutritional requirements. Additional consumption of supplementary products did not always meet the requirements of proper nutrition. Half of examined patients appraised nutrition variety as good but at the same time claimed the there was not enough fruits and vegetables.

  14. Combined selective dorsal rhizotomy and scoliosis correction procedure in patients with cerebral palsy.

    Science.gov (United States)

    Muquit, Samiul; Ammar, Amr; Nasto, Luigi; Moussa, Ahmad A; Mehdian, Hossein; Vloeberghs, Michael H

    2016-02-01

    Intrathecal baclofen (ITB) therapy for spasticity has been suggested to accelerate the development of scoliosis. We present the case of a 17-year-old female patient with cerebral palsy who had ITB therapy from the age of 11 years. During this period, she developed a severe scoliosis measuring 86° from T11 to L4, with pain due to costo-pelvic impingement. Her baclofen pump had reached its end of life and required replacement if ITB therapy was to continue. This coincided with plans for scoliosis corrective surgery. We performed scoliosis correction along with removal of baclofen pump and selective dorsal rhizotomy (SDR), as a single combined procedure. SDR was performed instead of ITB pump replacement for management of spasticity. Following surgery, scoliosis improved to 24°. At 6 month follow-up, there was significant improvement in spasticity and quality of life. This report illustrates the feasibility of a combined procedure to correct scoliosis and manage spasticity with SDR. We present the case details, our management and review of the published literature regarding the factors influencing treatment of scoliosis and spasticity.

  15. Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria

    Science.gov (United States)

    Faghih, Mahya; Gonzalez, Francisco Garcia; Makary, Martin A.; Singh, Vikesh K.

    2018-01-01

    Purpose of review Critical review of the indications for total pancreatectomy and highlight limitations in current diagnostic criteria for chronic pancreatitis. Recent findings The diagnosis of noncalcific chronic pancreatitis remains controversial because of an overreliance on nonspecific imaging and laboratories findings. Endoscopic ultrasound, s-magnetic resonance cholangiopancreatography, and/or endoscopic pancreatic function testing are often used to diagnose noncalcific chronic pancreatitis despite the fact that there is no gold standard for this condition. Abdominal pain is not specific for chronic pancreatitis and is more likely to be encountered in patients with functional gastrointestinal disorders based on the high incidence of these conditions. The duration of pain and opioid analgesic use results in central sensitization that adversely affects pain outcomes after total pancreatectomy. An alcoholic cause is associated with poorer pain outcomes after total pancreatectomy. Summary The lack of a gold standard for noncalcific chronic pancreatitis limits the diagnostic accuracy of imaging and laboratory tests. The pain of chronic pancreatitis is nonspecific and is affected by duration, preoperative opioid use, and cause. These factors will need to be considered in the development of future selection criteria for this morbid surgery. PMID:28700371

  16. Patient dose assessment due to fluoroscopic exposure for some selected fluoroscopic procedures in Ghana

    International Nuclear Information System (INIS)

    Gyekye, P. K.; Schandorf, C.; Boadu, M.; Yeboah, J.; Amoako, J. K.

    2009-01-01

    Organ and effective doses to 90 patients undergoing some selected fluoroscopic examinations at the Korle-Bu Teaching Hospital were estimated using the Monte Carlo-based program (PCXMC version 1.5). Radiation dose was estimated from free-in-air measurements. The mean effective doses were found to be 0.29 ± 0.07, 0.84 ± 0.13, 3.15 ± 0.44, 6.24 ± 0.70 and 0.38 ± 0.05 mSv for urethrogram, barium swallow, barium meal, barium enema and myelogram examinations, respectively. The dose area product was estimated to be 3.55 ± 0.95, 16.44 ± 2.60, 50.81 ± 7.04, 99.69 ± 10.85 and 9.32 ± 0.99 Gy cm 2 > for urethrogram, barium swallow, barium meal, barium enema and myelogram examinations, respectively. Optimisation of procedures is required for barium enema and barium meal examinations. (authors)

  17. Optimization of an effective growth medium for culturing probiotic bacteria for applications in strict vegetarian food products

    Directory of Open Access Journals (Sweden)

    Manju Pathak

    2012-10-01

    Full Text Available Background: This study aimed to modify de Man Rogosa Sharpe culture medium (termed MRS for selective cultivation of probiotics strain for the consumption by the strictly vegetarian human population. Vegetarian probiotic foods by definition must be free from all animal-derived ingredients. This not only includes the product ingredients but the probiotic inoculum as well. Probiotic starter cultures are traditionally grown and stored in media containing milk or meatderived ingredients. The presence of these ingredients makes the probiotic cell concentrates unsuitable for use in vegetarian products and thus creates the need for a growth medium which isfree from animal-derived ingredients. Present study investigated the growth of a strain of Lactobacillus lactis in MRS. The present invention relates in general to a bacterial culture media,and more specifically a complex microbial culture media, based on plant seed powder extract in place of animal extract for probiotic bacterial growth.Methods: Lactobacillus lactis, a probiotic, was grown in standard MRS culture medium as well as in our various test media (TM containing various vegetal source in place of beef extract, yeast extract and peptone as in case of MRS. The inoculated culture mediums were incubated at 37C for 72 hours and growth of probiotic is recorded at regular intervals. The growth was recorded as Colony Forming Units (CFUs.Results: The best growth of probiotic is observed in TM 2. TM 2 is the leguminous seed extract. Starter culture mediums for probiotics or other bacteria primarily contain protein from animal source. The possibility of using vegetal protein from TM 2 extract in place of peptones and meat extract for the nitrogen supplementation of culture media for the growth of lactic acid bacteria has been demonstrated.Functional Foods in Health and Disease 2012, 2(10:369-378 Conclusion: The absolute vegetarian culture medium containing TM 2 is better than standard MRS for the

  18. Investigating the Relationship Between Selective Attention and Cognitive Flexibility With Balance in Patients With Relapsing-Remitting Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Vali Shiri

    2018-01-01

    Conclusion A significant relationship between selective attentions to balance demonstrates that appropriately designed interventions to repair the attention, can decrease the balance problem in patients with MS. One of the possible reasons for this relationship can be found in the brain system that attention circuits are interacting with equilibrium systems, and any defect in selective attention leads to a loss of balance. Patients with MS experience constant imbalance due to cerebral plaques and relapsing-remitting periods, and in addition to rehabilitation of the balance system, cognitive systems such as attention should be treated.

  19. [Influence of distinct criteria for selecting patients for swabbing on estimation of the effectiveness of the influenza vaccine].

    Science.gov (United States)

    Martínez-Baz, Iván; Guevara, Marcela; Elía, Fernando; Ezpeleta, Carmen; Fernández Alonso, Mirian; Castilla, Jesús

    2014-01-01

    To estimate the effectiveness of the influenza vaccine under different criteria for selecting patients for swabbing. A case-control study was performed of laboratory-confirmed cases (n=909) and negative controls for influenza (n=732) in the 2010-2011 to 2012-2013 seasons in Navarre (Spain). The adjusted vaccine effectiveness was estimated by including all swabs from patients with influenza-like-illness and selecting only the first two cases per physician and week. The first two patients per physician and week were less frequently vaccinated against influenza (7.9% vs. 12.5%, p=0.021) and less often received confirmation of influenza (53.6% vs. 66.4%, p <0.001) than subsequent patients. These differences decreased after adjustment for covariates. The effectiveness of the influenza vaccine was 49% (95% CI: 23-66%) when all swabs were included and was 55% (95% CI: 27-72%) when we selected the first two swabs per week and physician. The selection of the first two patients per physician and week may bias assessment of the effectiveness of the influenza vaccine, although this bias was small in the seasons analyzed. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  20. Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

    Directory of Open Access Journals (Sweden)

    Schlitt Hans J

    2009-01-01

    Full Text Available Abstract Background Peritoneal tumor dissemination arising from colorectal cancer, appendiceal cancer, gastric cancer, gynecologic malignancies or peritoneal mesothelioma is a common sign of advanced tumor stage or disease recurrence and mostly associated with poor prognosis. Methods and results In the present review article preoperative workup, surgical technique, postoperative morbidity and mortality rates, oncological outcome and quality of life after CRS and HIPEC are reported regarding the different tumor entities. Conclusion Cytoreductive surgery (CRS and hyperthermic intraperitoneal chemotherapy (HIPEC provide a promising combined treatment strategy for selected patients with peritoneal carcinomatosis that can improve patient survival and quality of life. The extent of intraperitoneal tumor dissemination and the completeness of cytoreduction are the leading predictors of postoperative patient outcome. Thus, consistent preoperative diagnostics and patient selection are crucial to obtain a complete macroscopic cytoreduction (CCR-0/1.

  1. SIRveNIB: Selective Internal Radiation Therapy Versus Sorafenib in Asia-Pacific Patients With Hepatocellular Carcinoma.

    Science.gov (United States)

    Chow, Pierce K H; Gandhi, Mihir; Tan, Say-Beng; Khin, Maung Win; Khasbazar, Ariunaa; Ong, Janus; Choo, Su Pin; Cheow, Peng Chung; Chotipanich, Chanisa; Lim, Kieron; Lesmana, Laurentius A; Manuaba, Tjakra W; Yoong, Boon Koon; Raj, Aloysius; Law, Chiong Soon; Cua, Ian H Y; Lobo, Rolley R; Teh, Catherine S C; Kim, Yun Hwan; Jong, Yun Won; Han, Ho-Seong; Bae, Si-Hyun; Yoon, Hyun-Ki; Lee, Rheun-Chuan; Hung, Chien-Fu; Peng, Cheng-Yuan; Liang, Po-Chin; Bartlett, Adam; Kok, Kenneth Y Y; Thng, Choon-Hua; Low, Albert Su-Chong; Goh, Anthony S W; Tay, Kiang Hiong; Lo, Richard H G; Goh, Brian K P; Ng, David C E; Lekurwale, Ganesh; Liew, Wei Ming; Gebski, Val; Mak, Kenneth S W; Soo, Khee Chee

    2018-03-02

    Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresectable hepatocellular carcinoma (HCC) limited to the liver. This study compared the safety and efficacy of RE and sorafenib in patients with locally advanced HCC. Patients and Methods SIRveNIB (selective internal radiation therapy v sorafenib), an open-label, investigator-initiated, phase III trial, compared yttrium-90 ( 90 Y) resin microspheres RE with sorafenib 800 mg/d in patients with locally advanced HCC in a two-tailed study designed for superiority/detriment. Patients were randomly assigned 1:1 and stratified by center and presence of portal vein thrombosis. Primary end point was overall survival (OS). Efficacy analyses were performed in the intention-to-treat population and safety analyses in the treated population. Results A total of 360 patients were randomly assigned (RE, 182; sorafenib, 178) from 11 countries in the Asia-Pacific region. In the RE and sorafenib groups, 28.6% and 9.0%, respectively, failed to receive assigned therapy without significant cross-over to either group. Median OS was 8.8 and 10.0 months with RE and sorafenib, respectively (hazard ratio, 1.1; 95% CI, 0.9 to 1.4; P = .36). A total of 1,468 treatment-emergent adverse events (AEs) were reported (RE, 437; sorafenib, 1,031). Significantly fewer patients in the RE than sorafenib group had grade ≥ 3 AEs (36 of 130 [27.7%]) v 82 of 162 [50.6%]; P radiation hepatitis (two [1.5%] v zero [0%] patients). Fewer patients in the RE group (27 of 130 [20.8%]) than in the sorafenib group (57 of 162 [35.2%]) had serious AEs. Conclusion In patients with locally advanced HCC, OS did not differ significantly between RE and sorafenib. The improved toxicity profile of RE may inform treatment choice in selected patients.

  2. Identité stricte ou partielle et identification dans les phrases à copule. Comment les identifier ?

    Directory of Open Access Journals (Sweden)

    Amary-Coudreau Valérie

    2014-07-01

    éristiques propres à l’identité, ainsi que celles propres à la spécification et à l’identification, pour lesquelles X et Y ont des degrés de référentialité et/ou de prédicativité différents. Enfin, cette hypothèse nous amène à distinguer l’identité de l’identification, sur la base de tests qui, à l’inverse de Larreya (2003, différencient l’identité stricte de l’identité partielle.

  3. Prevalence of dermatologic diseases among patients with selective immunoglobulin A deficiency.

    Science.gov (United States)

    Magen, Eli; Masalha, Atheer; Waitman, Dan Andrei; Kahan, Natan; Viner, Igor; Klassov, Leonora; Vardy, Daniel

    2017-01-01

    There are no published large-scale epidemiologic studies regarding the prevalence of skin diseases in patients with selective immunoglobulin A (IgA) deficiency (sIgAD). The purpose of this study was to investigate the prevalence of dermatological diseases in patients with sIgAD. This retrospective matched case-control study was based on data from the Leumit Healthcare Services data base (approximately 725,000 residents of Israel), which was searched for all subjects aged ≥12 years who had undergone serum total IgA measurements during 2004-14 for any reason. The case group included subjects with sIgAD. The control A group was randomly sampled from those subjects in whom an IgA was drawn (n ≈ 725,000), with a ratio of 10 controls for every case (1:10). The control A group was randomly sampled from those subjects in whom an IgA was drawn (n = 104,729) and the control B group was randomly sampled from the full study population (n ≈ 725,000), with a ratio of 10 controls for every case (1:10). Comorbidity was compared between the study groups. The sIgAD group was characterized: 1) By a higher prevalence of atopic dermatitis (AD) (16 [4.6 %]) than the control A group (76 [2.1 %]; p = 0.004 and the control B group (64 [1.9 %]; p = 0.002). 2) By higher prevalence of acne (69 [19.9 %]) than the control A group (516 [13.8 %]; p = 0.013) and control B group (494 [14.2 %]; p < 0.001). 3) By higher rate of chronic spontaneous urticaria (CSU) (17 [4.9 %)] than in the control A group (31 [0.9 %], with odds ratio 5.54 [3.04-10.13]; p < 0.001) and the control B group (28 [0.8 %]; p < 0.001). sIgAD is characterized by a higher prevalence of AD, CSU and acne.

  4. Recurrence predictive models for patients with hepatocellular carcinoma after radiofrequency ablation using support vector machines with feature selection methods.

    Science.gov (United States)

    Liang, Ja-Der; Ping, Xiao-Ou; Tseng, Yi-Ju; Huang, Guan-Tarn; Lai, Feipei; Yang, Pei-Ming

    2014-12-01

    Recurrence of hepatocellular carcinoma (HCC) is an important issue despite effective treatments with tumor eradication. Identification of patients who are at high risk for recurrence may provide more efficacious screening and detection of tumor recurrence. The aim of this study was to develop recurrence predictive models for HCC patients who received radiofrequency ablation (RFA) treatment. From January 2007 to December 2009, 83 newly diagnosed HCC patients receiving RFA as their first treatment were enrolled. Five feature selection methods including genetic algorithm (GA), simulated annealing (SA) algorithm, random forests (RF) and hybrid methods (GA+RF and SA+RF) were utilized for selecting an important subset of features from a total of 16 clinical features. These feature selection methods were combined with support vector machine (SVM) for developing predictive models with better performance. Five-fold cross-validation was used to train and test SVM models. The developed SVM-based predictive models with hybrid feature selection methods and 5-fold cross-validation had averages of the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the ROC curve as 67%, 86%, 82%, 69%, 90%, and 0.69, respectively. The SVM derived predictive model can provide suggestive high-risk recurrent patients, who should be closely followed up after complete RFA treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Human papillomavirus detection and comorbidity: critical issues in selection of patients with oropharyngeal cancer for treatment De-escalation trials

    NARCIS (Netherlands)

    Rietbergen, M.M.; Brakenhoff, R.H.; Bloemena, E.; Witte, B.I.; Snijders, P.J.F.; Heideman, D.A.M.; Boon, D.; Koljenovic, S.; Baatenburg-de Jong, R.J.; Leemans, C.R.

    2013-01-01

    Background: The presence of human papillomavirus (HPV)-infection in oropharyngeal squamous cell carcinoma (OPSCC) is a major determinant in prognostic risk modeling. However, most risk models are based on clinical trials which only include a selected patient population. The clinical significance of

  6. Cost-effectiveness of early versus selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation

    NARCIS (Netherlands)

    Dijksman, L. M.; Hirsch, A.; Windhausen, F.; Asselman, F. F.; Tijssen, J. G. P.; Dijkgraaf, M. G. W.; de Winter, R. J.

    2009-01-01

    AIMS: The ICTUS trial compared an early invasive versus a selectively invasive strategy in high risk patients with a non-ST-segment elevation acute coronary syndrome and an elevated cardiac troponin T. Alongside the ICTUS trial a cost-effectiveness analysis from a provider perspective was performed.

  7. Selecting relevant and feasible measurement instruments for the revised Dutch clinical practice guideline for physical therapy in patients after stroke

    NARCIS (Netherlands)

    Otterman, Nicoline; Veerbeek, Janne; Schiemanck, Sven; van der Wees, Philip; Nollet, Frans; Kwakkel, Gert

    2017-01-01

    Purpose: To select relevant and feasible instruments for the revision of the Dutch clinical practice guideline for physical therapy in patients with stroke. Methods: In this implementation study a comprehensive proposal for ICF categories and matching instruments was developed, based on reliability

  8. Selecting relevant and feasible measurement instruments for the revised Dutch clinical practice guideline for physical therapy in patients after stroke

    NARCIS (Netherlands)

    Otterman, N.; Veerbeek, J.; Schiemanck, S.; Wees, P.J. van der; Nollet, F.; Kwakkel, G.

    2017-01-01

    PURPOSE: To select relevant and feasible instruments for the revision of the Dutch clinical practice guideline for physical therapy in patients with stroke. METHODS: In this implementation study a comprehensive proposal for ICF categories and matching instruments was developed, based on reliability

  9. Spinal fusion for chronic low back pain: systematic review on the accuracy of tests for patient selection

    NARCIS (Netherlands)

    Willems, P.C.P.H.; Staal, J.B.; Walenkamp, G.H.; Bie, R.A. de

    2013-01-01

    BACKGROUND CONTEXT: Spinal fusion is a common but controversial treatment for chronic low back pain (LBP) with outcomes similar to those of programmed conservative care. To improve the results of fusion, tests for patient selection are used in clinical practice. PURPOSE: To determine the prognostic

  10. Rectal Carriage of Extended-Spectrum-Beta-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients : Selective Preenrichment Increases Yield of Screening

    NARCIS (Netherlands)

    Kluijtmans-van den Bergh, Marjolein; Verhulst, C.; Willemsen, L. E.; Verkade, E.; Bonten, M. J. M.; Kluytmans, J. A. J. W.

    This study evaluated the added value of selective preenrichment for the detection of rectal carriage of extended-spectrum-beta-lactamase-producing Enterobacteriaceae (ESBL-E). ESBL-E rectal carriage was identified in 4.8% of hospitalized patients, and 25.9% of ESBL-E rectal carriers were identified

  11. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium

    NARCIS (Netherlands)

    Gribble, P.A.; Delahunt, E.; Bleakley, C.M.; Caulfield, B.; Docherty, C.L.; Fong, D.T.; Fourchet, F.; Hertel, J.; Hiller, C.E.; Kaminski, T.W.; McKeon, P.O.; Refshauge, K.M.; Wees, P.J. van der; Vicenzino, W.; Wikstrom, E.A.

    2014-01-01

    While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant or patient selection criteria across studies presents a potential obstacle to addressing the problem

  12. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium

    NARCIS (Netherlands)

    Gribble, P.A.; Delahunt, E.; Bleakley, C.; Caulfield, B.; Docherty, C.; Fourchet, F.; Fong, D.T.; Hertel, J.; Hiller, C.; Kaminski, T.; McKeon, P.; Refshauge, K.; Wees, P.J. van der; Vincenzino, B.; Wikstrom, E.

    2014-01-01

    While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly.

  13. Role of Tumor Location in Selecting Patients for Percutaneous Versus Surgical Cryoablation of Renal Masses

    Science.gov (United States)

    Long, Christopher J; Canter, Daniel J; Smaldone, Marc C; Li, Tianyu; Simhan, Jay; Rozenfeld, Boris; Teper, Ervin; Chen, David YT; Greenberg, Richard E; Viterbo, Rosalia; Uzzo, Robert G; Kutikov, Alexander

    2013-01-01

    Purpose To characterize the relationship between tumor location and choice in selecting surgical cryoablation (SCA) vs. percutaneous cryoablation (PCA) for treatment of renal masses. Materials and Methods MEDLINE search was performed to identify studies in which cryoablation was used as therapy for renal masses. Tumor location was stratified as anterior, posterior, or lateral. Lesions were also described by endophycity (endo-, meso-, or exophytic) and polarity (upper, mid, or lower pole). Treating specialty was stratified as urology, radiology, or both. Comorbidity reporting rates were indexed for each manuscript. Results 37 manuscripts included 2344 lesions treated by SCA or PCA formed the basis for the analysis. Comparing SCA vs. PCA series, anterior/posterior designation was reported in 31 vs. 47% of series; endophycity designation was reported in 17 vs. 40% of series; and polarity designation was reported in 48 vs. 47% of series (all p-values >0.05). Amongst those lesions treated by SCA, 44% were anterior lesions and 28% were posterior, while among PCA-treated lesions 9% were anterior and 81% were posterior. Tumor location description was entirely absent in 32% (14/44) of published series. Conclusions Despite data that tumor location is integral to choice of treatment for renal mass, anatomic tumor descriptors are vastly underreported in the cryotherapy literature. Nearly one third of masses treated with SCA are on the posterior surface of the affected kidney, and may be amenable to PCA, thus avoiding risk of general anesthesia and intraabdominal dissection in comorbid cohorts. Better reporting of objective measures of tumor anatomy and location in cryosurgery literature may facilitate standardization of treatment protocols in patients with renal mass. PMID:23040619

  14. Selective Fiber Degeneration in the Peripheral Nerve of a Patient With Severe Complex Regional Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Adrien Yvon

    2018-04-01

    Full Text Available Aims: Complex regional pain syndrome (CRPS is characterized by chronic debilitating pain disproportional to the inciting event and accompanied by motor, sensory, and autonomic disturbances. The pathophysiology of CRPS remains elusive. An exceptional case of severe CRPS leading to forearm amputation provided the opportunity to examine nerve histopathological features of the peripheral nerves.Methods: A 35-year-old female developed CRPS secondary to low voltage electrical injury. The CRPS was refractory to medical therapy and led to functional loss of the forelimb, repeated cutaneous wound infections leading to hospitalization. Specifically, the patient had exhausted a targeted conservative pain management programme prior to forearm amputation. Radial, median, and ulnar nerve specimens were obtained from the amputated limb and analyzed by light and transmission electron microscopy (TEM.Results: All samples showed features of selective myelinated nerve fiber degeneration (47–58% of fibers on electron microscopy. Degenerating myelinated fibers were significantly larger than healthy fibers (p < 0.05, and corresponded to the larger Aα fibers (motor/proprioception whilst smaller Aδ (pain/temperature fibers were spared. Groups of small unmyelinated C fibers (Remak bundles also showed evidence of degeneration in all samples.Conclusions: We are the first to show large fiber degeneration in CRPS using TEM. Degeneration of Aα fibers may lead to an imbalance in nerve signaling, inappropriately triggering the smaller healthy Aδ fibers, which transmit pain and temperature. These findings suggest peripheral nerve degeneration may play a key role in CRPS. Improved knowledge of pathogenesis will help develop more targeted treatments.

