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Sample records for successful intra-arterial alteplase

  1. Successful intra-arterial alteplase infusion is a predictor of 12-month limb survival in patients with lower limb arterial occlusion

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    Disini, L. [Interventional Radiology, Norfolk and Norwich University Hospital, Norfolk (United Kingdom)], E-mail: luisa.disini@nnuh.nhs.uk; Wilson, P.; Cockburn, J.F. [Interventional Radiology, Norfolk and Norwich University Hospital, Norfolk (United Kingdom)

    2008-06-15

    Aim: To determine the factors predicting amputation of the affected lower limb 12 months after thrombolysis for acute arterial occlusion. Materials and methods: The clinical endpoints of 39 patients (24 men, 15 women; average age 69 years) 1 year after catheter-directed thrombolysis with alteplase (mean dose 30 mg, mean duration 24 h) for lower limb arterial occlusion (30 native arteries, nine grafts) from January 2001 to June 2005 were assessed. The amputation rate at 12 months was analysed in relation to the thrombolytic outcome, type of vessel occluded, presence or absence of complications, and subsequent requirement for additional surgery on an elective basis using Fischer's exact test. Results: Successful thrombolysis, defined as complete clot dissolution based on angiographic imaging, was achieved in 64.1% of cases (19 native artery, six bypass graft) with a total complication rate of 23% (n = 9). The incidence of major haemorrhage was 7.5% (n = 3, hypotension and haematemesis, groin haematoma and hypotension, haematemesis). No patient had an intracranial bleed. One year after thrombolysis, 28.2% (n = 11) had further surgery (bypass graft, fasciotomy, embolectomy) and the amputation rate was 20.5% (n = 8). Statistical analysis showed that the amputation rate was significantly higher for patients with failed compared with successful thrombolysis (p = 0.02). The amputation rates did not reach statistical significance in relation to native artery or graft occlusion, presence or absence of complications, and whether or not additional surgery was required. Conclusion: Successful thrombolysis was a predictor for limb survival up to 12 months post-thrombolysis regardless of the type of vessel occlusion, presence of complications or additional surgical requirement.

  2. Successful Treatment of Two Cases of Squamous Cell Carcinoma on the Ear with Intra-Arterial Administration of Peplomycin through a Superficial Temporal Artery

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    Takahiro Haga

    2014-09-01

    Full Text Available Cutaneous squamous cell carcinoma (SCC is the second most common non-melanoma skin cancer and tends to develop in sun-exposed cosmetic areas, including the ear. In this report, we describe two cases of SCC on the ear successfully treated with intra-arterial administration of peplomycin through a superficial temporal artery. In addition to this selective chemotherapy, we administered oral tegafur, which achieved complete remission of the tumor. These findings suggest that intra-arterial administration of peplomycin with tegafur is one of the optimal therapies for the treatment of SCC developing on the ear.

  3. Successful daptomycin lock therapy for implantable intra-arterial catheter infection in a patient with liver metastases of colon cancer.

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    Vandenhende, Marie-Anne; Buret, Jennifer; Camou, Fabrice; Morlat, Philippe; Bonnet, Fabrice

    2014-04-01

    There are no data on how to manage implantable intra-arterial catheter (IAC) infections. We report the case of a patient with liver metastases of colon cancer treated by regional intra-arterial chemotherapy who presented a suspected IAC-related infection, in whom daptomycin systemic treatment and lock therapy allowed to cure the IAC infection. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Treatment in patients who are not eligible for intravenous alteplase: MR CLEAN subgroup analysis.

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    Mulder, Maxim Jhl; Berkhemer, Olvert A; Fransen, Puck Ss; Beumer, Debbie; van den Berg, Lucie A; Lingsma, Hester F; Roos, Yvo Bwem; van Oostenbrugge, Robert J; van Zwam, Wim H; Majoie, Charles Blm; van der Lugt, Aad; Dippel, Diederik Wj

    2016-08-01

    Patients with acute ischemic stroke due to intracranial large vessel occlusion benefit from intra-arterial therapy. Uncertainty exists about the effect of intra-arterial therapy in patients with contraindications for treatment with intravenous alteplase treatment. Our aim was to describe the clinical characteristics of this subgroup of patients and whether intra-arterial therapy is as safe and effective as it is after intravenous alteplase treatment. All 500 MR CLEAN patients were included and we distinguished between patients who were and were not treated with intravenous alteplase treatment. We estimated the effect of intra-arterial therapy on the shift on the modified Rankin Scale score with ordinal logistic regression analysis and tested for interaction of intravenous alteplase treatment with intra-arterial therapy on outcome. Furthermore, safety parameters and serious adverse events were analyzed. Fifty-five patients (11%) were not treated with intravenous alteplase treatment, mostly because of prolonged coagulation time tests or recent surgery. These patients were older and more often had atrial fibrillation or other vascular comorbidity. There was no interaction between intravenous alteplase treatment and intervention effect (p = 0.927). Intra-arterial therapy effect size in patients without intravenous alteplase treatment was 2.06 [95% CI: 0.69-6.13] and in patients with intravenous alteplase treatment 1.71 [95% CI: 1.22-2.40]. There were no safety issues. For patients with acute ischemic anterior circulation stroke caused by intracranial large vessel occlusion, who have contraindications for intravenous alteplase, intra-arterial treatment is not less effective or less safe than in patients who receive the treatment after intravenous alteplase. Clinical trial registration-URL: http://www.trialregister.nl. Unique identifier: (NTR)1804.Clinical trial registration-URL: http://www.controlled-trials.com. Unique identifier: ISRCTN10888758. © 2016 World

  5. Treatment in patients who are not eligible for intravenous alteplase: MR CLEAN subgroup analysis

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    Mulder, Maxim Jhl; Berkhemer, Olvert A.; Fransen, Puck Ss; Beumer, Debbie; van den Berg, Lucie A.; Lingsma, Hester F.; Roos, Yvo Bwem; van Oostenbrugge, Robert J.; van Zwam, Wim H.; Majoie, Charles Blm; van der Lugt, Aad; Dippel, Diederik Wj

    2016-01-01

    Patients with acute ischemic stroke due to intracranial large vessel occlusion benefit from intra-arterial therapy. Uncertainty exists about the effect of intra-arterial therapy in patients with contraindications for treatment with intravenous alteplase treatment. Our aim was to describe the

  6. Intra-arterial thrombolysis of digital artery occlusions in a patient with polycythemia vera.

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    Jud, Philipp; Hafner, Franz; Gary, Thomas; Ghanim, Leyla; Lipp, Rainer; Brodmann, Marianne

    2017-01-01

    There are limited therapeutic options for the resolution of digital artery occlusions. Intra-arterial thrombolysis with anticoagulative and thrombolytic drugs successfully restored the blood flow in the affected digital arteries.

  7. Intra-Arterial Thrombolysis for Deep Vein Thrombosis of the Lower Extremity: Case Report

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    Kim, Moo Sang; Roh, Byung Suk [Dept. of Radiology, Wonkwang University School of Medicine, Iksan (Korea, Republic of)

    2011-09-15

    If the appropriate catheterization of the affected vein was not possible because of a narrowed or thrombus-filled venous lumen, successful treatment gets into trouble during catheter directed regional thrombolysis for treatment of deep vein thrombosis. In this situation, intra-arterial thrombolysis can be considered as an alternative treatment, but to the best of our knowledge, only two reports have been described. We present here cases of successful intra-arterial thrombolysis in patients with deep vein thrombosis.

  8. Safe and easy method with little modification in technique is useful for successful internal jugular vein cannulation on the same side even after intra-arterial puncture without using ultrasound guidance in adult cardiac patients

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    Rajesh Thosani

    2016-01-01

    Full Text Available Background: The modification in technique is useful for successful right-sided internal jugular vein (IJV cannulation on the same side even after intra-arterial puncture without using ultrasound guidance in adult patients. Materials and Methods: This study was carried out in total 160 adult patient from American Society of Anesthesiologists Grade II to III patients male (n = 95 and female (n = 65 who underwent cardiac surgery where cannulation was done on right sided by triple lumen catheter (7 French using Seldinger technique. Results: Majority of patients were cannulated successfully by Seldinger technique with single or double attempt except for five patients in which arterial puncture occurred. All five patients were cannulated successfully on the same side with this modified technique without any significant major complications. They were managed by application of blocker at the end of arterial needle puncture without removing it. In our routine practice, we were used to removing this needle and applying compression for few minutes to prevent hematoma formation after an arterial puncture. In this study, cannula was used as a marker or guideline for the relocation of IJV on the same side and recannulation was performed by changing the direction of needle on same side lateral to the previous one and without going towards the same direction to prevent the arterial puncture again. Conclusion: Most simple and useful modified technique for institutes where the complications are most common with trainee doctors and in hospitals where there is no advanced facility like ultrasound-guided cannulation available. By this modification, it will be time saving, very comfortable, and user-friendly technique with high success rate.

  9. Endovascular Hypothermia in Acute Ischemic Stroke: Pilot Study of Selective Intra-Arterial Cold Saline Infusion.

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    Chen, Jian; Liu, Liqiang; Zhang, Hongqi; Geng, Xiaokun; Jiao, Liqun; Li, Guilin; Coutinho, Jonathan M; Ding, Yuchuan; Liebeskind, David S; Ji, Xunming

    2016-07-01

    We conducted a pilot feasibility and safety study of selective brain cooling with intra-arterial infusion of cold saline combined with endovascular reperfusion for acute ischemic stroke. Patients with large-vessel occlusion within 8 hours after symptom onset were enrolled. All patients received intra-arterial recanalization combined with infusion of cold isotonic saline (4°C) in the ischemic territory through the angiographic catheter. Twenty-six patients underwent the procedure, which was technically successful in all. The temperature of ischemic cerebral tissue was decreased by at least 2°C during infusion of the cold solution, and systemic temperature was mildly reduced (maximum 0.3°C). No obvious complications related to intra-arterial hypothermia were observed. Selective brain cooling by intra-arterial infusion of cold saline combined with endovascular recanalization therapy in acute ischemic stroke seems feasible and safe. © 2016 American Heart Association, Inc.

  10. Repeated Intra-Arterial Thrombectomy within 72 Hours in a Patient with a Clear Contraindication for Intravenous Thrombolysis

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    Mona Laible

    2015-01-01

    Full Text Available Introduction. Treating patients with acute ischemic stroke, proximal arterial vessel occlusion, and absolute contraindication for administering intravenous recombinant tissue plasminogen activator (rtPA poses a therapeutic challenge. Intra-arterial thrombectomy constitutes an alternative treatment option. Materials and Methods. We report a case of a 57-year-old patient with concomitant gastric adenocarcinoma, who received three intra-arterial thrombectomies in 72 hours due to repeated occlusion of the left medial cerebral artery (MCA. Findings. Intra-arterial recanalization of the left medial cerebral artery was performed three times with initially good success. However, two days later, the right medial cerebral artery became occluded. Owing to the overall poor prognosis at that time and knowing the wishes of the patient, we decided not to perform another intra-arterial recanalization procedure. Conclusion. To our knowledge, this is the first case illustrating the use of repeated intra-arterial recanalization in early reocclusion of intracranial vessels.

  11. Update on Intra-Arterial Chemotherapy for Retinoblastoma

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    Mario Zanaty

    2014-01-01

    Full Text Available The tools for managing retinoblastoma have been increasing in the past decade. While globe-salvage still relies heavily on intravenous chemotherapy, tumors in advanced stage that failed chemotherapy are now referred for intra-arterial chemotherapy (IAC to avoid enucleation. However, IAC still has many obstacles to overcome. We present an update on the indications, complications, limitations, success, and technical aspects of IAC. Given its safety and high efficacy, it is expected that IAC will replace conventional strategies and will become a first-line option even for tumors that are amenable for other strategies.

  12. Hepatic imaging following intra-arterial embolotherapy.

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    Kallini, Joseph Ralph; Miller, Frank H; Gabr, Ahmed; Salem, Riad; Lewandowski, Robert J

    2016-04-01

    To discuss guidelines and salient imaging findings of solid tumors treated with common intra-arterial procedures used in interventional oncology. A meticulous literature search of PubMed-indexed articles was conducted. Key words included "imaging + embolization," "imaging + TACE," "imaging + radioembolization," "imaging + Y90," "mRECIST," and "EASL." Representative post-treatment cross-sectional images were obtained from past cases in this institution. Intra-arterial therapy (IAT) in interventional oncology includes bland embolization, chemoembolization, and radioembolization. Solid tumors of the liver are the primary focus of these procedures. Cross-sectional CT and/or MR are the main modalities used to image tumors after treatment. Traditional size-based response criteria (WHO and RECIST) alone are of limited utility in determining response to IAT; tumoral necrosis and enhancement must be considered. Specifically for HCC, the EASL and mRECIST guidelines are becoming widely adopted response criteria to assess these factors. DWI, FDG-PET, and CEUS are modalities that play an adjunctive but controversial role. Radiologists must be aware that the different forms of intra-arterial therapy yield characteristic findings on cross-sectional imaging. Knowledge of these findings is integral to accurate assessment of tumor response and progression.

  13. First-line intra-arterial versus intravenous chemotherapy in unilateral sporadic group D retinoblastoma: evidence of better visual outcomes, ocular survival and shorter time to success with intra-arterial delivery from retrospective review of 20 years of treatment.

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    Munier, Francis L; Mosimann, Pascal; Puccinelli, Francesco; Gaillard, Marie-Claire; Stathopoulos, Christina; Houghton, Susan; Bergin, Ciara; Beck-Popovic, Maja

    2017-08-01

    The introduction of intra-arterial chemotherapy (IAC) as salvage treatment has improved the prognosis for eye conservation in group D retinoblastoma. The aim of this study was to compare the outcomes of consecutive patients with advanced unilateral disease treated with either first-line intravenous chemotherapy (IVC) or first-line IAC. This is a retrospective mono-centric comparative review of consecutive patients. Sporadic unilateral retinoblastoma group D cases treated conservatively at Jules-Gonin Eye Hospital and CHUV between 1997 and 2014. From January 1997 to August 2008, IVC, combined with focal treatments, was the primary treatment approach. From September 2008 to October 2014, IAC replaced IVC as first-line therapy. 48 patients met the inclusion criteria, receiving only either IAC or IVC as primary treatment modality. Outcomes of 23 patients treated by IVC were compared with those of 25 treated by IAC; mean follow-up was 105.3 months (range 29.2-218.6) and 41.7 months (range 19.6-89.5), respectively. Treatment duration was significantly shorter in the IAC group (p<0.001). Ten eyes in the IVC group underwent enucleation. Recordable visual acuity of the salvaged eyes was significantly better in the IAC group (0.9 vs 1.4 logarithm of the minimum angle of resolution, p<0.01). No extraocular disease, metastases or long-term systemic complications were observed in either group. The difference in the time frame between treatment groups had an impact on the availability of intravitreal chemotherapy treatment. Despite this, the results reported here imply that eyes treated with first-line IAC will have shorter treatment period, better ocular survival and visual acuity than first-line IVC. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. [Intra-arterial fibrinolysis in vertebrobasilar system].

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    Castaño-Duque, C H; de Juan-Delago, M; Muñoz-Casadevall, J; Martí-Fábregas, J; Franquet, E; Ruscalleda-Nadal, J; Guardia-Mas, E

    The acute vertebrobasilar occlussion is usually a life-treatening disease leading to death or major disability. The treatment with heparin and the selective fibrinolysis no show good results, for this reason the local intra-arterial fibrinolysis appear as the choice treatment in patients with stroke and a agiography with basilar artery occlussion or intracranial vertebral artery occlusion. This tecnique has been proved to be effective treatment for selected patients with acute thromboembolic occlusion of the middle cerebral artery, ophthalmic artery and vertebrobasilar system, reducing the mortality in the vertebrobasilar system from 90% to 40%. We present a 63 years-old man with a vertebrobasilar thrombosis of a probable cardioembolic origen. He was treated with r-TPA local intra-arterial fibrinolysis, to get a recanalization of vertebrobasilar system. In the control TC we see a haemorragic sufusion in the brain stem. The follow-up see a patient with tetraparesis and palsy of the low cranial nerves and normal superior cerebral functions. The local intra-arterial fibrinolysis is the choise treatment in the vertebrobasilar thrombosis because the high morbimortality of this patology and the inefficacy of the others therapeutics. The result depend of many factors as the thrombo location, the neurologic state, the evolution time, the start of treatment, the colateral circulation, the nervous tissue reserve, etc, that have dificult predict the result, but it is best of the natural history of the disease. Is necesary, change the concept of emergency and the attitude front the isquemic cerebral disease at the sanitary leaders, the doctors, and the general population, for dispose of more means to cofront this pathology, which permit diminish the morbimortality and reduce the grade of incapacity.

  15. Trombólise intra-arterial pulmonar no pós-operatório de clipagem de aneurisma cerebral: relato de caso Intra-arterial pulmonary thrombolysis at the postoperative period of brain aneurysm clamping: case report

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    Salomón Soriano Ordinola Rojas

    2008-09-01

    Full Text Available O tromboembolismo pulmonar (TEP é uma importante causa de morbimortalidade nos pacientes submetidos a procedimentos neurocirúrgicos. O objetivo deste estudo foi apresentar um caso de trombólise intra-arterial pulmonar em pós-operatório recente de neurocirurgia. Paciente do sexo masculino, sendo submetido a clipagem de aneurisma de artéria comunicante anterior, apresentou como complicação no sétimo dia de pós-operatório, tromboembolismo pulmonar maciço, apresentando instabilidade hemodinâmica, sendo optado pela trombólise intra-arterial pulmonar com alteplase. Apresentou evolução satisfatória, sem complicações hemorrágicas, recebendo alta hospitalar. O tromboembolismo pulmonar é uma condição com alta morbi-mortalidade no pós-operatório de neurocirurgia, devendo ser a trombólise ser uma alternativa terapêutica nos casos refratários ao tratamento clínico.Pulmonary thromboembolism is a major cause of morbidity and mortality of patients undergoing neurosurgical procedures. The purpose of this study was to present a case of intra-arterial pulmonary thrombolysis in recent neurosurgery postoperative period. Male patient, undergoing neurosurgery, presented as a complication on the seventh day of postoperative massive pulmonary embolism with hemodynamic instability and intraarterial pulmonary thrombolysis with alteplase was indicated. Evolution was satisfactory without bleeding complications and patient was discharged. Pulmonary thromboembolism is a high morbidity and mortality condition at neurosurgical postoperative period and thrombolysis should be an alternative therapy in cases refractory to clinical treatment.

  16. Higher dose intra-arterial milrinone and intra-arterial combined milrinone-nimodipine infusion as a rescue therapy for refractory cerebral vasospasm.

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    Duman, Enes; Karakoç, Fatma; Pinar, H Ulas; Dogan, Rafi; Fırat, Ali; Yıldırım, Erkan

    2017-12-01

    Background Cerebral vasospasm (CV) is a major cause of delayed morbidity and mortality in patients with subarachnoid hemorrhage (SAH). Various cerebral protectants have been tested in patients with aneurysmal SAH. We aimed to research the success rate of treatment of CV via intra-arterial milrinone injection and aggressive pharmacological therapy for refractory CV. Methods A total of 25 consecutive patients who received intra-arterial milrinone and nimodipine treatment for CV following SAH between 2014 and 2017 were included in the study. Patients who underwent surgical clipping were excluded. Refractory vasospasm was defined as patients with CV refractory to therapies requiring ≥3 endovascular interventions. Overall, six patients had refractory CV. Long-term neurological outcome was assessed 6-18 months after SAH using a modified Rankin score and Barthel index. Results The median modified Rankin scores were 1 (min: 0, max: 3) and Barthel index scores were 85 (min: 70, max: 100) From each vasospastic territory maximal 10-16 mg milrinone was given to patients; a maximum of 24 mg milrinone was given to each patient in a session and a maximum of 42 mg milrinone was given to a patient in a day. Both milrinone and nimodipine were given to three patients. There was a large vessel diameter increase after milrinone and nimodipine injections. No patient died due to CV; only one patient had motor dysfunction on the right lower extremity. Conclusion Higher doses of milrinone can be used effectively to control refractory CV. For exceptional patients with refractory CV, high dose intra-arterial nimodipine and milrinone infusion can be used as a rescue therapy.

  17. Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage

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    Bashir, Asma; Andresen, Morten; Bartek, Jiri

    2016-01-01

    Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpo...

  18. Alteplase vs. urokinase for occluded hemodialysis catheter: A randomized trial.

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    Pollo, Viviane; Dionízio, Danielle; Bucuvic, Edwa Maria; Castro, João Henrique; Ponce, Daniela

    2016-07-01

    Introduction Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to the elimination of vascular sites. To compare the efficacy of alteplase vs. urokinase in reestablishing adequate blood flow through completely occluded vascular catheters. Methods In this randomized study, patients with completely occluded tunneled HD catheters received 40 minutes intracatheter dwell with alteplase (1 mg/mL) or urokinase (5000 IU/mL). Primary endpoint was the proportion of patients with occluded catheters achieving post-thrombolytic blood flow of ≥250 mL/min. Safety endpoints included the incidence of hemorrhagic and infectious complications. Findings Eligible adult patients (n = 100) were treated with alteplase (n = 44) or urokinase (n = 56). The two groups were similar in gender (male: 51.8% vs. 56.8%, P = 0.35), age (60 ± 12 vs. 59 ± 13 years, P = 0.71), time on dialysis (678 ± 203 vs. 548 ± 189 days, P = 0.77), diabetes and cardiovascular disease (55.6% vs. 70.4%, P = 0.08 and 17.8% vs. 22.7%, P = 0.38, respectively), jugular vein as main vascular access (54.8% vs. 62.5%, P = 0.57), and time of CVC (278 ± 63 vs. 218 ± 59 days, P = 0.67). Primary success with alteplase and urokinase occurred in 42/44 (95%) vs. 46/56 (82%), P = 0.06. Success was not achieved after the second dose of alteplase and urokinase in 1 and 7 cases, respectively (2% vs. 12%, P = 0.075). Serious adverse effects were not observed in both groups. There was no difference between the two groups in infectious complications (P = 0.94). Discussion Alteplase and urokinase are effective thrombolytic agents for restoring HD catheter patency. Our study has revealed a likely slight superiority of alteplase over urokinase for unblocking central lines, but which has enrolled too few patients to be able to detect a difference of this size. © 2016 International Society for

  19. Alternative treatment for retinoblastoma: Intra-arterial chemotherapy with melphalan.

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    De Freytas, A; Harto-Castaño, M; Barranco, H; Aviño, J; Martinez-Costa, R

    2015-10-01

    A 10-month old infant was referred for the study of a leukocoria of the left eye of one month onset. On examination, a retinoblastoma occupying the macular area was detected. Treatment with intra-arterial chemotherapy (melphalan 6 mg) was performed, with no further intervention required for disease control. Melphalan is an effective chemotherapeutic agent. However, its use is limited by the systemic toxicity that may occur. Intra-arterial chemotherapy allows the selective release of melphalan into the ophthalmic artery, thus limiting its systemic toxicity. This combination of efficiency, safety and accuracy makes it an attractive therapeutic alternative for the management of retinoblastoma. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  20. Local intra-arterial fibrinolysis without arterial occlusion?

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    Schumacher, M.; Yin, L.; Klisch, J. [Section Neuroradiology, Univ. Hospital, Freiburg (Germany); Hetzel, A. [Dept. of Neurology, Univ. Hospital, Freiburg (Germany)

    1999-07-01

    Local intra-arterial fibrinolysis (LIF) is the best choice at present for treatment of acute vessel occlusion in the vertebrobasilar teritory and also, in selected cases, in the carotid territory. In almost all cases angiography demonstrates the site of occlusion exactly and gives information about collateral circulation. Contrary to this common approach, we report five patients with severe acute thromboembolic stroke in whom angiography revealed no occlusion of relevant arteries or their main branches. Under the hypothesis of persisting occlusion of perforating arteries to the brain stem we performed LIF in patients with a clinical basilar artery syndrome. Outcome in all but one of them was good following LIF. The clinical details are described and possible reasons discussed. (orig.)

  1. Spontaneously Resolving Periocular Erythema and Ciliary Madarosis Following Intra-arterial Chemotherapy for Retinoblastoma

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    Marr, Brian; Gobin, Pierre Y.; Dunkel, Ira J.; Brodie, Scott E.; Abramson, David H.

    2010-01-01

    Purpose and Design: To describe an unusual clinical finding seen in children undergoing intra-arterial chemotherapy for retinoblastoma. Materials and Methods: A retrospective review of 69 eyes of 63 patients receiving intra-arterial chemotherapy over a 3-year period. Charts and photographs of 69 consecutive cases were reviewed, and data were collected on patients with clinical evidence of a hyperemic cutaneous periocular abnormality following the procedure. Results: A blanching erythematous and edematous patch was noted in the periocular region in 16% (11 of 69) of the children who received intraarterial chemotherapy. The plaque extended into the region of the supertrochlear and medial marginal artery distribution on the ipsilateral side of the intra-arterial chemotherapy. All patches of erythema spontaneously resolved within 3 months following completion of the intra-arterial chemotherapy. Conclusion: Periocular erythema and swelling is a self-limited clinical finding associated with intra-arterial chemotherapy in a small number of patients. PMID:20844675

  2. The effects of low dose chemotherapy for advanced hepatocellular carcinoma through percutaneously implanted intra-arterial port system

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    Lee, Hyun Seok; Won, Je Hwan; Yoo, Byung Moo; Kim, Young Soo; Cho, Sung Won [Ajou Univ. College of Medicine, Suwon (Korea, Republic of); Park, Dong Won [Suwon Medical Center, Suwon (Korea, Republic of)

    2001-07-01

    To investigate the effects of low-dose FP (5-Fluorouracil[5FU]+Cispatin[CDDP]) therapy through a percutaneously implanted intra-arterial port system in patients with advanced hepatocellular carcinoma (HCC). Twenty-five patients with advanced HCCs and portal vein thrombosis, or large HCCs which were unresectable or for which transarterial chemoembolization was thought to be ineffective, underwent intra-arterial port implantation. The mean maxinal diameter of these tumors was 13.7 (range, 5-21.5) cm, and they were located at the right lobe (n=18), the left lobe(n=3), or throughout the liver (n=4). Tumor thrombosis was detected in the main (n=14), right (n=3) and left portal vein(n=1), the right portal vein and inferior vena cava(n=2), and the inferior vena cava(n=1). The four others patients had no portal vein thrombosis. All intra-arterial port implantations were performed percutaneously in the angiographic ward through the right or left common femoral artery. The port chamber was implanted in the inguinal area and fixed using histoacryl. For intra-arterial chemotherapy, 5-FU (250 mg/day) and CDDP (10 mg/day) were used for five days every four weeks. In order to observe changes in tumor size, follow-up CT scanning was performed every two months. Implantation of the port system was successful in all cases, and patients underwent between one and eleven (mena, 3.9) sessions of chemotherapy. Port-and catheter-related complications, namely dislodgement of the catheter(n=2), wound infection(n=2), migration of the coil(n=1) and catheter occlusion(n=1) occurred in six patients (24%), and chemotherapy-related complications, namely liver failure(n=3) and gastric ulcer bleeding(n=1), in four (16%). A complete response, i. e. the disappearance of tumor thrombosis of the portal vein, was achieved in one patient (4%), a partial response in three (12%), and a minor response in four (16%); the overall response rate was 32% and the mean survival period was 7.6 months. Low-dose FP

  3. Intra-arterial delivery of mesenchymal stem cells

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    Mitsuyoshi Watanabe

    2016-01-01

    Full Text Available While treatments have been developed to combat stroke, such as intravenous recombinant tissue plasminogen activator and endovascular recanalization therapies, their ability to decrease the long-term disability that accompanies stroke is limited. Currently, stem cell research focused on mesenchymal stem cells (MSCs. MSCs are multipotent, nonhematopoietic stem cells found in the stromal fraction of the bone marrow, along with the connective tissue of most organs. MSCs are an increasingly appealing cell source due to the relative ease in which they can be retrieved, developed, and handled in vitro. Despite the fact that numerous paths of stem cell transport to the brain in acute ischemic stroke (AIS exist, the intra-arterial (IA route of stem cell transport is most attractive. This is due to its great potential for clinical translation, especially considering the growing clinical application of endovascular treatment for AIS. Here, we evaluate research examining IA delivery of MSCs to the stroke region. The results of the study revealed the maximum tolerated dose and that the optimal time for administration was 24 h, following cerebral ischemia. It is important that future translational studies are performed to establish IA administration of MSCs as a widely used treatment for AIS.

  4. Development and usefulness of intra-arterial digital subtraction portography

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    Tamaoka, Koichi (Osaka City Univ. (Japan). Faculty of Medicine)

    1988-12-01

    To assess the clinical usefulness of newly developed intra-arterial digital subtraction portography (IA-DSP), IA-DSP findings were retrospectively reviewed in a total of 430 patients with hepatocellular carcinoma (299), metastatic liver tumor (32), liver cirrhosis without hepatocellular carcinoma(32), hepatic hemangioma (14), pancreatic cancer (11), cholangioma (10), cancer of the bile duct (3), or other disorders of the liver and biliary tract (26). The optimum amount of contrast medium was 15 ml, and the optimum speed of injection was 5 ml/sec. In comparing the results of IA-DSP with conventional superior mesenteric arterial portography (SMAP), obtained from 20 patients, IA-DSP was equivalent to SMAP and was equivalent or superior to SMAP in depicting the right branch and left branch of the portal vein, respectively. Side effects (pain and heat sensation) attributable to IA-DSP were mild. The time required for IA-DSP was extremely short. Of 390 IA-DSP images, 310 images (79.5%) were evaluated as good or excellent at the levels of the first- and second-order branches of the portal vein. Image quality of IA-DSP was independent of physical factors, including age, disease, liver function, and portal pressure. In 79 patients undergoing both IA-DSP and percutaneous transhepatic portography (PTP), IA-DSP was capable of identifying the third-order branches in 90%. Unidentified branches were attributable to misregistration artifacts caused by respiration or heart pulsation and to lamina flow of blood from the splenic vein. For 8 patients with PTP-proven abnormality at the second- and third-branches of the portal vein, the abnormality was also depicted on IA-DSP in 7 patients. IA-DSP would replace conventional SMAP, in that it may aid in deciding transarterial embolization, as well as providing information on occlusion, stenosis, and oppression of the hepatic portal branches due to tumors. (N.K.).

  5. Intra-arterial chemotherapy for retinoblastoma: First Indian report

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    Pukhraj Rishi

    2015-01-01

    Full Text Available Aim: To describe treatment outcomes and complications of selective intra-arterial chemotherapy (IAC for retinoblastoma (RB in Indian eyes. Materials and Methods: Single center, retrospective interventional case series of 6 eyes with RB who underwent IAC using Melphalan (3 mg/5 mg/7.5 mg and topetecan (1 mg (n = 4 or melphalan (3 mg/5 mg/7.5 mg alone (n = 2 between December 2013 and June 2014. In all, 17 IAC procedures were performed using selective ophthalmic artery cannulation. Treatment outcomes were evaluated in terms of tumor control, vitreous and subretinal seeds control and globe salvage rates. Results: IAC was employed as primary (n = 1 or secondary (n = 5 modality of treatment. Each eye received mean 3 IAC sessions (median: 3; range: 1-4 sessions. Eyes were classified according to international classification of RB as Group B (n = 1, C (n = 1, D (n = 2 and E (n = 2. Following IAC, complete regression of the main tumor was seen in 3 cases (50%, partial regression in 2 (33%, while 1 case (15% showed no response. Of 4 eyes with subretinal seeds, 1 (25% eye had complete regression while 3 (75% eyes had partial regression. Of 5 eyes with vitreous seeds, 2 (40% eyes had complete regression while 3 (60% eyes had a partial response. Globe salvage was achieved in 5 of 6 eyes (83%. Diffuse choroidal atrophy and vitreous hemorrhage were observed in 1 (17% eye, each. No hematologic toxicity or cerebro-vascular events were observed. Mean follow-up period was 5.5 months (median: 6 months, range: 1-6 months. Conclusion: IAC is an effective therapy for globe preservation in eyes with RB. Larger studies with longer follow-up are required to validate these results.

  6. The use of intravesicular alteplase for thrombolysis in a dog with urinary bladder thrombi.

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    Hooi, Kimberly S; Lemetayer, Julie D

    2017-09-01

    To describe the use of alteplase for intravesicular thrombolysis in a dog after development of urinary tract obstruction from a blood clot in the urinary bladder. A 5.8 kg, 6.5-year-old female neutered Bichon Frise was presented for signs of acute hematuria. A complete blood count (CBC) revealed marked thrombocytopenia and leukopenia, and nonregenerative anemia. Bone marrow aspirate cytology revealed mild hypercellularity, mild megakaryocytic hyperplasia, mildly left-shifted erythroid maturation, and moderately left-shifted myeloid maturation, suggesting ongoing recovery from an acute bone marrow insult. Thrombocytopenia and hematuria resolved concurrently; however, stranguria and oliguria developed acutely. Ultrasonography identified two large presumed thrombi within the urinary bladder. A urinary catheter was placed and 4 doses of 0.5 mg of alteplase diluted in 10 mL of 0.9% sodium chloride were instilled into the bladder with a 4-hour dwell time at 12-hour intervals. Prothombin and activated partial thromboplastin times were monitored during therapy and remained within normal limits. One thrombus was successfully dissolved after 48 hours of therapy and the remaining thrombus was reduced in size and was voided upon removal of the urinary catheter. This report describes the use of alteplase in a dog for thrombolysis of intravesicular thrombi. In patients that develop intravesicular thrombi, intravesical instillation of alteplase can be considered as a method for dissolution of these thrombi. © Veterinary Emergency and Critical Care Society 2017.

  7. Intra-Arterial Prostaglandin E1 Infusion in Patients with Rest Pain: Short-Term Results

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    A. Chatziioannou

    2012-01-01

    Full Text Available Purpose. To present our results after short-term (1 month intra-arterial infusion therapy of PGE1-alprostadil via a port system implanted in the ipsilateral external iliac artery (EIA in patients with severe rest pain. Methods. Ten patients with severe rest pain were included. All patients showed extensive peripheral vascular disease below the knee. The tip of the catheter was introduced via a retrograde puncture in the ipsilateral external iliac artery (EIA. The patients received intraarterial infusion of PGE1, 20 mgr alprostadil daily, via the port catheter for 1 month. Results. Clinical success was evaluated according to subjective grading of pain (group A significant decrease, group B moderate decrease and group C no response. A significant decrease of rest pain was observed in 8 (group A, 80% patients, a moderate decrease in 2 (Group B, 20%, whereas no patients demonstrated any significant response. Both patients of group B had Buergers' disease and continue to smoke during therapy. No peripheral thrombosis or clinical deterioration was noticed. Conclusion. Intraarterial infusion of PGE1 alprostadil on a daily basis, using a port catheter into the ipsilateral EIA, in selected patients with severe rest pain, seems to be very effective, without any serious complications.

  8. Intra-arterial infusion of leptin does not affect blood pressure in salt-loaded rabbits.

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    Mohammad, Mukhallad A; Talafih, Khalid; Mohamad, Mohamad M J; Khabaz, Mohammad Nidal

    2010-08-01

    The aim of this research is to see the effect of intra-arterial infusion of leptin on blood pressure of salt loaded rabbits in vivo. Increased blood pressure was produced in rabbits by giving diets containing 8% sodium chloride for 5 weeks. Leptin in different concentrations was infused intra-arterially into rabbits fed on high salt diets and the response was compared in rabbits fed with low salt diets. High salt diets produced significant increase in blood pressure. In rabbits fed with low salt diet, leptin infused intra-arterially caused an increase in blood pressure while infusion of leptin into rabbits fed with high salt diets does not affect the blood pressure. In conclusion, salt loading to rabbits abolishes the effect ofleptin on cardiovascular system. This may indicate that leptin effect on sympathetic activity is altered by high salt diets in these animals.

  9. Intra-Arterial Nimodipine Infusion for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage

    Science.gov (United States)

    Cho, W-S.; Kang, H-S.; Kim, J.E.; Kwon, O-K.; Oh, C.W.; Son, Y.J.; Kwon, B.J.; Jung, C.; Han, M.H.

    2011-01-01

    Summary This study evaluated the efficacy of intra-arterial nimodipine infusion for symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). Clinical data collected from 42 consecutive patients with symptomatic vasospasm after aSAH were retrospectively reviewed. Forty-two patients underwent 101 sessions of intra-arterial nimodipine infusion. Angiographic response, immediate clinical response, and clinical outcome were evaluated at discharge and six months later. Angiographic improvement was achieved in 82.2% of patients. The immediate clinical improvement rate was 68.3%, while the deterioration rate was 5.0%. A favorable clinical outcome was achieved in 76.2% at discharge and 84.6% six months. Vasospasm-related infarction occurred in 21.4%. There was no drug-related complication. The nimodipine group showed satisfactory outcomes. Nimodipine can be recommended as an effective and safe intra-arterial agent for the treatment of symptomatic vasospasm after aSAH. PMID:21696654

  10. Comparison of noninvasive oscillometric and intra-arterial blood pressure measurements in hyperacute stroke.

    Science.gov (United States)

    Manios, Efstathios; Vemmos, Konstantinos; Tsivgoulis, Georgios; Barlas, Gerasimos; Koroboki, Eleni; Eleni, Koroboki; Spengos, Konstantinos; Zakopoulos, Nikolaos

    2007-06-01

    This study aims to compare automatic oscillometric blood pressure recordings with simultaneous direct intra-arterial blood pressure measurements in hyperacute stroke patients to test the accuracy of oscillometric readings. A total of 51 first-ever stroke patients underwent simultaneous noninvasive automatic oscillometric and intra-arterial blood pressure monitoring within 3 h of ictus. Casual blood pressure was measured in both arms using a standard mercury sphygmomanometer on hospital admission. Patients who received antihypertensive medication during the blood pressure monitoring were excluded. The estimation of systolic blood pressure (SBP) using oscillometric recordings underestimated direct radial artery SBP by 9.7 mmHg (95% confidence interval: 6.5-13.0, Pblood pressure (DBP) recordings were compared with intra-arterial DBP recordings. For SBP and DBP, the Pearson correlation coefficients between noninvasive and intra-arterial recordings were 0.854 and 0.832, respectively. When the study population was stratified according to SBP bands (group A: SBP160 mmHg and SBP180 mmHg), higher mean DeltaSBP (intra-arterial SBP-oscillometric SBP) levels were documented in group C (+19.8 mmHg, 95% confidence intervals: 12.2-27.4) when compared with groups B (+8.5 mmHg, 95% confidence intervals: 2.7-14.5; P=0.025) and A (+5.9 mmHg, 95% confidence intervals: 1.8-9.9; P=0.002). Noninvasive automatic oscillometric BP measurements underestimate direct SBP recordings and overestimate direct DBP readings in acute stroke. The magnitude of the discrepancy between intra-arterial and oscillometric SBP recordings is even more prominent in patients with critically elevated SBP levels.

  11. Preoperative Localization of Mediastinal Parathyroid Adenoma with Intra-arterial Methylene Blue

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    Salman, Rida; Sebaaly, Mikhael G. [American University of Beirut Medical Center, Department of Diagnostic Radiology (Lebanon); Wehbe, Mohammad Rachad; Sfeir, Pierre; Khalife, Mohamad [American University of Beirut Medical Center, Department of General Surgery (Lebanon); Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb [American University of Beirut Medical Center, Department of Diagnostic Radiology (Lebanon)

    2017-06-15

    Ectopic parathyroid is found in 16% of patients with hyperparathyroidism. 2% of ectopic parathyroid adenomas are not accessible to standard cervical excision. In such cases, video-assisted thoracoscopic resection is the recommended definitive treatment. We present a case of mediastinal parathyroid adenoma localized preoperatively by injecting methylene blue within a branch of the internal mammary artery that is supplying the adenoma. Intra-arterial methylene blue injection facilitated visualization and resection of the adenoma. The preoperative intra-arterial infusion of methylene blue appears to be an effective and safe method for localization of ectopic mediastinal parathyroid adenomas and allows rapid identification during thoracoscopic resection.

  12. Preoperative Localization of Mediastinal Parathyroid Adenoma with Intra-arterial Methylene Blue.

    Science.gov (United States)

    Salman, Rida; Sebaaly, Mikhael G; Wehbe, Mohammad Rachad; Sfeir, Pierre; Khalife, Mohamad; Al-Kutoubi, Aghiad

    2017-06-01

    Ectopic parathyroid is found in 16% of patients with hyperparathyroidism. 2% of ectopic parathyroid adenomas are not accessible to standard cervical excision. In such cases, video-assisted thoracoscopic resection is the recommended definitive treatment. We present a case of mediastinal parathyroid adenoma localized preoperatively by injecting methylene blue within a branch of the internal mammary artery that is supplying the adenoma. Intra-arterial methylene blue injection facilitated visualization and resection of the adenoma. The preoperative intra-arterial infusion of methylene blue appears to be an effective and safe method for localization of ectopic mediastinal parathyroid adenomas and allows rapid identification during thoracoscopic resection.

  13. Percutaneous implantation of intra-arterial port system for regional drug infusion: results and complications in 110 cases

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    Won, Je Hwan; Lee, Jong Hyuk [College of Medicine, Ajou University, Seoul (Korea, Republic of); Ko, Kyung Hee; Won, Jong Yoon; Park, Sung Il; Lee, Do Yun [College of Medicine, Yonsei University, Seoul (Korea, Republic of); Kang, Byung Chul [Mokdong Hospital, College of Medicine, Ehwa Womans University, Seoul (Korea, Republic of)

    2000-10-01

    To investigate the feasibility and complications of a percutaneously implantable port system for regional drug infusion. For intra-arterial drug infusion, a 5.8 or 5-F pediatric venous port system was implanted in 110 patients with hepatocellular carcinoma (n=79), liver metastasis (n=16), gallbladder cancer (n=4), stomach cancer (n=3), pancreatic cancer (n=3), Burger's diseases mellitus (n=2), or lymphoma (n=1). All intra-arterial port implantations were performed percutaneously in an angiographic ward through the common femoral artery (n=98), left subclavian artery (n=10), or left superficial femoral artery (n=2). Complications were evaluated during the follow-up period, which ranged from 21 to 530 (mean, 163) days. The technical success rate for percutaneous implantation of the system was 97.3% (107 of 110 patients). The tips of the port catheter were located in the common hepatic artery (n=34), proper hepatic artery (n=49), right hepatic artery quick resulthepatic artery (n=1), descending aorta at T9 level (n=10), left popliteal artery (n=2), right external iliac artery (n=1), left external iliac artery (n=1), or left deep femoral artery (n=1). Complications were encountered in 24 patients (22.4%), namely chamber site infection (n=7), catheter dislodgement (n=7), catheter occlusion (n=3), migration of coil (n=2), disconnection between chamber and catheter (n=1), kinking of catheter (n=1), arterial occlusion (n=1), necrosis of overlying skin (n=1), and leakage around port chamber (n=1). Outcomes of complications included removal of port systems or cessation of therapy in 12 cases (11.2%), correction of catheter location using a guide wire in five (4.7%), thrombolysis with urokinase in three (2.8%), and straightening using a snare in one (0.9%). In three patients, the port system was used without reintervention. Percutaneous implantation of an intra-arterial port system showed a high technical success rate and a low rate of serious complications. The method

  14. Intra-arterial nimodipine for the treatment of vasospasm due to aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2016-12-01

    Full Text Available The cerebral vasospasm is still considered the most devastating complication for the patients with aneurysmal subarachnoid haemorrhage. The aim of this study was to evaluate the efficiency of intra-arterial nimodipine administration in cerebral vasospasm diminutions and outcome of the patients.

  15. Endovascular Hypothermia in Acute Ischemic Stroke: Pilot Study of Selective Intra-Arterial Cold Saline Infusion

    NARCIS (Netherlands)

    Chen, Jian; Liu, Liqiang; Zhang, Hongqi; Geng, Xiaokun; Jiao, Liqun; Li, Guilin; Coutinho, Jonathan M.; Ding, Yuchuan; Liebeskind, David S.; Ji, Xunming

    2016-01-01

    We conducted a pilot feasibility and safety study of selective brain cooling with intra-arterial infusion of cold saline combined with endovascular reperfusion for acute ischemic stroke. Patients with large-vessel occlusion within 8 hours after symptom onset were enrolled. All patients received

  16. Local intra-arterial thrombolysis in a 4-year-old male with vertebrobasilar artery thrombosis

    NARCIS (Netherlands)

    Janmaat, Mirjam; Gravendeel, Joost P; Uyttenboogaart, Maarten; Vroomen, Patrick C; Brouwer, Oebele F; Luijckx, Gert-Jan

    We report the case of a 4-year-old male with vertebrobasilar artery thrombosis for which he was treated with local intra-arterial urokinase 60 hours after onset of symptoms. Initially the patient had dysarthria and dysphagia. Brain magnetic resonance imaging (MRI) in a community hospital showed

  17. In vitro evaluation of the PUCA II intra-arterial LVAD

    NARCIS (Netherlands)

    Vandenberghe, S; Van Loon, JP; Segers, P; Rakhorst, G; Verdonck, P

    The "pulsatile catheter" (PUCA) pump is a minimally invasive intra-arterial left ventricular assist device intended for acute support of critically ill heart failure patients. To assess the hydrodynamic performance of the PUCA II, driven by an Arrow AutoCat IABP driver, we used a (static) mock

  18. [Hepatic intra-arterial infusion of BAK immune cells to treat metastatic liver cancer].

    Science.gov (United States)

    Ebina, Takusaburo

    2011-11-01

    Based on the "living with cancer" concept while maintaining a favorable QOL and avoiding side effects and drug resistance, we have developed a new immune cell treatment called BAK (BRM activated killer) therapy, primarily using CD56+ cells for a case of advanced progressive solid cancer. In the present case, we administered BAK cells by hepatic intra-arterial infusion to a patient who happened to be a surgeon and wished to undergo this therapy. The patient was a 52-year- old male surgeon who underwent surgery for rectal cancer in April 2007. Heavy particle radiotherapy was administered when liver metastases were identified in July 2008. Starting in December 2008, 10 billion BAK cells were administered each month by hepatic intra-arterial infusion via a catheter on a total of six different occasions. The 10 billion autologous lymphocytes were suspended in 200 mL of Ringer's solution and returned to the patient by hepatic intra-arterial infusion over a period of one hour. Interactions between the activated lymphocytes and liver cancer cells increased levels of serum α1AG, an inflammation marker, but these levels normalized following the sixth and final administration. Conventional drip-infusion BAK therapy was administered thereafter. Diagnostic imaging, including PET-CT and PET, confirmed a complete disappearance of liver metastases. This case suggests the effectiveness of hepatic intra-arterial infusion BAK cell therapy in treating liver cancer.

  19. Intra-arterial Ultra-low-Dose CT Angiography of Lower Extremity in Diabetic Patients

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    Özgen, Ali, E-mail: draliozgen@hotmail.com [Yeditepe University Hospital, Department of Radiology (Turkey); Sanioğlu, Soner [Yeditepe University Hospital, Department of Cardiovascular Surgery (Turkey); Bingöl, Uğur Anıl [Yeditepe University Hospital, Department of Plastic Surgery (Turkey)

    2016-08-15

    PurposeTo image lower extremity arteries by CT angiography using a very low-dose intra-arterial contrast medium in patients with high risk of developing contrast-induced nephropathy (CIN).Materials and MethodsThree cases with long-standing diabetes mellitus and signs of lower extremity atherosclerotic disease were evaluated by CT angiography using 0.1 ml/kg of the body weight of contrast medium given via 10-cm-long 4F introducer by puncturing the CFA. Images were evaluated by an interventional radiologist and a cardiovascular surgeon. Density values of the lower extremity arteries were also calculated. Findings in two cases were compared with digital subtraction angiography images performed for percutaneous revascularization. Blood creatinine levels were followed for possible CIN.ResultsIntra-arterial CT angiography images were considered diagnostic in all patients and optimal in one patient. No patient developed CIN after intra-arterial CT angiography, while one patient developed CIN after percutaneous intervention.ConclusionIntra-arterial CT angiography of lower extremity might be performed in selected patients with high risk of developing CIN. Our limited experience suggests that as low as of 0.1 ml/kg of the body weight of contrast medium may result in adequate diagnostic imaging.

  20. Globe Salvage With Intra-Arterial Topotecan-Melphalan Chemotherapy in Children With a Single Eye.

    Science.gov (United States)

    Leal-Leal, Carlos A; Asencio-López, Laura; Higuera-Calleja, Jesús; Bernal-Moreno, Max; Bosch-Canto, Vanessa; Chávez-Pacheco, Juan; Isaac-Otero, Gabriela; Beck-Popovic, Maja

    2016-01-01

    Intra-arterial chemotherapy is a novel therapeutic modality for retinoblastoma patients. Intra-arterial chemotherapy involves the administration of a super-selective drug through the ophthalmic artery, resulting in better ocular penetration and low systemic toxicity. The aim of this report was to evaluate the feasibility of intra-arterial chemotherapy in a large referral center in Mexico City. We included patients with bilateral retinoblastoma, one enucleation, and active disease in the other eye after at least two courses of systemic chemotherapy combined with topical treatments. All patients were treated with three courses of a combination of melphalan 4 mg and topotecan 1 mg. Patients were examined under general anesthesia three weeks after each chemotherapy cycle. From 14 eligible patients, three could not be treated due to inaccessibility of the ophthalmic artery. A complete response was observed in 5/11 patients, three in Stage C according to the International Classification for Intraocular Retinoblastoma, one in Stage D, and one in Stage B. The eyes of three patients were enucleated as a result of active/progressive disease, one in Stage B and two in Stage D. Eye preservation was 55% after a mean follow-up of 171 days (range 21-336). Super-selective intra-arterial chemotherapy is safe and effective for preventing the enucleation of 55% of affected eyes in this group of patients.

  1. Neoadjuvant chemotherapy in locally advanced cervical carcinoma: which is better, intravenous or intra-arterial?

    Directory of Open Access Journals (Sweden)

    Gui T

    2014-11-01

    Full Text Available Ting Gui,* Keng Shen,* Yang Xiang, Lingya Pan, Jinghe Lang, Ming Wu, Huifang Huang, Dongyan Cao, Jiaxin YangDepartment of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China *These authors contributed equally to the work Purpose: The aim of our study is to investigate the differences in therapeutic effects and clinical significance between intravenous systematic chemotherapy and intra-arterial interventional chemotherapy in stage Ib2-IIb cervical carcinomas. Methods: A retrospective analysis was performed on 93 cases of intravenous and 118 cases of intra-arterial neoadjuvant chemotherapy for stage Ib2-IIb cervical carcinomas treated in Peking Union Medical College Hospital from the year 2001 to 2010. Results: After neoadjuvant chemotherapy, the overall response rate was 84.9% versus (vs 88.2% and the operability rate was 77.4% vs 81.4%, for intravenous vs intra-arterial (P>0.05. There were no significant differences in toxicities, surgical duration, perioperative blood loss, and operative complications between these two groups. Postoperative pathological examination revealed a significantly lower parametrial infiltration in the intra-arterial group (12.5% vs 38.1%, P<0.05, while the positive vaginal margin, lymph node metastasis, and intravascular tumor embolus showed no significant differences. The intravenous group and the intra-arterial group had similar recurrence rate (16.0% vs 12.3%, distant metastasis rate (9.1% vs 8.5%, and 5 year survival rate (79.5% vs 84.9%, without significant differences. Conclusion: Neoadjuvant chemotherapy with cisplatin and 5-fluorouracil are safe and effective for patients with locally advanced cervical carcinomas. The intravenous and the intra-arterial approaches present with similar chemotherapy efficacy and clinical outcome. Since it is more simple and economical, the intravenous systematic

  2. Intra-arterial thrombolysis of the middle cerebral artery: an overview; Intraarterielle Lyse der A. cerebri media: ein Ueberblick

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    Struffert, T.; Ruffing, S.; Reith, W. [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie

    2005-05-01

    Until 1996, treatment of strokes consisted exclusively of efforts to prevent recurrence. The development of intravenous and intra-arterial thrombolysis changed the approach to a causal therapy. This article provides an overview of state-of-the-art intravenous and intra-arterial therapeutic concepts and attempts to define the position of the local intra-arterial fibrinolysis approach. (orig.) [German] Bis 1996 bedeutete Schlaganfalltherapie die Verhinderung weitere ischaemischer Insulte. Durch die Entwicklung der intravenoesen und intraarteriellen Lysetherapie mit rt-PA wurde erstmals eine kausale Therapie moeglich. In diesem Beitrag soll der Stand der intravenoesen Lysetherapie kurz dargestellt werden, um dann den Stellenwert der lokalen intraarteriellen Lysetherapie zu bewerten. (orig.)

  3. Efficacy of intra-arterial nimodipine in the treatment of cerebral vasospasm complicating subarachnoid haemorrhage

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    Hui, C. [Department of Diagnostic Imaging, Monash Medical Centre, Clayton, Vic. (Australia)]. E-mail: cathryn.hui@southernhealth.org.au; Lau, K.P. [Department of Diagnostic Imaging, Monash Medical Centre, Clayton, Vic. (Australia)

    2005-09-01

    AIM: To examine the efficacy and safety of nimodipine as an alternative to papaverine for the treatment of cerebral vasospasm following subarachnoid haemorrhage. METHODS: We retrospectively reviewed the procedure reports, anaesthetic records, clinical charts and CT and angiographic images of 9 patients who had received intra-arterial nimodipine; 1 of these patients received both nimodipine and papaverine. The difference in arterial luminal diameter before and after treatment was calculated as a percentage change. RESULTS: The average dose of nimodipine administered per vessel was 3.3 mg. The mean increase in arterial diameter was 66.6% in the vasospastic segment. There was no significant change in blood pressure of any of the subjects during endovascular treatment of vasospasm. CONCLUSION: Intra-arterial nimodipine is effective in improving angiographic vasospasm complicating subarachnoid haemorrhage. Further studies aimed at examining the clinical benefits of nimodipine are warranted, particularly in view of the low risk of adverse side effects of nimopidine when compared with papaverine.

  4. Lymphoscintigraphic evaluation of intra-arterial lymphocyte injection in patients with leg lymphedema

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    Suga, Kazuyoshi; Uchisako, Hiroji; Yoneshiro, Shu; Fujita, Takefumi; Nakanishi, Takashi; Wakamatsu, Takafumi; Esato, Kensuke (Yamaguchi Univ., Ube (Japan). School of Medicine)

    1992-05-01

    Three patients with chronic leg lymphedema were treated by intra-arterial lymphocyte injection and the effect was evaluated by lymphoscintigraphy using intradermal injection of {sup 99m}Tc-HSA. In all of the patients, the followed-up lymphoscintigraphy showed disappearance of the abnormalities of dermal back flow and/or collateral pathways observed before treatment and these findings were thought to indicate reduced load of dermal lymphatics induced by the treatment. These results indicated the usefulness of imaging with intradermal injection of {sup 99m}Tc-HSA for assessing the effect of treatment with intra-arterial lymphocyte injection. In addition, in two patients of them, analysis of lymph flow after treatment was underwent by time-activity curves obtained by lymphoscintigraphy using a load produced by standing. We also described the significance of the load test with standing. (author).

  5. Long-Term, Continuous Intra-Arterial Nimodipine Treatment of Severe Vasospasm After Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Hockel, Konstantin; Diedler, Jennifer; Steiner, Jochen; Birkenhauer, Ulrich; Danz, Sören; Ernemann, Ulrike; Schuhmann, Martin U

    2016-04-01

    Secondary vasospasm and disturbances in cerebrovascular autoregulation are associated with the development of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. An intra-arterial application of nimodipine has been shown to increase the vessel diameter, although this effect is transient. The feasibility of long-term, continuous, intra-arterial nimodipine treatment and its effects on macrovasospasm, autoregulation parameters, and outcome were evaluated in patients with refractory severe macrovasospasm. Ten patients were included with refractory macrovasospasm despite bolus nimodipine application (n = 4) or with primary severe vasospasm (n = 6). The patients were assessed with continuous multimodal neuromonitoring (mean arterial pressure, intraceranial pressure, cerebral perfusion pressure, brain tissue oxygen tension probe), daily transcranial Doppler examinations, and computed tomography angiography/perfusion. Autoregulation indices, the pressure reactivity index, and oxygen reactivity index were calculated. Indwelling microcatheters were placed in the extracranial internal carotid arteries and 0.4 mg nimodipine was continuously infused at 50 mL/hour. The duration of continuous, intra-arterial nimodipine ranged from 9 to 15 days. During treatment intracranial pressure remained stable, transcranial Doppler flow velocity decreased, and brain tissue oxygen tension improved by 37%. Macrovasospasm, as assessed via computed tomography angiography, had improved (n = 5) or disappeared (n = 5) at the end of treatment. Cerebrovascular autoregulation according to the pressure reactivity index and oxygen reactivity index significantly worsened during treatment. All patients showed a favorable outcome (median Glasgow Outcome Scale 5) at 3 months. In well-selected patients with prolonged severe macrovasospasm, continuous intra-arterial nimodipine treatment can be applied as a rescue therapy with relative safety for more than 2 weeks to prevent secondary

  6. Minimal exposure intra-arterial chemotherapy for children with retinoblastoma and 13q syndrome

    Directory of Open Access Journals (Sweden)

    Alexander B Dillon

    2016-01-01

    Full Text Available Two infants with retinoblastoma and 13q syndrome with multiorgan system anomalies were treated with targeted intra-arterial chemotherapy (IAC using one-to-three cycles of melphalan 5 mg to avoid systemic chemotherapeutic side effects. Both patients showed good response, with tumor control and no systemic chemotherapy side effects. Of the treatment modalities currently available, IAC may represent an optimal balance between tumor extermination and adverse drug reactions in this patient population with classically reduced multiorgan reserve.

  7. Intra-arterial intervention chemotherapy for sarcoma and cancerous ulcer via an implanted pump.

    Science.gov (United States)

    Liu, Cheng; Cui, Qiu; Guo, Jun; Li, Dingfeng; Zeng, Yanjun

    2014-04-01

    To observe the efficacy of intra-arterial chemotherapy with subcutaneously implanted pump for soft tissue sarcoma in extremities and cancerous ulcer. 31 patients with ulcerative skin squamous cell carcinoma or sarcoma in extremities who received treatment during the period from July 2003 to November 2011 at our hospital were recruited, including 15 male and 16 female patients, aging between 14 and 83 with average age of 49 years old. 10 patients had tumor in upper extremities and 21 patients in lower extremities. The pathological types of studied cases include 9 cases with skin squamous cell carcinoma, 6 cases with synovial sarcoma, 5 cases with malignant fibrous histiocytoma, 3 cases with liposarcoma, 3 cases with osteosarcoma, 2 cases with malignant melanoma, 2 cases with epidermoid sarcoma, and 1 case with protuberans. The main symptoms of cancerous ulcer were pain, infection and hemorrhage; All the studied patients were administrated with cisplatin and doxorubicin by intra-arterial chemotherapy pump, and the patients with squamous cell carcinoma were additionally applied with bleomycin and patients with malignant melanoma were additionally applied with dacarbazine. The chemotherapy efficiency was observed after at 3 cycles of intra-arterial chemotherapy. The total remission rate of pain (RR) was 87 %, and total remission rate of ulcer cicatrization (RR) was 71 %, with ulcer cicatrizing spontaneously in 9 cases and obvious homeostasis in 5 cases with bleeding ulcers. 19 patients underwent surgery after chemotherapy, in which 16 cases had limb-salvage surgery and 3 cases underwent lower leg amputation after chemotherapy, and 3 patients out of 16 cases had local recurrence (19 %). The subcutaneous intra-arterial targeting chemotherapy could be applied to treat refractory sarcoma and cancerous ulcer in extremities to significantly increase the chemotherapeutic concentration at tumor area so as to effectively constrain the tumor rupture induced main symptoms

  8. Persistent renal enhancement after intra-arterial versus intravenous iodixanol administration

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    Chou, Shinn-Huey; Wang, Zhen J.; Kuo, Jonathan; Cabarrus, Miguel; Fu Yanjun; Aslam, Rizwan; Yee, Judy; Zimmet, Jeffrey M.; Shunk, Kendrick; Elicker, Brett [Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States); Yeh, Benjamin M., E-mail: Benjamin.Yeh@ucsf.edu [Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States)

    2011-11-15

    Purpose: To examine the clinical significance of persistent renal enhancement after iodixanol administration. Methods: We retrospectively studied 166 consecutive patients who underwent non-enhanced abdominopelvic CT within 7 days after receiving intra-arterial (n = 99) or intravenous (n = 67) iodixanol. Renal attenuation was measured for each non-enhanced CT scan. Persistent renal enhancement was defined as CT attenuation >55 Hounsfield units (HU). Contrast-induced nephropathy (CIN) was defined as a rise in serum creatinine >0.5 mg/dL within 5 days after contrast administration. Results: While the intensity and frequency of persistent renal enhancement was higher after intra-arterial (mean CT attenuation of 73.7 HU, seen in 54 of 99 patients, or 55%) than intravenous contrast material administration (51.8 HU, seen in 21 of 67, or 31%, p < 0.005), a multivariate regression model showed that the independent predictors of persistent renal enhancement were a shorter time interval until the subsequent non-enhanced CT (p < 0.001); higher contrast dose (p < 0.001); higher baseline serum creatinine (p < 0.01); and older age (p < 0.05). The route of contrast administration was not a predictor of persistent renal enhancement in this model. Contrast-induced nephropathy was noted in 9 patients who received intra-arterial (9%) versus 3 who received intravenous iodixanol (4%), and was more common in patients with persistent renal enhancement (p < 0.01). Conclusion: Persistent renal enhancement at follow-up non-contrast CT suggests a greater risk for contrast-induced nephropathy, but the increased frequency of striking renal enhancement in patients who received intra-arterial rather than intravenous contrast material also reflects the larger doses of contrast and shorter time to subsequent follow-up CT scanning for such patients.

  9. Superselective intra-arterial fibrinolysis for acute cerebral ischemic infarct : usefulness of diffusion weighted MR imaging

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    Byun, Woo Mok; Lee, Se Jin [Yeungnam Univ. College of Medicine, Kyongnam (Korea, Republic of); Kim, Yong Sun [Kyungpook National Univ. School of Medicine, Taegu (Korea, Republic of); Han, Gun Soo; Bae, Won Kyong [Chunan Hospital, Soonchunhang Univ., Asan (Korea, Republic of)

    1999-12-01

    To evaluate the efficacy of superselective intra-arterial fibrinolysis for acute cerebral stroke and the usefulness of pre-and postfibrinolysis diffusion-weighted MRI (DWI). In 41 patients with acute ischemic stroke whose treatment involved intra-arterial fibrinolysis, the occlusion site, degree of recanalization, and clinical results were compared. In 12 patients, diffusion weighted MRI was performed before fibrinolysis, and eight of these also underwent diffusion-weighted MRI after fibrinolysis. Using diffusion-weighted MRI, neurological outcomes were compared with signal intensity ratio (SIR, or the average signal intensity within the region of interest divided by that in the contralateral, nonischemic, homologous region). Twenty patients showed complete recanalization, nine partial recanalization, and in twelve there was no recanalization. Fourteen patients (34%) improved neurologically. No relationship existed between occlusion sites, degree of recanalization, and clinical outcome. Among 12 patients who underwent DWI before fibrinolysis, complete recanalization was noted in eight. Neurological improvement was seen in four patients with low SIR(<1.55), while in four with high SIR(>1.7), neurological outcome was poor despite complete recanalization. Although superselective intra-arterial fibrinolysis for acute cerebral stroke is a good therapeutic method for recanalization, the clinical outcome can be disappointing. We therefore suggest that in cases of acute cerebral ischemic infaret, SIR-as seen on DWI-might be useful for predicting the benefits of recanalization. In such cases, further investigation of the use of DWI prior to fibrinolysis is therefore needed.

  10. Evaluation of the effects of intra-arterial sugammadex and dexmedetomidine: an experimental study

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    Volkan Hancı

    Full Text Available Abstract Background: Intra-arterial injection of medications may cause acute and severe ischemia and result in morbidity and mortality. There is no information in the literature evaluating the arterial endothelial effects of sugammadex and dexmedetomidine. The hypothesis of our study is that sugammadex and dexmedetomidine will cause histological changes in arterial endothelial structure when administered intra-arterially. Methods: Rabbits were randomly divided into 4 groups. Group Control (n = 7; no intervention performed. Group Catheter (n = 7; a cannula inserted in the central artery of the ear, no medication was administered. Group Sugammadex (n = 7; rabbits were given 4 mg/kg sugammadex into the central artery of the ear, and Group Dexmedetomidine (n = 7; rabbits were given 1 µg/kg dexmedetomidine into the central artery of the ear. After 72 h, the ears were amputated and histologically investigated. Results: There was no significant difference found between the control and catheter groups in histological scores. The endothelial damage, elastic membrane and elastic fiber damage, smooth muscle hypertrophy and connective tissue increase scores in the dexmedetomidine and sugammadex groups were significantly higher than both the control and the catheter groups (p < 0.05. There was no significant difference found between the dexmedetomidine and sugammadex groups in histological scores. Conclusion: Administration of sugammadex and dexmedetomidine to rabbits by intra-arterial routes caused histological arterial damage. To understand the histological changes caused by sugammadex and dexmedetomidine more clearly, more experimental research is needed.

  11. Intra-arterial thrombolysis for acute ischemic stroke: Our institutional experience

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    R V Narayana

    2012-01-01

    Full Text Available Introduction: The standard treatment for acute ischemic stroke is intravenous (IV rtPA for patients who can reach the hospital within 3 to 4.5 h. There are case reports, where IA thrombolysis has helped patients in case an IV thrombolysis has failed. We report 14 cases of acute ischemic stroke treated by intra-arterial (IA thrombolysis. Materials and Methods: We have retrospectively analyzed 14 cases of acute ischemic stroke treated at our department between December 2008 and October 2011 by intra-arterial thrombolysis. The patients with suspected large vessel occlusion (11 patients and patients not responding to IV rtPA (3 patients were considered for the IA thrombolysis. Results: We achieved complete recanalization (TIMI 3 in 11 patients. One patient had a bleed following the procedure but recovered well during the hospital stay. All the patients were followed up to 90 days. Majority of them have good functional outcome. Conclusions: Our study suggests that intra-arterial thrombolysis is a feasible option in the subgroup of patients with large vessel occlusion. However, there is a need for a randomized multi-centric study to support our results.

