WorldWideScience

Sample records for surgery centers ascs

  1. Ambulatory Surgical Center (ASC) Payment System

    Data.gov (United States)

    U.S. Department of Health & Human Services — This file contains a summary of service utilization by ASC supplier and is derived from 2011 ASC line item level data, updated through June 2012, that is, line items...

  2. Factors Affecting Innovation Within Aeronautical Systems Center (ASC) Organizations - An inductive Study

    National Research Council Canada - National Science Library

    Feil, Eric

    2003-01-01

    .... This thesis analyzed data collected during the 2002 Chief of Staff of the Air Force Organizational Climate Survey to identify factors that affect innovation within Aeronautical Systems Center (ASC) organizations...

  3. Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital?

    Science.gov (United States)

    Plotzke, Michael Robert; Courtemanche, Charles

    2011-07-01

    Ambulatory surgery centers (ASCs) are small (typically physician owned) healthcare facilities that specialize in performing outpatient surgeries and therefore compete against hospitals for patients. Physicians who own ASCs could treat their most profitable patients at their ASCs and less profitable patients at hospitals. This paper asks if the profitability of an outpatient surgery impacts where a physician performs the surgery. Using a sample of Medicare patients from the National Survey of Ambulatory Surgery, we find that higher profit surgeries do have a higher probability of being performed at an ASC compared to a hospital. After controlling for surgery type, a 10% increase in a surgery's profitability is associated with a 1.2 to 1.4 percentage point increase in the probability the surgery is performed at an ASC. Copyright © 2010 John Wiley & Sons, Ltd.

  4. ASC Distribution Management Center (DMC) Provides Materiel Management Capability

    National Research Council Canada - National Science Library

    Stewart, Tyler J

    2008-01-01

    ... logistics to sustain a transforming Army at war. The ASM Distribution Management Center (DMC) is the single interface for the synchronization and integration of logistical functions among active Army units in CONUS, Army Commands...

  5. Ambulatory surgery center market share and rates of outpatient surgery in the elderly.

    Science.gov (United States)

    Hollenbeck, Brent K; Hollingsworth, John M; Dunn, Rodney L; Zaojun Ye; Birkmeyer, John D

    2010-12-01

    Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P market share. The greatest difference, both in relative and absolute terms, was observed for patients undergoing cystoscopy. In areas of high ASC market share, the age-adjusted rate of cystoscopy was nearly 3-fold higher than in areas with low ASC market share (34.5 vs 11.9 per 1000 population; P elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

  6. Ambulatory Surgery Centers and Prices in Hospital Outpatient Departments.

    Science.gov (United States)

    Carey, Kathleen

    2017-04-01

    Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). I studied the impact of ASC market presence on actual prices paid to HOPDs during 2007-2010 for four common surgical procedures that were performed in both provider types. For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25% to 5.15% lower for each additional ASC per 100,000 persons in a market. HOPDs may have less negotiating leverage with commercial insurers on price in markets with high ASC market penetration, resulting in relatively lower prices.

  7. Ambulatory surgery center and general hospital competition: entry decisions and strategic choices.

    Science.gov (United States)

    Al-Amin, Mona; Housman, Michael

    2012-01-01

    General hospitals are consistently under pressure to control cost and improve quality. In addition to mounting payers' demands, hospitals operate under evolving market conditions that might threaten their survival. While hospitals traditionally were concerned mainly with competition from other hospitals, today's reimbursement schemes and entrepreneurial activities encouraged the proliferation of outpatient facilities such as ambulatory surgery centers (ASCs) that can jeopardize hospitals' survival. The purpose of this article was to examine the relationship between ASCs and general hospitals. More specifically, we apply the niche overlap theory to study the impact that competition between ASCs and general hospitals has on the survival chances of both of these organizational populations. Our analysis examined interpopulation competition in models of organizational mortality and market demand. We utilized Cox proportional hazard models to evaluate the impact of competition from each on ASC and hospital exit while controlling for market factors. We relied on two data sets collected and developed by Florida's Agency for Health Care Administration: outpatient facility licensure data and inpatient and outpatient surgical procedure data. Although ASCs do tend to exit markets in which there are high levels of ASC competition, we found no evidence to suggest that ASC exit rates are affected by hospital density. On the other hand, hospitals not only tend to exit markets with high levels of hospital competition but also experience high exit rates in markets with high ASC density. The implications from our study differ for ASCs and hospitals. When making decisions about market entry, ASCs should choose their markets according to the following: demand for outpatient surgery, number of physicians who would practice in the surgery center, and the number of surgery centers that already exist in the market. Hospitals, on the other hand, should account for competition from ASCs

  8. Cervical spine surgery performed in ambulatory surgical centers: Are patients being put at increased risk?

    Science.gov (United States)

    Epstein, Nancy E

    2016-01-01

    Spine surgeons are being increasingly encouraged to perform cervical operations in outpatient ambulatory surgical centers (ASC). However, some studies/data coming out of these centers are provided by spine surgeons who are part or full owners/shareholders. In Florida, for example, there was a 50% increase in ASC (5349) established between 2000-2007; physicians had a stake (invested) in 83%, and outright owned 43% of ASC. Data regarding "excessive" surgery by ASC surgeon-owners from Idaho followed shortly thereafter. The risks/complications attributed to 3279 cervical spine operations performed in 6 ASC studies were reviewed. Several studies claimed 99% discharge rates the day of the surgery. They also claimed major complications were "picked up" within the average postoperative observation window (e.g., varying from 4-23 hours), allowing for appropriate treatment without further sequelae. Morbidity rates for outpatient cervical spine ASC studies (e.g. some with conflicts of interest) varied up to 0.8-6%, whereas morbidity rates for 3 inpatient cervical studies ranged up to 19.3%. For both groups, morbidity included postoperative dysphagia, epidural hematomas, neck swelling, vocal cord paralysis, and neurological deterioration. Although we have no clear documentation as to their safety, "excessive" and progressively complex cervical surgical procedures are increasingly being performed in ASC. Furthermore, we cannot rely upon ASC-based data. At least some demonstrate an inherent conflict of interest and do not veridically report major morbidity/mortality rates for outpatient procedures. For now, cervical spine surgery performed in ASC would appear to be putting patients at increased risk for the benefit of their surgeon-owners.

  9. Identifying Natural Alignments Between Ambulatory Surgery Centers and Local Health Systems: Building Broader Communities of Surgical Care.

    Science.gov (United States)

    Funk, Russell J; Owen-Smith, Jason; Landon, Bruce E; Birkmeyer, John D; Hollingsworth, John M

    2017-02-01

    To develop and compare methods for identifying natural alignments between ambulatory surgery centers (ASCs) and hospitals that anchor local health systems. Using all-payer data from Florida's State Ambulatory Surgery and Inpatient Databases (2005-2009), we developed 3 methods for identifying alignments between ASCS and hospitals. The first, a geographic proximity approach, used spatial data to assign an ASC to its nearest hospital neighbor. The second, a predominant affiliation approach, assigned an ASC to the hospital with which it shared a plurality of surgeons. The third, a network community approach, linked an ASC with a larger group of hospitals held together by naturally occurring physician networks. We compared each method in terms of its ability to capture meaningful and stable affiliations and its administrative simplicity. Although the proximity approach was simplest to implement and produced the most durable alignments, ASC surgeon's loyalty to the assigned hospital was low with this method. The predominant affiliation and network community approaches performed better and nearly equivalently on these metrics, capturing more meaningful affiliations between ASCs and hospitals. However, the latter's alignments were least durable, and it was complex to administer. We describe 3 methods for identifying natural alignments between ASCs and hospitals, each with strengths and weaknesses. These methods will help health system managers identify ASCs with which to partner. Moreover, health services researchers and policy analysts can use them to study broader communities of surgical care.

  10. ASC-1

    DEFF Research Database (Denmark)

    Jakimoski, Goce; Khajuria, Samant

    2011-01-01

    uses leak extraction from diÆerent AES rounds to compute the key material that is XOR-ed with the message to compute the ciphertext. Unlike LEX, the ASC-1 operates in a CFB fashion to compute an authentication tag over the encrypted message. We argue that ASC-1 is secure by reducingits (IND-CCA , INT......The goal of the modes of operation for authenticated encryption is to achieve faster encryption and message authentication by performing both the encryption and the message authentication in a single pass as opposed to the traditional encrypt-then-mac approach, which requires two passes....... Unfortunately, the use of a block cipher as a building block limits the performance of the authenticated encryption schemes to at most one message block per block cipher evaluation. In this paper, we propose the authenticated encryption scheme ASC-1 (Authenticating Stream Cipher One). Similarly to LEX, ASC-1...

  11. Leading Causes of Anesthesia-Related Liability Claims in Ambulatory Surgery Centers.

    Science.gov (United States)

    Ranum, Darrell; Beverly, Anair; Shapiro, Fred E; Urman, Richard D

    2017-11-16

    We present a contemporary analysis of patient injury, allegations, and contributing factors of anesthesia-related closed claims, which involved cases that specifically occurred in free-standing ambulatory surgery centers (ASCs). We examined ASC-closed claims data between 2007 and 2014 from The Doctors Company, a medical malpractice insurer. Findings were coded using the Comprehensive Risk Intelligence Tool developed by CRICO Strategies. We compared coded data from ASC claims with hospital operating room (HOR) claims, in terms of injury severity category, nature of injury, nature of allegation, contributing factors identified, and contributing comorbidities and claim value. Ambulatory surgery center claims were more likely to be classified as medium severity than HOR claims, more likely to involve dental damage or pain than HOR claims, but less likely to involve death or respiratory or cardiac arrest. Technical performance was the most common contributing factor: 47% of ASCs and 48% of HORs. Only 7% of allegations relating to technical performance were judged to be a direct result of poor technical performance. The most common anesthesia procedures resulting in ASC claims were injection of anesthesia into a peripheral nerve (34%) and intubation (29%). Obesity was the most common contributing comorbidity in both settings. Mean closed claim value was significantly lower for ASC than HOR claims, averaging US $87,888 versus $107,325. Analysis of ASC and HOR claims demonstrates significant differences and several common sources of liability. These include improving strategies for thorough screening, preoperative assessment and risk stratifying of patients, incorporating routine dental and airway assessment and documentation, diagnosing and treating perioperative pain adequately, and improving the efficacy of communication between patients and care providers.

  12. Advanced Stirling Convertor (ASC) Technology Maturation

    Science.gov (United States)

    Wong, Wayne A.; Wilson, Scott; Collins, Josh; Wilson, Kyle

    2016-01-01

    The Advanced Stirling Convertor (ASC) development effort was initiated by NASA Glenn Research Center with contractor Sunpower, Inc., to develop high-efficiency thermal-to-electric power conversion technology for NASA Radioisotope Power Systems (RPSs). Early successful performance demonstrations led to the expansion of the project as well as adoption of the technology by the Department of Energy (DOE) and system integration contractor Lockheed Martin Space Systems Company as part of the Advanced Stirling Radioisotope Generator (ASRG) flight project. The ASRG integrates a pair of ASCs to convert the heat from a pair of General Purpose Heat Source (GPHS) modules into electrical power. The expanded NASA ASC effort included development of several generations of ASC prototypes or engineering units to help prepare the ASC technology and Sunpower for flight implementation. Sunpower later had two parallel contracts allowing the last of the NASA engineering units called ASC-E3 to serve as pathfinders for the ASC-F flight convertors being built for DOE. The ASC-E3 convertors utilized the ASC-F flight specifications and were built using the ASC-F design and process documentation. Shortly after the first ASC-F pair achieved initial operation, due to budget constraints, the DOE ASRG flight development contract was terminated. NASA continues to invest in the development of Stirling RPS technology including continued production of the ASC-E3 convertors, seven of which have been delivered with one additional unit in production. Starting in fiscal year 2015, Stirling Convertor Technology Maturation has been reorganized as an element of the RPS Stirling Cycle Technology Development (SCTD) Project and long-term plans for continued Stirling technology advancement are in reformulation. This paper provides a status on the ASC project, an overview of advancements made in the design and production of the ASC at Sunpower, and a summary of acceptance tests, reliability tests, and tactical

  13. Implementation of an Anesthesia Information Management System in an Ambulatory Surgery Center.

    Science.gov (United States)

    Mudumbai, Seshadri C

    2016-01-01

    Anesthesia information management systems (AIMS) are increasingly being implemented throughout the United States. However, little information exists on the implementation process for AIMS within ambulatory surgery centers (ASC). The objectives of this descriptive study are to document: 1) the phases of implementation of an AIMS at an ASC; and 2) lessons learnt from a socio-technical perspective. The ASC, within the Veterans Health Administration (VHA), has hosted an AIMS since 2008. As a quality improvement effort, we implemented a new version of the AIMS. This new version involved fundamental software changes to enhance clinical care such as real-time importing of laboratory data and total hardware exchange. The pre-implementation phase involved coordinated preparation over six months between multiple informatics teams along with local leadership. During this time, we conducted component, integration, and validation testing to ensure correct data flow from medical devices to AIMS and centralized databases. The implementation phase occurred in September 2014 over three days and was successful. Over the next several months, during post-implementation phase, we addressed residual items like latency of the application. Important lessons learnt from the implementation included the utility of partnering early with executive leadership; ensuring end user acceptance of new clinical workflow; continuous testing of data flow; use of a staged rollout; and providing additional personnel throughout implementation. Implementation of an AIMS at an ASC can utilize methods developed for large hospitals. However, issues unique to an ASC such as limited number of support personnel and distinctive workflows must be considered.

  14. Ambulatory surgery centers and interventional techniques: a look at long-term survival.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Parr, Allan T; Singh, Vijay; Fellows, Bert

    2011-01-01

    With health care expenditures skyrocketing, coupled with pervasive quality deficits, pressures to provide better and more proficient care continue to shape the landscape of the U.S. health care system. Payers, both federal and private, have laid out several initiatives designed to curtail costs, including value-based reimbursement programs, cost-shifting expenses to the consumer, reducing reimbursements for physicians, steering health care to more efficient settings, and finally affordable health care reform. Consequently, one of the major aspects in the expansion of health care for improving quality and reducing the costs is surgical services. Nearly 57 million outpatient procedures are performed annually in the United States, 14 million of which occur in elderly patients. Increasing use of these minor, yet common, procedures contributes to rising health care expenditures. Once exclusive within hospitals, more and more outpatient procedures are being performed in freestanding ambulatory surgery centers (ASCs), physician offices, visits to which have increased over 300% during the past decade. Concurrent with this growing demand, the number of ASCs has more than doubled since the 1990s, with more than 5,000 facilities currently in operation nationwide. Further, total surgical center ASC payments have increased from $1.2 billion in 1999 to $3.2 billion in 2009, a 167% increase. On the same lines, growth and expenditures for hospital outpatient department (HOPD) services and office procedures also have been evident at similar levels. Recent surveys have illustrated on overall annual growth per capita in Medicare allowed ASC services of pain management of 23%, with 27% growth seen in ASCs and 16% of the growth seen in HOPD. Further, the proportion of interventional pain management which was 4% of Medicare ASC spending in 2000 has increase to 10% in 2007. Thus, interventional pain management as an evolving specialty is one of the most commonly performed procedures in

  15. Performance Measurement of Advanced Stirling Convertors (ASC-E3)

    Science.gov (United States)

    Oriti, Salvatore M.