  15. Drop-out between the two liver resections of two-stage hepatectomy. Patient selection or loss of chance?

    Science.gov (United States)

    Viganò, L; Torzilli, G; Cimino, M; Imai, K; Vibert, E; Donadon, M; Castaing, D; Adam, R

    2016-09-01

    Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal liver metastases (CLM), but 25-35% of patients fail to complete the scheduled procedure (drop-out). To elucidate if drop-out of TSH is a patient selection (as usually considered) or a loss of chance. All the consecutive patients scheduled for a TSH at the Paul Brousse Hospital between 2000 and 2012 were considered. TSH patients were matched 1:1 with patients receiving a one-stage ultrasound-guided hepatectomy (OSH) at the Humanitas Research Hospital in the same period. Matching criteria were: primary tumor N status; timing of CLM diagnosis; CLM number and distribution into the liver. Sixty-three pairs of patients were analyzed. Demographic and tumor characteristics were similar (median 7 CLM), except for more chemotherapy lines and adjuvant chemotherapy in TSH. Drop-out rate of TSH was 38.1% (0% of OSH). The two groups had similar R0 resection rate (19.0% OSH vs. 15.9% TSH). OSH and completed TSH had similar five-year survival (from CLM diagnosis 49.8% vs. 49.7%, from liver resection 36.1% vs. 44.3%), superior to drop-out (10% three-year survival, p loss of chance rather than a criteria for patient selection. "Unselected" OSH patients had the same outcomes of selected patients who completed TSH. A complete resection is the main determinant of prognosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Supra-annular structure assessment for self-expanding transcatheter heart valve size selection in patients with bicuspid aortic valve.

    Science.gov (United States)

    Liu, Xianbao; He, Yuxin; Zhu, Qifeng; Gao, Feng; He, Wei; Yu, Lei; Zhou, Qijing; Kong, Minjian; Wang, Jian'an

    2018-04-01

    To explore assessment of supra-annular structure for self-expanding transcatheter heart valve (THV) size selection in patients with bicuspid aortic stenosis (AS). Annulus-based device selection from CT measurement is the standard sizing strategy for tricuspid aortic valve before transcatheter aortic valve replacement (TAVR). Because of supra-annular deformity, device selection for bicuspid AS has not been systemically studied. Twelve patients with bicuspid AS who underwent TAVR with self-expanding THVs were included in this study. To assess supra-annular structure, sequential balloon aortic valvuloplasty was performed in every 2 mm increments until waist sign occurred with less than mild regurgitation. Procedural results and 30 day follow-up outcomes were analyzed. Seven patients (58.3%) with 18 mm; three patients (25%) with sequential 18 mm, 20 mm; and only two patients (16.7%) with sequential 18 mm, 20 mm, and 22 mm balloon sizing were performed, respectively. According to the results of supra-annular assessment, a smaller device size (91.7%) was selected in all but one patient compared with annulus based sizing strategy, and the outcomes were satisfactory with 100% procedural success. No mortality and 1 minor stroke were observed at 30 d follow-up. The percentage of NYHA III/IV decreased from 83.3% (9/12) to 16.7% (2/12). No new permanent pacemaker implantation and no moderate or severe paravalvular leakage were found. A supra-annular structure based sizing strategy is feasible for TAVR in patients with bicuspid AS. © 2018 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

  17. Brace treatment of lumber spondylolysis in growing age. Patient selection by RI scintigraphy and repair of spondylolysis

    Energy Technology Data Exchange (ETDEWEB)

    Abumi, Kuniyoshi; Hino, Hiroyuki; Sato, Shigeyoshi; Kaneda, Kiyoshi [Hokkaido Univ., Sapporo (Japan). School of Medicine

    1996-07-01

    From 1987 to 1994, brace treatment was prescribed to 29 patients with lumbar spondylolysis in growing age, ranging from nine to 18 years, in whom {sup 99m}Tc bone scintigraphy showed positive at the pars interarticularis. Single photon emission computed tomography was also conducted an recent cases. Spondylolysis was bilateral in 27 patients and unilateral in two. Polypropylene brace was applied for three to four months with restriction of sport activities. As a result, 46 out of 58 spondylolysis healed with a healing rate of 79%. Selection of patients using bone scintigraphy for brace treatment in lumbar spondylolysis in growing age would help to increase the union rate. (author)

  18. Brace treatment of lumber spondylolysis in growing age. Patient selection by RI scintigraphy and repair of spondylolysis

    International Nuclear Information System (INIS)

    Abumi, Kuniyoshi; Hino, Hiroyuki; Sato, Shigeyoshi; Kaneda, Kiyoshi

    1996-01-01

    From 1987 to 1994, brace treatment was prescribed to 29 patients with lumbar spondylolysis in growing age, ranging from nine to 18 years, in whom 99m Tc bone scintigraphy showed positive at the pars interarticularis. Single photon emission computed tomography was also conducted an recent cases. Spondylolysis was bilateral in 27 patients and unilateral in two. Polypropylene brace was applied for three to four months with restriction of sport activities. As a result, 46 out of 58 spondylolysis healed with a healing rate of 79%. Selection of patients using bone scintigraphy for brace treatment in lumbar spondylolysis in growing age would help to increase the union rate. (author)

  19. Analysis of Inhaled Corticosteroid Selection in Patients with Bronchial Asthma Using a Questionnaire Survey—Effects of Age, Gender, and Disease Severity—

    Directory of Open Access Journals (Sweden)

    Kyuma Ota

    2009-01-01

    Conclusions: Our study indicates that ICS selection is reasonably adapted to each patient's background at least in the surveyed area. We need to elucidate the characteristics of ICS selection further in the future as new ICS and devices are developed.

  20. Antibiotic-Induced Within-Host Resistance Development of Gram-Negative Bacteria in Patients Receiving Selective Decontamination or Standard Care

    NARCIS (Netherlands)

    Noteboom, Yvonne; Ong, David S. Y.; Oostdijk, Evelien A.; Schultz, Marcus J.; de Jonge, Evert; Purmer, Ilse; Bergmans, Dennis; Fijen, Jan Willem; Kesecioglu, Jozef; Bonten, Marc J. M.

    2015-01-01

    To quantify antibiotic-associated within-host antibiotic resistance acquisition rates in Pseudomonas aeruginosa, Klebsiella species, and Enterobacter species from lower respiratory tract samples of ICU patients receiving selective digestive decontamination, selective oropharyngeal decontamination,

  1. Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making.

    Science.gov (United States)

    Mokhles, S; Nuyttens, J J M E; de Mol, M; Aerts, J G J V; Maat, A P W M; Birim, Ö; Bogers, A J J C; Takkenberg, J J M

    2018-01-15

    The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice. Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1-5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire. In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making. Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict.

  2. Normal Hearing Ability but Impaired Auditory Selective Attention Associated with Prediction of Response to Donepezil in Patients with Alzheimer's Disease

    Science.gov (United States)

    Ouchi, Yoshitaka; Meguro, Kenichi; Akanuma, Kyoko; Kato, Yuriko; Yamaguchi, Satoshi

    2015-01-01

    Background. Alzheimer's disease (AD) patients have a poor response to the voices of caregivers. After administration of donepezil, caregivers often find that patients respond more frequently, whereas they had previously pretended to be “deaf.” We investigated whether auditory selective attention is associated with response to donepezil. Methods. The subjects were40 AD patients, 20 elderly healthy controls (HCs), and 15 young HCs. Pure tone audiometry was conducted and an original Auditory Selective Attention (ASA) test was performed with a MoCA vigilance test. Reassessment of the AD group was performed after donepezil treatment for 3 months. Results. Hearing level of the AD group was the same as that of the elderly HC group. However, ASA test scores decreased in the AD group and were correlated with the vigilance test scores. Donepezil responders (MMSE 3+) also showed improvement on the ASA test. At baseline, the responders had higher vigilance and lower ASA test scores. Conclusion. Contrary to the common view, AD patients had a similar level of hearing ability to healthy elderly. Auditory attention was impaired in AD patients, which suggests that unnecessary sounds should be avoided in nursing homes. Auditory selective attention is associated with response to donepezil in AD. PMID:26161001

  3. Smoking cessation interventions for in-patients: a selective review with recommendations for hospital-based health professionals.

    Science.gov (United States)

    Wolfenden, Luke; Campbell, Elizabeth; Walsh, Raoul; Wiggers, John

    2003-12-01

    A selective review of the literature was conducted to provide evidence-based recommendations for the clinical management of hospitalized smokers. The Cochrane library, in particular the Cochrane review of 'Interventions for smoking cessation in hospitalised patients', was the basis for the review and was supplemented with other clinical and non-clinical literature where the review did not inform clinicians sufficiently. Evidence was reviewed on issues considered by the authors to be of importance to health professionals interested in providing a smoking cessation intervention to their patients. The review suggests that effective hospital interventions: incorporate an in-patient intervention lasting greater than 20 minutes in duration with extended post discharge follow-up; consist of at least five intervention contacts; and be delivered over at least a 3-month period. Furthermore, interventions should include in-patient advice and counselling, the provision of nicotine replacement therapy and extended proactive post discharge telephone support. The review also indicates that cessation interventions are particularly effective when delivered to patients with a cardiovascular diagnosis. All health professionals may be effective in providing cessation treatments; however, the addition of a specialist smoking cessation counsellor appears to improve interventions in this setting. Finally, without the development of supportive systems, routine intervention with smoking patients by health professionals is unlikely. Recommendations for the delivery of effective smoking cessation interventions in hospitals are provided. [Wolfenden L, Campbell E, Walsh RA, Wiggers J. Smoking cessation interventions for in-patients: a selective review with recommendations for hospital-based health professionals.

  4. Selection of indicators for continuous monitoring of patient safety: recommendations of the project 'safety improvement for patients in Europe'

    DEFF Research Database (Denmark)

    Kristensen, Solvejg; Mainz, Jan; Bartels, Paul

    2009-01-01

    , proving that safety of care has improved with their usage, is questionable. The exact incidence and prevalence of patient safety quality problems are unknown. Therefore, there is a need for firm, evidence-based methods to survey and develop patient safety and derived activities. OBJECTIVE: The objective......BACKGROUND: Initiatives to improve patient safety have high priority among health professionals and politicians in most developed countries. Currently, however, assessment of patient safety problems relies mainly on case-based methodologies. The evidence for their efficiency and reproducibility...... for systematic monitoring is that it will be possible to continuously estimate the prevalence and incidence of patient safety quality problems. The lesson learnt from quality improvement is that it will pay off in terms of improving patient safety....

  5. Strict liability as a legal mechanism protecting the aggrieved parties' interests within the nuclear liability regime

    International Nuclear Information System (INIS)

    Novotna, Marianna

    2016-01-01

    The no-fault liability principle of nuclear liability regime, its compensation schemes, sociological and legal grounds of its construction as well as liberation grounds are analysed. The simple existence of causation of damage and nuclear accident without necessity of proving negligence or any other type of fault on the part of the operator as an adequate basis for the operator’s strict liability is highlighted thus simplifying the litigation process eliminating potential obstacles, especially such as might exist with the burden of proof. The question of weighing the interests of society in the development of nuclear industry, the necessary extent of protection of victims of nuclear accidents and the interests of operators of nuclear facilities as main determinants of the strict nature of nuclear liability is also described. (orig.)

  6. Selection of genetic and phenotypic features associated with inflammatory status of patients on dialysis using relaxed linear separability method.

    Directory of Open Access Journals (Sweden)

    Leon Bobrowski

    Full Text Available Identification of risk factors in patients with a particular disease can be analyzed in clinical data sets by using feature selection procedures of pattern recognition and data mining methods. The applicability of the relaxed linear separability (RLS method of feature subset selection was checked for high-dimensional and mixed type (genetic and phenotypic clinical data of patients with end-stage renal disease. The RLS method allowed for substantial reduction of the dimensionality through omitting redundant features while maintaining the linear separability of data sets of patients with high and low levels of an inflammatory biomarker. The synergy between genetic and phenotypic features in differentiation between these two subgroups was demonstrated.

  7. Evidence of changes in renal charge selectivity in patients with type 1 (insulin-dependent) diabetes mellitus

    DEFF Research Database (Denmark)

    Kverneland, A; Feldt-Rasmussen, B; Vidal, P

    1986-01-01

    Altered filtration of macromolecules due to decreased electrical charge of the glomerular basement membrane might be the initial step in the development of albuminuria in patients with Type 1 (insulin-dependent) diabetes mellitus. We therefore investigated the selectivity index, i.e. renal...... clearance of non-glycated plasma albumin/clearance of glycated plasma albumin in 38 patients with Type 1 diabetes mellitus. The two albumin molecules differed slightly in charge, non-enzymatic glycated albumin being more anionic at physiological pH compared with unmodified plasma albumin. Glycated albumin...... in plasma and urine was determined by a specific, sensitive and highly reproducible chromatographic procedure. In diabetic patients with normal urinary albumin excretion, the selectivity index was increased three-fold compared with that of non-diabetic subjects (2 p less than 0.01). A significant...

  8. Characteristics and changes of gastric mucosal blood flow in patients with duodenal ulcer following highly selective vagotomy

    International Nuclear Information System (INIS)

    Doebroente, Zoltan; Kahan, Zsuzsanna; Baltas, Bela; Lang, Jenoe; Varro, Vince; Orvostudomanyi Egyetem, Szeged

    1985-01-01

    In patients with duodenal ulcer, mucosal blood flow of pentagastrin-stimulated stomach was studied using sup(99m)Tc-methylaminophenazone clearance technique published previously by the authors. Comparative investigations were carried out in active and inactive phases of the disease and in operated patients before and after highly selective vagotomy. The relation between gastric mucosal blood flow and acid secretion proved to be different from that of the normacid controls: in duodenal ulcer patients the secretory capacity in relation to the blood supply proved to be increased. Both the mucosal blood flow and acid secretion values were elevated in the active stage as compared to the inactive phase, while the proportion between them remained unchanged. The relation of secretion to mucosal blood flow after highly selective vagotomy became similar to that of the normal controls. It is suggested that the sup(99m)Tc-methylaminophenazone clearance method is a suitable tool to evaluate the effectiveness of vagotomy. (author)

  9. Selective fine needle aspiration of parotid masses. FNA should be performed in all patients older than 60 years.

    LENUS (Irish Health Repository)

    Kieran, S M

    2012-02-01

    OBJECTIVES: The exact role of fine needle aspiration in the pre-operative assessment of patients presenting with parotid masses is controversial. Some surgeons propose that fine needle aspiration be performed only selectively in those patients with likely malignant disease, whilst others recommend it for all patients presenting with such a mass. Intuitively, one would expect older patients to be more likely to suffer from primary malignant parotid tumours and secondary deposits of malignant skin tumours. Therefore, we hypothesised that older patients with a parotid mass should undergo fine needle aspiration regardless of their medical history. DESIGN: We retrospectively reviewed 197 consecutive parotidectomies to test this hypothesis. RESULTS: One hundred and twenty-one patients (61.4 per cent) were diagnosed with benign disease, whilst 76 (38.6 per cent) were diagnosed with malignant disease. Eighty-three per cent of patients aged 60 years or younger had benign disease, as opposed to 35.6 per cent of patients aged more than 60 years. Malignant disease occurred more commonly in patients older than 60 years (odds ratio 8.962, 95 per cent confidence interval 4.607-17.434). CONCLUSION: In patients with a parotid mass, fine needle aspiration should be performed on all those aged 60 years or older.

  10. Useful clinical features for the selection of ideal patients with strial fibrillation for mapping and catheter ablation

    Directory of Open Access Journals (Sweden)

    Mehta Niraj

    2002-01-01

    Full Text Available OBJECTIVE: To identify useful clinical characteristics for selecting patients eligible for mapping and ablation of atrial fibrillation. METHODS: We studied 9 patients with atrial fibrillation, without structural heart disease, associated with: 1 antiarrhythmic drugs, 2 symptoms of low cardiac output, and 3 intention to treat. Seven patients had paroxysmal atrial fibrillation and 2 had recurrent atrial fibrillation. RESULTS: In the 6 patients who underwent mapping (all had paroxysmal atrial fibrillation, catheter ablation was successfully carried out in superior pulmonary veins in 5 patients (the first 3 in the left superior pulmonary vein and the last 2 in the right superior pulmonary vein. One patient experienced a recurrence of atrial fibrillation after 10 days. We observed that patients who had short episodes of atrial fibrillation on 24-hour Holter monitoring before the procedure were those in whom mapping the focus of tachycardia was possible. Tachycardia was successfully suppressed in 4 of 6 patients. The cause of failure was due to the impossibility of maintaining sinus rhythm long enough for efficient mapping. CONCLUSION: Patients experiencing short episodes of atrial fibrillation during 24-hour Holter monitoring were the most eligible for mapping and ablation, with a final success rate of 66%, versus the global success rate of 44%. Patients with persistent atrial fibrillation were not good candidates for focal ablation.

  11. Potential Impact of Preoperative Magnetic Resonance Imaging of the Breast on Patient Selection for Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Kühr, Marietta; Wolfgarten, Matthias; Stölzle, Marco; Leutner, Claudia; Höller, Tobias; Schrading, Simone; Kuhl, Christiane; Schild, Hans; Kuhn, Walther; Braun, Michael

    2011-01-01

    Purpose: Accelerated partial breast irradiation (APBI) after breast-conserving therapy is currently under investigation in prospective randomized studies. Multifocality and multicentricity are exclusion criteria for APBI. Preoperative breast magnetic resonance imaging (MRI) can detect ipsilateral and contralateral invasive tumor foci or ductal carcinoma in situ in addition to conventional diagnostic methods (clinical examination, mammography, and ultrasonography). The objective of this retrospective study was to evaluate the impact of preoperative MRI on patient selection for APBI. Methods and Materials: From 2002 to 2007, a total of 579 consecutive, nonselected patients with newly diagnosed early-stage breast cancer received preoperative breast MRI in addition to conventional imaging studies at the Bonn University Breast Cancer Center. In retrospect, 113 patients would have met the criteria for APBI using conventional imaging workup (clinical tumor size ≤3 cm; negative axillary lymph node status; unifocal disease; no evidence of distant metastases; no invasive lobular carcinoma, ductal and lobular carcinoma in situ, or Paget’s disease). We analyzed the amount of additional ipsilateral and contralateral tumor foci detected by MRI. Results: MRI detected additional tumor foci in 8.8% of patients eligible for APBI (11 tumor foci in 10 of 113 patients), either ipsilateral (n = 7, 6.2%) or contralateral (n = 4, 3.5%). In 1 patient, MRI helped detect additional tumor focus both ipsilaterally and contralaterally. Conclusions: Preoperative breast MRI is able to identify additional tumor foci in a clinically relevant number of cases in this highly selected group of patients with low-risk disease and may be useful in selecting patients for APBI.

  12. Potential Impact of Preoperative Magnetic Resonance Imaging of the Breast on Patient Selection for Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kuehr, Marietta, E-mail: marietta.kuehr@ukb.uni-bonn.de [Department of Obstetrics and Gynecology and Center of Integrated Oncology, University of Bonn, Bonn (Germany); Wolfgarten, Matthias; Stoelzle, Marco [Department of Obstetrics and Gynecology and Center of Integrated Oncology, University of Bonn, Bonn (Germany); Leutner, Claudia [Department of Radiology, Center of Integrated Oncology, University of Bonn, Bonn (Germany); Hoeller, Tobias [Department of Medical Statistics and Epidemiology, University of Bonn, Bonn (Germany); Schrading, Simone; Kuhl, Christiane; Schild, Hans [Department of Radiology, Center of Integrated Oncology, University of Bonn, Bonn (Germany); Kuhn, Walther; Braun, Michael [Department of Obstetrics and Gynecology and Center of Integrated Oncology, University of Bonn, Bonn (Germany)

    2011-11-15

    Purpose: Accelerated partial breast irradiation (APBI) after breast-conserving therapy is currently under investigation in prospective randomized studies. Multifocality and multicentricity are exclusion criteria for APBI. Preoperative breast magnetic resonance imaging (MRI) can detect ipsilateral and contralateral invasive tumor foci or ductal carcinoma in situ in addition to conventional diagnostic methods (clinical examination, mammography, and ultrasonography). The objective of this retrospective study was to evaluate the impact of preoperative MRI on patient selection for APBI. Methods and Materials: From 2002 to 2007, a total of 579 consecutive, nonselected patients with newly diagnosed early-stage breast cancer received preoperative breast MRI in addition to conventional imaging studies at the Bonn University Breast Cancer Center. In retrospect, 113 patients would have met the criteria for APBI using conventional imaging workup (clinical tumor size {<=}3 cm; negative axillary lymph node status; unifocal disease; no evidence of distant metastases; no invasive lobular carcinoma, ductal and lobular carcinoma in situ, or Paget's disease). We analyzed the amount of additional ipsilateral and contralateral tumor foci detected by MRI. Results: MRI detected additional tumor foci in 8.8% of patients eligible for APBI (11 tumor foci in 10 of 113 patients), either ipsilateral (n = 7, 6.2%) or contralateral (n = 4, 3.5%). In 1 patient, MRI helped detect additional tumor focus both ipsilaterally and contralaterally. Conclusions: Preoperative breast MRI is able to identify additional tumor foci in a clinically relevant number of cases in this highly selected group of patients with low-risk disease and may be useful in selecting patients for APBI.