  12. Risk factors for severe neutropenia following intra-arterial chemotherapy for intra-ocular retinoblastoma.

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    Ira J Dunkel

    Full Text Available PURPOSE: Intra-arterial chemotherapy is a promising strategy for intra-ocular retinoblastoma. Neutropenia is the most commonly encountered systemic toxicity and in this study we aimed to determine the risk factors associated with the development of severe (≥ grade 3 neutropenia. METHODS: Retrospective review of 187 evaluable cycles of melphalan-containing intra-arterial chemotherapy from the first three cycles administered to 106 patients with intra-ocular retinoblastoma from May 2006 to June 2011. Cycles were considered to be evaluable if (1 blood count results were available in the 7 to 14 days post-treatment interval and (2 concurrent intravenous chemotherapy was not administered. Toxicity was assessed via the Common Terminology Criteria for Adverse Events version 4.0. RESULTS: 54 cycles (29% were associated with grade 3 (n = 43 or grade 4 (n = 11 neutropenia. Multivariate stepwise logistic regression revealed that a higher melphalan dose (>0.40 mg/kg was significantly associated with severe neutropenia during all 3 cycles (odds ratio during cycle one 4.11, 95% confidence interval 1.33-12.73, p = 0.01, but the addition of topotecan and/or carboplatin were not. Prior treatment with systemic chemotherapy was not associated with severe neutropenia risk in any analysis. CONCLUSIONS: Intra-arterial melphalan-based chemotherapy can cause severe neutropenia, especially when a dose of greater than 0.40 mg/kg is administered. Further study with a larger sample may be warranted.

  13. Intra-arterial drug and light delivery for photodynamic therapy using Visudyne®: implication for atherosclerotic plaque treatment

    OpenAIRE

    Manish Jain; Matthieu Zellweger; Aurélien Frobert; Jérémy Valentin; Hubert van den Bergh; Georges Wagnières; Stéphane Cook; Marie-Noelle Giraud

    2016-01-01

    Photodynamic therapy (PDT), which is based on the activation of photosensitizers with light, can be used to reduce plaque burden. We hypothesized that intra-arterial photosensitizer administration and photo-activation will lead to high and rapid accumulation within the plaque with reduced systemic adverse effects. Thus this intra-arterial PDT would be expected to have less side effects and due to the short time involved would be compatible with percutaneous coronary interventions. Aim: We cha...

  14. Effectiveness of sublingual nitroglycerin before puncture compared with conventional intra-arterial nitroglycerin in transradial procedures: a randomized trial

    Energy Technology Data Exchange (ETDEWEB)

    Turan, Burak, E-mail: drburakturan@gmail.com; Daşlı, Tolga; Erkol, Ayhan; Erden, İsmail

    2015-10-15

    Aim: Sublingual (SL) nitroglycerin administered before radial artery puncture can improve cannulation success and decrease the incidence of radial artery spasm (RAS) compared with intra-arterial (IA) nitroglycerin in transradial procedures. Methods: Patients undergoing diagnostic transradial angiography were randomized to IA (200 mcg) or SL (400 mcg) nitroglycerin. Primary endpoints were puncture time and puncture attempts. Secondary endpoint was the incidence of RAS. Results: Total of 101 participants (mean age 60 ± 11 years, 53% male) were randomized (51 in IA and 50 in SL groups). Puncture time (50 [36–75] vs 50 [35–90] sec), puncture attempts (1.18 ± 0.48 vs 1.20 ± 0.49), multiple punctures (13.7 vs 16.0%) and RAS (19.6 vs 24.0%) were not statistically different between IA vs SL groups respectively. A composite endpoint of all adverse events related to transradial angiography (multiple punctures, RAS, access site crossover, hypotension/bradycardia associated with nitroglycerin and radial artery occlusion) was very similar in IA vs SL groups (39 vs 40%, respectively). However puncture time was significantly longer with SL nitroglycerin in patients < 1.65 m height (47 [36–66] vs 63 [41–110] sec, p = 0.042). Multiple punctures seemed higher with SL nitroglycerin in patients with diabetes (0 vs 30%, p = 0.028) or in patients < 1.65 m height (7.4 vs 25%, p = 0.085). Likewise, RAS with SL nitroglycerin seemed more frequent in smokers compared to IA nitroglycerin (0 vs 27%, p = 0.089). Conclusions: SL nitroglycerin was not different from IA nitroglycerin in terms of efficiency and safety in overall study population. However it may be inferior to IA nitroglycerin in certain subgroups (shorter individuals, diabetics and smokers). - Highlights: • Improvement in radial artery puncture time and success with subcutaneous nitrate was reported. • Giving nitrate sublingually may have vasodilation along entire length of radial artery and may prevent RAS

  15. Is local intra-arterial fibrinolysis contraindicated in elderly patients with cerebral artery occlusion?

    Energy Technology Data Exchange (ETDEWEB)

    Schumacher, M.; Kraft, S.; Siekmann, R. [Freiburg Univ. (Germany). Abt. Radiologie

    1998-12-01

    Local intra-arterial fibrinolysis (LIF) is an effective treatment for selected patients in acute thromboembolic occlusion of the middle cerebral artery, vertebrobasilar system or ophthalmic artery. However, the risk/benefit ratio of thrombolysis in patient subgroups requires classification. Advanced age has been regarded as a prognostic factor for poor clinical outcome. We report our experience with LIF in seven patients with a mean age of 79 years (range 76-83 years) who represented thromboembolic occlusion of the basilar, middle cerebral or pericallosal arteries. We discuss why advanced age need not contraindicate LIF. (orig.) With 3 figs., 20 refs.

  16. Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy for gingival carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Mukai, Y.; Hata, M.; Koike, I.; Inoue, T. [Yokohama City University Graduate School of Medicine, Department of Radiology, Kanazawa-ku, Yokohama, Kanagawa (Japan); Mitsudo, K.; Koizumi, T.; Oguri, S.; Kioi, M.; Tohnai, I. [Yokohama City University Graduate School of Medicine, Department of Oral and Maxillofacial Surgery, Yokohama, Kanagawa (Japan); Omura, M. [Shonankamakura General Hospital, Department of Radiation Oncology, Kamakura, Kanagawa (Japan)

    2014-02-15

    The aim of this study was to review the efficacy and toxicity of radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy in the treatment of gingival carcinoma. In all, 34 patients (21 men and 13 women) with squamous cell carcinoma of the gingiva underwent radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy. Treatment consisted of daily external irradiation and concurrent retrograde superselective intra-arterial infusion with cisplatin and docetaxel. A median total dose of 60 Gy in 30 fractions was delivered to tumors. Of the 34 patients, 29 (85 %) achieved a complete response (CR) and 5 had residual tumors. Of the 29 patients with a CR, 2 had local recurrences and 1 had distant metastasis 1-15 months after treatment. Twenty-six of the 36 patients had survived at a median follow-up time of 36 months (range 12-79 months); 4 died of cancer and 4 died of non-cancer-related causes. At both 3 and 5 years after treatment, the overall survival rates were 79 % and the cause-specific survival rates were 85 %. Osteoradionecrosis of the mandibular bone only developed in 1 patient after treatment. Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy was effective and safe in the treatment of gingival carcinoma. This treatment may be a promising curative and organ-preserving treatment option for gingival carcinoma. (orig.) [German] Das Ziel dieser Studie war die Ueberpruefung der Effizienz und Toxizitaet einer Strahlenbehandlung des Gingivakarzinoms mit gleichzeitiger retrograder, superselektiver intraarterieller Chemotherapie. Insgesamt 34 Patienten (21 Maenner und 13 Frauen) mit Zahnfleischplattenzellkarzinom erhielten eine Strahlenbehandlung mit gleichzeitiger retrograder, superselektiver intraarterieller Chemotherapie. Die Behandlung umfasste eine taegliche externe Bestrahlung mit gleichzeitiger retrograder, superselektiver intraarterieller Infusion von Cisplatin und

  17. [Hepatic intra-arterial infusion of biological response modifier (BRM)-activated killer immune lymphocytes to treat liver cancer].

    Science.gov (United States)

    Ebina, Takusaburo

    2012-11-01

    To enable "life with cancer" while maintaining quality of life(QOL) and freedom from adverse effects, we have devised biological response modifier (BRM)-activated killer (BAK) therapy, a new immune cell therapy using CD56-positive lymphocytes designed to treat advanced solid cancers. This treatment is yet to be applied to liver cancer, because BAK cells administered by intravenous infusion are unlikely to reach lesions via the complex vascular and lymphatic systems. Here, we report a case in which the patient, a surgeon, requested that we attempt to deliver BAK cells to cancer lesions in the liver via hepatic intra-arterial infusion. In 2005, with the patient's consent, we injected autologous lymphocytes intra-arterially into the liver using a catheter and confirmed the absence of adverse effects. In December 2008, we began injecting BAK cells intra-arterially into the liver of the patient, a male physician aged 52 years at the time, after identifying liver metastases following surgery for rectal cancer. We injected 10 billion cells intra-arterially into the liver via a catheter once a month for 6 months, and then undertook conventional BAK therapy by monthly intravenous infusion. Based on images obtained by positron emission tomography-computed tomography, BAK therapy led to complete remission and disappearance of the liver metastases. This case highlights the effectiveness of hepatic intra-arterial infusion of BAK cells in cases of liver cancer.

  18. MRI evaluation of frequent complications after intra-arterial transplantation of mesenchymal stem cells in rats

    Science.gov (United States)

    Namestnikova, D.; Gubskiy, I.; Gabashvili, A.; Sukhinich, K.; Melnikov, P.; Vishnevskiy, D.; Soloveva, A.; Vitushev, E.; Chekhonin, V.; Gubsky, L.; Yarygin, K.

    2017-08-01

    Intra-arterial transplantation of mesenchymal stem cells (MSCs) is an effective delivery route for treatment of ischemic brain injury. Despite significant therapeutic effects and targeted cells delivery to the brain infraction, serious adverse events such as cerebral embolism have been reported and may restrict potential clinical applications of this method. In current study, we evaluate potential complications of intra-arterial MSCs administration and determine the optimum parameters for cell transplantation. We injected SPIO-labeled human MSCs via internal carotid artery with different infusion parameters and cell dose in intact rats and in rats with the middle cerebral occlusion stroke model. Cerebrovascular complications and labeled cells were visualized in vivo using MRI. We have shown that the incidence of cerebral embolic events depends on such parameters as cell dose, infusion rate and maintenance of blood flow in the internal carotid artery (ICA). Optimal parameters were considered to be 5×105 hMSC in 1 ml of PBS by syringe pump with velocity 100 μ/min and maintenance of blood flow in the ICA. Obtained data should be considered before planning experiments in rats and, potentially, can help in planning clinical trials in stroke patients.

  19. Role of selective intra-arterial embolization in benign liver tumors.

    Science.gov (United States)

    Ferrer Puchol, M D; Parra Casado, C La; Cervera Araez, A; Sala López, R; Esteban Hernández, E; Cremades Mira, A; Ramiro Gandia, R

    To present cases of symptomatic benign liver tumors diagnosed and treated with intra-arterial embolization before surgery. We present the cases of 7 patients diagnosed with symptomatic benign liver tumors that required treatment: 1 focal nodular hyperplasia, 2 giant cavernous hemangiomas, 1 hepatic adenomatosis, and 3 hepatic adenomas. Once the feeding arteries were identified, tumors were embolized with polyvinyl alcohol particles (500μm-700μm) and then the feeding artery was plugged with coils if there was an arterial pedicle to ensure the total vascular exclusion of the tumor. The surgical intervention took place 4 to 7 days after embolization. All 7 patients were women (age range, 23-74 years); presurgical intra-arterial embolization was done in 6. In 1 patient with adenomatosis, embolization was done to control intraparenchymal hepatic hemorrhage. In the 6 patients who underwent surgery, the tumor was completely excised and no intraoperative bleeding events or postoperative complications occurred. Provided there is a consensus among the multidisciplinary team, embolization is a useful option in the perioperative management of giant and/or symptomatic benign liver tumors. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Prognosis of patients with stage IIIb-IVa squamous cell carcinoma of the cervix following intra-arterial neoadjuvant chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Fujiwaki, R.; Maede, Y.; Ohnishi, Y.; Watanabe, Y.; Hata, K.; Miyazaki, K. [Shimane Medical Univ., Izumo (Japan)

    1999-06-01

    The aim was to determine the long-term prognosis in patients with stage IIIb-IVa squamous cell carcinoma of the cervix who were treated with intra-arterial neoadjuvant chemotherapy (NAC), and to analyze factors related to prognostic value. The authors assessed the disease-free survival of 21 patients with FIGO stage IIIb-IVa squamous cell carcinoma of the cervix treated with intra-arterial NAC followed by irradiation therapy. Before chemotherapy, five factors (age, clinical stage, histologic type, parametrial involvement and serum level of SCC) were evaluated for their correlation with disease-free survival. Univariate Cox's proportional hazard model also demonstrated that age was a significant prognostic factor as a continuous variable. Intra-arterial NAC thus appeared to be effective in treating older patients with stage IIIb-IVa squamous cell carcinoma of the cervix.

  1. Effect of Intra-Arterial and Intravenous Nimodipine Therapy of Cerebral Vasospasm After Subarachnoid Hemorrhage on Cerebrovascular Reactivity and Oxygenation.

    Science.gov (United States)

    Hockel, Konstantin; Diedler, Jennifer; Steiner, Jochen; Birkenhauer, Ulrich; Ernemann, Ulrike; Schuhmann, Martin U

    2017-05-01

    For the treatment and prevention of delayed cerebral ischemia after subarachnoid hemorrhage, the vasodilating agent nimodipine (NDP) is widely employed. This study investigates the effect of NDP on cerebrovascular autoregulation, assessed by pressure reactivity index (PRx), and brain tissue oxygenation (pbrO2) when given continuously intravenously as an intra-arterial bolus or during continuous intra-arterial therapy. Computerized continuous neuromonitoring data (intracranial pressure, mean arterial pressure, cerebral perfusion pressure [CPP], pbrO2, PRx) of 105 patients with aneurysmal SAH were retrospectively evaluated. The effect of NDP on all parameters was compared when applied intra-arterially for the treatment of severe macrovasospasm leading to perfusion deficits as either bolus treatment (n = 111 in 37 patients) or continuous infusion (n = 20 patients) to patients without or with only mild macrovasospasm who received either intravenous NDP or no NDP at all. Compared with patients without treatment, the intravenous application of NDP was associated with a significantly higher PRx. Autoregulation was strongly and long lastingly affected (high PRx) in continuous intra-arterial NDP infusion, accompanied by a sustained improvement of pbrO2. Intra-arterial bolus NDP application resulted as well in a significant increase of pbrO2 and PRx; the induced effect, however, was transient and subsided within 6 hours. Intracranial pressure, mean arterial pressure, and CPP were not affected during the monitoring period. The pharmacologically induced alteration of the cerebrovascular autoregulation by NDP correlates with changes of pbrO2 and indicates a beneficial effect on cerebral blood flow if CPP is maintained. This effect is limited to a few hours after bolus treatment and milder for intravenous compared with intra-arterial application. Copyright © 2017. Published by Elsevier Inc.

  2. Intra-Arterial Administration of Multipotent Mesenchymal Stromal Cells Promotes Functional Recovery of the Brain After Traumatic Brain Injury.

    Science.gov (United States)

    Silachev, D N; Plotnikov, E Yu; Babenko, V A; Danilina, T I; Zorov, L D; Pevzner, I B; Zorov, D B; Sukhikh, G T

    2015-08-01

    We compared the efficiency of delivery of multipotent mesenchymal stem cells into the brain after their intravenous and intra-arterial injection. Analysis of the therapeutic effects of cells after experimental traumatic brain injury revealed improvement of the neurological status and motor functions of the damaged hemisphere, the effect being more pronounced after intraarterial injection of cells. Intra-arterial administration was followed by rapid infiltration of the cells into the brain tissue and their number considerably surpassed that after intravenous infusion. Targeted delivery of multipotent mesenchymal stromal cells into the brain after their injection into the carotid arteries substantially potentiated their neuroprotective effects in traumatic brain injury.

  3. Intentional intra-arterial injection of midazolam in a patient with status epilepticus in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Muhammad Asghar Ali

    2017-01-01

    Full Text Available Fundamental medical care includes intravenous (IV access which provides prompt resuscitation and reliable delivery of analgesics, antibiotics, and vasoactive medication. Difficult access populations, especially in critical area, continue to challenge providers to consider and utilize alternative means to provide IV access. Potential options under such circumstances include intramuscular, intraosseous, and intratracheal drug administration, but in extreme cases where no other options are available, intra-arterial route might be considered. We present a case where midazolam was intentionally injected intra-arterially to abort seizure activity in a patient with status epilepticus in the Intensive Care Unit.

  4. Intra-arterial continuous infusion of cis-diamminedichloroplatinum in untreated head and neck cancer patients.

    Science.gov (United States)

    Frustaci, S; Barzan, L; Tumolo, S; Comoretto, R; Quadu, G; Galligioni, E; Lorenzini, M; Crivellari, D; Caruso, G; Piccinin, G

    1986-03-15

    The authors report the final analysis of a prospective phase I-II study in 53 previously untreated patients with squamous cell carcinoma (48 patients) and other histologic classifications (5 patients) of the head and neck region. Treatment consisted of cisplatin 10 mg infused intra-arterially in a 12-hour period, twice a day for 5 to 10 days via an external infusion pump. After a rest period of 5 to 7 days treatment could be restarted, with the same schedule, until a maximal total dose of 400 mg or toxicity. Patients who received at least 200 mg of cisplatin were considered evaluable for response. In 3 patients catheterization was not performed because of technical difficulties, in 9 treatment was stopped before reaching the total dose of 200 mg, (because of catheter-related toxicity in 7 patients, drug toxicity in 1, and both toxicities in 1); therefore, the patients evaluable for response, drug toxicity and catheter toxicity were 41, 43, and 49 respectively. Overall, 8 patients (19.5%) obtained a complete response (CR) and 20 (48.8%) a partial response (PR) with an objective response rate (RR) of 68.3%. Eleven patients obtained a minor response (MR), whereas only 2 (4.8%) developed a progressive disease (PD). The figures, limited only to squamous cell carcinoma of oral cavity and oropharinx (33 patients), are as follows: CR 8 (24.2%), PR 17 (51.5%), MR 7 (21.2%), and PD 1 (3.0%) for an objective RR of 75.7%. No grade IV and only 5 grade III toxicity were observed; whereas the most frequent grade I and II drug-related toxicities were anemia, transient renal impairment, and thrombocytopenia. Catheter-related toxicity accounted for five central nervous system complications (three transient motor weaknesses, one hemiparesis, one embolism) and six local problems (one coagulation of the catheter, one displacement, and four local extravasations). Intra-arterial cisplatin is, in our experience, an effective treatment and further trials employing cisplatin combination

  5. Is intra arterial nimodipine really beneficial in vasospasm following aneurysmal subarachnoid haemorrhage?

    Science.gov (United States)

    Goel, Rajeev; Aggarwal, Ashish; Salunke, Pravin; Kumar, Ajay; Chhabra, Rajesh

    2016-08-01

    Object/Background: Vasospasm is a common cause of mortality and morbidity following rupture of intracranial aneurysm. Hemodynamic therapy instituted in these patients in the past has been replaced by direct manipulation of the spastic vessels by angioplasty and intra-arterial infusion of vasodilators. However, no case control studies exist proving its superiority. The purpose of our study was to compare the efficacy of intra-arterial nimodipine (IAN) to that of hemodynamic therapy in patients with vasospasm following aSAH. Fifty-three patients who developed vasospasm following aSAH were included in the study. IAN was instilled in addition to hemodynamic therapy in 39 patients and 14 patients (who refused to give consent for IAN) were continued on hemodynamic therapy alone and served as controls. The response to IAN was studied on angiogram. The clinical response was assessed in both the groups at regular intervals. IAN was repeated if necessary. The outcome (GOS) at discharge and at 3 months after discharge was compared. Thirty-six (92.3%) out of 39 patients showed immediate angiographic reversal of vasospasm.28 of them showed clinical response, of which only 11 had lasting response. 11(28.2%) of 39 patients who received IAN had a good outcome at discharge and 23(58.9%) had a favourable outcome at 3 months follow up. In those who received hemodynamic therapy alone, 4 out of 14(28.6%) patients had a good outcome at discharge and 8 (57.1%) a favourable outcome at 3 months. Angiographic reversal of vasospasm is seen in majority of the patients following IAN. However, this does not necessarily translate into a long lasting clinical response. The final outcome in patients who received hemodynamic therapy is comparable to those who received additional IAN. IAN does not appear to provide a major added advantage over the conventional hemodynamic therapy.

  6. Quantitative evaluation of leg lymphedema by MR imaging. Estimation of therapeutic effect by intra-arterial injection of lymphocytes

    Energy Technology Data Exchange (ETDEWEB)

    Makimoto, Yumi; Harada, Masafumi; Matsuzaki, Kenji; Hayashi, Yoshinori; Nishitani, Hiromu; Yoshizumi, Masanori; Yoshida, Osamu; Katoh, Itsuo [Tokushima Univ. (Japan). School of Medicine

    1994-12-01

    The purpose of this study was to obtain characteristic findings of lymphedema and reactions after intra-arterial lymphocytes injection therapy by MRI and to evaluate quantitatively effect of intra-arterial lymphocytes injection. Five patients were treated by several intra-arterial lymphocytes injections. We measured T{sub 2} value on edematous tissue using triple echo sequence and shot TI IR (STIR) images to assess the extent of lymphedema. MRI was measured before and after each intra-arterial lymphocytes injection. Mean T{sub 2} and standard deviation (SD) of T{sub 2} distribution were obtained from T{sub 2}-calculated images. Characteristic findings of lymphedema were the thickening of subcutaneous, meshed pattern of fluid, thickening of skin, and fluid on the fascia. After therapy, thickness of subcutaneous tissue and meshed pattern were greatly decreased, but thickening of skin and fluid on the fascia still remained. Mean T{sub 2} and SD of T{sub 2} in edematous tissue were much higher than those of normal tissue. Both of them decreased extremely after therapy on improved cases but did not change on less effective cases. STIR could differentiate water from adipose tissue and clearly indicated the distribution of water. Mean T{sub 2} and SD of T{sub 2} distribution were useful to indicate evaluation of lymphedema and assessment of therapy. (author).

  7. High-dose superselective intra-arterial cisplatin and concomitant radiation (RADPLAT) for advanced head and neck cancer.

    NARCIS (Netherlands)

    Balm, A.J.M.; Rasch, C.R.; Schornagel, J.H.; Hilgers, F.J.M.; Keus, R.B.; Schultze Kool, L.J.; Ackerstaff, A.H.; Busschers, W.; Tan, I.B.

    2004-01-01

    BACKGROUND: The purpose of this study was to study the effect of intensive targeted chemoradiation in a group of patients with head and neck cancer with stage IV inoperable disease. METHODS: We examined 79 patients with inoperable stage IV head and neck cancer receiving intra-arterial infusion of

  8. Laryngeal preservation in advanced piriform sinus squamous cell carcinomas using superselective intra-arterial chemoradiation therapy with three agents.

    Science.gov (United States)

    Furusaka, Tohru; Matsuda, Akira; Tanaka, Akane; Matsuda, Hiroshi; Ikeda, Minoru

    2013-03-01

    Superselective intra-arterial chemotherapy, which enables local control and laryngeal preservation, is a safe and useful therapy for preservation of nutrition, speech, and swallowing functions. To improve the laryngeal preservation rate in patients with hypopharyngeal piriform sinus squamous cell carcinoma by superselective intra-arterial chemotherapy. Fifty-seven patients received anterograde intra-arterial administration of docetaxel and cisplatin, and two courses of intravenous continuous infusion of 5-fluorouracil as a neoadjuvant chemotherapy over 120 h starting on day 2. Concurrent chemoradiotherapy was administered from the third course to control the primary cancer. Remaining neck lymph node metastases were treated in principle by neck dissection. The 5- and 10-year survival rates were 68.5% and 58.9%, respectively. The 5-year rates by the T classification were 96.0% (10-year rate, 88.6%) in T3, 48.1% in T4a, and 16.7% in T4b. The 5- and 10-year laryngeal preservation rates were 65.2% and 62.4%, respectively. The 5-year rates by the T classification were 92.4% (10-year rate, 87.6%) in T3, 36.2% in T4a, and 16.7% in T4b. No irreversible side effects, complications, or sequelae were reported. Superselective intra-arterial chemotherapy showed superior laryngeal preservation as well as high survival rates, particularly in T3, and was considered a useful therapy.

  9. Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke

    NARCIS (Netherlands)

    Treurniet, K.M.; Yoo, A.J.; Berkhemer, O.A.; Lingsma, H.F.; Boers, A.M.; Fransen, P.S.; Beumer, D.; Berg, L.A. van den; Sprengers, M.E.; Jenniskens, S.F.M.; Lycklama, A.N.G.J.; Walderveen, M.A. van; Bot, J.C.; Beenen, L.F.; Berg, R. van den; Zwam, W.H. van; Lugt, A. van der; Oostenbrugge, R.J. van; Dippel, D.W.; Roos, Y.B.; Marquering, H.A.; Majoie, C.B.; Dijk, E.J. van; Vries, J. de

    2016-01-01

    BACKGROUND AND PURPOSE: A high clot burden score (CBS) is associated with favorable outcome after intravenous treatment for acute ischemic stroke. The added benefit of intra-arterial treatment might be less in these patients. The aim of this exploratory post hoc analysis was to assess the relation

  10. Hepatic Intra-arterial Delivery of a "Trojan-horses" Gene Therapy: A Pilot Study on Rabbit VX2 Hepatic Tumor Model.

    Science.gov (United States)

    Pellerin, Olivier; Amara, Ikram; Sapoval, Marc; Méachi, Tchao; Déan, Carole; Beaune, Philippe; de Waziers, Isabelle

    2017-10-31

    Gene-directed enzyme prodrug therapy (GDEPT) is a "Trojan-horses" suicide gene therapy that consists of tumor-targeted gene delivery (vectorized by mesenchymal stem cells MSCs) encoding an enzyme that converts a harmless prodrug into cytotoxic metabolites in situ. Then, cytotoxic metabolites passively diffuse in the neighboring tumor cells and kill them (bystander effect). The goal of our study was to assess the feasibility and efficacy of intra-arterial administration of MSCs transduced with an optimized gene (MSC-CYP2B6TM-RED) followed by intravenous administration of cyclophosphamide (CPA) into the VX2 rabbit liver tumor. Nine rabbits with a VX2 liver tumor were randomly assigned into three groups: Control group A (one rabbit) free of any treatment; Control group B (two rabbits) receiving intravenous injection of cyclophosphamide at day 3 and CPA at day 14; and Group C (six rabbits) receiving the GDEPT treatment, consisting of successive intra-arterial injection of transduced-MSCs at days 0 (n = 6) and 11 (n = 3), followed by injection of CPA at days 3 (n = 6) and 14 (n = 3). The tumor response was assessed by ultrasound scan every 7 days and histopathological analysis at sacrifice (D25). There was a significant difference in the tumor volume between control groups (A + B) and group C at D7: 38/19 cm3 (p = 0.024); D11: 51/20 cm3 (p = 0.024), and D25: 121/37 cm3 (p = 0.048). Tumor necrosis was significantly greater and metastatic spread was lower for rabbits who received GDEPT (78% of total tumor surface) than for control animals (A + B) (22% of total tumor surface (p = 0.006). Intra-arterial delivery of transduced-MSCs is feasible and, after CPA injection, resulted in 78% tumor necrosis (p = 0.006) and less metastasis in a VX2 liver tumor model.

  11. Influential factors of clinical outcome of local intra-arterial thrombolysis using urokinase in patients with hyperacute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Song, Jae Min; Yoon, Woong; Kim, Jae Kyu; Seo, Jeong Jin; Heo, Sook Hee; Park, Jin Gyoon; Jeong, Yoon Yeon; Kang, Heoung Keun [Chonam University Hospital, Kwangju (Korea, Republic of)

    2002-10-01

    To evaluate the clinical outcome and other relevant factors in cases where local intra-arterial thrombolysis (LIT) is used for the treatment of hyperacute ischemic stroke. Forty-eight hyperacute ischemic stroke patients were treated by LIT, using urokinase, within six hours of ictus, and for evaluation of their neurological status, the national institutes of health stroke scale (NIHSS) score was used. Angiography recanalization was classified according to Mori recanalization grades. Three months after LIT, the outcome was assessed by clinical examination using the modified rankin scale (good outcome: RS=0-3; poor outcome: RS=4-6). In all patients, the findings of pre- and post- LIT CT, and angiography, as well as neurological status and hemorrhagic complications, were also analysed. Thirty-three patients had occlusions of the middle cerebral artery (MCA), and 15, of the internal carotid artery (ICA). The NIHSS score averaged 16.9 at the onset of therapy and 13.5 at 24 hours later. Successful recanalization (Mori grade 3,4) was achieved in 28 (58.3%) of 48 patients, but in 20 (41.7%) the attempt failed. Twenty-two (45.8%) of the 48 patients had a good outcome, but in (54.2%) the outcome was poor. Thirteen (40.6%) of 32 patients with MCA occlusions and 13 (81.2%) of 16 with ICA occlusions had a poor outcome. Eight patients (16.7%) died. Overall, hemorrhages occured in 20 (41.7%) of 48 patients, with symptomatic hemorrhage in ten. Five (50%) of these ten died. LIT using urokinase for hyperacute ischemic stroke is feasible; patients with MCA occlusions had better outcomes than those with ICA occlusions. Hemorrhagic complications of LIT were frequent, and in cases of symptomatic hemorrhage a fatal outcome may be expected.

  12. External beam radiation plus concurrent intra-arterial chemotherapy with low dose cisplatin for muscle invasive bladder cancer

    Directory of Open Access Journals (Sweden)

    Yoshihiro Matsumoto

    2015-01-01

    Full Text Available Introduction: We aimed to investigate the long-term outcome of trimodality therapy consisting of transurethral resection of bladder tumor, external beam radiation therapy, and concurrent intra-arterial low dose cisplatin for patients with muscle invasive bladder cancer. Materials and Methods: We retrospectively reviewed the medical records of 37 consecutive patients (28 men and 9 women who underwent trimodality therapy for T2-3N0M0 bladder cancer at our hospital between 1996 and 2011. A total of 60Gy of external beam radiation therapy was administered. A daily low dose of cisplatin was administered intra-arterially through a subcutaneously placed reservoir on the days of radiation therapy. Complete response was defined as no residual cancer in transurethral resection specimens and negative cytology. When a complete response could not be achieved, patients underwent additional intra-arterial chemotherapy. Results: Five-year cause specific, disease free, and overall survival rates were 86.4%, 69.7%, and 69.6%, respectively, with a mean follow-up period of 56.5 ± 6.1 months. Five-year cause specific survivals of the complete response group after the trimodality therapy, the complete response group after additional intra-arterial chemotherapy and the non-complete response group were 100% (n = 21, 85.9% (n = 9 and 0% (n = 7, respectively. Five-year overall survivals of the complete response group after the trimodality therapy, the complete response group after additional intra-arterial chemotherapy and the non-complete response group were 82.8%, 85.3% and 0%, respectively. Conclusions: This trimodality therapy for muscle invasive bladder cancer could achieve favorable survival rates with bladder preservation and minimal adverse events. This trimodality therapy can be one of the useful treatment options.

  13. Early Anticipation of Candidacy for Intra-Arterial Reperfusion Therapy Based on Baseline Clinical Stroke Subtypes: Comparison with Multiparametric MRI Taken within 4.5 Hours from Stroke Onset

    Directory of Open Access Journals (Sweden)

    Yong-Won Kim

    2013-06-01

    Full Text Available Background: The decision to proceed with intra-arterial (IA reperfusion therapy is typically made late in the course of in-hospital treatment for acute ischemic stroke. Early anticipation of candidacy for IA reperfusion therapy based on clinical stroke subtypes would be useful for guiding stroke management. The aim of this study was to investigate the relationship between the clinical Oxfordshire Community Stroke Project (OCSP classification and MRI results taken within a 4.5-hour time window from stroke onset, with the hypothesis that the persistence of major arterial occlusion and extended ischemic penumbra, key criteria for proceeding with IA reperfusion therapy, would be distinctive between the clinical stroke subtypes. Methods: A total of 161 patients with acute ischemic stroke in the anterior circulation were included in this study. All patients were treated with intravenous alteplase, and MRI scans were performed following alteplase initiation. Prior to treatment, the patients were categorized, based on the OCSP classification scheme, as having total anterior circulation infarcts (TACI, partial anterior circulation infarcts (PACI, or lacunar infarcts (LACI. The relationship between OCSP subtypes, MRI parameters, and clinical variables was analyzed. Results: Overall, 40/161 patients (24.8% were candidates for IA rescue reperfusion. With respect to the classification, 30/69 TACI (43.5%, 6/33 PACI (18.2%, and 4/59 LACI patients (6.8% were candidates (p DWI-PWI ≥2 (Alberta Stroke Program Early CT Score were classified as TACI patients (p DWI-PWI ≥3, 74.3% were classified as TACI patients (p Conclusions: In this study, patients classified as having clinical TACI were significantly more likely to be candidates for IA rescue reperfusion. Additionally, they incurred a higher incidence of persistent major arterial occlusion and had a penumbra area that was significantly larger than normal. Therefore, clinical OCSP can be used as an

  14. Intra-arterial cisplatin and concurrent radiation for invasive bladder cancer

    Energy Technology Data Exchange (ETDEWEB)

    Miyanaga, Naoto; Ohtani, Mikinobu; Noguchi, Ryosuke (Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine) (and others)

    1991-10-01

    Fifteen patients with invasive bladder cancer were treated with selective intra-arterial cisplatin and external beam radiotherapy (30.6 Gy over 3 weeks) prior to a planned cystectomy. Cisplatin, in total 200 mg, was administered via bilateral internal iliac artery infusion during the course of radiotherapy. Seven patients were evaluated for local response. Partial response (PR) was revealed in 4, and minor response (MR) in 3. Ten patients received total cystectomy, and pathological effects by the criteria adipted by Japanese Urological Association and The Japanese Society of Pathology, were as follows: Ef.3 in 1 case, Ef.2 in 6. Ef.1b in 1 and Ef.1a in 2. Down staging was observed in 8 patients from the clinical to the pathological stage. Thirteen patients are alive for 21 months. Two patients have died (1 lung infarction, 1 pancreatic cancer). Though nausea and sciatica-like pain were observed in some cases, there were no severe systemic side effects such as bone marrow suppression and renal toxicity. From these results it is concluded that this therapeutic modality could be effective in the preoperative work-up of candidates for total cystectomy, and also that it could be useful in the treatment of patients in whom total cystectomy is contraindicated. (author).

  15. [Intra-arterial fibrinolysis in acute thrombosis of the basilar artery].

    Science.gov (United States)

    Solaz, J; Martínez-Rodrigo, J; Lonjedo, E; Poyatos, C; Vega, M; Palmero, J

    1998-12-01

    Ischemia in the territory of the basilar artery presents with a variable clinical picture of hemiparesia-tetraplegia, progressive deterioration of level of consciousness, irregular respiration and apnea leading to irreversible coma and death in between 75% and 86% of cases. The usual treatment is supportive. We present the case of a 49 year old woman with acute thrombosis of the basilar artery and a progressive course leading to coma. No bulbar lesions were seen on the CT scan done in the Emergency Department. Thrombosis of the basilar artery and permeable bilateral carotid systems were shown on arteriography. There were no contra-indications to fibrinolysis. Following local fibrinolytic treatment with urokinase the patient had full recovery from her neurological disorder and no sequelae. The basilar artery remained permeable six months later. Emergency treatment with cerebral intra-arterial fibrinolysis within the first six hours, in a case of neurological deficit progressing in the basilar artery territory, with persistence of brain-stem functions and no signs of decerebration (provided there are no contra-indications to fibrinolysis and the initial cerebral CT scan shows no bulbar lesions) may save the patient's life, with total or partial recovery of brain-stem function.

  16. Local intra-arterial thrombolysis in the carotid territory: does recanalization depend on the thromboembolus type?

    Energy Technology Data Exchange (ETDEWEB)

    Urbach, H.; Wilhelm, K.; Flacke, S.; Schild, H.H. [Department of Radiology/Neuroradiology, University of Bonn, Sigmund Freud Strasse 25, 53105 Bonn (Germany); Hartmann, A.; Pohl, C.; Klockgether, T. [Department of Neurology, University of Bonn, Sigmund Freud Strasse 25, 53105 Bonn (Germany); Omran, H. [Department of Cardiology, University of Bonn, Sigmund Freud Strasse 25, 53105 Bonn (Germany)

    2002-08-01

    Little is known about whether recanalization of carotid territory occlusions by local intra-arterial thrombolysis (LIT) depends on the type of the occluding thromboembolus. We retrospectively analysed the records of 62 patients with thromboembolic occlusions of the intracranial internal carotid artery (ICA) bifurcation or the middle cerebral artery who were undergoing LIT with urokinase within 6 h of symptom onset. We determined the influence of thromboembolus type (according to the TOAST criteria), thromboembolus location, leptomeningeal collaterals, time interval from onset of symptoms to onset of thrombolysis, and patient's age on recanalization. The thromboembolus type was atherosclerotic in six patients, cardioembolic in 29, of other determined etiology in four, and of undetermined etiology in 23 patients. Thirty-three (53%) thromboembolic occlusions were recanalized. The thromboembolus location but not the TOAST stroke type nor other parameters affected recanalization. In the TOAST group of patients with cardioembolic occlusions recanalization occurred significantly less frequently when transoesophageal echocardiography showed cardiac thrombus. The present study underlines the thromboembolus location as being the most important parameter affecting recanalization. The fact that thromboembolic occlusions originating from cardiac thrombi had a lower likelihood of being resolved by thrombolysis indicates the thromboembolus type as another parameter affecting recanalization. (orig.)

  17. Facial nerve paralysis after super-selective intra-arterial chemotherapy for oral cancer.

    Science.gov (United States)

    Sugiyama, S; Iwai, T; Oguri, S; Koizumi, T; Mitsudo, K; Tohnai, I

    2017-06-01

    Facial nerve paralysis (FNP) after super-selective intra-arterial chemotherapy (SSIAC) is a relatively rare local side effect of SSIAC to the maxillary artery (MA) or the middle meningeal artery (MMA). The incidence and prognosis of FNP after SSIAC in 381 patients with oral cancer (133 with catheterization of the MA, 248 without) was investigated retrospectively. Only three patients (two male and one female) had FNP, for an incidence of 0.8%. All patients with FNP had undergone catheterization of the MA, and the incidence of FNP in this group was 2.3% (3/133). One of the three patients with FNP had paralysis of the third branch of the trigeminal nerve. FNP occurred a mean of 8.7 days (range 5-11 days) after initial SSIAC, and the mean total dose of cisplatin was 55.8mg (range 42.5-67.2mg) and of docetaxel was 25.4mg (range 17.0-33.6mg). FNP resolved completely a mean of 12.7 months (range 6-19 months) after onset. Because the administration of anticancer agents via the MA or MMA carries a risk of FNP, this information will be useful when obtaining informed consent from patients before treatment. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Effectiveness of intra-arterial anesthesia for uterine fibroid embolization using dilute lidocaine

    Energy Technology Data Exchange (ETDEWEB)

    Zhan, Songhua; Li, Yi; Wang, Guoliang; Han, Hongjie; Yang, Zhenyan [Tongji Hospital of Tongji University, Department of Radiology, Shanghai (China)

    2005-08-01

    A modified protocol of uterine fibroid embolization (UFE) is proposed for alleviating the postinterventional pain. This randomized and double-blinded clinical trial is to evaluate the effectiveness of intra-arterial infusion of dilute lidocaine for postinterventional pain relief in UFE. Forty-six patients who underwent UFE were randomly grouped equally. In the test group, after the poly(vinyl alcohol) embolization was complete, a dilute lidocaine solution with 40 mg in 6.0 ml, 3.0 ml for each side or 4.0 and 2.0 ml for two sides, was given through the catheter. In the control group, the patients received 6.0 ml of saline solution as a placebo. A simple pain degree classification method for patient self-evaluation was developed. A questionnaire was completed by each patient to record the degree of pain during five periods; these were during the procedure, the first 12 h, the second 12 h, between 24 and 48 h, and between 48 and 72 h. The numbers of patients with the same degree of pain in the five time segments from the two groups were statistically compared. Compared with the control group, the patients in the test group experienced less pain within 48 h after the procedure (p<0.01). The results suggest that this improved UFE protocol is a simple approach to prevent the acute postinterventional pain of UFE. (orig.)

  19. Reassessing the Role of Intra-Arterial Drug Delivery for Glioblastoma Multiforme Treatment

    Directory of Open Access Journals (Sweden)

    Jason A. Ellis

    2015-01-01

    Full Text Available Effective treatment for glioblastoma (GBM will likely require targeted delivery of several specific pharmacological agents simultaneously. Intra-arterial (IA delivery is one technique for targeting the tumor site with multiple agents. Although IA chemotherapy for glioblastoma (GBM has been attempted since the 1950s, the predicted benefits remain unproven in clinical practice. This review focuses on innovative approaches to IA drug delivery in treating GBM. Guided by novel in vitro and in vivo optical measurements, newer pharmacokinetic models promise to better define the complex relationship between background cerebral blood flow and drug injection parameters. Advanced optical technologies and tracers, unique nanoparticles designs, new cellular targets, and rational drug formulations are continuously modifying the therapeutic landscape for GBM. Personalized treatment approaches are emerging; however, such tailored approaches will largely depend on effective drug delivery techniques and on the ability to simultaneously deliver multidrug regimens. These new paradigms for tumor-selective drug delivery herald dramatic improvements in the effectiveness of IA chemotherapy for GBM. Therefore, within this context of so-called “precision medicine,” the role of IA delivery for GBM is thoroughly reassessed.

  20. Clinical Variables Correlated with Numbers of Intra-arterial Nimodipine Infusion in Patients with Medically Refractory Cerebral Vasospasm

    OpenAIRE

    Kim, Sang-Young; Kim, Ki-Hong; Cho, Jae-Hoon; Kim, Young-Don

    2015-01-01

    Objective The objective of this study was to find out the clinical variables correlated with repeated intra-arterial (IA) nimodipine infusions in patients with medically refractory cerebral vasospasm (CV) following subarachnoid hemorrhage (SAH). Materials and Methods During the 36 months between January 2011 and December 2013, 275 patients were treated at our institute for SAH due to a ruptured intracranial aneurysm. Of the 275 patients, 26 patients (9.5%) met the inclusion criteria. For each...

  1. Comparison between oscillometric and intra-arterial blood pressure measurements in ill preterm and full-term neonates.

    Science.gov (United States)

    Lalan, Shwetal; Blowey, Douglas

    2014-01-01

    Conflicting data exist regarding the accuracy of the oscillometric method of blood pressure (BP) measurement in neonates. There is limited data regarding intra-arterial BP trends in neonates. We aimed to determine the accuracy of oscillometric BP measurements and to evaluate the BP distributions in ill neonates. A total of 1492 simultaneously obtained oscillometric and intra-arterial (umbilical arterial [UAC] or radial arterial) BP measurements were used for comparisons and 125,580 intra-arterial BP readings were used to the evaluate BP distribution. There was a statistically significant difference (P oscillometric and radial mean arterial BP (MAP) 4.8 ± 9.8 mm Hg, systolic BP 8.3 ± 11.6 mm Hg, diastolic BP 4.3 ± 9.3 mm Hg and between the oscillometric and UAC systolic BP 5.2 ± 11.9 mm Hg and diastolic BP -0.8 ± 10.4 mm Hg. The MAP increased with increases in weight (35.3 ± 4.92 mm Hg/kg), post-menstrual age (-0.29 ± 1.41 mm Hg/week) and advanced gestational age at birth (13.12 ± 0.90 mm Hg/week). Oscillometric BP measurements are not equivalent to the intra-arterial (UAC or radial arterial) BP in ill neonates. The BP increases with increase in weight, gestational age at birth, and post-menstrual age in ill neonates. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  2. Intra-Arterial Drug and Light Delivery for Photodynamic Therapy Using Visudyne?: Implication for Atherosclerotic Plaque Treatment

    OpenAIRE

    Jain, Manish; Zellweger, Matthieu; Frobert, Aurélien; Valentin, Jérémy; Bergh, Hubert van den; Wagnières, Georges; Cook, Stéphane; Giraud, Marie-Noelle

    2016-01-01

    Photodynamic therapy (PDT), which is based on the activation of photosensitizers with light, can be used to reduce plaque burden. We hypothesized that intra-arterial photosensitizer administration and photo-activation will lead to high and rapid accumulation within the plaque with reduced systemic adverse effects. Thus, this “intra-arterial” PDT would be expected to have less side effects and due to the short time involved would be compatible with percutaneous coronary interventions. Aim: ...

  3. Comparison of classification methods for voxel-based prediction of acute ischemic stroke outcome following intra-arterial intervention

    Science.gov (United States)

    Winder, Anthony J.; Siemonsen, Susanne; Flottmann, Fabian; Fiehler, Jens; Forkert, Nils D.

    2017-03-01

    Voxel-based tissue outcome prediction in acute ischemic stroke patients is highly relevant for both clinical routine and research. Previous research has shown that features extracted from baseline multi-parametric MRI datasets have a high predictive value and can be used for the training of classifiers, which can generate tissue outcome predictions for both intravenous and conservative treatments. However, with the recent advent and popularization of intra-arterial thrombectomy treatment, novel research specifically addressing the utility of predictive classi- fiers for thrombectomy intervention is necessary for a holistic understanding of current stroke treatment options. The aim of this work was to develop three clinically viable tissue outcome prediction models using approximate nearest-neighbor, generalized linear model, and random decision forest approaches and to evaluate the accuracy of predicting tissue outcome after intra-arterial treatment. Therefore, the three machine learning models were trained, evaluated, and compared using datasets of 42 acute ischemic stroke patients treated with intra-arterial thrombectomy. Classifier training utilized eight voxel-based features extracted from baseline MRI datasets and five global features. Evaluation of classifier-based predictions was performed via comparison to the known tissue outcome, which was determined in follow-up imaging, using the Dice coefficient and leave-on-patient-out cross validation. The random decision forest prediction model led to the best tissue outcome predictions with a mean Dice coefficient of 0.37. The approximate nearest-neighbor and generalized linear model performed equally suboptimally with average Dice coefficients of 0.28 and 0.27 respectively, suggesting that both non-linearity and machine learning are desirable properties of a classifier well-suited to the intra-arterial tissue outcome prediction problem.

  4. Intra-Arterially Delivered Mesenchymal Stem Cells Are Not Detected in the Brain Parenchyma in an Alzheimer's Disease Mouse Model.

    Directory of Open Access Journals (Sweden)

    Na Kyung Lee

    Full Text Available Mesenchymal stem cells (MSCs have a promising role as a therapeutic agent for neurodegenerative diseases such as Alzheimer's disease (AD. Prior studies suggested that intra-arterially administered MSCs are engrafted into the brain in stroke or traumatic brain injury (TBI animal models. However, a controversial standpoint exists in terms of the integrity of the blood brain barrier (BBB in transgenic AD mice. The primary goal of this study was to explore the feasibility of delivering human umbilical cord-blood derived mesenchymal stem cells (hUCB-MSCs into the brains of non-transgenic WT (C3H/C57 and transgenic AD (APP/PS1 mice through the intra-arterial (IA route. Through two experiments, mice were infused with hUCB-MSCs via the right internal carotid artery and were sacrificed at two different time points: 6 hours (experiment 1 or 5 minutes (experiment 2 after infusion. In both experiments, no cells were detected in the brain parenchyma while MSCs were detected in the cerebrovasculature in experiment 2. The results from this study highlight that intra-arterial delivery of MSCs is not the most favorable route to be implemented as a potential therapeutic approach for AD.

  5. Re-irradiation using proton beam therapy combined with weekly intra-arterial chemotherapy for recurrent oral cancer.

    Science.gov (United States)

    Hayashi, Yuichiro; Nakamura, Tatsuya; Mitsudo, Kenji; Kimura, Kanako; Yamaguchi, Hisashi; Ono, Takashi; Azami, Yusuke; Takayama, Kanako; Hirose, Katsumi; Yabuuchi, Tomonori; Suzuki, Motohisa; Hatayama, Yoshiomi; Kikuchi, Yasuhiro; Wada, Hitoshi; Fuwa, Nobukazu; Hareyama, Masato; Tohnai, Iwai

    2017-10-01

    The purpose of this study was to clarify the efficacy and toxicities of re-irradiation using proton beam therapy combined with weekly intra-arterial chemotherapy for recurrent oral cancer. Between October 2009 and July 2014, 34 patients who had recurrent oral cancer were treated by proton beam therapy combined with intra-arterial infusion chemotherapy at the Southern Tohoku Proton Therapy Center, Japan. For all patients, the median follow-up was 25 months (range, 3-77 months). After treatment, 22 patients (65%) achieved a complete response, and 12 patients (35%) achieved a partial response at the primary tumor site. One-year and 2-year overall survival (OS) rates were 62% and 42%, respectively. One-year and 2-year LC rates were 77% and 60%, respectively. No treatment-related deaths were observed during the treatment and follow-up periods. Re-irradiation using proton beam therapy combined with weekly intra-arterial chemotherapy improved OS and local control rates compared with other treatment modalities and could become a new treatment modality for patients with recurrent oral cancer. © 2016 John Wiley & Sons Australia, Ltd.

  6. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke

    NARCIS (Netherlands)

    Hacke, Werner; Kaste, Markku; Bluhmki, Erich; Brozman, Miroslav; Dávalos, Antoni; Guidetti, Donata; Larrue, Vincent; Lees, Kennedy R.; Medeghri, Zakaria; Machnig, Thomas; Schneider, Dietmar; von Kummer, Rüdiger; Wahlgren, Nils; Toni, Danilo; Hacke, W.; Dávalos, A.; Kaste, M.; von Kummer, R.; Larrue, V.; Toni, D.; Wahlgren, N.; Lees, K. R.; Heiss, W. D.; Lesaffre, E.; Orgogozo, J. M.; Bastianello, S.; Wardlaw, J. M.; Peyrieux, J.-C.; Sauce, C.; Medeghri, Z.; Mazenc, R.; Machnig, T.; Bluhmki, E.; Aichner, F.; Alf, C.; Baumhackl, U.; Brainin, M.; Eggers, C.; Gruber, F.; Ladurner, G.; Niederkorn, K.; Noistering, G.; Willeit, J.; Vanhooren, G.; Blecic, S.; Bruneel, B.; Caekebeke, J.; Laloux, P.; Simons, P. J.; Thijs, V.; Bar, M.; Dvorakova, H.; Vaclavik, D.; Boysen, G.; Andersen, G.; Iversen, H. K.; Traberg-Kristensen, B.; Marttila, R.; Sivenius, J.; Trouillas, P.; Amarenco, P.; Bouillat, J.; Ducrocq, X.; Giroud, M.; Jaillard, A.; Larrieu, J.-M.; Leys, D.; Magne, C.; Mahagne, M.-H.; Milhaud, D.; Sablot, D.; Saudeau, D.; Busse, O.; Berrouschot, J.; Faiss, J. H.; Glahn, J.; Görtler, M.; Grau, A.; Grond, M.; Haberl, R.; Hamann, G.; Hennerici, M.; Koch, H.; Krauseneck, P.; Marx, J.; Meves, S.; Meyding-Lamadé, U.; Ringleb, P.; Schneider, D.; Schwarz, A.; Sobesky, J.; Urban, P.; Karageorgiou, K.; Komnos, A.; Csányi, A.; Csiba, L.; Valikovics, A.; Agnelli, G.; Billo, G.; Bovi, P.; Comi, G.; Gigli, G.; Guidetti, D.; Inzitari, D.; Marcello, N.; Marini, C.; Orlandi, G.; Pratesi, M.; Rasura, M.; Semplicini, A.; Serrati, C.; Tassinari, T.; Brouwers, P. J. A. M.; Stam, J.; Naess, H.; Indredavik, B.; Kloster, R.; Czlonkowska, A.; Kuczyńska-Zardzewialy, A.; Nyka, W.; Opala, G.; Romanowicz, S.; Cunha, L.; Correia, C.; Cruz, V.; Pinho e Melo, T.; Brozman, M.; Dvorak, M.; Garay, R.; Krastev, G.; Kurca, E.; Alvarez-Sabin, J.; Chamorro, A.; del Mar Freijo Guerrero, M.; Herrero, J. A. E.; Gil-Peralta, A.; Leira, R.; Martí-Vilalta, J. L.; Masjuan Vallejo, J.; Millán, M.; Molina, C.; Mostacero, E.; Segura, T.; Serena, J.; Vivancos Mora, J.; Danielsson, E.; Cederin, B.; von Zweigberg, A. N.; Wahlgren, N.-G.; Welin, L.; Lyrer, P.; Bogousslavsky, J.; Hungerbühler, H.-J.; Weder, B.; Ford, G. A.; Jenkinson, D.; MacLeod, M. J.; MacWalter, R. S.; Markus, H. S.; Muir, K. W.; Sharma, A. K.; Walters, M. R.; Warburton, E. A.

    2008-01-01

    BACKGROUND: Intravenous thrombolysis with alteplase is the only approved treatment for acute ischemic stroke, but its efficacy and safety when administered more than 3 hours after the onset of symptoms have not been established. We tested the efficacy and safety of alteplase administered between 3

  7. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke

    DEFF Research Database (Denmark)

    Hacke, Werner; Kaste, Markku; Bluhmki, Erich

    2008-01-01

    BACKGROUND: Intravenous thrombolysis with alteplase is the only approved treatment for acute ischemic stroke, but its efficacy and safety when administered more than 3 hours after the onset of symptoms have not been established. We tested the efficacy and safety of alteplase administered between ...

  8. [Intra-arterial regional chemotherapy and intensive loco-regional radiotherapy in the treatment of locally advanced cancer of the breast].

    Science.gov (United States)

    Nicolato, A

    1990-09-01

    A multimodal treatment combining intra-arterial chemotherapy and intensive loco-regional radiotherapy was administered to 55 patients with locally advanced breast cancer. Adjuvant polychemotherapy followed, and eventually endocrino-therapy. Combined intra-arterial chemotherapy and intensive radiotherapy gave excellent results in both primary and lymph node lesions, with 90.9% and 92.2% complete/partial response rates. Three-year and 5-year actuarial survival rates were 69% and 59%, respectively. Patients showing better local responses to combined intra-arterial chemotherapy and intensive radiotherapy had longer survival and less frequent local recurrences. Combined intra-arterial chemotherapy and intensive loco-regional radiotherapy seems to be an effective modality for the treatment of locally advanced breast cancer.

  9. Outcome of acute ischemic stroke after intra-arterial thrombolysis: A study from India.

    Science.gov (United States)

    Chaudhuri, Jaydip Ray; Kumar, Randhir; Umamahesh, Matapathi; Mridula, Kandadai Rukmini; Alladi, Suvarnal; Bandaru, Srinivasarao

    2016-10-07

    Background: Intravenous recombinant tissue plasminogen activator (rt-PA) is the currently standard treatment of acute ischemic stroke within 4.5 hours of the onset of stroke. Recent studies have looked at the benefits of administration of intra-arterial (IA) rt-PA within 8 hours onset of symptoms. Our objective was to assess the outcome of stroke after administration of IA rt-PA in patients with acute ischemic stroke. Methods: We recruited 10 consecutive acute ischemic stroke patients with onset of stroke from 4.5 hours to 6.5 hours. The present study was conducted at Yashoda Hospital, Hyderabad, India, between January 2008 and December 2013. All patients underwent stroke subtyping and were administered rt-PA. We measured the thrombolysis in cerebral infarction (TICI) score after thrombolysis and functional outcomes at time of admission, after 24 hours, 30, 60, and 90 days. A good outcome was defined as modified Rankin Scale (mRS) ≤ 2 after 90 days. Results: Out of 10 patients 9 were men, mean age 56.3 ± 1.8 years and age range from 35-68 years. On stroke subtyping, 6 (60%) patients had large artery atherosclerosis, 3 (30%) had a stroke of indeterminate etiology and 1 (10%) had a stroke of other etiologies. Mean time of recanalization was 6.2 ± 0.5 hours, 7 (70%) patients showed major neurological improvement with a mRS score of ≤ 2 at 90 days and one patient was lost to follow-up. Conclusion: Our study established good outcome at 90 days after administration of IA thrombolysis rt-PA in acute ischemic stroke.

  10. Feeding Arteries of Primary Tongue Cancers on Intra-arterial Infusion Chemotherapy

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    Kamitani, Takeshi, E-mail: kamitani@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences (Japan); Kawanami, Satoshi, E-mail: kawanami-01@mac.com [Kyushu University, Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences (Japan); Asayama, Yoshiki, E-mail: asayama@radiol.med.kyushu-u.ac.jp; Matsuo, Yoshio, E-mail: yymatsuo@radiol.med.kyushu-u.ac.jp; Yonezawa, Masato, E-mail: ymasato@radiol.med.kyushu-u.ac.jp; Yamasaki, Yuzo, E-mail: yyama@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences (Japan); Nagao, Michinobu, E-mail: minagao@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences (Japan); Yamanouchi, Torahiko, E-mail: tora0228@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences (Japan); Yabuuchi, Hidetake, E-mail: h-yabu@med.kyushu-u.ac.jp [Kyushu University, Department of Health Sciences, Graduate School of Medical Sciences (Japan); Nakamura, Katsumasa, E-mail: nakam@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences (Japan); Nakashima, Torahiko, E-mail: nakatora@qent.med.kyushu-u.ac.jp [Kyushu University, Department of Otorhinolaryngology, Graduate School of Medical Sciences (Japan); Honda, Hiroshi, E-mail: honda@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences (Japan)

    2016-02-15

    PurposeTo evaluate the frequency and the predictive factor of each feeding artery on intra-arterial infusion chemotherapy (IAIC) in primary tongue cancer.Materials and MethodsWe retrospectively evaluated 20 patients who received IAIC for primary tongue cancer. The main and accompanying feeding arteries were identified on super-selective angiography of the branches of the external carotid artery. Tumor diameter, and extension to the contralateral side, tongue extrinsic muscles (TEMs), and lateral mesopharyngeal wall were determined based on magnetic resonance imaging or computed tomography findings.ResultsThe main feeding artery was the ipsilateral lingual artery (LA) in 15 of the 20 examined tumors and the contralateral LA in the other 5. Ten cancers had only one feeding artery, and multiple feeding arteries were detected in the remaining 10. Tumors >4 cm (n = 9), those with extension to the contralateral side (n = 13), and those with extension to TEMs (n = 15) were supplied by significantly larger numbers of feeding arteries compared to tumors without these features (P = 0.01, 0.049, and 0.02, respectively). The frequency of feeding from the contralateral LA was 64 % (9/14) and 17 % (1/6) in tumors with and without extension to the contralateral side, respectively. Feeding from a facial artery (FA) was not detected in tumors ≤4 cm, while 5 of the 9 (56 %) tumors >4 cm were supplied by a FA (P = 0.01).ConclusionA careful search for feeding arteries is required, especially in large tumors with extension to the contralateral side or to TEMs.

  11. Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms

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    Cho, Young Dae, E-mail: aronnn@naver.com [Department of Radiology, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 425 Sindaebang-dong, Dongjak-gu, Seoul 156-707 (Korea, Republic of); Lee, Jong Young, E-mail: gen78@naver.com [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Seo, Jung Hwa, E-mail: jhseo34@gmail.com [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Kang, Hyun-Seung, E-mail: hsk4428@yahoo.com [Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Kim, Jeong Eun, E-mail: eunkim@snu.ac.kr [Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Jung, Keun Hwa, E-mail: jungkh@gmail.com [Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Han, Moon Hee, E-mail: hanmh@snuh.org [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of)

    2012-10-15

    Introduction: Intra-arterial (IA) thrombolytic intervention for acute thrombosis has been challenged due to the risk of bleeding during the endovascular treatment of ruptured aneurysms. We present the results of IA tirofiban infusion for thromboembolic complications during coil embolization in patients with ruptured intracranial aneurysms. Methods: Thromboembolic events requiring thrombolytic intervention occurred in 39 (10.5%) cases during coil embolization of 372 consecutive ruptured intracranial aneurysms. Maximal aneurysm diameters of 39 patients (mean age, 54.7 ± 13.2 years; 23 female, 16 male) ranged from 2.1 to 13.1 mm (mean, 6.6 ± 3.0 mm). The anterior communicating artery was the most common site (n = 13), followed by the middle cerebral artery (n = 9) and the posterior communicating artery (n = 7). In this series, we used intracranial stents in 10 patients during the procedure. Superselective IA tirofiban infusion through a microcatheter was performed to resolve thrombi and emboli. We assessed the efficacy and safety of IA tirofiban infusion in patients with ruptured aneurysms. Results: Intraarterially administered tirofiban doses ranged from 0.25 to 1.25 mg (mean, 0.71 ± 0.26 mg). Effective thrombolysis or recanalization was achieved in 34 patients (87.2%), and three patients (7.7%) suffered distal migration of clots with partial recanalization. The rest (5.1%) had no recanalization. Nonconsequent intracerebral hemorrhage occurred in two patients (5.1%) after the procedure. Thromboemboli-related cerebral infarction developed in eight patients, and only two patients remained infarction related disabilities. Conclusion: IA tirofiban infusion seems to be efficacious and safe for thrombolysis during coil embolization in patients with ruptured intracranial aneurysms.

  12. Combined, sequential intravenous and intra-arterial chemotherapy (bridge chemotherapy for young infants with retinoblastoma.

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    Y Pierre Gobin

    Full Text Available BACKGROUND: Intra-arterial (i.a. chemotherapy has more risks of procedural complications in neonates and young infants. For these reasons, we have developed a strategy of bridge intravenous single agent chemotherapy to postpone i.a. chemotherapy in these children PROCEDURE: Neonates and young infants with retinoblastoma who required chemotherapy were treated with systemic carboplatin chemotherapy (18.7 mg/kg i.v. every 3-4 weeks until they reached the age of 3 months and a weight of 6 Kg. If necessary, i.a. chemotherapy was subsequently performed at 4 weeks intervals. Efficacy was judged by tumor regression on ophthalmological examination. Retinal toxicity was judged by electroretinography. RESULTS: Eleven children (19 eyes were treated. All patients are alive and no patient has developed metastatic disease or second malignancies (mean follow-up 27 months, range 9-46 months. Intravenous carboplatin (median 2 cycles, range 1-5 combined with cryotherapy and laser was given to all children. This was effective for five eyes, which did not require i.a. chemotherapy. I.a. chemotherapy was administered to 14 eyes (median 3.5 cycles per eye, range 1 to 6. No radiation therapy was required. The Kaplan Meier estimate of ocular radiation-free survival was 94.7% at one year (95% confidence interval 68.1-99.2%. One eye was enucleated due to tumor progression. ERG showed no deterioration of retinal function. CONCLUSION: Bridge i.v.-i.a. chemotherapy was feasible and safe, and is a promising strategy to treat retinoblastoma in neonates and young infants.

  13. Computational fluid dynamics study of intra-arterial chemotherapy for oral cancer.

    Science.gov (United States)

    Kitajima, Hiroaki; Oshima, Marie; Iwai, Toshinori; Ohhara, Yoshihito; Yajima, Yasuharu; Mitsudo, Kenji; Tohnai, Iwai

    2017-05-15

    Intra-arterial chemotherapy (IAC) for oral cancer can deliver a higher concentration of anticancer agent into a tumor-feeding artery than intravenous systemic chemotherapy. However, distribution of anticancer agent into several branches of the external carotid artery (ECA) in IAC has not demonstrated sufficient treatment efficacy. To improve the effectiveness of IAC, the flow distribution of anticancer agent into the branches of the ECA in several IAC methods was investigated using computational fluid dynamics (CFD). Patient-specific three-dimensional vessel models were created from CT images of 2 patients with tongue cancer. Catheter models were combined with the vessel models. Thirty-two models were generated with varying vertical and horizontal positions of the catheter tip. With the use of a zero-dimensional resistance model of the peripheral vessel network, conventional IAC and superselective IAC were simulated in 30 and 2 models, respectively. The flow distribution of anticancer agent into the branches of the ECA was investigated in 32 models. Additionally, the blood streamline was traced from the inlet of the common carotid artery toward each outlet to examine the flow of anticancer agent in all models, and the wall shear stress of the vessel was calculated for some models. The CFD simulations could be conducted within a reasonable computational time. In several models, the anticancer agent flowed into the target artery only when the catheter tip was located below the bifurcation of the ECA and each target artery. Furthermore, the anticancer agent tended to flow into the target artery when the catheter tip was shifted toward the target artery. In all ECA branches that had flow of anticancer agent, the blood streamlines to the target arteries contacted the catheter tip. Anticancer agent flowed into only the target artery in patients' models for superselective IAC. However, high wall shear stress was observed at the target artery in one patient's model. This

  14. Intra-Arterial Chemotherapy (Ophthalmic Artery Chemosurgery for Group D Retinoblastoma.

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    David H Abramson

    Full Text Available To report globe salvage rates, patient survival and adverse events of ophthalmic artery chemosurgery (OAC for International Classification of Retinoblastoma (ICRB group D retinoblastoma (naive and after prior failures.Single institution retrospective review of all Group D eyes treated with OAC from 5/2006-12/2012. Patients were treated according to our previously-published techniques. Primary outcome was globe retention without need for external beam radiotherapy (EBRT. Demographics, prior treatments, OAC agents used, and adverse events were also recorded.112 group D eyes (103 patients that underwent OAC were included (average follow-up was 34 months, range: 2-110 months. 47 eyes were treatment-naïve, 58 eyes received prior treatments elsewhere, and 7 young infants (7 eyes underwent our published "bridge therapy" (single agent intravenous carboplatin until old enough to undergo OAC. Median number of OAC sessions/eye was 3 (range 1-9. 110/112 eyes received intra-arterial melphalan, but only 31 eyes received melphalan alone. 43 eyes received carboplatin, and 78 eyes received topotecan (never as a single agent. 80/112 eyes received >1 drug over their treatment course, and 39 eyes received all three agents. 24 eyes (16 pretreated, 7 treatment-naïve, 1 bridge failed treatment and required enucleation during the study period. Enucleation and EBRT were avoided in 88/112 eyes (78.6%; including 40/47 [85.1%] treatment-naïve eyes, 42/58 [72.4%] previously-treated eyes, and 6/7 eyes [85.7%] among bridge patients. By Kaplan-Meier survival analysis, globe salvage rate was 74% at 110 months among all patients, and 85% at 110 months in the treatment-naïve subgroup. Transient grade 3/4 neutropenia was more common in patients receiving OAC bilaterally. No child died of metastatic disease.OAC is effective for curing group D retinoblastoma, achieving rates of globe salvage many times higher than systemic chemotherapy (10-47%, even in eyes that previously

  15. Alteplase use for malfunctioning central venous catheters correlates with catheter-associated bloodstream infections.