    2013-01-01

    NASA Glenn Research Center (GRC) has been supporting development of the Advanced Stirling Radioisotope Generator (ASRG) since 2006. A key element of the ASRG project is providing life, reliability, and performance testing data of the Advanced Stirling Convertor (ASC). The latest version of the ASC (ASC-E3, to represent the third cycle of engineering model test hardware) is of a design identical to the forthcoming flight convertors. For this generation of hardware, a joint Sunpower and GRC effort was initiated to improve and standardize the test support hardware. After this effort was completed, the first pair of ASC-E3 units was produced by Sunpower and then delivered to GRC in December 2012. GRC has begun operation of these units. This process included performance verification, which examined the data from various tests to validate the convertor performance to the product specification. Other tests included detailed performance mapping that encompassed the wide range of operating conditions that will exist during a mission. These convertors were then transferred to Lockheed Martin for controller checkout testing. The results of this latest convertor performance verification activity are summarized here.

  16. Pathfinding the Flight Advanced Stirling Convertor Design with the ASC-E3

    Science.gov (United States)

    Wong, Wayne A.; Wilson, Kyle; Smith, Eddie; Collins, Josh

    2012-01-01

    The Advanced Stirling Convertor (ASC) was initially developed by Sunpower, Inc. under contract to NASA Glenn Research Center (GRC) as a technology development project. The ASC technology fulfills NASA's need for high efficiency power convertors for future Radioisotope Power Systems (RPS). Early successful technology demonstrations between 2003 to 2005 eventually led to the expansion of the project including the decision in 2006 to use the ASC technology on the Advanced Stirling Radioisotope Generator (ASRG). Sunpower has delivered 22 ASC convertors of progressively mature designs to date to GRC. Currently, Sunpower with support from GRC, Lockheed Martin Space System Company (LMSSC), and the Department of Energy (DOE) is developing the flight ASC-F in parallel with the ASC-E3 pathfinders. Sunpower will deliver four pairs of ASC-E3 convertors to GRC which will be used for extended operation reliability assessment, independent validation and verification testing, system interaction tests, and to support LMSSC controller verification. The ASC-E3 and -F convertors are being built to the same design and processing documentation and the same product specification. The initial two pairs of ASC-E3 are built before the flight units and will validate design and processing changes prior to implementation on the ASC-F flight convertors. This paper provides a summary on development of the ASC technology and the status of the ASC-E3 build and how they serve the vital pathfinder role ahead of the flight build for ASRG. The ASRG is part of two of the three candidate missions being considered for selection for the Discovery 12 mission.

  17. A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers.

    Science.gov (United States)

    Bish, Ebru K; El-Amine, Hadi; Steighner, Laura A; Slonim, Anthony D

    2014-10-01

    To understand how structural and process elements may affect the risk for surgical site infections (SSIs) in the ambulatory surgery center (ASC) environment, the researchers employed a tool known as socio-technical probabilistic risk assessment (ST-PRA). ST-PRA is particularly helpful for estimating risks in outcomes that are very rare, such as the risk of SSI in ASCs. Study objectives were to (1) identify the risk factors associated with SSIs resulting from procedures performed at ASCs and (2) design an intervention to mitigate the likelihood of SSIs for the most common risk factors that were identified by the ST-PRA for a particular surgical procedure. ST-PRA was used to study the SSI risk in the ASC setting. Both quantitative and qualitative data sources were utilized, and sensitivity analysis was performed to ensure the robustness of the results. The event entitled "fail to protect the patient effectively" accounted for 51.9% of SSIs in the ambulatory care setting. Critical components of this event included several failure risk points related to skin preparation, antibiotic administration, staff training, proper response to glove punctures during surgery, and adherence to surgical preparation rules related to the wearing of jewelry, watches, and artificial nails. Assuming a 75% reduction in noncompliance on any combination of 2 of these 5 components, the risk for an SSI decreased from 0.0044 to between 0.0027 and 0.0035. An intervention that targeted the 5 major components of the major risk point was proposed, and its implications were discussed.

  18. Advanced Stirling Convertor (ASC-E2) Characterization Testing

    Science.gov (United States)

    Williams, Zachary D.; Oriti, Salvatore M.

    2012-01-01

    Testing has been conducted on Advanced Stirling Convertors (ASCs)-E2 at NASA Glenn Research Center in support of the Advanced Stirling Radioisotope Generator (ASRG) project. This testing has been conducted to understand sensitivities of convertor parameters due to environmental and operational changes during operation of the ASRG in missions to space. This paper summarizes test results and explains the operation of the ASRG during space missions

  19. Advanced Stirling Convertor (ASC) Development for NASA RPS

    Science.gov (United States)

    Wong, Wayne A.; Wilson, Scott; Collins, Josh

    2014-01-01

    Sunpower's Advanced Stirling Convertor (ASC) initiated development under contract to the NASA Glenn Research Center (GRC) and after a series of successful demonstrations, the ASC began transitioning from a technology development project to flight development project. The ASC has very high power conversion efficiency making it attractive for future Radioisotope Power Systems (RPS) in order to make best use of the low plutonium-238 fuel inventory in the U.S. In recent years, the ASC became part of the NASA-Department of Energy Advanced Stirling Radioisotope Generator (ASRG) Integrated Project. Sunpower held two parallel contracts to produce ASC convertors, one with the Department of Energy/Lockheed Martin to produce the ASC-F flight convertors, and one with NASA GRC for the production of ASC-E3 engineering units, the initial units of which served as production pathfinders. The integrated ASC technical team successfully overcame various technical challenges that led to the completion and delivery of the first two pairs of flight-like ASC-E3 by 2013. However, in late Fall 2013, the DOE initiated termination of the Lockheed Martin ASRG flight development contract driven primarily by budget constraints. NASA continues to recognize the importance of high efficiency ASC power conversion for RPS and continues investment in the technology including the continuation of ASC-E3 production at Sunpower and the assembly of the ASRG Engineering Unit #2. This paper provides a summary of ASC technical accomplishments, overview of tests at GRC, plans for continued ASC production at Sunpower, and status of Stirling technology development.

  20. Advanced Stirling Convertor (ASC) Technology Maturation in Preparation for Flight

    Science.gov (United States)

    Wong, Wayne A.; Cornell, Peggy A.

    2012-01-01

    The Advanced Stirling Convertor (ASC) is being developed by an integrated team of Sunpower and National Aeronautics and Space Administration s (NASA s) Glenn Research Center (GRC). The ASC development, funded by NASA s Science Mission Directorate, started as a technology development effort in 2003 and has since evolved through progressive convertor builds and successful testing to demonstrate high conversion efficiency, low mass, and capability to meet long-life Radioisotope Power System (RPS) requirements. The technology has been adopted by the Department of Energy and Lockheed Martin Space Systems Company s Advanced Stirling Radioisotope Generator (ASRG), which has been selected for potential flight demonstration on Discovery 12. This paper provides an overview of the status of ASC development including the most recent ASC-E2 convertors that have been delivered to GRC and an introduction to the ASC-E3 and ASC flight convertors that Sunpower will build next. The paper also describes the technology maturation and support tasks being conducted at GRC to support ASC and ASRG development in the areas of convertor and generator extended operation, high-temperature materials, heater head life assessment, organics, nondestructive inspection, spring fatigue testing, and other reliability verification tasks.

  1. Accuracy of patient's turnover time prediction using RFID technology in an academic ambulatory surgery center.

    Science.gov (United States)

    Marchand-Maillet, Florence; Debes, Claire; Garnier, Fanny; Dufeu, Nicolas; Sciard, Didier; Beaussier, Marc

    2015-02-01

    Patients flow in outpatient surgical unit is a major issue with regards to resource utilization, overall case load and patient satisfaction. An electronic Radio Frequency Identification Device (RFID) was used to document the overall time spent by the patients between their admission and discharge from the unit. The objective of this study was to evaluate how a RFID-based data collection system could provide an accurate prediction of the actual time for the patient to be discharged from the ambulatory surgical unit after surgery. This is an observational prospective evaluation carried out in an academic ambulatory surgery center (ASC). Data on length of stay at each step of the patient care, from admission to discharge, were recorded by a RFID device and analyzed according to the type of surgical procedure, the surgeon and the anesthetic technique. Based on these initial data (n = 1520), patients were scheduled in a sequential manner according to the expected duration of the previous case. The primary endpoint was the difference between actual and predicted time of discharge from the unit. A total of 414 consecutive patients were prospectively evaluated. One hundred seventy four patients (42%) were discharged at the predicted time ± 30 min. Only 24% were discharged behind predicted schedule. Using an automatic record of patient's length of stay would allow an accurate prediction of the discharge time according to the type of surgery, the surgeon and the anesthetic procedure.

  2. Revision of ASCE 4

    International Nuclear Information System (INIS)

    Nelson, T.A.; Murray, R.C.; Short, S.A.

    1995-01-01

    The original version of ASCE Standard 4, ''Seismic Analysis of Safety-Related Nuclear Structures'' was published in September 1986. It is ASCE policy to update its standards on a five year interval and the Working Group on Seismic Analysis of Safety Related Nuclear Structures was reconvened to formulate the revisions. The goal in updating the standard is to make sure that it is still relevant and that it incorporates the state of the practice in seismic engineering or, in some cases, where it has been demonstrated that state-of-the-art improvements need to be made to standard practice; new improvements are included. The contents of the new standard cover the same areas as the original version, with some additions. The contents are as follows: Input - response spectra and time histories; modeling of structures; analysis of structures; soil-structure interaction; input for subsystem analysis; special structures - buried pipes and conduits, earth-retaining walls, above-ground vertical tanks, raceways, and base-isolated structures; and an appendix providing seismic probabilistic risk assessment and margin assessment

  3. Pros and cons of the ambulatory surgery center joint venture.

    Science.gov (United States)

    Giannini, Deborah

    2008-01-01

    If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture.

  4. Structure of AscE and Induced Burial Regions in AscE and AscG upon Formation of the Chaperone Needle-subunit Complex of Type III Secretion System in Aeromonas Hydrophila

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Y.; Yu, H; Leung, K; Sivaraman, J; Mok, Y

    2008-01-01

    In the type III secretion system (T3SS) of Aeromonas hydrophila, the putative needle complex subunit AscF requires both putative chaperones AscE and AscG for formation of a ternary complex to avoid premature assembly. Here we report the crystal structure of AscE at 2.7 A resolution and the mapping of buried regions of AscE, AscG, and AscF in the AscEG and AscEFG complexes using limited protease digestion. The dimeric AscE is comprised of two helix-turn-helix monomers packed in an antiparallel fashion. The N-terminal 13 residues of AscE are buried only upon binding with AscG, but this region is found to be nonessential for the interaction. AscE functions as a monomer and can be coexpressed with AscG or with both AscG and AscF to form soluble complexes. The AscE binding region of AscG in the AscEG complex is identified to be within the N-terminal 61 residues of AscG. The exposed C-terminal substrate-binding region of AscG in the AscEG complex is induced to be buried only upon binding to AscF. However, the N-terminal 52 residues of AscF remain exposed even in the ternary AscEFG complex. On the other hand, the 35-residue C-terminal region of AscF in the complex is resistant to protease digestion in the AscEFG complex. Site-directed mutagenesis showed that two C-terminal hydrophobic residues, Ile83 and Leu84, of AscF are essential for chaperone binding.

  5. Authenticated Secure Container System (ASCS)

    International Nuclear Information System (INIS)

    1991-01-01

    Sandia National Laboratories developed an Authenticated Secure Container System (ASCS) for the International Atomic Energy Agency (IAEA). Agency standard weights and safeguards samples can be stored in the ASCS to provide continuity of knowledge. The ASCS consists of an optically clear cover, a base containing the Authenticated Item Monitoring System (AIMS) transmitter, and the AIMS receiver unit for data collection. The ASCS will provide the Inspector with information concerning the status of the system, during a surveillance period, such as state of health, tampering attempts, and movement of the container system. The secure container is located inside a Glove Box with the receiver located remotely from the Glove Box. AIMS technology uses rf transmission from the secure container to the receiver to provide a record of state of health and tampering. The data is stored in the receiver for analysis by the Inspector during a future inspection visit. 2 refs

  6. Financial impact of hand surgery programs on academic medical centers.

    Science.gov (United States)

    Hasan, Jafar S; Chung, Kevin C; Storey, Amy F; Bolg, Mary L; Taheri, Paul A

    2007-02-01

    This study analyzes the financial performance of hand surgery in the Department of Surgery at the University of Michigan. This analysis can serve as a reference for other medical centers in the financial evaluation of a hand surgery program. Fiscal year 2004 billing records for all patients (n = 671) who underwent hand surgery procedures were examined. The financial data were separated into professional revenues and costs (relating to the hand surgery program in the Section of Plastic Surgery) and into facility revenues and costs (relating to the overall University of Michigan Health System). Professional net revenue was calculated by applying historical collection rates to procedural and clinic charges. Facility revenue was calculated by applying historical collection rates to the following charge categories: inpatient/operating room, clinic facility, neurology/electromyography, radiology facilities, and occupational therapy. Total professional costs were calculated by adding direct costs and allocated overhead costs. Facility costs were obtained from the hospital's cost accounting system. Professional and facility incomes were calculated by subtracting costs from revenues. The net professional revenue and total costs were 1,069,836 and 1,027,421 dollars, respectively. Professional operating income was 42,415 dollars, or 3.96 percent of net professional revenue. Net facility revenue and total costs were 5,500,606 and 4,592,534 dollars, respectively. Facility operating income was 908,071 dollars, or 16.51 percent of net facility revenues. While contributing to the academic mission of the institution, hand surgery is financially rewarding for the Department of Surgery. In addition, hand surgery activity contributes substantially to the financial well-being of the academic medical center.

  7. Special article: Creation of a guide for the transfer of care of the malignant hyperthermia patient from ambulatory surgery centers to receiving hospital facilities.

    Science.gov (United States)

    Larach, Marilyn Green; Dirksen, Sharon J Hirshey; Belani, Kumar G; Brandom, Barbara W; Metz, Keith M; Policastro, Michael A; Rosenberg, Henry; Valedon, Arnaldo; Watson, Charles B

    2012-01-01

    Volatile anesthetics and/or succinylcholine may trigger a potentially lethal malignant hyperthermia (MH) event requiring critical care crisis management. If the MH triggering anesthetic is given in an ambulatory surgical center (ASC), then the patient will need to be transferred to a receiving hospital. Before May 2010, there was no clinical guide regarding the development of a specific transfer plan for MH patients in an ASC. MECHANISM BY WHICH THE STATEMENT WAS GENERATED: A consensual process lasting 18 months among 13 representatives of the Malignant Hyperthermia Association of the United States, the Ambulatory Surgery Foundation, the Society for Ambulatory Anesthesia, the Society for Academic Emergency Medicine, and the National Association of Emergency Medical Technicians led to the creation of this guide. EVIDENCE FOR THE STATEMENT: Most of the guide is based on the clinical experience and scientific expertise of the 13 representatives. The list of representatives appears in Appendix 1. The recommendation that IV dantrolene should be initiated pending transfer is also supported by clinical research demonstrating that the likelihood of significant MH complications doubles for every 30-minute delay in dantrolene administration (Anesth Analg 2010;110:498-507). This guide includes a list of potential clinical problems and therapeutic interventions to assist each ASC in the development of its own unique MH transfer plan. Points to consider include receiving health care facility capabilities, indicators of patient stability and necessary report data, transport team considerations and capabilities, implementation of transfer decisions, and coordination of communication among the ASC, the receiving hospital, and the transport team. See Appendix 2 for the guide.

  8. [Technology: training centers--a new method for learning surgery in visceral surgery].