  13. Selective sentinel lymph node biopsy in papillary thyroid carcinoma in patients with no preoperative evidence of lymph node metastasis.

    Science.gov (United States)

    González, Óscar; Zafon, Carles; Caubet, Enric; García-Burillo, Amparo; Serres, Xavier; Fort, José Manuel; Mesa, Jordi; Castell, Joan; Roca, Isabel; Ramón Y Cajal, Santiago; Iglesias, Carmela

    2017-10-01

    Lymphadenectomy is recommended during surgery for papillary thyroid carcinoma when there is evidence of cervical lymph node metastasis (therapeutic) or in high-risk patients (prophylactic) such as those with T3 and T4 tumors of the TNM classification. Selective sentinel lymph node biopsy may improve preoperative diagnosis of nodal metastases. To analyze the results of selective sentinel lymph node biopsy in a group of patients with papillary thyroid carcinoma and no evidence of nodal involvement before surgery. A retrospective, single-center study in patients with papillary thyroid carcinoma and no clinical evidence of lymph node involvement who underwent surgery between 2011 and 2013. The sentinel node was identified by scintigraphy. When the sentinel node was positive, the affected compartment was removed, and when sentinel node was negative, central lymph node dissection was performed. Forty-three patients, 34 females, with a mean age of 52.3 (±17) years, were enrolled. Forty-six (27%) of the 170 SNs resected from 24 (55.8%) patients were positive for metastasis. In addition, 94 (15.6%) out of the 612 lymph nodes removed in the lymphadenectomies were positive for metastases. Twelve of the 30 (40%) low risk patients (cT1N0 and cT2N0) changed their stage to pN1, whereas 12 of 13 (92%) high risk patients (cT3N0 and cT4N0) changed to pN1 stage. Selective sentinel lymph node biopsy changes the stage of more than 50% of patients from cN0 to pN1. This confirms the need for lymph node resection in T3 and T4 tumors, but reveals the presence of lymph node metastases in 40% of T1-T2 tumors. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Effect of the selective vasopressin V2 receptor antagonists in hepatic cirrhosis patients with ascites: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Shao-hui TANG

    2013-07-01

    Full Text Available Objective To evaluate the efficacy and safety of selective vasopressin V2 receptor antagonists in the treatment of hepatic cirrhosis patients with ascites. Methods PubMed, EMBASE, Web of Science, The Cochrane Central Register of Controlled Trials, Database for Chinese Technical Periodical (VIP, Chinese Journal Full-Text Database (CNKI, and Wan Fang Digital Journal Full-text Database were retrieved to collect clinical randomized controlled trials of hepatic cirrhosis with ascites treated by selective vasopressin V2 receptor antagonists. Meta analysis was performed by using Review Manager 5.0. Results Nine randomized controlled trials including 1884 patients met the inclusion criteria. Meta-analysis showed that: 1 The selective vasopressin V2 receptor antagonists were associated with a significant reduction in body weight compared with placebo (WMD=–1.98kg, 95%CI:–3.24-–0.72kg, P=0.002. Treatment with selective vasopressin V2 receptor antagonists was associated with an improvement of low serum sodium concentration compared to placebo (WMD=3.74mmol/L, 95%CI: 0.91-6.58mmol/L, P=0.01. The percentage of patients with worsening ascites was higher in the group of patients treated with placebo (RR=0.51, 95%CI: 0.34-0.77, P=0.001. 2 The amplitude of increased urine volume was obviously higher in selective vasopressin V2 receptor antagonists group than in placebo group (WMD=1437.65ml, 95%CI: 649.01-2226.30ml, P=0.0004. The difference of serum creatinine in the selective vasopressin V2 receptor antagonists group was not statistically significant compared with the control group (WMD=–3.49μmol/L, 95%CI: –12.54¬5.56μmol/L, P=0.45. 3 There was no statistical significance between the two groups in the heart rate, systolic pressure, diastolic pressure and mortality (P>0.05. The rate of other adverse reactions was higher in the selective vasopressin V2 receptor antagonists group compared with that of placebo group (P=0.003. Conclusion

  15. The impact of Sleep Time-Related Information and Communication Technology (STRICT) on sleep patterns and daytime functioning in American adolescents.

    Science.gov (United States)

    Polos, Peter G; Bhat, Sushanth; Gupta, Divya; O'Malley, Richard J; DeBari, Vincent A; Upadhyay, Hinesh; Chaudhry, Saqib; Nimma, Anitha; Pinto-Zipp, Genevieve; Chokroverty, Sudhansu

    2015-10-01

    This cross-sectional study explored the extent and impact of mobile device-based Sleep Time-Related Information and Communication Technology (STRICT) use among American adolescents (N = 3139, 49.3% female, mean age = 13.3 years). Nearly 62% used STRICT after bedtime, 56.7% texted/tweeted/messaged in bed, and 20.8% awoke to texts. STRICT use was associated with insomnia, daytime sleepiness, eveningness, academic underperformance, later bedtimes and shorter sleep duration. Moderation analysis demonstrated that the association between STRICT use and insomnia increased with age, the association between STRICT use and daytime sleepiness decreased with age, and the association between STRICT use and shorter sleep duration decreased with age and was stronger in girls. Insomnia and daytime sleepiness partially mediated the relationship between STRICT use and academic underperformance. Our results illustrate the adverse interactions between adolescent STRICT use and sleep, with deleterious effects on daytime functioning. These worrisome findings suggest that placing reasonable limitations on adolescent STRICT use may be appropriate. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  16. Verbal learning and memory outcome in selective amygdalohippocampectomy versus temporal lobe resection in patients with hippocampal sclerosis

    DEFF Research Database (Denmark)

    Foged, Mette Thrane; Vinter, Kirsten; Stauning, Louise

    2018-01-01

    on intraoperative electrocorticography. Verbal learning and verbal memory were tested pre- and postsurgery. RESULTS: Seizure outcome did not differ between patients operated using the SAH versus the TLR at 1year (p=0.951) nor at 7years (p=0.177). Verbal learning was more affected in patients resected in the left...... hemisphere than in the right (p=0.002). In patients with left-sided TLR, a worsening in verbal memory performance was found (p=0.011). Altogether, 73% were seizure-free for 1year and 64% for 7years after surgery. CONCLUSION: In patients with drug-resistant focal MTLE, HS and no magnetic resonance imaging...... (MRI) signs of dual pathology, selective amygdalohippocampectomy results in sustained seizure freedom and better memory function compared with patients operated with nonselective temporal lobe resection....

  17. How strict is galactose restriction in adults with galactosaemia? International practice

    NARCIS (Netherlands)

    Adam, Siddig Momin; Akroyd, R.; Bernabei, S.; Bollhalder, S.; Boocock, S.; Burlina, A.; Coote, T.; Corthouts, K.; Dalmau, Judith; Dawson, S.; Defourny, S.; Meyer, A.; Desloovere, A.; Devlin, Y.; Diels, M.; Dokoupil, K.; Donald, S.; Evans, S.; Fasan, I.; Ferguson, C.; Ford, S.; Forga, M.; Gallo, G.; Grünert, S.C.; Heddrich-Ellerbrok, M.; Heidenborg, C.; Jonkers, C.F.; Lefebure, K.; Luyten, K.; MacDonald, A.; Meyer, U.; Micciche, A.; Müller, E.; Portnoi, P.; Ripley, S.; Robert, C.M.; Robertson, L.V.; Rosenbaum-Fabian, S.; Sahm, K.; Schultz, Erica S; Singleton, K.; Sjöqvist, E.; Stoelen, L.; Terry, A.; Thompson, S.; Timmer, C.; Vande Kerckhove, K.; van den Ploeg, L.; Van Driessche, M.; van Rijn, M.; van Teeffelen-Heithoff, A.; Vitoria, I.; Voillot, C.; Wenz, J.; Westbrook, M.; Wildgoose, J.; Zweers, H.

    2015-01-01

    Dietary management of 418 adult patients with galactosaemia (from 39 centres/12 countries) was compared. All centres advised lactose restriction, 6 restricted galactose from galactosides. ±. fruits and vegetables and 12 offal. 38% (n. =. 15) relaxed diet by: 1) allowing traces of lactose in

  18. How strict is galactose restriction in adults with galactosaemia? International practice

    NARCIS (Netherlands)

    Adam, S.; Akroyd, R.; Bernabei, S.; Bollhalder, S.; Boocock, S.; Burlina, A.; Coote, T.; Corthouts, K.; Dalmau, J.; Dawson, S.; Defourny, S.; de Meyer, A.; Desloovere, A.; Devlin, Y.; Diels, M.; Dokoupil, K.; Donald, S.; Evans, S.; Fasan, I.; Ferguson, C.; Ford, S.; Forga, M.; Gallo, G.; Grünert, S. C.; Heddrich-Ellerbrok, M.; Heidenborg, C.; Jonkers, C.; Lefebure, K.; Luyten, K.; Macdonald, A.; Meyer, U.; Micciche, A.; Müller, E.; Portnoi, P.; Ripley, S.; Robert, M.; Robertson, L. V.; Rosenbaum-Fabian, S.; Sahm, K.; Schultz, S.; Singleton, K.; Sjöqvist, E.; Stoelen, L.; Terry, A.; Thompson, S.; Timmer, C.; Vande Kerckhove, K.; van der Ploeg, L.; van Driessche, M.; van Rijn, M.; van Teeffelen-Heithoff, A.; Vitoria, I.; Voillot, C.; Wenz, J.; Westbrook, M.; Wildgoose, J.; Zweers, H.

    2015-01-01

    Dietary management of 418 adult patients with galactosaemia (from 39 centres/12 countries) was compared. All centres advised lactose restriction, 6 restricted galactose from galactosides +/- fruits and vegetables and 12 offal. 38% (n = 15) relaxed diet by: 1) allowing traces of lactose in

  19. How strict is galactose restriction in adults with galactosaemia? International practice

    NARCIS (Netherlands)

    Adam, S.; Akroyd, R.; Bernabei, S.; Bollhalder, S.; Boocock, S.; Burlina, A.; Coote, T.; Corthouts, K.; Dalmau, J.; Dawson, S.; Defourny, S.; Meijer, A; Desloovere, A.; Devlin, Y.; Diels, M.; Dokoupil, K.; Donald, S.; Evans, S.; Fasan, I.; Ferguson, C.; Ford, S.; Forga, M.; Gallo, G.; Grunert, S.C.; Heddrich-Ellerbrok, M.; Heidenborg, C.; Jonkers, C.; Lefebure, K.; Luyten, K.; Macdonald, A.; Meyer, U.; Micciche, A.; Muller, E.; Portnoi, P.; Ripley, S.; Robert, M.; Robertson, L.V.; Rosenbaum-Fabian, S.; Sahm, K.; Schultz, S.; Singleton, K.; Sjoqvist, E.; Stoelen, L.; Terry, A.; Thompson, S.; Timmer, C.; Kerckhove, K. Vande; Ploeg, L. van der; Driessche, M. Van; Rijn, M. van de; Teeffelen-Heithoff, A. van; Vitoria, I.; Voillot, C.; Wenz, J.; Westbrook, M.; Wildgoose, J.; Zweers, H.E.

    2015-01-01

    Dietary management of 418 adult patients with galactosaemia (from 39 centres/12 countries) was compared. All centres advised lactose restriction, 6 restricted galactose from galactosides +/- fruits and vegetables and 12 offal. 38% (n=15) relaxed diet by: 1) allowing traces of lactose in manufactured

  20. How strict is galactose restriction in adults with galactosaemia? International practice

    NARCIS (Netherlands)

    Adam, S.; Akroyd, R.; Bernabei, S.; Bollhalder, S.; Boocock, S.; Burlina, A.; Coote, T.; Corthouts, K.; Dalmau, J.; Dawson, S.; Defourny, S.; De Meyer, A.; Desloovere, A.; Devlin, Y.; Diels, M.; Dokoupil, K.; Donald, S.; Evans, S.; Fasan, I.; Ferguson, C.; Ford, S.; Forga, M.; Gallo, G.; Gruenert, S. C.; Heddrich-Ellerbrok, M.; Heidenborg, C.; Jonkers, C.; Lefebure, K.; Luyten, K.; MacDonald, A.; Meyer, U.; Micciche, A.; Mueller, E.; Portnoi, P.; Ripley, S.; Robert, M.; Robertson, L. V.; Rosenbaum-Fabian, S.; Sahm, K.; Schultz, S.; Singleton, K.; Sjoqvist, E.; Stoelen, L.; Terry, A.; Thompson, S.; Timmer, C.; Vande Kerckhove, K.; van der Ploeg, L.; Van Driessche, M.; van Rijn, M.; van Teeffelen-Heithoff, A.; Vitoria, I.; Voillot, C.; Wenz, J.; Westbrook, M.; Wildgoose, J.; Zweers, H.

    Dietary management of 418 adult patients with galactosaemia (from 39 centres/12 countries) was compared. All centres advised lactose restriction, 6 restricted galactose from galactosides +/- fruits and vegetables and 12 offal. 38% (n = 15) relaxed diet by: 1) allowing traces of lactose in

  1. Knee disorders in primary care: design and patient selection of the HONEUR knee cohort.

    NARCIS (Netherlands)

    E.M. Heintjes (Edith); M.Y. Berger (Marjolein); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita)

    2005-01-01

    textabstractBACKGROUND: Knee complaints are a frequent reason for consultation in general practice. These patients constitute a specific population compared to secondary care patients. However, information to base treatment decisions on is generally derived from specialistic settings. Our cohort

  2. Evaluation of a strict protocol approach in managing women with severe disease due to hypertension in pregnancy: A before and after study

    Directory of Open Access Journals (Sweden)

    Backer Fèbè

    2005-09-01

    Full Text Available Abstract Background To evaluate whether the introduction of a strict protocol based on the systemic evaluation of critically ill pregnant women with complications of hypertension affected the outcome of those women. Method Study group: Indigent South African women managed in the tertiary hospitals of the Pretoria Academic Complex. Since 1997 a standard definition of women with severe acute maternal morbidity (SAMM, also referred to as a Nearmiss, has been used in the Pretoria Academic Complex. All cases of SAMM and maternal deaths (MD were entered on the Maternal Morbidity and Mortality Audit System programme (MaMMAS. A comparison of outcome of severely ill women who had complications of hypertension in pregnancy was performed between 1997–1998 (original protocol and 2002–2003 (strict protocol. Data include women referred from outside the Pretoria Academic Complex area to the tertiary hospitals. Results Between 1997–1998 there were 79 women with SAMM and 18 maternal deaths due to complications of hypertension, compared with 91 women with SAMM and 13 maternal deaths in 2002–2003. The mortality index (MI declined from 18.6% to 12.5% (OR 0.62, 95% CI 0.27–1.45. Statistically significant fewer women had renal failure (RR 0.37, 95% CI 0.21 – 0.66 and cerebral complications (RR 0.52, 95%CI 0.34 – 0.81 during the second period, and liver dysfunction (RR 0.27 95%CI 0.06 – 1.25 tended to be lower. However, there tended to be an increase in the number of women, who had immune system failure (RR 4.2 95%CI 0.93 – 18.94 and respiratory failure (RR 1.42 95%CI 0.88 – 2.29 although it did not reach significance. Cardiac failure remained constant (RR 0.84 95%CI 0.54 – 1.30. Conclusion The strict protocol approach based on the systemic evaluation of severely ill pregnant women with complications of hypertension and an intensive, regular feedback mechanism has been associated with a reduction in the number of patients with renal failure and

  3. Does Selection and Management of Patients with Chronic Kidney Disease In Government Run and Private Hospitals Differ?

    Science.gov (United States)

    Gowda, Anoop; Dutt, Aswini Raghavendra; Bangera, Shobith

    2017-08-01

    Globally, incidence of Chronic Kidney Disease (CKD) is rapidly rising with huge burden on the life expectancy of the patients. Regular haemodialysis improves the quality of life in these patients. They get treatment at either government run or private sector hospitals. A difference in disease pattern, comorbidity, patient management and number of access failures can be observed in these set ups. The present study was carried out to find out selection, management and disease pattern of CKD patients admitted for dialysis in government run and private hospital. A cross-sectional study on patients (18-90 years) admitted and undergoing dialysis at government run (N=129) and private hospital (N=182) was undertaken in Karnataka, India. Parameters like comorbidity (diabetes), number of dialysis per week, number of access failures, and follow up visits were compared between these patients. Chi- squared test was used to compare the data. All tests were two-tailed and pgovernment run hospital (pprivate hospital patients (pgovernment run hospital patients, as compared to those in private hospital. No statistical difference was seen with access failure in both these setups. No bias in management of CKD patient was seen among the two sets of hospitals though available facilities seemed to vary.

  4. Screening panoramic radiography of new adult patients: diagnostic yield when combined with bitewing radiography and identification of selection criteria.

    Science.gov (United States)

    Rushton, V E; Horner, K; Worthington, H V

    2002-03-09

    To measure the radiological diagnostic yield on screening panoramic radiographs taken of new adult patients and to identify selection criteria for panoramic radiography of new adult patients. Survey of 1,817 consecutive panoramic radiographs taken as 'routine' on new patients with statistical analysis of clinical and radiological findings. All radiographs were obtained from 41 general dental practitioners (GDPs). The GDPs provided the clinical information about the patient obtained by history and examination. Collection of material occurred in 1998/1999. Two dental radiologists recorded the radiological findings on each of 1,817 panoramic radiographs by consensus. Those findings that would have been identified from bilateral posterior bitewing radiographs of each patient were then excluded to give modified figures for radiological findings. Indices of diagnostic yield were devised and calculated for each radiograph from the data on radiological findings. Total diagnostic yield (DY) and modified diagnostic yield (MDY), after exclusion of findings identifiable on bitewing radiographs, were both calculated. Clinical indicators of a high MDY were identified using stepwise multiple regression analysis. MDY was 0 for 17% of the radiographs (all patients) and 23% of the radiographs when the asymptomatic group were considered. The clinical variables for which the significance was high (p panoramic radiography. Using clinical factors derived from the history and examination as radiographic selection criteria modestly improves the odds of achieving a high diagnostic yield from panoramic radiography.

  5. Atypical X-linked agammaglobulinaemia caused by a novel BTK mutation in a selective immunoglobulin M deficiency patient.

    Science.gov (United States)

    Lim, Lee-Moay; Chang, Jer-Ming; Wang, I-Fang; Chang, Wei-Chiao; Hwang, Daw-Yang; Chen, Hung-Chun

    2013-09-27

    X-linked agammaglobulinaemia (XLA) is the most common inherited humoural immunodeficiency disorder. Mutations in the gene coding for Bruton's tyrosine kinase (BTK) have been identified as the cause of XLA. Most affected patients exhibit a marked reduction of serum immunoglobulins, mature B cells, and an increased susceptibility to recurrent bacterial infections. However, the diagnosis of XLA can be a challenge in certain patients who have near-normal levels of serum immunoglobulin. Furthermore, reports on XLA with renal involvement are scant. We report an atypical XLA patient who presented with selective immunoglobulin M (IgM) immunodeficiency and nephropathy. He was diagnosed with selective IgM immunodeficiency, based on his normal serum immunoglobulin G (IgG) and immunoglobulin A (IgA) levels but undetectable serum IgM level. Intravenous immunoglobulin was initiated due to increased infections and persistent proteinuria but no improvement in proteinuria was found. A lupus-like nephritis was detected in his kidney biopsy and the proteinuria subsided after receiving a mycophenolate mofetil regimen. Although he had a history of recurrent bacterial infections since childhood, XLA was not diagnosed until B-lymphocyte surface antigen studies and a genetic analysis were conducted. We suggest that B-lymphocyte surface antigen studies and a BTK mutation analysis should be performed in familial patients with selective IgM deficiency to rule out atypical XLA.

  6. Antithrombotic properties of aspirin and resistance to aspirin: beyond strictly antiplatelet actions

    OpenAIRE

    Undas, Anetta; Brummel-Ziedins, Kathleen E.; Mann, Kenneth G.

    2007-01-01

    Aspirin is effective in the prevention of cardiovascular events in high-risk patients. The primary established effect of aspirin on hemostasis is to impair platelet aggregation via inhibition of platelet thromboxane A2 synthesis, thus reducing thrombus formation on the surface of the damaged arterial wall. Growing evidence also indicates that aspirin exerts additional antithrombotic effects, which appear to some extent unrelated to platelet thromboxane A2 production. Aspirin can reduce thromb...

  7. Exploring the relationship between accreditation and patient satisfaction - the case of selected Lebanese hospitals.

    Science.gov (United States)

    Haj-Ali, Wissam; Bou Karroum, Lama; Natafgi, Nabil; Kassak, Kassem

    2014-11-01

    Patient satisfaction is one of the vital attributes to consider when evaluating the impact of accreditation systems. This study aimed to explore the impact of the national accreditation system in Lebanon on patient satisfaction. An explanatory cross-sectional study of six hospitals in Lebanon. Patient satisfaction was measured using the SERVQUAL tool assessing five dimensions of quality (reliability, assurance, tangibility, empathy, and responsiveness). Independent variables included hospital accreditation scores, size, location (rural/urban), and patient demographics. The majority of patients (76.34%) were unsatisfied with the quality of services. There was no statistically significant association between accreditation classification and patient satisfaction. However, the tangibility dimension - reflecting hospital structural aspects such as physical facility and equipment was found to be associated with patient satisfaction. This study brings to light the importance of embracing more adequate patient satisfaction measures in the Lebanese hospital accreditation standards. Furthermore, the findings reinforce the importance of weighing the patient perspective in the development and implementation of accreditation systems. As accreditation is not the only driver of patient satisfaction, hospitals are encouraged to adopt complementary means of promoting patient satisfaction.