    Science.gov (United States)

    Rowan, Courtney M; Miller, Kathryn E; Beardsley, Andrew L; Ahmed, Sheikh S; Rojas, Luis A; Hedlund, Terri L; Speicher, Richard H; Nitu, Mara E

    2013-03-01

    A catheter thrombosis and the presence of a catheter-associated bloodstream infection (CBSI) often occur simultaneously, but it is unclear if or to what degree the two complications relate. Several animal and adult studies indicate a relationship between fibrin sheaths and thrombi in the development of CBSIs. To date, there has been limited human investigation in the pediatric population to determine a clear link between the presence of a thrombus and bacteremia. The use of alteplase for malfunctioning central venous catheter may indicate the formation of intraluminal thrombus or fibrin sheath. A catheter that requires alteplase is at higher risk of a CBSI. A retrospective chart review from July 2008 to December 2010. PICU. All patients with central catheters admitted to the PICU. No interventions performed with the retrospective study. Number of total central venous catheters, number of central venous catheters that received treatment with alteplase, and number of CBSIs. Preliminary data during the study period identified 3,289 central venous catheters. Twelve percent of these catheters required at least one dose of alteplase. There were 40 CBSIs during this same time period of which 28% received alteplase during the 5 days preceding the positive blood culture. The odds ratio for getting a CBSI when alteplase is administered is 2.87 (confidence interval 1.42-5.80; p = 0.002). The average age of the central venous catheters at time of infection was not statistically different, 16.1 days in the alteplase catheters compared with 25.6 days for the catheters that did not receive alteplase (p = 0.6). There is a positive correlation between the use of alteplase for malfunctioning central venous catheters and the development of a CASBI. This is likely associated with the presence of an intraluminal fibrin sheath or thrombus. This study adds evidence linking thrombus formation to CBSI.

  16. Efficacy of Intra-arterial Norcantharidin in Suppressing Tumour 14C-labelled Glucose Oxidative Metabolism in rat Morris Hepatoma

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    Peter Mack

    1996-01-01

    Full Text Available Norcantharidin is the demethylated form of Cantharidin, which is the active ingredient of the blister beetle, Mylabris, a long used Chinese traditional medicine. Though not well publicised outside China, Norcantharidin is known to possess significant anti-hepatoma activity, and is relatively free from side effects. In the present study, glucose oxidation in tumour and liver tissue slices harvested from hepatomabearing animals was quantified by measuring the radioactivity of 14C-labelled CO released from 14C-glucose in oxygen-enriched incubation medium. Results were expressed asa tumour/liver ratio. For comparison, treatments with Norcantharidin, Adriamycin and with hepatic artery ligation were studied. The mean tumour/liver ratio was 4.2+2.2 in untreated controls, but dropped significantly to 2.3+0.5 (p<0.05 with intra-arterial Norcantharidin (0.5 mg/kg and to 2.3+0.7 (p<0.05 with intra-arterial Adriamycin (2.4 mg/kg, and to 2.2+0.7 (p<0.05 with hepatic artery ligation. However, with intravenous Adriamycin at 2.4 mg/kg, the mean tumour/liver ratio was reduced to only 3.5+2.0 and was not significantly different from untreated controls. It is concluded that intra-arterial Norcantharidin is as effective as intraarterial Adriamycin and hepatic artery ligation in suppressing tumour glucose oxidative metabolism. These results imply that Norcantharidin may have a role to play in the chemotherapy ofprimary livercancer.

  17. Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke.

    Science.gov (United States)

    Treurniet, Kilian M; Yoo, Albert J; Berkhemer, Olvert A; Lingsma, Hester F; Boers, Anna M M; Fransen, Puck S S; Beumer, Debbie; van den Berg, Lucie A; Sprengers, Marieke E S; Jenniskens, Sjoerd F M; Lycklama À Nijeholt, Geert J; van Walderveen, Marianne A A; Bot, Joseph C J; Beenen, Ludo F M; van den Berg, René; van Zwam, Wim H; van der Lugt, Aad; van Oostenbrugge, Robert J; Dippel, Diederik W J; Roos, Yvo B W E M; Marquering, Henk A; Majoie, Charles B L M

    2016-12-01

    A high clot burden score (CBS) is associated with favorable outcome after intravenous treatment for acute ischemic stroke. The added benefit of intra-arterial treatment might be less in these patients. The aim of this exploratory post hoc analysis was to assess the relation of CBS with neurological improvement and endovascular treatment effect. For 499 of 500 patients in the MR CLEAN study (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), the CBS was determined. Ordinal logistic regression models with and without main baseline prognostic variables were used to assess the association between CBS (continuous or dichotomized at CBS of 6) and a shift toward better outcome on the modified Rankin Scale. The model without main baseline prognostic variables only included treatment allocation and CBS. Models with and without a multiplicative interaction term of CBS and treatment were compared using the χ2 test to assess treatment effect modification by CBS. Higher CBS was associated with a shift toward better outcome on the modified Rankin Scale; adjusted common odds ratio per point CBS was 1.12 (95% confidence interval, 1.04-1.20]. Dichotomized CBS had an adjusted common odds ratio of 1.67 (95% confidence interval, 1.12-2.51). Both effect estimates were slightly attenuated by adding baseline prognostic variables. The addition of the interaction terms did not significantly improve the fit of the models. There was a small and insignificant increase of intra-arterial treatment efficacy in the high CBS group. A higher CBS is associated with improved outcome and may be used as a prognostic marker. We found no evidence that CBS modifies the effect of intra-arterial treatment. URL: http://www.trialregister.nl. Unique identifier: NTR1804. URL: http://www.controlled-trials.com. Unique identifier: ISRCTN10888758. © 2016 American Heart Association, Inc.

  18. Access to the ophthalmic artery by retrograde approach through the posterior communicating artery for intra-arterial chemotherapy of retinoblastoma

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    Pham, Chi-Tuan; Blanc, Raphael; Pistocchi, Silvia; Bartolini, Bruno; Piotin, Michel [Fondation Rothschild Hospital, Department of Interventional Neuroradiology, Paris (France); Lumbroso-Le Rouic, Livia [Institut Curie, Department of Ocular Oncology, Paris (France)

    2012-08-15

    Intra-arterial infusion of chemotherapy into the ophthalmic artery for treatment of retinoblastoma has been realized after catheterization of the internal carotid and temporary balloon occlusion beyond the orifice of the ophthalmic artery, or more recently after superselective canulation of the ophthalmic artery by a microcatheter. The superselective catheterization of the ophthalmic artery could be cumbersome because of the implantation of the ostium on the carotid siphon or because of the tortuosity of the carotid siphon. We report our experience of using a retrograde approach through the posterior communicating artery that allows a more direct angle of access to the origin of the ophthalmic artery. (orig.)

  19. Clinical experience of intra-arterial therapy in patients with acute ischemic stroke from a single institute

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    Park, So Young [Dept. Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul (Korea, Republic of); Lee, Han Bin; Kim, Jong Guk; Oh, Seung Hun; Kim, Jin Kwon; Kim, Sang Heum; Kim, Ok Joon [CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of); Kim, Nam Keun [Institute for Clinical Research, School of Medicine, CHA University, Seongnam (Korea, Republic of)

    2016-11-15

    To compare the efficacy and safety between intra-arterial therapy (IAT) and intra-venous and intra-arterial combined therapy (IVIACT) in patients with acute ischemic stroke in the anterior circulation territory. Forty-one patients treated with IAT using Solitaire were retrospectively reviewed. Nineteen patients were treated with IAT, twenty-two patients were treated with IVIACT, and ten patients of the forty-one patients were managed with multimodal treatment like stent, balloon angioplasty etc. We investigated the rate of recanalization and hemorrhage, NIH stroke scale and 3-month modified Rankin Scale. The overall recanalization rate was 93% and symptomatic ICH occurred in 10% of the patients. There was no difference in hemorrhage, recanalization rate, and early improvement between IAT and IVIACT. Good outcome was more frequently observed in 59% of the patients with IVIACT than 36% of the patients treated with IAT without any significant difference. The patients managed with multimodal treatment did not show any significant hemorrhage outcome. IAT using Solitaire is a useful treatment method without high risk in patients with acute ischemic stroke in the anterior circulation territory. Also, IVIACT and multimodal treatment might be considered as reasonable therapeutic options in these patients.

  20. Comparison of multimodal intra-arterial treatment versus intravenous thrombolysis for hypertensive patients with severe large vessel cerebral infarction.

    Science.gov (United States)

    Tian, Zuojun; Liao, Geng; Li, Shaoming; Shen, Yuechun; Chen, Changbing; Liu, Lei; Li, Yiheng

    2017-10-01

    Since intravenous thrombolysis (IVT) is often associated with poor outcomes in hypertensive patients with severe acute cerebral infarction (ACI) due to occlusions of the internal carotid, basilar, or proximal middle cerebral artery, we evaluated whether multimodal intra-arterial treatment (IAT) might improve functional outcomes in this patient population. We retrospectively reviewed the charts of eligible patients who underwent multimodal IAT including intra-arterial thrombolysis, mechanical thrombectomy, balloon and/or stent angioplasty (IAT group) or IVT alone (IVT group). Outcomes included the revascularization rate 24 hours postprocedure, the frequency of survival at 7, 90, and 180 days postonset, and a measure of functional outcomes using the modified Rankin Scale (mRS). The IAT group included 62 patients and the IVT group included 31 patients. Multimodal IAT increased the revascularization rate at 24 hours (pmultimodal IAT (HR 0.1; 95% CI 0.0 to 0.4; pmultimodal IAT improved the outcomes, including early revascularization, survival, and functional outcome. © American Federation for Medical Research (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Continuous Selective Intra-Arterial Application of Nimodipine in Refractory Cerebral Vasospasm due to Aneurysmal Subarachnoid Hemorrhage

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    Stephanie Ott

    2014-01-01

    Full Text Available Background. Cerebral vasospasm is one of the leading courses for disability in aneurysmal subarachnoid hemorrhage. Effective treatment of vasospasm is therefore one of the main priorities for these patients. We report about a case series of continuous intra-arterial infusion of the calcium channel antagonist nimodipine for 1–5 days on the intensive care unit. Methods. In thirty patients with aneurysmal subarachnoid hemorrhage and refractory vasospasm continuous infusion of nimodipine was started on the neurosurgical intensive care unit. The effect of nimodipine on brain perfusion, cerebral blood flow, brain tissue oxygenation, and blood flow velocity in cerebral arteries was monitored. Results. Based on Hunt & Hess grades on admission, 83% survived in a good clinical condition and 23% recovered without an apparent neurological deficit. Persistent ischemic areas were seen in 100% of patients with GOS 1–3 and in 69% of GOS 4-5 patients. Regional cerebral blood flow and computed tomography perfusion scanning showed adequate correlation with nimodipine application and angiographic vasospasm. Transcranial Doppler turned out to be unreliable with interexaminer variance and failure of detecting vasospasm or missing the improvement. Conclusion. Local continuous intra-arterial nimodipine treatment for refractory cerebral vasospasm after aSAH can be recommended as a low-risk treatment in addition to established endovascular therapies.

  2. Continuous selective intra-arterial application of nimodipine in refractory cerebral vasospasm due to aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Ott, Stephanie; Jedlicka, Sheila; Wolf, Stefan; Peter, Mozes; Pudenz, Christine; Merker, Patrick; Schürer, Ludwig; Lumenta, Christianto Benjamin

    2014-01-01

    Cerebral vasospasm is one of the leading courses for disability in aneurysmal subarachnoid hemorrhage. Effective treatment of vasospasm is therefore one of the main priorities for these patients. We report about a case series of continuous intra-arterial infusion of the calcium channel antagonist nimodipine for 1-5 days on the intensive care unit. In thirty patients with aneurysmal subarachnoid hemorrhage and refractory vasospasm continuous infusion of nimodipine was started on the neurosurgical intensive care unit. The effect of nimodipine on brain perfusion, cerebral blood flow, brain tissue oxygenation, and blood flow velocity in cerebral arteries was monitored. Based on Hunt & Hess grades on admission, 83% survived in a good clinical condition and 23% recovered without an apparent neurological deficit. Persistent ischemic areas were seen in 100% of patients with GOS 1-3 and in 69% of GOS 4-5 patients. Regional cerebral blood flow and computed tomography perfusion scanning showed adequate correlation with nimodipine application and angiographic vasospasm. Transcranial Doppler turned out to be unreliable with interexaminer variance and failure of detecting vasospasm or missing the improvement. Local continuous intra-arterial nimodipine treatment for refractory cerebral vasospasm after aSAH can be recommended as a low-risk treatment in addition to established endovascular therapies.

  3. Imatinib mesylate induces responses in patients with liver metastases from gastrointestinal stromal tumor failing intra-arterial hepatic chemotherapy

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    Fiorentini Giammaria

    2006-01-01

    Full Text Available Background: Imatinib mesylate represents a real major paradigm shift in cancer therapy, targeting the specific molecular abnormalities, crucial in the etiology of tumor. Intra-arterial hepatic chemotherapy (IAHC followed by embolization, has been considered an interesting palliative option for patients with liver metastases from gastrointestinal stromal tumor (GIST, due to the typically hypervascular pattern of the tumor. Aims: We report our experience with IAHC followed by Imatinib mesylate, in order to show the superiority of the specific molecular approach in liver metastases from GIST. Materials and Methods: Three patients (pts with pretreated massive liver metastases from GIST, received IAHC with Epirubicin 50 mg/mq, every 3 weeks for 6 cycles. At the evidence of progression, they received Imatinib mesylate. Results: We observed progressive diseases in all cases. In 1998, one patient underwent Thalidomide at 150 mg orally, every day for 4 months, with evidence of stable disease and clinical improvement. In 2001, two patients received Imatinib mesylate at 400 mg orally, every day, with evidence of partial response lasting 18+ months and 16 months. One of them had grade 3 neutropenia, with suspension of therapy for 3 weeks. Conclusion: No patient treated with IAHC, reported objective responses, but two of them obtained partial response after the assumption of Imatinib mesylate and one showed temporary stabilization with thalidomide. Imatinib mesylate represents a new opportunity in GIST therapy, targeting the specific molecular alteration. It seems to be superior to conventional intra arterial hepatic chemotherapy.

  4. Intra-arterial drug and light delivery for photodynamic therapy using Visudyne®: implication for atherosclerotic plaque treatment

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    Manish Jain

    2016-09-01

    Full Text Available Photodynamic therapy (PDT, which is based on the activation of photosensitizers with light, can be used to reduce plaque burden. We hypothesized that intra-arterial photosensitizer administration and photo-activation will lead to high and rapid accumulation within the plaque with reduced systemic adverse effects. Thus this intra-arterial PDT would be expected to have less side effects and due to the short time involved would be compatible with percutaneous coronary interventions. Aim: We characterized the dose-dependent uptake and efficacy of intra-arterial PDT using Liposomal Verteporfin (Visudyne®, efficient for cancer-PDT but not tested before for PDT of atherosclerosis. Methods and Results: Visudyne® (100, 200 and 500 ng/ml was perfused for 5-30 minutes in atherosclerotic aorta isolated from ApoE-/- mice. The fluorescence Intensity (FI after 15 minutes of Visudyne® perfusion increased with doses of 100 (FI-5.5 ± 1.8, 200 (FI-31.9 ± 1.9 or 500 ng/ml (FI-42.9 ± 1.2. Visudyne® (500 ng/ml uptake also increased with the administration time from 5 minutes (FI-9.8 ± 2.5 to 10 minutes (FI-23.3 ± 3.0 and 15 minutes (FI-42.9 ± 3.4 before reaching saturation at 30 minutes (FI-39.3 ± 2.4 contact. Intra-arterial PDT (Fluence: 100 and 200 J/cm2, irradiance-334 mW/cm2 applied immediately after Visudyne® perfusion (500 ng/ml for 15 minutes using a cylindrical light diffuser coupled to a diode laser (690 nm, led to an increase of ROS (Dihydroethidium (FI-6.9 ± 1.8, 25.3 ± 5.5, 43.4 ± 13.9 and apoptotic cells (TUNEL (2.5 ± 1.6 %, 41.3 ± 15.3 %, 58.9 ± 6 %, mainly plaque macrophages (immunostaining (0.3 ± 0.2 %, 37.6 ± 6.4 %, 45.3 ± 5.4 % at light doses of 0, 100 or 200 J/cm2 respectively. Limited apoptosis was observed in the medial wall (0.5 ± 0.2 %, 8.5 ± 4.7 %, 15.3 ± 12.7 %. Finally, Visudyne®-PDT was found to be associated with reduced vessel functionality (Myogram. Conclusion: We demonstrated that sufficient accumulation of

  5. Intra-Arterial Therapy for Acute Stroke and the Effect of Technological Advances on Recanalization: Findings in a Community Hospital.

    Science.gov (United States)

    Goldstein, Jonas H; Denslow, Sheri A; Goldstein, Samuel J; Marx, William F; Short, John G; Taylor, Reid D; Schneider, Alexander L

    2016-01-01

    Recent randomized controlled studies have shown improvement in recanalization outcomes when physicians use the latest intra-arterial therapy devices in patients with acute, large-vessel, intracranial occlusions. The goal of this study was to explore how new procedures affected degree of and time to recanalization at a single center over the past 12 years as technology has improved. Patients were included in the study if they had a large or medium intracranial vessel occlusion and had undergone intra-arterial therapy for acute stroke during the period 2002-2013. Therapies were categorized as intra-arterial thrombolysis with tissue plasminogen activator (IA tPA), mechanical thrombectomy using 1st-generation devices (Merci and Penumbra), or mechanical thrombectomy using 2nd-generation devices (stent-trievers). Recanalization was defined using a modified Thrombolysis in Cerebral Infarction (TICI) scale. Primary treatment was IA tPA in 24 (12.4%) patients, 1st-generation devices in 128 (66.0%) patients, and 2nd-generation devices in 42 (21.6%) patients. TICI 2b was achieved in 7 (29.2%) patients treated with IA tPA, in 79 (61.7%) patients treated with 1st-generation devices, and in 38 (90.5%) patients treated with 2nd-generation devices. Compared to patients treated with IA tPA, patients treated with 2nd-generation devices were more likely to reach TICI 2b recanalization (odds ratio, 11.66; 95% CI, 1.56-87.01), and they did so in shorter times. Technological advances over 12 years in endovascular stroke treatments significantly improved the chance of and reduced time to achieving TICI 2b recanalization in our community hospital. This shows the importance of adopting new technologies in a rapidly evolving field in order to provide the best-practice standard of care for the people of our region. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

  6. Effects of the intra-arterial injection of bradykinin into the limbs, upon the activity of mesencephalic reticular units.

    Science.gov (United States)

    Lombard, M C; Guilbaud, G; Besson, J M

    1975-02-01

    The changes in firing rate of mesencephalic reticular units after intra-arterial injection into the limbs of a potent nociceptive agent, bradykinin, were studied in cats (unanesthetized, immobilized with flaxedil and hyperventilated). 30 per cent of the d35 studied cells were affected, 56 per cent were excited, 23 per cent inhibited and 5 per cent had mixed effects. Among the 75 excited cells, the activation of 16 of them seemed to related to the arousa- processes (group A); for 56 cells the increase seemed dire-tly dependent on the nociceptive stimulation itself (group B). The changes of firing rate were repruducible; their latencies and durations were of the same order as the latencies and duration of the nociceptive reactions and painful sensation s, which have been obtained in animals and men after bradykinin injections. The modifications induced by bradykinin administration were suppressed by Ketamin and Thiopental.

  7. Intra-arterial infusion therapy following alteration of pelvic blood flow and concurrent radiation therapy for invasive bladder cancer

    Energy Technology Data Exchange (ETDEWEB)

    Umeyama, Tomokazu; Mashimo, Tooru; Nakazato, Haruki; Tokunaga, Takashi; Uehara, Hisao; Shinozaki, Tadatoshi; Kawashima, Miho; Akimoto, Tetsuo [Jomo Urology Memorial Zenshukai Hospital, Maebashi (Japan)

    1996-11-01

    Intra-arterial infusion therapy following alteration of pelvic blood flow and concurrent radiation therapy was performed in 13 patients with muscle invading bladder cancer (T2, 2; T3, 6; T4, 5). The internal iliac artery of the opposite side was embolized and the ipsilateral gluteal and obturator arteries were embolized by metallic coils. A catheter was placed in the ipsilateral internal iliac artery. CDDP was administered daily at a dose of 7-9 mg/body over 1 minute. Radiation was done by Microtron using 10 MV x-ray. Total dose was 4500-7060 cGy. Evaluation was done by cystoscopy, radiography and biopsy. Eight patients achieved complete response (CR) histologically. Others had partial response (PR). All CR patients had no recurrence. The observation period was between 3 and 29 months, with a mean of 11 months. This treatment modality is effective for locally advanced bladder cancer. (author)

  8. Intra-arterial vasodilators to prevent radial artery spasm: a systematic review and pooled analysis of clinical studies

    Energy Technology Data Exchange (ETDEWEB)

    Kwok, Chun Shing, E-mail: shingkwok@doctors.org.uk [Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent (United Kingdom); Rashid, Muhammad [St. Helens & Knowsley Teaching Hospital (NHS) Trust, Whiston Hospital, Prescot (United Kingdom); Fraser, Doug [Manchester Heart Centre, Manchester Royal Infirmary (United Kingdom); Nolan, James [University Hospital of North Midlands, Stoke-on-Trent (United Kingdom); Mamas, Mamas [Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent (United Kingdom); Farr Institute, Institute of Population Health, University of Manchester, Manchester (United Kingdom)

    2015-12-15

    Objectives: The aim of this study is to review the available literature on the efficacy and safety of agents used for prevention of RAS. Background: Different vasodilator agents have been used to prevent radial artery spasm (RAS) in patients undergoing transradial cardiac catheterization. Methods: We included studies that evaluated any intra-arterial drug administered in the setting cardiac catheterization that was undertaken through the transradial access site (TRA). We also compared studies for secondary outcomes of major bleeding, procedure time, and procedure failure rate in setting of RAS prevention, patent hemostasis and radial artery occlusion. Results: 22 clinical studies met the inclusion criteria. For placebo, RAS rate was 12% (4 studies, 638 participants), which was similar to 2.5 mg of verapamil 12% (3 studies, 768 participants) but greater than 5 mg of verapamil (4%, 2 studies, 497 participants). For nicorandil, there was a much higher RAS rate compared to placebo (16%, 3 studies, 447 participants). The lowest rates of RAS was found for nitroglycerin at both 100 μg (4%) and 200 μg (2%) doses, isosorbide mononitrate (4%) and nicardipine (3%). We found no information regarding the procedure failure rates, patent hemostasis, and radial artery occlusion in these studies. Conclusions: In this largest and up-to-date review on intra-arterial vasodilators use to reduce RAS, we have found that the verapamil at a dose of 5 mg or verapamil in combination with nitroglycerine are the best combinations to reduce RAS. - Highlights: • Radial artery spasm (RAS) causes procedural failure in transradial catheterization. • RAS may complicate 10–15% procedures undertaken through the radial approach. • We reviewed the efficacy of vasodilators that have been used to minimize RAS. • The pooled RAS rate was lowest with 5 mg of verapamil (4%) compared to placebo (12%). • The best combination of drugs to minimize RAS is nitroglycerine and verapamil.

  9. Brain SPECT and transcranial Doppler (TCD) evaluation of the effects of intra-arterial papaverine for cerebral vasospasm

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, D.H.; Newell, D.W.; Eskridge, J.M. [Univ. of Washington School of Medicine, Seattle, WA (United States)] [and others

    1994-05-01

    Cerebral vasospasm (cv) is a common and serious consequence of subarachnoid hemorrhage. Interventional neuroradiologic techniques for treating cv refractory to medical and hemodynamic measures have included transluminal microballoon angioplasty and intra-arterial papaverine infusion (pap). Eight patients (pts) who had symptomatic cv but were not candidates for microballoon angioplasty received pap via arterial catheter. All 8 pts had brain SPECT with Tc-99m HMPAO and 7 had TCD readings before and after treatment. One pt had 2 separate treatments. Total treatments = 9. Results: Of the total of 9 treatments: 5 demonstrated marked improvement in regional cerebral blood flow on SPECT in the vascular territories that were ischemic, 3 showed mild to moderate improvement of blood flow, and 1 was unchanged. The pt that did not improve on SPECT died due to cardiorespiratory problems but remained comatose without neurologic improvement after the treatment. The other 8 had either prompt clinical improvement or modestly delayed improvement due to concomitant hydrocephalus. infection, recurrent vasospasm or other intervening medical problems. TCD readings in the treated vessels showed improved (lower) velocities that agreed with SPECT improvement after 4 intra-arterial pap treatments. There were 4 discrepancies of SPECT and TCD: 1 with rising TCD velocity in the mild cv range in the treated vessel that demonstrated SPECT improvement; 1 with unchanged velocity in the moderate cv range that showed SPECT improvement; 1 that showed lower velocity in the moderate cv range while the SPECT was unchanged; and 1 that had normal TCD velocities before and after treatment but high pulsatility indices on Doppler (which are characteristic of either elevated intra-cranial pressure or distal vessel disease) who had mild to moderate improvement of blood flow on SPECT after treatment.

  10. Selective intra-arterial administration of {sup 18}F-FDG to the rat brain - effects on hemispheric uptake

    Energy Technology Data Exchange (ETDEWEB)

    Arnberg, Fabian; Samen, Erik; Lundberg, Johan; Grafstroem, Jonas; Soederman, Michael; Stone-Elander, Sharon; Holmin, Staffan [Karolinska Institutet, Department of Clinical Neuroscience, Stockholm (Sweden); Karolinska University Hospital-Solna, Department of Neuroradiology, Stockholm (Sweden); Lu, Li [Karolinska University Hospital-Solna, KERIC, Stockholm (Sweden)

    2014-05-15

    The purpose of this study was to investigate the radioligand uptake and iodine contrast distribution in the intra- and extracranial circulation of the rat, after intra-arterial injections to the common carotid artery and different parts of the internal carotid artery. All animal experiments were carried out in accordance with Karolinska Institutet's guidelines and were approved by the local laboratory animal ethics committee. We used clinical neurointerventional systems to place microcatheters in the extra- or intracranial carotid artery of 15 Sprague-Dawley rats. Here, injection dynamics of iodine contrast was assessed using digital subtraction angiography. Maintaining the catheter position, the animals were placed in a micro PET and small-animal positron emission tomography (PET) was used to analyze injections [2-{sup 18}F]-2-fluoro-2-deoxy-d-glucose ({sup 18}F-FDG). Microcatheters had to be placed in the intracranial carotid artery (iICA) for the infusate to distribute to the brain. Selective injection via the iICA resulted in a 9-fold higher uptake of {sup 18}F-FDG in the injected hemisphere (p < 0.005) compared to both intravenous and more proximal carotid artery injections. Furthermore, selective injection gave a dramatically improved contrast between the brain and extracranial tissue. Intra-arterial injection increases the cerebral uptake of a radiotracer dramatically compared to systemic injection. This technique has potential applications for endovascular treatment of malignancies allowing intra-interventional modifications of injection strategy, based on information on tumor perfusion and risk to surrounding normal parenchyma. Furthermore the technique may increase diagnostic sensitivity and avoid problems due to peripheral pharmacological barriers and first passage metabolism of labile tracers. (orig.)

  11. Cost-effectiveness of magnetic resonance angiography versus intra-arterial digital subtraction angiography to follow-up patients with coiled intracranial aneurysms

    NARCIS (Netherlands)

    Schaafsma, Joanna D.; Koffijberg, Hendrik; Buskens, Erik; Velthuis, Birgitta K.; van der Graaf, Yolanda; Rinkel, Gabriël J.E.

    Background and Purpose-: To follow up patients with coiled intracranial aneurysms, magnetic resonance angiography (MRA) is a promising noninvasive alternative to current standard intra-arterial digital subtraction angiography (IA-DSA). MRA test results do not always concord with those of IA-DSA, and

  12. Cost-Effectiveness of Magnetic Resonance Angiography Versus Intra-arterial Digital Subtraction Angiography to Follow-Up Patients With Coiled Intracranial Aneurysms

    NARCIS (Netherlands)

    Schaafsma, Joanna D.; Koffijberg, Hendrik; Buskens, Erik; Velthuis, Birgitta K.; van der Graaf, Yolanda; Rinkel, Gabriel J. E.

    Background and Purpose-To follow up patients with coiled intracranial aneurysms, magnetic resonance angiography (MRA) is a promising noninvasive alternative to current standard intra-arterial digital subtraction angiography (IA-DSA). MRA test results do not always concord with those of IA-DSA, and

  13. Intra-arterial tert-Butyl-hydroperoxide infusion induces an exacerbated sensory response in the rat hind limb and is associated with an impaired tissue oxygen uptake.

    NARCIS (Netherlands)

    Tan, E.C.T.H.; Goor, H. van; Bahrami, S.; Kozlov, A.V.; Leixnering, M.; Redl, H.; Goris, R.J.A.

    2011-01-01

    The objective of this study was to investigate oxidative stress and oxygen extraction mechanisms in an animal model of continuous intra-arterial infusion of a free radical donor and in an in vitro model using isolated mitochondria. tert-Butyl-hydroperoxide (tert-BuOOH, 25 mM) was infused for 24 h in

  14. Comparison of peak serum C-reactive protein and hydroxybutyrate dehydrogenase levels in patients with acute myocardial infarction treated with alteplase and streptokinase

    NARCIS (Netherlands)

    K. Pietila; W.T. Hermens (Wim); A. Harmoinen (Aimo); T. Baardman (Taco); A. Pasternack (Amos); E.J. Topol (Eric); M.L. Simoons (Maarten)

    1997-01-01

    textabstractPeak serum C-reactive protein concentrations were measured in 146 patients randomized to receive streptokinase, alteplase, or a combination of streptokinase and alteplase in the GUSTO-I trial. Those receiving alteplase treatment had lower values than those receiving streptokinase or the

  15. Four-dimensional Transcatheter Intra-arterial Perfusion MR Imaging Before and After Uterine Artery Embolization in the Rabbit VX2 Tumor Model

    Science.gov (United States)

    Chung, Johnathan C.; Wang, Dingxin; Lewandowski, Robert J.; Tang, Richard; Chrisman, Howard B.; Vogelzang, Robert L.; Woloschak, Gayle E.; Larson, Andrew C.; Omary, Reed A.; Ryu, Robert K.

    2010-01-01

    Purpose To test the hypothesis that four-dimensional (4D) transcatheter intra-arterial perfusion (TRIP) MR imaging can measure uterine fibroid perfusion changes immediately before and after uterine artery embolization (UAE) in the rabbit VX2 tumor model. Materials and Methods Eight VX2 uterine tumors were grown in 6 rabbits. After positioning a catheter within the uterine artery, we performed 4D TRIP-MRI measurements with 3 mL injections of 2.5% gadopentetate dimeglumine. We used a dynamic 3D spoiled-GRE sequence with in vivo B1-field correction for improved accuracy during perfusion quantification. We performed UAE using 1 mL of gelatin microspheres (2×106 particles; diameter 40-120 μm). Two regions-of-interest were drawn within each tumor upon perfusion maps. Functional embolic endpoints were reported as the mean percent reduction in fibroid tumor perfusion. Measurements before and after UAE were compared using paired t-tests (α = 0.05). Results VX2 uterine tumor perfusion decreased significantly from 27.1 at baseline to 7.09 after UAE (mL/min/100 mL tissue, p < 0.0001). Overall perfusion reduction was 76.3% (95% CI: 66.3%-86.3%). Conclusion 4D TRIP MRI can objectively quantify uterine fibroid perfusion reductions during UAE in VX2 rabbits. This technique could be used clinically to potentially determine an optimal embolic endpoint with the long-term goals of improving UAE success rates and minimizing procedure-related ischemic pain. PMID:20432349

  16. Continuous intra-arterial nimodipine infusion in patients with severe refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a feasibility study and outcome results.

    Science.gov (United States)

    Bele, Sylvia; Proescholdt, Martin A; Hochreiter, Andreas; Schuierer, Gerhard; Scheitzach, Judith; Wendl, Christina; Kieninger, Martin; Schneiker, Andre; Bründl, Elisabeth; Schödel, Petra; Schebesch, Karl-Michael; Brawanski, Alexander

    2015-12-01

    Severe cerebral vasospasm is a major cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. No causative treatment is yet available and hypertensive hypervolemic therapy (HHT) is often insufficient to avoid delayed cerebral ischemia and neurological deficits. We compared patients receiving continuous intra-arterial infusion of the calcium-antagonist nimodipine with a historical group treated with HHT and oral nimodipine alone. Between 0.5 and 1.2 mg/h of nimodipine were continuously administered by intra-arterial infusion via microcatheters either into the internal carotid or vertebral artery or both, depending on the areas of vasospasm. The effect was controlled via multimodal neuromonitoring and transcranial Doppler sonography. Outcome was determined by means of the Glasgow Outcome Scale at discharge and 6 months after the hemorrhage and compared to a historical control group. Twenty-one patients received 28 intra-arterial nimodipine infusions. Six months after discharge, the occurrence of cerebral infarctions was significantly lower (42.6 %) in the nimodipine group than in the control group (75.0 %). This result was reflected by a significantly higher proportion (76.0 %) of patients with good outcome in the nimodipine-treated group, when compared to 10.0 % good outcome in the control group. Median GOS was 4 in the nimodipine group and 2 in the control group (p = 0.001). Continuous intra-arterial nimodipine infusion is an effective treatment for patients with severe cerebral vasospasm who fail to respond to HHT and oral nimodipine alone. Key to the effective administration of continuous intra-arterial nimodipine is multimodal neuromonitoring and the individual adaptation of dosage and time of infusion for each patient.

  17. Alteplase infusion versus dwell for clearance of partially occluded central venous catheters in critically ill pediatric patients.

    Science.gov (United States)

    Ragsdale, Carolyn E; Oliver, Maggee R; Thompson, A Jill; Evans, Melissa C

    2014-07-01

    To evaluate the efficacy and safety of alteplase infusions and alteplase local instillations (dwells) to clear partially occluded central venous catheters in critically ill children. Retrospective study. PICU in a single, tertiary care, academic children's hospital. Retrospective review of the medical records of all critically ill pediatric patients less than 18 years old who received an alteplase infusion or dwell as the treatment for a partial central venous catheter occlusion. The typical infusion regimen was to administer 0.1 mg/kg of body weight (maximum, 2 mg/dose) of alteplase in 25 mL of 0.9% sodium chloride over 3 hours. The standard dwell was to administer and aspirate alteplase in a 1 mg/mL concentration as a fixed dose as ordered by the prescriber (maximum, 2 mg/dose). Efficacy was defined as documentation of positive blood return from the catheter. Radiology reports, nursing and physician documentation, and laboratory values were reviewed to assess for bleeding events. None. One hundred fifty occlusion events were included for analysis. Overall, 72 of 84 alteplase infusions (86%) and 53 of 66 alteplase dwells (80%) resulted in resolution of the lumen occlusion event as documented by positive blood return from the catheter after a maximum of two doses (p = 0.39). One major bleeding event occurred in each arm; both were deemed unlikely related to alteplase. Alteplase infusions to clear partially occluded central venous catheters appear to be as efficacious as alteplase dwells in critically ill children. In occlusions treated with an infusion, more occlusions resolved in older and larger patients and in patients with catheters in place less than 7 days. In occlusions treated with a dwell, more occlusions resolved in smaller catheters. The safety profile for both infusions and dwells was acceptable for the pediatric critically ill population.

  18. Clinical Outcome of Intra-Arterial Embolization for Treatment of Patients with Pelvic Trauma

    Directory of Open Access Journals (Sweden)

    M. W. Barentsz

    2011-01-01

    Full Text Available Purpose. To analyse the technical success of pelvic embolization in our institution and to assess periprocedural hemodynamic status and morbidity/mortality of all pelvic trauma patients who underwent pelvic embolization. Methods. A retrospective analysis of patients with a pelvic fracture due to trauma who underwent arterial embolization was performed. Clinical data, pelvic radiographs, contrast-enhanced CT-scans, and angiographic findings were reviewed. Subsequently, the technical success and peri-procedural hemodynamic status were evaluated and described. Results. 19 trauma patients with fractures of the pelvis underwent arterial embolization. Initially, 10/19 patients (53% were hemodynamically unstable prior to embolization. Technical success of embolization was 100%. 14/19 patients (74% were stable after embolization, and treatment success was high as 74%. Conclusion. Angiography with subsequent embolization should be performed in patients with a pelvic fracture due to trauma and hemodynamic instability, after surgical intervention or with a persistent arterial blush indicative of an active bleeding on CT.

  19. Reversible Cerebral Vasoconstriction Syndrome: Treatment with Multiple Sessions of Intra-Arterial Nimodipine and Angioplasty

    Science.gov (United States)

    Ioannidis, I.; Nasis, N.; Agianniotaki, E.; Katsouda, E.; Andreou, A.

    2012-01-01

    Summary Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute severe headache with or without additional neurological symptoms and reversible cerebral vasoconstriction. Unruptured aneurysms have been reported in some cases with RCVS. We describe a severe case of a 50-year-old woman with RCVS presenting as cortical subarachnoid hemorrhage. Cerebral angiogram demonstrated the typical angiographic findings of RCVS and two very small unruptured aneurysms of the left internal carotid artery. The patient was treated with calcium channel blockers and the two aneurysms were successfully treated endovascularly. On day 16 the patient developed new focal neurological symptoms (severe paraparesis) and was successfully treated with intraarterial nimodipine and angioplasty in multiple sessions. PMID:22958768

  20. Effect of intra arterial nimodipine infusion for the treatment of symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jin Young; Shin, Hwa Seon; Choi, Hye Young; Chung, Sung Hoon; You, Jin Jong; Choi, Dae Seob; Son, Seung Nam [Gyeongsang National Univ. Hospital/Gyeongsang National Univ. School of Medicine, Jinju (Korea, Republic of); Ryu, Jae Wook [Samsung Seoul Hospital, Seoul (Korea, Republic of)

    2012-06-15

    Symptomatic cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH) is one of the major factors which cause morbidity and mortality of patients. The purpose of this study was to evaluate the effectiveness of intra-arterial nimodipine (IAN) infusion therapy in patients with symptomatic cerebral vasospasm. Between February 2005 and April 2011, fifty patients with symptomatic cerebral vasospasm following an aneurysmal SAH were treated with IAN infusion. After selective arterial catheterization, nimodipine was infused at a rate of 0.1 mg/min and a total of 2-3 mg per vessel was infused. We retrospectively reviewed the immediate angiographic results and clinical outcome at discharge. A grade of 5 and 4 in the Glasgow Outcome Scale (GOS) were considered favorable outcomes. In 50 patients, 117 procedures of IAN infusion (1-7; mean, 2.3)were done. After the treatment, immediate angiographic improvement was achieved in 113 (96.6%) of 117 procedures. No major complications occurred. At discharge, 38 (76%) patients showed a favorable clinical outcome in the GOS. IAN infusion therapy is safe and effective for the treatment of cerebral vasospasm following an aneurysmal SAH. However, the limitation is that repeated treatment is needed.

  1. Intra-arterial therapy for cardio embolic internal carotid artery terminus occlusion: The past and present status in real practice

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Guk; Jung, Cheol Kyu; KIm, Jae Hyoung; Choi, Byung Se; Kim, Beomn Joon; Han, Moon Ku; Bae, Hee Joon [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Kwon, Bae Ju [Dept. of Radiology, Myongji Hospital, Goyang (Korea, Republic of); Cha, Sang Hoon [Dept. of Radiology, Chungbuk National University College of Medicine, Daejeon (Korea, Republic of)

    2015-10-15

    There is little data on the effect of intra-arterial therapy (IAT) in acute cardioembolic internal carotid artery terminus (ICAT) occlusion that has poor prognosis. We determined procedural and clinical outcomes in patients with acute cardioembolic ICAT occlusion treated with different methods of IAT. On retrospective review of our registry, patients with cardioembolic ICAT occlusion were categorized as thrombolytic-based IAT group (TLG) and thrombectomy-based IAT group (TEG) according to the primary endovascular technique. Subsequently, procedural and clinical outcomes were compared. Fifty-five patients had cardioembolic ICAT occlusion and 18 patients were assigned to TLG and 37 patients to TEG. The rate of complete reperfusion was significantly higher and the groin puncture to reperfusion time was significantly shorter in TEG than those in TLG. There was a trend towards functional outcome at 3 months in the TEG group; however, it was not statistically significant (p = 0.06). Age, baseline Albert Stroke program early CT score and puncture to reperfusion time were factors affecting unfavorable outcome at 3 months, on multivariable analysis. Thrombectomy-based IAT has advantages over thrombolytic-based IAT in terms of the reduction of groin puncture to reperfusion time and improvement of the rate of complete reperfusion.

  2. Oscillometric and intra-arterial blood pressure in preterm and term infants: extent of discrepancy and factors associated with inaccuracy.

    Science.gov (United States)

    Shimokaze, Tomoyuki; Akaba, Kazuhiro; Saito, Emi

    2015-02-01

    Securing an arterial line to monitor continuous blood pressure (BP) is difficult in infants. We aimed to reveal the extent of discrepancies between oscillometric and direct BP. Infants who required continuous BP monitoring were prospectively enrolled. Direct and indirect BP were simultaneously recorded. Disposable BP cuffs matching one-half to two-thirds of the upper arm circumference were used. A total of 74 infants were studied (gestational age [GA], 24-42 weeks). The correlation coefficients of systolic, diastolic, and mean arterial BP of indirect and direct measurements were 0.87, 0.82, and 0.84, respectively (p Oscillometric measurements significantly underestimated systolic BP in light-for-gestational-age infants and diastolic BP in infants without fentanyl administration. There were no significant correlations between discrepant BP measurements and edema, vasopressor administration, arterial line location, GA, postnatal age, body weight, pulse rate, or hemoglobin level. In 4.1% of infants, systolic BP increased by 10 to 15 mm Hg at the time of cuff expansion. We recommend intra-arterial BP measurement when the BP values seriously influence the therapeutic protocol. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. Change apparent diffusion coefficient immediately after recanalization through intra-arterial revascularization therapy in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Ji Eun; Yeom, Joeng A; Kim, Young Soo; Yoon, Chang Hyo; Park, Min Gyu; Park, Kyung Pil; Baik, Seung Kug [Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

    2016-04-15

    Intra-arterial revascularization therapy (IART) for acute ischemic stroke has become increasingly popular recently. However, early change in apparent diffusion coefficient (ADC) values after full recanalization in human stroke has not received much attention. The aim of this study was to evaluate ADC changes immediately after interventional full-recanalization in patients with acute ischemic stroke. ADC values of 25 lesions from 18 acute ischemic stroke patients were recorded with both pre- and post-recanalization ADC maps. Measurement was done by placing region of interests over the representative images of the lesion. For analysis, lesions were divided into territorial infarction (TI) and watershed infarction (WI). Mean ADC values of the overall 25 lesions before IART were 415.12 × 10-6 mm{sup 2}/sec, and increased to 619.08 × 10-6 mm{sup 2}/sec after the IART. Average relative ADC (rADC) value for 22 TI increased from 0.59 to 0.92 (p < 0.000), whereas, average rADC value for 3 WI did not change significantly. There was a conspicuous increase of ADC values immediately after full-recanalization in TI lesions. On the other hand, WI lesions did not show significant change in ADC values after recanalization.

  4. Image-Based Analysis of Tumor Localization After Intra-Arterial Delivery of Technetium-99m-Labeled SPIO Using SPECT/CT and MRI

    Directory of Open Access Journals (Sweden)

    In Joon Lee MD, PhD

    2017-01-01

    Full Text Available The aim of this study is to evaluate the localization of 99mTc-labeled dextran-coated superparamagnetic iron oxide (SPIO nanoparticles to the liver tumor using image-based analysis. We delivered 99mTc-SPIO intravenously or intra-arterially (IA with/without Lipiodol to compare the tumor localization by gamma scintigraphy, single-photon emission computed tomography (SPECT, and magnetic resonance imaging (MRI in a rabbit liver tumor. The gamma and SPECT image-based analysis shows that the uptake ratio of the tumor to the normal liver parenchyma is highest after delivery of 99mTc-SPIO with Lipiodol IA and that well correlates with the trend of the signal decrease in the liver MRIs. Intra-arterial delivery of SPIO with Lipiodol might be a good drug delivery system targeting the hepatic tumors, as confirmed by image-based analysis.

  5. Image-Based Analysis of Tumor Localization After Intra-Arterial Delivery of Technetium-99m-Labeled SPIO Using SPECT/CT and MRI.

    Science.gov (United States)

    Lee, In Joon; Park, Ji Yong; Kim, Young-Il; Lee, Yun-Sang; Jeong, Jae Min; Kim, Jaeil; Kim, Euishin Edmund; Kang, Keon Wook; Lee, Dong Soo; Jeong, Seonji; Kim, Eun Jeong; Kim, Young Il; Chung, Jin Wook

    2017-01-01

    The aim of this study is to evaluate the localization of (99m)Tc-labeled dextran-coated superparamagnetic iron oxide (SPIO) nanoparticles to the liver tumor using image-based analysis. We delivered (99m)Tc-SPIO intravenously or intra-arterially (IA) with/without Lipiodol to compare the tumor localization by gamma scintigraphy, single-photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI) in a rabbit liver tumor. The gamma and SPECT image-based analysis shows that the uptake ratio of the tumor to the normal liver parenchyma is highest after delivery of (99m)Tc-SPIO with Lipiodol IA and that well correlates with the trend of the signal decrease in the liver MRIs. Intra-arterial delivery of SPIO with Lipiodol might be a good drug delivery system targeting the hepatic tumors, as confirmed by image-based analysis.

  6. Intra-Arterial Treatment in a Child with Embolic Stroke Due to Atrial Myxoma

    Science.gov (United States)

    van den Wijngaard, Ido; Wermer, Marieke; van Walderveen, Marianne; Wiendels, Natalie; Peeters-Scholte, Cacha; Lycklama à Nijeholt, Geert

    2014-01-01

    Summary Arterial ischaemic stroke is an important cause of morbidity in children. Timely diagnosis is necessary for acute stroke treatment but can be challenging in clinical practice. Due to a paucity of data there are no specific recommendations regarding the use of mechanical thrombectomy devices in current paediatric stroke guidelines. A 14-year-old boy presented with a severe acute left hemisphere stroke due to a proximal middle cerebral artery occlusion caused by emboli from an atrial myxoma. No clinical improvement was seen after administration of intravenous thrombolysis. Subsequent mechanical thrombectomy with a second-generation stent-based thrombectomy device resulted in successful recanalization and clinical improvement. To our knowledge, this is the first report of mechanical thrombectomy in a child with acute embolic stroke caused by atrial myxoma. PMID:24976098

  7. Intra-Arterial MR Perfusion Imaging of Meningiomas: Comparison to Digital Subtraction Angiography and Intravenous MR Perfusion Imaging.

    Directory of Open Access Journals (Sweden)

    Mark A Lum

    Full Text Available To evaluate the ability of IA MR perfusion to characterize meningioma blood supply.Studies were performed in a suite comprised of an x-ray angiography unit and 1.5T MR scanner that permitted intraprocedural patient movement between the imaging modalities. Patients underwent intra-arterial (IA and intravenous (IV T2* dynamic susceptibility MR perfusion immediately prior to meningioma embolization. Regional tumor arterial supply was characterized by digital subtraction angiography and classified as external carotid artery (ECA dural, internal carotid artery (ICA dural, or pial. MR perfusion data regions of interest (ROIs were analyzed in regions with different vascular supply to extract peak height, full-width at half-maximum (FWHM, relative cerebral blood flow (rCBF, relative cerebral blood volume (rCBV, and mean transit time (MTT. Linear mixed modeling was used to identify perfusion curve parameter differences for each ROI for IA and IV MR imaging techniques. IA vs. IV perfusion parameters were also directly compared for each ROI using linear mixed modeling.18 ROIs were analyzed in 12 patients. Arterial supply was identified as ECA dural (n = 11, ICA dural (n = 4, or pial (n = 3. FWHM, rCBV, and rCBF showed statistically significant differences between ROIs for IA MR perfusion. Peak Height and FWHM showed statistically significant differences between ROIs for IV MR perfusion. RCBV and MTT were significantly lower for IA perfusion in the Dural ECA compared to IV perfusion. Relative CBF in IA MR was found to be significantly higher in the Dural ICA region and MTT significantly lower compared to IV perfusion.

  8. Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage: Influence on clinical course and predictors of clinical outcome.

    Science.gov (United States)

    Bashir, Asma; Andresen, Morten; Bartek, Jiri; Cortsen, Marie; Eskesen, Vagn; Wagner, Aase

    2016-02-01

    Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpose was to evaluate the efficacy and clinical outcome of IAN treatment of symptomatic CV, and to assess the predictors of clinical outcome. Medical records of 25 patients undergoing a total of 41 IAN treatment sessions were retrospectively reviewed. Data on angiographic results, blood-flow velocities and the clinical condition before and after the IAN treatment were recorded. Predictors of the clinical outcome were assessed with a linear regression model. Positive angiographic response was achieved in 95.1% of 41 IAN treatment sessions. Flow-velocity measurements showed no relationship with angiographic responses of IAN. The immediate clinical improvement was observed in three patients (12%). Five patients (20%) had a favourable outcome at discharge and at three-month follow-up; 10 patients (40%) had a moderate to poor outcome; and the rest (40%) died. Increased number of affected vessels and number of procedures carried out per patient, and a trend toward an increased delay time from symptomatic CV to confirming angiographic CV and thus instituting IAN treatment predicted the poor clinical outcome. IAN treatment appears to be effective in reversing angiographic CV. However, it is not always effective in reversing clinical deterioration, as several other factors including treatment delay affect the clinical course. © The Author(s) 2016.

  9. Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment

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    Sogabe, Shu; Satomi, Junichiro; Tada, Yoshiteru; Kanematsu, Yasuhisa; Kuwayama, Kazuyuki; Yagi, Kenji; Yoshioka, Shotaro; Mizobuchi, Yoshifumi; Mure, Hideo; Yamaguchi, Izumi; Kitazato, Keiko T.; Nagahiro, Shinji [Tokushima University Graduate School, Department of Neurosurgery, Tokushima (Japan); Abe, Takashi; Harada, Masafumi [Tokushima University Graduate School, Department of Radiology, Tokushima (Japan); Yamamoto, Nobuaki; Kaji, Ryuji [Tokushima University Graduate School, Department of Clinical Neurosciences, Institute of Biomedical Biosciences, Tokushima (Japan)

    2017-06-15

    Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1-C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3-C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1-C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site. (orig.)

  10. Intra-arterial blood pressure response in hypertensive subjects during low- and high-intensity resistance exercise

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    Sandra de Souza Nery

    2010-01-01

    Full Text Available OBJECTIVE: The aim of this study was to describe blood pressure responses during resistance exercise in hypertensive subjects and to determine whether an exercise protocol alters these responses. INTRODUCTION: Resistance exercise has been recommended as a complement for aerobic exercise for hypertensive patients. However, blood pressure changes during this kind of exercise have been poorly investigated in hypertensives, despite multiple studies of normotensives demonstrating significant increases in blood pressure. METHODS: Ten hypertensive and ten normotensive subjects performed, in random order, two different exercise protocols, composed by three sets of the knee extension exercise conducted to exhaustion: 40% of the 1-repetition maximum (1RM with a 45-s rest between sets, and 80% of 1RM with a 90-s rest between sets. Radial intra-arterial blood pressure was measured before and throughout each protocol. RESULTS: Compared with normotensives, hypertensives displayed greater increases in systolic BP during exercise at 80% (+80±3 vs. +62±2 mmHg, P<0.05 and at 40% of 1RM (+75±3 vs. +67±3 mmHg, P<0.05. In both exercise protocols, systolic blood pressure returned to baseline during the rest periods between sets in the normotensives; however, in the hypertensives, BP remained slightly elevated at 40% of 1RM. During rest periods, diastolic blood pressure returned to baseline in hypertensives and dropped below baseline in normotensives. CONCLUSION: Resistance exercise increased systolic blood pressure considerably more in hypertensives than in normotensives, and this increase was greater when lower-intensity exercise was performed to the point of exhaustion.

  11. Safety and efficacy of intra-arterial hepatic chemotherapy with doxorubicin-loaded nanoparticles in hepatocellular carcinoma

    Science.gov (United States)

    Merle, Philippe; Camus, Philippe; Abergel, Armand; Pageaux, Georges Philippe; Masliah, Claude; Bronowicki, Jean Pierre; Zarski, Jean Pierre; Pelletier, Gilles; Bouattour, Mohamed; Farloux, Laetitia; Dorval, Etienne; verset, Gilles; Si-Ahmed, Si-Nafa; Doffoel, Michel; Couzigou, Patrice; Taieb, Julien; Vasseur, Bérangère; Attali, Pierre

    2017-01-01

    Background Doxorubicin Transdrug (DT), a nanoformulation of doxorubicin, was demonstrated to overcome the chemoresistance of hepatocellular carcinoma (HCC) in preclinical models. Its efficacy and safety were thus investigated in phase I and randomised phase II trials in unresectable HCC. Patients and methods Phase I was a single dose of DT through the hepatic intra-arterial (HIA) route, dose-escalating 3+3 trial, evaluating five-dose levels from 10 to 40 mg/m2 with maximal tolerated dose (MTD) as primary endpoint. The multicentre phase II trial randomly assigned (2:1 ratio) patients to receive either 30 mg/m2 of DT through HIA route every 4 weeks for up to three courses or best standard of care (BSC). Progression-free survival (PFS) rate at 3 months was the primary endpoint. Overall survival (OS) and disease control rate (DCR) were secondary endpoints. Results In phase I, haematological and respiratory limited toxicities were reported at 35 and 40 mg/m2, giving MTD at 30 mg/m2. Partial response rate was 10%, and stable disease 70%. Phase II was discontinued due to three severe acute respiratory distress events in the DT group while 17 patients had received 30 mg/m2 DT and 11 BSC. At 3 months, PFS was 64% (95% CI 31 to 89) vs 75% (95% CI 35 to 97), and DCR 35% vs 27% in DT and BSC, respectively (p=NS). Median OS was 32.6 months (95% CI 8.2 to 34.1) in DT group and 15 months (95% CI 8.0 to 18.8) in BSC group (p<0.05). Conclusion DT increased OS in unresectable HCC but induced severe respiratory distress. Efficacy data deserve further investigation using a safer dosing and schedule regimen. Trial registration number EUDRACT 2006-004088-77; Results. PMID:29104762

  12. Intra-Arterial Delivery of AAV Vectors to the Mouse Brain After Mannitol Mediated Blood Brain Barrier Disruption

    Science.gov (United States)

    Santillan, Alejandro; Sondhi, Dolan; Dyke, Jonathan P.; Crystal, Ronald G.; Gobin, Y. Pierre; Ballon, Douglas J.

    2014-01-01

    The delivery of therapeutics to neural tissue is greatly hindered by the blood brain barrier (BBB). Direct local delivery via diffusive release from degradable implants or direct intra-cerebral injection can bypass the BBB and obtain high concentrations of the therapeutic in the targeted tissue, however the total volume of tissue that can be treated using these techniques is limited. One treatment modality that can potentially access large volumes of neural tissue in a single treatment is intra-arterial (IA) injection after osmotic blood brain barrier disruption. In this technique, the therapeutic of interest is injected directly into the arteries that feed the target tissue after the blood brain barrier has been disrupted by exposure to a hyperosmolar mannitol solution, permitting the transluminal transport of the therapy. In this work we used contrast enhanced magnetic resonance imaging (MRI) studies of IA injections in mice to establish parameters that allow for extensive and reproducible BBB disruption. We found that the volume but not the flow rate of the mannitol injection has a significant effect on the degree of disruption. To determine whether the degree of disruption we observed with this method was sufficient for delivery of nanoscale therapeutics, we performed IA injections of an adeno-associated viral vector containing the CLN2 gene (AAVrh.10CLN2), which is mutated in the lysosomal storage disorder Late Infantile Neuronal Ceroid Lipofuscinosis (LINCL). We demonstrated that IA injection of AAVrh.10CLN2 after BBB disruption can achieve widespread transgene production in the mouse brain after a single administration. Further, we showed that there exists a minimum threshold of BBB disruption necessary to permit the AAV.rh10 vector to pass into the brain parenchyma from the vascular system. These results suggest that IA administration may be used to obtain widespread delivery of nanoscale therapeutics throughout the murine brain after a single

  13. Segurança do transplante autólogo, intra-arterial, de células mononucleares da medula óssea na fase aguda do acidente vascular cerebral isquêmico Intra-arterial autologous bone marrow mononuclear cell transplantation for acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Maria Lúcia Furtado de Mendonça

    2006-01-01

    Full Text Available O acidente vascular cerebral (AVC é a terceira causa de óbito e a principal causa de incapacidade em indivíduos adultos. Embora a mortalidade do AVC esteja diminuindo em alguns países, a morbidade tem aumentado em razão do envelhecimento da população e do aumento da sobrevida dos pacientes¹. O tratamento com ativador do plasminogênio tissular recombinante (rt-PA é eficaz quando instituído em até 3 horas após o início dos sintomas², porém seu uso está limitado a cerca de 5% dos pacientes na fase aguda do AVC isquêmico. Além disso, nenhum agente para neuroproteção teve sua eficácia comprovada em estudos clínicos em humanos. Portanto, outras estratégias terapêuticas precisam ser desenvolvidas. Em modelos animais, o uso de células-tronco correlacionou-se com melhora funcional após o AVC³. Publicações recentes têm demonstrado a segurança do tratamento com células mononucleares da medula óssea (CMMO injetadas via intracoronária em pacientes portadores de cardiopatia isquêmica aguda ou crônica4,5. Baseado nesses dados iniciais, há crescente interesse no estudo do transplante com CMMO na fase aguda do AVC. Relatamos o primeiro caso de transplante autólogo de CMMO via intra-arterial na fase aguda do AVC isquêmico.Stroke is the third cause of death and the leading cause of disability in adult subjects. Although stroke mortality has been declining in some countries, stroke morbidity has been increasing due to the aging of population and patients improved survival.¹ Treatment with recombinant tissue plasminogen activator (rtPA is successful provided it is administered within 3 hours of symptoms onset,² but its use is limited to about 5% of the patients with acute ischemic stroke. Furthermore, no neuroprotective agent has yet been proven effective in human clinical trials. The development of other therapeutic strategies is, therefore, warranted. The use of stem cells in animal models has led to functional improvement

  14. Spontaneous Splenic Rupture Following Intravenous Thrombolysis with Alteplase Applied as Stroke Therapy – Case Report and Review of Literature

    Science.gov (United States)

    Aleksic-Shihabi, Anka; Jadrijevic, Eni; Milekic, Nina; Bulicic, Ana Repic; Titlic, Marina; Suljic, Enra

    2016-01-01

    Introduction: Stroke is a medical emergency in neurology, and is one of the leading causes of death nowadays. At a recent time, a therapeutic method used in adequate conditions is thrombolysis, a treatment of an emerging clot in the brain vascular system by alteplase. The application of alteplase also has a high risk of life threatening conditions. Case report: This is a brief report of a case with thrombolysis complication which manifested as a spleen rupture. PMID:26980937

  15. Temporal evolution of vasospasm and clinical outcome after intra-arterial vasodilator therapy in patients with aneurysmal subarachnoid hemorrhage.

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    Laleh Daftari Besheli

    Full Text Available Intra-arterial (IA vasodilator therapy is one of the recommended treatments to minimize the impact of aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm refractory to standard management. However, its usefulness and efficacy is not well established. We evaluated the effect IA vasodilator therapy on middle cerebral artery blood flow and on discharge outcome. We reviewed records for 115 adults admitted to Neurointensive Care Unit to test whether there was a difference in clinical outcome (discharge mRS in those who received IA infusions. In a subset of 19 patients (33 vessels treated using IA therapy, we tested whether therapy was effective in reversing the trends in blood flow. All measures of MCA blood flow increased from day -2 to -1 before infusion (maximum Peak Systolic Velocity (PSV 232.2±9.4 to 262.4±12.5 cm/s [p = 0.02]; average PSV 202.1±8.5 to 229.9±10.9 [p = 0.02]; highest Mean Flow Velocity (MFV 154.3±8.3 to 172.9±10.5 [p = 0.10]; average MFV 125.5±6.3 to 147.8±9.5 cm/s, [p = 0.02] but not post-infusion (maximum PSV 261.2±14.6 cm/s [p = .89]; average PSV 223.4±11.4 [p = 0.56]; highest MFV 182.9±12.4 cm/s [p = 0.38]; average MFV 153.0±10.2 cm/s [p = 0.54]. After IA therapy, flow velocities were consistently reduced (day X infusion interaction p<0.01 for all measures. However, discharge mRS was higher in IA infusion group, even after adjusting for sex, age, and admission grades. Thus, while IA vasodilator therapy was effective in reversing the vasospasm-mediated deterioration in blood flow, clinical outcomes in the treated group were worse than the untreated group. There is need for a prospective randomized controlled trial to avoid potential confounding effect of selection bias.

  16. Intra-arterial hepatic chemotherapy for unresectable colorectal liver metastases: a review of medical devices complications in 3172 patients

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    Stefano Bacchetti

    2009-03-01

    .Conclusions: The fully implantable pump, maintaining a continuous infusion through the system, allows the lowest risk for thrombosis and infection and the best median number of cycles of loco-regional chemotherapy in HAI.Keywords: liver metastases, colorectal cancer, medical devices, loco-regional treatments, intra-arterial hepatic chemotherapy

  17. Patient discomfort associated with the use of intra-arterial iodinated contrast media: a meta-analysis of comparative randomized controlled trials.

    Science.gov (United States)

    McCullough, Peter A; Capasso, Patrizio

    2011-05-24

    Discomfort characterized by pain and warmth are common adverse effects associated with the use of intra-arterial iodinated contrast media (CM). The objective of this review was to pool patient-reported outcomes available from head-to-head randomized controlled trials (RCTs) and to compare the discomfort rates associated with iso-osmolar contrast media (IOCM; i.e., iodixanol) to those reported with various low-osmolar contrast media (LOCM). A review of the literature published between 1990 and 2009 available through Medline, Medline Preprints, Embase, Biological Abstracts, BioBase, Cab Abstracts, International Pharmaceutical Abstracts, Life Sciences Collection, Inside Conferences, Energy Database, Engineering Index and Technology Collection was performed to compare rates of discomfort associated with the use of the IOCM (iodixanol) vs. various LOCM agents in head-to-head RCTs. All trials with a Jadad score ≥2 that reported patient discomfort data following intra-arterial administration of CM were reviewed, coded, and extracted. A total of 22 RCTs (n = 8087) were included. Overall discomfort (regardless of severity) was significantly different between patients receiving IOCM and various LOCMs (risk difference [RD] -0.049; 95% confidence interval [CI]: -0.076, -0.021; p = 0.001). IOCM was favored over all LOCMs combined with a summary RD value of -0.188 (95% CI: -0.265, -0.112; p effect size and age and a negative relationship with increasing proportion of women. The opposite trends were observed with warmth sensation. IOCM was associated with less frequent and severe patient discomfort during intra-arterial administration. These data support differences in osmolality as a possible determinant of CM discomfort.

  18. Patient Discomfort Associated with the Use of Intra-arterial Iodinated Contrast Media: A Meta-Analysis of Comparative Randomized Controlled Trials

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    Capasso Patrizio

    2011-05-01

    Full Text Available Abstract Background Discomfort characterized by pain and warmth are common adverse effects associated with the use of intra-arterial iodinated contrast media (CM. The objective of this review was to pool patient-reported outcomes available from head-to-head randomized controlled trials (RCTs and to compare the discomfort rates associated with iso-osmolar contrast media (IOCM; i.e., iodixanol to those reported with various low-osmolar contrast media (LOCM. Methods A review of the literature published between 1990 and 2009 available through Medline, Medline Preprints, Embase, Biological Abstracts, BioBase, Cab Abstracts, International Pharmaceutical Abstracts, Life Sciences Collection, Inside Conferences, Energy Database, Engineering Index and Technology Collection was performed to compare rates of discomfort associated with the use of the IOCM (iodixanol vs. various LOCM agents in head-to-head RCTs. All trials with a Jadad score ≥2 that reported patient discomfort data following intra-arterial administration of CM were reviewed, coded, and extracted. Results A total of 22 RCTs (n = 8087 were included. Overall discomfort (regardless of severity was significantly different between patients receiving IOCM and various LOCMs (risk difference [RD] -0.049; 95% confidence interval [CI]: -0.076, -0.021; p = 0.001. IOCM was favored over all LOCMs combined with a summary RD value of -0.188 (95% CI: -0.265, -0.112; p Conclusions IOCM was associated with less frequent and severe patient discomfort during intra-arterial administration. These data support differences in osmolality as a possible determinant of CM discomfort.