    Science.gov (United States)

    Troidl, H

    1996-01-01

    The importance of training centers can be best described after first answering a few questions like: 1. What kind of surgery will we deal with in the future? 2. What kind of surgeon do we need for this surgery, if it is basically different? 3. How will this surgeon have to be educated/trained for this different surgery? Although I am aware of the fact, that statements about future prospects are usually doomed to fail, I maintain that endoscopic surgery will be an essential part of general surgery. If this is so, surgery will be dominated by extremely complicated technology, new techniques and new instruments. It will be a "different" surgery. It will offer more comfort at the same safety. The surgeon of the future will still need a certain personality; he will still need intuition and creativity. To survive in our society, he will have to be an organiser and even a businessman. Additionally, something new has to be added: he will have to understand modern, complicated technology and will have to use totally different instruments for curing surgical illness. This makes it clear that we will need a different education/training and may be even a different selection of surgeons. We should learn from other professions sharing common interests with surgery, for example, sports where the common interest is achieving most complicated motions and necessarily highly differentiated coordination. Common interest with airline pilots is the target of achieving absolute security. They have a highly differentiated selection and training concept. Training centers may be-under certain prerequisites-a true alternative for this necessary form of training. They must have a concept, i.e. contents and aims have to be defined, structured and oriented on the requirements of surgery for the patient. Responsibility for the concept, performance and control can only be in the hands of Surgical Societies and Universities. These prerequisites correspond most likely to training centers being

  9. SWOT analysis in Sina Trauma and Surgery Research Center.

    Science.gov (United States)

    Salamati, Payman; ashraf Eghbali, Ali; Zarghampour, Manijeh

    2014-01-01

    The present study was conducted with the aim of identifying and evaluating the internal and external factors, affecting the Sina Trauma and Surgery Research Center, affiliated to Tehran University of Medical Sciences and propose some of related strategies to senior managers. We used a combined quantitative and qualitative methodology. Our study population consisted of personnel (18 individuals) at Sina Trauma and Surgery Research Center. Data-collection tools were the group discussions and the questionnaires. Data were analyzed with descriptive statistics and SWOT (Strength, Weakness, Opportunities and Threats) analysis. 18 individuals participated in sessions, consisting of 8 women (44.4%) and 10 men (55.6%). The final scores were 2.45 for internal factors (strength-weakness) and 2.17 for external factors (opportunities-threats). In this study, we proposed 36 strategies (10 weakness-threat strategies, 10 weakness-opportunity strategies, 7 strength-threat strategies, and 9 strength-opportunity strategies). The current status of Sina Trauma and Surgery Research Center is threatened weak. We recommend the center to implement the proposed strategies.

  10. 77 FR 25168 - Appraisal Subcommittee (ASC); ASC Rules of Operation; Amended

    Science.gov (United States)

    2012-04-27

    ... heads of the Bureau of Consumer Financial Protection and the Federal Housing Finance Agency. The ASC Rules of Operation serve as corporate bylaws outlining the ASC's purpose, functions, authority... Title XI. The ASC Rules of Operation serve as corporate bylaws outlining the ASC's purpose, functions...

  11. Test Hardware Design for Flightlike Operation of Advanced Stirling Convertors (ASC-E3)

    Science.gov (United States)

    Oriti, Salvatore M.

    2012-01-01

    NASA Glenn Research Center (GRC) has been supporting development of the Advanced Stirling Radioisotope Generator (ASRG) since 2006. A key element of the ASRG project is providing life, reliability, and performance testing of the Advanced Stirling Convertor (ASC). For this purpose, the Thermal Energy Conversion branch at GRC has been conducting extended operation of a multitude of free-piston Stirling convertors. The goal of this effort is to generate long-term performance data (tens of thousands of hours) simultaneously on multiple units to build a life and reliability database. The test hardware for operation of these convertors was designed to permit in-air investigative testing, such as performance mapping over a range of environmental conditions. With this, there was no requirement to accurately emulate the flight hardware. For the upcoming ASC-E3 units, the decision has been made to assemble the convertors into a flight-like configuration. This means the convertors will be arranged in the dual-opposed configuration in a housing that represents the fit, form, and thermal function of the ASRG. The goal of this effort is to enable system level tests that could not be performed with the traditional test hardware at GRC. This offers the opportunity to perform these system-level tests much earlier in the ASRG flight development, as they would normally not be performed until fabrication of the qualification unit. This paper discusses the requirements, process, and results of this flight-like hardware design activity.

  12. 75 FR 80813 - Appraisal Subcommittee (ASC); ASC Rules of Operation; Amended

    Science.gov (United States)

    2010-12-23

    ... name and must rely on the General Services Administration (GSA) for the procurement of office space by... administration, procurement, and other services, consistent with directives of the ASC. In executing this... Conduct Section 11.01. Ethics Provision. The ASC members of the ASC and its officers and employees shall...

  13. Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study.

    Science.gov (United States)

    Brolin, Tyler J; Mulligan, Ryan P; Azar, Frederick M; Throckmorton, Thomas W

    2017-02-01

    Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Pros and cons of practice-owned and office-based ambulatory surgery centers.

    Science.gov (United States)

    Bert, J M

    2000-01-01

    A detailed feasibility analysis is imperative to ensure the success of a practice-owned ASC. Analysis of the payer mix and the market relating to surgical volume that can be performed at the ASC is imperative. If overbuilding, overequipping, and overstaffing are avoided and the group has adequate volume that can be managed at the ASC, the facility should be a success. Building a practice-owned ASC without an accurate and detailed financial feasibility and payer study can place the endeavor at risk. A well-planned, economically constructed and properly managed ASC will result in an efficient and successful ancillary service for the orthopedic group practice.

  15. 76 FR 71604 - Kamal Tiwari, M.D.; Pain Management and Surgery Center of Southern Indiana; Decision and Order

    Science.gov (United States)

    2011-11-18

    ..., and his principal place of business, the Pain Management and Surgery Center (Respondent PMSC), holder... Certificate of Registration, BP4917413, issued to Respondent Pain Management and Surgery Center of Southern..., M.D. and Pain Management and Surgery Center of Southern Indiana, to renew or modify such...

  16. Conference Support - Surgery in Extreme Environments - Center for Surgical Innovation

    Science.gov (United States)

    2007-01-01

    technology accelerator. Lunar capability concerns include (1) optimization of safety, habitability, and biomechanics ; (2) clinical infrastructure, limited... remove the tissue from the animals, we would then immerse them, fixating the tissues as well. A couple of interesting things though were strange. We had...cellular surgery, new surgical tools, intelligent prosthesis , tissue engineering, and suspended animation. Each of these concepts has a potential for

  17. Pericardial effusion following cardiac surgery. A single-center experience.

    Science.gov (United States)

    Nguyen, Hien Sinh; Nguyen, Hung Doan-Thai; Vu, Thang Duc

    2018-01-01

    Background Pericardial effusion is still a common postoperative complication after open heart surgery with cardiopulmonary bypass. Pericardial effusion significantly prolongs the hospital stay and associated costs as well as affecting overall outcomes after open heart surgery in Hanoi Heart Hospital, a tertiary hospital in Vietnam with an annual volume of 1000 patients. This study aimed to investigate the clinical presentation, incidence, and risk factors of postoperative pericardial effusion, which may ensure better prevention of pericardial effusion and improvement in surgical outcomes after open heart surgery. Methods A cross-sectional study was performed on 1127 patients undergoing open heart surgery from January 2015 to December 2015. Results Thirty-six (3.19%) patients developed pericardial effusion. Of these, 16 (44.4%) had cardiac tamponade. Pericardial effusion occurred after valve procedures in 77.8% of cases. Pericardial effusion was detected after discharge in 47.2% of cases at a mean time of 18.1 ± 13.7 days. Univariate logistic regression analysis showed that age > 25 years, body surface area ≥ 1.28 m 2 , preoperative liver dysfunction, New York Heart Association class III/IV, left ventricular end-diastolic diameter z score ≥ 0.55, and postoperative anticoagulant use were associated with postoperative pericardial effusion. Multivariate logistic regression analysis showed that left ventricular end-diastolic diameter z score ≥ 0.55 was an independent risk factor for postoperative pericardial effusion. Conclusions Routine postoperative echocardiography is necessary to detect postoperative pericardial effusion. Increased left ventricular end-diastolic dimension is an independent predictor of postoperative pericardial effusion.

  18. ASC-PROBA Interface Control Document

    DEFF Research Database (Denmark)

    Betto, Maurizio; Jørgensen, John Leif; Jørgensen, Finn E

    1999-01-01

    of Automation of the Technical University of Denmark. The document is structured as follows. First we present the ASC - heritage, system description, performance - then we address more specifically the environmental properties, like the EMC compatibility and thermal characteristics, and the design...... and reliability issues. Section 6 deals with the testing and the calibration procedures and in section 7 the mechanical and electrical interfaces are given. In section 8 and 9 we address issues like manufacturing, transportation and storage and to conclude we review the ASC specifications against the PROBA...

  19. Influence of podiatry on orthopedic surgery at a level I trauma center.

    Science.gov (United States)

    Jakoi, Andre M; Old, Andrew B; O'Neill, Craig A; Stein, Benjamin E; Stander, Eric P; Rosenblatt, Joseph; Herman, Martin J

    2014-06-01

    Level I trauma centers frequently see trauma at or below the ankle, which requires consultation with the orthopedic surgery department. However, as podiatry programs begin to firmly establish themselves in more Level I trauma centers, their consultations increase, ultimately taking those once seen by orthopedic surgery. A review of the literature demonstrates that this paradigm shift has yet to be discussed. The purpose of this study was to determine how many, if any, lower extremity fracture consultations a newly developed podiatry program would take from the orthopedic surgery department. A retrospective review was performed of emergency department records from January 2007 to December 2011. Seventeen different emergency department diagnoses were used to search the database. Ultimately, each patient's emergency department course was researched. Several trends were noted. First, if trauma surgery was involved, only the orthopedic surgery department was consulted for any injuries at or below the ankle. Second, the emergency department tended to consult the podiatry program only between the hours of 8 am and 6 pm. Third, as the podiatry program became more established, their number of consultations increased yearly, and, coincidentally, the orthopedic surgery department's consultations decreased. Finally, high-energy traumas involved only the orthopedic surgery department. Whether the orthopedic surgery department or podiatry program is consulted regarding trauma surgery is likely hospital dependent. Copyright 2014, SLACK Incorporated.

  20. Follow-Up After Cardiac Surgery Should be Extended to at Least 120 Days When Benchmarking Cardiac Surgery Centers.

    Science.gov (United States)

    Hansen, Laura S; Sloth, Erik; Hjortdal, Vibeke E; Jakobsen, Carl-Johan

    2015-08-01

    Short-term (30 days) mortality frequently is used as an outcome measure after cardiac surgery, although it has been proposed that the follow-up period should be extended to 120 days to allow for more accurate benchmarking. The authors aimed to evaluate whether mortality rates 120 days after surgery were comparable to general mortality and to compare causes of death between the cohort and the general population. A multicenter descriptive cohort study using prospectively entered registry data. University hospital. The cohort was obtained from the Western Denmark Heart Registry and matched to the Danish National Hospital Register as well as the Danish Register of Causes of Death. A weighted, age-matched general population consisting of all Danish patients who died within the study period was identified through the central authority on Danish statistics. A total of 11,988 patients (>15 years) who underwent cardiac-surgery at Aarhus, Aalborg and Odense University Hospitals from April 1, 2006 to December 31, 2012 were included. Coronary artery bypass grafting, valve surgery and combinations. Mortality after cardiac surgery matches with mortality in the general population after 140 days. Mortality curves run almost parallel from this point onwards, regardless of The European system for cardiac operative risk evaluation (EuroSCORE) and intervention. The causes of death in the cohort differed statistically significantly from the background population (pbenchmarking cardiac surgery centers. Regardless of preoperative heart function, heart failure was the consistent leading cause of death. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Implementation of laparoscopic approach in colorectal surgery - a single center's experience.

    Science.gov (United States)

    Kwiatkowski, Andrzej P; Stępińska, Gabriela; Stanowski, Edward; Paśnik, Krzysztof

    2018-03-01

    Implementation of the laparoscopic approach in colorectal surgery has not happened as rapidly as in cholecystectomy, because of concerns about oncological safety. The results of controlled trials in multiple centers showed the method to be safe. Consequently, surgeons decided to try the approach with colorectal surgery. This process, in our clinic, began in earnest about four years ago. To analyze and present the clinical outcomes of applying the laparoscopic approach to colorectal surgery in a single center. We retrospectively identified patients from a hospital database who underwent colorectal surgery - laparoscopic and open - between 2013 and 2016. Our focus was on laparoscopic cases. Study points included operative time, duration of the hospital stay, postoperative mortality and rates of complications, conversion, reoperation and readmission. Of 534 cases considered, the results showed that the relation between open and laparoscopic procedures had reversed, in favor of the latter method (2013: open: 82% vs. laparoscopic: 18%; 2016: open: 22.4% vs. laparoscopic: 77.6%). The most commonly performed procedure was right hemicolectomy. The total complication rate was 22%. The total rate of conversion to open surgery was 9.3%. The postoperative mortality rate was 3%. Use of the laparoscopic approach in colorectal surgery has increased in recent years world-wide - including in Poland - but the technique is still underused. Rapid implementation of the miniinvasive method in colorectal surgery, in centers with previous laparoscopic experience, is not only safe and feasible, but also highly recommended.

  2. The AscSimulationMode command

    DEFF Research Database (Denmark)

    Jørgensen, John Leif

    1998-01-01

    Complex instruments like the ASC may be quite difficult to test in closed loops. This problem is augmented by the fact, that no direct stimulation of the CHU is possible that will render the full performance, noise-spectrum and real-timeliness with high fidelity. In order to circumvent this impasse...

  3. Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe.

    Science.gov (United States)

    Mouthaan, Brian E; Rados, Matea; Barsi, Péter; Boon, Paul; Carmichael, David W; Carrette, Evelien; Craiu, Dana; Cross, J Helen; Diehl, Beate; Dimova, Petia; Fabo, Daniel; Francione, Stefano; Gaskin, Vladislav; Gil-Nagel, Antonio; Grigoreva, Elena; Guekht, Alla; Hirsch, Edouard; Hecimovic, Hrvoje; Helmstaedter, Christoph; Jung, Julien; Kalviainen, Reetta; Kelemen, Anna; Kimiskidis, Vasilios; Kobulashvili, Teia; Krsek, Pavel; Kuchukhidze, Giorgi; Larsson, Pål G; Leitinger, Markus; Lossius, Morten I; Luzin, Roman; Malmgren, Kristina; Mameniskiene, Ruta; Marusic, Petr; Metin, Baris; Özkara, Cigdem; Pecina, Hrvoje; Quesada, Carlos M; Rugg-Gunn, Fergus; Rydenhag, Bertil; Ryvlin, Philippe; Scholly, Julia; Seeck, Margitta; Staack, Anke M; Steinhoff, Bernhard J; Stepanov, Valentin; Tarta-Arsene, Oana; Trinka, Eugen; Uzan, Mustafa; Vogt, Viola L; Vos, Sjoerd B; Vulliémoz, Serge; Huiskamp, Geertjan; Leijten, Frans S S; Van Eijsden, Pieter; Braun, Kees P J

    2016-05-01

    In 2014 the European Union-funded E-PILEPSY project was launched to improve awareness of, and accessibility to, epilepsy surgery across Europe. We aimed to investigate the current use of neuroimaging, electromagnetic source localization, and imaging postprocessing procedures in participating centers. A survey on the clinical use of imaging, electromagnetic source localization, and postprocessing methods in epilepsy surgery candidates was distributed among the 25 centers of the consortium. A descriptive analysis was performed, and results were compared to existing guidelines and recommendations. Response rate was 96%. Standard epilepsy magnetic resonance imaging (MRI) protocols are acquired at 3 Tesla by 15 centers and at 1.5 Tesla by 9 centers. Three centers perform 3T MRI only if indicated. Twenty-six different MRI sequences were reported. Six centers follow all guideline-recommended MRI sequences with the proposed slice orientation and slice thickness or voxel size. Additional sequences are used by 22 centers. MRI postprocessing methods are used in 16 centers. Interictal positron emission tomography (PET) is available in 22 centers; all using 18F-fluorodeoxyglucose (FDG). Seventeen centers perform PET postprocessing. Single-photon emission computed tomography (SPECT) is used by 19 centers, of which 15 perform postprocessing. Four centers perform neither PET nor SPECT in children. Seven centers apply magnetoencephalography (MEG) source localization, and nine apply electroencephalography (EEG) source localization. Fourteen combinations of inverse methods and volume conduction models are used. We report a large variation in the presurgical diagnostic workup among epilepsy surgery centers across Europe. This diversity underscores the need for high-quality systematic reviews, evidence-based recommendations, and harmonization of available diagnostic presurgical methods. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  4. Ambulatory surgery centers best practices for the 90s.