  8. Exploring the relationship between accreditation and patient satisfaction – the case of selected Lebanese hospitals

    Science.gov (United States)

    Haj-Ali, Wissam; Bou Karroum, Lama; Natafgi, Nabil; Kassak, Kassem

    2014-01-01

    Background: Patient satisfaction is one of the vital attributes to consider when evaluating the impact of accreditation systems. This study aimed to explore the impact of the national accreditation system in Lebanon on patient satisfaction. Methods: An explanatory cross-sectional study of six hospitals in Lebanon. Patient satisfaction was measured using the SERVQUAL tool assessing five dimensions of quality (reliability, assurance, tangibility, empathy, and responsiveness). Independent variables included hospital accreditation scores, size, location (rural/urban), and patient demographics. Results: The majority of patients (76.34%) were unsatisfied with the quality of services. There was no statistically significant association between accreditation classification and patient satisfaction. However, the tangibility dimension – reflecting hospital structural aspects such as physical facility and equipment was found to be associated with patient satisfaction. Conclusion: This study brings to light the importance of embracing more adequate patient satisfaction measures in the Lebanese hospital accreditation standards. Furthermore, the findings reinforce the importance of weighing the patient perspective in the development and implementation of accreditation systems. As accreditation is not the only driver of patient satisfaction, hospitals are encouraged to adopt complementary means of promoting patient satisfaction. PMID:25396210

  9. A prospective study of conservative surgery without radiation therapy in select patients with Stage I breast cancer

    International Nuclear Information System (INIS)

    Lim, May; Bellon, Jennifer R.; Gelman, Rebecca; Silver, Barbara B.A.; Recht, Abram; Schnitt, Stuart J.; Harris, Jay R.

    2006-01-01

    Purpose: The effectiveness of radiation therapy (RT) in reducing local recurrence after breast-conserving surgery (BCS) in unselected patients with early stage invasive breast cancer has been demonstrated in multiple randomized trials. Whether a subset of women can achieve local control without RT is unknown. In 1986, we initiated a prospective one-arm trial of BCS alone for highly selected breast-cancer patients. This report updates those results. Methods and Materials: Eighty-seven (of 90 planned) patients enrolled from 1986 until closure in 1992, when a predefined stopping boundary was crossed. Patients were required to have a unicentric, T1, pathologic node-negative invasive ductal, mucinous, or tubular carcinoma without an extensive intraductal component or lymphatic-vessel invasion. Surgery included local excision with margins of at least 1 cm or a negative re-excision. No RT or systemic therapy was given. Results: Results are available on 81 patients (median follow-up, 86 months). Nineteen patients (23%) had local recurrence (LR) as a first site of failure (average annual LR: 3.5 per 100 patient-years of follow-up). Other sites of first failure included 1 ipsilateral axilla, 2 contralateral breast cancers, and 4 distant metastases. Six patients developed other (nonbreast) malignancies. Nine patients have died, 4 of metastatic breast cancer and 5 of unrelated causes. Conclusions: Even in this highly selected cohort, a substantial risk of local recurrence occurred after BCS alone with margins of 1.0 cm or more. These results suggest that with the possible exception of elderly women with comorbid conditions, radiation therapy after BCS remains standard treatment

  10. Psychosocial and Patient Education Needs of Prostate Cancers Selecting Watchful Waiting

    National Research Council Canada - National Science Library

    Knight, Sara J; Latini, David M

    2006-01-01

    ...-being. The few studies that have focused on these issues suggest that anxiety about untreated cancer and urologic and sexual impacts of the disease are important considerations in the selection...

  11. Usefulness of a selective neutrophil elastase inhibitor, sivelestat, in acute lung injury patients with sepsis

    Science.gov (United States)

    Miyoshi, Seigo; Hamada, Hironobu; Ito, Ryoji; Katayama, Hitoshi; Irifune, Kazunori; Suwaki, Toshimitsu; Nakanishi, Norihiko; Kanematsu, Takanori; Dote, Kentaro; Aibiki, Mayuki; Okura, Takafumi; Higaki, Jitsuo

    2013-01-01

    Background Neutrophil elastase plays a crucial role in the development of acute lung injury (ALI) in patients with systemic inflammatory response syndrome (SIRS). The clinical efficacy of the neutrophil elastase inhibitor, sivelestat, for patients with ALI associated with SIRS has not been convincingly demonstrated. The aim of this study was to determine if there are clinical features of patients with this condition that affect the efficacy of sivelestat. Methods This was a retrospective study of 110 ALI patients with SIRS. Clinical information, including the etiology of ALI, the number of organs failing, scoring systems for assessing the severity of illness, and laboratory data, was collected at the time of diagnosis. Information on the number of ventilator-free days (VFDs) and changes in PaO2/FIO2 (ΔP/F) before and 7 days after the time of ALI diagnosis was also collected. The effect of sivelestat on ALI patients was also examined based on whether they had sepsis and whether their initial serum procalcitonin level was ≥0.5 ng/mL. Results There were 70 patients who were treated with sivelestat and 40 control patients. VFDs and ΔP/F were significantly higher in the treated patients than in the control patients. However, there was no significant difference in the patient survival rate between the two groups. Sivelestat was more effective in ALI patients with a PaO2/FIO2 ratio ≥ 140 mmHg or sepsis. Sivelestat significantly prolonged survival and led to higher VFDs and increased ΔP/F in septic patients and patients with initial serum procalcitonin levels ≥ 0.5 ng/mL. Conclusion The results may facilitate a future randomized controlled trial to determine whether sivelestat is beneficial for ALI patients with sepsis. PMID:23596346

  12. The "high solubility" definition of the current FDA Guidance on Biopharmaceutical Classification System may be too strict for acidic drugs.

    Science.gov (United States)

    Yazdanian, Mehran; Briggs, Katherine; Jankovsky, Corinne; Hawi, Amale

    2004-02-01

    The purpose of this study was to assess if the definition of high solubility as proposed in the FDA Guidance on Biopharmaceutical Classification System (BCS) is too strict for highly permeable acidic drugs. The solubility and permeability values of 20 (18 acidic and 2 non-acidic) nonsteroidal anti-inflammatory drugs (NSAID) were determined. The NSAIDs were grouped into three different sets having acetic acid, propionic acid, or other acidic moieties such as fenamate, oxicam, and salicylate. Two nonacidic NSAIDs (celecoxib and rofecoxib) were also included for comparison purposes. Equilibrium solubility values were determined at pH 1.2, 5.0, 7.4, and in biorelevant media simulating fed intestinal fluid at pH 5.0. For a select number of acids, we also measured solubility values in media simulating gastric and fasted intestinal fluids. Permeability classification was established relative to that of reference drugs in the Caco-2 cell permeability model. Permeability coefficients for all drugs were measured at concentrations corresponding to the lowest and highest marketed dose strengths dissolved in 250 ml volume, and their potential interaction with cellular efflux pumps was investigated. All NSAIDs with different acidic functional groups were classified as highly permeable based on their Caco-2 cell permeability. Only ketorolac appeared to have a potential for interaction with cellular efflux pumps. Solubility classification was based on comparison of equilibrium solubility at pH 1.2, 5.0. and 7.4 relative to marketed dose strengths in 250 ml. The pKa values for the acidic NSAIDs studied were between 3.5 and 5.1. and, as expected, their solubility increased dramatically at pH 7.4 compared to pH 1.2. Only three NSAIDs, ketorolac, ketoprofen. and acetyl salicylic acid, meet the current criteria for high solubility over the entire pH range. However, with the exception of ibuprofen, oxaprozin, and mefenamic acid, the remaining compounds can be classified as Class I drugs

  13. Terminally differentiated memory T cells are increased in patients with common variable immunodeficiency and selective IgA deficiency

    Directory of Open Access Journals (Sweden)

    Jana Nechvatalova

    2017-10-01

    Full Text Available Introduction : Previous studies showed that several lymphocyte abnormalities seen in the most frequent symptomatic immunoglobulin deficiency, common variable immunodeficiency (CVID, were also observed in a genetically related asymptomatic disorder – selective IgA deficiency (IgAD. In this study we searched for abnormalities in the differentiation stages of T cells as well as for similarities of these abnormalities in CVID and IgAD patients. Material and methods : Using flow cytometry in 80 patients with IgAD, 48 patients with CVID, and 80 control persons we determined T-lymphocyte subsets: both CD4 and CD8 were divided into the naïve CD45RO–CD27 + , early differentiated CD45RO + CD27 + , late differentiated CD45RO + CD27– and fully differentiated effector CD45RO–CD27– memory T cells, as well as Treg cells, defined as CD4 + CD25highCD127low T cells. Results : An increase of CD4 + and CD8 + late differentiated memory cells was observed comparing CVID patients to controls, as well as comparing IgAD patients to controls. In CVID patients an increase of CD4 + early differentiated memory cells, a decrease of CD8 + intermediate memory cells, and CD4 + and CD8 + naïve cells were found as well. The abnormalities in IgAD patients might be explained by higher CMV seropositivity observed in our IgAD. We confirmed the repeatedly published decrease of Treg cells in CVID patients, while Treg cells in IgAD patients were increased compared to controls. Conclusions : Our results show T-cell activation not only in CVID, but also in IgAD patients. The increase in IgAD patients may be influenced by a more frequent CMV infection in our group of IgAD patients.

  14. Terminally differentiated memory T cells are increased in patients with common variable immunodeficiency and selective IgA deficiency.

    Science.gov (United States)

    Nechvatalova, Jana; Pavlik, Tomas; Litzman, Jiri; Vlkova, Marcela

    2017-01-01

    Previous studies showed that several lymphocyte abnormalities seen in the most frequent symptomatic immunoglobulin deficiency, common variable immunodeficiency (CVID), were also observed in a genetically related asymptomatic disorder - selective IgA deficiency (IgAD). In this study we searched for abnormalities in the differentiation stages of T cells as well as for similarities of these abnormalities in CVID and IgAD patients. Using flow cytometry in 80 patients with IgAD, 48 patients with CVID, and 80 control persons we determined T-lymphocyte subsets: both CD4 and CD8 were divided into the naïve CD45RO - CD27 + , early differentiated CD45RO + CD27 + , late differentiated CD45RO + CD27 - and fully differentiated effector CD45RO - CD27 - memory T cells, as well as Treg cells, defined as CD4 + CD25highCD127low T cells. An increase of CD4 + and CD8 + late differentiated memory cells was observed comparing CVID patients to controls, as well as comparing IgAD patients to controls. In CVID patients an increase of CD4 + early differentiated memory cells, a decrease of CD8 + intermediate memory cells, and CD4 + and CD8 + naïve cells were found as well. The abnormalities in IgAD patients might be explained by higher CMV seropositivity observed in our IgAD. We confirmed the repeatedly published decrease of Treg cells in CVID patients, while Treg cells in IgAD patients were increased compared to controls. Our results show T-cell activation not only in CVID, but also in IgAD patients. The increase in IgAD patients may be influenced by a more frequent CMV infection in our group of IgAD patients.

  15. Correlation analysis of the relationship between B-type natriuretic peptide and selected echocardiographic parameters in patients with permanent pacemakers

    Directory of Open Access Journals (Sweden)

    Janusz Sielski

    2016-01-01

    Full Text Available Introduction: The present study was undertaken to evaluate the practical value of BNP measurements and echocardiographic left ventricular volume index in patients with permanent pacemakers because there are no such reports in the literature. Aim of the research: The aim of the study was to reveal multiple correlations between BNP levels and selected echocardiographic parameters of the left atrium in patients with permanent pacemakers. In the literature there are reports on the significance of BNP values and left atrial size in patients with permanent pacemakers. The results of the present study appear to be of value in the outpatient assessment of these patients. Material and methods: We analysed a group of 117 patients with permanent pacemakers (AAI/R 21 patients, DDD/R 59 patients, VVI/R 37 patients and 48 healthy volunteers serving as the control group. BNP measurements were performed on venous blood samples using Triage meters. The Simpson method and the ellipse method were used to assess the left atrium on echocardiography. Results: There was a significant correlation between BNP and maximum left atrial volume, minimum left atrial volume, and left atrial volume index in patients with AAI/R, DDD/R, and VVI/R pacemakers at 3 and 6 months after the implantation. Conclusions : In patients after implantation of permanent pacemakers there are correlations between BNP values and echocardiographic left atrial parameters, especially in patients with DDD/R pacemakers. Left atrial function improves in patients with DDD/R pacemakers. Pacemaker check-up should be extended to include BNP measurements and echocardiographic assessment of the left atrium.

  16. Bariatric surgery in patients with bipolar spectrum disorders: Selection factors, postoperative visit attendance, and weight outcomes.

    Science.gov (United States)

    Friedman, Kelli E; Applegate, Katherine; Portenier, Dana; McVay, Megan A

    2017-04-01

    As many as 3% of bariatric surgery candidates are diagnosed with a bipolar spectrum disorder. 1) To describe differences between patients with bipolar spectrum disorders who are approved and not approved for surgery by the mental health evaluator and 2) to examine surgical outcomes of patients with bipolar spectrum disorders. Academic medical center, United States. A retrospective record review was conducted of consecutive patients who applied for bariatric surgery between 2004 and 2009. Patients diagnosed with bipolar spectrum disorders who were approved for surgery (n = 42) were compared with patients with a bipolar spectrum disorder who were not approved (n = 31) and to matched control surgical patients without a bipolar spectrum diagnosis (n = 29) on a variety of characteristics and surgical outcomes. Of bariatric surgery candidates diagnosed with a bipolar spectrum disorder who applied for surgery, 57% were approved by the psychologist and 48% ultimately had surgery. Patients with a bipolar spectrum disorder who were approved for surgery were less likely to have had a previous psychiatric hospitalization than those who were not approved for surgery. Bariatric surgery patients diagnosed with a bipolar spectrum disorder were less likely to attend follow-up care appointments 2 or more years postsurgery compared to matched patients without bipolar disorder. Among patients with available data, those with a bipolar spectrum disorder and matched patients had similar weight loss at 12 months (n = 21 for bipolar; n = 24 for matched controls) and at 2 or more years (mean = 51 mo; n = 11 for bipolar; n = 20 for matched controls). Patients diagnosed with a bipolar spectrum disorder have a high rate of delay/denial for bariatric surgery based on the psychosocial evaluation and are less likely to attend medical follow-up care 2 or more years postsurgery. Carefully screened patients with bipolar disorder who engage in long-term follow-up care may benefit from bariatric

  17. A prime determinant in selecting dialysis modality: peritoneal dialysis patient survival

    Directory of Open Access Journals (Sweden)

    Hyunwook Kim

    2017-03-01

    Full Text Available The number of patients with end-stage renal disease (ESRD has rapidly increased, as has the cost of dialysis. Peritoneal dialysis (PD is an established treatment for ESRD patients worldwide; it has a variety of advantages, including autonomy and flexibility, as well as economic benefits in many countries compared to hemodialysis (HD. However, the long-term survival rate of PD remains poor. Although direct comparison of survival rate between the dialysis modalities by randomized controlled trials is difficult due to the ethical issues, it has always been a crucial point when deciding which dialysis modality should be recommended to patients. Recently, in many countries, including the United States, Brazil, Spain, Australia, and New Zealand, the survival rate in PD patients has significantly improved. PD patient survival in Korea has also improved, but Korean PD patients are known to have higher risk of mortality and major adverse cardiovascular, cerebrovascular events than HD patients. Herein, we further evaluate why Korean PD patients had worse outcomes; we suggest that special attention should be paid to patients with diabetes, coronary artery disease, or congestive heart failure when they choose PD as the first dialysis modality in order to reduce mortality risk.

  18. A computational tool for patient specific dosimetry and radiobiological modeling of selective internal radiation therapy with (90)Y microspheres.

    Science.gov (United States)

    Kalantzis, Georgios; Leventouri, Theodora; Apte, Aditiya; Shang, Charles

    2015-11-01

    In recent years we have witnessed tremendous progress in selective internal radiation therapy. In clinical practice, quite often, radionuclide therapy is planned using simple models based on standard activity values or activity administered per unit body weight or surface area in spite of the admission that radiation-dose methods provide more accurate dosimetric results. To address that issue, the authors developed a Matlab-based computational software, named Patient Specific Yttrium-90 Dosimetry Toolkit (PSYDT). PSYDT was designed for patient specific voxel-based dosimetric calculations and radiobiological modeling of selective internal radiation therapy with (90)Y microspheres. The developed toolkit is composed of three dimensional dose calculations for both bremsstrahlung and beta emissions. Subsequently, radiobiological modeling is performed on a per-voxel basis and cumulative dose volume histograms (DVHs) are generated. In this report we describe the functionality and visualization features of PSYDT. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. [Side effects of COX-2 selective inhibitors. Critic related with its administration in patients with rheumatoid arthritis and osteoarthritis].

    Science.gov (United States)

    Carrillo Gutiérrez, Ofmara Y; Pérez Sánchez, Adriana G; Medina Serriteño, Nicolás; Rodríguez Orozco, Alain R

    2007-01-01

    At the end of 2000 the new age of AINEs was introduced, specially the selective inhibitors of the COX-2, whose main function is to block the production of the prostaglandins and the acute tissue inflammation. These inhibitors have analgesic, antithermal and antiinflammatory effects similar to traditional AINEs; they are prescribed specifically to diminish pain and inflammation in patients with rheumatoid arthritis and osteoarthritis. After them introduction, it was reported that they can produce cardiovascular effects, mainly infarcts. This revision exposes the adverse effects that selective inhibitors of the COX-2 produce when elevated doses are administered, during prolonged time, in patients with rheumatoid arthritis and osteoarthritis; in addition, it comments present recommendations for them prescription.

  20. Development of Highly Sensitive and Selective Breathing Sensors Using Molecular Imprinted Filtering for Diabetic and Alcoholic Patients

    Science.gov (United States)

    Bhuiyan, Md. Saleh Akram

    Wellness sensor technology is an emerging diagnostic test research field, which mostly deal with the point of care of the patients in the recent days. Due to the lack of awareness from the patients, most diseases cannot be detected in due time. This led to worse conditions, such as diabetic and alcoholic syndrome. Therefore, many research groups have been working to develop portable sensor devices that can track serious diseases. These include diabetic and alcoholic biomarkers in breathing. These devices have very high selectivity and reliability. However, the major limitation of biomarkers is that it deals with the bio-molecular based sensing mechanism. Extensive challenges exist in the selectivity and reliability of breathing sensors. These require development of proper materials and effective detection methods. Thus, selection of proper materials, correct sensing parameters, effective device architecture and simple fabrication processing are substantially critical. The goal of this work is to develop graphene based breathing sensors with high selectivity and sensitivity using a novel molecular imprinted filtering technique. The sensors have various applications including Point of Care Testing (POCT) device for personalized home and clinical use in early detection of diabetic and alcoholic patients. Different fabrication procedures were used to optimize the sensor performance. The optimized results demonstrate that a proper biomarker molecule imprinting process could selectively detect diabetes and alcohol. The graphene layer was optimized by maintaining spray coating time, pattern and distance between the substrate and spray coater. Graphene adhesion to the substrate was also improved using polyvinyl pyrrolidone. The molecular imprinting filter made on top of the graphene layer improved the performance of acetone and ethanol molecule detection, indicated by the change of resistance in the graphene layer. The sensors showed poor performance for long-time exposure

  1. Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Stær-Jensen, Henrik; Nakstad, Espen Rostrup; Fossum, Eigil; Mangschau, Arild; Eritsland, Jan; Drægni, Tomas; Jacobsen, Dag; Sunde, Kjetil; Andersen, Geir Øystein

    2015-10-01

    We aimed to investigate coronary angiographic findings in unselected out-of-hospital cardiac arrest patients referred to immediate coronary angiography (ICA) irrespective of their first postresuscitation ECG and to determine whether this ECG is useful to select patients with no need of ICA. All resuscitated patients admitted after out-of-hospital cardiac arrest without a clear noncardiac cause underwent ICA. Patients were retrospectively grouped according to the postresuscitation ECG blinded for ICA results: (1) ST elevation or presumably new left bundle branch block, (2) other ECG signs indicating myocardial ischemia, and (3) no ECG signs indicating myocardial ischemia. All coronary angiograms were reevaluated blinded for postresuscitation ECGs. Two hundred and ten patients were included with mean age 62±12 years. Six-months survival with good neurological outcome was 54%. Reduced Thrombolysis in Myocardial Infarction flow (0-2) was found in 55%, 34%, and 18% and a ≥90% coronary stenosis was present in 25%, 27%, and 19% of patients in group 1, 2, and 3, respectively. An acute coronary occlusion was found in 11% of patients in group 3. ST elevation/left bundle branch block identified patients with reduced Thrombolysis in Myocardial Infarction (0-2) flow with 70% sensitivity and 62% specificity. Among patients with initial nonshockable rhythms (24%), 32% had significantly reduced Thrombolysis in Myocardial Infarction flow. Initial ECG findings are not reliable in detecting patients with an indication for ICA after experiencing a cardiac arrest. Even in the absence of ECG changes indicating myocardial ischemia, an acute culprit lesion may be present and patients may benefit from emergent revascularization. CLINICAL TRIAL REGISTRATIONURL: http://www.clinicaltrials.gov. Unique identifier: NCT01239420. © 2015 American Heart Association, Inc.