  19. Regional intra-arterial vs. systemic chemotherapy for advanced pancreatic cancer: a systematic review and meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Fenghua Liu

    Full Text Available OBJECTIVE: To investigate the efficacy and safety of regional intra-arterial chemotherapy (RIAC versus systemic chemotherapy for stage III/IV pancreatic cancer. METHODS: Randomized controlled trials of patients with advanced pancreatic cancer treated by regional intra-arterial or systemic chemotherapy were identified using PubMed, ISI, EMBASE, Cochrane Library, Google, Chinese Scientific Journals Database (VIP, and China National Knowledge Infrastructure (CNKI electronic databases, for all publications dated between 1960 and December 31, 2010. Data was independently extracted by two reviewers. Odds ratios and relative risks were pooled using either fixed- or random-effects models, depending on I(2 statistic and Q test assessments of heterogeneity. Statistical analysis was performed using RevMan 5.0. RESULTS: Six randomized controlled trials comprised of 298 patients met the standards for inclusion in the meta-analysis, among 492 articles that were identified. Eight patients achieved complete remission (CR with regional intra-arterial chemotherapy (RIAC, whereas no patients achieved CR with systemic chemotherapy. Compared with systemic chemotherapy, patients receiving RIAC had superior partial remissions (RR = 1.99, 95% CI: 1.50, 2.65; 58.06% with RIAC and 29.37% with systemic treatment, clinical benefits (RR = 2.34, 95% CI: 1.84, 2.97; 78.06% with RAIC and 29.37% with systemic treatment, total complication rates (RR = 0.72, 95% CI: 0.60, 0.87; 49.03% with RIAC and 71.33% with systemic treatment, and hematological side effects (RR = 0.76, 95% CI: 0.63, 0.91; 60.87% with RIAC and 85.71% with systemic treatment. The median survival time with RIAC (5-21 months was longer than for systemic chemotherapy (2.7-14 months. Similarly, one year survival rates with RIAC (28.6%-41.2% were higher than with systemic chemotherapy (0%-12.9%.. CONCLUSION: Regional intra-arterial chemotherapy is more effective and has fewer complications than

  20. Thermochemoradiation Therapy Using Superselective Intra-arterial Infusion via Superficial Temporal and Occipital Arteries for Oral Cancer With N3 Cervical Lymph Node Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Mitsudo, Kenji, E-mail: mitsudo@yokohama-cu.ac.jp [Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama (Japan); Koizumi, Toshiyuki; Iida, Masaki; Iwai, Toshinori; Oguri, Senri [Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama (Japan); Yamamoto, Noriyuki [Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya (Japan); Itoh, Yoshiyuki [Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Kioi, Mitomu; Hirota, Makoto; Tohnai, Iwai [Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama (Japan)

    2012-08-01

    Purpose: To evaluate the therapeutic results and histopathological effects of treatment with thermochemoradiation therapy using superselective intra-arterial infusion via the superficial temporal and occipital arteries for N3 cervical lymph node metastases of advanced oral cancer. Methods and Materials: Between April 2005 and September 2010, 9 patients with N3 cervical lymph node metastases of oral squamous cell carcinoma underwent thermochemoradiation therapy using superselective intra-arterial infusion with docetaxel (DOC) and cisplatin (CDDP). Treatment consisted of hyperthermia (2-8 sessions), superselective intra-arterial infusions (DOC, total 40-60 mg/m{sup 2}; CDDP, total 100-150 mg/m{sup 2}) and daily concurrent radiation therapy (total, 40-60 Gy) for 4-6 weeks. Results: Six of 9 patients underwent neck dissection 5-8 weeks after treatment. In four of these 6 patients, all metastatic lymph nodes, including those at N3, were grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) tumors, as classified by the system by Shimosato et al (Shimosato et al Jpn J Clin Oncol 1971;1:19-35). In 2 of these 6 patients, the metastatic lymph nodes were grade 2b (destruction of tumor structures with a small amount of residual viable tumor cells). The other 3 patients did not undergo neck dissection due to distant metastasis after completion of thermochemoradiation therapy (n=2) and refusal (n=1). The patient who refused neck dissection underwent biopsy of the N3 lymph node and primary sites and showed grade 3 cancer. During follow-up, 5 patients were alive without disease, and 4 patients died due to pulmonary metastasis (n=3) and noncancer-related causes (n=1). Five-year survival and locoregional control rates were 51% and 88%, respectively. Conclusions: Thermochemoradiation therapy using intra-arterial infusion provided good histopathologic effects and locoregional control rates in patients with N3 metastatic lymph nodes. However, patients with N3

  1. The Norwegian tenecteplase stroke trial (NOR-TEST): randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke.

    Science.gov (United States)

    Logallo, Nicola; Kvistad, Christopher E; Nacu, Aliona; Naess, Halvor; Waje-Andreassen, Ulrike; Asmuss, Jörg; Aamodt, Anne Hege; Lund, Christian; Kurz, Martin W; Rønning, Ole Morten; Salvesen, Rolf; Idicula, Titto T; Thomassen, Lars

    2014-05-15

    Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking. The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenecteplase vs. alteplase. NOR-TEST is a multi-centre PROBE (prospective randomised, open-label, blinded endpoint) trial designed to establish superiority of tenecteplase 0.4 mg/kg (single bolus) as compared with alteplase 0.9 mg/kg (10% bolus + 90% infusion/60 minutes) for consecutively admitted patients with acute ischaemic stroke eligible for thrombolytic therapy, i.e. patients a) admitted <4½ hours after symptoms onset; b) admitted <4½ hours after awakening with stroke symptoms c) receiving bridging therapy before embolectomy.Randomisation tenecteplase:alteplase is 1:1. The primary study endpoint is favourable functional outcome defined as modified Rankin Scale 0-1 at 90 days. Secondary study endpoints are: 1) haemorrhagic transformation (haemorrhagic infarct/haematoma); 2) symptomatic cerebral haemorrhage on CT 24-48 hours; 3) major neurological improvement at 24 hours; 4) recanalisation at 24-36 hours; 5) death. NOR-TEST may establish a novel approach to acute ischaemic stroke treatment. A positive result will lead to a more effective, safer and easier treatment for all acute ischaemic stroke pasients.NOR-TEST is reviewed and approved by the Regional Committee for Medical and Health Research Ethics (2011/2435), and The Norwegian Medicines Agency (12/01402). NOR-TEST is registered with EudraCT No 2011-005793-33 and in ClinicalTrials.gov (NCT01949948).

  2. Late follow-up of the randomized radiation and concomitant high-dose intra-arterial or intravenous cisplatin (RADPLAT) trial for advanced head and neck cancer.

    Science.gov (United States)

    Heukelom, Jolien; Lopez-Yurda, Marta; Balm, Alfons J M; Wijers, Oda B; Buter, Jan; Gregor, Theo; Wiggenraad, Ruud; de Boer, Jan Paul; Tan, I Bing; Verheij, Marcel; Sonke, Jan-Jakob; Rasch, Coen R

    2016-04-01

    The radiation and concomitant high-dose intra-arterial or intravenous cisplatin (RADPLAT) phase III trial compared intra-arterial (IA) to intravenous (IV) cisplatin-based chemoradiation for head and neck cancer. Long-term efficacy and toxicity are reported after a median follow-up of 7.5 years. Patients with inoperable squamous cell carcinoma (SCC) of the oropharynx, oral cavity, or hypopharynx, were randomized between radiotherapy (RT) + IA cisplatin 150 mg/m(2) , followed by systemic rescue or RT + I.V. cisplatin 100 mg/m(2) . RT consisted of 46 Gy to the affected and elective areas, followed by a boost of 24 Gy. Among 237 patients, 57 recurred locally, 35 regionally, and 80 locoregionally. There were 32 second primary tumors, 65 distant metastases, and 154 deaths. Locoregional control and overall survival were not different between the treatment arms. Late dysphagia was worse in the I.V. arm (log-rank p = .014). IA cisplatin did not improve tumor control compared to I.V. administered cisplatin, despite the higher dose in IA delivery of the drug. © 2015 Wiley Periodicals, Inc. Head Neck 38: E488-E493, 2016. © 2015 Wiley Periodicals, Inc.

  3. Relevance of the Updated Food and Drug Administration Alteplase Label for Acute Ischemic Stroke: The Estimated Impact and Current Guidelines.

    Science.gov (United States)

    Shiue, Harn J; Albright, Karen C; Sands, Kara A

    2018-04-01

    In 2015, the Food and Drug Administration updated the contraindications for the use of alteplase in acute ischemic stroke (AIS), potentially creating a greater impact on treatment. A history of intracranial hemorrhage and recent stroke within 3 months were removed as contraindications, increasing the number of patients eligible for alteplase. The aim of this commentary is to call attention to the updates and discuss them relative to current American Heart Association/American Stroke Association guidelines. Additionally, we estimate the clinical impact of the updates by analyzing AIS admissions to a large-volume Comprehensive Stroke Center.

  4. Anesthetic strategy during endovascular therapy: General anesthesia or conscious sedation? (GOLIATH - General or Local Anesthesia in Intra Arterial Therapy) A single-center randomized trial

    DEFF Research Database (Denmark)

    Simonsen, Claus Z; Sørensen, Leif H; Juul, Niels

    2016-01-01

    RATIONALE: Endovascular therapy after acute ischemic stroke due to large vessel occlusion is now standard of care. There is equipoise as to what kind of anesthesia patients should receive during the procedure. Observational studies suggest that general anesthesia is associated with worse outcomes...... compared to conscious sedation. However, the findings may have been biased. Randomized clinical trials are needed to determine whether the choice of anesthesia may influence outcome. AIM AND HYPOTHESIS: The objective of GOLIATH (General or Local Anestesia in Intra Arterial Therapy) is to examine whether....... Patients with acute ischemic stroke, scheduled for endovascular therapy, are randomized to receive either general anesthesia or conscious sedation. STUDY OUTCOMES: The primary outcome measure is infarct growth after 48-72 h (determined by serial diffusion-weighted magnetic resonance imaging). Secondary...

  5. Interval between Intra-Arterial Infusion Chemotherapy and Surgery for Locally Advanced Oral Squamous Cell Carcinoma: Impacts on Effectiveness of Chemotherapy and on Overall Survival

    Directory of Open Access Journals (Sweden)

    Chih-Fung Wu

    2014-01-01

    Full Text Available Background. The interval between intra-arterial infusion chemotherapy (IAIC and surgery was investigated in terms of its effects on survival in patients with locally advanced oral squamous cell carcinoma (OSCC. Methods. This retrospective study analyzed 126 patients who had completed treatment modalities for stage IV OSCC. All patients were followed up for 3 years. Kaplan-Meier and Cox regression methods were used to determine how survival was affected by general factors, primary tumor volume, TNM stage, and duration of neoadjuvant chemotherapy. Results. In 126 patients treated for locally advanced OSCC by preoperative induction IAIC using methotrexate, multivariate analysis of relevant prognostic factors showed that an IAIC duration longer than 90 days was significantly associated with poor prognosis (hazard ratio, 1.77; P=0.0259. Conclusions. Duration of IAIC is a critical factor in the effectiveness of multimodal treatment for locally advanced OSCC. Limiting the induction course to 90 days improves overall survival.

  6. Surgical and histopathological effects of topical Ankaferd hemostat on major arterial vessel injury related to elevated intra-arterial blood pressure

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    A. Tulga Ulus

    2011-09-01

    Full Text Available Objective: The aim of this study was to assess the surgical and histopathological hemostatic effects of topical Ankaferd blood stopper (ABS on major arterial vessel injury related to elevated intra-arterial blood pressure in an experimental rabbit model.Materials and Methods: The study included 14 New Zealand rabbits. ABS was used to treat femoral artery puncture on 1 side in each animal and the other untreated side served as the control. Likewise, for abdominal aortic puncture, only 50% of the aortic injuries received topical liquid ABS and the others did not (control. The experiment was performed under conditions of normal arterial blood pressure and was repeated with a 50% increase in blood pressure. Histopathological analysis was performed in all of the studied animals.Results: Mean bleeding time in the control femoral arteries was 105.0±18.3 s, versus 51.4±9.8 s (p<0.05 in those treated with ABS. Mean blood loss from the punctured control femoral arteries was 5.0±1.5 mg and 1.6±0.4 mg from those treated with ABS (p<0.05. Histopathological examination of the damaged arterial structures showed that ABS induced red blood cell aggregates.Conclusion: ABS administered to experimental major arterial vessel injury reduced both bleeding time and blood loss under conditions of normal and elevated intra-arterial blood pressure. ABS-induced erythroid aggregation was prominent at the vascular tissue level. These findings will inform the design of future experimental and clinical studies on the anti-bleeding and vascular repairing effects of the novel hemostatic agent ABS.

  7. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

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    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin [Hannover Medical School, Department of Neurology and Clinical Neurophysiology, Hannover (Germany); Becker, Hartmut; Goetz, Friedrich [Hannover Medical School, Department of Neuroradiology, Hannover (Germany)

    2008-01-15

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  8. Randomised Phase I/II trial assessing the safety and efficacy of radiolabelled anti-carcinoembryonic antigen I131 KAb201 antibodies given intra-arterially or intravenously in patients with unresectable pancreatic adenocarcinoma

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    Bosonnet Lorraine

    2009-02-01

    Full Text Available Abstract Background Advanced pancreatic cancer has a poor prognosis, and the current standard of care (gemcitabine based chemotherapy provides a small survival advantage. However the drawback is the accompanying systemic toxicity, which targeted treatments may overcome. This study aimed to evaluate the safety and tolerability of KAb201, an anti-carcinoembryonic antigen monoclonal antibody, labelled with I131 in pancreatic cancer (ISRCTN 16857581. Methods Patients with histological/cytological proven inoperable adenocarcinoma of the head of pancreas were randomised to receive KAb 201 via either the intra-arterial or intravenous delivery route. The dose limiting toxicities within each group were determined. Patients were assessed for safety and efficacy and followed up until death. Results Between February 2003 and July 2005, 25 patients were enrolled. Nineteen patients were randomised, 9 to the intravenous and 10 to the intra-arterial arms. In the intra-arterial arm, dose limiting toxicity was seen in 2/6 (33% patients at 50 mCi whereas in the intravenous arm, dose limiting toxicity was noted in 1/6 patients at 50 mCi, but did not occur at 75 mCi (0/3. The overall response rate was 6% (1/18. Median overall survival was 5.2 months (95% confidence interval = 3.3 to 9 months, with no significant difference between the intravenous and intra-arterial arms (log rank test p = 0.79. One patient was still alive at the time of this analysis. Conclusion Dose limiting toxicity for KAb201 with I131 by the intra-arterial route was 50 mCi, while dose limiting toxicity was not reached in the intravenous arm.

  9. Cost-effectiveness of intravenous thrombolysis with alteplase within a 3-hour window after acute ischemic stroke

    DEFF Research Database (Denmark)

    Ehlers, Lars; Andersen, Grethe; Clausen, Lone Beltoft

    2006-01-01

    BACKGROUND AND PURPOSE: The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance imaging. METHODS: A health economic model wa...

  10. Curative effect of minimally invasive puncture and drainage assisted with alteplase on treatment of acute intracerebral hemorrhage

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    Jun-Lin Hu

    2017-01-01

    Full Text Available Objective: To investigate the different effects on evacuation of hematoma, the severity of nerve injury, inflammatory reaction and oxidative stress response in the treatment of acute intracerebral hemorrhage by using minimally invasive puncture and drainage assisted with alteplase or urokinase. Methods: A total of 114 patients with acute intracerebral hemorrhage treated with minimally invasive puncture and drainage in our hospital from May 2012 to October 2015 were retrospectively analyzed and divided into alteplase group and urokinase group, which received adjuvant therapy with alteplase and urokinase, respectively. Before and after treatment, CT was used for scanning, and the volume of hematoma and edema and the distance of midline shift were examined. After treatment, serum was collected for detecting the contents of molecular markers of nerve injury, inflammatory reaction and oxidative stress response. Results: On the 3rd day after treatment, the volume of hematoma and edema and the distance of midline shift in minimally invasive group were significantly lower than those of craniotomy group, and incidence of intracranial infection was lower than that of craniotomy group. There was no significant difference of rebleeding incidence compared to craniotomy group. The serum contents of osteopontin, S100β, glial fibrillary acidic protein, neuron-specific enolase, myelin basic protein, neuropeptide Y, ischemia modified albumin, tumor necrosis factor alpha, interleukin-1β, interleukin-6, interleukin-8, soluble intercellular adhesion molecule-1, highmobility group protein 1, malonaldehyde, advanced oxidation protein products and 8-hydroxy- 2'-deoxyguanosine urine of patients from alteplase group were significantly lower than those of urokinase group. The content of total antioxidant capacity was obviously higher than that of urokinase group. Conclusions: As for the effect on evacuation of hematoma and also the ameliorative effect on nerve injury

  11. The agreement between oscillometric and intra-arterial technique for blood pressure monitoring in the lower extremities for infants and toddlers undergoing aortic coarctation repair.

    Science.gov (United States)

    Peng, Zhe-Zhe; Zhang, Ma-Zhong; Sun, Ying; Bai, Jie; Gu, Hong-Bin; Liu, Pei-Pei; Li, Min; Cai, Mei-Hua

    2016-11-01

    Anesthetic management for patients undergoing surgical repair of aortic coarctation (CoA) should include constant blood pressure monitoring of the right upper extremity and a lower extremity. The delayed or absent pulse in the lower limbs often leads to unsuccessful arterial cannulation in infants and the oscillometric technique used for blood pressure measurement. The aim of this study was to evaluate the agreement between the oscillometric method and intra-arterial technique for blood pressure monitoring in the lower limbs of infants undergoing CoA. A total of 45 infants diagnosed with isolated CoA were initially enrolled in this study and five were excluded because of cannulation failure. Thus, 40 patients had their blood pressure measured simultaneously by both oscillometric technique on the thigh and femoral artery catheterization. After induction and intubation, five pairs of blood pressure readings from each patient were collected in an interval of 3 min. Statistical analysis was accomplished by revised Bland-Altman analysis. There was a strong correlation between oscillometric and invasive blood pressure measurements [systolic blood pressure (SBP) r = 0.771, diastolic blood pressure (DBP) r = 0.704 and mean artery pressure (MAP) r = 0.850]. The mean difference and 95% limits of agreement (95% LOA) between oscillometric and femoral artery blood pressure readings was 3.830 mmHg (-19.297, 26.957) for SBP, -8.725 mmHg (-26.236, 8.786) for DBP, and -3.235 mmHg (-18.842, 12.372) for MAP. There were only one pair of MAP (1/40) and two pairs of SBP readings (2/40) out of range (95% LOA), and all of paired DBP readings were within 95% LOA. There was a good agreement between oscillometric and invasive blood pressure measurements of lower extremities in infants with isolated CoA statistically. However, the oscillometry-measured SBP showed a tendency to overestimate the intra-arterial blood pressure reference, while oscillometry-measured DBP underestimated its

  12. Intra-arterial digital subtraction angiography of the pulmonary arteries using a flow-directed balloon catheter in the diagnosis of pulmonary embolism

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    Rooij, W.J.J. van; Heeten, G.J. den (St. Elisabethziekenhuis Tilburg, Dept. of Radiology (Netherlands))

    1992-04-01

    Selective intra-arterial digital subtraction angiography (IA-DSA) of the pulmonary vessels was performed in 70 patients suspected of acute pulmonary embolism. A flow-directed Swan-Ganz pulmonary angiography catheter was used. The spatial resolution of the equipment used was 3.3 lp/mm for DSA and 6.0 lp/mm for conventional pulmonary angiography (CPA). Image quality of the angiograms was assessed by determining the highest visible branching division of the main pulmonary artery. The mean visible branching division for IA-DSA was 4.71 (range 3-7). In 10 patients where IA-DSA and CPA were performed during the same procedure there was no difference in visualization of peripheral arteries (mean 4.70 visible or for both modalities). IA-DSA makes the procedure rapid, saves on films and contrast material and allows good visualization of areas where exposure is difficult. The spatial resolution of state-of-the-art equipment permits sufficient definition of subsegmental vessels. The use of the flow-directed balloon catheter makes the examination easy to perform and minimizes the risk of catheter induced cardiac arrhythmias. (orig.).

  13. Carotid stenosis measurement on colour Doppler ultrasound: Agreement of ECST, NASCET and CCA methods applied to ultrasound with intra-arterial angiographic stenosis measurement

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    Wardlaw, Joanna M. [Division of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU (United Kingdom)]. E-mail: jmw@skull.dcn.ed.ac.uk; Lewis, Steff [Division of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU (United Kingdom)

    2005-11-01

    Purpose: Carotid stenosis is usually determined on Doppler ultrasound from velocity readings. We wondered if angiography-style stenosis measurements applied to ultrasound images improved accuracy over velocity readings alone, and if so, which measure correlated best with angiography. Materials and methods: We studied prospectively patients undergoing colour Doppler ultrasound (CDU) for TIA or minor stroke. Those with 50%+ symptomatic internal carotid artery (ICA) stenosis had intra-arterial angiography (IAA). We measured peak systolic ICA velocity, and from the ultrasound image, the minimal residual lumen, the original lumen (ECST), ICA diameter distal (NASCET) and CCA diameter proximal (CCA method) to the stenosis. The IAAs were measured by ECST, NASCET and CCA methods also, blind to CDU. Results: Amongst 164 patients (328 arteries), on CDU the ECST, NASCET and CCA stenosis measures were similarly related to each other (ECST = 0.54 NASCET + 46) as on IAA (ECST = 0.6 NASCET + 40). Agreement between CDU- and IAA-measured stenosis was similar for ECST (r = 0.51), and CCA (r = 0.48) methods, and slightly worse for NASCET (r = 0.41). Adding IAA-style stenosis to the peak systolic ICA velocity did not improve agreement with IAA over peak systolic velocity alone. Conclusion: Angiography-style stenosis measures have similar inter-relationships when applied to CDU, but do not improve accuracy of ultrasound over peak systolic ICA velocity alone.

  14. The incidence of late neck recurrence in N0 maxillary sinus squamous cell carcinomas after superselective intra-arterial chemoradiotherapy without prophylactic neck irradiation.

    Science.gov (United States)

    Sakashita, Tomohiro; Homma, Akihiro; Hatakeyama, Hiromitsu; Kano, Satoshi; Mizumachi, Takatsugu; Furusawa, Jun; Yoshida, Daisuke; Fujima, Noriyuki; Onimaru, Rikiya; Tsuchiya, Kazuhiko; Yasuda, Koichi; Shirato, Hiroki; Fukuda, Satoshi

    2014-10-01

    The efficacy of elective neck irradiation (ENI) for patients with N0 carcinoma of the maxillary sinus has been controversial. The purpose of our study was to investigate the incidence of late neck recurrence and the mortality rate from regional disease in patients with N0 maxillary sinus cancer after superselective cisplatin infusion and concomitant radiotherapy (RADPLAT) without ENI. We retrospectively analyzed 48 patients with N0 maxillary sinus cancer who underwent RADPLAT. Chemotherapy consisted of 100-120 mg/m(2) superselective intra-arterial cisplatin administered at a median rate of four times weekly. Concurrent radiation therapy was administered at a median dose of 65 Gy without ENI. Late neck recurrence was observed in 8.3% (4/48). Three patients underwent salvage neck dissection and survived without any evidence of disease. The remaining patient did not undergo neck dissection due to coexistence with distant metastasis, and he died of regional disease. The mortality rate from regional disease was calculated to be 2% (1/48). The incidence of late neck recurrence was not frequent, and the mortality rate from regional disease was low. Salvage neck dissection was considered to be feasible for patients with late neck recurrence. When definitive radiotherapy and concomitant chemotherapy are applied, it is considered that ENI is not required for cases of N0 maxillary sinus cancer.

  15. Outcome after local intra-arterial fibrinolysis compared with the natural course of patients with a dense middle cerebral artery on early CT

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    Bendszus, M.; Urbach, H.; Solymosi, L. [Department of Neuroradiology, University of Wuerzburg (Germany); Ries, F. [Department of Neurology, University of Bonn (Germany)

    1998-01-01

    Our purpose was to relate the outcome after local intra-arterial fibrinolysis (LIF) to the natural course in middle cerebral artery (MCA) occlusion. We retrospectively studied 40 patients with a dense middle cerebral artery on early CT; 20 were treated with LIF within 6 h of onset of symptoms, 20 received ``conventional`` stroke therapy. The dense middle cerebral artery, which is regarded as a highly specific indicator of thromboembolic MCA occlusion, was chosen as inclusion criterion since patients with ``conventional`` stroke therapy were not exposed to cerebral angiography. Patients treated with LIF had a significantly better outcome using the Barthel index (P = 0.025): there was a 30 % increase in the proportion of patients with minimal or no disability. Mortality, however, did not differ significantly (P = 0.7). Two fatal haemorrhages occurred in the LIF group, and one haemorrhagic transformation in the ``conventional`` group. Leptomeningeal collateralisation correlated significantly with outcome in the LIF group (P = 0.04). Although the relation between outcome and interval from onset of symptoms to LIF was not significant (P = 0.74), all patients treated within 3 h had an excellent outcome. (orig.) With 3 figs., 27 refs.

  16. Professional oral health care reduces oral mucositis pain in patients treated by superselective intra-arterial chemotherapy concurrent with radiotherapy for oral cancer.

    Science.gov (United States)

    Kubota, Kosei; Kobayashi, Wataru; Sakaki, Hirotaka; Nakagawa, Hiroshi; Kon, Takao; Mimura, Mayu; Ito, Ryohei; Furudate, Ken; Kimura, Hiroto

    2015-11-01

    Oral mucositis (OM) is a painful complication of radiation therapy (RT) for head and neck cancer. OM can compromise nutrition, require opioid analgesics and hospitalization for pain control, and lead to interruption of treatment. Severe oral mucositis appears inevitable in superselective intra-arterial chemotherapy concurrent with radiotherapy (SSIACRT), requiring management of OM for the patient. The objective of this study was to assess the utility of professional oral health care (POHC) for the management of OM in patients undergoing SSIACRT. Thirty-three patients were enrolled in this study. The first 17 patients underwent SSIACRT before we created an oral management team, and thus did not receive POHC. The remaining 16 patients received POHC. Fever duration, duration of oral feeding difficulty, opioid usage, duration of opioid administration, duration of hospitalization, and number of hospital days from the end of irradiation to discharge were compared between these two groups. Median total dose of morphine during SSIACRT, median number of hospital days from end of irradiation to discharge, and duration of hospitalization all differed significantly between groups (P opioid administration, fever duration, and duration of oral feeding difficulty did not differ significantly between groups. These findings indicate that POHC may reduce opioid use and shorten the hospital stay. Such results might be obtained through infection control by POHC. This report appears to be the first study to evaluate the efficiency of POHC in SSIACRT for oral cancer from the perspective of mucositis pain and opioid use.

  17. Early survival prediction after intra-arterial therapies: a 3D quantitative MRI assessment of tumour response after TACE or radioembolization of colorectal cancer metastases to the liver

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    Chapiro, Julius; Savic, Lynn Jeanette [The Johns Hopkins Hospital, Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Baltimore, MD (United States); Charite Universitaetsmedizin, Department of Diagnostic and Interventional Radiology, Berlin (Germany); Duran, Rafael; Schernthaner, Ruediger; Wang, Zhijun; Geschwind, Jean-Francois [The Johns Hopkins Hospital, Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Baltimore, MD (United States); Lin, MingDe [The Johns Hopkins Hospital, Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Baltimore, MD (United States); U/S Imaging and Interventions (UII), Philips Research North America, Briarcliff Manor, NY (United States); Lesage, David [Philips Research, Medisys, Suresnes (France)

    2015-07-15

    This study evaluated the predictive role of 1D, 2D and 3D quantitative, enhancement-based MRI regarding overall survival (OS) in patients with colorectal liver metastases (CLM) following intra-arterial therapies (IAT). This retrospective analysis included 29 patients who underwent transarterial chemoembolization (TACE) or radioembolization and received MRI within 6 weeks after therapy. Tumour response was assessed using 1D and 2D criteria (such as European Association for the Study of the Liver guidelines [EASL] and modified Response Evaluation Criteria in Solid Tumors [mRECIST]). In addition, a segmentation-based 3D quantification of overall (volumetric [v] RECIST) and enhancing lesion volume (quantitative [q] EASL) was performed on portal venous phase MRI. Accordingly, patients were classified as responders (R) and non-responders (NR). Survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios (HR). Only enhancement-based criteria identified patients as responders. EASL and mRECIST did not predict patient survival (P = 0.27 and P = 0.44, respectively). Using uni- and multivariate analysis, qEASL was identified as the sole predictor of patient survival (9.9 months for R, 6.9 months for NR; P = 0.038; HR 0.4). The ability of qEASL to predict survival early after IAT provides evidence for potential advantages of 3D quantitative tumour analysis. (orig.)

  18. Methylene blue intra-arterial staining of resected colorectal cancer specimens improves accuracy of nodal staging: A randomized controlled trial.

    Science.gov (United States)

    Reima, H; Saar, H; Innos, K; Soplepmann, J

    2016-11-01

    Metastatic involvement of regional lymph nodes is a major prognostic factor of colorectal cancer, which influences also its treatment strategy. International consensus foresees retrieval of ≥12 lymph nodes from colorectal specimens. The aim of the study was to assess the effect of intra-arterial staining of colorectal specimens with methylene blue on lymph node harvest. A total of 266 radically operated colorectal cancer patients were randomized into the methylene blue staining and non-staining groups. In the staining group, methylene blue solution was injected into the colorectal specimen's artery after its removal. The specimens were analysed for lymph node count, diameter and metastatic involvement. The median number of lymph nodes was higher in the staining group, 27 (95% CI 23-31%), compared with the control group, 16 (95% CI 14-19, p Methylene blue staining improves significantly staging accuracy through finding more small-diameter lymph nodes. It enables to detect ≥12 lymph nodes in the majority of cases. We recommend routine use of this technique in all colorectal resections with curative intent. Copyright © 2016 Elsevier Ltd, BASO ~ the Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  19. Transcatheter intra-arterial infusion of doxorubicin loaded porous magnetic nano-clusters with iodinated oil for the treatment of liver cancer.

    Science.gov (United States)

    Jeon, Min Jeong; Gordon, Andrew C; Larson, Andrew C; Chung, Jin Wook; Kim, Young Il; Kim, Dong-Hyun

    2016-05-01

    A promising strategy for liver cancer treatment is to deliver chemotherapeutic agents with multifunctional carriers into the tumor tissue via intra-arterial (IA) transcatheter infusion. These carriers should release drugs within the target tissue for prolonged periods and permit intra-procedural multi-modal imaging of selective tumor delivery. This targeted transcatheter delivery approach is enabled via the arterial blood supply to liver tumors and utilized in current clinical practice which is called chemoembolization or radioembolization. During our study, we developed Doxorubicin (Dox) loaded porous magnetic nano-clusters (Dox-pMNCs). The porous structure and carboxylic groups on the MNCs achieved high-drug loading efficiency and sustained drug release, along with magnetic properties resulting in high MRI T2-weighted image contrast. Dox-pMNC within iodinated oil, Dox-pMNCs, and Dox within iodinated oil were infused via hepatic arteries to target liver tumors in a rabbit model. MRI and histological evaluations revealed that the long-term drug release and retention of Dox-pMNCs within iodinated oil induced significantly enhanced liver cancer cell death. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Lack of difference between continuous versus intermittent heparin infusion on maintenance of intra-arterial catheter in postoperative pediatric surgery: a randomized controlled study

    Directory of Open Access Journals (Sweden)

    Maria Carolina Witkowski

    2013-12-01

    Full Text Available OBJECTIVE: To compare two systems of arterial catheters maintenance in postoperative pediatric surgery using intermittent or continuous infusion of heparin solution and to analyze adverse events related to the site of catheter insertion and the volume of infused heparin solution. METHODS: Randomized control trial with 140 patients selected for continuous infusion group (CIG and intermittent infusion group (IIG. The variables analyzed were: type of heart disease, permanence time and size of the catheter, insertion site, technique used, volume of heparin solution and adverse events. The descriptive variables were analyzed by Student's t-test and the categorical variables, by chi-square test, being significant p<0.05. RESULTS: The median age was 11 (0-22 months, and 77 (55% were females. No significant differences between studied variables were found, except for the volume used in CIG (12.0±1.2mL/24 hours when compared to IIG (5.3±3.5mL/24 hours with p<0.0003. CONCLUSIONS: The continuous infusion system and the intermittent infusion of heparin solution can be used for intra-arterial catheters maintenance in postoperative pediatric surgery, regardless of patient's clinical and demographic characteristics. Adverse events up to the third postoperative day occurred similarly in both groups. However, the intermittent infusion system usage in underweight children should be considered, due to the lower volume of infused heparin solution [ClinicalTrials.gov Identifier: NCT01097031].

  1. Differential Clearance of Rat and Human Bone Marrow-Derived Mesenchymal Stem Cells From the Brain After Intra-arterial Infusion in Rats.

    Science.gov (United States)

    Khabbal, Joonas; Kerkelä, Erja; Mitkari, Bhimashankar; Raki, Mari; Nystedt, Johanna; Mikkonen, Ville; Bergström, Kim; Laitinen, Saara; Korhonen, Matti; Jolkkonen, Jukka

    2015-01-01

    Intra-arterial (IA) delivery of bone marrow-derived mesenchymal stem cells (BM-MSCs) has shown potential as a minimally invasive therapeutic approach for stroke. The aim of the present study was to determine the whole-body biodistribution and clearance of technetium-99m ((99m)Tc)-labeled rat and human BM-MSCs after IA delivery in a rat model of transient middle cerebral artery occlusion (MCAO) using single-photon emission computed tomography (SPECT). Our hypothesis was that xenotransplantation has a major impact on the behavior of cells. Male RccHan:Wistar rats were subjected to sham operation or MCAO. Twenty-four hours after surgery, BM-MSCs (2 × 10(6) cells/animal) labeled with (99m)Tc were infused into the external carotid artery. Whole-body SPECT images were acquired 20 min, 3 h, and 6 h postinjection, after which rats were sacrificed, and organs were collected and weighed for measurement of radioactivity. The results showed that the majority of the cells were located in the brain and especially in the ipsilateral hemisphere immediately after cell infusion both in sham-operated and MCAO rats. This was followed by fast disappearance, particularly in the case of human cells. At the same time, the radioactivity signal increased in the spleen, kidney, and liver, the organs responsible for destroying cells. Further studies are needed to demonstrate whether differential cell behavior has any functional impact.

  2. Curative and organ-preserving treatment with intra-arterial carboplatin induction followed by surgery and/or radiotherapy for advanced head and neck cancer: single-center five-year results

    Directory of Open Access Journals (Sweden)

    Tinelli Carmine

    2007-04-01

    Full Text Available Abstract Background This study evaluated the feasibility, toxicity, response rate and survival of neoadjuvant superselective intra-arterial infusion of high dose carboplatin in advanced head and neck cancer. Methods Forty-six patients with primary head and neck squamous cell carcinoma received 3 cycles of intra-arterial carboplatin (300 to 350 mg/m2 per cycle every 2 weeks, followed by radiotherapy or surgery plus radiotherapy. Results No complications or severe toxicity occurred. Sixteen patients (35% were complete responders, 20 (43% partial responders while 10 (22% did not respond to treatment. After completion of the multimodality treatment, 38/46 patients (83% were complete responders. After a 5-year follow-up period, 18/46 patients (39% are alive and disease-free, 3 (6,5% have died of a second primary tumor and 25 (54,5% have died of the disease. Conclusion Intra-arterial carboplatin induction chemotherapy is a safe, well-tolerated technique that discriminates between responders and non-responders and so may have prognostic significance in planning further integrated treatments aimed to organ preservation for advanced head and neck carcinomas.

  3. Sonographic detection of intrarenal and intra-arterial fungus balls in a preterm infant due to systemic candidiasis

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    Reither, M.; Schumacher, R.; Hagel, K.J.; Hering, F.

    1983-10-01

    Shortly after birth a preterm infant suffering from aspiration syndrome and subsequent Pseudomonas aeruginosa sepsis showed signs of renal insufficiency and mycotic infection: yeast cells were identified in several urinalyses; there was also an increasing anti-candida IgM antibody titer. At the same time sonographic examinations revealed an increasing echogenicity of the renal cortex and echogenic masses of variable size which did not cause acoustic shadows in both enlarged kidneys. A few days later, we found a right-sided hydronephrosis caused by an intraureteric prevesical mass of equal echogenicity. As we could observe sonographically, the aggressive antimycotic therapy was successful. Eleven weeks later there were signs of cardiac insufficiency. An angiographically demonstrated filling defect, within the pulmonary artery, showed the same sonographic findings as the previously found intrarenal masses. The baby underwent embolectomy and recovered. The thrombotic material contained yeast cells giving evidence of systemic candidasis. Provided appropriate equipment is available, ultrasound today is an excellent non-invasive screening and followup method not only for echoencephalography, but also for more complicated neonatologic problems as seen here. The detailed observation of a changing echogenicity of the renal cortex and pelvis is important and often allows a decisive diagnostic clue before other radiological methods become conclusive.

  4. The impact of alteplase on pulmonary graft function in donation after circulatory death – An experimental study

    Directory of Open Access Journals (Sweden)

    Annika Liersch-Nordqvist

    2017-10-01

    Conclusions: All the lungs showed excellent blood gases after EVLP, and they all meet the criteria's for clinical lung transplantation. The use of alteplase did not seem to have any obvious benefit to the donor lungs in a DCD situation. The donor lungs treated with alteplas showed slightly better blood gases and slightly lower PVR compared to the group without alteplas, however the difference was not significant. DCD appears to be a safe and effective method to expand the donor pool.

  5. Pretransplant Intra-arterial Liver-Directed Therapy Does Not Increase the Risk of Hepatic Arterial Complications in Liver Transplantation: A Single-Center 10-Year Experience.

    Science.gov (United States)

    Kallini, Joseph R; Gabr, Ahmed; Ali, Rehan; Abouchaleh, Nadine; Riaz, Ahsun; Baker, Talia; Kulik, Laura; Caicedo, Juan; Salem, Riad; Lewandowski, Robert J

    2017-09-12

    To investigate the association between pretransplant intra-arterial liver-directed therapy (IAT) for hepatocellular carcinoma (HCC) and hepatic arterial complications (HAC) in orthotopic liver transplantation (OLT) [namely hepatic artery thrombosis (HAT) and/or the need for hepatic arterial conduit]. A total of 175 HCC patients (mean age: 60 years) underwent IAT with either transarterial chemoembolization or yttrium-90 (90Y) transarterial radioembolization prior to OLT between 2003 and 2013. A matched control cohort of 159 HCC patients who underwent OLT without prior IAT was selected. Incidence of HAC in both cohorts was investigated. The categorical differences between both cohorts were calculated by chi-square test. Among the 175 patients (chemoembolization, n = 82; radioembolization, n = 93), 8 (5%) required conduits due to HA disease (chemoembolization, n = 6; radioembolization, n = 2), 3 (2%) developed HAT (chemoembolization, n = 2; radioembolization, n = 1). Eleven of 175 patients (6.7%) had HAC. Of the 159 control patients, 6 (4%) needed conduits for HA disease and 3 (2%) developed HAT. Nine of 159 patients (5.7%) had HAC. Chi-square analysis between the IAT cohort and the control group yielded a p value of 0.810. When comparing chemoembolization to radioembolization, p = 0.076 (not significant at p < 0.05). Although aggressive pretransplant radioembolization and chemoembolization are both utilized in most liver transplant centers, neither appears to increase the risk of peri-transplant hepatic arterial complications in HCC patients.

  6. Selective boron delivery by intra-arterial injection of BSH-WOW emulsion in hepatic cancer model for neutron capture therapy.

    Science.gov (United States)

    Yanagie, Hironobu; Dewi, Novriana; Higashi, Syushi; Ikushima, Ichiro; Seguchi, Koji; Mizumachi, Ryoji; Murata, Yuji; Morishita, Yasuyuki; Shinohara, Atsuko; Mikado, Shoji; Yasuda, Nakahiro; Fujihara, Mitsuteru; Sakurai, Yuriko; Mouri, Kikue; Yanagawa, Masashi; Iizuka, Tomoya; Suzuki, Minoru; Sakurai, Yoshinori; Masunaga, Shin-Ichiro; Tanaka, Hiroki; Matsukawa, Takehisa; Yokoyama, Kazuhito; Fujino, Takashi; Ogura, Koichi; Nonaka, Yasumasa; Sugiyama, Hirotaka; Kajiyama, Tetsuya; Yui, Sho; Nishimura, Ryohei; Ono, Koji; Takamoto, Sinichi; Nakajima, Jun; Ono, Minoru; Eriguchi, Masazumi; Hasumi, Kenichiro; Takahashi, Hiroyuki

    2017-06-01

    Boron neutron-capture therapy (BNCT) has been used to inhibit the growth of various types of cancers. In this study, we developed a (10)BSH-entrapped water-in-oil-in-water (WOW) emulsion, evaluated it as a selective boron carrier for the possible application of BNCT in hepatocellular carcinoma treatment. We prepared the (10)BSH-entrapped WOW emulsion using double emulsification technique and then evaluated the delivery efficacy by performing biodistribution experiment on VX-2 rabbit hepatic tumour model with comparison to iodized poppy-seed oil mix conventional emulsion. Neutron irradiation was carried out at Kyoto University Research Reactor with an average thermal neutron fluence of 5 × 10(12) n cm(-2). Morphological and pathological analyses were performed on Day 14 after neutron irradiation. Biodistribution results have revealed that (10)B atoms delivery with WOW emulsion was superior compared with those using iodized poppy-seed oil conventional emulsion. There was no dissemination in abdomen or lung metastasis observed after neutron irradiation in the groups treated with (10)BSH-entrapped WOW emulsion, whereas many tumour nodules were recognized in the liver, abdominal cavity, peritoneum and bilateral lobes of the lung in the non-injected group. Tumour growth suppression and cancer-cell-killing effect was observed from the morphological and pathological analyses of the (10)BSH-entrapped WOW emulsion-injected group, indicating its feasibility to be applied as a novel intra-arterial boron carrier for BNCT. Advances in knowledge: The results of the current study have shown that entrapped (10)BSH has the potential to increase the range of therapies available for hepatocellular carcinoma which is considered to be one of the most difficult tumours to cure.

  7. Intra-Arterial Chemotherapy as Primary Therapy for Retinoblastoma in Infants Less than 3 Months of Age: A Series of 10 Case-Studies.

    Directory of Open Access Journals (Sweden)

    Miaojuan Chen

    Full Text Available Retinoblastoma is the most common primary malignant intra-ocular tumor in children. Although intra-arterial chemotherapy (IAC by selectively infusing chemotherapy through the ophthalmic artery has become an essential technique in the treatment of advanced intra-ocular retinoblastoma in children, the outcome of IAC as primary therapy for infants less than 3 months of age remains unknown. In this retrospective study, we reviewed the outcome of IAC as primary therapy for retinoblastoma in infants less than 3 months of age.We retrospectively reviewed ten retinoblastoma patients attending our center from January 2009 to September 2015 and beginning primary IAC before the age of 3 months. The patient characteristics, overall outcomes and therapy-related complications were assessed.The mean patient age at the first IAC treatment was 10.4 weeks (range 4.9-12.9 weeks. These eyes were classified according to the International Classification of Retinoblastoma (ICRB as group A (n = 0, B (n = 2, C (n = 0, D (n = 9, or E (n = 2. A total of 28 catheterizations were performed, and the procedure was stopped in one patient because of internal carotid artery spasm. Each eye received a mean of 2.6 cycles of IAC (range 2-4 cycles. After IAC with a mean follow-up of 28.3 months (range 9-65 months, tumor regression was observed in 12 of 13 eyes. One eye was enucleated due to tumor progression. All patients are alive and no patient has developed metastatic disease or other malignancies.Our experience suggests IAC as primary therapy is a feasible and promising treatment for retinoblastoma in infants less than 3 months of age.

  8. Superselective intra-arterial infusion of high-dose cisplatin combined with radiation therapy for head and neck carcinoma. Experience of Yamagata University Hospital

    Energy Technology Data Exchange (ETDEWEB)

    Hamamoto, Yasushi; Niino, Keiji; Ishiyama, Hiromichi; Koike, Shuji; Hosoya, Takaaki; Aoyagi, Masaru [Yamagata Univ. (Japan). School of Medicine

    2003-03-01

    Local effectiveness and complication of superselective intra-arterial infusion of high-dose cisdiamminedichloroplatinum (CDDP) (SIC) combined with radiation therapy (RT) were investigated. Between 1998 and 2000, 18 head and neck carcinomas including 10 maxillary carcinomas (T3; 1, T4; 9), 3 oral cavity carcinomas (T2; 1, T4; 2), and 5 oropharyngeal carcinomas (T2; 2, T4; 3) were treated with SIC and RT with or without surgery. CDDP of 100-150 mg/body was administered weekly in principle for 2-9 weeks (mean: 4.9) with the simultaneous administration of sodium thiosulfate. Radiation doses ranged from 40 Gy to 70 Gy (mean: 56.8 Gy). Complete response was obtained in 7 of 10 maxillary carcinomas, 2 of 3 oral-cavity carcinomas, and 2 of 5 oropharyngeal carcinomas, respectively. When surgical intervention was performed if necessary, 2-year local control rates for maxillary carcinoma, and other carcinoma including oral-cavity carcinoma and oropharyngeal carcinoma were 80% and 63% respectively. Two-year local control rates for T4 maxillary carcinoma, and other T4 carcinoma including oral-cavity carcinoma and oropharyngeal carcinoma were 78% and 40% respectively. Two-year overall survival rates for all cases, maxillary carcinoma, and oral-cavity/oropharyngeal carcinoma were 88%, 90% and 86% respectively. All local recurrences occurred within 6 months from the initiation of treatment. The systemic toxicity of weekly SIC was comparatively mild; however, a total CDDP dose of 1,000 mg or more and/or RT of 70 Gy induced complications of local soft tissue such as mucosal ulcer and fistula. SIC combined with RT is useful to improve the local control/survival rates and to avoid the aggressive surgery for locally advanced head and neck carcinoma. A high total dose of CDDP and/or RT of a comparatively high dose may be risk factors for local soft tissue complications. (author)

  9. The effects of alteplase 3 to 6 hours after stroke in the EPITHET-DEFUSE combined dataset: post hoc case-control study.

    Science.gov (United States)

    Ogata, Toshiyasu; Christensen, Soren; Nagakane, Yoshinari; Ma, Henry; Campbell, Bruce C V; Churilov, Leonid; Lansberg, Maarten G; Straka, Matus; De Silva, Deidre A; Mlynash, Michael; Bammer, Roland; Olivot, Jean-Marc; Desmond, Patricia M; Albers, Gregory W; Davis, Stephen M; Donnan, Geoffrey A

    2013-01-01

    Two phase 2 studies of alteplase in acute ischemic stroke 3 to 6 hours after onset, Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET; a randomized, controlled, double-blinded trial), and Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study (DEFUSE; open-label, treatment only) using MR imaging-based outcomes have been conducted. We have pooled individual patient data from these to assess the response to alteplase. The primary hypothesis was that alteplase would significantly attenuate infarct growth compared with placebo in mismatch-selected patients using coregistration techniques. The EPITHET-DEFUSE study datasets were pooled while retaining the original inclusion and exclusion criteria. Significant hypoperfusion was defined as a Tmax delay >6 seconds), and coregistration techniques were used to define MR diffusion-weighted imaging/perfusion-weighted imaging mismatch. Neuroimaging, parameters including reperfusion, recanalization, symptomatic intracerebral hemorrhage, and clinical outcomes were assessed. Alteplase and placebo groups were compared for the primary outcome of infarct growth as well for secondary outcome measures. From 165 patients with adequate MR scans in the EPITHET-DEFUSE pooled data, 121 patients (73.3%) were found to have mismatch. For the primary outcome analysis, 60 patients received alteplase and 41 placebo. Mismatch patients receiving alteplase had significantly attenuated infarct growth compared with placebo (P=0.025). The reperfusion rate was also increased (62.7% vs 31.7%; P=0.003). Mortality and clinical outcomes were not different between groups. The data provide further evidence that alteplase significantly attenuates infarct growth and increases reperfusion compared with placebo in the 3- to 6- hour time window in patients selected based on MR penumbral imaging.

  10. Type I interferon receptor in peripheral blood mononuclear cells may predict response to intra-arterial 5-fluorouracil + interferon therapy for advanced hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Korenaga K

    2011-04-01

    Full Text Available Yasuyuki Tomiyama1, Naoko Yoshioka1, Yoshiaki Yanai2,3, Tomoya Kawase1, Sohji Nishina1, Yuichi Hara1, Koji Yoshida1, Keiko Korenaga1, Masaaki Korenaga1, Keisuke Hino11Department of Hepatology and Pancreatology, Kawasaki Medical University, Kurashiki, Japan; 2Institute of Fujisaki, Hayashibara Biochemical Lab Inc, Okayama, Japan; 3Pharmaceutical Marketing Division, Otsuka Pharmaceutical Co Ltd, Tokyo, JapanBackground: Type 1 interferon alpha receptor 2 (IFNAR2 in the liver has been reported to be a predictive factor for the response to intra-arterial 5-fluorouracil (5-FU + systemic interferon (IFN-alpha combination therapy in patients with advanced hepatocellular carcinoma. We tested whether IFNAR2 expression in peripheral blood mononuclear cells could predict the response to 5-FU + IFN.Methods: Predictive factors for survival and response to therapy were determined in 30 patients with advanced hepatocellular carcinoma who underwent treatment with 5-FU + IFN. IFNAR2 expression in peripheral blood mononuclear cells was measured in 11 of the 30 patients.Results: With a mean number of 4.2 courses of combination therapy, one patient (3% showed a complete response, eight (27% showed partial responses, 13 (43% had stable disease, and eight (27% showed progressive disease. The median survival time of responders (complete response/partial response was 12.7 months and that of nonresponders (stable disease/progressive disease was 7.5 months. The one-year and two-year cumulative survival rates of responders and nonresponders were 87/69% and 40/11%, respectively (P = 0.019. Multivariate analysis identified response to therapy (P = 0.037 as the sole independent determinant of survival. The expression level of IFNAR2 in peripheral blood mononuclear cells was significantly (P = 0.012 higher in responders (6.5 ± 2.4 than in nonresponders (2.4 ± 0.6, even though no clinical factors were identified as being associated with the response to the combination

  11. Improved Visibility of Metastatic Disease in the Liver During Intra-Arterial Therapy Using Delayed Arterial Phase Cone-Beam CT

    Energy Technology Data Exchange (ETDEWEB)

    Schernthaner, Ruediger E., E-mail: ruediger.schernthaner@meduniwien.ac.at [Medical University of Vienna, Section of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy (Austria); Haroun, Reham R., E-mail: rehamharoun1989@gmail.com; Duran, Rafael, E-mail: rafaelduran.md@gmail.com; Lee, Howard, E-mail: mail2howielee@gmail.com; Sahu, Sonia, E-mail: sonia.p.sahu@gmail.com; Sohn, Jae Ho, E-mail: sohn87@gmail.com; Chapiro, Julius, E-mail: j.chapiro@googlemail.com; Zhao, Yan, E-mail: yanzhao211@163.com; Gorodetski, Boris, E-mail: boris.gorodetski@charite.de; Fleckenstein, Florian, E-mail: florian.fleckenstein@charite.de; Smolka, Susanne, E-mail: susanne.smolka@charite.de [Yale University School of Medicine, Department of Radiology and Biomedical Imaging (United States); Radaelli, Alessandro, E-mail: Alessandro.Radaelli@philips.com; Bom, Imramsjah Martijn van der, E-mail: martijn.van.der.bom@philips.com [Philips Healthcare, Image-Guided Therapy Systems (Netherlands); Lin, MingDe, E-mail: ming.lin@philips.com; Geschwind, Jean Francois, E-mail: jeff.geschwind@yale.edu [Yale University School of Medicine, Department of Radiology and Biomedical Imaging (United States)

    2016-10-15

    PurposeTo compare the visibility of liver metastases on dual-phase cone-beam CT (DP-CBCT) and digital subtraction angiography (DSA), with reference to preinterventional contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver.MethodsThis IRB-approved, retrospective study included 28 patients with neuroendocrine (NELM), colorectal (CRCLM), or sarcoma (SLM) liver metastases who underwent DP-CBCT during intra-arterial therapy (IAT) between 01/2010 and 10/2014. DP-CBCT was acquired after a single contrast agent injection in the tumor-feeding arteries at early and delayed arterial phases (EAP and DAP). The visibility of each lesion was graded by two radiologists in consensus on a three-rank scale (complete, partial, none) on DP-CBCT and DSA images using CE-MRI as reference.Results47 NELM, 43 CRCLM, and 16 SLM were included. On DSA 85.1, 44.1, and 37.5 % of NELM, CRCLM, and SLM, were at least partially depicted, respectively. EAP-CBCT yielded significantly higher sensitivities of 88.3 and 87.5 % for CRCLM and SLM, respectively (p < 0.01), but not for NELM (89.4 %; p = 1.0). On DAP-CBCT all NELM, CRCLM, and SLM were visible (p < 0.001). Complete depiction was achieved on DSA for 59.6, 16.3, and 18.8 % of NELM, CRCLM, and SLM, respectively. The complete depiction rate on EAP-CBCT was significantly higher for CRCLM (46.5 %; p < 0.001), lower for NELM (40.4 %; p = 0.592), and similar for SLM (25 %, p = 0.399). On DAP-CBCT however, the highest rates of complete depiction were found—NELM (97.8 %; p = 0.008), CRCLM (95.3 %; p = 0.008), and SLM (100 %; p < 0.001).ConclusionDAP-CBCT substantially improved the visibility of liver metastases during IAT. Future studies need to evaluate the clinical impact.

  12. Feasibility evaluation of neutron capture therapy for hepatocellular carcinoma using selective enhancement of boron accumulation in tumour with intra-arterial administration of boron-entrapped water-in-oil-in-water emulsion.

    Science.gov (United States)

    Yanagie, Hironobu; Kumada, Hiroaki; Nakamura, Takemi; Higashi, Syushi; Ikushima, Ichiro; Morishita, Yasuyuki; Shinohara, Atsuko; Fijihara, Mitsuteru; Suzuki, Minoru; Sakurai, Yoshinori; Sugiyama, Hirotaka; Kajiyama, Tetsuya; Nishimura, Ryohei; Ono, Koji; Nakajima, Jun; Ono, Minoru; Eriguchi, Masazumi; Takahashi, Hiroyuki

    2011-12-01

    Hepatocellular carcinoma (HCC) is one of the most difficult to cure with surgery, chemotherapy, or other combinational therapies. In the treatment of HCC, only 30% patients can be operated due to complication of liver cirrhosis or multiple intrahepatic tumours. Tumour cell destruction in boron neutron-capture therapy (BNCT) is due to the nuclear reaction between (10)B atoms and thermal neutrons, so it is necessary to accumulate a sufficient quantity of (10)B atoms in tumour cells for effective tumour cell destruction by BNCT. Water-in-oil-in-water (WOW) emulsion has been used as the carrier of anti-cancer agents on intra-arterial injections in clinical. In this study, we prepared (10)BSH entrapped WOW emulsion by double emulsifying technique using iodized poppy-seed oil (IPSO), (10)BSH and surfactant, for selective intra-arterial infusion to HCC, and performed simulations of the irradiation in order to calculate the dose delivered to the patients. WOW emulsion was administrated with intra-arterial injections via proper hepatic artery on VX-2 rabbit hepatic tumour models. We simulated the irradiation of epithermal neutron and calculated the dose delivered to the tissues with JAEA computational dosimetry system (JCDS) at JRR4 reactor of Japan Atomic Research Institute, using the CT scans of a HCC patient. The (10)B concentrations in VX-2 tumour obtained by delivery with WOW emulsion were superior to those by conventional IPSO mix emulsion. According to the rabbit model, the boron concentrations (ppm) in tumour, normal liver tissue, and blood are 61.7, 4.3, and 0.1, respectively. The results of the simulations show that normal liver biologically weighted dose is restricted to 4.9 Gy-Eq (CBE; liver tumour: 2.5, normal liver: 0.94); the maximum, minimum, and mean tumour weighted dose are 43.1, 7.3, and 21.8 Gy-Eq, respectively, in 40 min irradiation. In this study, we show that (10)B entrapped WOW emulsion could be applied to novel intra-arterial boron delivery carrier

  13. Hepatic intra-arterial chemotherapy (HIAC) of high dose mitomycin and epirubicin combined with caval chemofiltration versus prolonged low doses in liver metastases from colorectal cancer: a prospective randomized clinical study.

    Science.gov (United States)

    Fiorentini, G; Poddie, D B; Cantore, M; Rossi, S; Tumolo, S; Dentico, P; Bernardeschi, P; Guadagni, S; Rossi, G; Valori, V M; De Simone, M

    2004-11-01

    A multicenter randomized study comparing high dose of mitomycin and epirubicin given as hepatic intra-arterial chemotherapy (HIAC) combined with caval chemofiltration (CF) versus low doses of the same drugs in unresectable liver metastases from colorectal cancer showed a significant improvement in the survival rate of the 20 patients treated with high dose compared to the 22 patients treated with low doses with a 1 year survival of 69% vs 39%. The median survival was 17 vs 11 months and the responses were 65% vs 33%. Toxicity was colangitis in 50% of patients considered. The extrahepatic progression was similar in the two groups (7/20 vs 8/22).

  14. Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial.

    Science.gov (United States)

    Davis, Stephen M; Donnan, Geoffrey A; Parsons, Mark W; Levi, Christopher; Butcher, Kenneth S; Peeters, Andre; Barber, P Alan; Bladin, Christopher; De Silva, Deidre A; Byrnes, Graham; Chalk, Jonathan B; Fink, John N; Kimber, Thomas E; Schultz, David; Hand, Peter J; Frayne, Judith; Hankey, Graeme; Muir, Keith; Gerraty, Richard; Tress, Brian M; Desmond, Patricia M

    2008-04-01

    Whether intravenous tissue plasminogen activator (alteplase) is effective beyond 3 h after onset of acute ischaemic stroke is unclear. We aimed to test whether alteplase given 3-6 h after stroke onset promotes reperfusion and attenuates infarct growth in patients who have a mismatch in perfusion-weighted MRI (PWI) and diffusion-weighted MRI (DWI). We prospectively and randomly assigned 101 patients to receive alteplase or placebo 3-6 h after onset of ischaemic stroke. PWI and DWI were done before and 3-5 days after therapy, with T2-weighted MRI at around day 90. The primary endpoint was infarct growth between baseline DWI and the day 90 T2 lesion in mismatch patients. Major secondary endpoints were reperfusion, good neurological outcome, and good functional outcome. Patients, caregivers, and investigators were unaware of treatment allocations. Primary analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00238537. We randomly assigned 52 patients to alteplase and 49 patients to placebo. Mean age was 71.6 years, and median score on the National Institutes of Health stroke scale was 13. 85 of 99 (86%) patients had mismatch of PWI and DWI. The geometric mean infarct growth (exponential of the mean log of relative growth) was 1.24 with alteplase and 1.78 with placebo (ratio 0.69, 95% CI 0.38-1.28; Student's t test p=0.239); the median relative infarct growth was 1.18 with alteplase and 1.79 with placebo (ratio 0.66, 0.36-0.92; Wilcoxon's test p=0.054). Reperfusion was more common with alteplase than with placebo and was associated with less infarct growth (p=0.001), better neurological outcome (p<0.0001), and better functional outcome (p=0.010) than was no reperfusion. Alteplase was non-significantly associated with lower infarct growth and significantly associated with increased reperfusion in patients who had mismatch. Because reperfusion was associated with improved clinical outcomes, phase III trials beyond 3 h after treatment are

  15. Factors that influence clinicians' decisions to offer intravenous alteplase in acute ischemic stroke patients with uncertain treatment indication: Results of a discrete choice experiment.

    Science.gov (United States)

    De Brún, Aoife; Flynn, Darren; Ternent, Laura; Price, Christopher I; Rodgers, Helen; Ford, Gary A; Rudd, Matthew; Lancsar, Emily; Simpson, Stephen; Teah, John; Thomson, Richard G

    2017-01-01

    Background Treatment with intravenous alteplase for eligible patients with acute ischemic stroke is underused, with variation in treatment rates across the UK. This study sought to elucidate factors influencing variation in clinicians' decision-making about this thrombolytic treatment. Methods A discrete choice experiment using hypothetical patient vignettes framed around areas of clinical uncertainty was conducted with UK-based clinicians. Mixed logit regression analyses were conducted on the data. Results A total of 138 clinicians completed the discrete choice experiment. Seven patient factors were individually predictive of increased likelihood of immediately offering IV alteplase (compared to reference levels in brackets): stroke onset time 2 h 30 min [50 min]; pre-stroke dependency mRS 3 [mRS 4]; systolic blood pressure 185 mm/Hg [140 mm/Hg]; stroke severity scores of NIHSS 5 without aphasia, NIHSS 14 and NIHSS 23 [NIHSS 2 without aphasia]; age 85 [68]; Afro-Caribbean [white]. Factors predictive of withholding treatment with IV alteplase were: age 95 [68]; stroke onset time of 4 h 15 min [50 min]; severe dementia [no memory problems]; SBP 200 mm/Hg [140 mm/Hg]. Three clinician-related factors were predictive of an increased likelihood of offering IV alteplase (perceived robustness of the evidence for IV alteplase; thrombolyzing more patients in the past 12 months; and high discomfort with uncertainty) and one with a decreased likelihood (high clinician comfort with treating patients outside the licensing criteria). Conclusions Both patient- and clinician-related factors have a major influence on the use of alteplase to treat patients with acute ischemic stroke. Clinicians' views of the evidence, comfort with uncertainty and treating patients outside the license criteria are important factors to address in programs that seek to reduce variation in care quality regarding treatment with IV alteplase. Further research is needed to further understand

  16. Análise de custo-efetividade da trombólise com alteplase no Acidente Vascular Cerebral Análisis de costo-efectividad de la trombólisis con alteplase en el accidente vascular cerebral Analysis of the cost-effectiveness of thrombolysis with alteplase in stroke

    Directory of Open Access Journals (Sweden)

    Denizar Vianna Araújo

    2010-07-01

    Full Text Available FUNDAMENTO: Acidente Vascular Cerebral (AVC é a principal causa de óbito no Brasil e pouca informação está disponível sobre custo do tratamento. OBJETIVO: Elaborar análise de custo-efetividade da trombólise no AVC, até três horas após o início dos sintomas, comparando o tratamento com alteplase versus conservador, sob a perspectiva do Sistema Único de Saúde (SUS. MÉTODOS: Modelo de análise de decisão foi desenvolvido para comparar os dois tratamentos. Ciclos foram considerados, durante os quais pacientes poderiam transitar entre cinco estágios de incapacidade pós-AVC, baseados na escala modificada de Rankin. A probabilidade de apresentar hemorragia intracerebral no primeiro ano foi obtida do ensaio NINDS. Para os anos subsequentes, ciclos de um ano foram considerados, para contabilizar a mortalidade dos pacientes. O desfecho foi expresso em Anos de Vida Ajustados pela Qualidade (QALY. Tanto os custos diretos quanto os indiretos foram considerados na análise. Custos e desfecho foram descontados em 5% ao ano. RESULTADOS: No primeiro ano, o QALY ganho foi de 0,06 para ambos os gêneros, com custo incremental de R$ 2.558 para homens e R$ 2.312 para mulheres. A razão de custo-efetividade incremental em um ano foi de R$ 40.539 / QALY (USD 28.956 para homens e R$ 36.640 / QALY (USD 26.171 para mulheres. Após o segundo ano, o tratamento com alteplase reduziu o custo do tratamento (índice de Paridade do Poder de Compra US$ 1 = R$ 1,4. CONCLUSÃO: Terapia trombolítica com alteplase nas primeiras três horas após o AVC é custo-efetiva no cenário do Sistema Único de Saúde.FUNDAMENTO: Accidente Vascular Cerebral (AVC es la principal causa de óbito en el Brasil y poca información está disponible sobre el costo del tratamiento. OBJETIVO: Elaborar análisis de costo-efectividad de la trombólisis en el AVC, hasta tres horas después del comienzo de los síntomas, comparando el tratamiento con alteplase versus conservador, bajo la

  17. Side Effects of Long-Term Continuous Intra-arterial Nimodipine Infusion in Patients with Severe Refractory Cerebral Vasospasm after Subarachnoid Hemorrhage.

    Science.gov (United States)

    Kieninger, Martin; Flessa, Julia; Lindenberg, Nicole; Bele, Sylvia; Redel, Andreas; Schneiker, André; Schuierer, Gerhard; Wendl, Christina; Graf, Bernhard; Silbereisen, Vera

    2017-07-06

    Long-term continuous intra-arterial nimodipine infusion (CIAN) is a rescue therapy option in cases of severe refractory cerebral vasospasm (CV) following acute non-traumatic subarachnoid hemorrhage (SAH). However, CIAN therapy can be associated with relevant side effects. Available studies focus on intracerebral complications, whereas extracerebral side effects are rarely examined. Aim of the present study was to generate descriptive data on the clinical course during CIAN therapy and expectable extracerebral side effects. All patients treated with CIAN therapy for at least 5 days between May 2011 and December 2015 were included. We retrospectively extracted data from the patient data management system regarding the period between 2 days before the beginning and 5 days after the termination of CIAN therapy to analyze the course of ventilation parameters and pulmonary gas exchange, hemodynamic support, renal and liver function, integrity of the gastrointestinal tract, and the occurrence of infectious complications. In addition, we recorded the mean daily values of intracranial pressure (ICP) and intracerebral problems associated with CIAN therapy. Data from 28 patients meeting inclusion criteria were analyzed. The mean duration of long-term CIAN therapy was 10.5 ± 4.5 days. Seventeen patients (60.7%) reached a good outcome level (Glasgow Outcome Scale [GOS] 4-5) 6 months after SAH. An impairment of the pulmonary gas exchange occurred only at the very beginning of CIAN therapy. The required vasopressor support with norepinephrine was significantly higher on all days during and the first day after CIAN therapy compared to the situation before starting CIAN therapy. Two patients required short-time resuscitation due to cardiac arrest during CIAN therapy. Acute kidney injury was observed in four patients, and one of them required renal replacement therapy with sustained low-efficiency daily dialysis. During CIAN therapy, 23 patients (82.1%) needed the escalation

  18. Application of neutron capture autoradiography to Boron Delivery seeking techniques for selective accumulation of boron compounds to tumor with intra-arterial administration of boron entrapped water-in-oil-in-water emulsion

    Science.gov (United States)

    Mikado, S.; Yanagie, H.; Yasuda, N.; Higashi, S.; Ikushima, I.; Mizumachi, R.; Murata, Y.; Morishita, Y.; Nishimura, R.; Shinohara, A.; Ogura, K.; Sugiyama, H.; Iikura, H.; Ando, H.; Ishimoto, M.; Takamoto, S.; Eriguchi, M.; Takahashi, H.; Kimura, M.