    Science.gov (United States)

    Hoover, J A

    1994-05-01

    Outpatient surgery will be the driving force in the continued growth of ambulatory care in the 1990s. Providing efficient, high-quality ambulatory surgical services should therefore be a priority among healthcare providers. Arthur Andersen conducted a survey to discover best practices in ambulatory surgical service. General success characteristics of best performers were business-focused relationships with physicians, the use of clinical protocols, patient convenience, cost management, strong leadership, teamwork, streamlined processes and efficient design. Other important factors included scheduling to maximize OR room use; achieving surgical efficiencies through reduced case pack assembly errors and equipment availability; a focus on cost capture rather than charge capture; sound materiel management practices, such as standardization and vendor teaming; and the appropriate use of automated systems. It is important to evaluate whether the best practices are applicable to your environment and what specific changes to your current processes would be necessary to adopt them.

  5. Surgical management of gynecomastia: experience of a general surgery center.

    Science.gov (United States)

    Longheu, A; Medas, F; Corrias, F; Farris, S; Tatti, A; Pisano, G; Erdas, E; Calò, P G

    2016-01-01

    Gynecomastia is a common finding in male population of all ages. The aim of our study was to present our experience and goals in surgical treatment of gynecomastia. Clinical records of patients affected by gynecomastia referred to our Department of Surgery between September 2008 and January 2015 were analyzed. 50 patients were included in this study. Gynecomastia was monolateral in 12 patients (24%) and bilateral in 38 (76%); idiopathic in 41 patients (82%) and secondary in 9 (18%). 39 patients (78%) underwent surgical operation under general anaesthesia, 11 (22%) under local anaesthesia. 3 patients (6%) presented recurrent disease. Webster technique was performed in 28 patients (56%), Davidson technique in 16 patients (32%); in 2 patients (4%) Pitanguy technique was performed and in 4 patients (8%) a mixed surgical technique was performed. Mean surgical time was 80.72±35.14 minutes, median postoperative stay was 1.46±0.88 days. 2 patients (4%) operated using Davidson technique developed a hematoma, 1 patient (2%) operated with the same technique developed hypertrophic scar. Several surgical techniques are described for surgical correction of gynecomastia. If performed by skilled general surgeons surgical treatment of gynecomastia is safe and permits to reach satisfactory aesthetic results.

  6. Congenital Heart Surgery Case Mix Across North American Centers and Impact on Performance Assessment.

    Science.gov (United States)

    Pasquali, Sara K; Wallace, Amelia S; Gaynor, J William; Jacobs, Marshall L; O'Brien, Sean M; Hill, Kevin D; Gaies, Michael G; Romano, Jennifer C; Shahian, David M; Mayer, John E; Jacobs, Jeffrey P

    2016-11-01

    Performance assessment in congenital heart surgery is challenging due to the wide heterogeneity of disease. We describe current case mix across centers, evaluate methodology inclusive of all cardiac operations versus the more homogeneous subset of Society of Thoracic Surgeons benchmark operations, and describe implications regarding performance assessment. Centers (n = 119) participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 through 2014) were included. Index operation type and frequency across centers were described. Center performance (risk-adjusted operative mortality) was evaluated and classified when including the benchmark versus all eligible operations. Overall, 207 types of operations were performed during the study period (112,140 total cases). Few operations were performed across all centers; only 25% were performed at least once by 75% or more of centers. There was 7.9-fold variation across centers in the proportion of total cases comprising high-complexity cases (STAT 5). In contrast, the benchmark operations made up 36% of cases, and all but 2 were performed by at least 90% of centers. When evaluating performance based on benchmark versus all operations, 15% of centers changed performance classification; 85% remained unchanged. Benchmark versus all operation methodology was associated with lower power, with 35% versus 78% of centers meeting sample size thresholds. There is wide variation in congenital heart surgery case mix across centers. Metrics based on benchmark versus all operations are associated with strengths (less heterogeneity) and weaknesses (lower power), and lead to differing performance classification for some centers. These findings have implications for ongoing efforts to optimize performance assessment, including choice of target population and appropriate interpretation of reported metrics. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Effects of different cutting centers on LASIK surgery in myopic patients

    Directory of Open Access Journals (Sweden)

    Yan-Wei Liu

    2017-07-01

    Full Text Available AIM:To investigate the effect of different cutting centers on the visual acuity, refractive diopter and visual quality of patients undergoing laser assisted in situ keratomileusis(LASIK. METHODS: A total of 80 patients(160 eyeswith myopia treated by elective LASIK were divided into two groups. Thirty-six cases(72 eyeswith visual axis corneal reflection point(VACRPas the cutting center were included into the VACRP group while 44 cases(88 eyeswith pupil center(PCas the cutting center were included into the PC group. The uncorrected visual acuity(UCVA, the best corrected visual acuity(BCVA, refractive diopter, corneal aberration \\〖total corneal and anterior corneal surface higher-order aberrations(HOA, spherical aberration(Z40, vertical coma(Z3-1, horizontal coma(totZ31and offset of cutting centers were determined before surgery and 1mo after surgery. RESULTS: There was no difference in the probability of UCVA ≥ 0.1, BCVA and refractive diopter between the two groups at 1mo after surgery(P>0.05. The astigmatism and cutting center deviation of VACRP group were lower than those of PC group(P40, totZ3-1, totZ31, froHOA, froZ3-1、froZ31 and froZ40 were lower in VACRP group than PC group at 1mo after surgery(PCONCLUSION: The UCVA of patients treated with both cutting centers for LASIK is good but VACRP has more advantages in reducing the offset of cutting center and improving postoperative visual quality.

  8. A corporate partner in the endoscopic ambulatory surgery center. Is it worth the cost?

    Science.gov (United States)

    Frakes, James T

    2002-04-01

    In the preceding article of this two-part polemic on the advisability of a corporate partner in the endoscopic ambulatory surgery center (EASC), the advantages of such a partner were discussed and criteria given for judging its performance. Alternatives to the corporate partner were discussed. In that article, the corporate partnership in the EASC is a positive development yielding many benefits and few disadvantages to the physicians and the center. In this article, the balance tilts the other way.

  9. Outcome of Cushing's disease following transsphenoidal surgery in a single center over 20 years.

    LENUS (Irish Health Repository)

    Hassan-Smith, Zaki K

    2012-04-01

    Historically, Cushing\\'s disease (CD) was associated with a 5-yr survival of just 50%. Although advances in CD management have seen mortality rates improve, outcome from transsphenoidal surgery (TSS), the current first-line treatment, varies significantly between centers.

  10. Aortic Root Surgery in Marfan Syndrome: Medium-Term Outcome in a Single-Center Experience.

    Science.gov (United States)

    Attenhofer Jost, Christine H; Connolly, Heidi M; Scott, Christopher G; Ammash, Naser M; Bowen, Juan M; Schaff, Hartzell V

    2017-01-01

    The study aim was to analyze the authors' experience with aortic root surgery in Marfan syndrome (MFS), and to expand the surgical outcome data of patients meeting the Ghent criteria (Marfan registry). Analyses were performed of data acquired from MFS patients (who met the Ghent criteria), including an aortic root surgery and Kaplan-Meier survival. Between April 2004 and February 2012, a total of 59 MFS patients (mean age at surgery 36 ± 13 years) underwent 67 operations for aortic root aneurysm (n = 52), aortic valve (AV) regurgitation (n = 15), acute aortic dissection (n = 2), and/or mitral valve (MV) regurgitation resulting from MV prolapse (n = 7). Of 59 initial operations, 21 (36%) involved AV-replacing root surgery, 38 (64%) AV-sparing root surgery, seven (12%) aortic arch or hemi-arch repair, and five (8%) simultaneous MV surgery. There were no early mortalities. The mean follow up was 6.8 ± 1.2 years, with five deaths (8%) and a relatively low reoperation rate (10 reoperations in nine patients; 14%). Seven reoperations involved AV or aortic root surgery (including four for AV regurgitation following failed AV-sparing surgery), two MV repair/replacements, and one coronary artery bypass graft. Eight patients (21%) with AV-sparing surgery had moderate/severe AV regurgitation at the last follow up before re-intervention. The mean five-year freedom from postoperative death was 91.2 ± 8.8%, from cardiac reoperation 86.3 ± 4.5%, and more-than-moderate AV regurgitation 90.3 ± 4.8%. Prophylactic aortic surgery in MFS patients with AV-replacing root or AV-sparing root surgery carries a low risk of operative morbidity and death when performed at an experienced center. AV-sparing root surgery increases the risk of AV regurgitation and, possibly, of re-intervention. Regular clinical follow up is important after any aortic root surgery in MFS patients, with a delineation of risk factors for AV regurgitation after AV rootsparing surgery.

  11. Therapeutic outcomes of transsphenoidal surgery in pediatric patients with craniopharyngiomas: a single-center study.

    Science.gov (United States)

    Yamada, Shozo; Fukuhara, Noriaki; Yamaguchi-Okada, Mitsuo; Nishioka, Hiroshi; Takeshita, Akira; Takeuchi, Yasuhiro; Inoshita, Naoko; Ito, Junko

    2018-03-30

    OBJECTIVE The aim of this study was to analyze the outcomes of transsphenoidal surgery (TSS) in a single-center clinical series of pediatric craniopharyngioma patients treated with gross-total resection (GTR). METHODS The authors retrospectively reviewed the surgical outcomes for 65 consecutive patients with childhood craniopharyngiomas (28 girls and 37 boys, mean age 9.6 years) treated with TSS (45 primary and 20 repeat surgeries) between 1990 and 2015. Tumors were classified as subdiaphragmatic or supradiaphragmatic. Demographic and clinical characteristics, including extent of resection, complications, incidence of recurrence, pre- and postoperative visual disturbance, pituitary function, and incidence of diabetes insipidus (DI), as well as new-onset obesity, were analyzed and compared between the primary surgery and repeat surgery groups. RESULTS Of the 45 patients in the primary surgery group, 26 (58%) had subdiaphragmatic tumors and 19 had supradiaphragmatic tumors. Of the 20 patients in the repeat surgery group, 9 (45%) had subdiaphragmatic tumors and 11 had supradiaphragmatic tumors. The only statistically significant difference between the 2 surgical groups was in tumor size; tumors were larger (mean maximum diameter 30 mm) in the primary surgery group than in the repeat surgery group (25 mm) (p = 0.008). GTR was accomplished in 59 (91%) of the 65 cases; the GTR rate was higher in the primary surgery group than in the repeat surgery group (98% vs 75%, p = 0.009). Among the patients who underwent GTR, 12% experienced tumor recurrence, with a median follow-up of 7.8 years, and recurrence tended to occur less frequently in primary than in repeat surgery patients (7% vs 27%, p = 0.06). Of the 45 primary surgery patients, 80% had deteriorated pituitary function and 83% developed DI, whereas 100% of the repeat surgery patients developed these conditions. Among patients with preoperative visual disturbance, vision improved in 62% but worsened in 11%. Visual

  12. Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities.

    Science.gov (United States)

    Gupta, Varun; Parikh, Rikesh; Nguyen, Lyly; Afshari, Ashkan; Shack, R Bruce; Grotting, James C; Higdon, K Kye

    2017-02-01

    There has been a dramatic rise in office-based surgery. However, due to wide variations in regulatory standards, the safety of office-based aesthetic surgery has been questioned. This study compares complication rates of cosmetic surgery performed at office-based surgical suites (OBSS) to ambulatory surgery centers (ASCs) and hospitals. A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 were identified from the CosmetAssure database (Birmingham, AL). Patients were grouped by type of accredited facility where the surgery was performed: OBSS, ASC, or hospital. The primary outcome was the incidence of major complication(s) requiring emergency room visit, hospital admission, or reoperation within 30 days postoperatively. Potential risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of procedure, and combined procedures were reviewed. Of the 129,007 patients (183,914 procedures) in the dataset, the majority underwent the procedure at ASCs (57.4%), followed by hospitals (26.7%) and OBSS (15.9%). Patients operated in OBSS were less likely to undergo combined procedures (30.3%) compared to ASCs (31.8%) and hospitals (35.3%, P procedures. Plastic surgeons should continue to triage their patients carefully based on other significant comorbidities that were not measured in this present study. LEVEL OF EVIDENCE 3. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  13. User-centered design of discharge warnings tool for colorectal surgery patients.

    Science.gov (United States)

    Naik, Aanand D; Horstman, Molly J; Li, Linda T; Paasche-Orlow, Michael K; Campbell, Bryan; Mills, Whitney L; Herman, Levi I; Anaya, Daniel A; Trautner, Barbara W; Berger, David H

    2017-09-01

    Readmission following colorectal surgery, typically due to surgery-related complications, is common. Patient-centered discharge warnings may guide recognition of early complication signs after colorectal surgery. User-centered design of a discharge warnings tool consisted of iterative health literacy review and a heuristic evaluation with human factors and clinical experts as well as patient end users to establish content validity and usability. Literacy evaluation of the prototype suggested >12th-grade reading level. Subsequent revisions reduced reading level to 8th grade or below. Contents were formatted during heuristic evaluation into 3 action-oriented zones (green, yellow, and red) with relevant warning lexicons. Usability testing demonstrated comprehension of this 3-level lexicon and recognition of appropriate patient actions to take for each level. We developed a discharge warnings tool for colorectal surgery using staged user-centered design. The lexicon of surgical discharge warnings could structure communication among patients, caregivers, and clinicians to improve post-discharge care. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.

  14. ASC deficiency suppresses proliferation and prevents medulloblastoma incidence.

    Science.gov (United States)

    Knight, E R W; Patel, E Y; Flowers, C A; Crowther, A J; Ting, J P; Miller, C R; Gershon, T R; Deshmukh, M

    2015-01-15

    Apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) is silenced by promoter methylation in many types of tumors, yet ASC's role in most cancers remains unknown. Here, we show that ASC is highly expressed in a model of medulloblastoma, the most common malignant pediatric brain cancer; ASC is also expressed in human medulloblastomas. Importantly, while ASC deficiency did not affect normal cerebellar development, ASC knockout mice on the Smoothened (ND2:SmoA1) transgenic model of medulloblastoma exhibited a profound reduction in medulloblastoma incidence and a delayed tumor onset. A similar decrease in tumorigenesis with ASC deficiency was also seen in the hGFAP-Cre:SmoM2 mouse model of medulloblastoma. Interestingly, hyperproliferation of the external granule layer (EGL) was comparable at P20 in both wild-type and ASC-deficient SmoA1 mice. However, while the apoptosis and differentiation markers remained unchanged at this age, proliferation makers were decreased, and the EGL was reduced in thickness and area by P60. This reduction in proliferation with ASC deficiency was also seen in isolated SmoA1 cerebellar granule precursor cells in vitro, indicating that the effect of ASC deletion on proliferation was cell autonomous. Interestingly, ASC-deficient SmoA1 cerebella exhibited disrupted expression of genes in the transforming growth factor-β pathway and increased level of nuclear Smad3. Taken together, these results demonstrate an unexpected role for ASC in Sonic hedgehog-driven medulloblastoma tumorigenesis, thus identifying ASC as a promising novel target for antitumor therapy.