  2. Nurses' impoliteness as an impediment to patients' rights in selected Kenyan hospitals.

    Science.gov (United States)

    Ojwang, Benson Oduor; Ogutu, Emily Atieno; Matu, Peter Maina

    2010-12-15

    The institutionalization of patients' rights is a recent phenomenon in Kenya. In 2006, Kenya's Ministry of Health initiated policy measures to improve patient satisfaction through a charter of patients' rights. The aim was to change the longstanding public perception that nurses in public hospitals routinely ignored patients' right to respectful treatment. This paper focuses on linguistic indicators of violation or promotion of patients' rights in the health care context. We examine the extent to which patients' rights to dignity, respect, and humaneness are observed or denied, and we argue that impolite utterances impede rather than promote the realization of other fundamental human rights. It appears that nurses' impoliteness does not merely constitute rudeness, but encodes a violation of dignity which, in turn, hampers the chances of enjoyment of broader human rights such as the right to autonomy, free expression, self-determination, information, personalized attention, and non-discrimination. We argue that, for patients to enjoy their rights in the hospital setting, a clear definition of roles and relationships and public education on strategies of asserting their rights without intimidation are necessary. It emerges that when patients' rights are denied, patients resort to retaliation by violating the dignity of the nurses. This jeopardizes the envisaged mutual support in the nurse-patient relationship and compromises patient satisfaction. Copyright © 2010 Ojwang, Ogutu, and Matu. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

  3. Reduced plasma aldosterone concentrations in randomly selected patients with insulin-dependent diabetes mellitus.

    LENUS (Irish Health Repository)

    Cronin, C C

    2012-02-03

    Abnormalities of the renin-angiotensin system have been reported in patients with diabetes mellitus and with diabetic complications. In this study, plasma concentrations of prorenin, renin, and aldosterone were measured in a stratified random sample of 110 insulin-dependent (Type 1) diabetic patients attending our outpatient clinic. Fifty-four age- and sex-matched control subjects were also examined. Plasma prorenin concentration was higher in patients without complications than in control subjects when upright (geometric mean (95% confidence intervals (CI): 75.9 (55.0-105.6) vs 45.1 (31.6-64.3) mU I-1, p < 0.05). There was no difference in plasma prorenin concentration between patients without and with microalbuminuria and between patients without and with background retinopathy. Plasma renin concentration, both when supine and upright, was similar in control subjects, in patients without complications, and in patients with varying degrees of diabetic microangiopathy. Plasma aldosterone was suppressed in patients without complications in comparison to control subjects (74 (58-95) vs 167 (140-199) ng I-1, p < 0.001) and was also suppressed in patients with microvascular disease. Plasma potassium was significantly higher in patients than in control subjects (mean +\\/- standard deviation: 4.10 +\\/- 0.36 vs 3.89 +\\/- 0.26 mmol I-1; p < 0.001) and plasma sodium was significantly lower (138 +\\/- 4 vs 140 +\\/- 2 mmol I-1; p < 0.001). We conclude that plasma prorenin is not a useful early marker for diabetic microvascular disease. Despite apparently normal plasma renin concentrations, plasma aldosterone is suppressed in insulin-dependent diabetic patients.

  4. Strict molecular sieving over electrodeposited 2D-interspacing-narrowed graphene oxide membranes.

    Science.gov (United States)

    Qi, Benyu; He, Xiaofan; Zeng, Gaofeng; Pan, Yichang; Li, Guihua; Liu, Guojuan; Zhang, Yanfeng; Chen, Wei; Sun, Yuhan

    2017-10-10

    To separate small molecules/species, it's crucial but still challenging to narrow the 2D-interspacing of graphene oxide (GO) membranes without damaging the membrane. Here the fast deposition of ultrathin, defect-free and robust GO layers is realized on porous stainless steel hollow fibers (PSSHFs) by a facile and practical electrophoresis deposition (ED) method. In this approach, oxygen-containing groups of GO are selectively reduced, leading to a controlled decrease of the 2D channels of stacked GO layers. The resultant ED-GO@PSSHF composite membranes featured a sharp cutoff between C2 (ethane and ethene) and C3 (propane and propene) hydrocarbons and exhibited nearly complete rejections for the smallest alcohol and ion in aqueous solutions. This demonstrates the versatility of GO based membranes for the precise separation of various types of mixtures. At the same time, a robust mechanical strength of the ED-GO@PSSHF membrane is also achieved due to the enhanced interaction at GO/support and GO/GO interfaces.Producing graphene oxide membranes with narrow channels is desirable for small molecule separations, but methods to narrow the 2D spacing typically result in membrane damage. Here the authors exploit electrophoresis-deposition to prepare GO membranes that are reduced in situ, leading to narrow and uniform 2D channels.

  5. Non-selective β-blockers do not affect mortality in cirrhosis patients with ascites

    DEFF Research Database (Denmark)

    Bossen, Lars; Krag, Aleksander; Vilstrup, Hendrik

    2016-01-01

    , variceal bleeding, bacterial infection, and/or development of the hepatorenal syndrome. CONCLUSION: This large and detailed dataset on worldwide non-protocol use of NSBBs in cirrhosis patients with ascites shows that NSBBs did not increase the patients' mortality. The decision to stop NSBB treatment...

  6. Obstetric Patients Who Select and Those Who Refuse Medical Students' Participation in Their Care.

    Science.gov (United States)

    Magrane, Diane; And Others

    1994-01-01

    A survey of 222 obstetrics patients assisted by medical clerkship students from the University of Vermont and 78 who refused student participation found privacy the primary motivation for refusal and a desire to contribute to students' education a primary reason for accepting student participation. Patients frequently erroneously anticipated the…

  7. Usefulness of a selective neutrophil elastase inhibitor, sivelestat, in acute lung injury patients with sepsis

    Directory of Open Access Journals (Sweden)

    Miyoshi S

    2013-04-01

    Full Text Available Seigo Miyoshi,1 Hironobu Hamada,1,2 Ryoji Ito,1 Hitoshi Katayama,1 Kazunori Irifune,1 Toshimitsu Suwaki,3 Norihiko Nakanishi,4 Takanori Kanematsu,5 Kentaro Dote,6 Mayuki Aibiki,7 Takafumi Okura,1 Jitsuo Higaki1 1Department of Integrated Medicine and Informatics, Ehime University, Graduate School of Medicine, Toon, 2Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 3Department of Respiratory Medicine, Sumitomo Besshi Hospital, Niihama, 4Department of Respiratory Medicine, Ehime Prefectural Central Hospital, Matsuyama, 5Department of Respiratory Medicine, Matsuyama Red Cross Hospital, Matsuyama, 6Intensive Care Division, Ehime University Hospital, Toon, 7Department of Emergency Medicine, School of Medicine, Ehime University, Toon, Japan Background: Neutrophil elastase plays a crucial role in the development of acute lung injury (ALI in patients with systemic inflammatory response syndrome (SIRS. The clinical efficacy of the neutrophil elastase inhibitor, sivelestat, for patients with ALI associated with SIRS has not been convincingly demonstrated. The aim of this study was to determine if there are clinical features of patients with this condition that affect the efficacy of sivelestat. Methods: This was a retrospective study of 110 ALI patients with SIRS. Clinical information, including the etiology of ALI, the number of organs failing, scoring systems for assessing the severity of illness, and laboratory data, was collected at the time of diagnosis. Information on the number of ventilator-free days (VFDs and changes in PaO2/FIO2 (ΔP/F before and 7 days after the time of ALI diagnosis was also collected. The effect of sivelestat on ALI patients was also examined based on whether they had sepsis and whether their initial serum procalcitonin level was ≥0.5 ng/mL. Results: There were 70 patients who were treated with sivelestat and 40 control patients. VFDs and ΔP/F were significantly higher in the treated

  8. [Selected aspects of quality of life of patients treated for neoplasms of oral cavity].

    Science.gov (United States)

    Fraczak, Piotr

    2008-01-01

    Neoplasms of oral cavity make up 2.4% of all neoplasms in male and 1.1% in female population of Poland. Treatment of neoplasms in this area is mainly surgical and leads to a smaller or larger disability with a disorder of basic physiological functions such as breathing, swallowing and speech. It leads as well to the creation of psychological symptoms such as anxiety, depression. Lack of available data in Polish literature as well as in foreign literature on the subject of psychological state and quality of life of those patients, convinced me to start research in this area. The research was conducted on a group of 131 patients aged 44-82 years. The patients were divided into three groups: group I consisted of patients after surgical procedures in the face area, group II of patients with serious prognosis (leukaemia) and group III of healthy patients. All patients were subject to survey, which consisted of 2 parts. First part contained 7 questions and related to patient's knowledge as to prognosis for further life (this part pertained patients from group I and II). Second part of the questionnaire was a shortened version of a depression scale based on 15 traits and short version based on 4 traits. It was adopted, that this is a good research tool in case of depression, since it is directed exclusively on diagnosis of depression symptoms. Short research technique facilitates the patient to answer questions asked. The results were interpreted according to depression rating scale. The research indicated that amongst patients after surgical procedures; over 50% of women and almost 40% of man showed intensified growth of depression. This percentage was significantly lower in the group of patients with serious prognosis. In the healthy group, all of the women and over 80% of men had no depression. Education statistically had no significant influence on the depression level. It can be ascertained that surgical procedures in the facial area and oral cavity have influence

  9. Exposure to selected fragrance materials. A case study of fragrance-mix-positive eczema patients

    DEFF Research Database (Denmark)

    Johansen, J D; Rastogi, Suresh Chandra; Menné, T

    1996-01-01

    The aim of the present study was to assess exposure to constituents of the fragrance mix from cosmetic products used by fragrance-mix-positive eczema patients. 23 products, which had either given a positive patch and/or use test in a total of 11 fragrance-mix-positive patients, were analyzed....... In all cases, the use of these cosmetics completely or partly explained present or past episodes of eczema. Between 1 to 6 constituents of the fragrance mix were found in 22 out of 23 products. The cosmetics of all the patients sensitive to hydroxycitronellal, eugenol, cinnamic alcohol and alpha......-amylcinnamic aldehyde were found to contain the respective substances. Exposure concentrations were seen to cover a large range. The content of hydroxycitronellal was, on average, 5 x higher in cosmetics from hydroxycitronellal-sensitive patients, compared to cosmetics from hydroxycitronellal-negative patients...

  10. Patient selection and preparation strategies for the use of contrast material in patients with chronic kidney disease

    DEFF Research Database (Denmark)

    Andersen, Poul Erik

    2012-01-01

    . If contrast is deemed essential, the patient should be well hydrated, the amount of contrast should be restricted, the examination should be focused, metformin and diuretics stopped, and renal function monitored. Sodium bicarbonate and N-acetylcysteine are popular but their efficiency is not evidence...

  11. Postprandial hypotension in clinical geriatric patients and healthy elderly: prevalence related to patient selection and diagnostic criteria.

    NARCIS (Netherlands)

    Orshoven, N.P. Van; Jansen, P.A.M.; Oudejans, I.; Schoon, Y.; Oey, P.L.

    2010-01-01

    The aims of this study were to find out whether Postprandial hypotension (PPH) occurs more frequently in patients admitted to a geriatric ward than in healthy elderly individuals, what the optimal interval between blood pressure measurements is in order to diagnose PPH and how often it is associated

  12. Hepatic transplantation outcomes for carefully selected cirrhotic patients with hepatocellular carcinoma: experience at a small- to medium-volume centre.

    LENUS (Irish Health Repository)

    Qasim, A

    2012-02-01

    BACKGROUND: Hepatic transplantation outcomes for cirrhotic patients with hepatocellular carcinoma (HCC) at a small- to medium-volume centre are not fully known due to relative novelty of patient selection criteria. AIM: To determine hepatic transplantation outcomes for HCC at a small- to medium-volume centre. Patients and methods Hepatocellular carcinoma patients were listed for transplantation according to the International Guideline and further categorized as those fulfilling or exceeding Milan or University of San Francisco (UCSF) criteria on explanted liver morphology. Outcomes including mortality, retransplantation, and tumour recurrence rate were analysed. RESULTS: Twenty-six patients had HCC and on explanted liver morphology, Milan and UCSF criteria met 15 and 18 patients, respectively. Patients and graft survival at 3 months, 1 and 5 years were 100, 96, 84, and 88, 84, 77%, respectively. Outcomes favoured Milan criteria but did not reach statistical significance. CONCLUSIONS: Hepatic transplantation for HCC at a small-to medium-volume transplant centre had comparable survival outcomes to high-volume centres.

  13. Perspectives on providing good access to dental services for elderly people: patient selection, dentists' responsibility and budget management.

    Science.gov (United States)

    Grytten, Jostein; Holst, Dorthe

    2013-06-01

    To suggest a model for organizing and financing dental services for elderly people so that they have good access to services. There are few studies on how dental services for elderly people should be organized and financed. This is surprising if we take into consideration the fact that the proportion of elderly people is growing faster than any other group in the population, and that elderly people have more dental diseases and poorer access to dental services than the rest of the adult population. In several countries, dental services are characterized by private providers who often operate in a market with competition and free price-setting. Private dentists have no community responsibility, and they are free to choose which patients they treat. Literature review and critical reasoning. In order to avoid patient selection, a patient list system for elderly people is recommended, with per capita remuneration for the patients that the dentist is given responsibility for. The patient list system means that the dentist assumes responsibility for a well-defined list of elderly people. Our model will lead to greater security in the dentist/patient relationship, and patients with great treatment needs will be ensured access to dental services. © 2012 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

  14. Comparative gut microbiota and resistome profiling of intensive care patients receiving selective digestive tract decontamination and healthy subjects.

    Science.gov (United States)

    Buelow, Elena; Bello González, Teresita D J; Fuentes, Susana; de Steenhuijsen Piters, Wouter A A; Lahti, Leo; Bayjanov, Jumamurat R; Majoor, Eline A M; Braat, Johanna C; van Mourik, Maaike S M; Oostdijk, Evelien A N; Willems, Rob J L; Bonten, Marc J M; van Passel, Mark W J; Smidt, Hauke; van Schaik, Willem

    2017-08-14

    The gut microbiota is a reservoir of opportunistic pathogens that can cause life-threatening infections in critically ill patients during their stay in an intensive care unit (ICU). To suppress gut colonization with opportunistic pathogens, a prophylactic antibiotic regimen, termed "selective decontamination of the digestive tract" (SDD), is used in some countries where it improves clinical outcome in ICU patients. Yet, the impact of ICU hospitalization and SDD on the gut microbiota remains largely unknown. Here, we characterize the composition of the gut microbiota and its antimicrobial resistance genes ("the resistome") of ICU patients during SDD and of healthy subjects. From ten patients that were acutely admitted to the ICU, 30 fecal samples were collected during ICU stay. Additionally, feces were collected from five of these patients after transfer to a medium-care ward and cessation of SDD. Feces from ten healthy subjects were collected twice, with a 1-year interval. Gut microbiota and resistome composition were determined using 16S rRNA gene phylogenetic profiling and nanolitre-scale quantitative PCRs. The microbiota of the ICU patients differed from the microbiota of healthy subjects and was characterized by lower microbial diversity, decreased levels of Escherichia coli and of anaerobic Gram-positive, butyrate-producing bacteria of the Clostridium clusters IV and XIVa, and an increased abundance of Bacteroidetes and enterococci. Four resistance genes (aac(6')-Ii, ermC, qacA, tetQ), providing resistance to aminoglycosides, macrolides, disinfectants, and tetracyclines, respectively, were significantly more abundant among ICU patients than in healthy subjects, while a chloramphenicol resistance gene (catA) and a tetracycline resistance gene (tetW) were more abundant in healthy subjects. The gut microbiota of SDD-treated ICU patients deviated strongly from the gut microbiota of healthy subjects. The negative effects on the resistome were limited to selection

  15. Fermentative Degradation of Polyethylene Glycol by a Strictly Anaerobic, Gram-Negative, Nonsporeforming Bacterium, Pelobacter venetianus sp. nov

    OpenAIRE

    1983-01-01

    The synthetic polyether polyethylene glycol (PEG) with a molecular weight of 20,000 was anaerobically degraded in enrichment cultures inoculated with mud of limnic and marine origins. Three strains (Gra PEG 1, Gra PEG 2, and Ko PEG 2) of rod-shaped, gram-negative, nonsporeforming, strictly anaerobic bacteria were isolated in mineral medium with PEG as the sole source of carbon and energy. All strains degraded dimers, oligomers, and polymers of PEG up to a molecular weight of 20,000 completely...

  16. An Iterative Algorithm Combining Viscosity Method with Parallel Method for a Generalized Equilibrium Problem and Strict Pseudocontractions

    Directory of Open Access Journals (Sweden)

    2009-03-01

    Full Text Available We introduce a new approximation scheme combining the viscosity method with parallel method for finding a common element of the set of solutions of a generalized equilibrium problem and the set of fixed points of a family of finitely strict pseudocontractions. We obtain a strong convergence theorem for the sequences generated by these processes in Hilbert spaces. Based on this result, we also get some new and interesting results. The results in this paper extend and improve some well-known results in the literature.

  17. Criteria for the selective use of chest computed tomography in blunt trauma patients

    International Nuclear Information System (INIS)

    Brink, Monique; Dekker, Helena M.; Kool, Digna R.; Blickman, Johan G.; Deunk, Jaap; Edwards, Michael J.R.; Vugt, Arie B. van; Kuijk, Cornelis van

    2010-01-01

    The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. This observational study prospectively included consecutive patients (≥16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre. We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age ≥55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <-3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with ≥1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant. Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected. (orig.)

  18. Electrons for intraoperative radiotherapy in selected breast-cancer patients: late results of the Montpellier phase II trial

    International Nuclear Information System (INIS)

    Lemanski, Claire; Azria, David; Gourgou-Bourgade, Sophie; Ailleres, Norbert; Pastant, Aurelie; Rouanet, Philippe; Fenoglietto, Pascal; Dubois, Jean-Bernard; Gutowski, Marian

    2013-01-01

    The Montpellier cancer institute phase II trial started in 2004 and evaluated the feasibility of intraoperative radiotherapy (IORT) technique given as a sole radiation treatment for patients with an excellent prognostic and very low recurrence risk. Forty-two patients were included between 2004 and 2007. Inclusion criteria were patients ≥ 65 years old, T0-T1, N0, ductal invasive unifocal carcinoma, free-margin > 2 mm. IORT was delivered using dedicated linear accelerator. One fraction of 21 Gy was prescribed and specified at the 90% isodose using electrons. In vivo dosimetry was performed for all patients. Primary end-point was the quality index. Secondary endpoints were quality of life, local recurrences, cosmetic results, specific and overall survival. At inclusion, median age was 72 years (range, 66–80). Median tumor diameter was 10 mm. All patients received the total prescribed dose. No acute grade 3 toxicities were observed. Late cosmetic results were good at 5 years despite the poor agreement of accuracy assessment between patients and physicians. Four patients (9.5%) experienced a local failure and underwent salvage mastectomy. The 5 year-disease free survival is 92.7% (range 79.1−97.6). All patients are still alive with a median follow-up of 72 months (range 66–74). Our results confirm with a long-term follow-up that exclusive partial breast IORT is feasible for early-breast cancer in selected patients. IORT provides good late cosmetics results and should be considered as a safe and very comfortable “one-step” treatment procedure. Nevertheless, patient assessments are essential for long-term quality results

  19. Selective reactivation of human herpesvirus 6 in patients with autoimmune connective tissue diseases.

    Science.gov (United States)

    Broccolo, Francesco; Drago, Francesco; Cassina, Giulia; Fava, Andrea; Fusetti, Lisa; Matteoli, Barbara; Ceccherini-Nelli, Luca; Sabbadini, Maria Grazia; Lusso, Paolo; Parodi, Aurora; Malnati, Mauro S

    2013-11-01

    Viral infections have been associated with autoimmune connective tissue diseases. To evaluate whether active infection by Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus (HHV)-6, -7, -8, as well as parvovirus B19 (B19V) occur in patients with autoimmune connective tissue diseases, viral DNA loads were assessed in paired samples of serum and peripheral blood mononuclear cells (PBMCs) of 115 patients affected by different disorders, including systemic sclerosis, systemic, and discoid lupus erythematosus, rheumatoid arthritis, and dermatomyositis. Two additional groups, patients affected by inflammatory diseases (n=51) and healthy subjects (n=58) were studied as controls. The titers of anti-HHV-6 and anti-EBV antibodies were also evaluated. Cell-free HHV-6 serum viremia was detected in a significantly higher proportion of connective tissue diseases patients compared to controls (P<0.0002); a significant association between HHV-6 reactivation and the active disease state was found only for lupus erythematosus (P=0.021). By contrast, the rate of cell-free EBV viremia was similar in patients and controls groups. Cell-free CMV, HHV-8, and B19V viremia was not detected in any subject. Anti-HHV-6 and anti-EBV early antigen IgG titers were both significantly higher in autoimmune diseases patients as compared to healthy controls, although they were not associated with the presence of viremia. EBV, HHV-6, -7 prevalence and viral load in PBMCs of patients with connective tissue diseases and controls were similar. These data suggest that HHV-6 may act as a pathogenic factor predisposing patients to the development of autoimmune connective tissue diseases or, conversely, that these disorders may predispose patients to HHV-6 reactivation. © 2013 Wiley Periodicals, Inc.