    2009-06-01

    It is necessary to accumulate the 10B atoms selectively to the tumor cells for effective Boron Neutron Capture Therapy (BNCT). In order to achieve an accurate measurement of 10B accumulations in the biological samples, we employed a technique of neutron capture autoradiography (NCAR) of sliced samples of tumor tissues using CR-39 plastic track detectors. The CR-39 track detectors attached with the biological samples were exposed to thermal neutrons in the thermal column of the JRR3 of Japan Atomic Energy Agency (JAEA). We obtained quantitative NCAR images of the samples for VX-2 tumor in rabbit liver after injection of 10BSH entrapped water-in-oil-in-water (WOW) emulsion by intra-arterial injection via proper hepatic artery. The 10B accumulations and distributions in VX-2 tumor and normal liver of rabbit were investigated by means of alpha-track density measurements. In this study, we showed the selective accumulation of 10B atoms in the VX-2 tumor by intra-arterial injection of 10B entrapped WOW emulsion until 3 days after injection by using digitized NCAR images (i.e. alpha-track mapping).

  19. Application of neutron capture autoradiography to Boron Delivery seeking techniques for selective accumulation of boron compounds to tumor with intra-arterial administration of boron entrapped water-in-oil-in-water emulsion

    Energy Technology Data Exchange (ETDEWEB)

    Mikado, S. [Physical Science Laboratories, College of Industrial Technology, Nihon University, Chiba (Japan)], E-mail: mikado@cit.nihon-u.ac.jp; Yanagie, H. [Department of Nuclear Engineering and Management, University of Tokyo, Tokyo (Japan); Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, Tokyo (Japan); Yasuda, N. [Fundamental Technology Center, National Institute of Radiological Sciences, Chiba (Japan); Higashi, S.; Ikushima, I. [Miyakonojyo Metropolitan Hospital, Miyazaki (Japan); Mizumachi, R.; Murata, Y. [Department of Pharmacology, Kumamoto Institute Branch, Mitsubishi Chemical Safety Institute Ltd., Kumamoto (Japan); Morishita, Y. [Department of Human and Molecular Pathology, University of Tokyo, Tokyo (Japan); Nishimura, R. [Faculty of Agriculture, Laboratory of Veterinary Surgery, University of Tokyo (Japan); Shinohara, A. [Department of Humanities, The Graduate School of Seisen University, Tokyo (Japan); Ogura, K. [Physical Science Laboratories, College of Industrial Technology, Nihon University, Chiba (Japan); Sugiyama, H. [Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, Tokyo (Japan); Iikura, H.; Ando, H. [Japan Atomic Energy Agency, Ibaraki (Japan); Ishimoto, M. [Department of Nuclear Professional School, University of Tokyo (Japan); Takamoto, S. [Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, Tokyo (Japan); Department of Cardiac Surgery, University of Tokyo Hospital, Tokyo (Japan); Eriguchi, M. [Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, Tokyo (Japan); Department of Microbiology, Syowa University School of Pharmaceutical Sciences, Tokyo (Japan); Takahashi, H. [Department of Nuclear Engineering and Management, University of Tokyo, Tokyo (Japan); Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, Tokyo (Japan); Kimura, M. [Department of Physics, Toho University, Chiba (Japan)

    2009-06-21

    It is necessary to accumulate the {sup 10}B atoms selectively to the tumor cells for effective Boron Neutron Capture Therapy (BNCT). In order to achieve an accurate measurement of {sup 10}B accumulations in the biological samples, we employed a technique of neutron capture autoradiography (NCAR) of sliced samples of tumor tissues using CR-39 plastic track detectors. The CR-39 track detectors attached with the biological samples were exposed to thermal neutrons in the thermal column of the JRR3 of Japan Atomic Energy Agency (JAEA). We obtained quantitative NCAR images of the samples for VX-2 tumor in rabbit liver after injection of {sup 10}BSH entrapped water-in-oil-in-water (WOW) emulsion by intra-arterial injection via proper hepatic artery. The {sup 10}B accumulations and distributions in VX-2 tumor and normal liver of rabbit were investigated by means of alpha-track density measurements. In this study, we showed the selective accumulation of {sup 10}B atoms in the VX-2 tumor by intra-arterial injection of {sup 10}B entrapped WOW emulsion until 3 days after injection by using digitized NCAR images (i.e. alpha-track mapping)

  20. Feasibility evaluation of neutron capture therapy for hepatocellular carcinoma using selective enhancement of boron accumulation in tumour with intra-arterial administration of boron-entrapped water-in-oil-in-water emulsion

    Energy Technology Data Exchange (ETDEWEB)

    Yanagie, Hironobu, E-mail: yanagie@n.t.u-tokyo.ac.jp [Dept of Nuclear Engineering and Management, Graduate School of Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656 (Japan)] [Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, Tokyo (Japan); Kumada, Hiroaki [Proton Medical Research Center, University of Tsukuba, Ibaraki (Japan); Nakamura, Takemi [Japan Atomic Energy Research Institute, Ibaraki (Japan); Higashi, Syushi [Dept of Surgery, Ebihara Memorial Hospital, Miyazaki (Japan)] [Kyushu Industrial Sources Foundation, Miyazaki (Japan); Ikushima, Ichiro [Dept of Radiology, Miyakonojyo Metropolitan Hospital, Miyazaki (Japan); Morishita, Yasuyuki [Dept of Human and Molecular Pathology, Graduate School of Medicine, University of Tokyo, Tokyo (Japan); Shinohara, Atsuko [Dept of Humanities, Graduate School of Seisen University, Tokyo (Japan); Fijihara, Mitsuteru [SPG Techno Ltd. Co., Miyazaki (Japan); Suzuki, Minoru; Sakurai, Yoshinori [Research Reactor Institute, Kyoto University, Osaka (Japan); Sugiyama, Hirotaka [Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, Tokyo (Japan); Kajiyama, Tetsuya [Kyushu Industrial Sources Foundation, Miyazaki (Japan); Nishimura, Ryohei [Dept of Veternary Surgery, University of Tokyo Veternary Hospital, Tokyo (Japan); Ono, Koji [Research Reactor Institute, Kyoto University, Osaka (Japan); Nakajima, Jun; Ono, Minoru [Dept of Cardiothracic Surgery, University of Tokyo Hospital, Tokyo (Japan); Eriguchi, Masazumi [Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, Tokyo (Japan)] [Department of Surgery, Shin-Yamanote Hospital, Saitama (Japan); Takahashi, Hiroyuki [Dept of Nuclear Engineering and Management, Graduate School of Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656 (Japan)] [Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, Tokyo (Japan)

    2011-12-15

    Introduction: Hepatocellular carcinoma (HCC) is one of the most difficult to cure with surgery, chemotherapy, or other combinational therapies. In the treatment of HCC, only 30% patients can be operated due to complication of liver cirrhosis or multiple intrahepatic tumours. Tumour cell destruction in boron neutron-capture therapy (BNCT) is due to the nuclear reaction between {sup 10}B atoms and thermal neutrons, so it is necessary to accumulate a sufficient quantity of {sup 10}B atoms in tumour cells for effective tumour cell destruction by BNCT. Water-in-oil-in-water (WOW) emulsion has been used as the carrier of anti-cancer agents on intra-arterial injections in clinical. In this study, we prepared {sup 10}BSH entrapped WOW emulsion by double emulsifying technique using iodized poppy-seed oil (IPSO), {sup 10}BSH and surfactant, for selective intra-arterial infusion to HCC, and performed simulations of the irradiation in order to calculate the dose delivered to the patients. Materials and methods: WOW emulsion was administrated with intra-arterial injections via proper hepatic artery on VX-2 rabbit hepatic tumour models. We simulated the irradiation of epithermal neutron and calculated the dose delivered to the tissues with JAEA computational dosimetry system (JCDS) at JRR4 reactor of Japan Atomic Research Institute, using the CT scans of a HCC patient. Results and discussions: The {sup 10}B concentrations in VX-2 tumour obtained by delivery with WOW emulsion were superior to those by conventional IPSO mix emulsion. According to the rabbit model, the boron concentrations (ppm) in tumour, normal liver tissue, and blood are 61.7, 4.3, and 0.1, respectively. The results of the simulations show that normal liver biologically weighted dose is restricted to 4.9 Gy-Eq (CBE; liver tumour: 2.5, normal liver: 0.94); the maximum, minimum, and mean tumour weighted dose are 43.1, 7.3, and 21.8 Gy-Eq, respectively, in 40 min irradiation. In this study, we show that {sup 10}B

  1. Successful thrombolysis of major pulmonary embolism 5 days after lobectomy

    DEFF Research Database (Denmark)

    Eckardt, Jens; Licht, Peter B

    2012-01-01

    Aggressive intravenous thrombolysis of pulmonary emboli after major thoracic surgery has rarely been reported and is controversial because of an assumed risk of fatal bleeding. We report a 62-year old female who underwent left upper lobectomy. Her postoperative course was complicated with symptom...... with symptomatic pulmonary embolism and on postoperative day 5 she was successfully treated with intravenous thrombolysis using alteplase (Actilyse(®)) without signs of bleeding. She was discharged from the hospital 12 days postoperatively....

  2. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial.

    Science.gov (United States)

    Logallo, Nicola; Novotny, Vojtech; Assmus, Jörg; Kvistad, Christopher E; Alteheld, Lars; Rønning, Ole Morten; Thommessen, Bente; Amthor, Karl-Friedrich; Ihle-Hansen, Hege; Kurz, Martin; Tobro, Håkon; Kaur, Kamaljit; Stankiewicz, Magdalena; Carlsson, Maria; Morsund, Åse; Idicula, Titto; Aamodt, Anne Hege; Lund, Christian; Næss, Halvor; Waje-Andreassen, Ulrike; Thomassen, Lars

    2017-10-01

    Tenecteplase is a newer thrombolytic agent with some pharmacological advantages over alteplase. Previous phase 2 trials of tenecteplase in acute ischaemic stroke have shown promising results. We aimed to investigate the safety and efficacy of tenecteplase versus alteplase in patients with acute stroke who were eligible for intravenous thrombolysis. This phase 3, randomised, open-label, blinded endpoint, superiority trial was done in 13 stroke units in Norway. We enrolled adults with suspected acute ischaemic stroke who were eligible for thrombolysis and admitted within 4·5 h of symptom onset or within 4·5 h of awakening with symptoms, or who were eligible for bridging therapy before thrombectomy. Patients were randomly assigned (1:1) to receive intravenous tenecteplase 0·4 mg/kg (to a maximum of 40 mg) or alteplase 0·9 mg/kg (to a maximum of 90 mg), via a block randomisation schedule stratified by centre of inclusion. Patients were not informed of treatment allocation; treating physicians were aware of treatment allocation but those assessing the primary and secondary endpoints were not. The primary outcome was excellent functional outcome defined as modified Rankin Scale (mRS) score 0-1 at 3 months. The primary analysis was an unadjusted and non-stratified intention-to-treat analysis with last observation carried forward for imputation of missing data. This study is registered with ClinicalTrials.gov, number NCT01949948. Between Sept 1, 2012, and Sept 30, 2016, 1107 patients met the inclusion criteria and seven patients were excluded because informed consent was withdrawn or eligibility for thrombolytic treatment was reconsidered. 1100 patients were randomly assigned to the tenecteplase (n=549) or alteplase (n=551) groups. The median age of participants was 77 years (IQR 64-79) and the median National Institutes of Health Stroke Scale score at baseline was 4 points (IQR 2-8). A final diagnosis other than ischaemic stroke or transient ischaemic attack was found

  3. Efeitos cardiovasculares e renais da injeção intra-arterial de contraste radiológico iônico em cães com restrição hídrica Efectos cardiovasculares y renales de la inyección intra-arterial de contraste radiológico iónico en perros con restricción hídrica Cardiovascular and renal effects of intra-arterial injection of ionic radiological contrast in dogs under fluid restriction

    Directory of Open Access Journals (Sweden)

    Marisa Aparecida Lima Verderese

    2005-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O objetivo desta pesquisa foi estudar os efeitos agudos do contraste radiológico em situações de restrição de volume, avaliando-se os efeitos renais e cardiovasculares após a injeção intra-arterial de contraste radiológico de alta osmolaridade. MÉTODO: Participaram do estudo 16 cães anestesiados com tiopental sódico (15 mg.kg-1 e fentanil (15 µg.kg-1 em bolus, seguido de infusão contínua nas doses de 40 µg.kg-1.min-1 (tiopental sódico e 0,1 µg.kg-1.min-1 (fentanil. Foi feita hidratação com solução de glicose a 5% (0,03 mL.kg-1.min-1 e a ventilação pulmonar foi controlada mecanicamente com ar comprimido. Foram verificados os seguintes atributos: freqüência cardíaca (FC; pressão arterial média (PAM; pressão da veia cava inferior (PVI; débito cardíaco (DC; hematócrito (Ht; fluxo plasmático efetivo renal (FPER; fluxo sangüíneo renal (FSR; ritmo de filtração glomerular (RFG; fração de filtração; resistência vascular renal (RVR; volume urinário (VU; osmolaridade plasmática e urinária; depuração osmolar, depuração de água livre e depuração de sódio e de potássio; sódio e potássio plasmáticos; excreção urinária e fracionária de sódio e potássio e temperatura retal. Estes atributos foram avaliados em quatro momentos: 30 (M1, 60 (M2, 90 (M3 e 120 (M4 minutos após o início da infusão de para-aminohipurato de sódio e creatinina (início da experiência. No momento 2, no grupo G1 foi feita injeção intra-arterial de solução fisiológica a 0,9% (1,24 mL.kg-1, e no grupo G2 foi injetado contraste radiológico (1,24 mL.kg-1 pela mesma via. RESULTADOS: O grupo G1 apresentou aumento da FC, do FPER, do FSR, da osmolaridade plasmática, da depuração de sódio e da excreção urinária de sódio; apresentou ainda diminuição da osmolaridade urinária, do potássio plasmático, da depuração de potássio e da temperatura retal. No grupo G2 ocorreu aumento da FC, da

  4. Effects of alteplase for acute stroke according to criteria defining the European Union and United States marketing authorizations: Individual-patient-data meta-analysis of randomized trials.

    Science.gov (United States)

    Hacke, Werner; Lyden, Patrick; Emberson, Jonathan; Baigent, Colin; Blackwell, Lisa; Albers, Gregory; Bluhmki, Erich; Brott, Thomas; Cohen, Geoffrey; Davis, Stephen M; Donnan, Geoffrey A; Grotta, James C; Howard, George; Kaste, Markku; Koga, Masatoshi; von Kummer, Rüdiger; Lansberg, Maarten G; Lindley, Richard I; Olivot, Jean-Marc; Parsons, Mark; Sandercock, Peter Ag; Toni, Danilo; Toyoda, Kazunori; Wahlgren, Nils; Wardlaw, Joanna M; Whiteley, William N; Del Zoppo, Gregory; Lees, Kennedy R

    2018-02-01

    Background The recommended maximum age and time window for intravenous alteplase treatment of acute ischemic stroke differs between the Europe Union and United States. Aims We compared the effects of alteplase in cohorts defined by the current Europe Union or United States marketing approval labels, and by hypothetical revisions of the labels that would remove the Europe Union upper age limit or extend the United States treatment time window to 4.5 h. Methods We assessed outcomes in an individual-patient-data meta-analysis of eight randomized trials of intravenous alteplase (0.9 mg/kg) versus control for acute ischemic stroke. Outcomes included: excellent outcome (modified Rankin score 0-1) at 3-6 months, the distribution of modified Rankin score, symptomatic intracerebral hemorrhage, and 90-day mortality. Results Alteplase increased the odds of modified Rankin score 0-1 among 2449/6136 (40%) patients who met the current European Union label and 3491 (57%) patients who met the age-revised label (odds ratio 1.42, 95% CI 1.21-1.68 and 1.43, 1.23-1.65, respectively), but not in those outside the age-revised label (1.06, 0.90-1.26). By 90 days, there was no increased mortality in the current and age-revised cohorts (hazard ratios 0.98, 95% CI 0.76-1.25 and 1.01, 0.86-1.19, respectively) but mortality remained higher outside the age-revised label (1.19, 0.99-1.42). Similarly, alteplase increased the odds of modified Rankin score 0-1 among 1174/6136 (19%) patients who met the current US approval and 3326 (54%) who met a 4.5-h revised approval (odds ratio 1.55, 1.19-2.01 and 1.37, 1.17-1.59, respectively), but not for those outside the 4.5-h revised approval (1.14, 0.97-1.34). By 90 days, no increased mortality remained for the current and 4.5-h revised label cohorts (hazard ratios 0.99, 0.77-1.26 and 1.02, 0.87-1.20, respectively) but mortality remained higher outside the 4.5-h revised approval (1.17, 0.98-1.41). Conclusions An age-revised European Union label or 4

  5. Intravenous Alteplase for Acute Ischemic Stroke in Taiwan: Can We Expand the National Health Insurance's Reimbursement Criteria?

    Science.gov (United States)

    Hsieh, Cheng-Yang

    2017-03-15

    lization of intravenous thrombolysis with alteplase was very low in Taiwanese patients with acute ischemic stroke(1). One of the reasons is the strict reimbursement guideline made by the Bureau of National Health Insurance (NHI) in 2004(2). In this issue of the Acta Neurologica Taiwanica, Yu-Hsiang Su and co-authors(3) retrospectively evaluated outcomes of their thrombolysed stroke patients who were "mismatched" between updated clinical practice guideline and NHI reimbursement criteria. They concluded that the outcomes of patients treated according to guidelines were comparable between the reimbursement and non-reimbursement groups. Despite the inherent selection bias and no comparison with the non-treated patients in this observational study, it might serve the an important local evidence for physicians in Taiwan when evaluating intravenous thrombolysis for acute ischemic stroke. SO, CAN WE EXPAND THE REIMBURSEMENT CRITERIA FOR INTRAVENOUS ALTEPLASE IN STROKE PATIENTS? At the present time, the answer may still probably be NO! The insurance payer, usually after an economic evaluation, may decide to pay a pharmaceutical product for its beneficiaries. As a rule of thumb, insurance reimbursement criteria should not be greater than the labelled prescribing information. Thus, the essence of this question should be back to the labelled indications and contraindications of alteplase for stroke, made by Taiwanese regulator in Nov 2002(4). Although data from high-quality meta-analyses(5,6) of new trials in the past decade challenged some of the major contraindications, such as onset > 3 hours or age > 80 years, the Taiwan's Food and Drug Administration has turned down twice the application by the manufacturer to change the package insert regarding those two contraindications. The reasons were mostly "insufficient of benefits". Without the change of labelled prescribing information, the NHI reimbursement criteria cannot be expanded. WHAT CAN WE DO NOW? Pragmatically

  6. Uso de alteplase no tratamento do acidente vascular encefálico isquêmico agudo: o que sabem os enfermeiros?

    Directory of Open Access Journals (Sweden)

    Samia Jardelle Costa de Freitas Maniva

    2012-06-01

    Full Text Available O estudo objetivou analisar o conhecimento de enfermeiros acerca do uso de alteplase no tratamento do acidente vascular encefálico (AVE isquêmico agudo. Estudo descritivo-exploratório realizado em uma unidade de AVE de um hospital público localizado na cidade de Fortaleza-CE, durante o mês de outubro de 2010. Participaram do estudo dez enfermeiros, com idade média de 25 anos. Os benefícios da medicação foram apresentados em justaposição com as limitações do uso. Estratégias para ampliar a utilização de alteplase foram apontadas pelos enfermeiros. O conhecimento da realidade investigada contribui na construção do saber de enfermagem e pode auxiliar o enfermeiro que presta assistência direta ao paciente que se submete a este tratamento.

  7. Effect of alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis on the neurological function and serum cytokines in patients with cerebral infarction

    Directory of Open Access Journals (Sweden)

    Yi-Ping Dan

    2017-04-01

    Full Text Available Objective: To study the effect of alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis on the neurological function and serum cytokines in patients with cerebral infarction. Methods: Patients with acute cerebral infarction who received alteplase thrombolysis in Zigong Fourth People's Hospital between June 2014 and October 2016 were retrospectively analyzed and divided into the intervention group who received low molecular heparin calcium treatment and the control group who did not receive low molecular heparin calcium treatment. The serum was collected before and after treatment to determine the contents of platelet activation factors, nerve injury molecules, soluble apoptotic molecules and growth factors. Results: Serum CD62p, CD63, PAF, GMP-140, NSE, S100B, GFAP, sFas, sFasL, sTRAIL, IGF-1, VEGF, BDNF and bFGF levels of both groups of patients after treatment were lower than those before treatment, serum CD62p, CD63, PAF, GMP-140, NSE, S100B, GFAP, sFas, sFasL and sTRAIL levels of intervention group after treatment were lower than those of control group while IGF-1, VEGF, BDNF and bFGF levels were higher than those of control group. Conclusion: Alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis for acute cerebral infarction can inhibit platelet activation and cell apoptosis, alleviate nerve injury and improve neurotrophy status.

  8. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials.

    Science.gov (United States)

    Lees, Kennedy R; Bluhmki, Erich; von Kummer, Rüdiger; Brott, Thomas G; Toni, Danilo; Grotta, James C; Albers, Gregory W; Kaste, Markku; Marler, John R; Hamilton, Scott A; Tilley, Barbara C; Davis, Stephen M; Donnan, Geoffrey A; Hacke, Werner; Allen, Kathryn; Mau, Jochen; Meier, Dieter; del Zoppo, Gregory; De Silva, D A; Butcher, K S; Parsons, M W; Barber, P A; Levi, C; Bladin, C; Byrnes, G

    2010-05-15

    Early administration of intravenous recombinant tissue plasminogen activator (rt-PA) after ischaemic stroke improves outcome. Previous analysis of combined data from individual patients suggested potential benefit beyond 3 h from stroke onset. We re-examined the effect of time to treatment with intravenous rt-PA (alteplase) on therapeutic benefit and clinical risk by adding recent trial data to the analysis. We added data from ECASS III (821 patients) and EPITHET (100 patients) to a pool of common data elements from six other trials of alteplase for acute stroke (2775 patients). We used multivariate logistic regression to assess the relation of stroke onset to start of treatment (OTT) with treatment on favourable 3-month outcome (defined as modified Rankin score 0-1), mortality, and occurrence and outcome of clinically relevant parenchymal haemorrhage. The presence of an arterial occlusion was inferred from the patient's symptoms and absence of haemorrhage or other causes of ischaemic stroke. Vascular imaging was not a requirement in the trials. All patients with confirmed OTT within 360 min were included in the analysis. Treatment was started within 360 min of stroke onset in 3670 patients randomly allocated to alteplase (n=1850) or to placebo (n=1820). Odds of a favourable 3-month outcome increased as OTT decreased (p=0.0269) and no benefit of alteplase treatment was seen after around 270 min. Adjusted odds of a favourable 3-month outcome were 2.55 (95% CI 1.44-4.52) for 0-90 min, 1.64 (1.12-2.40) for 91-180 min, 1.34 (1.06-1.68) for 181-270 min, and 1.22 (0.92-1.61) for 271-360 min in favour of the alteplase group. Large parenchymal haemorrhage was seen in 96 (5.2%) of 1850 patients assigned to alteplase and 18 (1.0%) of 1820 controls, with no clear relation to OTT (p=0.4140). Adjusted odds of mortality increased with OTT (p=0.0444) and were 0.78 (0.41-1.48) for 0-90 min, 1.13 (0.70-1.82) for 91-180 min, 1.22 (0.87-1.71) for 181-270 min, and 1.49 (1.00-2.21) for

  9. Clinical result of intra-arterial lymphocyte injection therapy for treatment of lymphedema and the evaluation of the efficacy of the therapy. Quantitative analysis by an injection of {sup 111}In-labeled lymphocytes and by MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Yoshizumi, Masanori; Kitagawa, Tetsuya; Hori, Takaki; Katoh, Itsuo; Harada, Masashi; Matsumoto, Takahiro; Nishitani, Hiromu [Tokushima Univ. (Japan). School of Medicine

    1995-11-01

    We have employed the intra-arterial lymphocytes injection therapy for treatment of lymphedema of the limbs with various causes. In the present study, we observed the clinical outcome of our therapy in 38 patients with lymphedema of the limbs. Results showed that the therapy was effective in 26 of 38 patients (68% of the total). Moreover, a marked efficacy was obtained in 13 of 38 patients (34% of the total). In the latest 5 patients, to evaluate the efficacy of our therapy, we examined the distribution of the {sup 111}In-oxine labeled lymphocytes injected into the proximal artery of the affected limb. The radioactivities of the affected limbs were apparently higher than that of the healthy limbs in effective cases. Moreover, MR imaging showed that the reduction of STIR ratio and T{sub 2} ratio well correlate with the results of clinical course. Thus, the efficacy of the lymphocyte injection therapy is able to be evaluated by radiolabeled lymphocytes and MR imaging. (author).

  10. Embolização intra-arterial pré-operatória de tumor do corpo carotídeo Preoperative intraarterial embolization of carotid body tumor

    Directory of Open Access Journals (Sweden)

    Gaudêncio Espinosa

    2006-09-01

    Full Text Available Os autores relatam um caso de tumor de corpo carotídeo (paraganglioma em um paciente de 74 anos de idade, submetido a embolização intra-arterial com micropartículas esféricas, de polivinil acetato, com casca de polivinil álcool (PVAc + PVA, previamente à ressecção do tumor. O estudo angiográfico demonstrou massa altamente vascularizada na bifurcação carotídea esquerda, sendo a embolização pré-operatória utilizada no intuito de diminuir a vascularização e reduzir a perda sangüínea, aumentando a segurança do tratamento cirúrgico. O estudo histopatológico confirmou a presença de trombose e isquemia tecidual.The authors report a case of carotid body tumor (paraganglioma in a 74-year-old male patient, submitted to intraarterial embolization with spherical core/shield polyvinyl acetate and polyvinyl alcohol (PVAc + PVA microparticles prior to surgical excision. Angiography has demonstrated a highly vascularized mass in the left carotid bifurcation, and preoperative embolization was used in order to decrease vascularity, reduce blood loss and improve safety of surgical treatment. Microscopic study confirmed presence of thrombosis and tissue ischemia.

  11. Cerebral venous thrombosis: treatment with local fibrinolysis plus alteplase; Trombosis venosa cerebral. Tratamiento mediante fibrinolisis local con alteplasa

    Energy Technology Data Exchange (ETDEWEB)

    Asis Bravo, F. de; Delgado, F.; Cano, A.; Bautista, D.

    2002-07-01

    Cerebral venous thrombosis is a rare entity with widely variable clinical signs: thus, a high degree of suspicion is required for diagnosis. It affects the dural sinuses and may or may not invade cerebral veins. The diagnosis has usually been based on an angiographic study although, at the present time, new noninvasive imaging techniques, such as computed tomography, magnetic resonance and magnetic resonance angiography are being employed in a growing number of cases. Treatment should involve symptomatic and etiologic therapy. Although anti coagulation would appear to be a reasonable option in these patients, it remains controversial. As in other processes such as pulmonary embolism and coronary thrombosis, the introduction of novel and increasingly safe fibrinolytic drugs, together with technical innovations in the field of interventional neuroradiology, is changing the perspectives for the management of these patients. We present the case of a 43-year-old woman with right sinus thrombosis who was treated with local thrombolysis plus alteplase (tissue plasminogen activator). The authors describe the technique employed and review the literature. (Author) 16 refs.

  12. Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands).

    Science.gov (United States)

    Mulder, Maxim J H L; Ergezen, Saliha; Lingsma, Hester F; Berkhemer, Olvert A; Fransen, Puck S S; Beumer, Debbie; van den Berg, Lucie A; Lycklama À Nijeholt, Geert; Emmer, Bart J; van der Worp, H Bart; Nederkoorn, Paul J; Roos, Yvo B W E M; van Oostenbrugge, Robert J; van Zwam, Wim H; Majoie, Charles B L M; van der Lugt, Aad; Dippel, Diederik W J

    2017-07-01

    High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT. This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). BP was measured at baseline, before IAT or stroke unit admission. We estimated the association of baseline BP with the score on the modified Rankin Scale at 90 days and safety parameters with ordinal and logistic regression analysis. Effect of BP on the effect of IAT was tested with multiplicative interaction terms. Systolic BP (SBP) had the best correlation with functional outcome. This correlation was U-shaped; both low and high baseline SBP were associated with poor functional outcome. Higher SBP was associated with symptomatic intracranial hemorrhage (adjusted odds ratio, 1.25 for every 10 mm Hg higher SBP [95% confidence interval, 1.09-1.44]). Between SBP and IAT, there was no interaction for functional outcome, symptomatic intracranial hemorrhage, or other safety parameters; the absolute benefit of IAT was evident for the whole SBP range. The same was found for diastolic BP. BP does not affect the benefit or safety of IAT in patients with acute ischemic stroke caused by proximal intracranial vessel occlusion. Our data provide no arguments to withhold or delay IAT based on BP. URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758. © 2017 American Heart Association, Inc.

  13. POSSIBILITIES OF ORGAN-PRESERVING TREATMENT OF PATIENTS WITH MULTIPNEOADJUVANT COMBINATION CHEMOTHERAPY IN A PATIENT WITH CERVICAL CANCER IIIB STAGE WITH THE USE OF INTRA-ARTERIAL ADMINISTRATION OF PLATINUM DRUGS

    Directory of Open Access Journals (Sweden)

    A. G. Rerberg

    2017-01-01

    Full Text Available The main treatment for cervical cancer are surgery, radiation and combined (surgery + radiotherapy, the role of chemotherapy in this localization is studied less fully. In recent years the new possibilities of chemotherapy, including neoadjuvant intraarterial chemotherapy, are explored. Theoretical prerequisites for this are the best drug delivery to the tumor by blood vessels, undamaged due to radiation therapy and surgery. This paper describes a clinical case of a patient with primary inoperable cervical cancer. As an alternative to preoperativ e radiotherapy the patient was proposed neoadjuv ant com bination chemotherapy with the use of regional administration of platinum drugs and systemic administration of drugs of taxan series as a stage of preparation for further surgical treatment. According to the prevalence of the tumor process patient underwent 2 courses of neoadjuv ant chemotherapy by a method of superselective intra-arterial administration of cisplatin and paclitaxel intravenously. According to a comprehensive examination after treatment data for the presence of tumor was absent. During the second stage the patient underwent surgical treatment in the volume of nerve-sparing radical hysterectomy with appendages. The next step, according to the histological form of the tumor, stage of disease, was the radiotherapy in the postoperative period on the pelv ic area and routes of lym ph drainage. The patient underwent external beam radiotherapy to the pelvic area of FD = 20 Gr, intracavitary gamma-therapy and external beam radiation on the area of parametrial and lymphopenia FD = 50 Gr.The patient passed the control examinations every 3 months. According to a comprehensive survey a year after the start of treatment — there is no data for the presence of recurrence and spread of tumor process.

  14. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Yaghi, Shadi; Willey, Joshua Z; Cucchiara, Brett; Goldstein, Joshua N; Gonzales, Nicole R; Khatri, Pooja; Kim, Louis J; Mayer, Stephan A; Sheth, Kevin N; Schwamm, Lee H

    2017-12-01

    Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment. A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH. The document sections were divided among writing group members who performed the literature review, summarized the literature, and provided suggestions on the diagnosis and treatment of patients with sICH caused by systemic thrombolysis with alteplase. Several drafts were circulated among writing group members until a consensus was achieved. sICH is an uncommon but severe complication of systemic thrombolysis in acute ischemic stroke. Prompt diagnosis and early correction of the coagulopathy after alteplase have remained the mainstay of treatment. Further research is required to establish treatments aimed at maintaining integrity of the blood-brain barrier in acute ischemic stroke based on inhibition of the underlying biochemical processes. © 2017 American Heart Association, Inc.

  15. Early detection and intervention using neutrophil gelatinase-associated lipocalin (NGAL may improve renal outcome of acute contrast media induced nephropathy: A randomized controlled trial in patients undergoing intra-arterial angiography (ANTI-CIN Study

    Directory of Open Access Journals (Sweden)

    Stiegler Philipp

    2011-08-01

    Full Text Available Abstract Background Patients with pre-existing impaired renal function are prone to develop acute contrast media induced nephropathy (CIN. Neutrophil gelatinase-associated lipocalin (NGAL, a new biomarker predictive for acute kidney injury (AKI, has been shown to be useful for earlier diagnosis of CIN; however, urinary NGAL values may be markedly increased in chronic renal failure at baseline. Results from those studies suggested that urinary NGAL values may not be helpful for the clinician. An intravenous volume load is a widely accepted prophylactic measure and possibly a reasonable intervention to prevent deterioration of renal function. The aim of our study is to evaluate NGAL as an early predictor of CIN and to investigate the clinical benefit of early post-procedural i.v. hydration. Methods/Design The study will follow a prospective, open-label, randomized controlled design. Patients requiring intra-arterial contrast media (CM application will be included and receive standardized, weight-based, intravenous hydration before investigation. Subjects with markedly increased urinary NGAL values after CM application will be randomized into one of two study groups. Group A will receive 3-4 ml/kg BW/h 0.9% saline intravenously for 6 hours. Group B will undergo only standard treatment consisting of unrestricted oral fluid intake. The primary outcome measure will be CIN defined by an increase greater than 25% of baseline serum creatinine. Secondary outcomes will include urinary NGAL values, cystatin C values, contrast media associated changes in cardiac parameters such as NT-pro-BNP/troponin T, changes in urinary cytology, need for renal replacement treatment, length of stay in hospital and death. We assume that 20% of the included patients will show a definite rise in urinary NGAL. Prospective statistical power calculations indicate that the study will have 80% statistical power to detect a clinically significant decrease of CIN of 40% in the

  16. Local lysis with Alteplase for the treatment of acute embolic leg ischemia following the use of the Duett {sup trademark} closure device: preliminary results; Lokale Alteplase-Lyse zur Therapie der akuten embolischen Beinischaemie nach Einsatz des Duett {sup trademark} -Verschluss-Systems: vorlaeufige Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schuermann, K.; Buecker, A.; Wingen, M.; Tacke, J.; Wein, B.; Guenther, R.W. [Klinik fuer Radiologische Diagnostik des Universitaetsklinikums der RWTH Aachen (Germany); Janssens, U. [Medizinische Klinik I (Kardiologie) des Universitaetsklinikums der RWTH Aachen (Germany)

    2004-04-01

    Purpose: To analyze retrospectively the result of the alteplase lysis therapy of embolic complications following the use of the Duett closure device. Methods and Materials: For 3.5 years, the Duett closure device was used in 1,398 angiographies to close the femoral puncture site. The Duett device consists of a balloon and a liquid procoagulant containing collagen and thrombin, which is injected into the puncture tract under endovascular balloon protection of the arterial puncture site. In 9 patients (0.64%), the procoagulant was incidentally injected into the femoral artery causing acute leg ischemia. Eight patients received local lysis therapy with alteplase via a contralateral femoral access. One patient underwent surgery. On average, 21 mg alteplase (4-35 mg) were administered within 14 h (4-21 h). The course of the lysis was followed angiographyically and clinically. All patients were inteerviewed by telephone 23 months (4-35 months) later.Results: In 3 patients, lysis was complete. In 5 patients, only little thrombotic material remained. In all patients, symptoms of ischemia resolved completely within the first hours after initiation of lysis. In 5 cases, bleeding occurred at the puncture site closed with the Duett device during lysis, including development of a false aneurysm in 2 cases. Complications led to premature termination (n=2) or interruption of the lysis (n=3). All complications were treated conservatively. Clinically, long-term sequelae were paresthesia and hypoesthesia in the lower leg and foot in 2 patients treated with lysis, and in the patient who underwent surgery. (orig.) [German] Ziel: Das Ergebnis der Alteplase-Lysetherapie von Embolien nach Einsatz des Duett-Verschluss-Systems wurde retrospektiv untersucht. Methoden: Innerhalb von 3,5 Jahren wurde nach 1398 Angiographien das Duett-System zum Verschluss der femoralen Punktionsstelle eingesetzt. Das System besteht aus einem Ballon und einem fluessigen Prokoagulans (Kollagen, Thrombin), das

  17. Successful Preoperative Chemoembolization in the Treatment of a Giant Malignant Phyllodes Tumor.

    Science.gov (United States)

    Hashimoto, Kazuki; Mimura, Hidefumi; Arai, Yasunori; Doi, Masatomo; Kojima, Yasuyuki; Tsugawa, Koichiro; Nakajima, Yasuo

    2016-07-01

    The malignant phyllodes tumor is a relatively rare neoplasm and has not previously been a therapeutic target of interventional radiology. Herein, we report a successful case of preoperative chemoembolization of a giant malignant phyllodes tumor. The objective was to achieve sufficient tumor shrinkage before surgery to avoid the requirement for skin grafting after resection. Intra-arterial epirubicin infusion and subsequent embolization with Embosphere Microspheres (BioSphere Medical, Rockland, MA, USA) was undertaken three times over the course of 6 weeks and was well tolerated. The patient underwent surgery without skin grafting. Neither local recurrence nor distant metastasis was observed at 6 months after surgery.

  18. Successful Preoperative Chemoembolization in the Treatment of a Giant Malignant Phyllodes Tumor

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Kazuki, E-mail: kazkik1980@gmail.com; Mimura, Hidefumi; Arai, Yasunori [St. Marianna University School of Medicine, Department of Radiology (Japan); Doi, Masatomo [St. Marianna University School of Medicine, Department of Pathology (Japan); Kojima, Yasuyuki; Tsugawa, Koichiro [St. Marianna University School of Medicine, Division of Breast and Endocrine Surgery, Department of Surgery (Japan); Nakajima, Yasuo [St. Marianna University School of Medicine, Department of Radiology (Japan)

    2016-07-15

    The malignant phyllodes tumor is a relatively rare neoplasm and has not previously been a therapeutic target of interventional radiology. Herein, we report a successful case of preoperative chemoembolization of a giant malignant phyllodes tumor. The objective was to achieve sufficient tumor shrinkage before surgery to avoid the requirement for skin grafting after resection. Intra-arterial epirubicin infusion and subsequent embolization with Embosphere Microspheres (BioSphere Medical, Rockland, MA, USA) was undertaken three times over the course of 6 weeks and was well tolerated. The patient underwent surgery without skin grafting. Neither local recurrence nor distant metastasis was observed at 6 months after surgery.

  19. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Demaerschalk, Bart M; Kleindorfer, Dawn O; Adeoye, Opeolu M; Demchuk, Andrew M; Fugate, Jennifer E; Grotta, James C; Khalessi, Alexander A; Levy, Elad I; Palesch, Yuko Y; Prabhakaran, Shyam; Saposnik, Gustavo; Saver, Jeffrey L; Smith, Eric E

    2016-02-01

    To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. After a review of the current literature, it was clearly evident that the levels of evidence supporting individual exclusion criteria for intravenous alteplase vary widely. Several exclusionary criteria have already undergone

  20. Outcome of Acute Ischemic Stroke after the Treatment with Edaravone and 0.6 Mg/Kg Alteplase in Japanese Patients with Diabetes.

    Science.gov (United States)

    Tanahashi, Norio; Yamaguchi, Takenori; Awano, Hideto; Matsuda, Hiroaki

    2018-01-17

    We investigated how diabetes mellitus (DM) affects the outcome of acute ischemic stroke (AIS), comparing with the outcomes in those who had hypertension (HT) and atrial fibrillation (AF). This study was a sub-analysis of PROTECT4.5, which was previously performed as a large-scale, prospective observational study of edaravone with approximately 10,000 patients with AIS in Japan. The study patients treated with edaravone alone or edaravone + alteplase (recombinant tissue plasminogen activator [tPA]) were analyzed for their outcomes and explored for the risk factors of poor outcome, after being divided into 8 groups according to their affected complications of DM, HT, or AF in the groups treated with edaravone alone or edaravone + tPA. Among patients treated with edaravone alone and edaravone + tPA, the mean reduction in the National Institutes of Health Stroke Scale from baseline to 3 months after the onset was 2.0 and 4.4 in DM groups, respectively. The reduction was smaller in these groups compared with other groups (3.3-4.3 and 6.0-7.7, respectively). The logistic regression model revealed that DM was an independent risk factor for highly unfavorable outcome of modified Rankin Scale score 3-6 at 3 months after the onset, among both patients treated with edaravone alone and those treated with edaravone + tPA (odds ratio [OR]: 2.23, 95% confidential interval [CI]: 1.42-3.50 and OR: 2.05, 95% CI: 1.33-3.14, respectively). DM is suggested to adversely affect the outcome of AIS in Japanese patients. Copyright © 2018. Published by Elsevier Inc.

  1. Refined balloon pulmonary angioplasty driven by combined assessment of intra-arterial anatomy and physiology--Multimodal approach to treated lesions in patients with non-operable distal chronic thromboembolic pulmonary hypertension--Technique, safety and efficacy of 50 consecutive angioplasties.

    Science.gov (United States)

    Roik, Marek; Wretowski, Dominik; Łabyk, Andrzej; Kostrubiec, Maciej; Irzyk, Katarzyna; Dzikowska-Diduch, Olga; Lichodziejewska, Barbara; Ciurzyński, Michał; Kurnicka, Katarzyna; Gołębiowski, Marek; Pruszczyk, Piotr

    2016-01-15

    Balloon pulmonary angioplasty (BPA) is an emerging therapeutic method in CTEPH. We aimed to prove the safety and efficacy of refined BPA driven by combined assessment of intra-arterial anatomy (IVUS/OCT) and physiology (pulmonary pressure ratio, PPR) in non-operable distal CTEPH. 11 pts (mean age 76, 59–84, 7 males) were enrolled in the BPA program according to the following inclusion criteria: 1. Non-operable CTEPH; 2. RHC with mPAP > 30 mm Hg; 3. At least one segmental perfusion defect at lung scintigraphy; 4. WHO class > II. Overall, 9 pts underwent 27 BPA sessions (mean 3 sessions per patient, range 1–5), 50 pulmonary arteries were dilated (mean 6 vessels per patient, range 3–9; 2.03 dilated arteries per session). All the angioplasties were performed according to an algorithm, which incorporated anatomical and functional assessment of targeted lesions. We performed BPA of 32 web lesions, 5 ring-like stenosis and 13 complete obstructions. BPA resulted in clinical and hemodynamic improvement. WHO class improved from pre-BPA to post-BPA (p = 0.018), and 6 MWD increased from 304 m to 384 m (p = 0.03), NT-proBNP dropped from 1248 pg/ml to 730 pg/ml (p < 0.001). Mean PAP and PVR decreased (p = 0.01), while CO and CI increased (p = 0.01). All dilated arteries were patent at angiographic reassessment. No significant complications occurred and all treated patients are still alive. Insignificant transient reperfusion pulmonary oedema occurred in only 2 patients, who responded well to supplemental oxygen. Refined BPA with assessment of intrapulmonary physiology using a pressure wire and precise evaluation of anatomy with IVUS and OCT provides hemodynamic and functional improvement, with minimal complications in distal non-operable CTEPH. This observation requires further validation in a large prospective study.

  2. Intra-arterial digital angiography of the liver

    Energy Technology Data Exchange (ETDEWEB)

    Dalla Palma, L.; Stacul, F.; Maffessanti, M.; Pozzi-Mucelli, R.

    1983-08-01

    The authors report the preliminary results of the intraarterial digital angiography of the liver. A series of 30 patients were examined comparing conventional and digital technique following the injection of the coeliac, splenic, hepatic and mesenteric arteries. The results obtained with the digital technique have been of good quality and sometimes even better in spite of significant dilution of the contrast medium. It is concluded that intraarterial digital angiography of the liver gives some advantages compared with the conventional technique, that is the use of a much lower concentrated contrast medium, the better visualization of the portal branches and its collaterals and the very low cost of the film material.

  3. Thrombolysis for acute ischaemic stroke with alteplase in an Asian population: results of the multicenter, multinational Safe Implementation of Thrombolysis in Stroke-Non-European Union World (SITS-NEW).

    Science.gov (United States)

    Rha, Joung-Ho; Shrivastava, Vasantha Padma; Wang, Yongjun; Lee, Kim En; Ahmed, Niaz; Bluhmki, Erich; Hermansson, Karin; Wahlgren, Nils

    2014-10-01

    Safe Implementation of Thrombolysis in Stroke-Non-European Union World was a multinational, prospective, open, monitored, observational study of intravenous alteplase as thrombolytic therapy in clinical practice. Safe Implementation of Thrombolysis in Stroke-Non-European Union World was required to assess the safety of alteplase in an Asian population by comparison with results from the European Safe Implementation of Thrombolysis in Stroke-Monitoring Study and pooled results from randomized controlled trials. To evaluate the efficacy and safety of intravenous alteplase (0·9 mg/kg) as thrombolytic therapy within three-hours of onset of acute ischaemic stroke in an Asian population. The 591 patients included were treated at 48 centers in four countries (South Korea, China, India, and Singapore) between 2006 and 2008. Primary outcomes were symptomatic (deterioration in National Institutes of Health Stroke Scale score ≥4 or death within the first 24 h) intracerebral haemorrhage type 2 22-36 h after the thrombolysis and mortality at three-month follow-up. The secondary outcome was functional independence (modified Rankin Scale score 0-2) at three-months. Results were compared with those from Safe Implementation of Thrombolysis in Stroke-Monitoring Study (n = 6483) and pooled results of patients (n = 415) who received intravenous alteplase (0·9 mg/kg) zero- to three-hours from onset of stroke symptoms in four randomized controlled trials (National Institute of Neurological Disorders and Stroke A and B, Altephase Thrombolysis for Acute Noninterventional Therapy in Ischaemic Stroke, and European Cooperative Acute Stroke Study II). Results are presented as Safe Implementation of Thrombolysis in Stroke-Non-European Union World vs. Safe Implementation of Thrombolysis in Stroke-Monitoring Study vs. pooled randomized controlled trials. Median age was 64 vs. 68 vs. 70 years, National Institutes of Health Stroke Scale score at baseline was 12 vs. 12 vs. 13

  4. Correlation between clot density and recanalization success or stroke etiology in acute ischemic stroke patients.

    Science.gov (United States)

    Jagani, Manoj; Kallmes, David F; Brinjikji, Waleed

    2017-06-01

    Background Predicting recanalization success for patients undergoing endovascular treatment for acute ischemic stroke is of significant interest. Studies have previously correlated the success of recanalization with the density of the clot. We evaluated clot density and its relationship to revascularization success and stroke etiology. Methods We conducted a retrospective review of 118 patients undergoing intra-arterial therapy for acute ischemic stroke. Mean and maximum thrombus density was measured by drawing a circular region of interest on an axial slice of a non-contrast computed tomography scan. T-tests were used to compare clot density to recanalization success or to stroke etiology, namely large artery atherosclerosis and cardioembolism. Recanalization success was compared in four device groups: aspiration, stent retriever, aspiration and stent retriever, and all other. Results There was no significant difference in the mean clot density in patients with successful ( n = 80) versus unsuccessful recanalization ( n = 38, 50.1 ± 7.4 Hounsfield unit (HU) vs. 53 ± 12.7 HU; P = 0.17). Comparing the large artery thromboembolism ( n = 35) to the cardioembolic etiology group ( n = 56), there was no significant difference in mean clot density (51.5 ± 7.7 HU vs. 49.7 ± 8.5 HU; P = 0.31). A subgroup analysis of middle cerebral artery occlusions ( n = 65) showed similar, non-statistically significant differences between groups. There was no difference in the rate of recanalization success in patients with a mean clot density greater than 50 HU or less than 50 HU in each of the four device groups. Conclusions There was no relationship between clot density and revascularization success or stroke etiology in our study. More research is needed to determine if clot density can predict recanalization rates or indicate etiology.

  5. Successful ageing

    DEFF Research Database (Denmark)

    Kusumastuti, Sasmita; Derks, Marloes G. M.; Tellier, Siri

    2016-01-01

    on the objective measurements as determined by researchers. Subsequent sub-clustering analysis pointed to different domains of functioning and various ways of assessment. CONCLUSION: In the current literature two mutually exclusive concepts of successful ageing are circulating that depend on whether the individual......BACKGROUND: Ageing is accompanied by an increased risk of disease and a loss of functioning on several bodily and mental domains and some argue that maintaining health and functioning is essential for a successful old age. Paradoxically, studies have shown that overall wellbeing follows...... a curvilinear pattern with the lowest point at middle age but increases thereafter up to very old age. OBJECTIVE: To shed further light on this paradox, we reviewed the existing literature on how scholars define successful ageing and how they weigh the contribution of health and functioning to define success...

  6. Successful ageing

    DEFF Research Database (Denmark)

    Bülow, Morten Hillgaard; Söderqvist, Thomas

    2014-01-01

    Since the late 1980s, the concept of ‘ successful ageing’ has set the frame for discourse about contemporary ageing research. Through an analysis of the reception to John W. Rowe and Robert L. Kahn's launch of the concept of ‘ successful ageing’ in 1987, this article maps out the important themes...... strategies; and the importance of individual, societal and scientific conceptualisations and understandings of ageing. By presenting an account of the recent historical uses, interpretations and critiques of the concept, the article unfolds the practical and normative complexities of ‘ successful ageing’....... and discussions that have emerged from the interdisciplinary field of ageing research. These include an emphasis on interdisciplinarity; the interaction between biology, psycho-social contexts and lifestyle choices; the experiences of elderly people; life-course perspectives; optimisation and prevention...

  7. Citation Success

    DEFF Research Database (Denmark)

    Vaio, Gianfranco Di; Waldenström, Daniel; Weisdorf, Jacob Louis

    2012-01-01

    This study examines the determinants of citation success among authors who have recently published their work in economic history journals. Besides offering clues about how to improve one's scientific impact, our citation analysis also sheds light on the state of the field of economic history....... Consistent with our expectations, we find that full professors, authors appointed at economics and history departments, and authors working in Anglo-Saxon and German countries are more likely to receive citations than other scholars. Long and co-authored articles are also a factor for citation success. We...... find similar patterns when assessing the same authors' citation success in economics journals. As a novel feature, we demonstrate that the diffusion of research — publication of working papers, as well as conference and workshop presentations — has a first-order positive impact on the citation rate....

  8. Citation Success

    DEFF Research Database (Denmark)

    Di Vaio, Gianfranco; Waldenström, Daniel; Weisdorf, Jacob Louis

    This study analyses determinants of citation success among authors publishing in economic history journals. Bibliometric features, like article length and number of authors, are positively correlated with the citation rate up to a certain point. Remarkably, publishing in top-ranked journals hardly...... affects citations. In regard to author-specific characteristics, male authors, full professors and authors working economics or history departments, and authors employed in Anglo-Saxon countries, are more likely to get cited than others. As a ‘shortcut' to citation success, we find that research diffusion...

  9. Successful management of aortic thrombi resulting in spinal cord infarction in a patient with antiphospholipid antibody syndrome and acute cholecystitis

    Directory of Open Access Journals (Sweden)

    Izumi M

    2011-12-01

    Full Text Available Manabu Izumi, Shoko Teraoka, Keisuke Yamashita, Kenji Matsumoto, Tomohiro Muronoi, Yoshimitsu Izawa, Chikara Yonekawa, Masaki Ano, Masayuki SuzukawaDepartment of Emergency and Critical Care Medicine, Jichi Medical University, Tochigi, JapanAbstract: A 74-year-old man with coronary artery disease was suffering from acute nonobstructive cholecystitis and was admitted to a nearby hospital. Dual antiplatelet (aspirin and ticlopidine therapy was discontinued before preparation for surgical resection of the gall bladder. During his time in hospital he was aware of lumbar pain and weakness in both legs. He was transferred to our hospital for further evaluation and therapy. Diffuse intra-aortic thrombi were revealed by computed tomography with contrast media, and magnetic resonance imaging showed spinal cord infarction. However, computed tomography scans of the descending aorta obtained 4 months before admission exhibited no signs of atherosclerotic plaques or intra-aortic thrombi. Laboratory data suggest that antiphospholipid antibody syndrome might have caused these acute multiple intra-arterial thrombi. By restarting dual antiplatelet therapy and increasing the dose of heparin (from 10,000 IU/day to 15,000 IU/day we successfully managed the patient's clinical condition and symptoms. It is important to understand that stopping antiplatelet therapy may rapidly grow thrombi in patients with a hypercoagulative state.Keywords: intra-aortic thrombus, antiphospholipid antibody syndrome, spinal cord infarction

  10. Successful Aging

    Directory of Open Access Journals (Sweden)

    Taufiqurrahman Nasihun

    2015-06-01

    Full Text Available The emerging concept of successful aging is based on evidence that in healthy individual when they get aged, there are  considerable variations in physiological functions alteration. Some people exhibiting greater, but others very few or no age related alteration. The first is called poor aging and the later is called successful pattern of aging (Lambert SW, 2008. Thus, in the simple words the successful aging concept is define as an opportunity of old people to stay  active and productive condition despite they get aged chronologically. Aging itself might be defined as the progressive accumulation of changes with time associated with or responsible for the ever-increasing susceptibility to disease and death which accompanies advancing age (Harman D, 1981. The time needed to accumulate changes is attributable to aging process. The marked emerging questions are how does aging happen and where does aging start? To answer these questions and because of the complexity of aging process, there are more than 300 aging theories have been proposed to explain how and where aging occured and started respectively. There are too many to enumerate theories and classification of aging process. In summary, all of these aging theories can be grouped into three clusters: 1. Genetics program theory, this theory suggests that aging is resulted from program directed by the genes; 2. Epigenetic theory, in these theory aging is resulted from environmental random events not determined by the genes; 3. Evolutionary theory, which propose that aging is a medium for disposal mortal soma in order to avoid competition between organism and their progeny for food and space, did not try to explain how aging occur, but possibly answer why aging occur (De la Fuente. 2009. Among the three groups of aging theories, the epigenetic theory is useful to explain and try to solve the enigma of aging which is prominently caused by internal and external environmental influences

  11. Ensuring a successful family business management succession

    OpenAIRE

    Desbois, Joris

    2016-01-01

    Succession is the biggest long-term challenge that most family businesses face. Indeed, leaders ‘disposition to plan for their succession is frequently the key factor defining whether their family business subsists or stops. The research seeks to find out how to manage successfully the business management succession over main principles. This work project aims at researching the key points relevant to almost all family firms, to have a viable succession transition and positioni...

  12. Intraoperative Localization of Vascular Malformation of Small Bowel by Selective Intra-arterial Dye Injection

    Science.gov (United States)

    Eshpuniyani, Priya B.; Kantharia, Chetan V.; Prabhu, RamKrishna Y.; Supe, Avinash N.

    2010-01-01

    Angiomatous malformation is the most common vascular abnormality, accounting for 30-40% cases of obscure GI bleeding from small bowel. Surgical resection is the treatment of choice in severe or recurrent hemorrhage requiring multiple blood transfusions. However, the diffuse nature of the lesions poses a challenge to localize them accurately preoperatively, for exact resection. We present a case in which we have used selective mesenteric angiography with selective cannulation and exact localization of the lesion by injecting dye such as methylene blue, indigo carmine, and fluorescein, to localize the angiomatous malformation before surgical resection and also to determine the exact resection to be done. PMID:20871200

  13. Vascular Response to Intra-arterial Injury in the Thrombospondin-1 Null Mouse

    OpenAIRE

    Budhani, Faisal; Leonard, Katherine A.; Bergdahl, Andreas; Gao, Jimin; Lawler, Jack; Davis, Elaine C.

    2007-01-01

    Thrombospondin-1 (TSP-1) is a multifunctional, extracellular matrix protein that has been implicated in the regulation of smooth muscle cell proliferation, migration and differentiation during vascular development and injury. Vascular injury in wildtype and TSP-1 null mice was carried out by insertion of a straight spring guidewire into the femoral artery via a muscular arterial branch. Blood flow was restored after the muscular branch was ligated. The injury completely denuded the endotheliu...

  14. Catheter-Directed Intra-Arterial Abciximab Administration for Acute Thrombotic Occlusions during Neurointerventional Procedures

    OpenAIRE

    Duncan, I.C.; Fourie, P.A.

    2002-01-01

    Abciximab is one of a new class of platelet aggregation inhibitors that has to date been used mainly in the management of acute coronary ischaemic syndromes or during cardiac intervention for the prevention and treatment of acute vessel occlusion during and after angioplasty or stent placement. More recently, it has begun to play a similar role in neurointerventional work. Its administration during acute stent or vessel occlusions has usually been via systemic intravenous infusion. We describ...

  15. [Technical solution to a complication caused by intra-arterial catheterization].

    Science.gov (United States)

    Oliu Torres, O; Pedroso Mendoza, L E; Figueredo Barreras, F; Corteguera Fonte, M E

    1990-01-01

    Knot formation in the distal segment of an angiographic catheter is not very frequent. Its early recognition, as well as domination of several techniques in order to untie it, may avoid surgery. An unique technique in order to untie a knot in a catheter is described, which consists in using other more rigid catheter with "J" shaped end by contralateral femoral via and under direct fluoroscopic visualization, with image magnifier and fitted TV.

  16. Intra-arterial blood pressure reading in intensive care unit patients in the lateral position

    NARCIS (Netherlands)

    Aries, M.J.H.; Aslan, A.; Elting, J.W.J.; Stewart, R.E.; Zijlstra, Jan G.; de Keyser, J.; Vroomen, P.C.A.J.

    Background. Routine lateral turning of patients has become an accepted standard of care to prevent complications of immobility. The haemodynamic and oxygenation effects for patients in both lateral positions (45 degrees) are still a matter of debate. We aimed to study the effect of these positions

  17. Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

    Directory of Open Access Journals (Sweden)

    Dae-Sung Lee

    2013-05-01

    Full Text Available We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

  18. Assessing Intra-arterial Complications of Planning and Treatment Angiograms for Y-90 Radioembolization

    Energy Technology Data Exchange (ETDEWEB)

    Ahmed, Osman, E-mail: osman1423@gmail.com [Rush University Medical Center, Section of Interventional Radiology, Department of Radiology (United States); Patel, Mikin V. [University of Chicago, Department of Radiology (United States); Masrani, Abdulrahman; Chong, Bradford; Osman, Mohammed; Tasse, Jordan; Soni, Jayesh; Turba, Ulku Cenk; Arslan, Bulent [Rush University Medical Center, Section of Interventional Radiology, Department of Radiology (United States)

    2017-05-15

    PurposeTo report hepatic arterial-related complications encountered during planning and treatment angiograms for radioembolization and understand any potential-associated risk factors.Materials and Methods518 mapping or treatment angiograms for 180 patients with primary or metastatic disease to the liver treated by Yttrium-90 radioembolization between 2/2010 and 12/2015 were retrospectively reviewed. Intra-procedural complications were recorded per SIR guidelines. Patient demographics, indication for treatment, prior exposure to chemotherapeutic agents, operator experience, and disease burden were reviewed. Technical variables including type of radioembolic (glass vs. resin microspheres), indication for angiography (mapping vs. treatment), variant anatomy, and attempts at coil embolization were also assessed.ResultsThirteen (13/518, 2.5%) arterial-related complications occurred in 13 patients. All but two complications resulted during transcatheter coil embolization to prevent non-target embolization. Complications included coil migration (n = 6), arterial dissection (n = 2), focal vessel perforation (n = 2), arterial thrombus (n = 2), and vasospasm prohibiting further arterial sub-selection (n = 1). Transarterial coiling was identified as a significant risk factor of complications on both univariate and multivariate regression analysis (odds ratio 7.8, P = 0.004). Usage of resin microspheres was also a significant risk factor (odds ratio 9.5, P = 0.042). No other technical parameters or pre-procedural variables were significant after adjusting for confounding on multivariate analysis (P > 0.05).ConclusionIntra-procedural hepatic arterial complications encountered during radioembolization were infrequent but occurred mainly during coil embolization to prevent non-target delivery to extra-hepatic arteries.

  19. Machine learning for outcome prediction of acute ischemic stroke post intra-arterial therapy.

    Directory of Open Access Journals (Sweden)

    Hamed Asadi

    Full Text Available INTRODUCTION: Stroke is a major cause of death and disability. Accurately predicting stroke outcome from a set of predictive variables may identify high-risk patients and guide treatment approaches, leading to decreased morbidity. Logistic regression models allow for the identification and validation of predictive variables. However, advanced machine learning algorithms offer an alternative, in particular, for large-scale multi-institutional data, with the advantage of easily incorporating newly available data to improve prediction performance. Our aim was to design and compare different machine learning methods, capable of predicting the outcome of endovascular intervention in acute anterior circulation ischaemic stroke. METHOD: We conducted a retrospective study of a prospectively collected database of acute ischaemic stroke treated by endovascular intervention. Using SPSS®, MATLAB®, and Rapidminer®, classical statistics as well as artificial neural network and support vector algorithms were applied to design a supervised machine capable of classifying these predictors into potential good and poor outcomes. These algorithms were trained, validated and tested using randomly divided data. RESULTS: We included 107 consecutive acute anterior circulation ischaemic stroke patients treated by endovascular technique. Sixty-six were male and the mean age of 65.3. All the available demographic, procedural and clinical factors were included into the models. The final confusion matrix of the neural network, demonstrated an overall congruency of ∼ 80% between the target and output classes, with favourable receiving operative characteristics. However, after optimisation, the support vector machine had a relatively better performance, with a root mean squared error of 2.064 (SD: ± 0.408. DISCUSSION: We showed promising accuracy of outcome prediction, using supervised machine learning algorithms, with potential for incorporation of larger multicenter datasets, likely further improving prediction. Finally, we propose that a robust machine learning system can potentially optimise the selection process for endovascular versus medical treatment in the management of acute stroke.

  20. Machine learning for outcome prediction of acute ischemic stroke post intra-arterial therapy.

    Science.gov (United States)

    Asadi, Hamed; Dowling, Richard; Yan, Bernard; Mitchell, Peter

    2014-01-01

    Stroke is a major cause of death and disability. Accurately predicting stroke outcome from a set of predictive variables may identify high-risk patients and guide treatment approaches, leading to decreased morbidity. Logistic regression models allow for the identification and validation of predictive variables. However, advanced machine learning algorithms offer an alternative, in particular, for large-scale multi-institutional data, with the advantage of easily incorporating newly available data to improve prediction performance. Our aim was to design and compare different machine learning methods, capable of predicting the outcome of endovascular intervention in acute anterior circulation ischaemic stroke. We conducted a retrospective study of a prospectively collected database of acute ischaemic stroke treated by endovascular intervention. Using SPSS®, MATLAB®, and Rapidminer®, classical statistics as well as artificial neural network and support vector algorithms were applied to design a supervised machine capable of classifying these predictors into potential good and poor outcomes. These algorithms were trained, validated and tested using randomly divided data. We included 107 consecutive acute anterior circulation ischaemic stroke patients treated by endovascular technique. Sixty-six were male and the mean age of 65.3. All the available demographic, procedural and clinical factors were included into the models. The final confusion matrix of the neural network, demonstrated an overall congruency of ∼ 80% between the target and output classes, with favourable receiving operative characteristics. However, after optimisation, the support vector machine had a relatively better performance, with a root mean squared error of 2.064 (SD: ± 0.408). We showed promising accuracy of outcome prediction, using supervised machine learning algorithms, with potential for incorporation of larger multicenter datasets, likely further improving prediction. Finally, we propose that a robust machine learning system can potentially optimise the selection process for endovascular versus medical treatment in the management of acute stroke.

  1. Combating Ageism: How Successful Is Successful Aging?

    Science.gov (United States)

    Calasanti, Toni

    2016-12-01

    To explore the extent to which the successful aging discourse has accomplished Rowe and Kahn's (1998) goal of combating ageism by (a) eradicating the narrative of decline and burden, and highlighting the positive aspects of aging; and (b) emphasizing individuals' ability to age successfully. To investigate this, I first situate ageism in a framework of age relations. Using a qualitative approach, I analyze data generated from semistructured, in-depth interviews conducted among a diverse sample of 19 middle-aged men and women. Respondents were asked about what successful aging means to them, as well as their perceptions of their own aging, and old age. Respondents are familiar with the notion of successful aging, and they believe that they can and should achieve this. However, rather than easing ageism, they experience the mandate to age successfully as a source of tension as they simultaneously realize that it is outside their control. They express continued fears of aging; and they implicitly blame themselves or others who fail to age successfully. Their comments suggest that, rather than supplanting the discourse of decline, the successful aging narrative coexists with it. By not challenging the age relations that denigrate differences, the successful aging framework does not eliminate ageism and might even increase it. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

  2. The Project of Success

    DEFF Research Database (Denmark)

    Kreiner, Kristian

    . To the extent that project success becomes a matter of meeting the explicit targets, it loses its relevance as independent phenomenon. For that reason, perhaps, project success is hardly ever discussed in the project management literature. However, empirical studies demonstrate that project success is a much...... more complicated matter than meeting targets. While success may ultimately be justified in terms of a correspondence between aims and achievements, the understanding of both aspects is highly dependent on the project process. An example of a successful project that did not meet the original performance...... targets will serve to show that success is at matter of perspective as much as it is a matter of achievement. Other types of research, e.g. social psychology, have addressed the issue of success more explicitly. I draw on such literature to conceptualize project success anew and to reestablish...

  3. Success in Science, Success in Collaboration

    Energy Technology Data Exchange (ETDEWEB)

    Johnston, Mariann R. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-08-25

    This is a series of four different scientific problems which were resolved through collaborations. They are: "Better flow cytometry through novel focusing technology", "Take Off®: Helping the Agriculture Industry Improve the Viability of Sustainable, Large-Production Crops", "The National Institutes of Health's Models of Infectious Disease Agent Study (MIDAS)", and "Expanding the capabilities of SOLVE/RESOLVE through the PHENIX Consortium." For each one, the problem is listed, the solution, advantages, bottom line, then information about the collaboration including: developing the technology, initial success, and continued success.

  4. Human Resource Outsourcing Success

    OpenAIRE

    Hasliza Abdul-Halim; Elaine Ee; T. Ramayah; Noor Hazlina Ahmad

    2014-01-01

    The existing literature on partnership seems to take the relationship between partnership quality and outsourcing success for granted. Therefore, this article aims at examining the role of service quality in strengthening the relationship between partnership quality and human resource (HR) outsourcing success. The samples were obtained from 96 manufacturing organizations in Penang, Malaysia. The results showed that par...