  15. ASC Trilab L2 Codesign Milestone 2015

    Energy Technology Data Exchange (ETDEWEB)

    Trott, Christian Robert [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hammond, Simon David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Dinge, Dennis [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Lin, Paul T. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Vaughan, Courtenay T. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Cook, Jeanine [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Edwards, Harold C. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Rajan, Mahesh [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hoekstra, Robert J. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-09-01

    For the FY15 ASC L2 Trilab Codesign milestone Sandia National Laboratories performed two main studies. The first study investigated three topics (performance, cross-platform portability and programmer productivity) when using OpenMP directives and the RAJA and Kokkos programming models available from LLNL and SNL respectively. The focus of this first study was the LULESH mini-application developed and maintained by LLNL. In the coming sections of the report the reader will find performance comparisons (and a demonstration of portability) for a variety of mini-application implementations produced during this study with varying levels of optimization. Of note is that the implementations utilized including optimizations across a number of programming models to help ensure claims that Kokkos can provide native-class application performance are valid. The second study performed during FY15 is a performance assessment of the MiniAero mini-application developed by Sandia. This mini-application was developed by the SIERRA Thermal-Fluid team at Sandia for the purposes of learning the Kokkos programming model and so is available in only a single implementation. For this report we studied its performance and scaling on a number of machines with the intent of providing insight into potential performance issues that may be experienced when similar algorithms are deployed on the forthcoming Trinity ASC ATS platform.

  16. A modified fast-track program for pancreatic surgery: a prospective single-center experience.

    Science.gov (United States)

    di Sebastiano, Pierluigi; Festa, Leonardina; De Bonis, Antonio; Ciuffreda, Andrea; Valvano, Maria Rosa; Andriulli, Angelo; di Mola, F Francesco

    2011-03-01

    The objective of this study is to evaluate the impact of a fast-track protocol in a high-volume center for patients with pancreatic disorders. The concept of fast-track surgery allowing accelerated postoperative recovery is accepted in colorectal surgery, but efficacy data are only preliminary for patients undergoing major pancreatic surgery. We aimed to evaluate the impact of a modified fast-track protocol in a high-volume center for patients with pancreatic disorders. Between February 2005 and January 2010, 145 subjects had resective pancreatic surgery and were enrolled in the program. Essential features of the program were no preanaesthetic medication, upper and lower air-warming device, avoidance of excessive i.v. fluids perioperatively, effective control of pain, early reinstitution of oral feeding, and immediate mobilization and restoration of bowel function following surgery. Outcome measures were postoperative complications such as pancreatic fistula, delayed gastric emptying, biliary leak, intra-abdominal abscess, post-pancreatectomy hemorrhage, acute pancreatitis, wound infection, 30-day mortality, postoperative hospital stay, and readmission rates. On average, patients were discharged on postoperative day 10 (range 6-69), with a 30-day readmission rate of 6.2%. Percentage of patients with at least one complication was 38.6%. Pancreatic anastomotic leakage occurred in seven of 101 pancreatico-jejunostomies, and biliary leak in three of 109 biliary jejunostomies. Postoperative hemorrhage occurred in ten (6.9%) patients and wound infection in nine (6.2%) cases. In-hospital mortality was 2.7%. Fast-track parameters, such as normal food and first stool, correlated significantly with early discharge (jaundice, and resumption of normal diet by the 5th postoperative day were independent factors of early discharge. Fast-track programs are feasible, easy, and also applicable for patients undergoing a major surgery such as pancreatic resection.

  17. Does Certification as Bariatric Surgery Center and Volume Influence the Outcome in RYGB-Data Analysis of German Bariatric Surgery Registry.

    Science.gov (United States)

    Stroh, Christine; Köckerling, F; Lange, V; Wolff, S; Knoll, C; Bruns, C; Manger, Th

    2017-02-01

    To examine the association between the certification as bariatric surgery center and volume and patient outcome, data collected in the German Bariatric Surgery Registry were evaluated. All data were registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg. Data collection began in 2005 for all bariatric procedures in an online database. Participation in the quality assurance study is required for all certified bariatric surgery centers in Germany. Descriptive evaluation and matched pairs analysis were performed. Patients were matched via propensity score taking into account BMI, age, and incidence of comorbidities. During the period from 2005 to 2013, 3083 male and 10,639 female patients were operated on with the RYGB primary approach. In Centers of Competence (77.2 %) and non-accredited hospitals (76.3 %), the proportion of female patients was significantly lower than in Centers of Reference/Excellence (78.7 %; p = 0.002). The mean age in Centers of Reference/Excellence (41.2 years) was significantly lower than in Centers of Competence (43.2 years; p bariatric surgery centers with higher volume. The study supports the concept of certification. There are different factors which can and cannot be preoperatively modified and influence the perioperative outcome.

  18. Plastic Surgery Complications from Medical Tourism Treated in a U.S. Academic Medical Center.

    Science.gov (United States)

    Ross, Kimberly M; Moscoso, Andrea V; Bayer, Lauren R; Rosselli-Risal, Liliana; Orgill, Dennis P

    2018-04-01

    Medical tourism is a growing, multi-billion dollar industry fueled by improvements in the global transportation infrastructure. The authors studied patients living in the United States who travel to other countries for plastic surgical procedures and returned to have their complications treated in the authors' center. A retrospective patient evaluation was performed. Patients who had presented to an urban tertiary academic hospital plastic surgery service with complications or complaints associated with plastic surgery performed in a developing country were studied. The authors collected demographic information, types of surgery performed, destinations, insurance coverage, and complications. Seventy-eight patients were identified over 7 years. Most commonly, complications were seen following abdominoplasty (n = 35), breast augmentation (n = 25), and foreign body injections (n = 15). Eighteen patients underwent multiple procedures in one operative setting. The most common destination country was the Dominican Republic (n = 59). Complications included surgical-site infections (n = 14), pain (n = 14), and wound healing complications (n = 12). Eighty-six percent of patients (n = 67) relied on their medical insurance to pay for their follow-up care or manage their complications, with the most common type of health insurance coverage being Massachusetts Medicaid (n = 48). Cosmetic surgery performed in developing countries can carry substantial risks of complications that can be challenging to patients, primary care providers, insurers, and plastic surgical teams not associated with the original surgery. These complications pose significant burdens on our public health systems.

  19. Emergency pediatric surgery: Comparing the economic burden in specialized versus nonspecialized children's centers.

    Science.gov (United States)

    Kvasnovsky, Charlotte L; Lumpkins, Kimberly; Diaz, Jose J; Chun, Jeannie Y

    2018-05-01

    The American College of Surgeons has developed a verification program for children's surgery centers. Highly specialized hospitals may be verified as Level I, while those with fewer dedicated resources as Level II or Level III, respectively. We hypothesized that more specialized children's centers would utilize more resources. We performed a retrospective study of the Maryland Health Services Cost Review Commission (HSCRC) database from 2009 to 2013. We assessed total charge, length of stay (LOS), and charge per day for all inpatients with an emergency pediatric surgery diagnosis, controlling for severity of illness (SOI). Using published resources, we assigned theoretical level designations to each hospital. Two hospitals would qualify as Level 1 hospitals, with 4593 total emergency pediatric surgery admissions (38.5%) over the five-year study period. Charges were significantly higher for children treated at Level I hospitals (all P<0.0001). Across all SOI, children at Level I hospitals had significantly longer LOS (all P<0.0001). Hospitals defined as Level II and Level III provided the majority of care and were able to do so with shorter hospitalizations and lower charges, regardless of SOI. As care shifts towards specialized centers, this charge differential may have significant impact on future health care costs. Level III Cost Effectiveness Study. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Complications of Impulse Generator Exchange Surgery for Deep Brain Stimulation: A Single-Center, Retrospective Study.

    Science.gov (United States)

    Helmers, Ann-Kristin; Lübbing, Isabel; Birkenfeld, Falk; Witt, Karsten; Synowitz, Michael; Mehdorn, Hubertus Maximilian; Falk, Daniela

    2018-05-01

    Nonrechargeable deep brain stimulation impulse generators (IGs) with low or empty battery status require surgical IG exchange several years after initial implantation. The aim of this study was to investigate complication rates after IG exchange surgery and identify risk factors. We retrospectively analyzed complications following IG exchange surgery from 2008 to 2015 in our department. Medical records of all patients who underwent IG exchange surgery were systematically reviewed. The shortest follow-up time was 19 months. From 2008 to 2015, 438 IGs were exchanged in 319 patients. Overall complication rate was 8.90%. Infection developed in 12 patients (2.74%). Six patients (1.37%) experienced local wound erosions. Hardware malfunctions were present in 11 patients (2.51%), and local hemorrhage was observed in 3 cases (0.68%). Repeated fixation of the IG was required in 2 patients (0.46%). Traction of the connecting cables necessitated surgical revision in 2 patients (0.46%). In 2 cases (0.46%), the IG was placed abdominally or exchanged for a smaller device owing to patient discomfort resulting from the initial positioning. One 80-year-old patient (0.23%) had severely worsening heart failure and died 4 days after IG exchange surgery. IG exchange surgery, although often considered a minor surgery, was associated with a complication rate of approximately 9% in our center. Patients and physicians should understand the complication rates associated with IG exchange surgery because this information might facilitate selection of a rechargeable IG. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. ASC FY17 Implementation Plan, Rev. 1

    Energy Technology Data Exchange (ETDEWEB)

    Hamilton, P. G. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2017-06-14

    The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balance of resources, including technical staff, hardware, simulation software, and computer science solutions.

  2. Robotic surgery for rectal cancer: a single center experience of 100 consecutive cases.

    Science.gov (United States)

    Stănciulea, O; Eftimie, M; David, L; Tomulescu, V; Vasilescu, C; Popescu, I

    2013-01-01

    Minimally invasive techniques have revolutionized the field of general surgery over the few last decades. Despite its advantages, in complex procedures such as rectal surgery, laparoscopy has not achieved a high penetration rate because of its steep learning curve, its relatively high conversion rate and technical challenges. The aim of this study was to present a single center experience with robotic surgery for rectal cancer focusing mainly on early and mid-term postoperative outcome. A series of 100 consecutive patients who underwent robotic rectal surgery between January 2008 and June 2012 was analyzed retrospectively in terms of demographics, pathological data, surgical and oncological outcomes. Seventy-seven patients underwent robotic sphincter-saving resection, and 23 patients underwent robotic abdominoperineal resection. There were 4 conversions. The median operative time for sphincter-saving procedures was 180 min. The median time for robotic abdominoperineal resection was 160 min. The median distal resection margin of the operative specimen was 3 cm. The median number of retrieved lymph nodes was 14. The median hospital stay was 10 days. In-hospital mortality was nil. The overall morbidity was 30%. Four patients presented transitory postoperative urinary dysfunction. Severe erectile dysfunction was reported by 3 patients. The median length of follow-up was 24 months. The 3-year overall survival rate was 90%. Robotic surgery is advantageous for both surgeons (in that it facilitates dissection in a narrow pelvis) and patients (in that it affords a very good quality of life via the preservation of sexual and urinary function in the vast majority of patients and it has low morbidity and good midterm oncological outcomes). In rectal cancer surgery, the robotic approach is a promising alternative and is expected to overcome the low penetration rate of laparoscopy in this field. Celsius.

  3. Improved Short-Term Outcomes following Orthognathic Surgery Are Associated with High-Volume Centers.

    Science.gov (United States)

    Berlin, Nicholas L; Tuggle, Charles T; Steinbacher, Derek M

    2016-08-01

    Previous studies assessing outcomes following orthognathic surgery rely primarily on single-center/surgeon experience. In addition to issues of generalizability, these studies are limited in evaluating the effect of operative volume on patient outcomes. Orthognathic procedures were identified in the 1999 to 2011 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Outcomes included occurrence of any in-hospital complication, extended length of stay (>2 days), and increased costs (>$10,784). High-volume hospitals were defined as the 90th percentile of case volume or higher (>31 cases/year). Univariate and multivariate analyses were conducted to identify independent predictors of outcomes. Trend analyses were performed to assess changes in the annual rate of patients treated at high-volume hospitals over the study period. Among 101,692 orthognathic surgery patients, 19.6 percent underwent concurrent ancillary procedures (i.e., genioplasty, rhinoplasty, or septoplasty), and 37.6 percent underwent double-jaw surgery. Fifty-three percent were treated at high-volume hospitals. High-volume hospitals more often performed ancillary procedures (21.4 percent versus 17.4 percent; p surgery (41.3 percent versus 33.4 percent; p orthognathic cases nationwide are performed at a small number of high-volume hospitals. These hospitals discharge patients earlier, perform more complex procedures, and have fewer complications. Risk, III.

  4. Evolution in breast cancer suspicion and extent of surgery at a radio-oncology center

    International Nuclear Information System (INIS)

    Lopez L, Veronica; Carvajal C, Claudia; Gallardo M, Manuel; Russo N, Moies

    2014-01-01

    Introduction: Breast cancer diagnosis and treatment ad evolved over the past quarter century. From self-examination to mammography as main suspicion tool and from radical to conservative surgery plus radiotherapy as prefered treatment. The aim of this review was to assess the evolution of presentation and local management of breast cancer at a Chilean radio-oncology center. Materials and Methods: We analyzed 1.204 breast cancer patients who received postoperative irradiation on two four-years periods.The first period included 223 patients and coincides with the introduction of mammography and conservative surgery. The second included 981 patients managed according to current guidelines. The variables analyzed were type of clinical suspicion, time between clinical suspicion and diagnosis confirmation, type of surgery, histology and tumor size. Data were obtained from medical records and analyzed using STATA 2. Results: In the second period mammographic suspicion reached 39.88%. Time between clinical suspicion and histological diagnosis was reduced to 50%, the proportion of tumors larger than 2 cm was reduced from 61 to 45%, the proportion of DCIS was tripled from 6 to 18%, use of conservative surgery as an absolute increase of 28%. All of these differences were statistically significant (p < 0.01). Conclusion: The introduction of mammography and conservative management allowed early diagnosis of breast cancer in the analyzed population

  5. Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for ambulatory surgical centers - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of ambulatory surgical center ratings for the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey....

  6. Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir Jr.; Kalil, Renato A. K.; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2014-06-15

    The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery.

  7. Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience

    Directory of Open Access Journals (Sweden)

    Atakan Sezer

    2011-06-01

    Full Text Available Objective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19. Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4. Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80 months.Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients.

  8. Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

    International Nuclear Information System (INIS)

    Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir Jr.; Kalil, Renato A. K.; Portal, Vera Lúcia

    2014-01-01

    The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery

  9. Multi-center evaluation of post-operative morbidity and mortality after optimal cytoreductive surgery for advanced ovarian cancer.