  20. Symptoms Are More Useful Than Echocardiography in Patient Selection for Pulmonary Endarterectomy.

    Science.gov (United States)

    Donahoe, Laura; Vanderlaan, Rachel; Thenganatt, John; McRae, Karen; Bykova, Anastasia; Moric, Jakov; Granton, John; de Perrot, Marc

    2017-10-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is still largely underdiagnosed in the general population. Although transthoracic echocardiogram (TTE) is recommended to screen for CTEPH, it may not detect patients with chronic thromboembolic disease (CTED) and mild or exercise-induced pulmonary hypertension (PH) who could also benefit from pulmonary endarterectomy (PEA). All patients referred to our CTEPH program with persistent mismatched perfusion defects on ventilation-perfusion (VQ) scan between January 2005 and June 2015 were divided into three groups according to TTE and right heart catheterization (RHC) as follows: (1) typical CTEPH group (PH on RHC and TTE), (2) TTE-negative (neg) CTEPH group (PH on RHC, but not TTE), or (3) CTED group (no PH on RHC and TTE). Of 225 patients with abnormal VQ scans, 188 (84%) had typical CTEPH, 15 had TTE-neg CTEPH, and 22 had CTED. PEA was performed in 179 patients (80%). Reasons for exclusion in CTEPH patients included primarily distal disease (n = 11) and comorbidities (n = 10). In contrast, the absence of functional limitation was the main cause of exclusion in CTED patients (75% versus 3% in CTEPH patients, p TTE-neg CTEPH and CTED groups. Pulmonary arterial pressures and functional class significantly improved after PEA in all three groups. Patients with mild CTEPH can benefit from PEA, but may not be detected by TTE. Symptomatic patients with functional limitation and persistent mismatched perfusion defects on VQ scan should undergo further investigations with pulmonary angiogram and RHC. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. MUCOSITIS PREVENTION BY SELECTIVE ELIMINATION OF ORAL FLORA IN IRRADIATED HEAD AND NECK-CANCER PATIENTS

    NARCIS (Netherlands)

    SPIJKERVET, FKL; VANSAENE, HKF; VANSAENE, JJM; PANDERS, AK; VERMEY, A; MEHTA, DM

    1990-01-01

    Mucositis induced by irradiation is the reactive inflammatory-like process of the oropharyngeal mucous membranes following irradiation. Bacteria colonizing the oral tissues are thought to contribute to this inflammatory process. The eradication of Gram-negative bacilli (selective elimination of oral

  2. Selective testing for calreticulin gene mutations in patients with splanchnic vein thrombosis: A prospective cohort study.

    Science.gov (United States)

    Poisson, Johanne; Plessier, Aurélie; Kiladjian, Jean-Jacques; Turon, Fanny; Cassinat, Bruno; Andreoli, Annalisa; De Raucourt, Emmanuelle; Goria, Odile; Zekrini, Kamal; Bureau, Christophe; Lorre, Florence; Cervantes, Francisco; Colomer, Dolors; Durand, François; Garcia-Pagan, Juan-Carlos; Casadevall, Nicole; Valla, Dominique-Charles; Rautou, Pierre-Emmanuel; Marzac, Christophe

    2017-09-01

    Myeloproliferative neoplasms (MPN) are the leading cause of splanchnic vein thrombosis (SVT). Janus kinase 2 gene (JAK2) V617F mutations are found in 80 to 90% of patients with SVT and MPN. Mutations of the calreticulin (CALR) gene have also been reported. However, as their prevalence ranges from 0 to 2%, the utility of routine testing is questionable. This study aimed to identify a group of patients with SVT at high risk of harboring CALR mutations and thus requiring this genetic testing. CALR, JAK2 V617F and thrombopoietin receptor gene (MPL) mutations were analysed in a test cohort that included 312 patients with SVT. Criteria to identify patients at high risk of CALR mutations in this test cohort was used and evaluated in a validation cohort that included 209 patients with SVT. In the test cohort, 59 patients had JAK2 V617F , five had CALR and none had MPL mutations. Patients with CALR mutations had higher spleen height and platelet count than patients without these mutations. All patients with CALR mutations had a spleen height ⩾16cm and platelet count >200×10 9 /L. These criteria had a positive predictive value of 56% (5/9) and a negative predictive value of 100% (0/233) for the identification of CALR mutations. In the validation cohort, these criteria had a positive predictive value of 33% (2/6) and a negative predictive value of 99% (1/96). CALR mutations should be tested in patients with SVT, a spleen height ⩾16cm, platelet count >200×10 9 /L, and no JAK2 V617F . This strategy avoids 96% of unnecessary CALR mutations testing. Lay summary: Mutations of the CALR gene are detected in 0 to 2% of patients with SVT, thus the utility of systematic CALR mutation testing to diagnose MPN is questionable. This study demonstrates that CALR mutations testing can be restricted to patients with SVT, a spleen height ⩾16cm, a platelet count >200×10 9 /L, and no JAK2 V617F . This strategy avoids 96% of unnecessary CALR mutations testing. Copyright © 2017 European

  3. Multifocal manifestation does not affect vascular invasion of hepatocellular carcinoma: implications for patient selection in liver transplantation.

    Science.gov (United States)

    Löhe, Florian; Angele, Martin K; Rentsch, Markus; Graeb, Christian; Gerbes, Alexander; Löhrs, Udo; Beuers, Ulrich; Jauch, Karl-Walter

    2007-01-01

    Liver transplantation (OLT) for hepatocellular carcinoma (HCC) improves patient survival when tumor size and number are limited according to the Milan criteria. However, the impact of tumor size vs. the number of lesions for tumor recurrence after OLT is unclear. Microvascular invasion appears to be a significant risk factor for tumor recurrence. Therefore, it was the aim of this study to investigate tumor differentiation and microvascular invasion in relation to tumor number and size and their impact on survival after transplantation. In 97 adult HCC patients who underwent OLT between June 1985 and December 2005 the incidence of microvascular invasion, tumor differentiation, and the number and size of tumor lesions were analyzed retrospectively. Their impact on survival was studied by multivariate analysis. Microvascular invasion was the only independent negative predictor of survival after OLT for HCC (p = 0.025). Tumor size > 5 cm was predictive for microvascular invasion (p = 0.007). In contrast, tumor number did not affect the incidence of microvascular invasion or cumulative survival. The size of the largest HCC lesion, but not the number of tumors, determined microvascular invasion, a predictor of the outcome following OLT for HCC. Thus, the number of HCC lesions should not be applied to patient selection prior to OLT. These data support the extension of the Milan criteria for the selection of HCC patients for OLT with regard to tumor number, but not tumor size.

  4. Implant and endodontic treatment selection are influenced by patients' demographic characteristics, insurance status, and medical history: A retrospective cohort study.

    Science.gov (United States)

    Chatzopoulos, Georgios S; Wolff, Larry F

    2017-01-01

    The aim of this study was to examine any potential association between demographic characteristics, socioeconomic status, dental insurance, and medical and tobacco history between patients that received endodontic treatment or extraction and implant treatment in a university dental clinic. Dental charts of patients who received root canal treatment and implant therapy were retrieved from the University of Minnesota School of Dentistry records. Age at the time of the procedure, gender, medical history, tobacco use, dental insurance status, zip code, and type of treatment provided were recorded. Patients who had both treatment modalities were excluded from the analysis. A total of 8,540 records of patients with a mean age of 50.66 years who have received either endodontic treatment (73.6%) or implant therapy (26.4%) were included. A statistically significant (P implant treatment as related to age, socioeconomic status, high blood pressure, asthma, thyroid disorders, arthritis, artificial joint, osteoporosis, depression, anxiety, cancer, and cancer treatment. Nonsmokers were significantly more likely to select a treatment plan with implants rather than an endodontic therapy. Within the limitations of this retrospective study, demographic parameters, insurance status, smoking, and medical history significantly affected the treatment selection between implant and endodontic treatment in a university setting.

  5. Maintenance of Taste Organs Is Strictly Dependent on Epithelial Hedgehog/GLI Signaling.

    Science.gov (United States)

    Ermilov, Alexandre N; Kumari, Archana; Li, Libo; Joiner, Ariell M; Grachtchouk, Marina A; Allen, Benjamin L; Dlugosz, Andrzej A; Mistretta, Charlotte M

    2016-11-01

    alterations in cancer patients using systemic Hedgehog pathway inhibitors result principally from interruption of signaling activity in taste papillae.

  6. Impact of selective and nonselective beta-blockers on the risk of severe exacerbations in patients with COPD

    Directory of Open Access Journals (Sweden)

    Huang YL

    2017-10-01

    Full Text Available Yueh Lan Huang,1 Chih-Cheng Lai,2 Ya-Hui Wang,3 Cheng-Yi Wang,1 Jen-Yu Wang,1 Hao-Chien Wang,4 Chong-Jen Yu,4 Likwang Chen5 On behalf of the Taiwan Clinical Trial Consortium for Respiratory Diseases (TCORE 1Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, 2Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, 3Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, 4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, 5Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan Background: There is conflicting information regarding the effects of selective and nonselective beta-blocker treatment in patients with COPD.Participants and methods: This nested case–control study used the Taiwan National Health Insurance Research Database. We included COPD patients who used inhalation steroid and beta-blockers between 1998 and 2010. From this cohort, there were 16,067 patients with severe exacerbations included in the analysis and 55,970 controls matched on age, sex, COPD diagnosis year, and beta-blockers treatment duration by risk set sampling.Results: For the selective beta-blocker users, the current users had a lower risk of severe exacerbations than the nonusers (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.85–0.96. In contrast, for the nonselective beta-blocker users, the current users had a higher risk of severe acute exacerbations than the nonusers (OR, 1.21; 95% CI, 1.14–1.27. A higher risk of severe exacerbation during increasing mean daily dose or within about the initial 300 days was found in nonselective beta-blockers, but not in selective beta-blockers. One selective beta-blocker, betaxolol, had a

  7. Rectus femoris release in selected patients with cerebral palsy: a preliminary report.

    Science.gov (United States)

    Sutherland, D H; Larsen, L J; Mann, R

    1975-02-01

    Two theories concerning the effects of surgical release of the proximal origins of the rectus femoris in spastic patients are (1) that release reduces hip flexion contracture and lumbar lordosis and diminishes crouch, and (2) that release primarily enhances early swing-phase knee flexion. A series of eight patients with pre-operative electromyography and pre- and post-operative dynamic knee measurements are reviewed. In these patients, back-knee thrust did not improve because it was not caused by rectus contracture. The effect upon hip was also variable: two patients had increased hip flexion and a third had diminished hip flexion after release. In six of the eight patients knee flexion was improved in early swing phase. Improvement from surgery can be expected when rectus spasticity is sufficient (1) to interfere with the initiation of swing phase, and (2) to decrease the amplitude of knee flexion. Little change occurred in the patients who did not have these functional deficits. A review of the cases supports the primary knee effect theory of Silfvenskiöld; however, insufficient information was obtained from this series to rule out hip and pelvic changes.

  8. Selection for biopsy of kidney transplant patients by diffusion-weighted MRI

    Energy Technology Data Exchange (ETDEWEB)

    Steiger, Philipp; Barbieri, Sebastiano; Ith, Michael; Thoeny, Harriet C. [Inselspital, Bern University Hospital, University of Bern, Inselspital, Department of Radiology, Neuroradiology, and Nuclear Medicine, Institute of Diagnostic, Pediatric, and Interventional Radiology, Bern (Switzerland); Kruse, Anja [Inselspital, Bern University Hospital, University of Bern, Inselspital, Department of Nephrology and Hypertension, Bern (Switzerland)

    2017-10-15

    To assess retrospectively whether diffusion-weighted magnetic resonance imaging (DW-MRI) allows physicians to determine the severity of histopathologic findings in biopsies of renal allograft patients with deteriorating renal function. Forty consecutive kidney transplant patients underwent DW-MRI and biopsy. Patients were assigned to one group with severe and to another group with normal or mild histopathologic findings. These two groups were compared based on a qualitative DW-MRI assessment (homo-/heterogeneity) and the combination of qualitative and quantitative DW-MRI parameters (ADC, and intravoxel incoherent motion, IVIM, parameters: D, f, D*). Sensitivity, specificity, and accuracy were determined for each parameter. Biopsy findings were severe in 25 patients and normal or mild in 15 patients. Qualitative DW-MRI led to a sensitivity of 44.0% and a specificity of 93.3%. Combined qualitative and quantitative DW-MRI led to an accuracy of 80% for both the minimal ADC (ADCmin) and the minimal perfusion fraction (fmin) with a sensitivity of 84.0% and 92.0% and a specificity of 73.3% and 60.0%, respectively. Combined qualitative and quantitative DW-MRI might allow physicians to determine the severity of histopathologic findings in biopsies of a high number of kidney transplant patients. (orig.)

  9. Neuroimaging for patient selection for medial temporal lobe epilepsy surgery: Part 1 Structural neuroimaging.

    Science.gov (United States)

    Stylianou, Petros; Hoffmann, Chen; Blat, Ilan; Harnof, Sagi

    2016-01-01

    The objective of part one of this review is to present the structural neuroimaging techniques that are currently used to evaluate patients with temporal lobe epilepsy (TLE), and to discuss their potential to define patient eligibility for medial temporal lobe surgery. A PubMed query, using Medline and Embase, and subsequent review, was performed for all English language studies published after 1990, reporting neuroimaging methods for the evaluation of patients with TLE. The extracted data included demographic variables, population and study design, imaging methods, gold standard methods, imaging findings, surgical outcomes and conclusions. Overall, 56 papers were reviewed, including a total of 1517 patients. This review highlights the following structural neuroimaging techniques: MRI, diffusion-weighted imaging, tractography, electroencephalography and magnetoencephalography. The developments in neuroimaging during the last decades have led to remarkable improvements in surgical precision, postsurgical outcome, prognosis, and the rate of seizure control in patients with TLE. The use of multiple imaging methods provides improved outcomes, and further improvements will be possible with future studies of larger patient cohorts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Prevalence and patient awareness of selected potential drug interactions with self-medication.

    Science.gov (United States)

    Indermitte, J; Reber, D; Beutler, M; Bruppacher, R; Hersberger, K E

    2007-04-01

    In community pharmacies potential drug interactions between prescription only medicines (POM) and over-the-counter (OTC) drugs purchased for self-medication arise mainly in two situations: (i) if an OTC drug is purchased by a passer-by customer whose prescribed drug therapy is not known; or (ii) if a POM or an OTC drug is requested by a regular customer whose prescribed drug therapy is usually recorded. With this study we aimed to assess the prevalence of potential drug interactions with selected POM and OTC drugs in passer-by and regular customers as well as their awareness of these potential drug interactions. Data were collected in 14 community pharmacies in the region of Basel, Switzerland by observation of customer contacts and interviews with passer-by customers purchasing selected OTC drugs, and telephone-interviews with regular customers treated with selected POMs identified in community pharmacies' databases. The selected POMs and OTC drugs are drugs which could lead to clinically relevant drug interactions of varying severity but manageable through different interventions such as adjustment of dose and its timing and/or monitoring of the therapy, and avoidance of the combination by choosing an alternative treatment. Of 1183 passer-by customers observed, 164 (14 x 4%) purchased at least one of the selected OTC drugs. One hundred and two (62 x 2%) of those subjects were interviewed. Forty-three (42 x 2%) mentioned taking prescribed drugs, and three of them were exposed to potential drug interactions of moderate severity. Out of 592 regular customers selected from the community pharmacy database, 434 (73 x 3%) could be interviewed. Sixty-nine (15 x 9%) of them were exposed to a potential drug interaction between purchased OTC drug for self-medication and their POM. Furthermore, 116 (26 x 7%) regular customers were exposed to potential drug interactions within their prescribed drugs and in 28 (6 x 5%) multiple (>or=2) potential drug interactions were found

  11. The role of endorectal coil MRI in patient selection and treatment planning for prostate seed implants

    International Nuclear Information System (INIS)

    Clarke, Daniel H.; Banks, Stephen J.; Wiederhorn, A. Roger; Klousia, John W.; Lissy, Jeanne M.; Miller, Michelle; Able, Arnold M.; Artiles, Carlos; Hindle, William V.; Blair, Deborah N.; Houk, Russell R.; Sheridan, Michael J.

    2002-01-01

    Purpose: To assess the role of endorectal coil magnetic resonance imaging (MRI) staging for patients undergoing seed implantation (SI) with or without external beam radiotherapy (EBRT). Methods and Materials: Between October 1994 and December 1998, 390 patients underwent prostate SI (98% Pd-103, 2% I-125). Seventy-six percent of patients had a prostate serum antigen (PSA) 20. Ten percent of patients had a Gleason score (GS) of 4-5, 54% had GS 6, 29% had GS 7, and 7% had GS ≥ 8. Monotherapy was employed in 46% of patients, and the remaining 54% received combined EBRT and SI. Three hundred twenty-seven were staged by high-resolution phased array pelvic coil, or in most cases, an endorectal coil MRI. The MRI findings were used to guide stage-appropriate treatment recommendations, and to assist in the preplanning and optimization of seed distributions. The criteria utilized to determine MRI-based stage were founded on the reported literature from the University of Pennsylvania. All MRI studies were reviewed by C.A., D.B., or W.H., who were unaware of clinical stage at the time of their review. The biopsy report was available to them as the only clinical correlate. Results: Of the 327 patients staged by MRI, 70% were upstaged from the digital rectal examination-based clinical stage; 26% of T 1 , T 2 patients were upstaged to T 3 . Perineural invasion and the percentage of positive cores predicted for T 3 MRI stage (p 3 intermediate-risk group patients treated by combined therapy with a previous study of T 3 intermediate-risk group treated by radical prostatectomy (RP) at the University of Pennsylvania. Our 36-month PSA FFP was 94% compared with 21% for the previous study's RP patients. Conclusion: MRI is a valuable staging procedure for prostate cancer patients treated by SI. PSA FFP results appear to be improved by MRI staging. MRI T 3 disease can be treated more effectively by SI + EBRT than by RP

  12. COPD phenotypes on computed tomography and its correlation with selected lung function variables in severe patients

    Directory of Open Access Journals (Sweden)

    da Silva SMD

    2016-03-01

    Full Text Available Silvia Maria Doria da Silva, Ilma Aparecida Paschoal, Eduardo Mello De Capitani, Marcos Mello Moreira, Luciana Campanatti Palhares, Mônica Corso PereiraPneumology Service, Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP, Campinas, São Paulo, BrazilBackground: Computed tomography (CT phenotypic characterization helps in understanding the clinical diversity of chronic obstructive pulmonary disease (COPD patients, but its clinical relevance and its relationship with functional features are not clarified. Volumetric capnography (VC uses the principle of gas washout and analyzes the pattern of CO2 elimination as a function of expired volume. The main variables analyzed were end-tidal concentration of carbon dioxide (ETCO2, Slope of phase 2 (Slp2, and Slope of phase 3 (Slp3 of capnogram, the curve which represents the total amount of CO2 eliminated by the lungs during each breath.Objective: To investigate, in a group of patients with severe COPD, if the phenotypic analysis by CT could identify different subsets of patients, and if there was an association of CT findings and functional variables.Subjects and methods: Sixty-five patients with COPD Gold III–IV were admitted for clinical evaluation, high-resolution CT, and functional evaluation (spirometry, 6-minute walk test [6MWT], and VC. The presence and profusion of tomography findings were evaluated, and later, the patients were identified as having emphysema (EMP or airway disease (AWD phenotype. EMP and AWD groups were compared; tomography findings scores were evaluated versus spirometric, 6MWT, and VC variables.Results: Bronchiectasis was found in 33.8% and peribronchial thickening in 69.2% of the 65 patients. Structural findings of airways had no significant correlation with spirometric variables. Air trapping and EMP were strongly correlated with VC variables, but in opposite directions. There was some overlap between the EMP and AWD

  13. Specific inspiratory muscle training is safe in selected patients who are ventilator-dependent: a case series.

    Science.gov (United States)

    Bissett, Bernie; Leditschke, I Anne; Green, Margot

    2012-04-01

    Mechanical ventilation of intensive care patients results in inspiratory muscle weakness. Inspiratory muscle training may be useful, but no studies have specifically described the physiological response to training. Is inspiratory muscle training with a threshold device safe in selected ventilator-dependent patients? Does inspiratory muscle strength increase with high-intensity inspiratory muscle training in ventilator-dependent patients? Prospective cohort study of 10 medically stable ventilator-dependent adult patients. Tertiary adult intensive care unit. Inspiratory muscle training 5-6 days per week with a threshold device attached to the tracheostomy without supplemental oxygen. Physiological response to training (heart rate, mean arterial pressure, oxygen saturation and respiratory rate), adverse events, training pressures. No adverse events were recorded in 195 sessions studied. For each patient's second training session, no significant changes in heart rate (Mean Difference 1.3 bpm, 95% CI -2.7 to 5.3), mean arterial pressure (Mean Difference -0.9 mmHg, 95% CI -6.4 to 4.6), respiratory rate (Mean Difference 1.2 bpm, 95% CI -1.1 to 3.5 bpm) or oxygen saturation (Mean Difference 1.2%, 95% CI -0.6 to 3.0) were detected Training pressures increased significantly (Mean Difference 18.6 cmH(2)O, 95% CI 11.8-25.3). Threshold-based inspiratory muscle training can be delivered safely in selected ventilator-dependent patients without supplemental oxygen. Inspiratory muscle training is associated with increased muscle strength, which may assist ventilatory weaning. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Clinical characteristics of patient selection and imaging predictors of outcome in solid tumors treated with checkpoint-inhibitors

    International Nuclear Information System (INIS)

    Rossi, Sabrina; Toschi, Luca; Castello, Angelo; Grizzi, Fabio; Mansi, Luigi; Lopci, Egesta

    2017-01-01

    The rapidly evolving knowledge on tumor immunology and the continuous implementation of immunotherapy in cancer have recently led to the FDA and EMA approval of several checkpoint inhibitors as immunotherapic agents in clinical practice. Anti-CTLA-4, anti-PD-1, and anti-PDL-1 antibodies are becoming standard of care in advanced melanoma, as well as in relapsed or metastatic lung and kidney cancer, demonstrating higher and longer response compared to standard chemotherapy. These encouraging results have fostered the evaluation of these antibodies either alone or in combination with other therapies in several dozen clinical trials for the treatment of multiple tumor types. However, not all patients respond to immune checkpoint inhibitors, hence, specific biomarkers are necessary to guide and monitor therapy. The utility of PD-L1 expression as a biomarker has varied in different clinical trials, but, to date, no consensus has been reached on whether PD-L1 expression is an ideal marker for response and patient selection; approximately 20-25% of patients will respond to immunotherapy with checkpoint inhibitors despite a negative PD-L1 staining. On the other hand, major issues concern the evaluation of objective response in patients treated with immunotherapy. Pure morphological criteria as commonly used in solid tumors (i.e. RECIST) are not sufficient because change in size is not an early and reliable marker of tumor response to biological therapies. Thus, the scientific community has required a continuous adaptation of immune-related response criteria (irRC) to overcome the problem. In this context, metabolic information and antibody-based imaging with positron emission tomography (PET) have been investigated, providing a powerful approach for an optimal stratification of patients at staging and during the evaluation of the response to therapy. In the present review we provide an overview on the clinical characteristics of patient selection when using imaging

  15. Selecting treatment for patients with malignant epidural spinal cord compression-does age matter?: results from a randomized clinical trial.