  5. Fear of Success.

    Science.gov (United States)

    Petty, Steve

    Fear of success in a group of high school students (N=127) was studied, with research findings supporting the following generalizations: (1) high school students with an intermediate level of self-esteem have greater fear of success than those with high and low levels of self-esteem; (2) high school students with BSRI (Bem Sex Role Inventory)…

  6. The Student Success Coach

    Science.gov (United States)

    Neuhauser, Claudia; Weber, Kendra

    2011-01-01

    An innovative position, a Student Success Coach, was created in response to a newly developed undergraduate-degree program on the recently established University of Minnesota Rochester campus. Student Success Coaches serve as the link between the academic and student affairs sides of the campus. They interact closely with students and faculty to…

  7. Successful systems sustaining change.

    Science.gov (United States)

    Bullas, Sheila; Bryant, John

    2007-01-01

    Much has been published on the success and particularly the failure of IT projects; still failures are commonplace. This prospective study focused from the outset on assessing risk of failure and addressing critical success factors. The aim was to apply existing methods in a challenging acute care hospital where success demanded rapid achievement of sustainable improvements in clinical and administrative processes. The implementations were part of the English National Programme for IT. The desired outcomes required the integration of accepted tools and techniques to provide a pragmatic approach to systems implementation: Lean, Six Sigma, PRINCE2 and Benefits Management. The outcome and further insights into success and failure of IT projects in healthcare are described. In particular lessons are identified related to the business need for the project and the successful achievement of the required benefits and business change.

  8. MERGERS - SUCCESS OR FAILURE?

    Directory of Open Access Journals (Sweden)

    Irina Sandu căs. Chiriac

    2011-03-01

    Full Text Available Mergers are transactions of great importance, not only for organizations involved, but for many stakeholders. Success or failure of such enterprises may have consequences enormous for the shareholders of an organization, creditors, employees, competitors and community. Empirical evidence indicates a high rate of failure of mergers in terms of create value for shareholders. This study examines the causes of merger failure and offers a possible solution to make the merger successful. The internal audit has evolved from its traditional role to an active advisory. Internal auditors can ensure successful merger process.

  9. Distance Education Success Factors.

    Science.gov (United States)

    Wagner, Ellen D.

    1995-01-01

    Anticipating and supporting the needs of users of technologies, programs, and services are critical to the success of distance education programs. Principal stakeholders are instructors who teach at a distance, learners pursuing distance education courses, site facilitators, and administrators. (JOW)

  10. Goodbye Career, Hello Success.

    Science.gov (United States)

    Komisar, Randy

    2000-01-01

    Success in today's economy means throwing out the old career rules. The "noncareer" career is driven by passion for the work and has the fluidity and flexibility needed in the contemporary workplace. (JOW)

  11. Successful project management

    CERN Document Server

    Young, Trevor L

    2016-01-01

    Successful Project Management, 5th edition, is an essential guide for anyone who wants to improve the success rate of their projects. It will help managers to maintain a balance between the demands of the customer, the project, the team and the organization. Covering the more technical aspects of a project from start to completion it contains practised and tested techniques, covering project conception and start-up, how to manage stake holders, effective risk management, project planning and launch and execution. Also including a brand new glossary of key terms, it provides help with evaluating your project as well as practical checklists and templates to ensure success for any ambitious project manager. With over one million copies sold, the hugely popular Creating Success series covers a wide variety of topic, with the latest editions including new chapters such as Tough Conversations and Treating People Right. This indispensable business skills collection is suited to a variety of roles, from someone look...

  12. Sustaining Success in Haiti

    National Research Council Canada - National Science Library

    Oakley, Robert

    1996-01-01

    ... irreversible. The next several months are critical. Sustaining the success of Operation Uphold Democracy requires Haiti--and the international community--to confront, simultaneously, crucial transitions in political leadership, law and order, economic...

  13. Fertility Clinic Success Rates

    Science.gov (United States)

    ... Defects ART and Autism 2013 Assisted Reproductive Technology Fertility Clinic Success Rates Report Recommend on Facebook Tweet ... Additional Information About ART in the United States. Fertility Clinic Tables Introduction to Fertility Clinic Tables [PDF - ...

  14. Human Resource Outsourcing Success

    Directory of Open Access Journals (Sweden)

    Hasliza Abdul-Halim

    2014-07-01

    Full Text Available The existing literature on partnership seems to take the relationship between partnership quality and outsourcing success for granted. Therefore, this article aims at examining the role of service quality in strengthening the relationship between partnership quality and human resource (HR outsourcing success. The samples were obtained from 96 manufacturing organizations in Penang, Malaysia. The results showed that partnership quality variables such as trust, business understanding, and communication have significant positive impact on HR outsourcing success, whereas in general, service quality was found to partially moderate these relationships. Therefore, comprehending the HR outsourcing relationship in the context of service quality may assist the organizations to accomplish HR outsourcing success by identifying areas of expected benefits and improvements.

  15. Definition of successful defibrillation

    NARCIS (Netherlands)

    Koster, Rudolph W.; Walker, Robert G.; van Alem, Anouk P.

    2006-01-01

    OBJECTIVES: The definition of defibrillation shock "success" endorsed by the International Liaison Committee on Resuscitation since the publication of Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiac Care has been removal of ventricular fibrillation at 5 secs after shock

  16. Time to treatment with intravenous alteplase and outcome in stroke

    DEFF Research Database (Denmark)

    Lees, Kennedy R; Bluhmki, Erich; von Kummer, Rüdiger

    2010-01-01

    BACKGROUND: Early administration of intravenous recombinant tissue plasminogen activator (rt-PA) after ischaemic stroke improves outcome. Previous analysis of combined data from individual patients suggested potential benefit beyond 3 h from stroke onset. We re-examined the effect of time to trea...

  17. Research into Success

    Directory of Open Access Journals (Sweden)

    Bogomir Novak

    1997-12-01

    Full Text Available As competition is becoming ever more fierce, research into the prerequisites for success is gaining ground. By most people, success is perceived as an external phenomenon, but it is in fact the consequence of a person's readiness to perform in the world (of business. In the paper, Novak distinguishes between internal, external and group success. The essence of interna!success, which is the condition for the other two types of success, is assuming responsibility for, and exercising self-control over one's psychic phenomena. This in fact means that one needs to "reprogramme" the old patterns of behaviour and substitute them for the new, which leads to personality changes based on the understanding and acceptance of the self and others as they are. In realizing personal abilities, motives and goals, mental guiding laws must also be taken into account. Nowadays, the overall success of an organization is an important indicator of the quality of gro up work. The working patterns of individuals comply with the patterns used by his or her colleagues. When we do something for ourselves, we do it for others. In certain organizations, through accepted ways of communication all people become successful, and no body needs to be paid off. Employees wholly identify themselves with their organization, and vice versa. This three-part paradigm (I-Others-Community is the basis for various models of practical training for success, which are often idealized, but are primarily aimed at abolishing passivity and flaws in the system and its wider environment.

  18. Untangling Performance from Success

    CERN Document Server

    Yucesoy, Burcu

    2015-01-01

    Fame, popularity and celebrity status, frequently used tokens of success, are often loosely related to, or even divorced from professional performance. This dichotomy is partly rooted in the difficulty to distinguish performance, an individual measure that captures the actions of a performer, from success, a collective measure that captures a community's reactions to these actions. Yet, finding the relationship between the two measures is essential for all areas that aim to objectively reward excellence, from science to business. Here we quantify the relationship between performance and success by focusing on tennis, an individual sport where the two quantities can be independently measured. We show that a predictive model, relying only on a tennis player's performance in tournaments, can accurately predict an athlete's popularity, both during a player's active years and after retirement. Hence the model establishes a direct link between performance and momentary popularity. The agreement between the performa...

  19. Success in Entrepreneurship

    DEFF Research Database (Denmark)

    Iversen, Jens; Malchow-Møller, Nikolaj; Sørensen, Anders

    2016-01-01

    What makes a successful entrepreneur? Using Danish register data, we find strong support for the hypothesis that theoretical skills from schooling and practical skills acquired through wage-work are complementary inputs in the human capital earnings function of entrepreneurs. In fact, we find tha...

  20. Successful aging at work

    NARCIS (Netherlands)

    Zacher, Hannes

    2015-01-01

    The expression successful aging at work and related terms such as active, healthy, and productive aging at work are frequently used by organizational researchers and practitioners. However, there are no concrete definitions or theoretical frameworks that explain their meaning, assumptions, and

  1. ACT and College Success

    Science.gov (United States)

    Bleyaert, Barbara

    2010-01-01

    What is the relationship between ACT scores and success in college? For decades, admissions policies in colleges and universities across the country have required applicants to submit scores from a college entrance exam, most typically the ACT (American College Testing) or SAT (Scholastic Aptitude Test). This requirement suggests that high school…

  2. Styles of success

    DEFF Research Database (Denmark)

    Dahlgaard, Jens Jørn; Nørgaard, Anders; Jakobsen, Søren

    1997-01-01

    Corporate success stories tend to emphasize the "great men" theory of history. But now a European research project established the managerial attributes that can turn an ordinary leader into one ideal for the pursuit of business excellence. The emergence of five leadership styles as crucial drivers...

  3. Successful Parent Meetings.

    Science.gov (United States)

    Foster, Suzanne M.

    1994-01-01

    Key ingredients to successful parent meetings include planning with parents and including the children; assessing parents' needs and interests; planning the details of the meeting, such as meeting place, transportation, child care arrangements, and refreshments and activities; and planning the key elements of the meeting, such as presentations and…

  4. USAR Recruiting Success Factors.

    Science.gov (United States)

    1987-12-01

    have been developed to measure personalit , characteristics and have been used with varying amounts of success. Table . suimmarizes the individual...probity and propriety; acceptance of rules, proper authority, and custom; a person who seldom if ever gets into trouble . The CPI is essentially self

  5. International Student Success

    Science.gov (United States)

    Smith, Clayton

    2016-01-01

    This article, with a focus on North American postsecondary education, identifies international students as a strategic enrollment management institutional priority; presents themes in the international student retention, satisfaction, and success research literature; and describes related best practices. It also presents the findings from an…

  6. Together in student success

    African Journals Online (AJOL)

    Together in student success. John Schuh*. * Director and Distinguished Professor, School of Education, Iowa State University, USA. AFRICAN. MINDS www.jsaa.ac.za. Journal of Student Affairs in Africa | Volume 2 (1) 2014, v–vi | 2307-6267 | DOI: 10.14426/jsaa.v2i1.45. I have had two opportunities to visit South Africa in ...

  7. Success in a Hurry

    Science.gov (United States)

    Martin, Harold L., Sr.

    2015-01-01

    Although a young program, the North Carolina A&T Honors Program illustrates how quickly and successfully honors can achieve its goals of providing a quality education to its high-achieving students, and how these students can benefit academically and personally from the experiences that honors provides for them. This article provides a brief…

  8. Determinants of project success

    Science.gov (United States)

    Murphy, D. C.; Baker, B. N.; Fisher, D.

    1974-01-01

    The interactions of numerous project characteristics, with particular reference to project performance, were studied. Determinants of success are identified along with the accompanying implications for client organization, parent organization, project organization, and future research. Variables are selected which are found to have the greatest impact on project outcome, and the methodology and analytic techniques to be employed in identification of those variables are discussed.

  9. Mindfulness and Student Success

    Science.gov (United States)

    Leland, Matt

    2015-01-01

    Mindfulness has long been practiced in Eastern spiritual traditions for personal improvement, and educators and educational institutions have recently begun to explore its usefulness in schools. Mindfulness training can be valuable for helping students be more successful learners and more connected members of an educational community. To determine…

  10. Characteristics of Successful Entrepreneurs.

    Science.gov (United States)

    McClelland, David C.

    1987-01-01

    Comparison of characteristics of 12 average and 12 superior small business people in three developing nations (India, Malawi, and Ecuador) found proactive qualities such as initiative and assertiveness, achievement orientation, and commitment to others characteristic of successful entrepreneurs. Other expected qualities (self-confidence,…

  11. FOCUS: Sustainable Mathematics Successes

    Science.gov (United States)

    Mireles, Selina V.; Acee, Taylor W.; Gerber, Lindsey N.

    2014-01-01

    The FOCUS (Fundamentals of Conceptual Understanding and Success) Co-Requisite Model Intervention (FOCUS Intervention) for College Algebra was developed as part of the Developmental Education Demonstration Projects (DEDP) in Texas. The program was designed to use multiple services, courses, and best practices to support student completion of a…

  12. Successful School Composting.

    Science.gov (United States)

    Mahar, Rhea Dawn

    2001-01-01

    School composting programs that have met the challenges inherent in long-term composting have several traits in common: a supportive educational program, schoolwide participation, and a consistent maintenance program. Examines the elements of success, offers examples of incorporating composting into the curriculum, and describes three methods of…

  13. Pathways to School Success

    Science.gov (United States)

    University of Pittsburgh Office of Child Development, 2012

    2012-01-01

    In 2006, the University of Pittsburgh Office of Child Development began implementing a multi-year school readiness project in several area schools. Evidence from both research and the field point to several key elements that foster school readiness and create pathways to school success for all children. This paper presents components of a…

  14. Ensuring Students' Success

    Science.gov (United States)

    Oblinger, James L.

    2006-01-01

    James L. Oblinger, Chancellor of North Carolina State University, argues that higher education must continually evolve new methods of teaching and learning to support students' lifelong skills and impending careers. Part of ensuring students' success lies in finding alternative learning models, such as the Student-Centered Activities for Large…

  15. Intra-arterial infusion of prostaglandin E1 in normal subjects and patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Nielsen, P E; Nielsen, S L; Holstein, P

    1976-01-01

    Acute vasodilatation was produced by infusion of prostaglandin E1 (PGE1) in the femoral artery in 6 patients with occlusive arterial disease of the legs and in 3 normal subjects. The effect on blood flow and on blood pressure was measured at different segments of the leg with the strain gauge...

  16. Intra-arterial chemoembolization with hepasphere 50–100 μm for patients with unresectable hepatocellular

    Directory of Open Access Journals (Sweden)

    Talal Amer

    2015-12-01

    Conclusion: Hepasphere 50–100 μm is efficient for the treatment of hypervascular HCC. Further advances in drug-eluting beads including their size tailored to tumor anatomy may improve the results. Large series of patients, follow up for longer periods and comparison with conventional TACE and TACE with other DEB are needed.

  17. Intra-arterial treatment with {sup 90}Y microspheres for hepatocellular carcinoma: 4 years experience at the Ghent University Hospital

    Energy Technology Data Exchange (ETDEWEB)

    Lambert, Bieke; Mertens, Jeroen; Oltenfreiter, Ruth [Ghent University Hospital, Department of Nuclear Medicine, Ghent (Belgium); Sturm, Emiel; Defreyne, Luc [Ghent University Hospital, Department of Vascular and Interventional Radiology, Ghent (Belgium); Smeets, Peter [Ghent University Hospital, Department of Radiology, Ghent (Belgium); Troisi, Roberto [Ghent University Hospital, Department of Hepatobiliary Surgery and Liver Transplantation, Ghent (Belgium); Vlierberghe, Hans van [Ghent University Hospital, Department of Gastroenterology and Hepatology, Ghent (Belgium)

    2011-12-15

    We report on our experience in terms of eligibility, safety, response and survival for treatment of hepatocellular carcinoma (HCC) with {sup 90}Y microspheres. Secondly, we investigated the urinary excretion of {sup 90}Y following treatment. We retrospectively reviewed all HCC patients referred to our department for {sup 90}Y microsphere treatment. We recorded reasons for not proceeding to actual treatment. In case treatment was performed, we assessed the tolerance (Common Terminology Criteria for Adverse Events v3.0, CTCAE v3.0), the response [modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria] and long-term survival (Kaplan-Meier). The urinary excretion was estimated by 12-h urine collections post-injection for analysis in a gamma counter. Forty-three HCC patients were referred for radioembolization. Fourteen patients were excluded, mainly due to unfavourable {sup 99m}Tc-macroaggregated albumin (MAA) distribution. Twenty-nine patients were treated with {sup 90}Y microspheres (TheraSphere, mean activity 2.17 GBq). In four patients severe clinical adverse events were encountered, however only in one case clearly related to the therapy. Twenty patients were assessable by mRECIST: complete response in 15%, partial response in 35%, stable disease in 30% and progression in 20% were observed. A median survival of 12.3 months (95% confidence interval 9.4-15.2) was estimated. Concerning the substudy on urinary excretion, only 0.0025% of the administered activity was excreted in the urine within the first 12 h following TheraSphere. Following a strict workup before admitting patients to radioembolization with TheraSphere, we found good clinical tolerance in the vast majority of patients. Radiological response assessment yielded an overall response rate of 50%, when evaluated early following treatment. Urine analysis showed consistently only low activities of {sup 90}Y excreted in the urine. (orig.)

  18. Intra-arterial papaverine and leg vascular resistance during in situ bypass surgery with high or low epidural anaesthesia

    DEFF Research Database (Denmark)

    Rørdam, Peter; Jensen, Leif Panduro; Schroeder, T V

    1993-01-01

    patients were operated during high epidural anaesthesia (> Th. 10). Flow increased and arterial pressure decreased after i.a. papaverine in all patients. When compared with patients operated during high epidural anaesthesia, flow increase and decrease in vascular resistance took place in patients operated...... in flow after i.a. papaverine was not significantly different to that noted during high epidural anaesthesia. The results indicate that the level of analgesia influences graft flow after i.a. papaverine, probably reflecting differences in the effect of epidural anaesthesia on sympathetic tone to the leg....

  19. Why use Finapres or Portapres rather than intra-arterial or intermittent non-invasive techniques of blood pressure measurement?

    NARCIS (Netherlands)

    Langewouters, G. J.; Settels, J. J.; Roelandt, R.; Wesseling, K. H.

    1998-01-01

    In the clinic, blood pressure is measured almost exclusively using non-invasive intermittent techniques, of which the auscultatory (Riva-Rocci/Korotkoff, RRK) and the computerized oscillometric method are most often used. However, both methods only provide a momentary value. In addition, the

  20. Broad band spectral analysis of 24 h continuous finger blood pressure: Comparison with intra-arterial recordings

    NARCIS (Netherlands)

    Castiglioni, P.; Parati, G.; Omboni, S.; Mancia, G.; Imholz, B.P.M.; Wesseling, K.H.; Rienzo, M. di

    1999-01-01

    The present study compares the spectral characteristics of 24-h blood pressure variability estimated invasively at the brachial artery level with those estimated by measurement of blood pressure at the finger artery using the non-invasive Portapres device. Broad-band spectra (from 3 x

  1. Why use Finapres or Portapres rather than intra-arterial or intermittent non-invasive techniques of blood pressure measurement?

    NARCIS (Netherlands)

    Langewouters, G.J.; Settels, J.J.; Roelandt, R.; Wesseling, K.H.

    1998-01-01

    In the clinic, blood pressure is measured almost exclusively using non- invasive intermittent techniques, of which the auscultatory (Riva- Rocci/Korotkoff, RRK) and the computerized oscillometric method are most often used. However, both methods only provide a momentary value. In addition, the

  2. Non-invasive continuous finger blood pressure measurement during orthostatic stress compared to intra-arterial pressure

    NARCIS (Netherlands)

    Imholz, B. P.; Settels, J. J.; van der Meiracker, A. H.; Wesseling, K. H.; Wieling, W.

    1990-01-01

    The aim of the study was to evaluate whether invasive blood pressure responses to orthostatic stress can be replaced by non-invasive continuous finger blood pressure responses. DESIGN - Intrabrachial and Finapres blood pressures were simultaneously measured during passive head up tilt and during

  3. Comparison of non-invasive blood pressure monitoring using modified arterial applanation tonometry with intra-arterial measurement.

    Science.gov (United States)

    Harju, Jarkko; Vehkaoja, Antti; Kumpulainen, Pekka; Campadello, Stefano; Lindroos, Ville; Yli-Hankala, Arvi; Oksala, Niku

    2018-02-01

    Intermittent non-invasive blood pressure measurement with tourniquets is slow, can cause nerve and skin damage, and interferes with other measurements. Invasive measurement cannot be safely used in all conditions. Modified arterial tonometry may be an alternative for fast and continuous measurement. Our aim was to compare arterial tonometry sensor (BPro®) with invasive blood pressure measurement to clarify whether it could be utilized in the postoperative setting. 28 patients who underwent elective surgery requiring arterial cannulation were analyzed. Patients were monitored post-operatively for 2 h with standard invasive monitoring and with a study device comprising an arterial tonometry sensor (BPro®) added with a three-dimensional accelerometer to investigate the potential impact of movement. Recordings were collected electronically. The results revealed inaccurate readings in method comparison between the devices based on recommendations by Association for the Advancement of Medical Instrumentation (AAMI). On a Bland-Altman plot, the bias and precision between these two methods was 19.8 ± 16.7 (Limits of agreement - 20.1 to 59.6) mmHg, Spearman correlation coefficient r = 0.61. For diastolic pressure, the difference was 4.8 ± 7.7 (LoA - 14.1 to 23.6) mmHg (r = 0.72), and for mean arterial pressure it was 11.18 ± 11.1 (LoA - 12.1 to 34.2) mmHg (r = 0.642). Our study revealed inaccurate agreement (AAMI) between the two methods when measuring systolic and mean blood pressures during post-operative care. The readings for diastolic pressures were inside the limits recommended by AAMI. Movement increased the failure rate significantly (p invasive blood pressure measurement in these patients.

  4. Intra-arterial AICA-riboside administration induces NO-dependent vasodilation in vivo in human skeletal muscle.

    NARCIS (Netherlands)

    Bosselaar, M.; Boon, H.; Loon, L.J. van; Broek, P.H.H. van den; Smits, P.; Tack, C.J.J.

    2009-01-01

    In animal models, administration of the adenosine analog AICA-riboside has shown beneficial effects on ischemia-reperfusion injury and glucose homeostasis. The vascular and/or metabolic effects of AICA-riboside administration in humans remain to be established. AICA-riboside was infused

  5. Quality of life after intra-arterial treatment for acute ischemic stroke in the MR CLEAN trialUpdate

    NARCIS (Netherlands)

    Schreuders, Jennifer; van den Berg, Lucie A.; Fransen, Puck Ss; Berkhemer, Olvert A.; Beumer, Debbie; Lingsma, Hester F.; van Oostenbrugge, Robert J.; van Zwam, Wim H.; Majoie, Charles B. L. M.; van der Lugt, Aad; de Kort, Paul L. M.; Roos, Yvo B. W. E. M.; Dippel, Diederik W. J.

    2017-01-01

    Background Health-related quality of life measured with the EuroQol Group 5-Dimension Self-Report Questionnaire was one of the secondary outcomes in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN). We reported no

  6. Quality of life after intra-arterial treatment for acute ischemic stroke in the MR CLEAN trial—Update

    NARCIS (Netherlands)

    Schreuders, J. (Jennifer); L.A. Van Den Berg (Lucie A.); P.S.S. Fransen (Puck); O.A. Berkhemer (Olvert); D. Beumer (Debbie); H.F. Lingsma (Hester); R.J. van Oostenbrugge (Robert); W.H. van Zwam (Wim); C.B. Majoie (Charles); A. van der Lugt (Aad); P.L.M. de Kort (Paul); Y.B.W.E.M. Roos (Yvo); D.W.J. Dippel (Diederik)

    2017-01-01

    textabstractBackground: Health-related quality of life measured with the EuroQol Group 5-Dimension Self-Report Questionnaire was one of the secondary outcomes in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN). We reported

  7. Intra-arterial infusion of prostaglandin E1 in normal subjects and patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Nielsen, P E; Nielsen, S L; Holstein, P

    1976-01-01

    Acute vasodilatation was produced by infusion of prostaglandin E1 (PGE1) in the femoral artery in 6 patients with occlusive arterial disease of the legs and in 3 normal subjects. The effect on blood flow and on blood pressure was measured at different segments of the leg with the strain gauge...... technique, isotope clearance technique, and photoelectric technique. Skin temperature was measured at different levels by using thermocouples. The blood pressure on the legs decreased at all segments during vasodilatation as well in patients as in controls. The blood flow increased in all segments in normal...... controls. In patients the blood flow increased proximally in the legs. Distally, however, no increase could be demonstrated. As a good effect of PGE1, on ischaemic rest pains has been reported, mechanisms other than vasodilatation should probably be considered....

  8. Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke : mapping of intra-arterial treatment effect

    NARCIS (Netherlands)

    Boers, A M M; Berkhemer, O A; Slump, C H; van Zwam, W H; Roos, Y B W E M; van der Lugt, A; van Oostenbrugge, R J; Yoo, A J; Dippel, D W J; Marquering, H A; Majoie, C B L M; Vroomen, P. C.

    2017-01-01

    BACKGROUND: Since proof emerged that IA treatment (IAT) is beneficial for patients with acute ischemic stroke, it has become the standard method of care. Despite these positive results, recovery to functional independence is established in only about one-third of treated patients. The effect of IAT

  9. Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke: mapping of intra-arterial treatment effect.

    Science.gov (United States)

    Boers, A M M; Berkhemer, O A; Slump, C H; van Zwam, W H; Roos, Y B W E M; van der Lugt, A; van Oostenbrugge, R J; Yoo, A J; Dippel, D W J; Marquering, H A; Majoie, C B L M

    2017-05-01

    Since proof emerged that IA treatment (IAT) is beneficial for patients with acute ischemic stroke, it has become the standard method of care. Despite these positive results, recovery to functional independence is established in only about one-third of treated patients. The effect of IAT is commonly assessed by functional outcome, whereas its effect on brain tissue salvage is considered a secondary outcome measure (at most). Because patient and treatment selection needs to be improved, understanding the treatment effect on brain tissue salvage is of utmost importance. To introduce infarct probability maps to estimate the location and extent of tissue damage based on patient baseline characteristics and treatment type. Cerebral infarct probability maps were created by combining automatically segmented infarct distributions using follow-up CT images of 281 patients from the MR CLEAN trial. Comparison of infarct probability maps allows visualization and quantification of probable treatment effects. Treatment impact was calculated for 10 Alberta Stroke Program Early CT Score (ASPECTS) and 27 anatomical regions. The insular cortex had the highest infarct probability in both control and IAT populations (47.2% and 42.6%, respectively). Comparison showed significant lower infarct probability in 4 ASPECTS and 17 anatomical regions in favor of IAT. Most salvaged tissue was found within the ASPECTS M2 region, which was 8.5% less likely to infarct. Probability maps intuitively visualize the topographic distribution of infarct probability due to treatment, which makes it a promising tool for estimating the effect of treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Innovation in catheter design for intra-arterial liver cancer treatments results in favorable particle-fluid dynamics.

    Science.gov (United States)

    van den Hoven, Andor F; Lam, Marnix G E H; Jernigan, Shaphan; van den Bosch, Maurice A A J; Buckner, Gregory D

    2015-08-01

    Liver tumors are increasingly treated with radioembolization. Here, we present first evidence of catheter design effect on particle-fluid dynamics and downstream branch targeting during microsphere administrations. A total of 7 experiments were performed in a bench-top model of the hepatic arterial vasculature with recreated hemodynamics. Fluorescent microspheres and clinically used holmium microspheres were administered with a standard microcatheter (SMC) and an anti-reflux catheter (ARC) positioned at the same level along the longitudinal vessel axis. Catheter-related particle flow dynamics were analyzed by reviewing video recordings of UV-light illuminated fluorescent microsphere administrations. Downstream branch distribution was analyzed by quantification of collected microspheres in separate filters for two first-order branches. Mean deviation from a perfectly homogenous distribution (DHD) was used to compare the distribution homogeneity between catheter types. The SMC administrations demonstrated a random off-centered catheter position (in 71 % of experiments), and a laminar particle flow pattern with an inhomogeneous downstream branch distribution, dependent on catheter position and injection force. The ARC administrations demonstrated a fixed centro-luminal catheter position, and a turbulent particle flow pattern with a more consistent and homogenous downstream branch distribution. Quantitative analyses confirmed a significantly more homogeneous distribution with the ARC; the mean DHD was 40.85 % (IQR 22.76 %) for the SMC and 15.54 % (IQR 6.46 %) for the ARC (p = 0.047). Catheter type has a significant impact on microsphere administrations in an in-vitro hepatic arterial model. A within-patient randomized controlled trial has been initiated to investigate clinical catheter-related effects during radioembolization treatment.

  11. Focal cerebral ischemia measured by the intra-arterial 133xenon method. Limitations of 2-dimensional blood flow measurements

    DEFF Research Database (Denmark)

    Skyhøj Olsen, T; Larsen, B; Bech Skriver, E

    1981-01-01

    The limitations of 2-dimensional isotope techniques in the study of focal cerebral ischemia were investigated using the intra-carotid 133 xenon injection method and a 254 multidetector scintillation camera. To make sure that the detectors "look" directly on infarcted areas, only patients with inf......The limitations of 2-dimensional isotope techniques in the study of focal cerebral ischemia were investigated using the intra-carotid 133 xenon injection method and a 254 multidetector scintillation camera. To make sure that the detectors "look" directly on infarcted areas, only patients...... of 133 xenon (rCBF), 2) the initial distribution of isotope during the first 5 sec and 3) the cumulated counts recorded during 15 min. Compton scatter and the "look through phenomenon" were responsible for the majority of counts recorded from the infarcted areas and the blood flow recorded was found...

  12. Extra cardiac activity detected on myocardial perfusion scintigraphy after intra-arterial injection of 99mTc-MIBI

    DEFF Research Database (Denmark)

    Afzelius, Pia; Henriksen, Jens H

    2008-01-01

    (dipyridamol) imaging and followed by rest imaging day 2 was performed. RESULTS: On day 2, when rest perfusion scintigraphy was carried out, extra cardiac activity was present in the left part of thorax and in the left upper extremity resulting in reduced accumulation of 99mTc-MIBI in cardiac tissue......, prolongation of the study and interference of the extra cardiac activity with the cardiac image reconstructions. Whole-body scintigraphy disclosed an arterial flow distribution of activity to skeletal muscles in left shoulder and upper limb. CONCLUSION: Accidentally injected radiotracer retrogradely...

  13. Intra-arterial infusion of prostaglandin E1 in normal subjects and patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Nielsen, P E; Nielsen, S L; Holstein, P

    1976-01-01

    Acute vasodilatation was produced by infusion of prostaglandin E1 (PGE1) in the femoral artery in 6 patients with occlusive arterial disease of the legs and in 3 normal subjects. The effect on blood flow and on blood pressure was measured at different segments of the leg with the strain gauge...... technique, isotope clearance technique, and photoelectric technique. Skin temperature was measured at different levels by using thermocouples. The blood pressure on the legs decreased at all segments during vasodilatation as well in patients as in controls. The blood flow increased in all segments in normal...

  14. Regional cerebral blod flow studied by xenon-133. Intra-arterial injection studies and inhalation studies using emission tomography

    DEFF Research Database (Denmark)

    Lassen, N A

    1980-01-01

    .) technique is insensitive both to hyperemia and ischemia yielding essentially only a mean flow value. A new rapidly moving single photon tomograph following D. Kuhl's principle is presented applicable to Xe-133. Preliminary clinical data show that this technique is able to detect ischemic areas both with Xe...

  15. DEFINING SUCCESS IN PROJECTS

    Directory of Open Access Journals (Sweden)

    José Rodrigues de Farias Filho

    2011-05-01

    Full Text Available The Project Management Discipline has been widely used in the last years for companies around the world and these companies have been investing large amounts on surveys, training and consulting in order to get benefits for the organizations that need to create competitive advantage in the high competitive Market and to achieve their business strategy goals. Studies from the major world authors show many ways to define success at the organizations. In Brazil, the Benchmarking Study in GP from the PMI Chapters in 2009, show most studied companies don’t have a process do assess whether they are achieving the expected business goals with their investments in Project Management. This article goal is to demonstrate many ways to define success in project, which will facilitate the process to assess whether the companies are achieving these expected goals. The methodology used was a literature review, collecting publications, textbooks and documents from subject-matter-experts.

  16. Small(pox) success?

    Science.gov (United States)

    Birn, Anne-Emanuelle

    2011-02-01

    The 30th anniversary of the World Health Organization's (WHO) official certification of smallpox eradication was marked by a slew of events hailing the campaign's dramatic tale of technological and organizational triumph against an ancient scourge. Yet commemorations also serve as moments of critical reflection. This article questions the acclaim showered upon smallpox eradication as the single greatest public health success in history. It examines how and why smallpox eradication and WHO's concurrent social justice-oriented primary health care approach (following from the Declaration of Alma-Ata) became competing paradigms. It synthesizes critiques of eradication's shortcomings and debunks some of the myths surrounding the global eradication campaign as a public health priority and necessity, and as a Cold War victory of cooperation. The article concludes with thoughts on integrating technical and social-political aspects of health within the context of welfare states as the means to achieving widespread and enduring global public health success.

  17. Small(pox success?

    Directory of Open Access Journals (Sweden)

    Anne-Emanuelle Birn

    Full Text Available The 30th anniversary of the World Health Organization's (WHO official certification of smallpox eradication was marked by a slew of events hailing the campaign's dramatic tale of technological and organizational triumph against an ancient scourge. Yet commemorations also serve as moments of critical reflection. This article questions the acclaim showered upon smallpox eradication as the single greatest public health success in history. It examines how and why smallpox eradication and WHO's concurrent social justice-oriented primary health care approach (following from the Declaration of Alma-Ata became competing paradigms. It synthesizes critiques of eradication's shortcomings and debunks some of the myths surrounding the global eradication campaign as a public health priority and necessity, and as a Cold War victory of cooperation. The article concludes with thoughts on integrating technical and social-political aspects of health within the context of welfare states as the means to achieving widespread and enduring global public health success.

  18. Profile of success

    DEFF Research Database (Denmark)

    Dahlgaard, Jens Jørn; Nørgaard, Anders; Jakobsen, Søren

    1998-01-01

    What management skills must Europe's business leaders improve to achieve business excellence? Which country's leaders are best placed for success? Does the next generation have what it takes to compete? In the second half of their study of the leadership styles that drive business excellence, Jens...... Dahlgaard, Anders Nørgaard and Søren Jakobsen describe an excellent leadership profile that provides the answers....

  19. Successful time management

    CERN Document Server

    Forsyth, Patrick

    2016-01-01

    Packed with tips and techniques, Successful Time Management serves as a guide to reviewing and assessing new work practices to improve time management. It includes great time-saving ideas, practical solutions, checklists, and advice on controlling paperwork, delegating and working with others, prioritizing to focus on key issues, and getting and staying organized. This new third edition contains new practical tips on using email in a time effective manner and dealing with other internet-based tools and apps to help productivity.

  20. Untangling Performance from Success

    Science.gov (United States)

    Yucesoy, Burcu; Barabasi, Albert-Laszlo

    Fame, popularity and celebrity status, frequently used tokens of success, are often loosely related to, or even divorced from professional performance. This dichotomy is partly rooted in the difficulty to distinguish performance, an individual measure that captures the actions of a performer, from success, a collective measure that captures a community's reactions to these actions. Yet, finding the relationship between the two measures is essential for all areas that aim to objectively reward excellence, from science to business. Here we quantify the relationship between performance and success by focusing on tennis, an individual sport where the two quantities can be independently measured. We show that a predictive model, relying only on a tennis player's performance in tournaments, can accurately predict an athlete's popularity, both during a player's active years and after retirement. Hence the model establishes a direct link between performance and momentary popularity. The agreement between the performance-driven and observed popularity suggests that in most areas of human achievement exceptional visibility may be rooted in detectable performance measures. This research was supported by Air Force Office of Scientific Research (AFOSR) under agreement FA9550-15-1-0077.

  1. Implant success!!!.....simplified

    Directory of Open Access Journals (Sweden)

    Luthra Kaushal

    2009-01-01

    Full Text Available The endeavor towards life-like restoration has helped nurture new vistas in the art and science of implant dentistry. The protocol of "restoration-driven implant placement" ensures that the implant is an apical extension of the ideal future restoration and not the opposite. Meticulous pre-implant evaluation of soft and hard tissues, diagnostic cast and use of aesthetic wax-up and radiographic template combined with surgical template can simplify the intricate roadmap for appropriate implant treatment. By applying the harmony of artistic skill, scientific knowledge and clinical expertise, we can simply master the outstanding implant success in requisites of aesthetics, phonetics and function.

  2. Implant success!!!.....simplified.

    Science.gov (United States)

    Luthra, Kaushal K

    2009-01-01

    The endeavor towards life-like restoration has helped nurture new vistas in the art and science of implant dentistry. The protocol of "restoration-driven implant placement" ensures that the implant is an apical extension of the ideal future restoration and not the opposite. Meticulous pre-implant evaluation of soft and hard tissues, diagnostic cast and use of aesthetic wax-up and radiographic template combined with surgical template can simplify the intricate roadmap for appropriate implant treatment.By applying the harmony of artistic skill, scientific knowledge and clinical expertise, we can simply master the outstanding implant success in requisites of aesthetics, phonetics and function.

  3. Successful innovation by motivation

    Directory of Open Access Journals (Sweden)

    Petra Koudelková

    2015-10-01

    Full Text Available Innovation is one of the most important factors for business growth. Human capital plays a significant role in the successful process of innovation. This article deals with employee motivation in the innovation process and the main scientific aim of this study is to present results of research that was undertaken in the Czech Republic at the beginning of 2013. Questionnaires were used for the survey and statistical analyses such as Chi square test or Hierarchical cluster analysis were used for data processing. This study also provides a theoretical and practical overview of business innovation in the Czech Republic.

  4. LEIR commissioning successfully completed

    CERN Multimedia

    2006-01-01

    An important milestone has been passed in the preparation of the injector complex to supply ions to the LHC experiments. The LEIR lead-ion beam, seen on one of the control screens just before the PS injection region. The Low-Energy Ion Ring - LEIR for short - has passed its first tests with flying colours. On 12 May, the ring that will accumulate lead ions for the LHC was shut down after seven months of tests (see Bulletin 44/2005). 'The commissioning phase was a resounding success,' enthuses a satisfied Michel Chanel, head of the LEIR construction project. After several months of fine-tuning, the LEIR team has achieved its aim of producing the kind of beam required for first lead-ion collisions in the LHC in 2008. This involved creating bunches containing 230 million ions, in line with the specifications for those first beams. This success can be put down to the machine's outstanding design and components. 'It's a great achivement by all the teams involved in the machine's construction,' underlines Christian...

  5. A case of successful systemic thrombolysis in massive thromboembolia of pulmonary artery against the background of pregnancy

    Directory of Open Access Journals (Sweden)

    V. E. Tyukachev

    2017-11-01

    Full Text Available We present a clinical case of successful systemic thrombolysis in a pregnant patient with massive pulmonary embolism. A 29-year old patient at 28 weeks of pregnancy was hospitalized 2 hours after sudden suffocation in a presyncopal state and hypotension of 90/50 mm Hg. ECG showed the signs of overload of right heart chambers in the form of a typical S1-Q3-T3 (McGinn–White syndrome, as well as the Kosuge sign. Echocardiography verified pulmonary 3 Grade hypertension (81 mm Hg, enlargement of the right atrium and ventricle, 3 Grade tricuspid regurgitation and paradoxical movement of the interventricular septum. Multislice computed tomography of the chest with contrast of the pulmonary artery revealed a defect of contrast in the right main pulmonary artery, occlusive clearance, and thrombotic mass, extending to the bifurcation of the left main pulmonary artery ("clot - rider". Thrombolytic therapy was started with recombinant tissue plasminogen activator (alteplase 10 mg bolus, then 90 mg for 2 hours. The patient was daily examined by a gynecologist. The viability of the fetus, monitoring of possible hemorrhagic complications of the placenta were evaluated. After thrombolysis, the patient began to note clinical improvement in the form of a regression of dyspnea. According to echocardioscopy control, the signs of overload of right heart chambers completely regressed. There were no complications both in the mother and in the fetus during the subsequent days until discharge. On 25.05.16 there was uncomplicated delivery vaginally of live full-term girl. Thus, when there is life-threatening massive pulmonary embolism, the application of General principles of diagnosis and treatment of this disease in patients with pregnancy is warranted. The carrying out of thrombolytic therapy in massive pulmonary embolism enables to reduce the manifestations of pulmonary hypertension, right ventricular failure, and to conduct births on time. Used intravenous

  6. LHC synchronization test successful

    CERN Multimedia

    The synchronization of the LHC's clockwise beam transfer system and the rest of CERN's accelerator chain was successfully achieved last weekend. Tests began on Friday 8 August when a single bunch of a few particles was taken down the transfer line from the SPS accelerator to the LHC. After a period of optimization, one bunch was kicked up from the transfer line into the LHC beam pipe and steered about 3 kilometres around the LHC itself on the first attempt. On Saturday, the test was repeated several times to optimize the transfer before the operations group handed the machine back for hardware commissioning to resume on Sunday. The anti-clockwise synchronization systems will be tested over the weekend of 22 August.Picture:http://lhc-injection-test.web.cern.ch/lhc-injection-test/

  7. Trabectome success factors

    Science.gov (United States)

    Okeke, Constance O.; Miller-Ellis, Eydie; Rojas, Mario

    2017-01-01

    Abstract Our objective is to investigate which factors and patient characteristics are associated with success in Trabectome surgery. A total of 658 phakic cases with at least of 12 months follow-up were included in the analysis. Baseline demographics and medical data were collected. The main outcome measure was intraocular pressure (IOP), glaucoma medication (Rx), and secondary glaucoma surgery if any. Success was defined as IOP reduction of 20% or more from preoperative IOP and IOP < 21 mm Hg with no secondary surgery throughout the follow-up period. Risk factors for failure were determined by using univariate and multivariate cox regression. At baseline, the average IOP was 23.6 ± 7.8 mm Hg and the average number of medications was 2.6 ± 1.3 for all cases. At 12 months, the average IOP was 16.0 ± 3.6 mm Hg (P < .01∗) and the average number of medications was 1.8 ± 1.3 (P < .01∗). Based on the result of multivariate cox regression model, we found that the Trabectome + Phaco (TP) and Trabectome alone (TA) group had a 94% and 79% survival rate at 12 months, respectively. TP cases had 78% lower risk of failure than TA (95% confidence interval [CI]: 54–89), diagnosis of pseudoexfoliation glaucoma had a 54% lower risk of failure than primary open angle glaucoma patients (95% CI: 1–78). Hispanics had an estimated hazard ratio that is 60% lower than Caucasians (95% CI: 18–80); 20% of TA cases and 3% of TP cases were required to undergo additional secondary surgery (P < .01). Trabectome surgery, whether in combination with phacoemulsification cataract removal or stand alone, is associated with a significant reduction of IOP and glaucoma medication. Patients having a higher baseline IOP are expected to have a higher IOP reduction after Trabectome. Pseudoexfoliation glaucoma, combination with phacoemulsification cataract surgery and Hispanic race are factors associated with enhanced Trabectome survival. PMID:28614223

  8. Success and adaptation

    CERN Multimedia

    2013-01-01

    Yesterday morning, the last colliding proton beams of 2013 were extracted from the LHC, heralding the start of the machine’s first long shutdown (LS1) and crowning its first three glorious years of running. I hardly need to tell the CERN community what a fabulous performance all the people running the machine, the experiments, the computing and all supporting infrastructures put in. Those people are you, and you all know very well what a great job everyone did.   Nevertheless, I would like to express my thanks to all the people who made this first LHC run such a success. Re-measuring the whole Standard Model in such a short period, and then completing it with the discovery of what looks increasingly like the Higgs boson, is no mean feat. What I’d like to focus on today is another aspect of our field: its remarkable ability to adapt. When I started out in research, experiments involved a handful of people and lasted a few years at most. The timescale for the development of ...

  9. Success requires seizing opportunities.

    Science.gov (United States)

    Melum, M M

    1987-01-01

    The well-trained group of professionals had worked hard at the business they knew well. Their efforts had paid off--they were highly respected for their quality; their business grew; they had a close, trusting relationship with their customers; and they had the satisfaction of running their business as they alone knew to be best. As they looked ahead, they saw the personal security of a bright, safe future, of more of the same success. Then, slowly at first but building steadily to a feverish pace, their business and their lives were uprooted and torn apart in an all-encompassing economic and social earthquake. Now, with a force the professionals could hardly believe, let alone keep track of, the very definition of their business was changing, the trusting relationship with customers began to break down as massive numbers of new and different competitors vied for their business, many new players began to control how they ran their business, and security vanished into a confusion of competition, entrepreneurship, and risk.

  10. Assessing call centers’ success:

    Directory of Open Access Journals (Sweden)

    Hesham A. Baraka

    2013-07-01

    This paper introduces a model to evaluate the performance of call centers based on the Delone and McLean Information Systems success model. A number of indicators are identified to track the call center’s performance. Mapping of the proposed indicators to the six dimensions of the D&M model is presented. A Weighted Call Center Performance Index is proposed to assess the call center performance; the index is used to analyze the effect of the identified indicators. Policy-Weighted approach was used to assume the weights with an analysis of different weights for each dimension. The analysis of the different weights cases gave priority to the User satisfaction and net Benefits dimension as the two outcomes from the system. For the input dimensions, higher priority was given to the system quality and the service quality dimension. Call centers decision makers can use the tool to tune the different weights in order to reach the objectives set by the organization. Multiple linear regression analysis was used in order to provide a linear formula for the User Satisfaction dimension and the Net Benefits dimension in order to be able to forecast the values for these two dimensions as function of the other dimensions

  11. Prerana: a success story.

    Science.gov (United States)

    1995-01-01

    Prerana-Associate CEDPA, a women- and youth-focused community organization headquartered in New Delhi, has expanded its program activities with recent grants from two leading donors, the John D. and Catherine T. MacArthur Foundation and the Rockefeller Foundation. CEDPA provides important support through grants from The Xerox Foundation, The Turner Foundation, World Bank, and the US Agency for International Development. Founded in 1976, Prerana--whose name means "Inspiration" in Hindi--has grown steadily as knowledge of its comprehensive community-based program has spread. The organization conducts the CEDPA Better Life Options health, education, and vocational skills programs for girls and young women, maternal and child health services, and integrated community-based family planning. A parallel Better Life Options program for boys and young men was recently started. With almost 20 years of experience in the private sector, Prerana provides training and assistance to other private organizations. Prerana's Better Life Options program received international recognition in UNFPA's "The State of World Population 1994." The publication featured an article by a young Indian woman who participated in the program and as a result was able to develop life skills, improve her self-esteem, and, with her husband, decide to delay parenthood. "This success story," said Prerana Executive Director Dr. Uma Agarwal (WIM 29), "is being repeated by many other girls who find support at Prerana." full text

  12. Auditing Marketing Strategy Implementation Success

    OpenAIRE

    Herhausen, Dennis; Egger, Thomas; Oral, Cansu

    2014-01-01

    What makes a marketing strategy implementation successful and how can managers measure this success? To answer these questions, we developed a two-step audit approach. First, managers should measure the implementation success regarding effectiveness, efficiency, performance outcomes, and strategic embeddedness. Second, they should explore the reasons that have led to success or failure by regarding managerial, leadership, and environmental traps. Doing so will also provide corrective action p...

  13. Verbal Behavior and Courtroom Success.

    Science.gov (United States)

    Parkinson, Michael G.

    1981-01-01

    Identifies characteristics of successful courtroom speech for prosecuting attorneys, defense attorneys, and accuseds using computer-based content analysis and rater judgments of verbal behaviors. Demonstrates that verbal aggression is an important factor for successful prosecutors, equivocation is important to success for defense attorneys, and…

  14. Dynamic Leadership Succession: Strengthening Urban Principal Succession Planning

    Science.gov (United States)

    Peters-Hawkins, April L.; Reed, Latish C.; Kingsberry, Francemise

    2018-01-01

    The Dynamic Leadership Succession model is used to analyze a leadership succession case in an urban school district. The qualitative findings show that the district did not forecast school leadership needs well; however, the principal sought to develop and mentor teacher leaders as her assistant principals. Second, sustaining efforts within the…

  15. Critical success factors influencing project success in the ...

    African Journals Online (AJOL)

    This article assesses the perceptions of contractors and project managers on the critical success factors that lead to project success in the construction industry. This article is based on the four COMs model (comfort, competence, communication and commitment). A survey was conducted among 95 project managers and 61 ...

  16. The composition of international success

    DEFF Research Database (Denmark)

    Helles, Rasmus; Lai, Signe Sophus

    Danish television series have in recent years enjoyed an unprecedented level of international success, with series such as Borgen (2010-13) and The Killing (2007-12) travelling to multiple countries in Europe and beyond. Several explanations for the success have been put forward – ranging from ae...

  17. Identity and Fear of Success.

    Science.gov (United States)

    Larkin, Linda

    1987-01-01

    Investigated the relation between ego identity and fear of success using the Rasmussen Ego Identity Scale (EIS), the Marcia interview for identity status, the Cohen People Knowing Questionnaire (PKO) to measure fear of success, and an occupational behavior and attitude questionnaire. EIS and PKO scores correlated significantly with each other and…

  18. Success Analysis for School Administrators.

    Science.gov (United States)

    Carranza, Elihu

    The success analysis approach consists of individual and group exercises through which participants, in sharing meaning-centered experiences, identify their strengths and needs and clarify values operative in both past and expected successes. This approach constitutes a rational and practical perspective whereby students, teachers, staff, and…

  19. Does Happiness Promote Career Success?

    Science.gov (United States)

    Boehm, Julia K.; Lyubomirsky, Sonja

    2008-01-01

    Past research has demonstrated a relationship between happiness and workplace success. For example, compared with their less happy peers, happy people earn more money, display superior performance, and perform more helpful acts. Researchers have often assumed that an employee is happy and satisfied because he or she is successful. In this article,…

  20. SUCCESSION MANAGEMENT: UPAYA HUMAN RESOURCE PLANNING MENUJU SUCCESS CORPORATE

    Directory of Open Access Journals (Sweden)

    Rini Kuswati

    2010-06-01

    create a more flexible and dynamic approach for preparing future executive and have the leadership necessary ready to meet the business challenges of the remainder of the decade and beyond. Succession management allows the corporate leadership to instill a more dynamic process became easier to integrate with the firm’s strategic initiatives. It better aligns organizational thinking with the external environment where the discontinuities make it possible to anticipate the full spectrum of change that a corporation will confront. It is the leadership and succession philosophy that focuses on developing the creativity and flexibility that allows for a more rapid response to change. So succession management as one way to became the success corporate.

  1. Successful Industry/Academia Cooperation

    DEFF Research Database (Denmark)

    Stoustrup, Jakob

    2013-01-01

    The control literature is rich on impressive applications of advanced control, and within almost any industrial sector there are numerous examples of successful advanced control applications. Nevertheless, there is a widespread belief that there is still a wide potential for increased cooperation...... between academia and industry within this area. In this position paper, it is advocated that one of the enablers for successful cooperation between industry and academia within the control area is a proper framework for cooperation projects between companies and universities. Some suggestions...... by less complex but industrially feasible solutions. The proposed approach is illustrated by three case studies of successful industrial/academic cooperation....

  2. Organizational Climate for Successful Aging.

    Science.gov (United States)

    Zacher, Hannes; Yang, Jie

    2016-01-01

    Research on successful aging at work has neglected contextual resources such as organizational climate, which refers to employees' shared perceptions of their work environment. We introduce the construct of organizational climate for successful aging (OCSA) and examine it as a buffer of the negative relationship between employee age and focus on opportunities (i.e., beliefs about future goals and possibilities at work). Moreover, we expected that focus on opportunities, in turn, positively predicts job satisfaction, organizational commitment, and motivation to continue working after official retirement age. Data came from 649 employees working in 120 companies (M age = 44 years, SD = 13). We controlled for organizational tenure, psychological climate for successful aging (i.e., individuals' perceptions), and psychological and organizational age discrimination climate. Results of multilevel analyses supported our hypotheses. Overall, our findings suggest that OCSA is an important contextual resource for successful aging at work.

  3. Success Neurosis in College Seniors

    Science.gov (United States)

    Roulet, Norman L.

    1976-01-01

    The incidence and causes of success neurosis in undergraduate students are examined and the suggestion is made that while therapy of the manifest problem is often relatively easy, the longer-term fate is still problematic. (MB)

  4. Success Teaching Spelling with Music.

    Science.gov (United States)

    Martin, Mariellen

    1983-01-01

    A spelling approach which incorporates music on a cassette with spelling, pronunciation, and definition of specific words was successful in improving junior high learning disabled students' spelling performance, self-esteem, and sequential memories. (CL)

  5. The neurobiology of successful abstinence.

    Science.gov (United States)

    Garavan, H; Brennan, K L; Hester, R; Whelan, R

    2013-08-01

    This review focuses on the neurobiological processes involved in achieving successful abstinence from drugs of abuse. While there is clinical and public health value in knowing if the deficits associated with drug use correct with abstinence, studying the neurobiology that underlies successful abstinence can also illuminate the processes that enable drug-dependent individuals to successfully quit. Here, we review studies on human addicts that assess the neurobiological changes that arise with abstinence and the neurobiological predictors of successfully avoiding relapse. The literature, while modest in size, suggests that abstinence is associated with improvement in prefrontal structure and function, which may underscore the importance of prefrontally mediated cognitive control processes in avoiding relapse. Given the implication that the prefrontal cortex may be an important target for therapeutic interventions, we also review evidence indicating the efficacy of cognitive control training for abstinence. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Geometry success in 20 mins

    CERN Document Server

    Editors, LearningExpress

    2010-01-01

    Whether you're new to geometry or just looking for a refresher, this completely revised and updated third edition of Geometry Success in 20 Minutes a Day offers a 20-step lesson plan that provides quick and thorough instruction in practical, critical skills. Stripped of unnecessary math jargon but bursting with geometry essentials, Geometry Success in 20 Minutes a Day is an invaluable resource for both students and adults.

  7. Enterprise architecture for business success

    CERN Document Server

    Wijegunaratne, Inji; Evans-Greenwood, Peter

    2014-01-01

    Enterprise Architecture (EA) has evolved to become a prominent presence in today's information systems and technology landscape. The EA discipline is rich in frameworks, methodologies, and the like. However, the question of 'value' for business ;professionals remains largely unanswered - that is, how best can Enterprise Architecture and Enterprise Architects deliver value to the enterprise? Enterprise Architecture for Business Success answers this question. Enterprise Architecture for Business Success is primarily intended for IT professionals working in the area of Enterprise Architectu

  8. The characteristics of successful entrepreneurs

    OpenAIRE

    Pokrajčić Dragana M.

    2004-01-01

    This paper examines the economic, psychological and social-behavioral theories of the entrepreneur in order to determine the characteristics of a successful entrepreneur. The major contribution of economic theories of the entrepreneur is better understanding of the entrepreneur and his/her role in economic development. The psychological characteristic theory of entrepreneur argues that successful entrepreneurs possess certain personality traits that mark them out as special, and tries to dete...

  9. Organizational Climate for Successful Aging

    OpenAIRE

    Zacher, Hannes; Yang, Jie

    2016-01-01

    Research on successful aging at work has neglected contextual resources such as organizational climate, which refers to employees’ shared perceptions of their work environment. We introduce the construct of organizational climate for successful aging (OCSA) and examine it as a buffer of the negative relationship between employee age and focus on opportunities (i.e., beliefs about future goals and possibilities at work). Moreover, we expected that focus on opportunities, in turn, positively pr...

  10. Fast Success and Slow Failure

    DEFF Research Database (Denmark)

    Mors, Louise; Waguespack, David

    Full Abstract: Do the benefits of cross boundary collaborations outweigh the costs? We seek to answer this question by examining 5079 collaborations in the Internet Engineering Task Force (IETF). Our findings suggest that crossing formal boundaries is positively related to success and efficiency...... of success, suggesting that firms are better off investing in nondiverse projects. This finding has important implications for how we think about the benefits of seeking novelty....

  11. The characteristics of successful entrepreneurs

    Directory of Open Access Journals (Sweden)

    Pokrajčić Dragana M.

    2004-01-01

    Full Text Available This paper examines the economic, psychological and social-behavioral theories of the entrepreneur in order to determine the characteristics of a successful entrepreneur. The major contribution of economic theories of the entrepreneur is better understanding of the entrepreneur and his/her role in economic development. The psychological characteristic theory of entrepreneur argues that successful entrepreneurs possess certain personality traits that mark them out as special, and tries to determine and to evaluate these special traits. The social-behavioral theories stress the influence of experience, knowledge, social environment and ability to learn on the entrepreneur’s success as well as his/her personality traits. Neither of the examined theories of entrepreneur gives a satisfactory explanation of the entrepreneur’s success, but taken as a whole, they can explain key factors of entrepreneur’s success. The entrepreneur’s success comes about as a result of his/her personality traits, ability to learn from experience and ability to adjust to his/her environment.

  12. Successful Aging Through Successful Accommodation With Assistive Devices.

    Science.gov (United States)

    Freedman, Vicki A; Kasper, Judith D; Spillman, Brenda C

    2017-03-01

    To provide a profile of older adults who successfully accommodate declines in capacity by using assistive devices. Using the National Health and Aging Trends Study, we provide national estimates of prevalent, incident, and persistent successful accommodation of mobility and self-care activity limitations. For incident and persistent accommodation groups, we describe their subjective wellbeing and participation restrictions, health and functioning, demographic and socioeconomic characteristics, and acquisition of assistive devices and environmental features. We estimate regression models predicting incident and persistent successful accommodation and the extent of wellbeing and participation restrictions for incident and persistent groups (vs. those who are fully able). Nearly one-quarter of older adults have put in place accommodations that allow them to carry out daily activities with no assistance or difficulty. In adjusted models, incident and persistent successful accommodation is more common for those ages 80-89, those with more children, and those living in homes with environmental features already installed; wellbeing levels for these groups are similar and participation restrictions only slightly below those who are fully able. A focus on facilitating successful accommodation among those who experience declines in capacity may be an effective means of promoting participation and wellbeing in later life.

  13. Characteristics of successful alien plants.

    Science.gov (United States)

    van Kleunen, M; Dawson, W; Maurel, N

    2015-05-01

    Herbert Baker arguably initiated the search for species characteristics determining alien plant invasion success, with his formulation of the 'ideal weed'. Today, a profusion of studies has tested a myriad of traits for their importance in explaining success of alien plants, but the multiple, not always appropriate, approaches used have led to some confusion and criticism. We argue that a greater understanding of the characteristics explaining alien plant success requires a refined approach that respects the multistage, multiscale nature of the invasion process. We present a schema of questions we can ask regarding the success of alien species, with the answering of one question in the schema being conditional on the answer of preceding questions (thus acknowledging the nested nature of invasion stages). For each question, we identify traits and attributes of species we believe are likely to be most important in explaining species success, and we make predictions as to how we expect successful aliens to differ from natives and from unsuccessful aliens in their characteristics. We organize the findings of empirical studies according to the questions in our schema that they have addressed, to assess the extent to which they support our predictions. We believe that research on plant traits of alien species has already told us a lot about why some alien species become successful after introduction. However, if we ask the right questions at the appropriate scale and use appropriate comparators, research on traits may tell us whether they are really important or not, and if so under which conditions. © 2014 John Wiley & Sons Ltd.

  14. Success and Admission Criteria for Potentially Successful Risks. Final Report.

    Science.gov (United States)

    Nicholson, Everard

    The focus of this study was upon students who were academic "risks." The basic definition of "risk" was based on a cutoff of 620 in College Board verbal scholastic aptitude scores. A study was made of the past success of these risks, with the major purpose of finding new variables and methods which would assist admissions officers in the selection…

  15. [Successful breastfeeding after reduction mammaplasty].

    Science.gov (United States)

    Witte, P M; van der Lei, B; van der Biezen, J J; Spronk, C A

    2004-06-26

    To determine if it is possible to successfully breastfeed after reduction mammaplasty with intact continuity between papilla and glandular tissue. Retrospective by use of a written questionnaire. Between 1986 and 2000, 994 women under the age of 35 underwent a reduction mammaplasty at the Medical Centre in Leeuwarden, The Netherlands. They were all sent a questionnaire of which 585 were completed correctly and returned. Of the 585 women, 215 had had one or more children and 90 had started breastfeeding, 57 of whom were successful (63%). In non-operated women this figure is 69%. The advice to try to breastfeed was associated with a higher percentage of success than the advice not to try--78% and 42% respectively. It appears to be justified to encourage women who have had a breast reduction to attempt to breastfeed after the birth of a child.

  16. Factors of Project Manager Success

    Directory of Open Access Journals (Sweden)

    Raafat George Saadé

    2015-06-01

    Full Text Available This research seeks to analyse the project success factors related to project managers’ traits. The context of the research entails a ‘United Nations’ type of organization. Critical success factors from previous recent studies were adopted for this research. Nineteen factors were adopted and a survey methodology approach was followed. Sixty six participants completed the survey. Exploratory factor analysis results revealed the existence of two constructs: project manager engagement, and project manager certification. The total number of factors representing these two constructs after the factor reduction exercise is nine. Our findings indicate that the capacity for a project manager to communicate and lobby for the project to create and sustain positive perceptions, is the most important factor; whereas project manager credentials are viewed as not important for his/her success. The results may seem counter-intuitive, however, in the context of United Nations Organizations, consideration of their political, cultural and international nature reveals that the results apply.

  17. Successful change: renaissance without revolution.

    Science.gov (United States)

    Sweeney, Y T; Whitaker, C

    1994-12-01

    Change does not have to be painful. In fact, with careful planning it can even be liberating, empowering, and fun. Creating a vision, establishing trust, and encouraging participation are all critical steps in the process of change. Additionally, understanding the organizational culture, effective communication and assessing readiness are necessary in managing the change process and setting the stage for success. A case presentation describing the development and implementation of a staff on-call program is presented to illustrate the important steps in planning for a successful change process.

  18. Human capital and career success

    DEFF Research Database (Denmark)

    Frederiksen, Anders; Kato, Takao

    formal schooling and subsequent human capital obtained informally on the job are found to be complements in the production of career success. Fourth, though there is a large body of the literature on the relationship between firm-specific human capital and wages, the relative value of firm-specific human...

  19. MINORITY UNDERGRADUATE NURSING STUDENT SUCCESS.

    Science.gov (United States)

    Ferrell, Denise K; DeCrane, Susan K; Edwards, Nancy; Foli, Karen J; Tennant, Kathleen F

    2016-01-01

    Minority providers are more likely to practice in underserved areas with minority populations. Currently the representation of minorities in healthcare professions is less than that of the United States population. More research is needed to examine specific variables associated with educational success of minority students. The purpose of this study is to examine, and increase the understanding of, current factors that influence success among ethnic and minority nursing students. The revised Minority Student Nurse Questionnaire (MSNQ) was utilized for this study with a sample of 31 students from 2 entry-level nursing programs in the Midwest. Minority students were slightly older than traditional college students and consisted of African-American Black, Native (American) Indian, Asian, Hispanic/Latino, and Hawaiian. Students reported multiple factors that influenced their higher education experience. Academic services and cultural organizations were available, free, but were used by less than half of the students. Several sources of financial assistance are important, including scholarships, federal subsidized and unsubsidized loans, and grants. Students most strongly disagreed with the statement that 'the number of minorities in this program is representative of the number of minorities overall.' Students felt that several services were supportive and helpful strategies for success. Although progress has been made to improve success of minority students, numbers continue to lag between demographic population overall.

  20. 2012 Critical Success Factors Report

    Science.gov (United States)

    North Carolina Community College System (NJ1), 2012

    2012-01-01

    The Critical Success Factors Report is the North Carolina Community College System's major accountability document. This annual performance report is based on data compiled from the previous year and serves to inform colleges and the public on the performance of North Carolina's 58 community colleges. In 1993, the State Board of Community Colleges…

  1. 2011 Critical Success Factors Report

    Science.gov (United States)

    North Carolina Community College System (NJ1), 2011

    2011-01-01

    The Critical Success Factors Report is the North Carolina Community College System's major accountability document. This annual performance report serves to inform colleges and the public on the performance of North Carolina's 58 community colleges. In 1993, the State Board of Community Colleges began monitoring performance data on specific…

  2. Successful bonding in orthodontics: 1.

    Science.gov (United States)

    Turner, P J

    1996-11-01

    Since it was first described in 1955, direct bonding of orthodontic attachments to the teeth has become routine in fixed appliance therapy. The technique used is deceptively simple: meticulous attention to detail and a thorough understanding of the factors involved are needed to ensure a successful outcome.

  3. Defining and Measuring Academic Success

    Science.gov (United States)

    York, Travis T.; Gibson, Charles; Rankin, Susan

    2015-01-01

    Despite, and perhaps because of its amorphous nature, the term "academic success" is one of the most widely used constructs in educational research and assessment within higher education. This paper conducts an analytic literature review to examine the use and operationalization of the term in multiple academic fields. Dominant…

  4. Lobomycosis Successfully Treated with Posaconazole

    Science.gov (United States)

    Bustamante, Beatriz; Seas, Carlos; Salomon, Martín; Bravo, Francisco

    2013-01-01

    Lobomycosis is a chronic subcutaneous mycosis for which no standard treatment is available to date. We describe a patient in Peru with lobomycosis on the left earlobe that was successfully treated with posaconazole for 27 months. No evidence of recurrence was observed after five years of follow-up. PMID:23546805

  5. Successful Aging: A Developmental Approach.

    Science.gov (United States)

    Ryff, Carol D.

    1982-01-01

    Examines earlier conceptualizations of successful aging and calls for a reformulation that is more responsive to developmental processes and theoretical guidance. Discusses issues of operational definitions, selective sampling, and stage theory. The perspective is illustrated with empirical research in the personality realm. (Author)

  6. Successive Standardization of Rectangular Arrays

    Directory of Open Access Journals (Sweden)

    Richard A. Olshen

    2012-02-01

    Full Text Available In this note we illustrate and develop further with mathematics and examples, the work on successive standardization (or normalization that is studied earlier by the same authors in [1] and [2]. Thus, we deal with successive iterations applied to rectangular arrays of numbers, where to avoid technical difficulties an array has at least three rows and at least three columns. Without loss, an iteration begins with operations on columns: first subtract the mean of each column; then divide by its standard deviation. The iteration continues with the same two operations done successively for rows. These four operations applied in sequence completes one iteration. One then iterates again, and again, and again, ... In [1] it was argued that if arrays are made up of real numbers, then the set for which convergence of these successive iterations fails has Lebesgue measure 0. The limiting array has row and column means 0, row and column standard deviations 1. A basic result on convergence given in [1] is true, though the argument in [1] is faulty. The result is stated in the form of a theorem here, and the argument for the theorem is correct. Moreover, many graphics given in [1] suggest that except for a set of entries of any array with Lebesgue measure 0, convergence is very rapid, eventually exponentially fast in the number of iterations. Because we learned this set of rules from Bradley Efron, we call it “Efron’s algorithm”. More importantly, the rapidity of convergence is illustrated by numerical examples.