    Directory of Open Access Journals (Sweden)

    Arash Rafii

    Full Text Available PURPOSE: While optimal cytoreduction is the standard of care for advanced ovarian cancer, the related post-operative morbidity has not been clearly documented outside pioneering centers. Indeed most of the studies are monocentric with inclusions over several years inducing heterogeneity in techniques and goals of surgery. We assessed the morbidity of optimal cytoreduction surgery for advanced ovarian cancer within a short inclusion period in 6 referral centers dedicated to achieve complete cytoreduction. PATIENTS AND METHODS: The 30 last optimal debulking surgeries of 6 cancer centers were included. Inclusion criteria included: stage IIIc- IV ovarian cancer and optimal surgery performed at the site of inclusion. All post-operative complications within 30 days of surgery were recorded and graded using the Memorial secondary events grading system. Student-t, Chi2 and non-parametric statistical tests were performed. RESULTS: 180 patients were included. There was no demographic differences between the centers. 63 patients underwent surgery including intestinal resections (58 recto-sigmoid resection, 24 diaphragmatic resections, 17 splenectomies. 61 patients presented complications; One patient died post-operatively. Major (grade 3-5 complications requiring subsequent surgeries occurred in 21 patients (11.5%. 76% of patients with a major complication had undergone an ultraradical surgery (P = 0.004. CONCLUSION: While ultraradical surgery may result in complete resection of peritoneal disease in advanced ovarian cancer, the associated complication rate is not negligible. Patients should be carefully evaluated and the timing of their surgery optimized in order to avoid major complications.

  10. Current standards of neuropsychological assessment in epilepsy surgery centers across Europe.

    Science.gov (United States)

    Vogt, Viola Lara; Äikiä, Marja; Del Barrio, Antonio; Boon, Paul; Borbély, Csaba; Bran, Ema; Braun, Kees; Carette, Evelien; Clark, Maria; Cross, Judith Helen; Dimova, Petia; Fabo, Daniel; Foroglou, Nikolaos; Francione, Stefano; Gersamia, Anna; Gil-Nagel, Antonio; Guekht, Alla; Harrison, Sue; Hecimovic, Hrvoje; Heminghyt, Einar; Hirsch, Edouard; Javurkova, Alena; Kälviäinen, Reetta; Kavan, Nicole; Kelemen, Anna; Kimiskidis, Vasilios K; Kirschner, Margarita; Kleitz, Catherine; Kobulashvili, Teia; Kosmidis, Mary H; Kurtish, Selin Yagci; Lesourd, Mathieu; Ljunggren, Sofia; Lossius, Morten Ingvar; Malmgren, Kristina; Mameniskiené, Ruta; Martin-Sanfilippo, Patricia; Marusic, Petr; Miatton, Marijke; Özkara, Çiğdem; Pelle, Federica; Rubboli, Guido; Rudebeck, Sarah; Ryvlin, Philippe; van Schooneveld, Monique; Schmid, Elisabeth; Schmidt, Pia-Magdalena; Seeck, Margitta; Steinhoff, Bernhard J; Shavel-Jessop, Sara; Tarta-Arsene, Oana; Trinka, Eugen; Viggedal, Gerd; Wendling, Anne-Sophie; Witt, Juri-Alexander; Helmstaedter, Christoph

    2017-03-01

    We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup. Strong agreement was found on indications (localization, epileptic dysfunctions, adverse drugs effects, and postoperative monitoring) and the domains to be evaluated (memory, attention, executive functions, language, visuospatial skills, intelligence, depression, anxiety, and quality of life). Although 186 different tests are in use throughout these European centers, a core group of tests reflecting a moderate level of agreement could be discerned. Variability exists with regard to indications, protocols, and paradigms for the assessment of hemispheric language dominance. For the tests in use, little published evidence of clinical validity in epilepsy was provided. Participants in the survey reported a need for improvement concerning the validity of the tests, tools for the assessment of everyday functioning and accelerated forgetting, national norms, and test co-normalization. Based on the present survey, we documented a consensus regarding the indications and principles of neuropsychological testing. Despite the variety of tests in use, the survey indicated that there may be a core set of tests chosen based on experience, as well as on published evidence. By combining these findings with the results of an ongoing systematic literature review, we aim for a battery that can be recommended for the use across epilepsy surgical centers in Europe. Wiley Periodicals, Inc. © 2017 International League

  11. The Astrobiology in Secondary Classrooms (ASC) curriculum: focusing upon diverse students and teachers.

    Science.gov (United States)

    Arino de la Rubia, Leigh S

    2012-09-01

    The Minority Institution Astrobiology Collaborative (MIAC) began working with the NASA Goddard Center for Astrobiology in 2003 to develop curriculum materials for high school chemistry and Earth science classes based on astrobiology concepts. The Astrobiology in Secondary Classrooms (ASC) modules emphasize interdisciplinary connections in astronomy, biology, chemistry, geoscience, physics, mathematics, and ethics through hands-on activities that address national educational standards. Field-testing of the Astrobiology in Secondary Classrooms materials occurred over three years in eight U.S. locations, each with populations that are underrepresented in the career fields of science, technology, engineering, and mathematics. Analysis of the educational research upon the high school students participating in the ASC project showed statistically significant increases in students' perceived knowledge and science reasoning. The curriculum is in its final stages, preparing for review to become a NASA educational product.

  12. The development of the brake system of the BMW 850i including ABS and ASC. Entwicklung des Bremssystems des BMW 850i einschliesslich ABS und ASC

    Energy Technology Data Exchange (ETDEWEB)

    Kraft, H.J.; Leffler, H.

    1990-02-01

    The brake system of the new BMW 850i is described in the following. The brake actuation takes place via an hydraulic brake booster. The disc brakes at front and rear axle are arranged in diagnonal brake split. The 4-channel ABS is fitted as standard equipment. The ABS control unit also incorporates the algorithm for the Automatic Stability Control System ASC or ASC+T. The ASC+T shows improved traction compared with the pure stability system ASC and is standard in the BMW 850i with manual gear box. The automatic gear box equipped BMW 850i are supplied with ASC, the ASC+T is available as an option. Both systems, the ASC and the ASC+T are described with special view on the electronical and hydraulical network in the car. A performance comparison of the ASC-systems completes the description. (orig.).

  13. ASC Addresses Unit Commanders' Concerns through LBE and Reset Programs

    National Research Council Canada - National Science Library

    Young, Mark E

    2008-01-01

    .... Army Sustainment Command (ASC), part of the U.S. Army Materiel Command (AMC) team, is available to assist, identify, and resolve equipment and maintenance problems as well as materiel readiness issues for combatant commanders...

  14. USDA-ASCS 1936-1939 Air Photos

    Data.gov (United States)

    Minnesota Department of Natural Resources — This data set is a digital version of aerial photographs taken during the 1936-1939 time frame for the USDA-ASCS. These photos were originally recorded at a scale of...

  15. The American Satellite Company (ASC) satellite deployed from payload bay

    Science.gov (United States)

    1985-01-01

    The American Satellite Company (ASC) communications satellite is deployed from the payload bay of the Shuttle Discovery. A portion of the cloudy surface of the earth can be seen to the left of the frame.

  16. De-hospitalization of the pediatric day surgery by means of a freestanding surgery center: pilot study in the lazio region

    Directory of Open Access Journals (Sweden)

    Mangia Giovanni

    2012-02-01

    Full Text Available Abstract Background Day surgery should take place in appropriate organizational settings. In the presence of high volumes, the organizational models of the Lazio Region are represented by either Day Surgery Units within continuous-cycle hospitals or day-cycle Day Surgery Centers. This pilot study presents the regional volumes provided in 2010 and the additional volumes that could be provided based on the best performance criterion with a view to suggesting the setting up of a regional Freestanding Center of Pediatric Day Surgery. Methods This is an observational retrospective study. The activity volumes have been assessed by means of a DRG (Diagnosis Related Group-specific indicator that measures the ratio of outpatients to the total number of treated patients (freestanding indicator, FI. The included DRGs had an FI exceeding the 3rd quartile present in at least a health-care facility and a volume exceeding 0.5% of the total patients of the pediatric surgery and urology facilities of the Lazio Region. The relevant data have been provided by the Public Health Agency and relate to 2010. The best performance FI has been used to calculate the theoretical volume of transferability of the remaining facilities into freestanding surgery centers. Patients under six months of age and DRGs common to other disciplines have been excluded. The Chi Square test has been used to compare the FI of the health-care facilities and the FI of the places of origin of the patients. Results The DRG provided in 2010 amounted to a total of 5768 belonging to 121 types of procedures. The application of the criteria of inclusion have led to the selection of seven final DRG categories of minor surgery amounting to 3522 cases. Out of this total number, there were 2828 outpatients and 694 inpatients. The recourse of the best performance determines a potential transfer of 497 cases. The total outpatient volume is 57%. The Chi Square test has pointed to a statistically significant

  17. Trends in refractive surgery at an academic center: 2007-2009

    Directory of Open Access Journals (Sweden)

    Kuo Irene C

    2011-05-01

    Full Text Available Abstract Background The United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in the summer quarter in 2007 and the same quarter in 2009 at an academic center. A secondary goal was to determine whether the volume of astigmatism- or presbyopia-correcting intraocular lenses (IOLs has concurrently changed because like laser refractive surgery, these "premium" IOLs involve out-of-pocket costs for patients. Methods Retrospective case series. Medical records were reviewed for all patients completing surgery at the Wilmer Laser Vision Center in the summer quarter of 2007 and the summer quarter of 2009. Outcome measures were the proportions of treated refractive errors, the proportion of photorefractive keratectomy (PRK vs. laser-assisted in-situ keratomileusis (LASIK, and the mean age of patients in each quarter. Chi-square test was used to compare the proportions of treated refractive errors and the proportions of procedures; two-tailed t-test to compare the mean age of patients; and two-tailed z-test to compare proportions of grouped refractive errors in 2007 vs. 2009; alpha = 0.05 for all tests. Refractive errors were grouped by the spherical equivalent of the manifest refraction and were considered "low myopia" for 6 diopters (D of myopia or less, "high myopia" for more than 6 D, and "hyperopia" for any hyperopia. Billing data were reviewed to obtain the volume of premium IOLs. Results Volume of laser refractive procedures decreased by at least 30%. The distribution of proportions of treated refractive errors did not change (p = 0.10. The

  18. Trends in refractive surgery at an academic center: 2007-2009.

    Science.gov (United States)

    Kuo, Irene C

    2011-05-14

    The United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in the summer quarter in 2007 and the same quarter in 2009 at an academic center. A secondary goal was to determine whether the volume of astigmatism- or presbyopia-correcting intraocular lenses (IOLs) has concurrently changed because like laser refractive surgery, these "premium" IOLs involve out-of-pocket costs for patients. Retrospective case series. Medical records were reviewed for all patients completing surgery at the Wilmer Laser Vision Center in the summer quarter of 2007 and the summer quarter of 2009. Outcome measures were the proportions of treated refractive errors, the proportion of photorefractive keratectomy (PRK) vs. laser-assisted in-situ keratomileusis (LASIK), and the mean age of patients in each quarter. Chi-square test was used to compare the proportions of treated refractive errors and the proportions of procedures; two-tailed t-test to compare the mean age of patients; and two-tailed z-test to compare proportions of grouped refractive errors in 2007 vs. 2009; alpha = 0.05 for all tests. Refractive errors were grouped by the spherical equivalent of the manifest refraction and were considered "low myopia" for 6 diopters (D) of myopia or less, "high myopia" for more than 6 D, and "hyperopia" for any hyperopia. Billing data were reviewed to obtain the volume of premium IOLs. Volume of laser refractive procedures decreased by at least 30%. The distribution of proportions of treated refractive errors did not change (p = 0.10). The proportion of high myopes, however, decreased (p = 0

  19. Patient-centered and visual quality outcomes of premium cataract surgery: a systematic review.

    Science.gov (United States)

    Wang, Sophia Y; Stem, Maxwell S; Oren, Gale; Shtein, Roni; Lichter, Paul R

    2017-06-26

    Over 8 million cataract surgeries are performed in the United States and the European Union annually, with many patients choosing to pay out of pocket for premium options including premium intraocular lens implants (IOLs) or laser-assisted cataract surgery (LACS). This report provides a systematic review evaluating patient-centered and visual quality outcomes comparing standard monofocal IOLs to premium cataract surgery options. PubMed and EMBASE were searched for publications published between January 1, 1980, and September 18, 2016, on multifocal, accommodative, and toric IOLs, monovision, and LACS, which reported on 1) dysphotopsias, 2) contrast sensitivity, 3) spectacle independence, 4) vision-related quality of life or patient satisfaction, and 5) IOL exchange. Multifocal lenses achieved higher rates of spectacle independence compared to monofocal lenses but also had higher reported frequency of dysphotopsia and worse contrast sensitivity, especially with low light or glare. Accommodative lenses were not associated with reduced contrast sensitivity or more dysphotopsia but had only modest improvements in spectacle independence compared to monofocal lenses. Studies of monovision did not target a sufficiently myopic outcome in the near-vision eye to achieve the full potential for spectacle independence. Patients reported high levels of overall satisfaction regardless of implanted IOL. No studies correlated patient-reported outcomes with patient expectations. Studies are needed to thoroughly compare patient-reported outcomes with concomitant patient expectations. In light of the substantial patient costs for premium options, patients and their surgeons will benefit from a better understanding of which surgical options best meet patients' expectations and how those expectations can be impacted by premium versus monofocal-including monovision-options.

  20. Building the Nonuniversity, Tertiary Care Center Hepatobiliary and Pancreatic Surgery Practice: Structural and Financial Considerations.

    Science.gov (United States)

    Baker, Erin H; Siddiqui, Imran; Vrochides, Dionisios; Iannitti, David A; Martinie, John B; Rorabaugh, Lauren; Jeyarajah, D Rohan; Swan, Ryan Z

    2016-12-01

    Early in their careers, many new surgeons lack the background and experience to understand essential components needed to build a surgical practice. Surgical resident education is often devoid of specific instruction on the business of medicine and practice management. In particular, hepatobiliary and pancreatic (HPB) surgeons require many key components to build a successful practice secondary to significant interdisciplinary coordination and a scope of complex surgery, which spans challenging benign and malignant disease processes. In the following, we describe the required clinical and financial components for developing a successful HPB surgery practice in the nonuniversity tertiary care center. We discuss significant financial considerations for understanding community need and hospital investment, contract establishment, billing, and coding. We summarize the structural elements and key personnel necessary for establishing an effectual HPB surgical team. This article provides useful, essential information for a new HPB surgeon looking to establish a surgical practice. It also provides insight for health-care administrators as to the value an HPB surgeon can bring to a hospital or health-care system.

  1. Safety and efficacy of bariatric surgery in Mexico: A detailed analysis of 500 surgeries performed at a high-volume center.

    Science.gov (United States)

    Guilbert, L; Joo, P; Ortiz, C; Sepúlveda, E; Alabi, F; León, A; Piña, T; Zerrweck, C

    2018-06-19

    Bariatric surgery is the best method for treating obesity and its comorbidities. Our aim was to provide a detailed analysis of the perioperative outcomes in Mexican patients that underwent surgery at a high-volume hospital center. A retrospective study was conducted on all the patients that underwent bariatric surgery at a single hospital center within a time frame of 4 and one-half years. Demographics, the perioperative variables, complications (early and late), weight loss, failure, and type 2 diabetes mellitus remission were all analyzed. Five hundred patients were included in the study, 83.2% of whom were women. Mean patient age was 38.8 years and BMI was 44.1kg/m 2 . The most common comorbidities were high blood pressure, dyslipidemia, and diabetes. Laparoscopic gastric bypass surgery was performed in 85.8% of the patients, sleeve gastrectomy in 13%, and revision surgeries in 1%. There were 9.8% early complications and 12.2% late ones, with no deaths. Overall weight loss as the excess weight loss percentage at 12 and 24 months was 76.9 and 77.6%. The greatest weight loss at 12 months was seen in the patients that underwent laparoscopic gastric bypass. A total of 11.4% of the patients had treatment failure. In the patients with type 2 diabetes mellitus, 68.7% presented with complete disease remission and 9.3% with partial remission. There was improvement in 21.8% of the cases. In our experience at a high-volume hospital center, bariatric surgery is safe and effective, based on the low number of adverse effects and consequent weight loss and type 2 diabetes mellitus control. Long-term studies with a larger number of patients are needed to determine the final impact of those procedures. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  2. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan : ASC software quality engineering practices Version 3.0.