    Science.gov (United States)

    Chi, John H; Gokaslan, Ziya; McCormick, Paul; Tibbs, Phillip A; Kryscio, Richard J; Patchell, Roy A

    2009-03-01

    Randomized clinical trial. OBJECTIVE.: To determine if age affects outcomes from differing treatments in patients with spinal metastases. Recently, class I data were published supporting surgery with radiation over radiation alone for patients with malignant epidural spinal cord compression (MESCC). However, the criteria to properly select candidates for surgery remains controversial and few independent variables which predict success after treatment have been identified. Data for this study was obtained in a randomized clinical trial comparing surgery versus radiation for MESCC. Hazard ratios were determined for the effect of age and the interaction between age and treatment. Age estimates at which prespecified relative risks could be expected were calculated with greater than 95% confidence to suggest possible age cut points for further stratification. Multivariate models and Kaplan-Meier curves were tested using stratified cohorts for both treatment groups in the randomized trial each divided into 2 age groups. Secondary data analysis with age stratification demonstrated a strong interaction between age and treatment (hazard ratio = 1.61, P = 0.01), such that as age increases, the chances of surgery being equal to radiation alone increases. The best estimate for the age at which surgery is no longer superior to radiation alone was calculated to be between 60 and 70 years of age (95% CI), using sequential prespecified relative risk ratios. Multivariate modeling and Kaplan-Meier curves for stratified treatment groups showed that there was no difference in outcome between treatments for patients >or=65 years of age. Ambulation preservation was significantly prolonged in patients variable in predicting preservation of ambulation and survival for patients being treated for spinal metastases. Our results provide compelling evidence for the first time that particular age cut points may help in selecting patients for surgical or nonsurgical intervention based on outcome.

  16. Clinical characteristics of patient selection and imaging predictors of outcome in solid tumors treated with checkpoint-inhibitors

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Sabrina; Toschi, Luca [Humanitas Clinical and Research Hospital, Medical Oncology, Rozzano (Italy); Castello, Angelo [Humanitas Clinical and Research Hospital, Nuclear Medicine, Rozzano (Italy); Grizzi, Fabio [Humanitas Clinical and Research Hospital, Immunology and Inflammation, Rozzano (Italy); Mansi, Luigi [Seconda Universita di Napoli, Nuclear Medicine, Naples (Italy); Lopci, Egesta [Humanitas Clinical and Research Hospital, Nuclear Medicine, Rozzano (Italy); Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Nuclear Medicine, Rozzano, MI (Italy)

    2017-12-15

    The rapidly evolving knowledge on tumor immunology and the continuous implementation of immunotherapy in cancer have recently led to the FDA and EMA approval of several checkpoint inhibitors as immunotherapic agents in clinical practice. Anti-CTLA-4, anti-PD-1, and anti-PDL-1 antibodies are becoming standard of care in advanced melanoma, as well as in relapsed or metastatic lung and kidney cancer, demonstrating higher and longer response compared to standard chemotherapy. These encouraging results have fostered the evaluation of these antibodies either alone or in combination with other therapies in several dozen clinical trials for the treatment of multiple tumor types. However, not all patients respond to immune checkpoint inhibitors, hence, specific biomarkers are necessary to guide and monitor therapy. The utility of PD-L1 expression as a biomarker has varied in different clinical trials, but, to date, no consensus has been reached on whether PD-L1 expression is an ideal marker for response and patient selection; approximately 20-25% of patients will respond to immunotherapy with checkpoint inhibitors despite a negative PD-L1 staining. On the other hand, major issues concern the evaluation of objective response in patients treated with immunotherapy. Pure morphological criteria as commonly used in solid tumors (i.e. RECIST) are not sufficient because change in size is not an early and reliable marker of tumor response to biological therapies. Thus, the scientific community has required a continuous adaptation of immune-related response criteria (irRC) to overcome the problem. In this context, metabolic information and antibody-based imaging with positron emission tomography (PET) have been investigated, providing a powerful approach for an optimal stratification of patients at staging and during the evaluation of the response to therapy. In the present review we provide an overview on the clinical characteristics of patient selection when using imaging

  17. Visual function improvement using photocromic and selective blue-violet light filtering spectacle lenses in patients affected by retinal diseases.

    Science.gov (United States)

    Colombo, L; Melardi, E; Ferri, P; Montesano, G; Samir Attaalla, S; Patelli, F; De Cillà, S; Savaresi, G; Rossetti, L

    2017-08-22

    To evaluate functional visual parameters using photocromic and selective blue-violet light filtering spectacle lenses in patients affected by central or peripheral scotoma due to retinal diseases. Sixty patients were enrolled in this study: 30 patients affected by central scotoma, group 1, and 30 affected by peripheral scotoma, group 2. Black on White Best Corrected Visual Acuity (BW-BCVA), White on Black Best Corrected Visual Acuity (WB-BCVA), Mars Contrast Sensitivity (CS) and a Glare Test (GT) were performed to all patients. Test results with blue-violet filter, a short-pass yellow filter and with no filters were compared. All scores from test results increased significantly with blue-violet filters for all patients. The mean BW-BCVA increased from 0.30 ± 0.20 to 0.36 ± 0.21 decimals in group 1 and from 0.44 ± 0.22 to 0.51 ± 0.23 decimals in group 2 (Mean ± SD, p Blue filter compared to Yellow filter in all tests (p blue-violet light filter showed functional benefit in all evaluated patients.

  18. Select critically ill patients at risk of augmented renal clearance: experience in a Malaysian intensive care unit.

    Science.gov (United States)

    Adnan, S; Ratnam, S; Kumar, S; Paterson, D; Lipman, J; Roberts, J; Udy, A A

    2014-11-01

    Augmented renal clearance (ARC) refers to increased solute elimination by the kidneys. ARC has considerable implications for altered drug concentrations. The aims of this study were to describe the prevalence of ARC in a select cohort of patients admitted to a Malaysian intensive care unit (ICU) and to compare measured and calculated creatinine clearances in this group. Patients with an expected ICU stay of patients were included, with a median age of 34 years. Most study participants were male and admitted after trauma. Thirty-nine percent were found to have ARC. These patients were more commonly admitted in emergency (P=0.03), although no other covariants were identified as predicting ARC, likely due to the inclusion criteria and the study being under-powered. Significant imprecision was demonstrated when comparing calculated Cockcroft-Gault creatinine clearance (Crcl) and measured Crcl. Bias was larger in ARC patients, with Cockcroft-Gault Crcl being significantly lower than measured Crcl (P patients with 'normal' serum creatinine concentrations have varied Crcl. Many are at risk of ARC, which may necessitate individualised drug dosing. Furthermore, significant bias and imprecision between calculated and measured Crcl exists, suggesting clinicians should carefully consider which method they employ in assessing renal function.

  19. Membranous glomerulopathy in a patient with selective IgA deficiency: is there a link?

    Science.gov (United States)

    Vanacker, A; Van Dorpe, J; Maes, B

    2011-01-01

    We report a 42-year-old woman, who presented with proteinuria (3.85 g/day) and malleolar oedema. She had a medical history of Graves' disease, recurrent upper respiratory tract infections, episodes of Raynaud phenomenon and dysphagia. Biochemistry showed a selective IgA deficiency (SIgAD). Percutaneous renal needle biopsy showed diffuse global thickening of the glomerular basement membranes on light microscopy and granular deposits of IgG and C3 along the glomerular basement membranes on immunofluorescence. The pathological diagnosis was membranous glomerulopathy stage II. A treatment with dietary salt restriction and an angiotensin-converting enzyme inhibitor was initiated, resulting in a reduction of proteinuria. Despite the fact that selective IgA deficiency is associated with various autoimmune disorders, the association with glomerular disease is rather rare and the pathogenesis is not fully understood.

  20. Low-tube-voltage selection for triple-rule-out CTA: relation to patient size

    Energy Technology Data Exchange (ETDEWEB)

    Takx, Richard A.P. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Krissak, Radko [Medical Faculty Mannheim - Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (Germany); Hufeland Klinikum GmbH, Department of Diagnostic and Interventional Radiology, Bad Langensalza (Germany); Fink, Christian [Medical Faculty Mannheim - Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (Germany); General Hospital Celle, Department of Radiology, Celle (Germany); Bachmann, Valentin; Henzler, Thomas; Meyer, Mathias; Schoenberg, Stefan O. [Medical Faculty Mannheim - Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (Germany); Nance, John W. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Apfaltrer, Paul [Medical Faculty Mannheim - Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (Germany); Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria)

    2017-06-15

    To investigate the relationship between image quality and patient size at 100 kilovoltage (kV) compared to 120 kV ECG-gated Triple-Rule-Out CT angiography (TRO-CTA). We retrospectively included 73 patients (age 64 ± 14 years) who underwent retrospective ECG-gated chest CTA. 40 patients were scanned with 100 kV while 33 patients with 120 kV. Body mass index (BMI), patients' chest circumference (PC) and thoracic surface area (TSA) were recorded. Quantitative image quality was assessed as vascular attenuation in the ascending aorta (AA), pulmonary trunk (PA) and left coronary artery (LCA) and the signal-to-noise ratio (SNR) in the AA. There was no significant difference in BMI (26.0 ± 4.6 vs. 28.0 ± 6.7 kg/m{sup 2}), PC (103 ± 7 vs. 104 ± 10 cm{sup 2}) and TSA (92 ± 15 vs. 91 ± 19 cm{sup 2}) between 100 kV and 120 kV group. Mean vascular attenuation was significantly higher in the 100 kV compared to the 120 kV group (AA 438 vs. 354 HU, PA 460 vs. 349 HU, LCA 370 vs. 299 HU all p < 0.001). SNR was not significantly different, even after adjusting for patient size. Radiation dose was significantly lower in the 100 kV group (10.7 ± 4.1 vs. 20.7 ± 10.7 mSv; p < 0.001). 100 kV TRO-CTA is feasible in normal-to-overweight patients while maintaining image quality and achieving substantial dose reduction. (orig.)

  1. Selected non-somatic risk factors for pregnancy loss in patients with abnormal early pregnancy

    Directory of Open Access Journals (Sweden)

    Maciej Paszkowski

    2015-12-01

    The results of this study confirm the complexity of the early pregnancy loss etiopatogenesis. Further research need to be conducted in order to identify the non-somatic causative agents of various clinical forms of miscarriage. It may help do select women in reproductive age at high risk of early pregnancy loss and show the ways in which effective preventive measures can be introduced in such population.

  2. New echocardiographic techniques in optimal patient selection for cardiac resynchronization therapy in the treatment of chronic heart failure

    Directory of Open Access Journals (Sweden)

    Petrović Milan

    2009-01-01

    Full Text Available Cardiac resynchronization therapy (CRT has important role in the contemporary treatment of heart failure, systolic dysfunction and mechanical disynchrony. Classical indications for CRT are severe heart failure (NYHA class III or IV, a broad QRS (more than 120 ms and left ejection fraction less than 35% despite optimal medical therapy. Several have studies demonstrated the important role of echocardiography in patient selection for CRT, follow up and estimation of CRT effects, as well as the optimization of biventricular pacemaker. Basically, there are three types of cardiac asynchrony: interventricular asynchrony, between the right and left ventricle, intraventricular asynchrony, between the myocardial segments within the left ventricle and atrioventricular asynchrony, between the atria and ventricles. Although many echocardiographic techniques are used in patient selection for CRT, no ideal approach has yet been found. There are several techniques and parameters used in the assessment of myocardial asynchrony: two dimensional (2D echocardiography, one dimensional echocardiography (M-mode, Doppler echocardiography, different modalities of tissue Doppler including Colour Coded Tissue Doppler Imaging - TDI, measurements of local tissue deformation indices (strain and strain rate, speckle tracking, 3D echocardiography, semiquantitative assessment of myocardial border, vector velocity imaging. Each of these techniques has advantages and limitations. A special accent in this revue is on the consensus report from the American Society of Echocardiography Dyssynchrony Writing group. According to this consensus report color coded tissue Doppler is the most appropriate technique for myocardial asynchrony estimation and patients selection for CRT. The same group recommended that definitive decision for CFT implantation should not be based only on echocardiographic analysis, but rather on the whole clinical aspect of the patient.

  3. Adaptive terminal sliding mode control for hypersonic flight vehicles with strictly lower convex function based nonlinear disturbance observer.

    Science.gov (United States)

    Wu, Yun-Jie; Zuo, Jing-Xing; Sun, Liang-Hua

    2017-11-01

    In this paper, the altitude and velocity tracking control of a generic hypersonic flight vehicle (HFV) is considered. A novel adaptive terminal sliding mode controller (ATSMC) with strictly lower convex function based nonlinear disturbance observer (SDOB) is proposed for the longitudinal dynamics of HFV in presence of both parametric uncertainties and external disturbances. First, for the sake of enhancing the anti-interference capability, SDOB is presented to estimate and compensate the equivalent disturbances by introducing a strictly lower convex function. Next, the SDOB based ATSMC (SDOB-ATSMC) is proposed to guarantee the system outputs track the reference trajectory. Then, stability of the proposed control scheme is analyzed by the Lyapunov function method. Compared with other HFV control approaches, key novelties of SDOB-ATSMC are that a novel SDOB is proposed and drawn into the (virtual) control laws to compensate the disturbances and that several adaptive laws are used to deal with the differential explosion problem. Finally, it is illustrated by the simulation results that the new method exhibits an excellent robustness and a better disturbance rejection performance than the convention approach. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  4. Strictly monolayer large continuous MoS{sub 2} films on diverse substrates and their luminescence properties

    Energy Technology Data Exchange (ETDEWEB)

    Mohapatra, P. K.; Deb, S.; Singh, B. P.; Vasa, P.; Dhar, S., E-mail: dhar@phy.iitb.ac.in [Department of Physics, Indian Institute of Technology Bombay, Mumbai 400076 (India)

    2016-01-25

    Despite a tremendous interest on molybdenum disulfide as a thinnest direct band gap semiconductor, single step synthesis of a large area purely monolayer MoS{sub 2} film has not yet been reported. Here, we report a CVD route to synthesize a continuous film of strictly monolayer MoS{sub 2} covering an area as large as a few cm{sup 2} on a variety of different substrates without using any seeding material or any elaborate pretreatment of the substrate. This is achieved by allowing the growth to take place in the naturally formed gap between a piece of SiO{sub 2} coated Si wafer and the substrate, when the latter is placed on top of the former inside a CVD reactor. We propose a qualitative model to explain why the MoS{sub 2} films are always strictly monolayer in this method. The photoluminescence study of these monolayers shows the characteristic excitonic and trionic features associated with monolayer MoS{sub 2}. In addition, a broad defect related luminescence band appears at ∼1.7 eV. As temperature decreases, the intensity of this broad feature increases, while the band edge luminescence reduces.

  5. Event-Sampled Direct Adaptive NN Output- and State-Feedback Control of Uncertain Strict-Feedback System.

    Science.gov (United States)

    Szanto, Nathan; Narayanan, Vignesh; Jagannathan, Sarangapani

    2017-04-12

    In this paper, a novel event-triggered implementation of a tracking controller for an uncertain strict-feedback system is presented. Neural networks (NNs) are utilized in the backstepping approach to design a control input by approximating unknown dynamics of the strict-feedback nonlinear system with event-sampled inputs. The system state vector is assumed to be unknown and an NN observer is used to estimate the state vector. By using the estimated state vector and backstepping design approach, an event-sampled controller is introduced. As part of the controller design, first, input-to-state-like stability for a continuously sampled controller that has been injected with bounded measurement errors is demonstrated, and subsequently, an event-execution control law is derived, such that the measurement errors are guaranteed to remain bounded. Lyapunov theory is used to demonstrate that the tracking errors, the observer estimation errors, and the NN weight estimation errors for each NN are locally uniformly ultimately bounded in the presence bounded disturbances, NN reconstruction errors, as well as errors introduced by event sampling. Simulation results are provided to illustrate the effectiveness of the proposed controllers.

  6. [Evaluation of selected socioeconomic factors in patients with acute ethanol intoxication and alcohol withdrawal syndrome].

    Science.gov (United States)

    Lukasik-Głębocka, Magdalena; Sommerfeld, Karina

    2014-01-01

    Ethanol is commonly overused psychoactive substance in Poland and all around the world. It causes addiction, which occurs as a result of its chronic administration. One of the main symptoms of addiction is hunger due to psychoactive substance that prevents interruption of its adoption and contributes to relapse drinking. Acute poisoning with ethyl alcohol and alcohol withdrawal syndrome are diseases causing a potential danger to life. The prevalence of use and abuse of alcoholic beverages is a potential risk, causing health problems, including permanent damage of the central and peripheral nervous system and socio-economic problems. The aim of this study is to analyze certain aspects of the socio-economic situation of the patients hospitalized in the Department of Toxicology in Raszeja City Hospital in Poznan due to acute ethanol intoxication or alcohol withdrawal syndrome in 2010. 299 patients history was evaluated, among which 161 were treated for acute intoxication with ethanol and 138 due to alcohol withdrawal syndrome. Objects of interest were elements of subjective tests including: marital status of patients, their education and professional activity and the problem of homelessness. The study group consisted of 299 patients in age from 16 to 77 years, hospitalized in the Department of Toxicology in Raszeja City Hospital in Poznan due to acute ethanol intoxication or alcohol withdrawal syndrome. It was found that the largest group consisted of patients remaining married (42.81%) and unmarried (30.43%). Alcohol abuse affects people of all levels of education. In the present study, most patients had a vocational education (37.79%) and medium (23.08%). Patients were analyzed in terms of economic activity, among which about 40% were unemployed. In the whole group more than 10% of those were homeless. Ethyl alcohol intoxication and alcohol withdrawal represents a significant hazard. As a result of reliance, patients lose control of alcohol consumption and they

  7. Evaluation of selected interleukins in patients with different gastric neoplasms: a preliminary report

    Science.gov (United States)

    Madej-Michniewicz, Anna; Budkowska, Marta; Sałata, Daria; Dołęgowska, Barbara; Starzyńska, Teresa; Błogowski, Wojciech

    2015-01-01

    Abnormal interactions between cytokines may be an overlooked mechanism linking the development of different types of gastric neoplasms. In this study a comprehensive analysis of the systemic levels of interleukins (IL-1,IL-6, IL-8,IL-10 and IL-12) was performed in 75 patients with different gastric neoplasms (cancer, gastrointestinal stromal tumors, neuroendocrine neoplasms, lymphomas) and 40 healthy volunteers. Patients with gastric cancer (GC) have significantly higher IL-6 levels, and lower IL-8 and IL-10 concentrations, in comparison to controls and patients with other gastric neoplasms. Analogous results were observed in terms of IL-6/IL-8 and IL-6/IL-10 ratios, whose values were also higher in GC patients. In GC patients no associations were detected between the systemic levels/values of interleukins (ratios) and TNM staging. IL-6, IL-10, IL-6/IL-8 and IL-6/IL-10 ratios appeared to hold diagnostic potential in confirming/excluding the presence of GC. Their sensitivity/specificity in GC detection/exclusion was approximately 54–72%. In conclusion, disturbed systemic biochemical balance in multiple interleukins exists at the earliest stages of and appears to be specific to GC. The interleukin ratios proposed here seem to be more promising indicators of GC in humans than direct systemic levels of interleukins, and probably possess the potential to be applied as a supporting factor for techniques routinely used. PMID:26486258

  8. [GISE/AIAC position paper on percutaneous left atrial appendage occlusion in patients with nonvalvular atrial fibrillation: recommendations for patient selection, facilities, competences, organizing and training requirements].

    Science.gov (United States)

    Berti, Sergio; Themistoclakis, Sakis; Santoro, Gennaro; De Ponti, Roberto; Danna, Paolo; Zecchin, Massimo; Bedogni, Francesco; Padeletti, Luigi

    2014-09-01

    Thromboembolism from the left atrial appendage is the most feared complication in patients with atrial fibrillation (AF). The cornerstone for the management of chronic nonvalvular AF is stroke reduction with oral anticoagulation (OAC). However, poor compliance, maintaining a narrow therapeutic window, and major side effects such as bleeding have severely limited its use, creating a therapeutic dilemma. About 20% of AF patients do not receive OAC due to contraindications and less than half of AF patients are not on OAC due to reluctance of the prescribing physician and/or patient non-compliance. Fortunately, over the past decade, the introduction of percutaneous approaches for left atrial appendage occlusion has offered a viable alternative to the management of nonvalvular AF in patients with OAC contraindication. Occlusion devices such as the Amplatzer Cardiac Plug and Watch man device have shown their noninferiority to OAC for stroke prophylaxis with less bleeding complications, while more recently some new devices have been introduced. The aim of this position paper is to review the most relevant clinical aspects of left atrial appendage occlusion from patient selection to periprocedural and follow-up management. In addition, the importance of a medical team and an organizational environment adequate to optimize all the steps of this procedure is discussed.