  7. Parents, School Success, and Health

    Centers for Disease Control (CDC) Podcasts

    2009-08-03

    In this podcast, Dr. William Jeynes, CDC Parenting Speaker Series guest, discusses the importance of parental involvement in children's academic success and lifelong health.  Created: 8/3/2009 by National Center on Birth Defects and Developmental Disabilities (NCBDDD).   Date Released: 8/3/2009.

  8. Successful Internet Based Online Instruction

    Science.gov (United States)

    Challoo, L.; Saldana, J.; Davis, R.; Kupczynski, Lori

    2010-01-01

    This study identifies factors in distance learning that affect the educational excellence of institutions of higher learning. The main elements of this study are: the examination of benefits and disadvantages of implementing online instruction in institutions of higher learning; investigating the factors that contribute to successful web-based…

  9. [Success factors in hospital management].

    Science.gov (United States)

    Heberer, M

    1998-12-01

    The hospital environment of most Western countries is currently undergoing dramatic changes. Competition among hospitals is increasing, and economic issues have become decisive factors for the allocation of medical care. Hospitals therefore require management tools to respond to these changes adequately. The balanced scorecard is a method of enabling development and implementation of a business strategy that equally respects the financial requirements, the needs of the customers, process development, and organizational learning. This method was used to derive generally valid success factors for hospital management based on an analysis of an academic hospital in Switzerland. Strategic management, the focus of medical services, customer orientation, and integration of professional groups across the hospital value chain were identified as success factors for hospital management.

  10. The sudden success of prose

    DEFF Research Database (Denmark)

    Mortensen, Lars Boje

    2017-01-01

    . It is also suggested that the exactly contemporary rise of French and Old Norse prose (c. 1200-1230) most probably is connected. The four literatures are each shown in chronological charts so as to visualize the timeline and the relation between poetic and prosaic works. The article furthermore reflects......The article presents a new model for understanding the sudden success of prose in four literatures: Greek, Latin, French and Old Norse. Through comparison and quantitative observations, and by focusing on the success of prose rather than its invention, it is shown that in all four cases two...... reading aloud) has been underplayed in previous scholarship mostly focused on authorial choices and invention. For two of the literatures (Greek, French) the fast dynamics of the rise of prose has already been identified and discussed, but for the two others (Latin, Old Norse), the observation is new...

  11. Writing a successful business plan.

    Science.gov (United States)

    Haag, A B

    1997-01-01

    1. In creating and building a business, the entrepreneur assumes all the responsibilities for its development and management, as well as the risks and risks and rewards. Many businesses do not survive because business owners fail to develop an effective plan. 2. The business plan focuses on major areas of concern and their contribution to the success of a new business. The finished product communicates the product/service to others and provides the basis for the financial proposal. 3. Planning helps identify customers, market area, pricing strategy, and competitive conditions. It aids in decision making and is an essential guide for operating a business successfully and measuring progress. 4. The business plan not only serves as a mechanism for obtaining any needed financial resources, but also indicates the future direction of the company.

  12. Another successful Doctoral Student Assembly

    CERN Multimedia

    Katarina Anthony

    2014-01-01

    On Wednesday 2 April, CERN hosted its third Doctoral Student Assembly in the Council Chamber.   CERN PhD students show off their posters in CERN's Main Building. Speaking to a packed house, Director-General Rolf Heuer gave the assembly's opening speech and introduced the poster session that followed. Seventeen CERN PhD students presented posters on their work, and were greeted by their CERN and University supervisors. It was a very successful event!

  13. Delivering success in Milton Keynes.

    Science.gov (United States)

    2004-01-01

    The national roll out of the new procurement route, for publicly funded health schemes over 1 million Pound, has recently been implemented and NHS Trusts are quite naturally looking to the pilot regions for a demonstration of what can be achieved. One such example is the successful delivery of the new Treatment Centre for Milton Keynes General Hospital NHS Trust by Norwest Hoist Construction and its supply chain.

  14. Communication: essential strategies for success.

    Science.gov (United States)

    O'Connor, Mary

    2013-06-01

    This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advance organizational change, content includes evidence-based projects, tool, and resources that mobilize and sustain organizational change initiatives. In this article, the author discusses strategies for communication for change processes, whether large or small. Intentional planning and development of a communication strategy alongside, not as an afterthought, to change initiatives are essential.

  15. Fumigation success for California facility.

    Science.gov (United States)

    Hacker, Robert

    2010-02-01

    As Robert Hacker, at the time director of facilities management at the St John's Regional Medical Center in Oxnard, California, explains, the hospital, one of the area's largest, recently successfully utilised a new technology to eliminate mould, selecting a cost and time-saving fumigation process in place of the traditional "rip and tear" method. Although hospital managers knew the technology had been used extremely effectively in other US buildings, this was reportedly among the first ever healthcare applications.

  16. The Ingredients for Corporate Success?

    OpenAIRE

    Dickmann, Michael; Hughes, Heather

    2017-01-01

    The search for excitement, adventure, cross-cultural learning and the avoidance of problems at home are amongst key drivers to seek an international assignment (Hippler, 2009; Doherty et al., 2011). Global careers and talent management are amongst the crucial ingredients for corporate success (Scullion and Collings, 2011) and understanding individual drivers and designing matching and motivating Global Mobility (GM) approaches is at the heart of high performance GM work (Dickmann et al., 2008...

  17. The Successive Mean Quantization Transform

    OpenAIRE

    Nilsson, Mikael; Dahl, Mattias; Claesson, Ingvar

    2005-01-01

    This paper presents the Successive Mean Quantization Transform (SMQT). The transform reveals the organization or structure of the data and removes properties such as gain and bias. The transform is described and applied in speech processing and image processing. The SMQT is considered as an extra processing step for the mel frequency cepstral coefficients commonly used in speech recognition. In image processing the transform is applied in automatic image enhancement and dynamic range compress...

  18. Strategic Planning: Shaping Future Success

    Science.gov (United States)

    2016-09-01

    Defense AT&L: September-October 2016 46 Strategic Planning Shaping Future Success Brian Schultz “What’s the use of running if you are not on the...fielding, the PM may also be planning for future increments, sustainment and other long-term ef- forts. Strategic planning can help the PM position these...future programs and actions for good outcomes. So what is this strategic planning all about? Let’s start with some background, including a strategic

  19. What influences crowdfunding campaign success.

    OpenAIRE

    Drabløs, Christian

    2015-01-01

    Master thesis Business Administration- University of Agder, 2015 Crowdfunding is a recently emerged market for entrepreneurs; it represents a new and growing source of potential capital. The potential crowdfunding is starting to reach it potential, and has beginning to go mainstream. There is a gap in the research on crowdfunding and within the field of what separates a successful campaign from a failed one. To explore the variables influencing crowdfunding campaign this paper ...

  20. What influences crowdfunding campaign success.

    OpenAIRE

    Drabløs, Christian

    2015-01-01

    Crowdfunding is a recently emerged market for entrepreneurs; it represents a new and growing source of potential capital. The potential crowdfunding is starting to reach it potential, and has beginning to go mainstream. There is a gap in the research on crowdfunding and within the field of what separates a successful campaign from a failed one. To explore the variables influencing crowdfunding campaign this paper looks into academic articles, the crowdfunding platforms, general...

  1. Fast Success and Slow Failure

    DEFF Research Database (Denmark)

    Mors, Louise; Waguespack, David

    by examining 5079 collaborations in the Internet Engineering Task Force (IETF). Our findings suggest that crossing formal boundaries is positively related to success of the collaboration, as well as efficiency of the project. Yet there are high costs associated with cross boundary collaborations...... investing in non-diverse projects. This finding has important implications for how we think about organization design and the expected benefits of seeking novelty....

  2. Emerging Prospects for Repository Success

    Energy Technology Data Exchange (ETDEWEB)

    Isaacs, T

    2006-01-12

    Recent events are again raising some old issues and creating new opportunities regarding the future disposition of the used, or spent, fuel from nuclear power plants. Handling these challenges well will not only help set the stage for a robust nuclear energy future, but will reflect the growing linkages among nuclear power, nuclear waste management, international security, and public and political acceptance. The emerging global nuclear regime may make spent fuel management not only more important, but improve chances of success.

  3. ORCID @ CMU: Successes and Failures

    Directory of Open Access Journals (Sweden)

    Denise Troll Covey

    2016-02-01

    Full Text Available Setting and Objectives: Carnegie Mellon University (CMU recently planned and implemented a project to help CMU researchers get an Open Researcher and Contributor Identifier (ORCID and to enable administrators to integrate the ORCIDs into university systems. This article describes and assesses the planning, performance, and outcome of this initiative, branded ORCID @ CMU. Design and Methods: The article chronicles why and how ORCID was integrated at CMU, including the rationale for changes in strategic plans. It assesses researcher participation in the project using transaction log and content analyses, and the performance of the ORCID project team using recommendations in the Jisc ORCID project report, frankly reporting the team’s successes and failures. The article concludes with lessons learned that should inform ORCID integration projects and expectations at other institutions. Results: The ORCID @ CMU web application was a great success. However, the project team did not allow enough time to prepare or devote enough attention to advocacy. The marketing message was not sufficiently persuasive and the marketing channels were not particularly effective. The overall participation rate in ORCID @ CMU was far below the target of 40%, though participation in many demographics exceeded the goal. Conclusions: Strategic planning does not guarantee success. Secure more than lip service from senior administrators. Recruit champions from across the institution. Develop a message that resonates with researchers. Allow sufficient time to prepare. Empower the project manager. Start with the low hanging fruit. Develop special outreach to doctoral students and postdocs.

  4. Succession planning for technical experts

    Energy Technology Data Exchange (ETDEWEB)

    Kirk, Bernadette Lugue [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Cain, Ronald A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Dewji, Shaheen A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Agreda, Carla L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2017-07-01

    This report describes a methodology for identifying, evaluating, and mitigating the loss of key technical skills at nuclear operations facilities. The methodology can be adapted for application within regulatory authorities and research and development organizations, and can be directly applied by international engagement partners of the Department of Energy’s National Nuclear Security Administration (NNSA). The resultant product will be of direct benefit to two types of NNSA missions: (1) domestic human capital development programs tasked to provide focused technical expertise to succeed an aging nuclear operations workforce, and (2) international safeguards programs charged with maintaining operational safeguards for developing/existing nuclear power program in nations where minimal available resources must be used effectively. This report considers succession planning and the critical skills necessary to meet an institution’s goals and mission. Closely tied to succession planning are knowledge management and mentorship. In considering succession planning, critical skill sets are identified and are greatly dependent on the subject matter expert in question. This report also provides examples of critical skills that are job specific.

  5. Success in Transdisciplinary Sustainability Research

    Directory of Open Access Journals (Sweden)

    Tobias Luthe

    2017-01-01

    Full Text Available The complexity of sustainable development and societal transitions require both analytical understandings of how coupled human-environment systems function and transdisciplinary science-to-practice approaches. The academic discourse has advanced in developing a framework for defining success in transdisciplinary research (TDR. Further empirical evidence is needed to validate the proposed concepts with TDR case studies. This paper applies a widely used TDR framework to test and critically evaluate its design principles and criteria of success with five TDR case studies the author is intimately familiar with. Overall, the design principles of the framework are validated for the five cases. Additional design principles are derived from the case analysis and proposed to complement the applied framework: (1 A project origin from society as opposed to with and for society; (2 Quickly available initiation funding; (3 Flexibility in time, objectives and methods throughout the research process; (4 Acceptance of process vs. project results; (5 Inclusion of public science communication; and (6 A demand-driven transition to a prolonged or new project partnership. The complementing principles are proposed for integration in the applied framework and are subject to further empirical testing. The reflexive empirical approach I have taken in this paper offers a key step towards removing institutional barriers for successful TDR, demonstrating how conceptual frameworks can be applied.

  6. Successful Climate Science Communication Strategies

    Science.gov (United States)

    Sinclair, P.

    2016-12-01

    In the past decade, efforts to communicate the facts of global change have not successfully moved political leaders and the general public to action. In response, a number of collaborative efforts between scientists and professional communicators, writers, journalists, bloggers, filmmakers, artists and others have arisen seeking to bridge that gap. As a result, a new cadre of science-literate communicators, and media-savvy scientists have made themselves visible across diverse mainstream, traditional, and social media outlets. Because of these collaborations, in recent years, misinformation, and disinformation have been successfully met with accurate and credible rebuttals within a single news cycle.Examples of these efforts is the Dark Snow Project, a science/communication collaboration focusing initially on accelerated arctic melt and sea level rise, and the Climate Science Rapid Response team, which matches professional journalists with appropriate science experts in order to respond within a single news cycle to misinformation or misunderstandings about climate science.The session will discuss successful examples and suggest creative approaches for the future.

  7. Exploring mobile learning success factors

    Directory of Open Access Journals (Sweden)

    Thomas D. Cochrane

    2010-12-01

    Full Text Available This paper is a comparative account and analysis of three mobile Web 2.0 projects instigated within a tertiary learning environment during 2008. Following the successful instigation of a mobile Web 2.0 project in the third year of a Bachelor of Product Design course during semester one, similar projects were initiated in semester two within the first-year and second-year Bachelor of Product Design courses. A common methodology for supporting and facilitating mobile Web 2.0 projects was used for all three projects. The projects were designed to explore the potential of mobile Web 2.0 tools to enhance both the formal and informal teaching and learning environments with a focus upon mobile blogging (moblogging. A comparison of student and teaching staff feedback from each of the three projects provided a basis for identifying and illustrating critical success factors within similar m-learning scenarios. Critical success factors identified include: the importance of the pedagogical integration of the technology into the course assessment, lecturer modelling of the pedagogical use of the tools, the need for regular formative feedback from lecturers to students, and the appropriate choice of mobile devices and software to support the pedagogical model underlying the course.

  8. Supporting Success for All Students

    Science.gov (United States)

    Manduca, C. A.; Macdonald, H.; McDaris, J. R.; Weissmann, G. S.

    2015-12-01

    The geoscience student population in the United States today does not reflect the diversity of the US population. Not only does this challenge our ability to educate sufficient numbers of students in the geosciences, it also challenges our ability to address issues of environmental justice, to bring geoscience expertise to diverse communities, and to pursue a research agenda reflecting the needs and interests of our nation as a whole. Programs that are successful in supporting students from underrepresented groups attend to the whole student (Jolly et al, 2004) as they develop not only knowledge and skills, but a sense of belonging and a drive to succeed in geoscience. The whole student approach provides a framework for supporting the success of all students, be they members of underrepresented groups or not. Important aspects of support include mentoring and advising, academic support, an inclusive learning community, and opportunities to learn about the profession and to develop geoscience and professional skills. To successfully provide support for the full range of students, it is critical to consider not only what opportunities are available but the barriers different types of students face in accessing these opportunities. Barriers may arise from gaps in academic experiences, crossing into a new and unfamiliar culture, lack of confidence, stereotype threat, implicit bias and other sources. Isolation of geoscience learning from its application and social context may preferentially discourage some groups. Action can be taken to increase support for all students within an individual course, a department or an institution. The InTeGrate STEP Center for the Geosciences, the Supporting and Advancing Geoscience Education at Two-Year Colleges program and the On the Cutting Edge Professional Development for Geoscience Faculty program all provide resources for individuals and departments including on line information, program descriptions, and workshop opportunities.

  9. How to market OR successfully

    Directory of Open Access Journals (Sweden)

    R.E.D. Woolsey

    2003-12-01

    Full Text Available It was with considerable amusement that I noticed a recent flyer from ORSSA for a one day workshop on "Marketing Operations Research". The brochure contained some amusing but painful truths such as "Most O.R. Practitioners experience difficulty in marketing O.R." For those of you who did not attend the course, but would like some advice for free, here it is. As this is a precis of what I have been saying (and doing for over twenty years, I also provide (with my usual humility a bibliography of my (personally tested suggestions for successfully marketing O.R.

  10. Successful commercialization of nanophotonic technology

    Science.gov (United States)

    Jaiswal, Supriya L.; Clarke, Roger B. M.; Hyde, Sam C. W.

    2006-08-01

    The exploitation of nanotechnology from proof of principle to realizable commercial applications encounters considerable challenges in regards to high volume, large scale, low cost manufacturability and social ethics. This has led to concerns over converting powerful intellectual property into realizable, industry attractive technologies. At The Technology Partnership we specifically address the issue of successful integration of nanophotonics into industry in markets such as biomedical, ophthalmic, energy, telecommunications, and packaging. In this paper we draw on a few examples where we have either developed industrial scale nanophotonic technology or engineering platforms which may be used to fortify nano/microphotonic technologies and enhance their commercial viability.

  11. A Risk Communication Success Story

    Science.gov (United States)

    Peecook, Keith

    2010-01-01

    A key success of the decommissioning effort at the National Aeronautics and Space Administration's (NASA's) Plum Brook Reactor Facility (PBRF) has been the public outreach program. The approach has been based on risk communications rather than a public relations approach. As a result it has kept the public feeling more involved in the process. It ensures they have the information needed to understand the project and its goals, and to make recommendations. All this is done so that NASA can better plan and execute the necessary work without delays or suprises.

  12. Double success for neutrino lab

    CERN Multimedia

    2010-01-01

    "The Gran Sasso National Laboratory in Italy is celebrating two key developments in the field of neutrino physics. Number one is the first ever detection, by the OPERA experiement, of possible tau neutrino that has switched its identity from a muon neutrino as it travelled form its origins at CERN in Switzerland to the Italian lab. Number two is the successful start-up of the ICARUS detector, which, like OPERA, is designed to study neutrinos that "oscillate" between types" (0.5 pages)

  13. Organize for success: seven steps to a successful building project.

    Science.gov (United States)

    Arneill, B P; Nuelsen, P H

    1999-01-01

    Intended for ambulatory care administrators considering a building project, the article discusses seven key steps to a successful project: Avoid common pitfalls: allow enough time, avoid over-delegation, focus staff on issues rather than egos, require staff "buy-ins" to project concepts and design, and understand the realties of construction. Select the right team: how to interview, assess qualifications, and make a sound decision. Understand all the project costs; construction cost is only one of many. Understand the various construction methods and pricing alternatives; become a sophisticated consumer. Understand the nature and scope of the risks inherent in building projects. Understand all the management issues. Start your project off right through producing. Identify strategic goals and needs, then quantify and qualify your project's intent, scope, and basic financial assumptions.

  14. Towards Successful Cloud Ordering Service

    Directory of Open Access Journals (Sweden)

    Chen Yan-Kwang

    2015-03-01

    Full Text Available Background: The rise of cloud services has led to a drastic growth of e-commerce and a greater investment in development of new cloud services systems by related industries. For SaaS developers, it is important to understand customer needs and make use of available resources at as early as the system design and development stage. Objectives: This study integrates E-commerce Systems (ECS Success model and Importance-Performance Analysis (IPA into empirical research of the critical factors for cloud ordering system success. Methods/Approach: A survey research is conducted to collect data on customer perceptions of the importance and performance of each attribute of the particular cloud ordering service. The sample is further divided according to the degree of use of online shopping into high-usage users and low-usage users in order to explore their views regarding the system and generate adequate coping strategies. Results: Developers of online ordering systems can refer to the important factors obtained in this study when planning strategies of product/service improvement. Conclusions: The approach proposed in this study can also be applied to evaluation of other kinds of cloud services systems.

  15. LS1 Report: Successful tests

    CERN Multimedia

    CERN Bulletin

    2013-01-01

    At the PS Booster, the new beam dump and the associated shielding blocks surrounding it have been successfully installed and the installation of the beam transfer lines are now under way. The BI.SMH septum magnet has been successfully repaired following a confirmed vacuum leak.   At the PS, the consolidation of the seven main PS magnets has started, and the replacement of the old cooling and ventilation system continues to progress well. At the SPS, the replacement of the irradiated cables in Long Straight Section 1 (LSS1) of the SPS is now well under way and proceeding well. At the LHC, the Superconducting Magnets and Circuits Consolidation (SMACC) project remains ongoing. The closure of internal sleeves has begun in sector 7-8, and the shunt installations, a major consolidation activity, are progressing well in sector 8-1. The equivalent of more than one sector's outer sleeves (W) have been closed, and leak tests are in progress in several sub-sector...

  16. A Construct Validation of Fear of Success.

    Science.gov (United States)

    Sellers, Elizabeth Bull; Keenan, Verne C.

    Fear of success, as traditionally measured by Horner's projective medical school cue and as measured by Pappo's Fear of Success Questionnaire, was examined in an exploratory attempt at validating the fear of success construct. Sixty-eight male and 119 female undergraduates were administered a battery of tests designed to measure fear of success,…

  17. Proactive Assessment for Collaboration Success

    Directory of Open Access Journals (Sweden)

    Teresa L. Ju

    2014-07-01

    Full Text Available This study describes a government–academia–industry joint training project that produces Vietnamese midlevel technical managers. To ensure collaboration success, a proactive assessment methodology was developed as a supplement to the conventional project management practices. In the postproject feedback, the funding agencies acknowledged that the project fulfilled its contractual obligations and achieved its objectives. The implementing university was pleased as it broke ground in this type of collaboration in Taiwan. The industrial partners, however, were not so sure about the effectiveness of this collaborative training endeavor because there were many skirmishes between company supervisors and Vietnamese interns caused by the interns’ self-interested perception and expectation. Consequently, a theoretical framework for predicting internship acceptance and preventing unfavorable perceptions was proposed to strengthen the proactive assessment methodology. Collaboration research, funding agencies, academia, and industry could all benefit from this study.

  18. Makisangguni expansion: a qualified success.

    Science.gov (United States)

    1984-01-01

    A recent study conducted by the Evaluation and Monitoring Unit of the Family Planning Organization of the Philippines indicates that the Family Planning-Information and Service Outlets (FP-ISO) project of Makisangguni has been a qualified success. The project, initiated in 1981, involves subsidized contraceptive marketing through retail outlets in crowded downtown areas in the city Manila. Family planning information and services are provided through 17 outlets in Quezon City, Taguig, and Manila, including 8 magazien stands, 5 drugstores, 2 private clinics, 1 church, and 1 exclusive family planning booth. Manager-owners of commercial establishments receive training on commercial contraceptive marketing. The current project had its roots in a pilot project aimed at assessing the potential of a Quiapo underpass as a source of family planning information and supplies. This project recruited 4219 new acceptors and 1644 continuing users.

  19. Psychose passionnelle in successive generations.

    Science.gov (United States)

    Berry, J; Haden, P

    1980-12-01

    This paper describes two women. The first was admitted to hospital having suddenly, and without adequate reason, developed the idea that a senior married colleague at her workplace had fallen deeply in love with her. The second woman is her mother, who had been admitted to the same hospital twenty-two years earlier with a well systematized delusion that her husband was unfaithful. Both syndromes have been described by de Clérambault as two of the three forms of psychose passionnelle. The present report is intended to clarify the concepts of psychose passionelle and demonstrate the similarities between jealousy and erotomania. We believe these case histories describe the first reported instance of psychose passionnelle in successive generations of one family.

  20. The success of structural genomics.

    Science.gov (United States)

    Terwilliger, Thomas C

    2011-07-01

    The International Conference on Structural Genomics (ICSG 2011, http://sgc.utoronto.ca/ICSG2011/index.php ) [corrected], held in Toronto Canada May 10-14, 2011 was a rich and exciting demonstration of how far structural genomics has come. Structural genomics has now matured into a field that includes both structure and the biology that structure enables. This has allowed targeting based on systematic approaches and on known biological importance and allows biochemical studies to be closely tied to structure determination. The wealth of purified proteins, clones, and chemical probes produced by structural genomics groups will enable a vast amount of follow-on research. The technologies, the structures, and the biology that were described at the meeting were at the cutting edge of science. Structural genomics has become a success.

  1. Minimal Marking: A Success Story

    Directory of Open Access Journals (Sweden)

    Anne McNeilly

    2014-11-01

    Full Text Available The minimal-marking project conducted in Ryerson’s School of Journalism throughout 2012 and early 2013 resulted in significantly higher grammar scores in two first-year classes of minimally marked university students when compared to two traditionally marked classes. The “minimal-marking” concept (Haswell, 1983, which requires dramatically more student engagement, resulted in more successful learning outcomes for surface-level knowledge acquisition than the more traditional approach of “teacher-corrects-all.” Results suggest it would be effective, not just for grammar, punctuation, and word usage, the objective here, but for any material that requires rote-memory learning, such as the Associated Press or Canadian Press style rules used by news publications across North America.

  2. Relationships and project marketing success

    DEFF Research Database (Denmark)

    Skaates, Maria Anne; Tikkanen, Henrikki; Lindblom, Jarno

    2002-01-01

    -Chinese turnkey project case at the level of the individual project and a Danish-German professional service project case at the level of multiple projects. It is concluded that project managers and marketers should focus their attention on the management of project relationships before, during, and after......Project operations are a dominating mode of international business. Managing relationships and networks is crucial to project marketing success both at the level of the individual project and at the level of multiple projects. This article first defines key characteristics of project business......, identifies potentially relevant actors in the project marketing milieu, and emphasizes the importance of constantly nurturing project business relationships, also in "sleeping relationship" periods where concrete projects are not expected. Thereafter the points made are illustrated with a Finnish...

  3. Evolution, Appearance, and Occupational Success

    Directory of Open Access Journals (Sweden)

    Anthony C. Little

    2012-12-01

    Full Text Available Visual characteristics, including facial appearance, are thought to play an important role in a variety of judgments and decisions that have real occupational outcomes in many settings. Indeed, there is growing evidence suggesting that appearance influences hiring decisions and even election results. For example, attractive individuals are more likely to be hired, taller men earn more, and the facial appearance of candidates has been linked to real election outcomes. In this article, we review evidence linking physical appearance to occupational success and evaluate the hypothesis that appearance based biases are consistent with predictions based on evolutionary theories of coalition formation and leadership choice. We discuss why appearance based effects are so pervasive, addressing ideas about a “kernel of truth” in attributions and about coalitional psychology. We additionally highlight that appearance may be differently related to success at work according to the types of job or task involved. For example, leaders may be chosen because the characteristics they possess are seen as best suited to lead in particular situations. During a time of war, a dominant-appearing leader may inspire confidence and intimidate enemies while during peace-time, when negotiation and diplomacy are needed, interpersonal skills may outweigh the value of a dominant leader. In line with these ideas, masculine-faced leaders are favored in war-time scenarios while feminine-faced leaders are favored in peace-time scenarios. We suggest that such environment or task specific competencies may be prevalent during selection processes, whereby individuals whose appearance best matches perceived task competences are most likely selected, and propose the general term “task-congruent selection” to describe these effects. Overall, our review highlights how potentially adaptive biases could influence choices in the work place. With respect to certain biases

  4. Obesity management: what brings success?

    Science.gov (United States)

    Rössner, Stephan

    2013-01-01

    The upward trend in obesity prevalence across regions and continents is a worldwide concern. Today a majority of the world’s population live in a country where being overweight or obese causes more deaths than being underweight. Only a portion of those qualifying for treatment will get the health care they need. Still, a minor weight loss of 5–10% seems to be sufficient to provide a clinically significant health benefit in terms of risk factors for cardiovascular disease and diabetes. Diet, exercise and behavior modifications remain the current cornerstones of obesity treatment. Weight-loss drugs play a minor role. Drugs which were available and reasonably effective have been withdrawn because of side effects. The fact that the ‘old’ well known, but pretty unexciting tools remain the basic armamentarium causes understandable concern and disappointment among both patients and therapists. Hence, bariatric surgery has increasingly been recognized and developed, as it offers substantial weight loss and prolonged weight control. The present review highlights the conventional tools to counter obesity, lifestyle modification, pharmacotherapy and bariatric surgery, including some of the barriers to successful weight loss: (1) unrealistic expectations of success; (2) high attrition rates; (3) cultural norms of self-acceptance in terms of weight and beliefs of fat being healthy; (4) neighborhood attributes such as a lack of well-stocked supermarkets and rather the presence of convenience stores with low-quality foods; and (5) the perception of the neighborhood as less safe and with low walkability. Prevention is the obvious key. Cost-effective societal interventions such as a tax on unhealthy food and beverages, front-of-pack traffic light nutrition labeling and prohibition of advertising of junk food and beverages to children are also discussed. PMID:23320052

  5. Evolution, appearance, and occupational success.

    Science.gov (United States)

    Little, Anthony C; Roberts, Craig S

    2012-01-01

    Visual characteristics, including facial appearance, are thought to play an important role in a variety of judgments and decisions that have real occupational outcomes in many settings. Indeed, there is growing evidence suggesting that appearance influences hiring decisions and even election results. For example, attractive individuals are more likely to be hired, taller men earn more, and the facial appearance of candidates has been linked to real election outcomes. In this article, we review evidence linking physical appearance to occupational success and evaluate the hypothesis that appearance based biases are consistent with predictions based on evolutionary theories of coalition formation and leadership choice. We discuss why appearance based effects are so pervasive, addressing ideas about a "kernel of truth" in attributions and about coalitional psychology. We additionally highlight that appearance may be differently related to success at work according to the types of job or task involved. For example, leaders may be chosen because the characteristics they possess are seen as best suited to lead in particular situations. During a time of war, a dominant-appearing leader may inspire confidence and intimidate enemies while during peace-time, when negotiation and diplomacy are needed, interpersonal skills may outweigh the value of a dominant leader. In line with these ideas, masculine-faced leaders are favored in war-time scenarios while feminine-faced leaders are favored in peace-time scenarios. We suggest that such environment or task specific competencies may be prevalent during selection processes, whereby individuals whose appearance best matches perceived task competences are most likely selected, and propose the general term "task-congruent selection" to describe these effects. Overall, our review highlights how potentially adaptive biases could influence choices in the work place. With respect to certain biases, understanding their origin and current

  6. Obesity management: what brings success?

    Science.gov (United States)

    Lagerros, Ylva Trolle; Rössner, Stephan

    2013-01-01

    The upward trend in obesity prevalence across regions and continents is a worldwide concern. Today a majority of the world's population live in a country where being overweight or obese causes more deaths than being underweight. Only a portion of those qualifying for treatment will get the health care they need. Still, a minor weight loss of 5-10% seems to be sufficient to provide a clinically significant health benefit in terms of risk factors for cardiovascular disease and diabetes. Diet, exercise and behavior modifications remain the current cornerstones of obesity treatment. Weight-loss drugs play a minor role. Drugs which were available and reasonably effective have been withdrawn because of side effects. The fact that the 'old' well known, but pretty unexciting tools remain the basic armamentarium causes understandable concern and disappointment among both patients and therapists. Hence, bariatric surgery has increasingly been recognized and developed, as it offers substantial weight loss and prolonged weight control. The present review highlights the conventional tools to counter obesity, lifestyle modification, pharmacotherapy and bariatric surgery, including some of the barriers to successful weight loss: (1) unrealistic expectations of success; (2) high attrition rates; (3) cultural norms of self-acceptance in terms of weight and beliefs of fat being healthy; (4) neighborhood attributes such as a lack of well-stocked supermarkets and rather the presence of convenience stores with low-quality foods; and (5) the perception of the neighborhood as less safe and with low walkability. Prevention is the obvious key. Cost-effective societal interventions such as a tax on unhealthy food and beverages, front-of-pack traffic light nutrition labeling and prohibition of advertising of junk food and beverages to children are also discussed.

  7. What drives successful verbal communication?

    Directory of Open Access Journals (Sweden)

    Miriam eDe Boer

    2013-10-01

    Full Text Available There is a vast amount of potential mappings between behaviours and intentions in communication: a behaviour can indicate a multitude of different intentions, and the same intention can be communicated with a variety of behaviours. Humans routinely solve these many-to-many referential problems when producing utterances for an Addressee. This ability might rely on social cognitive skills, for instance, the ability to manipulate unobservable summary variables to disambiguate ambiguous behaviour of other agents (mentalizing and the drive to invest resources into changing and understanding the mental state of other agents (communicative motivation. Alternatively, the ambiguities of verbal communicative interactions might be solved by general-purpose cognitive abilities that process cues that are incidentally associated with the communicative interaction. In this study, we assess these possibilities by testing which cognitive traits account for communicative success during a verbal referential task. Cognitive traits were assessed with psychometric scores quantifying motivation, mentalizing abilities, and general-purpose cognitive abilities, taxing abstract visuo-spatial abilities. Communicative abilities of participants were assessed by using an on-line interactive task that required a speaker to verbally convey a concept to an Addressee. The communicative success of the utterances was quantified by measuring how frequently a number of Evaluators would infer the correct concept. Speakers with high motivational and general-purpose cognitive abilities generated utterances that were more easily interpreted. These findings extend to the domain of verbal communication the notion that motivational and cognitive factors influence the human ability to rapidly converge on shared communicative innovations.

  8. Critical success factors for achieving superior m-health success.

    Science.gov (United States)

    Dwivedi, A; Wickramasinghe, N; Bali, R K; Naguib, R N G

    2007-01-01

    Recent healthcare trends clearly show significant investment by healthcare institutions into various types of wired and wireless technologies to facilitate and support superior healthcare delivery. This trend has been spurred by the shift in the concept and growing importance of the role of health information and the influence of fields such as bio-informatics, biomedical and genetic engineering. The demand is currently for integrated healthcare information systems; however for such initiatives to be successful it is necessary to adopt a macro model and appropriate methodology with respect to wireless initiatives. The key contribution of this paper is the presentation of one such integrative model for mobile health (m-health) known as the Wi-INET Business Model, along with a detailed Adaptive Mapping to Realisation (AMR) methodology. The AMR methodology details how the Wi-INET Business Model can be implemented. Further validation on the concepts detailed in the Wi-INET Business Model and the AMR methodology is offered via a short vignette on a toolkit based on a leading UK-based healthcare information technology solution.

  9. Localização de insulinoma pela injeção seletiva intra-arterial de cálcio

    Directory of Open Access Journals (Sweden)

    Gaudêncio Espinosa

    Full Text Available Insulinomas are rare endocrine tumors with an estimated incidence of 1(one per million. Optimal therapy for all islet tumors of the pancreas is curative surgical resection. However, previous reports have show that, in the absence of preoparative localization, insulinoma may not be found intraoperatively in about 20% of patients. With current imaging technology, including serial computed tomography (CT, magnetic resonance imaging (MRI and ultrasonography, localization of insulinomas less than 2cm remains inadequate. This case report shows that selective intraarterial calcium injection with hepatic venous sampling for insulin levels measured is a efficient technique for the localization of insulinomas.

  10. Adjuvant therapy of Dukes' C colon cancer by intra-arterial P-32 colloid for internal radiation therapy of the liver

    Energy Technology Data Exchange (ETDEWEB)

    Grady, E.D.

    1984-09-01

    To prevent probable occult metastatic liver cancer from progressing to clinical disease, the author used internal radiation therapy as an effective adjuvant to surgical excision of primary Dukes' C colonic cancer. A calculated radiation dose of 5000 rads was delivered to the liver by injecting radioactive 32-P chromic phosphate colloid through the superior mesenteric and celiac arteries. When this was done, the colloid passed through the intestines and was mixed thoroughly with the blood and delivered to the liver by the portal vein. The Kupffer cells in the liver trapped the colloid, and a minimum amount passed through the liver and got into the general circulation. This kept the amount of colloid deposited in the bone marrow to a minimum. In a phase-I pilot study in which nine patients were treated, no serious side effects were noted. In eight patients, the liver has remained free of cancer for more than 1 year.

  11. Three-Dimensional Spheroid-Cultured Mesenchymal Stem Cells Devoid of Embolism Attenuate Brain Stroke Injury After Intra-Arterial Injection

    Science.gov (United States)

    Guo, Ling; Ge, Jianfeng; Zhou, Ying; Wang, Shan; Zhao, Robert C.H.

    2014-01-01

    The therapeutic effect of mesenchymal stem cells (MSCs) in tissue repair/regeneration is substantially dampened by the loss of primitive properties and poor engraftment to target organs. In this study, the multipotency and cell sizes of human MSCs, which had been expanded in monolayer culture for several passages, were dramatically restored after an episode of three-dimensional (3D) spheroid culture. Unlike MSCs derived from monolayer, which caused embolism and blindness, MSCs derived from 3D spheroids did not cause vascular obstructions, after intra-carotid artery infusion in rats. Importantly, intra-carotid infusion of 1 million 3D spheroid MSCs in rats 24 h after middle cerebral artery occlusion and reperfusion resulted in engraftment of the cells into the lesion and significant (over 70%) reduction of infarct size along with restoration of neurologic function. Moreover, the enhanced effect of spheroid MSCs was coincided with significantly increased differentiation of the MSCs into neurons and markedly increased number of endogenous glial fibrillary acidic protein–positive neural progenitors in the peri-infarct boundary zone. However, the similarly administered monolayer MSCs resulted in a modest functional improvement. Our results suggest that 3D MSCs, in combination with intra-carotid delivery, may represent a novel therapeutic approach of MSCs for stroke. PMID:24341685

  12. Hepatic intra-arterial injection of irinotecan drug eluting beads (DEBIRI) for patients with unresectable colorectal liver metastases: A systematic review.

    Science.gov (United States)

    Akinwande, Olaguoke; Dendy, Meaghan; Ludwig, Johannes M; Kim, Hyun S

    2017-09-01

    To systematically review the safety and efficacy of transarterial drug-eluting beads, irinotecan (DEBIRI) for the treatment of pretreated patients with unresectable colorectal liver metastases (CRLM). A systematic search of the current literature was conducted to extract publications reporting on the use of DEBIRI for CRLM. Data on the safety and efficacy was extracted and tabulated. Weighted average values (WAV) were calculated for each variable to provide a single value representing the pooled safety and efficacy data. 13 studies (15 treatment arms) were evaluated, comprising a total of 850 patients. There were 6 prospective phase I/II trials, 5 retrospective trials and 2 randomized control trials. All papers involved patients previously treated with systemic chemotherapy. The weighted average all-grade toxicity rate was 35.2% (range; 6-100%). The high-grade WAV toxicity rate was 10.1% (range; 0-32%). Weighted average response rates were 56.2% and 51.1% according to RECIST (Response Evaluation Criteria in Solid Tumors) and modified RECIST/EASL (European Association for the Study of the Liver) response criteria respectively. The weighted average progression-free survival and overall survival were 8.1 months and 16.8 months, respectively. Transarterial DEBIRI is safe and effective in the treatment of unresectable CRLM to the liver. Further studies are warranted to better define its role in the treatment algorithm of this patient subset. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial.

    Science.gov (United States)

    Tomsick, T A; Foster, L D; Liebeskind, D S; Hill, M D; Carrozella, J; Goyal, M; von Kummer, R; Demchuk, A M; Dzialowski, I; Puetz, V; Jovin, T; Morales, H; Palesch, Y Y; Broderick, J; Khatri, P; Yeatts, S D

    2015-11-01

    Intracarotid arterial infusion of nonionic, low-osmolal iohexol contrast medium has been associated with increased intracranial hemorrhage in a rat middle cerebral artery occlusion model compared with saline infusion. Iso-osmolal iodixanol (290 mOsm/kg H2O) infusion demonstrated smaller infarcts and less intracranial hemorrhage compared with low-osmolal iopamidol and saline. No studies comparing iodinated radiographic contrast media in human stroke have been performed, to our knowledge. We hypothesized that low-osmolal contrast media may be associated with worse outcomes compared with iodixanol in the Interventional Management of Stroke III Trial (IMS III). We reviewed prospective iodinated radiographic contrast media data for 133 M1 occlusions treated with endovascular therapy. We compared 5 prespecified efficacy and safety end points (mRS 0-2 outcome, modified TICI 2b-3 reperfusion, asymptomatic and symptomatic intracranial hemorrhage, and mortality) between those receiving iodixanol (n = 31) or low-osmolal contrast media (n = 102). Variables imbalanced between iodinated radiographic contrast media types or associated with outcome were considered potential covariates for the adjusted models. In addition to the iodinated radiographic contrast media type, final covariates were those selected by using the stepwise method in a logistic regression model. Adjusted relative risks were then estimated by using a log-link regression model. Of baseline or endovascular therapy variables potentially linked to outcome, prior antiplatelet agent use was more common and microcatheter iodinated radiographic contrast media injections were fewer with iodixanol. Relative risk point estimates are in favor of iodixanol for the 5 prespecified end points with M1 occlusion. The percentage of risk differences are numerically greater for microcatheter injections with iodixanol. While data favoring the use of iso-osmolal iodixanol for reperfusion of M1 occlusion following IV rtPA are inconclusive, potential pathophysiologic mechanisms suggesting clinical benefit warrant further investigation. © 2015 by American Journal of Neuroradiology.

  14. Continuous Non-invasive finger cuff CareTaker® comparable to invasive intra-arterial pressure in patients undergoing major intra-abdominal surgery.

    Science.gov (United States)

    Gratz, Irwin; Deal, Edward; Spitz, Francis; Baruch, Martin; Allen, I Elaine; Seaman, Julia E; Pukenas, Erin; Jean, Smith

    2017-03-21

    Despite increased interest in non-invasive arterial pressure monitoring, the majority of commercially available technologies have failed to satisfy the limits established for the validation of automatic arterial pressure monitoring by the Association for the Advancement of Medical Instrumentation (AAMI). According to the ANSI/AAMI/ISO 81060-2:2013 standards, the group-average accuracy and precision are defined as acceptable if bias is not greater than 5 mmHg and standard deviation is not greater than 8 mmHg. In this study, these standards are used to evaluate the CareTaker® (CT) device, a device measuring continuous non-invasive blood pressure via a pulse contour algorithm called Pulse Decomposition Analysis. A convenience sample of 24 patients scheduled for major abdominal surgery were consented to participate in this IRB approved pilot study. Each patient was monitored with a radial arterial catheter and CT using a finger cuff applied to the contralateral thumb. Hemodynamic variables were measured and analyzed from both devices for the first thirty minutes of the surgical procedure including the induction of anesthesia. The mean arterial pressure (MAP), systolic and diastolic blood pressures continuously collected from the arterial catheter and CT were compared. Pearson correlation coefficients were calculated between arterial catheter and CT blood pressure measurements, a Bland-Altman analysis, and polar and 4Q plots were created. The correlation of systolic, diastolic, and mean arterial pressures were 0.92, 0.86, 0.91, respectively (p pressures, respectively with a standard deviation of 7.34, 6.47, 5.33 mmHg for systolic, diastolic, and mean arterial pressures, respectively (p blood pressure measured using the non-invasive CT device was shown to correlate well with the arterial catheter measurements. Larger studies are needed to confirm these results in more varied settings. Most patients exhibited very good agreement between methods. Results were well within the limits established for the validation of automatic arterial pressure monitoring by the AAMI.

  15. Superselective intra-arterial DSA in patients with femoral head necrosis and femoral neck fracture. Superselektive intraarterielle DSA bei Hueftkopfnekrose und Schenkelhalsfraktur

    Energy Technology Data Exchange (ETDEWEB)

    Langer, R.; Scholz, A.; Langer, M.; Astinet, F.; Ferstl, F.; Felix, R. (Klinikum Rudolf Virchow, Berlin (Germany, F.R.). Strahlenklinik und Poliklinik); Schwetlick, G. (Freie Univ. Berlin (Germany, F.R.). Orthopaedische Universitaetsklinik)

    1991-06-01

    The prospective study includes 25 patients without pathology of the femoral head for the evaluation of the normal femoral head perfusion. In addition 34 patients with femoral head necrosis underwent i.a. DSA preoperatively before pedicled pelvic bone grafting. 15 patients after pelvic bone graft operation and 7 patients with medial femoral head fracture were also examined via superselective DSA. In cases with femoral head necrosis a rarefaction or interruption of the rami nutricii proximales, or an occlusion of the medial circumflex femoral artery were observed. Patients with medial femoral neck fracture showed an interruption of the rami nutricii proximales of the femoral head. Postoperative DSA - after pedicled pelvic bone graft - revealed a regular arterial graft perfusion in 82%. (orig.).

  16. Does the concomitant intra-arterial injection of asialoerythropoietin and edaravone mitigate ischaemic mucosal damage after acute superior mesenteric artery thromboembolism in a rabbit autologous fibrin clot model?

    Science.gov (United States)

    Sonoda, A; Nitta, N; Seko, A; Ohta, S; Takemura, S; Sugimoto, T; Uzu, T; Yokomaku, Y; Takahashi, M; Kashiwagi, A; Murata, K

    2010-02-01

    To increase the survival rate of patients with acute superior mesenteric artery thromboembolism (ASMAT) treated by catheter thrombolysis, we examined the effects of delivering edaravone and asialoerythropoietin, agents with tissue-protective activities, using a rabbit autologous fibrin clot ASMAT model. Japanese white rabbits (n=32) were randomly separated into four equal groups. 45 min after introducing autologous fibrin clot, Group U received urokinase and heparin; Group E received urokinase and heparin plus edaravone; Group A received urokinase and heparin plus asialoerythropoietin; and Group EA received urokinase, heparin and edaravone plus asialoerythropoietin via a catheter. The intestines were removed 6 h later and intestinal mucosal damage was scored using the Park's injury score. Survival time was assessed. Average mucosal injury was 5.78+/-1.52 (Group U), 2.88+/-0.72 (Group E), 1.90+/-1.23 (Group A) and 1.18+/-1.25 (Group EA). The degree of mucosal injury was significantly lower in Group EA than in Groups U and E (pASMAT rabbit models, the delivery of an appropriate dose of asialoerythropoietin is required, together with the development of methods to assess peripheral recanalisation.

  17. An improvement of cerebral hemodynamics in a newly developed perfusion area evaluated by intra-arterial SPECT following vascular reconstructive surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nochide, Ichiro [Ehime Univ., Shigenobu (Japan). School of Medicine

    1999-06-01

    The purpose of this study was to evaluate the changes in regional cerebral blood flow (rCBF) and vascular reserve ({Delta}CBF) responding to acetazolamide loading by {sup 133}Xe SPECT. In combination, this study assessed the newly developed region of cerebral perfusion via bypass arteries after surgical vascular reconstruction in 11 hemispheres of 11 patients with atherosclerotic arterial occlusive disease and adult onset moyamoya disease. In patients with atherosclerotic occlusive disease, the cerebral perfusion from bypass arteries mainly developed in the preoperatively low {Delta}CBF territory. Although rCBF did not significantly alter after vascular reconstruction, preoperatively low {Delta}CBF was significantly improved to the normal range in the promotion of postoperatively newly born perfusion from bypass arteries. In 21 hemispheres of 13 patients with adult onset moyamoya disease, the postoperatively newly born perfusion from bypass arteries was significantly developed in the regions with either preoperative low rCBF or low {Delta}CBF. Although both rCBF and {Delta}CBF were significantly improved after the operation, {Delta}CBF was not restored satisfactorily up to the normal range in contrast to the sufficient increase of rCBF, even where the perfusion from the bypass artery was observed after the reconstructive surgeries. Vascular reconstructive surgeries were beneficial for the improvement of {Delta}CBF in the atherosclerotic arterial occlusive disease and rCBF in the adult-onset moyamoya disease, respectively. (author)

  18. The Success of Podcasting as a Success for Science Outreach

    Science.gov (United States)

    Haupt, R. J.; Wheatley, P.; Padilla, A. J.; Barnhart, C. J.

    2015-12-01

    Podcasts are downloadable web-hosted audio programs (radio on demand). The medium's popularity has grown immensely since its beginning 10+ years ago. "Science and Medicine" remains a prominent category in iTunes (the most popular podcast marketplace), but is unfortunately inundated with non-scientific and dubious content (e.g. the paranormal, health fads, etc.). It seems unlikely that legitimate science content would thrive in such an environment. However, our experience as an independent science podcast shows it is possible to successfully present authentic science to a general audience and maintain popularity. Our show, Science… sort of, began in the fall of 2009, and we have since produced episodes regularly. As of July 31, 2015, our feed hosts 235 episodes, with an average ~6,700 downloads per episode, and over 1.6 million total downloads originating from all across the globe. Thanks to listener involvement and contribution, the show is financially self-sustaining. While production requires a significant time input, no external financial support from the creators or other granting agencies is needed. Traditional media outlets rely on advertisers, thus pressuring shows to produce "popular" content featuring science celebrities. In contrast, independent podcasts can interview big name science communicators, such as Dr. Neil DeGrasse Tyson, while also exploring the research of graduate students and early career scientists. This level playing field provides an unprecedented opportunity for studies to reach a global audience and share research that previously may have only be seen by those at a specialized conference or subscribed to niche journals. Further, direct public engagement helps the audience personally connect to the research and researcher. In combination with other social media platforms, podcasting is a powerful tool in the outreach arsenal, enabling one to share science directly with the world in a way that both educates and excites listeners.

  19. Developing a successful robotics program.

    Science.gov (United States)

    Luthringer, Tyler; Aleksic, Ilija; Caire, Arthur; Albala, David M

    2012-01-01

    Advancements in the robotic surgical technology have revolutionized the standard of care for many surgical procedures. The purpose of this review is to evaluate the important considerations in developing a new robotics program at a given healthcare institution. Patients' interest in robotic-assisted surgery has and continues to grow because of improved outcomes and decreased periods of hospitalization. Resulting market forces have created a solid foundation for the implementation of robotic surgery into surgical practice. Given proper surgeon experience and an efficient system, robotic-assisted procedures have been cost comparable to open surgical alternatives. Surgeon training and experience is closely linked to the efficiency of a new robotics program. Formally trained robotic surgeons have better patient outcomes and shorter operative times. Training in robotics has shown no negative impact on patient outcomes or mentor learning curves. Individual economic factors of local healthcare settings must be evaluated when planning for a new robotics program. The high cost of the robotic surgical platform is best offset with a large surgical volume. A mature, experienced surgeon is integral to the success of a new robotics program.

  20. UK policy: A success story?

    Science.gov (United States)

    Bradshaw, Jonathan

    2007-10-01

    Child poverty is at the heart of the United Kingdom (UK) government's social policy agenda. Child poverty rose rapidly in the 1980s; the child poverty rate was one of the highest in Europe by 2000. In 1999, the government's objective was to reduce child poverty by 50% by 2004/2005, which it narrowly failed to meet. In 2005/2006, there was an increase in child poverty. An index of child well-being found that the UK was 21st out of the 25 European Union countries. Overall, the UK came in last in the UNICEF well-being index. The government's child poverty strategy has been to manage the economy to maximize employment and to improve in-work incomes. Both have been successful in reducing child poverty. Out-of-work incomes have also been improved, but not enough to lift many children out of poverty. Public expenditure on services, especially health, education and childcare, has also increased; although there are questions about how much of this extra spending has focused on children and child poverty. The comprehensive spending review, reporting later in 2007, is likely to be tight, and it is now unlikely that the government will succeed in its aim of reducing child poverty by 50% by 2010 unless there are radical changes in policy. Constraints on the government's ability to do this include the structural inequalities in British society and public attitudes toward people in poverty.

  1. Nurse manager succession planning: a concept analysis.

    Science.gov (United States)

    Titzer, Jennifer L; Shirey, Maria R

    2013-01-01

    The current nursing leadership pipeline is inadequate and demands strategic succession planning methods. This article provides concept clarification regarding nurse manager succession planning. Attributes common to succession planning include organizational commitment and resource allocation, proactive and visionary leadership approach, and a mentoring and coaching environment. Strategic planning, current and future leadership analysis, high-potential identification, and leadership development are succession planning antecedents. Consequences of succession planning are improved leadership and organizational culture continuity, and increased leadership bench strength. Health care has failed to strategically plan for future leadership. Developing a strong nursing leadership pipeline requires deliberate and strategic succession planning. © 2013 Wiley Periodicals, Inc.

  2. Reconstruction of Anacostia wetlands: success?

    Science.gov (United States)

    Hammerschlag, R.S.; Perry, M.C.

    2002-01-01

    Historically, the tidal Anacostia River in Washington, D.C. had been an extensive system of freshwater tidal marshes replete with a full array of wetland vegetation dominated by wild rice. The local Nacochtank Indians had found the abundant fish and wildlife sufficient to sustain their daily lives. White man's intrusion upon the landscape gradually brought about deterioration of the natural (and associated cultural) system. Total demise followed mid-20th century dredge and fill channelization, which was conducted from the confluence of the Anacostia with the Potomac near the heart of Washington, D.C. to the terminus of the tidal regime at Bladensburg, Maryland. The National Park Service (NPS) became the manager for much of the land along the Anacostia, particularly the eastern bank. As part of its planning effort, the NPS envisioned returning portions of the Anacostia under its control to a natural system as a vignette. The concept was based on bringing back as comprehensive a collection of vegetation and wildlife as possible through the reestablishment of tidal marshes at Kenilworth and Kingman. The resultant wetlands were to be made accessible to the public both logistically and through a well designed interpretative program. In fact, this vision has been realized due to an impressive cooperative effort among a number of Federal and local agencies and organizations. In 1993, 32 acres of freshwater tidal marsh were reconstructed at Kenilworth. Based upon the 5-year monitoring program that has been in place since reconstruction, several generalizations may be made concerning the degree of success of the marsh reconstruction. Water quality in the marsh system and nearby tidal waters has not been noticeably improved. The poor quality may be clue to the overwhelmingly high loads (e.g., sediment, nutrients, etc.) brought in on the twice daily tidal cycle from the Anacostia and to the relatively small volume of water which actually interacts with the emergent marsh

  3. They teach it more successfully

    Science.gov (United States)

    Reyes Ruiz-Gallardo, Jose; Valdés, Arturo; Castaño, Santiago

    2010-05-01

    Science education has been involved in a crisis due to the way in which teachers teach future teachers (McDermott, 1990; Bernal, 2005). During generations, students have been learning sciences as something already done, based on memorizing a number of contents or formulas that always give a correct answer (CUSE, 1997). Thus, Lederman y Abd-El-Khalick (1998) considered that is difficult that future teachers feel Science as something tempting and based on empiricism, if they only learn contents. To learn Science it is required to think, to do and to talk (Pujol, 2003). In this study an experience where students are teachers is shown. 160 students from the Faculty of Education have participated. They had to make, in cooperative groups of four, several activities to eliminate typical Science conceptual mistakes in children (such as minerals and rocks as the same thing, or the proportion of the Earth flattened out at the poles). Some peer groups have to develop activities as kids, question teachers and extract activity strengths and weakness from a kid point of view. A condition of these activities is that they are not mere teacher's demonstrations. Kids have to discover by themselves the conceptual mistake throughout the proposed activity. Afterwards, teacher's groups pass to occupy children's role and vice-versa with new activities from other conceptual mistakes. The experience was tested from two different points of view: a) student's perception of the experience, and b) final exam outcomes. Results show that 95% of the students prefer to be explained by their peers than by the lecturer. As outcomes, 94% of the students that experienced with their peers these activities and explanations, answer successfully the exam questions, while in former experiences where lecturer explain the same concepts, this value decreased up to 64%. These results coincide with other experiences concluding that students have more success than the teacher to make understand concepts to their

  4. Drug: D02837 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available D02837 Drug Alteplase (genetical recombination) (JAN); Alteplase (USP/INN); Activas...OTIC AGENTS B01A ANTITHROMBOTIC AGENTS B01AD Enzymes B01AD02 Alteplase D02837 Alteplase (genetical recombina...ther ophthalmologicals S01XA13 Alteplase D02837 Alteplase (genetical recombinatio...thers D02837 Alteplase (genetical recombination) (JAN); Alteplase (USP/INN) Anatomical Therapeutic Chemical ...R:br08301] 3 Agents affecting metabolism 39 Other agents affecting metabolism 395 Enzyme preparations 3959 O

  5. Optimal entropic uncertainty relation for successive measurements ...

    Indian Academy of Sciences (India)

    Home; Journals; Pramana – Journal of Physics; Volume 60; Issue 6. Optimal entropic uncertainty relation for successive measurements in quantum information theory ... Keywords. Uncertainty relations; information-theoretic entropy; optimum bounds; successive measurements; influence of measurements on uncertainties.

  6. Transfer of the Rights of Succession

    National Research Council Canada - National Science Library

    Asta Dambrauskaite

    2010-01-01

    ...) of the rights of succession. As a starting point, the author of the article analyses the formation and further development of the transfer of succession as a whole (hereditas) in the Roman law...

  7. CSM a success in Bangladesh.

    Science.gov (United States)

    1983-01-01

    The Bangladesh Social Marketing Project (SMP), providing contraceptives at an annual rate of 931,000 couple years of protection (CYP) as of June 1983, is a success. This figure has grown markedly since the start of the program in late 1975, when the SMP provided 80,000 CYPs, or 8% of nonclinical protection provided. The SMP has contributed to the steadily increasing national nonclinical contraceptive distribution. Currently, SMP distribution accounts for as much as the government and nongovernment programs combined. When clinical methods (including sterilizations) are added to national distribution, the SMP share represents about 28% of total contraceptive use. The SMP does not provide clinical methods, but the entire increase in nonclinical protection provided by the national program since 1975 has been the result of SMP product sales. The SMP utilizes the available mass media for promotion, including print, radio, television, as well as outdoor media and point of purchase materials. Mobile Film Units (MFUs) are an innovative promotional method employed by the SMP. Approximately 80 night time outdoor showings are organized each month in rural areas by SMP promoters. Typically, several short films, usually a popular story with a family planning theme, are run. Between each film the SMP products are of advertised. Products are often sold during and after the films. Retail outlets for SMP products include general stores, pharmacies, and other small shops. When products were introduced in 1975 retail outlets totaled 7500. By August 1983 the number of country wide retailers carrying SMP products had grown to nearly 100,000. In 1982 a marketing strategy emphasizing the role of doctors and rural medical practitioners (RMPs) was introduced. There are between 70,00-100,000 RMPs in Bangladesh. They are well known and respected "doctors" in their villages and add an extensive family planning outreach to the SMP system. The most important advantage of using the RMPs is their

  8. The Daily Practices of Successful Principals

    Science.gov (United States)

    Brock, Barbara L.; Grady, Marilyn L.

    2011-01-01

    While many books outline the attributes of successful school leaders, few describe how those traits manifest in daily practice. "The Daily Practices of Successful Principals" goes beyond the outward picture of excellence and provides a compendium of daily practices used by successful principals in various settings. Written by former administrators…

  9. Critical success factors for managing purchasing groups

    NARCIS (Netherlands)

    Schotanus, Fredo; Telgen, Jan; de Boer, L.

    2010-01-01

    In this article, we identify critical success factors for managing small and intensive purchasing groups by comparing successful and unsuccessful purchasing groups in a large-scale survey. The analysis of our data set suggests the following success factors: no enforced participation, sufficient

  10. Crop succession requirements in agricultural production planning

    NARCIS (Netherlands)

    Klein Haneveld, W.K.; Stegeman, A.

    2005-01-01

    A method is proposed to write crop succession requirements as linear constraints in an LP-based model for agricultural production planning. Crop succession information is given in the form of a set of inadmissible successions of crops. The decision variables represent the areas where a certain

  11. School Bond Success: An Exploratory Case Study

    Science.gov (United States)

    Holt, Carleton R.; Wendt, Matthew A,; Smith, Roland M.

    2006-01-01

    Following two-failed school bond issues in 1995 and 1998, one mid-sized rural school district organized an effort that led to two successful school bond elections in 2001 and 2003. The school district's strategic plan mirrored many of the recommendations for successful bond referendums published in School Bond Success: A Strategy for Building…

  12. Student Success: Institutional and Individual Perspectives

    Science.gov (United States)

    Mullin, Christopher M.

    2012-01-01

    This article examines measures of student success, with a focus on how they apply to community colleges. A conceptual framework is presented as a way of facilitating thinking about and accurately grounding discussions of student success. The article closes with an examination of emerging concepts related to the measurement of student success in…

  13. Project Success in Agile Development Software Projects

    Science.gov (United States)

    Farlik, John T.

    2016-01-01

    Project success has multiple definitions in the scholarly literature. Research has shown that some scholars and practitioners define project success as the completion of a project within schedule and within budget. Others consider a successful project as one in which the customer is satisfied with the product. This quantitative study was conducted…

  14. 5 CFR 412.201 - Management succession.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Management succession. 412.201 Section 412.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS SUPERVISORY, MANAGEMENT, AND EXECUTIVE DEVELOPMENT Succession Planning § 412.201 Management succession. The head of each...

  15. Characteristics of Successful and Unsuccessful Organizational Development

    Science.gov (United States)

    1975-03-01

    AD/A-006 912 CHARACTERISTICS OF SUCCESSFUL AND UNSUCCESSFUL ORGANIZATIONAL DEVELOPMENT Jerome L. Franklin Michigan University Prepared for: Office of... Organizational Development Data Gathering Exit Procedures Organizational Type Development Strategy External Change-Agent Successful Change Development Technique...Successful and Unsuccessful Organizational Development Jerome L. Franklin Center for Research on Utilization of Scientific Knowledge Institute for Social

  16. Critical success factors in ERP implementation

    Directory of Open Access Journals (Sweden)

    Blerta Abazi Chaushi

    2016-11-01

    Full Text Available This study conducts state of the art literature review of critical success factors for enterprise resource planning systems implementation success. Since research on critical success factors for ERP implementation success is very rare and fragmented, this study provides a more comprehensive list of ten factors that companies that have adopted and struggle with the implementation, as well as companies who are in the process of considering implementation of ERP system can easily adopt and follow. The main contribution of this paper is that these ten new critical success factors are identifi ed through a thorough analysis of 22 selected research papers and is more comprehensive and straightforwardly employable for use.

  17. Medical abortion. defining success and categorizing failures

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Vestermark, Vibeke

    2003-01-01

    Medical abortion was performed in 461 consecutive women with gestational age LT /= 63 days using a regimen of mifepristone 600 mg followed 2 days later by gemeprost 1 mg vaginally. Success, defined as no surgical intervention, declined from 98.7% after 2 weeks to 94.6% after 15 weeks......-hCG values and smaller reductions of beta-hCG than those treated successfully. To optimize comparison of success rates after different medical abortion regimens, we suggest that the criteria for success are stated clearly, that the success rates are stratified according to gestational age...

  18. Successful scientist: What's the winning formula?

    Science.gov (United States)

    Stull, April J; Ciappio, Eric D

    2014-11-01

    What does it take to become a successful scientist? This question is usually asked or thought about at some point in a young scientist's career. The early stages of a scientific career are fraught with many hardships, and achieving success can seem impossible and daunting. After encountering many obstacles, it becomes easy to focus on failures and lose sight of career goals. The journey to success can seem so simple when looked upon from the outside, but even the best scientists have endured many hardships, which are often not communicated. This educational symposium featured a diverse panel of 5 accomplished scientists representing different work environments, such as government, industry, and academia. They discussed tips on how to have a successful career journey and the key qualities of a successful scientist. Also, they revealed the secret to what's in the winning formula for success. © 2014 American Society for Nutrition.

  19. CONSTRUCTION MANAGER'S INFLUENCE ON PROJECT SUCCESS

    OpenAIRE

    LATORRE, V.

    2009-01-01

    Merged with duplicate record 10026.1/827 on 27.02.2017 by CS (TIS) Construction managers aim to deliver successful construction projects; however it is unclear how they perceive construction project success and how they influence that success. Focusing on the construction phase of the project, a Systems Conceptual Framework is induced from the literature review. In-depth interviews undertaken by 10 construction managers, whose experience accounts for over 130 construction pr...

  20. Analysing success criteria for ict projects

    OpenAIRE

    MILIS, Koen; VANHOOF, Koen

    2006-01-01

    Since the 1960's many authors accepted the triple constraints (time, cost, specification) as a standard measure of success and this still appears to be extremely important in evaluating the success of ICT (information communication technology) projects. However, an ICT project cannot always be seen as a complete success or a complete failure. Moreover, the parties involved may perceive the terms “success” or “failure” differently. A quasi-experiment (gaming) was developed in...

  1. Telling Successes of Japanese Foreign Aid

    DEFF Research Database (Denmark)

    Hansen, Annette Skovsted

    Stakeholders of two success story events negotiated an idea of development as individual entrepreneurship. The sixty-five-year-old Japanese Foreign Aid history includes stories of successes told by professionals from developing countries throughout the world. Their stories reflect the cultural...... interested in evaluating the impact of foreign aid define criteria for success that can be measured preferably in numbers just as the investment in foreign aid is measured in amounts of money. This essay is about how a number of different stakeholders negotiate narratives of successful impact of private...

  2. RE-Powering Success Stories: Green Manufacturing

    Science.gov (United States)

    These success stories discuss sites on formerly contaminated lands, landfills, and mine sites that are manufacturing components for renewable energy, either solar panels, wind turbines, or other components.

  3. Gender and physical therapy career success factors.

    Science.gov (United States)

    Rozier, C K; Raymond, M J; Goldstein, M S; Hamilton, B L

    1998-07-01

    Gender and profession are thought to affect how career success is perceived as well as how it is achieved. This study investigated items considered important in defining career success for male and female physical therapists. The study also explored the relationship among gender, beliefs about career success, and career experiences. Data were obtained through an investigator-developed survey. The self-report questionnaire consisted of 78 items in 4 areas: descriptive information, items important in characterizing career success, items perceived to enhance or inhibit career success, and items assessing self-esteem. Questionnaires were mailed to a random sample of active physical therapist members of the American Physical Therapy Association (N = 5,000). The response rate was 38.1% (n = 1,906). Both men and women selected indicators such as practicing ethically, improving patient health, and feeling satisfied over high income or status when describing career success. All respondents agreed that clinical competency and motivation are key factors related to achieving career success. Family issues, full-time employment, and flexibility of practice conditions emerged as primary gender differences. A unique set of indicators describe physical therapy career success. Gender differences in its description and factors that influence its achievement are related primarily to family issues. Career success for women depends to a greater degree on the ability to manage family responsibilities in conjunction with employment opportunities.

  4. Establishing a Successful Smart Card Program.

    Science.gov (United States)

    Wiens, Janet

    2001-01-01

    Discusses how to run a successful smart card program through a comprehensive approach that includes a detailed plan for the present and future, high level support from school administration, and extensive user input. Florida State University is used to illustrate a successfully implemented smart card program. (GR)

  5. Influence of Social Integration on Class Success

    Science.gov (United States)

    Littlepage, Ben; Hepworth, Daniel

    2016-01-01

    The present study investigated whether an integrative behavior for one student success outcome could be applied to another student success outcome. Braxton and colleagues (2013) state that student perception of the institution's commitment to student welfare influences the level of social integration by the student, which affects student…

  6. Successful restrained eating and trait impulsiveness

    NARCIS (Netherlands)

    van Koningsbruggen, G.M.; Stroebe, W.; Aarts, H.