    Energy Technology Data Exchange (ETDEWEB)

    Turgeon, Jennifer L.; Minana, Molly A.; Hackney, Patricia; Pilch, Martin M.

    2009-01-01

    The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in the US Department of Energy/National Nuclear Security Agency (DOE/NNSA) Quality Criteria, Revision 10 (QC-1) as 'conformance to customer requirements and expectations'. This quality plan defines the SNL ASC Program software quality engineering (SQE) practices and provides a mapping of these practices to the SNL Corporate Process Requirement (CPR) 001.3.6; 'Corporate Software Engineering Excellence'. This plan also identifies ASC management's and the software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals. This SNL ASC Software Quality Plan establishes the signatories commitments to improving software products by applying cost-effective SQE practices. This plan enumerates the SQE practices that comprise the development of SNL ASC's software products and explains the project teams opportunities for tailoring and implementing the practices.

  3. Repair of Achilles tendon defect with autologous ASCs engineered tendon in a rabbit model.

    Science.gov (United States)

    Deng, Dan; Wang, Wenbo; Wang, Bin; Zhang, Peihua; Zhou, Guangdong; Zhang, Wen Jie; Cao, Yilin; Liu, Wei

    2014-10-01

    Adipose derived stem cells (ASCs) are an important cell source for tissue regeneration and have been demonstrated the potential of tenogenic differentiation in vitro. This study explored the feasibility of using ASCs for engineered tendon repair in vivo in a rabbit Achilles tendon model. Total 30 rabbits were involved in this study. A composite tendon scaffold composed of an inner part of polyglycolic acid (PGA) unwoven fibers and an outer part of a net knitted with PGA/PLA (polylactic acid) fibers was used to provide mechanical strength. Autologous ASCs were harvested from nuchal subcutaneous adipose tissues and in vitro expanded. The expanded ASCs were harvested and resuspended in culture medium and evenly seeded onto the scaffold in the experimental group, whereas cell-free scaffolds served as the control group. The constructs of both groups were cultured inside a bioreactor under dynamic stretch for 5 weeks. In each of 30 rabbits, a 2 cm defect was created on right side of Achilles tendon followed by the transplantation of a 3 cm cell-seeded scaffold in the experimental group of 15 rabbits, or by the transplantation of a 3 cm cell-free scaffold in the control group of 15 rabbits. Animals were sacrificed at 12, 21 and 45 weeks post-surgery for gross view, histology, and mechanical analysis. The results showed that short term in vitro culture enabled ASCs to produce matrix on the PGA fibers and the constructs showed tensile strength around 50 MPa in both groups (p > 0.05). With the increase of implantation time, cell-seeded constructs gradually form neo-tendon and became more mature at 45 weeks with histological structure similar to that of native tendon and with the presence of bipolar pattern and D-periodic structure of formed collagen fibrils. Additionally, both collagen fibril diameters and tensile strength increased continuously with significant difference among different time points (p tendon tissue with fibril structure observable only at 45 weeks

  4. Return-to-Duty Rates Following Minimally Invasive Spine Surgery Performed on Active Duty Military Patients in an Ambulatory Surgery Center.

    Science.gov (United States)

    Granger, Elder; Prada, Stefan; Bereczki, Zoltan; Weiss, Michael; Wade, Chip; Davis, Reginald

    2018-05-21

    Low back pain is a primary health care utilization driver in the US population. Health care evaluation visits for low back pain are as common as medical evaluation for the common cold. Low back pain is the most common reason for reductions in activities of daily living and work activity in the general population. Although these statistics are compelling, in the military population, there is arguably a significantly greater economic impact on the military population, as the cost to train, retain, and deploy a service member is a tremendous cost. The current study retrospectively examines surgical outcomes, return to duty, and patient-centric outcomes among 82 active duty or reserve military patients who underwent an outpatient minimally invasive spine surgery Laminotomy Foraminotomy Decompression for the treatment of lumbar spinal stenosis in an ambulatory surgery center. Overall, our results indicate that within the 82 active duty military service members, 100% of the service members return to duty within 3 mo. Additionally, there was a significant reduction in self-reported pain and disability 12 mo postoperative, whereas the average length of surgery was 62 min with an average estimated blood loss of 30.64 mL. The current study indicates that minimally invasive procedures for the treatment of lumbar spinal stenosis in an ambulatory surgery center setting are an effective option for active duty servicemen to reduce return-to-duty rates and symptomatic back-related pain and disability.

  5. Laparoscopic versus open surgery in management of congenital duodenal obstruction in neonates: a single-center experience with 112 cases.

    Science.gov (United States)

    Son, Tran Ngoc; Kien, Hoang Huu

    2017-12-01

    A single center study was conducted to compare the short-term clinical outcome between laparoscopic surgery (LS) and open surgery (OS) repair for neonates with congenital duodenal obstruction (CDO). Medical records of all neonates with bodyweight at surgery over 1500g and without other gastrointestinal anomalies that underwent surgery (duodeno-duodenostomy or duodeno-jejunostomy) for CDO at our center between January 2009 and July 2015 were reviewed. The choice of OS or LS was surgeon-dependent. One hundred twelve patients were identified, with a median age and weight at surgery 8.5days and 2500g respectively. Forty-four patients underwent OS and 68 patients LS. There were no significant differences between the two groups regarding patient age, gender, weight at surgery, associated anomalies, and mean operative time. Compared to OS, the LS group had lower postoperative complications (5.9% vs 36.4%, p<0.0001), shorter mean time to initial oral feeding and mean postoperative hospital stay (3.9 vs. 7.1days and 8.6 vs. 12.9days respectively, p<0.0001) and better postoperative cosmesis. LS treatment for neonatal CDO is associated with lower postoperative morbidity, shorter recovery time and postoperative hospital stay and better postoperative cosmesis than OS. Retrospective Comparative Study. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. CVC related infections reported from Salam Center for Cardiac Surgery of Khartoum

    Directory of Open Access Journals (Sweden)

    Margherita Scapaticci

    2010-06-01

    Full Text Available Introduction: Central venous catheter (CVC plays an essential part in clinical management of patients admitted in Intensive Care Unit (ICU, even though catheterization is an invasive procedure that may facilitate bacterial migration from the skin surrounding the catheter insertion site to the catheter tip, representing a risk factor for the arise of bacteraemia and sepsis. Aim of our study was to assess the prevalence of micro-organisms found as responsibles of CVC-related infections and check their correspondence with those found in blood cultures collected from the same patients. Methods: The study was conduced from April 2008 to March 2009. In this period were analysed 29 CVC samples sent from ICU to the laboratory of the Salam Center for Cardiac Surgery of Khartoum (Sudan. CVC was removed after pericatheter skin disinfection and its tip was cut, put in a sterile container and finally sent to the laboratory, where it was immersed in Brain Heart Infusion (BHI and incubated at 37°C.A first culture of the sample on Blood Agar plate was done after an incubation period of 1 hour, the second one after 24 hours. In case of bacterial growth were practiced identification and sensitivity test of the isolated bacteria. Results: Of the 29 analysed samples 38% showed bacterial growth of which 27% caused by gram positive and 73% by gram negative bacteria. The identification tests showed also that among gram positive-related infection predominated those caused by Methicillin-Resistent Staphylococcus aureus (MRSA (67%, while among the gram negative infections predominated those caused by Pseudomonas spp (57%, followed by Enterobacter spp and Serratia spp. Conclusion: All the above mentioned infections were confirmed by examination of blood cultures collected simultaneously from the same patients. Furthermore the study showed that 73% of infections affected post-operative patients rather than those waiting for surgery.

  7. Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

    Science.gov (United States)

    Ristagno, Giuseppe; Beluffi, Simonetta; Tanzi, Dario; Belloli, Federica; Carmagnini, Paola; Croci, Massimo; D’Aviri, Giuseppe; Menasce, Guido; Pastore, Juan C.; Pellanda, Armando; Pollini, Alberto; Savoia, Giorgio

    2018-01-01

    (1) Background: This study evaluated the perioperative red blood cell (RBC) transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2) Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3) Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6%) required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008), significantly older, with a higher ASA grade (p = 0.0002), and with lower pre-surgery hemoglobin (HB) level and hematocrit (p < 0.0001). In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI) 2.84 (2.11–3.82)), a higher ASA class (1.77 (1.03–3.05)) and a longer operative time (1.02 (1.01–1.02)) were independently associated with RBC transfusion. (4) Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation. PMID:29385760

  8. Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

    Directory of Open Access Journals (Sweden)

    Giuseppe Ristagno

    2018-01-01

    Full Text Available (1 Background: This study evaluated the perioperative red blood cell (RBC transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2 Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3 Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6% required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008, significantly older, with a higher ASA grade (p = 0.0002, and with lower pre-surgery hemoglobin (HB level and hematocrit (p < 0.0001. In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI 2.84 (2.11–3.82, a higher ASA class (1.77 (1.03–3.05 and a longer operative time (1.02 (1.01–1.02 were independently associated with RBC transfusion. (4 Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation.

  9. Lung surgery

    Science.gov (United States)

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

  10. Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa.

    Science.gov (United States)

    Chowdhury, Sharfuddin; Nicol, Andrew John; Moydien, Mahammed Riyaad; Navsaria, Pradeep Harkison; Montoya-Pelaez, Luis Felipe

    2018-01-01

    The optimal timing for emergency surgical interventions and implementation of protocols for trauma surgery is insufficient in the literature. The Groote Schuur emergency surgery triage (GSEST) system, based on Cape Triaging Score (CTS), is followed at Groote Schuur Hospital (GSH) for triaging emergency surgical cases including trauma cases. The study aimed to look at the effect of delay in surgery after scheduling based on the GSEST system has an impact on outcome in terms of postoperative complications and death. Prospective audit of patients presenting to GSH trauma center following penetrating or blunt chest, abdominal, neck and peripheral vascular trauma who underwent surgery over a 4-month period was performed. Post-operative complications were graded according to Clavien-Dindo classification of surgical complications. One-hundred six patients underwent surgery during the study period. One-hundred two (96.2%) cases were related to penetrating trauma. Stab wounds comprised 71 (67%) and gunshot wounds (GSW) 31 (29.2%) cases. Of the 106 cases, 6, 47, 40, and 13 patients were booked as red, orange, yellow, and green, respectively. The median delay for green, yellow, and orange cases was within the expected time. The red patients took unexpectedly longer (median delay 48 min, IQR 35-60 min). Thirty-one (29.3%) patients developed postoperative complications. Among the booked red, orange, yellow, and green cases, postoperative complications developed in 3, 18, 9, and 1 cases, respectively. Only two (1.9%) postoperative deaths were documented during the study period. There was no statistically significant association between operative triage and post-operative complications ( p  = 0.074). Surgical case categorization has been shown to be useful in prioritizing emergency trauma surgical cases in a resource constraint high-volume trauma center.

  11. Establishment of computed tomography reference dose levels in Onassis Cardiac Surgery Center

    International Nuclear Information System (INIS)

    Tsapaki, V.; Kyrozi, E.; Syrigou, T.; Mastorakou, I.; Kottou, S.

    2001-01-01

    The purpose of the study was to apply European Commission (EC) Reference Dose Levels (RDL) in Computed Tomography (CT) examinations at Onassis Cardiac Surgery Center (OCSC). These are weighted CT Dose Index (CTDI w ) for a single slice and Dose-Length Product (DLP) for a complete examination. During the period 1998-1999, the total number of CT examinations, every type of CT examination, patient related data and technical parameters of the examinations were recorded. The most frequent examinations were chosen for investigation which were the head, chest, abdomen and pelvis. CTDI measurements were performed and CTDI w and DLP were calculated. Third Quartile values of CTDI w were chosen to be 43mGy for head, 8mGy for chest, and 22mGy for abdomen and pelvis examinations. Third quartile values of DLP were chosen to be 740mGycm for head, 370mGycm for chest, 490mGycm for abdomen and 420mGycm for pelvis examination. Results confirm that OCSC follows successfully the proposed RDL for the head, chest, abdomen and pelvis examinations in terms of radiation dose. (author)

  12. Dionis: A Novel Remote-Center-of-Motion Parallel Manipulator for Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    R. Beira

    2011-01-01

    Full Text Available The large volume and reduced dexterity of current surgical robotic systems are factors that restrict their effective performance. To improve the usefulness of surgical robots in minimally invasive surgery (MIS, a compact and accurate positioning mechanism, named Dionis, is proposed in this paper. This spatial hybrid mechanism based on a novel parallel kinematics is able to provide three rotations and one translation for single port procedures. The corresponding axes intersect at a remote center of rotation (RCM that is the MIS entry port. Another important feature of the proposed positioning manipulator is that it can be placed below the operating table plane, allowing a quick and direct access to the patient, without removing the robotic system. This, besides saving precious space in the operating room, may improve safety over existing solutions. The conceptual design of Dionis is presented in this paper. Solutions for the inverse and direct kinematics are developed, as well as the analytical workspace and singularity analysis. Due to its unique design and kinematics, the proposed mechanism is highly compact, stiff and its dexterity fullfils the workspace specifications for MIS procedures.

  13. Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center

    Directory of Open Access Journals (Sweden)

    Bauer NJ

    2016-05-01

    Full Text Available Natasha Johan Bauer Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK Background: Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of ­England and the British Medical Association. Methods: A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Results: Just over half (52% of the time, no handover took place. The majority of handovers (64% occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient’s age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. Conclusion: These findings were presented to the department, and a handover proforma

  14. Trends in refractive surgery at an academic center: 2007-2009

    OpenAIRE

    Kuo, Irene C

    2011-01-01

    Abstract Background The United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in t...

  15. A novel remote center of motion mechanism for the force-reflective master robot of haptic tele-surgery systems.

    Science.gov (United States)

    Hadavand, Mostafa; Mirbagheri, Alireza; Behzadipour, Saeed; Farahmand, Farzam

    2014-06-01

    An effective master robot for haptic tele-surgery applications needs to provide a solution for the inversed movements of the surgical tool, in addition to sufficient workspace and manipulability, with minimal moving inertia. A novel 4 + 1-DOF mechanism was proposed, based on a triple parallelogram linkage, which provided a Remote Center of Motion (RCM) at the back of the user's hand. The kinematics of the robot was analyzed and a prototype was fabricated and evaluated by experimental tests. With a RCM at the back of the user's hand the actuators far from the end effector, the robot could produce the sensation of hand-inside surgery with minimal moving inertia. The target workspace was achieved with an acceptable manipulability. The trajectory tracking experiments revealed small errors, due to backlash at the joints. The proposed mechanism meets the basic requirements of an effective master robot for haptic tele-surgery applications. Copyright © 2013 John Wiley & Sons, Ltd.

  16. How to set up a robotic-assisted laparoscopic surgery center and training of staff.

    Science.gov (United States)

    Lenihan, John P

    2017-11-01

    The use of computers to assist surgeons in the operating room has been an inevitable evolution in the modern practice of surgery. Robotic-assisted surgery has been evolving now for over two decades and has finally matured into a technology that has caused a monumental shift in the way gynecologic surgeries are performed. Prior to robotics, the only minimally invasive options for most Gynecologic (GYN) procedures including hysterectomies were either vaginal or laparoscopic approaches. However, even with over 100 years of vaginal surgery experience and more than 20 years of laparoscopic advancements, most gynecologic surgeries in the United States were still performed through an open incision. However, this changed in 2005 when the FDA approved the da Vinci Surgical Robotic System tm for use in gynecologic surgery. Over the last decade, the trend for gynecologic surgeries has now dramatically shifted to less open and more minimally invasive procedures. Robotic-assisted surgeries now include not only hysterectomy but also most all other commonly performed gynecologic procedures including myomectomies, pelvic support procedures, and reproductive surgeries. This success, however, has not been without controversies, particularly around costs and complications. The evolution of computers to assist surgeons and make minimally invasive procedures more common is clearly a trend that is not going away. It is now incumbent on surgeons, hospitals, and medical societies to determine the most cost-efficient and productive use for this technology. This process is best accomplished by developing a Robotics Program in each hospital that utilizes robotic surgery. Copyright © 2017. Published by Elsevier Ltd.