  9. A patient and community-centered approach selecting endpoints for a randomized trial of a novel advance care planning tool

    Directory of Open Access Journals (Sweden)

    Bridges JFP

    2018-02-01

    Full Text Available John FP Bridges,1,2 Norah L Crossnohere,2 Anne L Schuster,1 Judith A Miller,3 Carolyn Pastorini,3,† Rebecca A Aslakson2,4,5 1Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 2Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 3Patient-Centered Outcomes Research Institute (PCORI Project, Baltimore, MD, 4Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, 5Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, Baltimore, MD, USA †Carolyn Pastorini passed away on August 24, 2015 Background: Despite a movement toward patient-centered outcomes, best practices on how to gather and refine patients’ perspectives on research endpoints are limited. Advanced care planning (ACP is inherently patient centered and would benefit from patient prioritization of endpoints for ACP-related tools and studies.Objective: This investigation sought to prioritize patient-centered endpoints for the content and evaluation of an ACP video being developed for patients undergoing major surgery. We also sought to highlight an approach using complementary engagement and research strategies to document priorities and preferences of patients and other stakeholders.Materials and methods: Endpoints identified from a previously published environmental scan were operationalized following rating by a caregiver co-investigator, refinement by a patient co-investigator, review by a stakeholder committee, and validation by patients and family members. Finalized endpoints were taken to a state fair where members of the public who indicated that they or a loved one had undergone major surgery prioritized their most relevant endpoints and provided comments.Results: Of the initial 50 ACP endpoints identified from the review, 12 endpoints were selected for public

  10. Speech and voice rehabilitation in selected patients fitted with a bone anchored hearing aid (BAHA).

    Science.gov (United States)

    Thomas, J

    1996-01-01

    With the Birmingham osseointegrated implant programme there have been several patients with severe pre-lingual conductive hearing loss. The majority of these have been patients with Treacher Collins syndrome. There are characteristic features of speech and voice in those with long-standing conductive hearing loss. In addition, the associated abnormalities of jaw, teeth and palate may amplify the problem. There may be spontaneous improvement in features such as voice pitch, quality and intensity following the fitting of a BAHA. However, in those with a pre-lingual hearing impairment, speech therapy may be necessary. Patients assessed as suitable for BAHA have a full assessment of communication skills including audio recording of speech and voice. Post-operative training improves auditory discrimination and perception and is followed by training in the production of the newly perceived speech sounds.

  11. Profile of rheumatology patients willing to report adverse drug reactions: bias from selective reporting

    Directory of Open Access Journals (Sweden)

    Protić D

    2016-02-01

    Full Text Available Dragana Protić,1 Nada Vujasinović-Stupar,2 Zoran Bukumirić,3 Slavica Pavlov-Dolijanović,4 Snežana Baltić,5 Slavica Mutavdžin,6 Ljiljana Markovic-Denić,7 Marija Zdravković,8 Zoran Todorović1 1Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department 2, Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 3Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 4Department 5, Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 5Department 5, Institute of Rheumatology, Belgrade, Serbia; 6Institute of Physiology “Rihard Burjan”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 7Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 8Department of Cardiology, Medical Center “Bežanijska kosa”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia Background: Adverse drug reactions (ADRs have a significant impact on human health and health care costs. The aims of our study were to determine the profile of rheumatology patients willing to report ADRs and to identify bias in such a reporting system. Methods: Semi-intensive ADRs reporting system was used in our study. Patients willing to participate (N=261 completed the questionnaire designed for the purpose of the study at the hospital admission. They were subsequently classified into two groups according to their ability to identify whether they had experienced ADRs during the previous month. Group 1 included 214 out of 261 patients who were able to identify ADRs, and group 2 consisted of 43 out of 261 patients who were not able to identify ADRs in their recent medical history. Results: Group 1 patients were more significantly aware of their diagnosis than the patients from group 2. Marginal significance was found

  12. Selection of patients for heart transplantation in the current era of heart failure therapy.

    Science.gov (United States)

    Butler, Javed; Khadim, Ghazanfar; Paul, Kimberly M; Davis, Stacy F; Kronenberg, Marvin W; Chomsky, Don B; Pierson, Richard N; Wilson, John R

    2004-03-03

    We sought to assess the relationship between survival, peak exercise oxygen consumption (VO(2)), and heart failure survival score (HFSS) in the current era of heart failure (HF) therapy. Based on predicted survival, HF patients with peak VO(2) 14 ml/min/kg (p = 0.04). Of the patients with peak VO(2) of 10 to 14 ml/min/kg, 55% had low-risk HFSS and exhibited 88% one-year event-free survival. One-year survival after transplantation was 88%, which is similar to the 85% rate reported by the United Network for Organ Sharing for 1999 to 2000. Survival for HF patients in the current era has improved significantly, necessitating re-evaluation of the listing criteria for heart transplantation.

  13. Stent selection in patients with myocardial infarction: drug eluting, biodegradable polymers or bare metal stents?

    Science.gov (United States)

    Mieres, Juan; Rodríguez, Alfredo E

    2012-08-01

    Percutaneous coronary intervention (PCI) has been increasingly used in the last years during interventional procedures in patients with acute coronary syndromes (ACS) including ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). In patients with either STEMI, NSTEMI, high risk ACS with EKG changes or cardiac enzymes rises; PCI with bare metal stent (BMS) implantation has been associated with a significant improvement in clinical outcome. Therefore, BMS implantation during primary PCI in STEMI has become a standard of practice. With the introduction of drug eluting stents (DESs) in this decade, the use of these new devices instead of BMSs in patients with STEMI has emerged as a rational PCI alternative in this particular subgroup of patients. In spite of the unquestionable benefits of DESs in terms of reduction of restenosis and TVR, specific concerns have arisen with regard to their long-term safety. High incidence of very late stent thrombosis has been described with these devices, and special attention should be paid in patients with unstable coronary lesions, in which plaque composition and remodeling may play a main role in their safety and long-term outcome. Intraluminal thrombus caused by plaque rupture is the most frequent mechanism of STEMI, in which the necrotic core and thin fibrous cap play a major role. In this context, the use of first DESs designs may be futile or even unsafe because delayed healing may further contribute to plaque instability. Adjunctive invasive imaging tools can improve stent deployment and safety outcome in these lesions with intravascular findings of plaque instability. Recently, other players such as new dedicated antithrombotic BMS designs, including selfexpanding stents or drug-eluting coated balloons, are exploring their potential indications in patients with ACS and myocardial infarction. This paper reports and discusses new stent devices and adjunctive pharmacologic agents. It

  14. [Analysis of effectiveness of selected treatment methods in patients with chronic low back pain].

    Science.gov (United States)

    Kowalczyk, Monika; Zgorzalewicz-Stachowiak, Małgorzata; Głowacka, Orina

    2015-11-01

    Chronic low back pain (CLBP) are becoming more and more frequently met disorder in modern society. Appearance of these symptoms mainly contribute degenerative changes in spine joints. Preventive, noninvasive treatment constitutes an important factor in therapy of chronic pain, therefore effective treatment methods for inhibiting the disease progression, pain-reducing and retrieving patients the functional ability are still seeking. The aim of the study was to evaluate the efficacy of ultrasounds, exercise therapy and combination therapy of both methods in the treatment of CLBP and comparing their effectiveness. The study included 90 patients in the age of 42-82 treated for CLBP as a result of degenerative changes. Patients were divided into three 30-members groups. The first group used treatment consisted of ultrasounds. The second one included only exercise therapy and the third one underwent the combination of both methods - exercise therapy and sonotherapy. Treatment was continued for 2 weeks and was performed daily with the weekend break. Assessment of the pain level of was done with a VAS scale and a Laitinen questionnaire. The level of functional disability was determined on the basis of a modified Oswestry questionnaire. The spine motion was measured according to the Zembaty's methodology. Patients were examined twice - before and after therapy. In all patients significant pain reduction was noticed. In addition, level of disability of patients became considerably less and the mobility of the spine for all tests increased significantly. There were no significant differences between groups after all therapies. Ultrasounds, exercise therapy and combination of these two methods had a similar effectiveness in treatment of CLBP. © 2015 MEDPRESS.

  15. The Clinical and Economic Effect of Vascular Access Selection in Patients Initiating Hemodialysis with a Catheter.

    Science.gov (United States)

    Al-Balas, Alian; Lee, Timmy; Young, Carlton J; Kepes, Jeffrey A; Barker-Finkel, Jill; Allon, Michael

    2017-12-01

    Patients in the United States frequently initiate hemodialysis with a central venous catheter (CVC) and subsequently undergo placement of a new arteriovenous fistula (AVF) or arteriovenous graft (AVG). Little is known about the clinical and economic effects of initial vascular access choice. We identified 479 patients starting hemodialysis with a CVC at a large medical center (during 2004-2012) who subsequently had an AVF ( n =295) or AVG ( n =105) placed or no arteriovenous access (CVC group, n =71). Compared with patients receiving an AVG, those receiving an AVF had more frequent surgical access procedures per year (1.01 [95% confidence interval, 0.95 to 1.08] versus 0.62 [95% confidence interval, 0.55 to 0.70]; P access procedures per year. Patients receiving an AVF had a higher median annual cost (interquartile range) of surgical access procedures than those receiving an AVG ($4857 [$2523-$8835] versus $2819 [$1411-$4274]; P access procedures was similar in both groups. The AVF group had a higher median overall annual access-related cost than the AVG group ($10,642 [$5406-$19,878] versus $6810 [$3718-$13,651]; P =0.001) after controlling for patient age, sex, race, and diabetes. The CVC group had the highest median annual overall access-related cost ($28,709 [$11,793-$66,917]; P access-related procedures and complications is higher in patients who initially receive an AVF versus an AVG. Copyright © 2017 by the American Society of Nephrology.

  16. Baha-mediated rehabilitation of patients with unilateral deafness: selection criteria.

    Science.gov (United States)

    Saroul, N; Akkari, M; Pavier, Y; Gilain, L; Mom, T

    2014-01-01

    The aim of our study was to identify clinical criteria for optimizing rehabilitation of patients with unilateral deafness using the Baha device. We made a retrospective study of 102 patients with unilateral deafness requesting auditory rehabilitation over a period of 5 years. All subjects underwent a series of stereo audiometric tests, with and without Baha worn on a headband, and were then referred to a hearing care specialist for a real life trial of 15 days. The Glasgow Health Status Inventory (GHSI) questionnaire was administered. Patients refusing the implantation were retrospectively submitted to a questionnaire specifically designed to ask the reasons for refusal. We measured stereo audiometric test results, age, aetiology of deafness, duration of auditory deprivation on the rehabilitated ear, and GHSI score. At the conclusion of testing, the implantation rate was 29%. During preoperative testing, the improvement in understanding of speech-in-noise was 22 ± 11% for patients agreeing to the implantation versus 13 ± 11% for patients refusing the implantation. Age, aetiology of deafness and duration of auditory deprivation had no influence on the implantation decision. Speech-in-noise testing and aided stereo audiometric gain were the only two measures showing statistically significant differences between the groups agreeing to and refusing the implantation. There were multiple reasons for refusal of the implantation. Among these, the four principal reasons were: absence of perceived benefit during stereo audiometric testing (59%), requirement for surgery (35%), cost of the solution (44%), and aesthetics (41%). Hence, no other criteria except the preoperative improvement in understanding of speech-in-noise and the aided gain from Baha worn on a headband were found to be predictive of the patient's acceptance of surgical implantation of a bone-anchored implant/abutment for Baha. Speech-in-noise testing with and without Baha worn on a headband has a role to

  17. Evaluation of serum concentrations of the selected cytokines in patients with localized scleroderma

    Directory of Open Access Journals (Sweden)

    Jolanta Budzyńska-Włodarczyk

    2016-02-01

    Full Text Available Introduction : Localized scleroderma is an autoimmune disease primarily affecting the skin. The cause of disease remains unexplained although environmental factors are implicated, which are likely to be responsible for activation of the endothelium and subsequent inflammation leading to excessive synthesis of collagen and extracellular matrix components. Aim: To determine concentrations of interleukin (IL-27, transforming growth factor (TGF-β1, TGF-β2, IL-6, and sIL-6R in patients with localized scleroderma compared to controls and to assess the relations between their levels and laboratory markers. Material and methods: The study encompassed 17 females with localized scleroderma (aged 25–67. The control group consisted of 30 age-matched healthy women. The blood was sampled from the basilic vein. Serum levels of cytokines were determined using ELISA. Results : The TGF-β2 levels were found to be significantly lower in patients with localized scleroderma compared to controls. Concentrations of TGF-β1 were decreased in scleroderma patients when compared to controls but without statistical significance. There were no significant differences in serum IL-6, sIL-6R and IL-27 levels between patients and the control group; however, we found a significant positive correlation between the level of sIL-6 and ESR among subjects with localized scleroderma. Conclusions : The findings of decreased serum levels of TGF-β1 and TGF-β2 in patients with localized scleroderma demonstrate a possible association of these cytokines with pathogenesis of the disease. The results suggest also that sIL-6R is likely to be involved in inflammation in patients with localized scleroderma.

  18. Evaluation of serum concentrations of the selected cytokines in patients with localized scleroderma.

    Science.gov (United States)

    Budzyńska-Włodarczyk, Jolanta; Michalska-Jakubus, Małgorzata M; Kowal, Małgorzata; Krasowska, Dorota

    2016-02-01

    Localized scleroderma is an autoimmune disease primarily affecting the skin. The cause of disease remains unexplained although environmental factors are implicated, which are likely to be responsible for activation of the endothelium and subsequent inflammation leading to excessive synthesis of collagen and extracellular matrix components. To determine concentrations of interleukin (IL)-27, transforming growth factor (TGF)-β1, TGF-β2, IL-6, and sIL-6R in patients with localized scleroderma compared to controls and to assess the relations between their levels and laboratory markers. The study encompassed 17 females with localized scleroderma (aged 25-67). The control group consisted of 30 age-matched healthy women. The blood was sampled from the basilic vein. Serum levels of cytokines were determined using ELISA. The TGF-β2 levels were found to be significantly lower in patients with localized scleroderma compared to controls. Concentrations of TGF-β1 were decreased in scleroderma patients when compared to controls but without statistical significance. There were no significant differences in serum IL-6, sIL-6R and IL-27 levels between patients and the control group; however, we found a significant positive correlation between the level of sIL-6 and ESR among subjects with localized scleroderma. The findings of decreased serum levels of TGF-β1 and TGF-β2 in patients with localized scleroderma demonstrate a possible association of these cytokines with pathogenesis of the disease. The results suggest also that sIL-6R is likely to be involved in inflammation in patients with localized scleroderma.

  19. An evaluation of selected oral health indicators and cariogenic bacteria titer in patients with Helicobacter pylori.

    Science.gov (United States)

    Urban, Jakub; Koszowski, Rafał; Płachetka, Anna; Wiczkowski, Andrzej

    2017-01-01

    Studies based on polymerase chain reaction (PCR) techniques indicate that Helicobacter pylori can be constantly or temporarily present in the oral cavity in virulent or non-virulent form. Streptococcus mutans exerts a strong inhibitory effect on H. pylori. The aim of the present study was to investigate the prevalence and virulence of H. pylori in the oral cavity and the correlation of these factors with oral health and cariogenic bacteria titer. The study involved 108 adults who were positive in urease tests for H. pylori presence in the gastric mucosa. Group I consisted of 50 patients with positive saliva tests using PCR for the presence of H. pylori DNA, while group II comprised 58 patients with negative tests. The research material consisted of saliva and dental plaque. To determine the density of S. mutans and Lactobacillus, commercially available S. mutans and LB sets were used. H. pylori DNA was found in the oral cavities of 46% of the patients who had tested positive in urease tests for the presence of these bacteria in the stomach. Among those who tested positive for the presence of H. pylori in the oral cavity, virulent strains were identified in 16% of the patients. Approximal plaque index (API) and bleeding on probing (BOP) were found to be significantly higher in patients with confirmed H. pylori in the oral cavity. This group also had a smaller number of S. mutans colonies. H. pylori is found more often in patients with poor oral hygiene. Oral sanitation and hygiene instructions should be considered relevant as a complement to eradication therapy.

  20. Interventional Decentralized Telemonitoring: Bridging the Gap Between Patient's Device and Physician's Needs in Well Selected Indications

    Directory of Open Access Journals (Sweden)

    Egbert G. Schulz

    2015-03-01

    Full Text Available Telemedicine comprises different concepts aiming to close a spatial distance between practitioner, medical staff and patient. It's functionality can include mere data transmission but extend as well to triggering alarms or enable consultation and therapy suggestions. A special form of telemedicinal application is interventional decentralized telemonitoring. Here practitioner-patient communication is characterized by telemedicinial data collection driven therapy-control and -optimization. To identify feasible indications for the employment of telemonitoring a detailed definition of communicated parameters, alarm rules and algorithms of intervention are required as well as a benefit-cost analysis. The quality of the telemedical application is determined by the medical quality of the resulting actions.

  1. Rational Selection and Use of Antimicrobials in Patients with Burn Injuries.

    Science.gov (United States)

    Hill, David M; Sinclair, Scott E; Hickerson, William L

    2017-07-01

    Caring for patients with burn injuries is challenging secondary to the acute disease process, chronic comorbidities, and underrepresentation in evidence-based literature. Much current practice relies on extrapolation of guidance from different patient populations and wide variations in universal practices. Identifying infections or sepsis in this hypermetabolic population is imperfect and often leads to overprescribing of antimicrobials, suboptimal dosing, and multidrug resistance. An understanding of pharmacokinetics and pharmacodynamics may aid optimization of dosing regimens to better attain treatment targets. This article provides an overview of the current status of burn infection and attempts recommendations for consideration to improve universally accepted care. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Assessment of selected cognitive processes in elderly patients after urologic surgery.

    Science.gov (United States)

    Wioletta, Mędrzycka-Dąbrowska; Sebastian, Dąbrowski; Andrzej, Basiński

    2016-01-01

    The issue of postoperative disorders of cognitive functions is a highly topical problem as more and more elderly people undergo medical treatments. Patients may lose the ability of assimilating information and their linguistic functions may deteriorate. Cognitive disorders may result in the temporary exclusion of the patient from social activity. The purpose of the paper was to assess the incidence of certain cognitive disorders in the elderly after urological surgeries. The study was conducted in a group of 218 patients aged over 65, male and female, after an urological surgery under different types of anesthesia. Standardized neuropsychological tests of cognitive functions were employed in the study. Analysis of the data showed that in the control group were obtained similar results in the study of the first and second. However, in the test group demonstrated a reduction cognitive function in all the tests in a second study. The reduction of cognitive functions in the study group was observed in all the domains but it was the most marked in visual memory tests. Postoperative reduction of cognitive functions is correlated with the patient's age, education and mood. Postoperative reduction of cognitive functions is not correlated with the type of surgery, anesthesia and its duration. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  3. Radionuclide imaging of drug delivery for patient selection in targeted therapy

    NARCIS (Netherlands)

    Heskamp, Sandra; van Laarhoven, Hanneke W. M.; van der Graaf, Winette T. A.; Oyen, Wim J. G.; Boerman, Otto C.

    2014-01-01

    Introduction: During the last decade, numerous antibodies and tyrosine kinase inhibitors have been developed for cancer treatment. However, only a limited number of these agents have been shown to significantly improve survival of patients. Therefore, it is of crucial importance to identify the

  4. Selective patient and public involvement: The promise and perils of pharmaceutical intervention for autism

    DEFF Research Database (Denmark)

    Russell, Ginny; Starr, Sandy; Rodogno, Raffaele

    2017-01-01

    was to scrutinize patient and public involvement (PPI) by a pan-European biomedical consortium working to develop drugs to treat autism. We aimed to use this as an example to illustrate how PPI has been utilized in biomedical research. Setting, participants and analysis: Two public events, one in the UK and one...

  5. Exposure to selected fragrance materials. A case study of fragrance-mix-positive eczema patients

    DEFF Research Database (Denmark)

    Johansen, J D; Rastogi, Suresh Chandra; Menné, T

    1996-01-01

    . In all cases, the use of these cosmetics completely or partly explained present or past episodes of eczema. Between 1 to 6 constituents of the fragrance mix were found in 22 out of 23 products. The cosmetics of all the patients sensitive to hydroxycitronellal, eugenol, cinnamic alcohol and alpha...

  6. Neuropsychological profile of Parkinson's disease patients selected for deep brain stimulation surgery

    Directory of Open Access Journals (Sweden)

    Flavia Amaral Machado

    Full Text Available ABSTRACT Background: Parkinson's disease (PD shows symptoms involving motor and non-motor complications, including cognitive and behavioral changes, such changes might to contraindicate deep brain stimulation surgery (DBS. Objective: The aim of study was to investigate the neuropsychological profile of patients with PD in a waiting list for DBS. Methods: The neuropsychological evaluation was held in 30 patients of the ISCMPA Movement Disorders Clinic, with surgical indication based on the criteria of the responsible neurologists, in the period of 12 months. Instruments used: MMSE, FAB, MoCA, BDI, Semantic Verbal Fluency, PDQ-39, PDSS; and the UPDRS and Hoehn-Yahr scale. Results: The patients were mostly male (66.7% with a mean age of 59.37 (SD 10.60 and disease duration 9.33 (SD 4.08. There was cognitive impairment in 56.7% of patients by FAB and 76.7% by MoCA. Conclusion: Even in the earliest stages of the disease, there is the incidence of non-motor symptoms, especially in those subjects who had an early onset of the disease.

  7. Colectomy and ileorectal anastomosis is still an option for selected patients with familial adenomatous polyposis

    DEFF Research Database (Denmark)

    Bülow, Steffen; Bulow, C.; Vasen, H.

    2008-01-01

    PURPOSE: The risk of rectal cancer after colectomy and ileorectal anastomosis may be reduced in the last decades, as patients with severe polyposis now have an ileoanal pouch. We have reevaluated the risk of rectal cancer and proctectomy for all causes according to the year of operation. METHODS:...

  8. Selective inhibition of nuclear export with selinexor in patients with non-Hodgkin lymphoma

    DEFF Research Database (Denmark)

    Kuruvilla, John; Savona, Michael; Baz, Rachid

    2017-01-01

    %), leukopenia (16%), fatigue (11%), and hyponatremia (10%). Tumor biopsies showed decreases in cell-signaling pathways (Bcl-2, Bcl-6, c-Myc), reduced proliferation (Ki67), nuclear localization of XPO1 cargos (p53, PTEN), and increased apoptosis after treatment. Twenty-two (31%) of the 70 evaluable patients had...