    2013-01-01

    Restrained eaters with high scores on the Perceived Self-Regulatory Success in Dieting Scale (PSRS) are more successful than low scorers in regulating their food intake. According to the theory of temptation-elicited goal activation (Fishbach, Friedman, & Kruglanski, 2003), they have become

  7. Critical Success Factors in Online Language Learning

    Science.gov (United States)

    Alberth

    2011-01-01

    With the proliferation of online courses nowadays, it is necessary to ask what defines the success of teaching and learning in these new learning environments exactly. This paper identifies and critically discusses a number of factors for successful implementation of online delivery, particularly as far as online language learning is concerned.…

  8. University Students and Fear of Success.

    Science.gov (United States)

    Froelich, Rick L.

    When faced with personal success, some persons appear to become anxious and will do something to avoid or sabotage their efforts. This fear of success among university students was investigated in this study. The sampling included 210 students, 83 males and 127 females. The independent variables under consideration were locus of control, gender,…

  9. Fear of Success in Gay Women.

    Science.gov (United States)

    Itzkowitz, Stuart; Petrie, Donna

    1982-01-01

    Compared gay women (N=11) with heterosexual women (N=12) for frequency of high and low fear of success responses. Probability analysis determined the two groups differed significantly, with gay women evidencing less fear of success than expected. Devised a continuum of kinds of responses with subsequent analysis. (Author)

  10. Successful euthanasia of a juvenile fin whale.

    OpenAIRE

    Daoust, P Y; Ortenburger, A I

    2001-01-01

    A stranded juvenile fin whale was successfully euthanized with an intravenous injection of sedative and cardioplegic drugs. Veterinarians may face a number of serious difficulties if called to perform this task, and advance preparation is required for successful euthanasia of these animals.

  11. Successful Enterprise System Re-Implementation

    DEFF Research Database (Denmark)

    Svejvig, Per

    2017-01-01

    Achieving success in enterprise systems (ES) implementations is challenging. The success rate is not high in view of the sums invested by many organizations in these companywide systems. The literature is charged with reasons for unsuccessful implementations, such as a lack of top management...

  12. Undergraduate Research Internships and Graduate School Success.

    Science.gov (United States)

    Nnadozie, Emmanuel; Ishiyama, John; Chon, Jane

    2001-01-01

    Surveys alumni and program directors to determine relationship between participation in internship and success in graduate school for students served by the Ronald E. McNair Postbaccalaureate Achievement Program. Internship rigor was positively related to success in graduate school as measured by placement, secured funding, and completion. Three…

  13. Accelerated Baccalaureate Nursing Students: Perceptions of Success

    Science.gov (United States)

    Blozen, Barbara B.

    2010-01-01

    Although there are a number of anecdotal reports on demographic characteristics and academic success of accelerated nursing students, few empirical studies have been undertaken to examine these students' success, despite this type of programs' existence for more than a decade, and only three studies have sought to examine the perspective of the…

  14. Academic Resilience and Reading: Building Successful Readers

    Science.gov (United States)

    McTigue, Erin M.; Washburn, Erin K.; Liew, Jeffrey

    2009-01-01

    The socioemotional factors, which influence students' trajectories on their pathways to reading success, are often overlooked in literacy screenings and reading instruction. This article outlines the connections between personality factors, in particular resilient personalities, and early literacy success. It also offers teachers a series of six…

  15. Voices of Resilience: Successful Jamaican Women Educators

    Science.gov (United States)

    Dole, Sharon

    2014-01-01

    Through the use of the framework of risk and resilience in a narrative inquiry, the present study examined the protective factors affecting the academic success of 24 Jamaican women in a graduate cohort in educational administration. All but two of the women rose from poverty to become academically successful, defined as having achieved graduate…

  16. Aging Successfully: A Four-Factor Model

    Science.gov (United States)

    Lee, Pai-Lin; Lan, William; Yen, Tung-Wen

    2011-01-01

    The study was designed to validate a model for a successful aging process and examine the gender differences in the aging process. Three hundred twelve participants who were 65 or older completed a Taiwan Social Change Survey that measures four factors that define successful aging process: including physical, psychological, social support, and…

  17. Telling Successes of Japanese Foreign Aid

    DEFF Research Database (Denmark)

    Hansen, Annette Skovsted

    Stakeholders of two success story events negotiated an idea of development as individual entrepreneurship. The sixty-five-year-old Japanese Foreign Aid history includes stories of successes told by professionals from developing countries throughout the world. Their stories reflect the cultural...... sector training programs partly financed by Japanese Official development Assistance (ODA)....

  18. Stories of Resiliency: Successful Female Educational Leaders

    Science.gov (United States)

    Pankake, Anita M.; Beaty, Danna M.

    2005-01-01

    Information about the experiences successful leaders perceive as vital to their development can be helpful to one's understanding of resiliency. Such information can also offer insights into the ways successful leaders use positive and negative situations as learning opportunities and the strategies they implement in addressing adversity. The…

  19. Investigating critical success factors in tile industry

    Directory of Open Access Journals (Sweden)

    Davood Salmani

    2014-04-01

    Full Text Available This paper presents an empirical investigation to determine critical success factors influencing the success of tile industry in Iran. The study designs a questionnaire in Likert scale, distributes it among some experts in tile industry. Using Pearson correlation test, the study has detected that there was a positive and meaningful relationship between marketing planning and the success of tile industry (r = 0.312 Sig. = 0.001. However, there is not any meaningful relationship between low cost production and success of tile industry (r = 0.13 Sig. = 0.12 and, there is a positive and meaningful relationship between organizational capabilities and success of tile industry (r = 0.635 Sig. = 0.000. Finally, our investigation states that technology and distributing systems also influence on the success of tile industry, positively. The study has also used five regression analyses where the success of tile industry was the dependent variable and marketing planning, low cost production and organizational capabilities are independent variables and the results have confirmed some positive and meaningful relationship between the successes of tile industry with all independent variables.

  20. Build an Early Foundation for Algebra Success

    Science.gov (United States)

    Knuth, Eric; Stephens, Ana; Blanton, Maria; Gardiner, Angela

    2016-01-01

    Research tells us that success in algebra is a factor in many other important student outcomes. Emerging research also suggests that students who are started on an algebra curriculum in the earlier grades may have greater success in the subject in secondary school. What's needed is a consistent, algebra-infused mathematics curriculum all…

  1. Successful Globalisation, Education and Sustainable Development

    Science.gov (United States)

    Little, Angela W.; Green, Andy

    2009-01-01

    This article examines the role of education in "successful globalisation" and how this links with agendas for sustainable development. In the first part "successful globalisation" is defined as economic growth combined with equality and social peace. Japan and the East Asian tiger economies--particularly South Korea and…

  2. Parent Power: Build the Bridge to Success

    Science.gov (United States)

    US Department of Education, 2010

    2010-01-01

    President Obama has a cradle-to-career plan to reform the nation's schools. He also is calling on parents to take responsibility for their child's success. His vision includes the belief that all children can and will succeed, and that parents are the bridge to this success. Parents, guardians and caregivers can help children by connecting with…

  3. Partitioning sexual selection into its mating success and fertilization success components.

    Science.gov (United States)

    Pischedda, Alison; Rice, William R

    2012-02-07

    Postcopulatory sexual selection due to sperm competition and/or cryptic female choice has been documented in a diversity of taxonomic groups and is considered a pivotal component of sexual selection. Despite this apparent importance, the relative contribution of postcopulatory fertilization success to overall sexual selection has not yet been measured in any species. Here, we used a laboratory-adapted population of the promiscuous fruit fly Drosophila melanogaster to partition the variance in male reproductive success into mating success (a major component of precopulatory sexual selection) and fertilization success (a major component of postcopulatory sexual selection). We found that fertilization success contributed nearly as strongly as mating success to a male's net performance in sexual selection, but that most of this postcopulatory component was attributable to variation in male mating order (the tendency to be the last male to mate a female). After adjusting for mating order, only ≈2% of the residual variation in male reproductive success was attributable to differential fertilization success. We found no correlation between male mating success and fertilization success in this system. Unlike natural populations of Drosophila, our laboratory population is adapted to a semelparous lifecycle, so our findings will be most applicable to other promiscuous species with strong sperm precedence and one short breeding period per year or lifetime. In these species, fertilization success may have as much influence on male reproductive success as mating success, but the timing of mating (mating order) may be the predominant factor contributing to variation in fertilization success.

  4. The Extended Family and Children's Educational Success

    DEFF Research Database (Denmark)

    Jæger, Mads Meier

    2012-01-01

    characteristics of grandparents and aunts and uncles have few direct effects on educational success, resources in the extended family compensate lacking resources in low-SES families, which in turn promote children’s educational success. The main conclusion is that the total effect of family background......Research on family background and educational success focuses almost exclusively on two generations and on parents and children. This paper argues that the extended family makes up a significant part of the total effect of family background on educational success. Empirical results based...... on the Wisconsin Longitudinal Study show that, net of family factors shared by siblings from the same immediate family, factors shared by first cousins from the same extended family account for a nontrivial part of the total variance in children’s educational success. Results also show that while socioeconomic...

  5. Successful aging and the epidemiology of HIV.

    Science.gov (United States)

    Vance, David E; McGuinness, Teena; Musgrove, Karen; Orel, Nancy Ann; Fazeli, Pariya L

    2011-01-01

    By 2015, it is estimated that nearly half of those living with HIV in the US will be 50 years of age and older. This dramatic change in the demographics of this clinical population represents unique challenges for patients, health care providers, and society-at-large. Fortunately, because of highly active antiretroviral therapy (HAART) and healthy lifestyle choices, it is now possible for many infected with HIV to age successfully with this disease; however, this depends upon one's definition of successful aging. It is proposed that successful aging is composed of eight factors: length of life, biological health, cognitive efficiency, mental health, social competence, productivity, personal control, and life satisfaction. Unfortunately, HIV and medication side effects can compromise these factors, thus diminishing one's capacity to age successfully with this disease. This article explores how HIV, medication side effects from HAART, and lifestyle choices can compromise the factors necessary to age successfully. Implications for practice and research are posited.

  6. Determining Success Criteria and Success Factors for International Construction Projects for Malaysian Contractors

    Directory of Open Access Journals (Sweden)

    Ali Mohammed Alashwal

    2017-06-01

    Full Text Available The success of international construction projects is fraught with various challenges such as competitiveness, lack of resources, versatile global economy, and specific conditions in the host country. Malaysian contractors have been venturing into global construction market since early 1980s. However, their venturing was not successful all the time. The number of international projects awarded to Malaysian contractors has reduced drastically during the past decade. Taking advantage of this experience, this paper aims to identify the success criteria and success factors of international construction projects. The data was collected from 120 respondents using a questionnaire survey and analysed using principal component analysis and regression analysis. The results revealed three principal criteria of project success namely, Management Success, Functional Success, and Organisation Success. The main components of success factors include Team Power and Skills, Resource Availability, External Environment, Organisation Capability, Project Support, and Project Organisation. Further analysis emphasized the importance of strong financing capacity of contractors, project social environment, and competence of the project manager in achieving project success. The results of this paper can serve as a guideline for contractors and project managers to achieve success in this context. Future studies may provide in-depth analysis of success criteria and success factors specific for construction project type and host-country location.

  7. Medical abortion. defining success and categorizing failures

    DEFF Research Database (Denmark)

    Rørbye, Christina; Nørgaard, Mogens; Vestermark, Vibeke

    2003-01-01

    Medical abortion was performed in 461 consecutive women with gestational age LT /= 63 days using a regimen of mifepristone 600 mg followed 2 days later by gemeprost 1 mg vaginally. Success, defined as no surgical intervention, declined from 98.7% after 2 weeks to 94.6% after 15 weeks. The differe......Medical abortion was performed in 461 consecutive women with gestational age LT /= 63 days using a regimen of mifepristone 600 mg followed 2 days later by gemeprost 1 mg vaginally. Success, defined as no surgical intervention, declined from 98.7% after 2 weeks to 94.6% after 15 weeks....... The difference in short- and long-term success rates increased with increasing gestational age. The majority of failures (76%) were diagnosed more than 2 weeks after initiation of the abortion. At a 2-week follow-up visit, the women who turned out to be failures had a larger endometrial width, higher beta......-hCG values and smaller reductions of beta-hCG than those treated successfully. To optimize comparison of success rates after different medical abortion regimens, we suggest that the criteria for success are stated clearly, that the success rates are stratified according to gestational age...

  8. Reframing Success and Failure of Information Systems

    DEFF Research Database (Denmark)

    Cecez-Kecmanovic, Dubravka; Kautz, Karlheinz; Abrahall, Rebecca

    2014-01-01

    he paper questions common assumptions in the dominant representational framings of information systems success and failure and proposes a performative perspective that conceives IS success and failure as relational effects performed by sociomaterial practices of IS project actor-networks of devel......he paper questions common assumptions in the dominant representational framings of information systems success and failure and proposes a performative perspective that conceives IS success and failure as relational effects performed by sociomaterial practices of IS project actor......-networks of developers, managers, technologies, project documents, methodologies, and other actors. Drawing from a controversial case of a highly innovative information system in an insurance company-considered a success and failure at the same time- the paper reveals the inherent indeterminacy of IS success and failure...... and describes the mechanisms by which success and failure become performed and thus determined by sociomaterial practices. This is explained by exposing ontological politics in the reconfiguration and decomposition of the IS project actor-network and the emergence of different agencies of assessment...

  9. Social-philosophical practices of success

    Directory of Open Access Journals (Sweden)

    S. R. Karpenko

    2017-01-01

    Is social-philosophical experts of success represent the complicated system of various world outlook, speech, mental factors and events in life of the various professional, age and subcultural bunches producing assessments under different visual angles, from positions of various social installations and identity in what the social philosophy of success expresses. In the course of forming social an expert (both in daily, and in an institutional discourse are shaped also theoretical ideas success: instrumental, is social-philosophical, is social-psychological, world outlook, historical and cultural, etc., characterising thereby various systems of a social discourse. Examination is social-philosophical the success expert shows the real complexity and ambiguity of the given appearance. Besides the presented typology constructed as the most approximate abstract plan, in each separate case probably build-up of typological models according to a principle ad hoc. It looks quite justified, considering that circumstance that representations about success and the successful person are constantly transformed and acquire new performances. Efficiency of the further examinations of a discourse and a success expert will depend on accepting of new heuristic approaches, capable to consider multidimensionality and ambiguity of the given phenomenon.

  10. Factors associated with successful treatment of smoking

    Directory of Open Access Journals (Sweden)

    Raúl Godoy Mayoral

    2016-09-01

    Full Text Available Objectives: To assess the success of smoking cessation treatment, according to sex, comorbidities and treatments used. Method: Retrospective, descriptive study of the results obtained after analyzing the sample of all patients who attended the “Specialized Smoking Treatment” Unit in the University Hospital of Albacete from the 1st of January 2008 until the 31st of December 2009 and the subsequent posterior year follow-up. Results: 838 patients sent from Primary Care and Pneumology Service were included. 53.7% were men. The average age of the sample was 46.18 years. The average daily cigarette consumption was over a pack daily with 27.30 cigarettes per day. Most of the patients had comorbidities; among which was psychiatric comorbidity (37.7%, cardiovascular risk factors (CVRFs; among which the most common factor was dyslipidemia followed by hypertension and diabetes, and respiratory comorbidity (COPD, obstructive sleep apnea, asthma and chronic carriers of Domiciliary Oxygen Therapy. The global success in patients who attended the first consultation was (13.8%, while the success in patients who did not abandon the study without starting the treatment was 27.6%. With the variable “Respiratory Diseases / Cardiovascular Diseases” (RD/CVD it was observed that having a respiratory or a cardiovascular disease does not influence the success of smoking cessation. There are hardly any differences in the success probability according to whether the patient is suffering or not hypertension, diabetes, dyslipidemia, psychiatric disorder, alcoholism or neoplasias. However statistical difference between success and the possibility of being diagnosed or not with SAHS was observed (p <0.028. Nor were found differences regarding the number of previous attempts to quit before starting the treatment and success. Moreover, the success was calculated according to the number of cigarettes smoked per day, but no statistically significant difference was found

  11. Fear of success among business students.

    Science.gov (United States)

    Rothman, M

    1996-06-01

    The concept of "Fear of Success" was measured with 352 male and female business students using the prompt, After first term finals, Ann(John) finds her(him)self at the top of her(his) Medical/Nursing school class. Analysis indicated a greater frequency of fear-of-success imagery among men than women and in particular to the John in Medical school and Ann in Nursing school cues. In addition, the Ann cue and the Medical school cue generated more fear-of-success responses among men than women.

  12. Attributions to sexual minority women's academic success.

    Science.gov (United States)

    McCleaf, Kathy J

    2014-01-01

    Narratives from 33 sexual minority women were examined to discover what factors contributed to their ability to acquire academic success, and what, if any, attributions are evident in some sexual minority women's experiences that provide the ability to persist and graduate. Coping strategies the participants used to gain the resiliency and persistence necessary to acquire academic success are discussed. Intrinsic themes were work ethic values, altruism, and self-efficacy. Extrinsic themes were mentors, family, and friends. Sexual minority women identified the complexity of intrinsic and extrinsic attributions that were used to successfully complete a four-year undergraduate degree in the United States.

  13. Successes and Challenges of Emerging Economy Multinationals

    DEFF Research Database (Denmark)

    Successes and Challenges of Emerging Economy Multinationals investigates a broad variety of cases presenting clear evidence of fast successful internationalization of emerging economy multinationals originating not only from big economic players such as China, India and Russia but also from other...... successfully internationalizing emerging countries, namely South Africa and Poland. In terms of size, the firms vary from huge multinational firms such as Huawei, Tata and Gazprom, to really small high technology firms. The in-depth analysis conducted in this book leads to the indication of numerous novel...

  14. Successive Transitions in Cholesteric Liquid Crystals

    Science.gov (United States)

    Hirata, Shoji; Matsuzaki, Ichiro; Yanagita, Akihiro; Tako, Toshiharu

    1981-12-01

    Successive transitions in an AC electric field in cholesteric liquid crystals with negative dielectric anisotropy have been investigated systematically. According to the relations between the frequency of applied AC field and the threshold voltage Vth of successive transitions and between Vth and cell thickness divided by cholesteric pitch D/P0 several features are observed. The threshold voltage for the dielectric regime extends to a DC electric regime. Quenching of the conduction regime is observed in a thinner sample cell. Some curious behaviors of the domain corresponding to the dielectric regime are also observed. A new model which can explain the mechanism of successive transitions in conduction regime is proposed.

  15. Investigation on the Success of Peasant Entrepreneurs

    Science.gov (United States)

    Li, Guohao; Wu, Bing; Bai, Guanglin

    Peasant entrepreneurs are one important force to promote the development of new rural construction, so it has practical significance to study success factors of peasant entrepreneurs. 40 cases involving peasant entrepreneurs are studied through content analysis method and the results show that: (1) Making good use of existing resources in rural areas is a key factor for peasant entrepreneurs; (2) hard work, strong willness, tactics and courage, social responsibility are four most important success factors; (3) 23 items of success factor can be summarized into three categorized, personality traits, abilities, and behavior characteristics.

  16. Effects of education on breastfeeding success.

    Science.gov (United States)

    Hill, P D

    1987-01-01

    This study investigated effects of a prenatal breastfeeding education program on the success of breastfeeding among low-income pregnant women. The sample population was comprised of 64 subjects who delivered at a university hospital in the Midwest. A pretest and posttest were used to measure breastfeeding knowledge in the treatment group. Six weeks following delivery the subjects completed the Telephone Interview Survey (TIS) to determine their method of infant feeding and their perception of success at breastfeeding. Subjects in the treatment group were more knowledgeable about breastfeeding after instruction. However, there was no difference in breastfeeding duration and perception of success between subjects in the treatment and control groups.

  17. Fostering Success or Stratification? A Macroapproach to Understanding "Success" in the Community College Context

    Science.gov (United States)

    Ireland, S. Mei-Yen

    2015-01-01

    The topic of student success is a central focus for community college educators and researchers, yet little consideration is given to the long-term success that community college students may or may not be attaining. What role (if any) do concerns about social stratification have in the debate over student success? Exploring the ways in which…

  18. Passing Success Percentages and Ball Possession Rates of Successful Teams in 2014 FIFA World Cup

    Directory of Open Access Journals (Sweden)

    Kemal GÖRAL

    2015-03-01

    Full Text Available This study was conducted to examine the ball possession and passing success percentage of successful teams in 2014 FIFA World Cup. The data were obtained from international TV channels publishing competitions and the database of the website of the Fédération Internationale de Football Association - FIFA through official overviews of the games. So the parameters such as ball possession percentages, passing attempted, passing success percentages, accurate and non-accurate passes of successful teams in matches were analyzed. These performance indicators were analyzed by e-Analyze Soccer computer program. The data obtained in this study was recorded in SPSS 16.0 program and interpreted by calculating frequency and percentage values. Ball possession percentages of the successful teams vary between 50.32% and 56.71%. Among 17102 passing attempts of successful teams, it was determined that 133378 were successful having a high rate of passing success such as 78.22%. As a result, in the organizations such as World Cup which elite athletes participated, while successful teams had high rates of the ball possession it can be said that having the ball in midfield and offensive region and passing attempt, successful passing scores, passing success percent at a high level are the most basic principles that bring success.

  19. Creating a culture for information systems success

    CERN Document Server

    Belkhamza, Zakariya

    2015-01-01

    It has been widely reported that issues related to organizational context appear frequently in discussions of information systems success. The statement that the information system did not fit the behavioral context in an organization is often part of the explanation of why particular information system encountered unanticipated resistance and never met expectation. While this context has been intensively studied, we still lack evidence on how this organizational context is affecting the success of information system from a managerial action perspective. This type of managerial involvement is often neglected to the extent that it became an essential obstacle to organizational performance. The objective of Creating a Culture for Information Systems Success is to assist CIOs and IT managers on how to use their managerial actions to create a suitable cultural environment in the organization, which leads to a successful implementation of information systems. This  book will also provide guidelines fo...

  20. Mindset: the new psychology of success

    National Research Council Canada - National Science Library

    Dweck, Carol S

    2006-01-01

    Reveals how established attitudes affect all aspects of one's life, explains the differences between fixed and growth mindsets, and stresses the need to be open to change in order to achieve fulfillment and success...

  1. Graduate Education Week celebrates successes, possibilities

    OpenAIRE

    Harris, Sally L.

    2005-01-01

    During this year's Graduate Education Week at Virginia Tech March 21-25, participants will celebrate graduate-student successes, such as student research, and explore future possibilities for graduate education, including a new Graduate Life Center.

  2. Potential success factors in brand development

    DEFF Research Database (Denmark)

    Esbjerg, Lars; Grunert, Klaus G.; Poulsen, Carsten Stig

    2005-01-01

    ? This is the question we want to answer. More specifically, we want to identify potential success factors in building strong brands, understood as brands with high consumer-based brand equity. Keller (1993, p. 2) defined customer-based brand equity as "the differential effect of brand knowledge on consumer response...... of this paper is to identify potential success factors in developing strong brands and to test whether these factors can be used to discriminate between strong and weak brands. It does so through a review of the literature for potential success factors. Furthermore, to ensure that important factors have...... not been overlooked by the literature a brainstorming session with practitioners and researchers was carried out. Based on the literature and the brainstorming session, we present a list of potential success factors in brand development in the FMCG sector. To test the validity of these factors, they were...

  3. Sociomateriality and Information Systems Success and Failure

    DEFF Research Database (Denmark)

    Kautz, Karlheinz; Cecez-Kecmanovic, Dubravka

    2013-01-01

    The aim of this essay is to put forward a performative, sociomaterial perspective on Information Systems (IS) success and failure in organisations by focusing intently upon the discursive-material nature of IS development and use in practice. Through the application of Actor Network Theory (ANT......) to the case of an IS that transacts insurance products we demonstrate the contribution of such a perspective to the understanding of how IS success and failure occur in practice. The manuscript puts our argument forward by first critiquing the existing perspectives on IS success and failure in the literature...... continually enacted in practice. As enactments in practice IS development and use produce realities of IS success and failure....

  4. VetSuccess on Campus (VSOC)

    Data.gov (United States)

    Department of Veterans Affairs — The VSOC program provides a VA Vocational Rehabilitation Counselor (VRC) to each VSOC school. These VRCs are called VetSuccess on Campus (VSOC) Counselors. A VA Vet...

  5. Successful and unsuccessful psychopaths: a neurobiological model.

    Science.gov (United States)

    Gao, Yu; Raine, Adrian

    2010-01-01

    Despite increasing interest in psychopathy research, surprisingly little is known about the etiology of non-incarcerated, successful psychopaths. This review provides an analysis of current knowledge on the similarities and differences between successful and unsuccessful psychopaths derived from five population sources: community samples, individuals from employment agencies, college students, industrial psychopaths, and serial killers. An initial neurobiological model of successful and unsuccessful psychopathy is outlined. It is hypothesized that successful psychopaths have intact or enhanced neurobiological functioning that underlies their normal or even superior cognitive functioning, which in turn helps them to achieve their goals using more covert and nonviolent methods. In contrast, in unsuccessful, caught psychopaths, brain structural and functional impairments together with autonomic nervous system dysfunction are hypothesized to underlie cognitive and emotional deficits and more overt violent offending.

  6. Career success in a boundaryless career world

    NARCIS (Netherlands)

    Arthur, Michael B.; Khapova, S.N.; Wilderom, Celeste P.M.

    2005-01-01

    This paper compares contemporary career theory with the theory applied in recent career success research. The research makes inconsistent use of career theory, and in particular neglects the interdependence of the objective and subjective careers, and boundaryless career issues of

  7. Prenatal ultrasonographic diagnosis and successful management of ...

    African Journals Online (AJOL)

    A case of mediastinal teratoma, diagnosed in utero by realtime ultrasonography during a late 3rd trimester evaluation of polyhydramnios, is described. Prompt respiratory assistance to the infant at birth and early surgical intervention led to a successful outcome.

  8. SUCCESS Utah Polarization Diversity LIDAR data set

    Data.gov (United States)

    National Aeronautics and Space Administration — The SUCCESS_UTAH_PDL data set contains ground-based measurements made by the University of Utah Polarization Diversity LIDAR at the CART site during the April-May...

  9. Successful conservative treatment of chylothorax following ...

    African Journals Online (AJOL)

    Successful conservative treatment of chylothorax following oesophagectomy – a clinical algorithm. ... Design. During a 2-year period, 3 patients developed chylothorax after oesophagectomy. This was treated conservatively, following our departmental protocol. Results. Conservative management (total parenteral nutrition, ...

  10. Successful selective angiographic embolisation of a gastroduodenal ...

    African Journals Online (AJOL)

    New endoscopic and endovascular therapies have revolutionised the management of complex traumatic visceral aneurysms. A pseudoaneurysm of the gastroduodenal artery following penetrating abdominal trauma was successfully managed by selective angiographic embolisation.

  11. Successful Thrombolysis of Aortic Prosthetic Valve Thrombosis ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    threatening. Standard surgical treatment using cardiopulmonary bypass carries high maternal and fetal complications. Here we report a case of an antenatal female in first trimester with aortic prosthetic valve thrombosis (PVT), who was successfully ...

  12. Performance Dynamics and Success in Online Games

    OpenAIRE

    Sapienza, Anna; Peng, Hao; Ferrara, Emilio

    2018-01-01

    Online data provide a way to monitor how users behave in social systems like social networks and online games, and understand which features turn an ordinary individual into a successful one. Here, we propose to study individual performance and success in Multiplayer Online Battle Arena (MOBA) games. Our purpose is to identify those behaviors and playing styles that are characteristic of players with high skill level and that distinguish them from other players. To this aim, we study Defense ...

  13. Prior knowledge and entrepreneurial innovative success

    OpenAIRE

    Cantner, Uwe; Goethner, Maximilian; Meder, Andreas

    2007-01-01

    This paper is concerned with the relationship between innovative success of entrepreneurs and their prior knowledge at the stage of firm formation. We distinguish between different kinds of experience an entrepreneur can possess and find evidence that the innovative success subsequent to firm formation is enhanced by entrepreneur’s prior technological knowledge but not by prior market and organizational knowledge. Moreover we find that prior technological knowledge gathered through embeddedne...

  14. Demystifying the institutional repository for success

    CERN Document Server

    Buehler, Marianne

    2013-01-01

    Institutional repositories remain key to data storage on campus, fulfilling the academic needs of various stakeholders. Demystifying the Institutional Repository for Success is a practical guide to creating and sustaining an institutional repository through marketing, partnering, and understanding the academic needs of all stakeholders on campus. This title is divided into seven chapters, covering: traditional scholarly communication and open access publishing; the academic shift towards open access; what the successful institutional repository looks like; institutional repository collaboratio

  15. Successful Community-Based Seed Production Strategies

    OpenAIRE

    Anonymous,; Monyo, Emmanuel; Banziger, Marianne

    2004-01-01

    Designed to address the issues that limit the access of small-scale farmers in sub-Saharan Africa to quality, affordable seed of the crops on which they depend for food security and livelihoods, this collection of articles describes successful principles for and experiences in community-based seed production. Among other things, the manuscripts analyze current seed production systems and models; propose ways to design successful community-based seed production schemes; describe proper seed pr...

  16. Successful Aging: Multiple Trajectories and Population Heterogeneity

    OpenAIRE

    Fengyan Tang

    2014-01-01

    Following Rowe and Kahn¡¯s successful aging model, this study identified successful aging as a distinctive aging trajectory and examined gender differences in the aging process. Using the Health and Retirement Study data (2000-2008), this study applied group-based trajectory analysis to identify multiple aging trajectories in a sample of older Americans aged 65 and over (N=9,226). Six dimensions were analyzed in the multi-trajectory model: chronic disease, physical functional limitation, disa...

  17. A Framework for successful new product development

    Directory of Open Access Journals (Sweden)

    Nadia Bhuiyan

    2011-12-01

    Full Text Available Purpose: The purpose of this paper is to propose a framework of critical success factors, metrics, and tools and techniques for implementing metrics for each stage of the new product development (NPD process.Design/methodology/approach: To achieve this objective, a literature review was undertaken to investigate decades of studies on NPD success and how it can be achieved. These studies were scanned for common factors for firms that enjoyed success of new products on the market.Findings: The paper summarizes NPD success factors, suggests metrics that should be used to measure these factors, and proposes tools and techniques to make use of these metrics. This was done for each stage of the NPD process, and brought together in a framework that the authors propose should be followed for complex NPD projects.Research limitations/implications: Several different research directions could provide additional useful information both to firms finding critical success factors (CSF and measuring product development success as well as to academics performing research in this area. The main research opportunity exists in implementing or testing the proposed framework.Practical implications: The framework can be followed by managers of complex NPD projects to ensure success.Originality/value: While many studies have been conducted on critical success factors for NPD, these studies tend to be fragmented and focus on one or a few phases of the NPD process. To the authors’ knowledge, this is the first time a framework that synthesizes these studies into a single framework.

  18. Emotional Intelligence and Leadership Success of Secondary ...

    African Journals Online (AJOL)

    User

    leadership success of principals due to their gender and age. Result of Table 5 showed that the t-test analysis of influence of high emotional intelligence on leadership success of male and female principals gave a t-calculated value of 3.97 which is greater than the critical t-value of. 1.96 at 0.05 level of significance and df of ...

  19. Successful aging and the epidemiology of HIV

    Directory of Open Access Journals (Sweden)

    Vance DE

    2011-06-01

    Full Text Available David E Vance1, Teena McGuinness1, Karen Musgrove3, Nancy Ann Orel4, Pariya L Fazeli21School of Nursing, 2Department of Psychology and Center for Research in Applied Gerontology, University of Alabama at Birmingham, 3Birmingham AIDS Outreach, Birmingham, AL, USA; 4Gerontology Program, Bowling Green State University, Bowling Green, OH, USAAbstract: By 2015, it is estimated that nearly half of those living with HIV in the US will be 50 years of age and older. This dramatic change in the demographics of this clinical population represents unique challenges for patients, health care providers, and society-at-large. Fortunately, because of highly active antiretroviral therapy (HAART and healthy lifestyle choices, it is now possible for many infected with HIV to age successfully with this disease; however, this depends upon one’s definition of successful aging. It is proposed that successful aging is composed of eight factors: length of life, biological health, cognitive efficiency, mental health, social competence, productivity, personal control, and life satisfaction. Unfortunately, HIV and medication side effects can compromise these factors, thus diminishing one’s capacity to age successfully with this disease. This article explores how HIV, medication side effects from HAART, and lifestyle choices can compromise the factors necessary to age successfully. Implications for practice and research are posited.Keywords: HIV, AIDS, successful aging, spirituality, depression, hardiness

  20. Successful aging: considering non-biomedical constructs

    Science.gov (United States)

    Carver, Lisa F; Buchanan, Diane

    2016-01-01

    Objectives Successful aging continues to be applied in a variety of contexts and is defined using a number of different constructs. Although previous reviews highlight the multidimensionality of successful aging, a few have focused exclusively on non-biomedical factors, as was done here. Methods This scoping review searched Ovid Medline database for peer-reviewed English-language articles published between 2006 and 2015, offering a model of successful aging and involving research with older adults. Results Seventy-two articles were reviewed. Thirty-five articles met the inclusion criteria. Common non-biomedical constructs associated with successful aging included engagement, optimism and/or positive attitude, resilience, spirituality and/or religiosity, self-efficacy and/or self-esteem, and gerotranscendence. Discussion Successful aging is a complex process best described using a multidimensional model. Given that the majority of elders will experience illness and/or disease during the life course, public health initiatives that promote successful aging need to employ non-biomedical constructs, facilitating the inclusion of elders living with disease and/or disability. PMID:27956828

  1. Paving the Road to Success: A Framework for Implementing the Success Tutoring Approach

    Directory of Open Access Journals (Sweden)

    Spark Linda

    2017-12-01

    Full Text Available The exponential growth of higher education enrolment in South Africa has resulted in increased diversity of the student body, leading to a proliferation of factors that affect student performance and success. Various initiatives have been adopted by tertiary institutions to mitigate the negative impact these factors may have on student success, and it is suggested that interventions that include aspects of social integration are the most successful. This paper outlines an approach called Success Tutoring (a non-academic tutorial approach used as part of a student success and support programme in the Faculty of Commerce, Law, and Management at the University of the Witwatersrand, which is underscored by empirical evidence drawn from evaluation data collected during Success Tutor symposia. The authors draw conclusions and make recommendations based on a thematic analysis of the dataset, and ultimately provide readers with a framework for implementing Success Tutoring at their tertiary institutions.

  2. Leadership and Project Success in Development Sector

    Directory of Open Access Journals (Sweden)

    Saghir Ahmed

    2017-10-01

    Full Text Available Aim/purpose - The study aims to investigate the relationship among the leadership, operational efficiency and project success in general and the impact of transformational leadership and operational efficiency on project success in particular. Design/methodology/approach - Mean comparison from descriptive statistics and multiple linear regression from inferential statistics was used to determine the association between variables and further impact of the transformational leadership and operational efficiency on project success in the development sector. The paper presents the results of a survey conducted among 200 employees from the top, middle & lower management levels of various national & international development organizations working in Pakistan like Microfinance Banks and other Rural Support Programs. Statistical Package for Social Sciences (SPSS was used to process data. Findings - The result shows positive association among transformational leadership, operational efficiency and project success. In addition, it was found that transformational leadership and operational efficiency have a positive and statistically significant impact on the project success. It is concluded that both transformational leadership and operational efficiency are vital to achieving the optimum level of success in any project, especially in the development sector. Research implications/limitations - The integral limitation of the study was the respondents because most of the development organizations have their operations in rural areas where access was difficult because of limited time and resources. In addition, such organizations are always reluctant to provide survey feedback. Originality/value/contribution - The paper contribution is in the theoretical and practical knowledge of the project success factors in the development sector which is still a somehow unexplored area. Regulators of the development sector may be benefited from this study.

  3. Dietary patterns as predictors of successful ageing.

    Science.gov (United States)

    Hodge, A M; O'Dea, K; English, D R; Giles, G G; Flicker, L

    2014-03-01

    To examine associations between dietary patterns identified by factor analysis, and successful ageing. Prospective cohort study with diet measured in 1990-4, and successful ageing in 2003-7. Ordered logistic regression with outcome determined as dead/usual ageing/successful ageing was used to examine associations with quintile groups of dietary factor scores. Men and women (n=6308), without history of major illness at baseline, and aged >70 years at follow-up, or who had died before follow-up but would have been aged >70 at the commencement of follow-up, from the Melbourne Collaborative Cohort Study. Frequencies of intake of 121 foods at baseline were collected in a food frequency questionnaire. Anthropometry and other health and lifestyle data were collected. At follow-up, questionnaire data relating to mental health, physical function and medical history were used to define successful ageing. Four dietary factors were identified, characterized by higher loadings for (1) vegetables; (2) fruit, (3) feta, legumes, salad, olive oil, and inverse loadings for tea, margarine, cake, sweet biscuits and puddings; (4) meat, white bread, savoury pastry dishes and fried foods. In models excluding body size, the second factor 'Fruit' was positively associated with successful ageing (OR in top 20% vs lowest 20% of score 1.31, 95%CI (1.05-1.63), p trend across quintile groups 0.001); while the fourth factor 'Meat/fatty foods' was inversely associated (OR in top 20% vs lowest 20% of score 0.69, 95%CI (0.55-0.86), p trend across quintile groups 0.001). Factors 1 and 3 did not show significant associations with successful ageing. The association for 'Fruit' was little altered after adjustment for body size, while for 'Meat/fatty foods' the association was somewhat attenuated. A dietary pattern including plenty of fruit while limiting meat and fried foods may improve the likelihood of ageing successfully.

  4. Successful Second Microsurgical Replantation for Amputated Penis.

    Science.gov (United States)

    Fujiki, Masahide; Ozaki, Mine; Kai, Akiko; Takushima, Akihiko; Harii, Kiyonori

    2017-09-01

    Penile amputation is a rare emergency, but the best method for its repair is required due to the organ's functional and societal role. Since the first successful microsurgical replantation of the amputated penis, microsurgical techniques have matured and become the standard treatment for the penile replantation. However, the successful second microsurgical replantation for amputated penis has been rarely reported. We present the case of a 40-year-old man with schizophrenia who had a past history of penile self-mutilation and successful replantation at another hospital 2 years ago. After stopping oral medication for schizophrenia, he again cut his penis with a kitchen knife. We successfully replanted the amputated penis by anastomosing both circumflex arteries, the superficial dorsal vein, and the deep dorsal vein using microsurgical techniques. Postoperatively, the foreskin of the replanted penis gradually developed partial necrosis, requiring surgical debridement. The aesthetic and functional results were satisfactory and retrograde urethrography showed no evidence of leakage and stricture of the urethra. Although skin necrosis after penile replantation has been reported as an unavoidable process owing to the nature of injury, the rate would be higher after secondary replantation because of scar formation due to the previous operation. Therefore, our case of successful secondary replantation suggests that skin necrosis would be a predictable postoperative complication and the debridement timing of the devitalized foreskin should be closely monitored, and also secondary amputation is not a contraindication of replantation.

  5. The influence of numbers on invasion success.

    Science.gov (United States)

    Blackburn, Tim M; Lockwood, Julie L; Cassey, Phillip

    2015-05-01

    The process by which a species becomes a biological invader, at a location where it does not naturally occur, can be divided into a series of sequential stages (transport, introduction, establishment and spread). A species' success at passing through each of these stages depends, in a large part, on the number of individuals available to assist making each transition. Here, we review the evidence that numbers determine success at each stage of the invasion process and then discuss the likely mechanisms by which numbers affect success. We conclude that numbers of individuals affect transport and introduction by moderating the likelihood that abundant (and widespread) species are deliberately or accidentally translocated; affect establishment success by moderating the stochastic processes (demographic, environmental, genetic or Allee) to which small, introduced populations will be vulnerable; and affect invasive spread most likely because of persistent genetic effects determined by the numbers of individuals involved in the establishment phase. We finish by suggesting some further steps to advance our understanding of the influence of numbers on invasion success, particularly as they relate to the genetics of the process. © 2015 John Wiley & Sons Ltd.

  6. Successful Second Microsurgical Replantation for Amputated Penis

    Directory of Open Access Journals (Sweden)

    Masahide Fujiki, MD

    2017-09-01

    Full Text Available Summary:. Penile amputation is a rare emergency, but the best method for its repair is required due to the organ’s functional and societal role. Since the first successful microsurgical replantation of the amputated penis, microsurgical techniques have matured and become the standard treatment for the penile replantation. However, the successful second microsurgical replantation for amputated penis has been rarely reported. We present the case of a 40-year-old man with schizophrenia who had a past history of penile self-mutilation and successful replantation at another hospital 2 years ago. After stopping oral medication for schizophrenia, he again cut his penis with a kitchen knife. We successfully replanted the amputated penis by anastomosing both circumflex arteries, the superficial dorsal vein, and the deep dorsal vein using microsurgical techniques. Postoperatively, the foreskin of the replanted penis gradually developed partial necrosis, requiring surgical debridement. The aesthetic and functional results were satisfactory and retrograde urethrography showed no evidence of leakage and stricture of the urethra. Although skin necrosis after penile replantation has been reported as an unavoidable process owing to the nature of injury, the rate would be higher after secondary replantation because of scar formation due to the previous operation. Therefore, our case of successful secondary replantation suggests that skin necrosis would be a predictable postoperative complication and the debridement timing of the devitalized foreskin should be closely monitored, and also secondary amputation is not a contraindication of replantation.

  7. RELATION CONATIVE CHARACSTERISTICS AND SUCCESS IN GYMNASTICS

    Directory of Open Access Journals (Sweden)

    Katarina Herodek

    2013-07-01

    Full Text Available The young gymnasts from seven cities in the Republic of Serbia at the age of 8-12 years was covered with programmed gymnastic training 3-4 times a week for 90 minutes and the system of competition within the "C" program GSS. The case studies are examined relationships conative characteristics modified by Catel 16PF questionnaire with success in gymnastics, which is estimated to success in the competition in the "C" program of the Gymnastics Federation of Serbia. Using canonical correlation analysis of the data show that in the space of conative characteristics examined were found to be factors I-sensitivity-sharp temper, H- fearlessness and Q1- openness to change. Success in gymnastics was defined positive relations with disciplines Rings (.77, Pommel horse and Bar (.73 and Vault (.63. The hypothesis that says "conative characteristics have a positive relationship with success in gymnastics" can not be accepted because there is a statistically positive relationship that is explained with 83%. Young gymnasts who show a sharp temper and willingness to learn new cause the contents with strong courage, can successfully realizes "C" program GS Serbia in gymnastics.

  8. Strategies for successful software development risk management

    Directory of Open Access Journals (Sweden)

    Marija Boban

    2003-01-01

    Full Text Available Nowadays, software is becoming a major part of enterprise business. Software development is activity connected with advanced technology and high level of knowledge. Risks on software development projects must be successfully mitigated to produce successful software systems. Lack of a defined approach to risk management is one of the common causes for project failures. To improve project chances for success, this work investigates common risk impact areas to perceive a foundation that can be used to define a common approach to software risk management. Based on typical risk impact areas on software development projects, we propose three risk management strategies suitable for a broad area of enterprises and software development projects with different amounts of connected risks. Proposed strategies define activities that should be performed for successful risk management, the one that will enable software development projects to perceive risks as soon as possible and to solve problems connected with risk materialization. We also propose a risk-based approach to software development planning and risk management as attempts to address and retire the highest impact risks as early as possible in the development process. Proposed strategies should improve risk management on software development projects and help create a successful software solution.

  9. What Does Successful Aging Mean? Lay Perception of Successful Aging Among Elderly Singaporeans.

    Science.gov (United States)

    Feng, Qiushi; Straughan, Paulin Tay

    2017-03-01

    We explore the culturally specific meaning of successful aging in Singapore, an ethnically diverse city-state in Asia. We aim to investigate lay perceptions of successful aging among the elderly individuals in Singapore and further examine variations of these perceptions. We applied a mixed-method research design. Firstly, we conducted qualitative interviews with 49 elderly respondents, generating 12 main subjective components of successful aging. Next, we did a national survey with a sample of 1,540 local residents aged 50 to 69 years, in which respondents were asked to evaluate the importance of each subjective component of successful aging. We used the regression models and latent class analysis to analyze the correlatives of successful aging and to classify the elderly individuals by perception types. Among 12 components of successful aging, those related to self-sufficiency received the highest acknowledgment among the elderly individuals in Singapore. At least half of them simultaneously highlighted independence from family and dependence on family. Malays and Indians in Singapore valued more of the roles of spouse and children in successful aging, as compared with Chinese. The latent class analysis classified four groups of the elderly individuals according to their lay views on successful aging. As compared with the western model of successful aging, the elderly individuals in Singapore perceived successful aging with a strong focus on familism. These lay perceptions also significantly varied among these elderly individuals.

  10. Love Influences Reproductive Success in Humans

    Science.gov (United States)

    Sorokowski, Piotr; Sorokowska, Agnieszka; Butovskaya, Marina; Karwowski, Maciej; Groyecka, Agata; Wojciszke, Bogdan; Pawłowski, Bogusław

    2017-01-01

    As love seems to be universal, researchers have attempted to find its biological basis. However, no studies till date have shown its direct association with reproductive success, which is broadly known to be a good measure of fitness. Here, we show links between love, as defined by the Sternberg Triangular Theory of Love, and reproductive success among the Hadza—traditional hunter-gatherer population. We found that commitment and reproductive success were positively and consistently related in both sexes, with number of children showing negative and positive associations with intimacy and passion, respectively, only among women. Our study may shed new light on the meaning of love in humans' evolutionary past, especially in traditional hunter-gatherer societies in which individuals, not their parents, were responsible for partner choice. We suggest that passion and commitment may be the key factors that increase fitness, and therefore, that selection promoted love in human evolution. However, further studies in this area are recommended. PMID:29209243

  11. Understanding China’s Economic Success

    DEFF Research Database (Denmark)

    Li, Xing

    2016-01-01

    This study attempts to provide a framework for understanding the role of the “embeddedness” in China’s economic success reflected by a unique embedded integration of state-market-society relations. “Embeddedness with Chinese characteristics” is the central concept of this study for analyzing how...... cultural and political uniqueness influences economic activities and shapes distinctive institutional forms. In order to grasp the factors behind the Chinese economic success, it is important to understand how the disembedded forces of marketization and commodification were balanced by the embedded forces...... during its economic development in the past decades. The conclusion is that China’s economic reform and success manifest a long and innovative grinding-in process of state-market-society relations....

  12. Factors favorable to public participation success

    Energy Technology Data Exchange (ETDEWEB)

    Peelle, E.; Schweitzer, M.; Munro, J.; Carnes, S.; Wolfe, A.

    1996-05-01

    Categories of factors linked to successful public participation (PP) program outcomes include PP process, organizational context, sociopolitical context, strategic considerations and unique (special circumstances) factors. We re-order the long list factors according to how essential, important, and unique they are and discuss their significance and interrelationships. It is argued that bureacratic structure and operational modes are basically in conflict with features of successful PP programs (openness, two-way education, communication with nonexpert outsiders). If this is so, then it is not surprising that the factors essential for PP success in bureacracies involve extraordinary management efforts by agencies to bypass, compensate for, or overcome structural constraints. We conclude by speculating about the long-term viability of PP practices in the agency setting as well as the consequences for agencies that attempt the problematic task of introducing PP into their complex, mission-oriented organizations.

  13. Organic farming improves pollination success in strawberries.

    Science.gov (United States)

    Andersson, Georg K S; Rundlöf, Maj; Smith, Henrik G

    2012-01-01

    Pollination of insect pollinated crops has been found to be correlated to pollinator abundance and diversity. Since organic farming has the potential to mitigate negative effects of agricultural intensification on biodiversity, it may also benefit crop pollination, but direct evidence of this is scant. We evaluated the effect of organic farming on pollination of strawberry plants focusing on (1) if pollination success was higher on organic farms compared to conventional farms, and (2) if there was a time lag from conversion to organic farming until an effect was manifested. We found that pollination success and the proportion of fully pollinated berries were higher on organic compared to conventional farms and this difference was already evident 2-4 years after conversion to organic farming. Our results suggest that conversion to organic farming may rapidly increase pollination success and hence benefit the ecosystem service of crop pollination regarding both yield quantity and quality.

  14. Organic farming improves pollination success in strawberries.

    Directory of Open Access Journals (Sweden)

    Georg K S Andersson

    Full Text Available Pollination of insect pollinated crops has been found to be correlated to pollinator abundance and diversity. Since organic farming has the potential to mitigate negative effects of agricultural intensification on biodiversity, it may also benefit crop pollination, but direct evidence of this is scant. We evaluated the effect of organic farming on pollination of strawberry plants focusing on (1 if pollination success was higher on organic farms compared to conventional farms, and (2 if there was a time lag from conversion to organic farming until an effect was manifested. We found that pollination success and the proportion of fully pollinated berries were higher on organic compared to conventional farms and this difference was already evident 2-4 years after conversion to organic farming. Our results suggest that conversion to organic farming may rapidly increase pollination success and hence benefit the ecosystem service of crop pollination regarding both yield quantity and quality.

  15. Determinants of construction project success in India

    CERN Document Server

    Jha, Kumar Neeraj

    2013-01-01

    This study presents exploratory work and seeks to identify and evaluate the success and failure factors that could form a guideline for further study and to some extent help professionals to understand some critical aspects that impact project performance concerning construction in India. A total of 55 attributes affecting the performance of construction projects are analysed in terms of their level of influence on four key performance criteria – schedule, cost, quality, and no disputes – using a two-stage questionnaire survey. These attributes are then further analysed, interpreted and evaluated.   Based on the critical success factors obtained from the study, a neural network model-based predictive model for project performance has been developed. The performance prediction models have been derived for all four project performance criteria. Further, a hypothesis that ‘project success’ is influenced by ‘success traits’ has also been formulated. The hypothesized positive inter-relationships betwe...

  16. Requirements for success in clinical islet transplantation.

    Science.gov (United States)

    Ricordi, Camillo; Inverardi, Luca; Kenyon, Norma S; Goss, John; Bertuzzi, Federico; Alejandro, Rodolfo

    2005-05-27

    A few groups have endured the challenges of time, anecdotal success stories, logistic and funding impediments, to bring the field of clinical islet transplantation where it stands today. The recent improvement in clinical results has paralleled a renewed interest in islet transplantation and an increasing number of centers have entered the field. Selected institutions have now clearly demonstrated that insulin independence can be a reproducible and achievable goal. Other centers struggle with mixed results, while occasional early failures of islet transplants are still observed. This center effect underlines not just a learning curve, but also the complexity of the approach, which requires multidisciplinary expertise and attention to critical variables that need to be closely monitored to assure adequate clinical outcomes. The future success and large scale applicability of islet transplantation will rely on the synergistic research progress in critical areas that contribute to the sequential and integrated approach required for success in clinical islet transplantation.

  17. Critical success factors in infrastructure projects

    Science.gov (United States)

    Zakaria, Siti Fairus; Zin, Rosli Mohamad; Mohamad, Ismail; Balubaid, Saeed; Mydin, Shaik Hussein; Mohd Rahim, E. M. Roodienyanto

    2017-11-01

    Construction of infrastructure project is different from buildings. The main difference is term of project site where infrastructure project need to command a long stretch while building mostly confine to a limited area. As such factors that are critical to infrastructure project may not be that significant to building project and vice versa. Flood mitigation can be classified under infrastructure projects under which their developments are planned by the government with the specific objective to reduce or avoid the negative effects of flood to the environment and livelihood. One of the indicators in project success is delay. The impact of project delay in construction industry is significant that it decelerates the projects implementation, specifically the government projects. This study attempted to identify and compare the success factors between infrastructure and building projects, as such comparison rarely found in the current literature. A model of flood mitigation projects' success factors was developed by merging the experts' views and reports from the existing literature. The experts' views were obtained from the responses to open-ended questions on the required fundamentals to achieve successful completion of flood mitigation projects. An affinity analysis was applied to these responses to develop the model. The developed model was then compared to the established success factors found in building project, extracted from the previous studies to identify the similarities and differences between the two models. This study would assist the government and construction players to become more effective in constructing successful flood mitigation projects for the future practice in a flood-prone country like Malaysia.

  18. Studies of key success factors of product development success: A reinterpretation of results

    DEFF Research Database (Denmark)

    Plichta, Kirsten; Harmsen, Hanne

    In this paper the general validity of the research area of key factors of success in product development is discussed. To be more specific we argue that validity hinges on the causal relation between success and success factrors ­ a relation that unaccounted for in the empirical studies....... The theoretical tradition of the resource-based perspective provides ­ at least to some extent ­ an account of this causality. An important point in the paper is that the key factors of success in the empi studies are not factors causally related to success, but at the most a number of valuable resources and thus......, but in the studies problems concerning implementation are not discussed. When the lists factors of success are interprested as valuable resources and capabilities, we show that some implications on the implementability might be deduced from the resource-based perspective....

  19. Reengineering in Australia: factors affecting success

    Directory of Open Access Journals (Sweden)

    Felicity Murphy

    1998-11-01

    Full Text Available Business process reengineering (BPR is being used in many organisations worldwide to realign operations. Most of the research undertaken has been focused on North American or European practices. The study reported here replicates a US reengineering study in an Australian context by surveying large public and private sector Australian organisations. The study makes three main contributions by: (1 presenting a picture of BPR practices in Australia, (2 clarifying factors critical to the success of reengineering projects in Australia, and (3 providing a comparison of factors leading to success in Australian BPR projects with those found in the US.

  20. Predicting student success in General Chemistry

    Science.gov (United States)

    Figueroa, Daphne Elizabeth

    The goal of this research was to determine the predictors of student success in college level General Chemistry. The potential predictors were categorized as cognitive, non-cognitive, affective, or demographic factors. A broader goal of the study was to provide a reference for academic personnel to better judge the prerequisite skills, knowledge and attitudes that students should attain before enrolling in General Chemistry. Therefore, the study is relevant to chemical educators who are attempting to matriculate candidates for the scientific workforce and to chemical education researches who are interested in student success, student retention and curricular reform. The major hypotheses were that several factors from each category would emerge as significant predictors and that these would differ for students enrolled at three different post-secondary institutions: a community college, a private university and a public university. These hypotheses were tested using multiple regression techniques to analyze grade, student survey and post-test data collected from General Chemistry students at the three institutions. Over-all, twelve factors (six demographic, three cognitive and three affective) emerged as strong, significant predictors of student success. In addition, there were marked differences in which factors emerged based on the type of institution and on how student success was defined. Thus, the major hypotheses of the study were supported. Over-all, this study has significant implications for educational policy, theory, and practice. With regard to policy, there is a need for institutions and departments that offer General Chemistry to provide support for a diverse population of students. And, at the community college level, in particular, there is a need for better academic advising and more institutional support for underprepared students. In the classroom, the professor plays a critical role in influencing students' academic self-concept, which in turn

  1. Successful microsurgical replantation of an amputated penis

    Directory of Open Access Journals (Sweden)

    Sanchit Garg

    2016-01-01

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

  2. Parental Influences on Hmong University Students' Success

    Directory of Open Access Journals (Sweden)

    Yudan Wang

    2010-01-01

    Full Text Available This study reports findings from a series of focus groups conducted on Hmong American university students. The purpose of the focus groups was to understand how, from the perspective of Hmong American students themselves, acculturative stress and parents influencedacademic success. Findings of a thematic analysis centered on general themes across focus group respondents that related to parental socialization, gendered socialization, and ethnic identification. Each identified themes is discussed in reference to gendered patterns of experiences in Hmong American families and in reference to academic success.

  3. Successful Management of Neobladder Variceal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-10-15

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

  4. Geometry success in 20 minutes a day

    CERN Document Server

    LLC, LearningExpress

    2014-01-01

    Whether you're new to geometry or just looking for a refresher, Geometry Success in 20 Minutes a Day offers a 20-step lesson plan that provides quick and thorough instruction in practical, critical skills. Stripped of unnecessary math jargon but bursting with geometry essentials, Geometry Success in 20 Minutes a Day: Covers all vital geometry skills, from the basic building blocks of geometry to ratio, proportion, and similarity to trigonometry and beyond Provides hundreds of practice exercises in test format Applies geometr

  5. European Success Stories in Industrial Mathematics

    CERN Document Server

    Esteban, Maria J; Lery, Thibaut; Maday, Yvon

    2011-01-01

    This unique book presents real world success stories of collaboration between mathematicians and industrial partners, showcasing first-hand case studies, and lessons learned from the experiences, technologies, and business challenges that led to the successful development of industrial solutions based on mathematics. It shows the crucial contribution of mathematics to innovation and to the industrial creation of value, and the key position of mathematics in the handling of complex systems, amplifying innovation. Each story describes the challenge that led to the industrial cooperation, how the

  6. Successful defibrillation in the prone position.

    Science.gov (United States)

    Miranda, C C; Newton, M C

    2001-12-01

    Early defibrillation provides the greatest chance of survival after ventricular fibrillation. Conventional cardiopulmonary resuscitation and defibrillation requires the patient to be in the supine position. Electrical treatment of arrhythmias such as atrial fibrillation by means of a defibrillator back paddle in patients receiving prone ventilation in intensive care has been described. We report a case in which electrical defibrillation was successfully performed in the prone position in a patient undergoing complex spinal surgery. We suggest that, if defibrillation were required in ventilated patients positioned prone, defibrillation should be attempted in the prone position, as turning the patient supine would consume valuable minutes and reduce the chances of successful defibrillation.

  7. 5 keys to business analytics program success

    CERN Document Server

    Boyer, John; Green, Brian; Harris, Tracy; Van De Vanter, Kay

    2012-01-01

    With business analytics is becoming increasingly strategic to all types of organizations and with many companies struggling to create a meaningful impact with this emerging technology, this work-based on the combined experience of 10 organizations that display excellence and expertise on the subject-shares the best practices, discusses the management aspects and sociology that drives success, and uncovers the five key aspects behind the success of some of the top business analytics programs in the industry. Readers will learn about numerous topics, including how to create and manage a changing

  8. Associative Cognitive CREED for Successful Grammar Learning

    Directory of Open Access Journals (Sweden)

    Andrias Tri Susanto

    2016-06-01

    Full Text Available This research article reports a qualitative study which was conducted to investigate ways successful EFL learners learned English grammar. The subjects of this research were eight successful EFL learners from six different countries in Asia: China, Indonesia, Japan, South Korea, Thailand, and Vietnam. The data was collected by interviewing each subject in person individually at an agreed time and place. The result showed that all the grammar learning processes described by the subjects were closely linked to the framework of Associative Cognitive CREED. There were also some contributing factors that could be integrally combined salient to the overall grammar learning process. However, interestingly, each subject emphasized different aspects of learning.

  9. Medical group mergers: strategies for success.

    Science.gov (United States)

    Latham, Will

    2014-01-01

    As consolidation sweeps over the healthcare industry, many medical groups are considering mergers with other groups as an alternative to employment. While mergers are challenging and fraught with risk, an organized approach to the merger process can dramatically increase the odds for success. Merging groups need to consider the benefits they seek from a merger, identify the obstacles that must be overcome to merge, and develop alternatives to overcome those obstacles. This article addresses the benefits to be gained and issues to be addressed, and provides a tested roadmap that has resulted in many successful medical group mergers.

  10. Top 10 Steps to Business Success

    Science.gov (United States)

    Arnold, Gianna

    2013-03-01

    What does it really take to build a successful technology based company? This fast paced and interactive discussion will highlite potential missteps as well as actions that increase the likelihood of success. Topics under consideration will include: how to begin, creating an organizational structure, creating a plan, selecting a name, financing, allocating resources as efficiently as possible, building a team, protecting intangible assets, strategic alliances, obtaining revenue and transitioning from startup to growth. The primary goal of this presentation is to help you identify value-creating practices as well as wasteful practices, while providing the general nuts and bolts required to move forward.

  11. Childhood acute basilar artery thrombosis successfully treated with mechanical thrombectomy using stent retrievers: case report and review of the literature.

    Science.gov (United States)

    Nicosia, Giancarlo; Cicala, Domenico; Mirone, Giuseppe; Spennato, Pietro; Trischitta, Vincenzo; Ruggiero, Claudio; Guarneri, Gianluigi; Muto, Mario; Cinalli, Giuseppe

    2017-02-01

    Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal cause of strokes in both adults and children, and it is usually due to vertebral artery dissection (VAD). VAD has been found to be usually a consequence of traumatic vertebral artery injury. ABAO usually presents with symptoms of acute ischemic stroke (AIS) of the posterior circulation or transient ischemic attack (TIA). It may lead to death or long-term disability if not promptly recanalized. Basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents. We report the case of a 23-month old baby that came to the emergency room of our hospital for progressive impairment of consciousness associated with widespread stiffness and plaintive cry, appeared after accidental fall from stroller. An emergency brain CT scan was obtained showing multiple infarction lesions in the brainstem and left cerebellum suggestive of acute stroke in posterior circulation territories. An MR scan with angiography and diffusion-weighted sequences confirmed the multiple infarction lesions and demonstrated poor representation of the flow signal at the V3 segment of the left vertebral artery and absent representation of the flow signal at the distal segment of the basilar artery suggestive of acute thrombotic occlusion. The patient was immediately referred to interventional neuroradiology unit, and digital subtraction angiography showed complete basilar artery occlusion and left vertebral artery dissection at extracranial V2-V3 segment. The patient underwent intra-arterial thrombectomy using stent retrievers and occlusion of the V2-V3 segment of the left vertebral artery. The patient survived and long-term outcome was excellent. To our knowledge, only nine cases of ABAO in children treated with intra-arterial thrombectomy have been previously reported in the literature. In only three

  12. A Model of Successful School Leadership from the International Successful School Principalship Project

    OpenAIRE

    David Gurr

    2015-01-01

    The International Successful School Principalship Project (ISSPP) has been actively conducting research about the work of successful principals since 2001. Findings from four project books and eight models derived from this project are synthesised into a model of successful school leadership. Building on Gurr, Drysdale and Mulford’s earlier model, the work of school leaders is described as engaging within the school context to influence student and school outcomes through interventions in tea...

  13. How Enterprise Architecture Formative Critical Success Facets Might Affect Enterprise Architecture Success: A Literature Analysis

    OpenAIRE

    Wan, Haining; Luo, Aimin; Luo, Xueshan

    2014-01-01

    Part 4: Enterprise Architecture; International audience; Though Enterprise Architecture (EA) is getting increasing attentions from both academics and practitioners, EA research around EA success factors remains modest and immature. This study explores how EA formative critical success facets/factors would affect the achievement of EA success. This research highlights the importance of four mediators, i.e., (I) Real and mature business needs; (II) Real and continuous commitment; (III) Actionab...

  14. Successful Admission Criteria to Predict Academic and Clinical Success in Entry-Level Radiography Programs.

    Science.gov (United States)

    Ingrassia, Jennett M

    2016-05-01

    To examine successful admission criteria in health education programs. Health sciences databases were searched for admission criteria in medical and allied health education. Special emphasis was placed on radiologic technology investigations. Many medical and health sciences programs use cognitive and noncognitive factors to predict student success. However, research has not identified common admission criteria that can be used to predict academic and clinical success of candidates in radiologic technology education programs. Further research is needed to investigate the use of cognitive and noncognitive factors as admission criteria for radiologic technology programs and to determine whether these factors can be used to predict student success.

  15. Successful images of successful ageing? Representations of vigorous elderly people in a Swedish educational television programme

    National Research Council Canada - National Science Library

    Wallander, Kristina

    2013-01-01

    ..., conceptualized as successful ageing. The present article demonstrates how representations of vigorous elderly people are construed in the programme VeteranTV, produced by UR, Swedish educational television...

  16. Embracing Online Education: Exploring Options for Success

    Science.gov (United States)

    Robinson, Leroy

    2017-01-01

    As the marketplace for higher education changes, attracting and retaining students is of utmost importance. Providing successful course delivery methods (e.g. face-to-face, fully online, hybrid) offers an opportunity for universities to differentiate from each other. This research investigates the relationships involved in student acceptance of…

  17. The Value of Successful MBSE Adoption

    Science.gov (United States)

    Parrott, Edith

    2016-01-01

    The value of successful adoption of Model Based System Engineering (MBSE) practices is hard to quantify. Most engineers and project managers look at the success in terms of cost. But there are other ways to quantify the value of MBSE and the steps necessary to achieve adoption. The Glenn Research Center (GRC) has been doing Model-Based Engineering (design, structural, etc.) for years, but the system engineering side has not. Since 2010, GRC has been moving from documents centric to MBSE/SysML. Project adoption of MBSE has been slow, but is steadily increasing in both MBSE usage and complexity of generated products. Sharing of knowledge of lessons learned in the implementation of MBSE/SysML is key for others who want to be successful. Along with GRC's implementation, NASA is working hard to increase the successful implementation of MBSE across all the other centers by developing guidelines, templates and libraries for projects to utilize. This presentation will provide insight into recent GRC and NASA adoption efforts, lessons learned and best practices.

  18. Characteristics of potential successful emerging commercial cotton ...

    African Journals Online (AJOL)

    Characteristics of potential successful emerging commercial cotton farmers. ... This paper describes a typology of sample households in terms of their farming ... The realistic description of the various socio-economic groupings can facilitate the design of the support system based on the needs and aspiration of such groups.

  19. Seeding big sagebrush successfully on Intermountain rangelands

    Science.gov (United States)

    Susan E. Meyer; Thomas W. Warren

    2015-01-01

    Big sagebrush can be seeded successfully on climatically suitable sites in the Great Basin using the proper seeding guidelines. These guidelines include using sufficient quantities of high-quality seed of the correct subspecies and ecotype, seeding in late fall to mid-winter, making sure that the seed is not planted too deeply, and seeding into an environment...

  20. Study of Successful Latina/o Students

    Science.gov (United States)

    Zalaquett, Carlos P.

    2006-01-01

    This study analyzed the stories of successful Latina/o students. The qualitative analysis confirmed the presence of three barriers affecting their access to higher education and eight supporting factors: family, education, responsibility toward others, sense of accomplishment, friendship, scholarships, community support, and school personnel.…