  17. Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery

    Directory of Open Access Journals (Sweden)

    Ahmet Kale

    Full Text Available ABSTRACT Objective: To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique. Materials and Methods: Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed. Results: The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period. Conclusion: Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolapse surgery. Pectopexy may increase a surgeon's technical perspective for apical prolapse surgery.

  18. Custodiol versus blood cardioplegia in pediatric cardiac surgery, two-center study

    Directory of Open Access Journals (Sweden)

    Ebtehal A. Qulisy

    2016-05-01

    Conclusions: Custodial cardioplegia is associated with less optimal myocardial protection and higher adverse outcomes compared to cold blood cardioplegia in children undergoing cardiac surgery. A randomized comparison is warranted.

  19. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1: ASC software quality engineering practices, Version 2.0.

    Energy Technology Data Exchange (ETDEWEB)

    Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Minana, Molly A.; Hackney, Patricia; Forsythe, Christi A.; Schofield, Joseph Richard, Jr. (,; .); Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2006-09-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  20. A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center

    OpenAIRE

    Soleimanha, Mehran; Haghighi, Mohammad; Mirbolook, Ahmadreza; Sedighinejad, Abbas; Mardani-Kivi, Mohsen; Naderi-Nabi, Bahram; Chavoshi, Tahereh; Mehrnoosh, Mehrnoosh Ghandili

    2016-01-01

    Background: Increased costs and mortality associated with inappropriate blood transfusions have led to investigations about blood request and blood transfusion techniques. We investigated the transfusion status in patients who underwent orthopedic surgery in Poursina Hospital (Rasht, Iran) to optimizing blood usage and determine if a scheduled transfusion program for every orthopedic surgery could improve blood transfusion management. Method: In this descriptive-prospective study, all orthop...

  1. A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center

    Directory of Open Access Journals (Sweden)

    Mehran Soleimanha

    2016-01-01

    Full Text Available Background: Increased costs and mortality associated with inappropriate blood transfusions have led to investigations about blood request and blood transfusion techniques. We investigated the transfusion status in patients who underwent orthopedic surgery in Poursina Hospital (Rasht, Iran to optimizing blood usage and determine if a scheduled transfusion program for every orthopedic surgery could improve blood transfusion management. Method: In this descriptive-prospective study, all orthopedic surgeries in Poursina Hospital, Rasht, between April to June 2013 were reviewed. All patient information was recorded, including: demographics, type of surgery, hemoglobin level, cross-match test, duration of surgery, and blood loss, and transfusion. Based on the one-way ANOVA and independent samples test analysis, cross-match to transfusion ratio and transfusion possibility, the transfusion index, and maximal surgical blood order schedule were calculated to determine blood transfusion status. Results: Among 872 selected orthopedic surgery candidates, 318 of them were cross-matched and among those, 114 patients received a blood transfusion. In this study, the cross-match to transfusion ratio was 6.4, transfusion possibility 36.47%, transfusion index 0.6, and maximal surgical blood order schedule 0.9. Conclusion: We found that blood ordering was moderately higher than the standard; so it is highly recommended to focus on the knowledge of evidence based on transfusion and standard guidelines for blood transfusion to avoid over-ordering.

  2. Colon and rectal surgery for cancer without mechanical bowel preparation: one-center randomized prospective trial.

    Science.gov (United States)

    Scabini, Stefano; Rimini, Edoardo; Romairone, Emanuele; Scordamaglia, Renato; Damiani, Giampiero; Pertile, Davide; Ferrando, Valter

    2010-04-30

    Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. The aim of the study was to assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation. Patients undergoing elective colon and rectal resections with primary anastomosis were prospectively randomized into two groups. Group A had mechanical bowel preparation with polyethylene glycol before surgery, and group B had their surgery without preoperative mechanical bowel preparation. Patients were followed up for 30 days for wound, anastomotic, and intra-abdominal infectious complications. Two hundred forty four patients were included in the study, 120 in group A and 124 in group B. Demographic characteristics, type of surgical procedure and type of anastomosis did not significantly differ between the two groups. There was no difference in the rate of surgical infectious complications between the two groups but the overall infectious complications rate was 20.0% in group A and 11.3% in group B (p .05). Wound infection (p = 0.18), anastomotic leak (p = 0.52), and intra-abdominal abscess (p = 0.36) occurred in 9.2%, 5.8%, and 5.0% versus 4.8%, 4.0%, and 2.4%, respectively. No mechanical bowel preparation seems to be safe also in rectal surgery. These results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.

  3. Nutrition adequacy in enhanced recovery after surgery: a single academic center experience.

    Science.gov (United States)

    Gillis, Chelsia; Nguyen, Thi Haiyen; Liberman, A Sender; Carli, Francesco

    2015-06-01

    A prospective observational study was initiated to determine the prevalence of nutrition risk before surgery and assess nutrition adequacy of food choices after elective colorectal surgery. Patient-Generated Subjective Global Assessment was used to screen all preoperative clinic patients (n = 70) scheduled for elective colorectal surgery. Adequacy of dietary intake (n = 40) was determined for the first 3 postoperative days by estimating total energy and protein intake from leftover food at each meal based on standard hospital portions with food composition tables. Food access questionnaire provided a rationale for observed food intake. All patients received Enhanced Recovery After Surgery (ERAS) and room service system care. Before surgery, 63% of patients were considered well-nourished, 29% suspected or moderately undernourished, and 8% severely undernourished. Fifty-one percent of patients scored > 4 on the Patient-Generated Subjective Global Assessment, indicating requirement for dietary intervention or symptom management. On average, 77% ± 27%, 63% ± 28%, and 92% ± 39% of energy requirements were met on postoperative days 1, 2, and 3, respectively; conversely, 55% ± 24%, 43% ± 16%, and 45% ± 12% of protein requirements were met. Most common reasons for missed meals included loss of appetite and feelings of fatigue or worry. Preoperative nutrition risk tended to result in a greater 30-day hospital readmission rate compared to well-nourished patients (P = .07). A third of patients scheduled for elective colorectal surgery were at nutrition risk. An acceptable intake of dietary protein was not achieved during the first 3 days of hospitalization. Preoperative nutrition education, as part of Enhanced Recovery Programs, may be useful to optimize nutrition status before surgery to mitigate clinical consequences associated with undernutrition and empower patients to make adequate food choices for recovery. NCT 01727570. © 2014 American Society for Parenteral and

  4. [Incidence of postoperative venous thromboembolism after thoracic surgery and its characteristic: a single center, prospective cohort study].

    Science.gov (United States)

    Song, C F; Li, H; Tian, B; Chen, S; Miao, J B; Fu, Y L; You, B; Chen, Q R; Li, T; Hu, X X; Zhang, W Q; Hu, B

    2018-04-01

    Objective: To evaluate the incidence of postoperative venous thromboembolism (VTE) after thoracic surgery and its characteristic. Methods: This was a single-center, prospective cohort study. Patients undergoing major thoracic surgeries between July 2016 and March 2017 at Department of Thoracic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University were enrolled in this study. Besides the routine examination, all patients were screened for deep venous thrombosis (DVT) by using noninvasive duplex lower-extremity ultrasonography after surgery. CT pulmonary angiography (CTPA) was carried out if patients had one of the following conditions including typical symptoms of PE, high Caprini score (>9 points) or new diagnosed postoperative DVT. Caprini risk assessment model was used to detect high risk patients. No patients received any prophylaxis of VTE before surgery. Further data was analyzed for identifying the incidence of postoperative VTE. The t -test, χ 2 test or Wilcoxon rank-sum test was used to analyze the quantitative data and classification data, respectively. Results: Totally 345 patients who undergoing major thoracic surgery were enrolled in this study including 145 benign diseases and 200 malignant diseases.There were 207 male and 138 female, aging from 15 to 85 years. Surgery procedures included 285 lung surgeries, 27 esophagectomies, 22 mediastinal surgeries and 11 other procedures. The overall incidence of VTE was 13.9% (48 of 345) after major thoracic surgery including 39 patients with newly diagnosed DVT (81.2%), 1 patient with PE (2.1%) and 8 patients with DVT+ PE (16.7%). The median time of VTE detected was 4.5 days postoperative. There were 89.6% (43/48) VTE cases diagnosed in 1 week. The incidence of VTE was 9.0% in patients with benign diseases, while 17.5% in malignant diseases (χ 2 =5.112, P patients with pulmonary diseases was 12.6%, among that, in patients with lung cancer and benign lung diseases was 16.4% and 7.5 % (χ 2

  5. Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences

    Directory of Open Access Journals (Sweden)

    Wolfram Malter

    2014-01-01

    Full Text Available Breast-conserving surgery followed by whole-breast irradiation is the standard local therapy for early breast cancer. The international discussion of reduced importance of wider tumor-free resection margins than “tumor not touching ink” leads to the development of five principles in targeted oncoplastic breast surgery. IORT improves local recurrence risk and diminishes toxicity since there is less irradiation of healthy tissue. Intraoperative radiotherapy (IORT can be delivered in two settings: an IORT boost followed by a conventional regimen of external beam radiotherapy or a single IORT dose. The data from TARGIT-A and ELIOT reinforce the conviction that intraoperative radiotherapy during breast-conserving surgery is a reliable alternative to conventional postoperative fractionated irradiation, but only in a carefully selected population at low risk of local recurrence. We describe our experiences with IORT boost (50 kV energy X-rays; 20 Gy in combination with targeted oncoplastic breast surgery in a routine clinical setting. Our experiences demonstrate the applicability and reliability of combining IORT boost with targeted oncoplastic breast surgery in breast-conserving therapy of early breast cancer.

  6. Extended Operation of Stirling Convertors at NASA Glenn Research Center

    Science.gov (United States)

    Oriti, Salvatore, M.

    2012-01-01

    NASA Glenn Research Center (GRC) has been supporting development of free-piston Stirling conversion technology for spaceflight electrical power generation since 1999. GRC has also been supporting the development of the Advanced Stirling Radioisotope Generator (ASRG) since 2006. A key element of the ASRG project is providing life, reliability, and performance data for the Advanced Stirling Convertor (ASC). The Thermal Energy Conversion branch at GRC is conducting extended operation of several free-piston Stirling convertors. The goal of this effort is to generate long-term performance data (tens of thousands of hours) on multiple units to build a life and reliability database. Currently, GRC is operating 18 convertors. This hardware set includes Technology Demonstration Convertors (TDCs) from Infinia Corporation, of which one pair (TDCs #13 and #14) has accumulated over 60,000 hr (6.8 years) of operation. Also under test are various Sunpower, Inc. convertors that were fabricated during the ASC development activity, including ASC-0, ASC-E (including those in the ASRG engineering unit), and ASC-E2. The ASC-E2s also completed, or are in progress of completing workmanship vibration testing, performance mapping, and extended operation. Two ASC-E2 units will also be used for durability testing, during which components will be stressed to levels above nominal mission usage. Extended operation data analyses from these tests are covered in this paper.

  7. Center edge angle measurement for hip preservation surgery: technique and caveats.

    Science.gov (United States)

    Anderson, Lucas A; Gililland, Jeremy; Pelt, Christopher; Linford, Samuel; Stoddard, Gregory J; Peters, Christopher L

    2011-01-01

    Anterior and lateral center edge angles have traditionally been used to determine acetabular coverage, and thereby strongly influence the decision to perform acetabular reorientation versus osteochondroplasty in patients with dysplasia and/or femoroacetabular impingement. We propose templating the center of the contained articular femoral head in aspherical hips to provide reliable assessment of acetabular coverage. Digital radiographs of 30 patients with various combinations of femoral and acetabular morphologies were evaluated using 2 methods to identify the anterior center edge angle and lateral center edge angle. The control method used an estimated femoral head center for angle apex. The study technique determined the center of the femoral head by templating the congruent aspect of the femoral head contained by the acetabulum while ignoring the increasing lateral and anterior radius associated with cam deformities. Four readers measured lateral center edge angles on anteroposterior radiographs and anterior center edge angles on false-profile radiographs. Two reads were performed by each reader using both the estimated and the templated methods for a total of 4 reads. Interobserver reliability using the proposed method compared to the standard was much improved for anterior center edge angles (intraclass correlation coefficient of 0.76 vs 0.55) as well as with lateral center edge angles (ICC of 0.80 vs 0.42). Decreased correlation was most commonly associated with abnormal sourcil morphology, posterior wall deficiency combined with calcified labra, and os acetabuli. Including the anterolateral cam deformity in identifying the center of the femoral head for measuring center edge angles leads to an underestimation of acetabular coverage, which may negatively affect hip preservation surgical decision making. Copyright 2011, SLACK Incorporated.

  8. Towards patient-centered colorectal cancer surgery : focus on risks, decisions and clinical auditing

    NARCIS (Netherlands)

    Snijders, Heleen Simone

    2014-01-01

    The aim of this thesis was to explore several aspects of both clinical decision making and quality assessment in colorectal cancer surgery. Part one focusses on benefits and risks of treatment options, preoperative information provision and Shared Decision Making (SDM); part two investigates changes

  9. Mental Health Support Provided Throughout the Bariatric Surgery Clinical Pathway in French Specialized Care Centers for Obesity.

    Science.gov (United States)

    Lamore, Kristopher; Kaci, Sandra S; Czernichow, Sébastien; Bretault, Marion; Bouillot, Jean-Luc; Naudé, Anne-Jeanne; Gribe-Ouaknine, Sandra; Carette, Claire; Flahault, Cécile

    2017-03-01

    Pre-operative psychological assessment is recommended by international guidelines for bariatric surgery candidates. Thereby, service teams caring for bariatric patients should include at least one mental health provider (e.g., a psychologist or psychiatrist). The objective of this study was to evaluate the psychology and psychiatry resources and practices in the 37 specialized obesity centers (CSOs) created by the French Ministry of Health. CSO coordinators were contacted by e-mail to collect general information on the centers (e.g., number of bariatric operations). Secondly, psychologists and psychiatrists of each center completed an anonymous questionnaire assessing their professional practices and their organization of care pathways. The vast majority of CSO coordinators (81%, n = 26/32) answered our survey. These results show significant differences and shortages in terms of the psychology/psychiatry resources available. Most of the psychologists (n = 26/31) and psychiatrists (n = 10/10) stated that they systematically meet new patients only before surgery (56%) or both before and after the operation (30%); however, some psychologists and psychiatrists (14%) do not systematically meet all the patients (before and/or after surgery). Nevertheless, all the professionals provide psychology assessments, and about 75% of them offer a psychological follow-up, indicating a similarity regarding the practices of psychologists and psychiatrists. Our results highlight the place of psychological/psychiatric evaluations in French CSOs and emphasize the absence of mental health providers in several of these services. Post-operative psychological follow-up is not usually provided. It would be appropriate to create clear recommendations for post-operative psychological or psychiatric long-term follow-up.

  10. Hepatic Steatosis Following Pancreatic Surgery: A Swedish Centers Experience with Demographics, Risks and Outcome

    OpenAIRE

    Tommy Ivanics; Srinivas Sanjeevi; Christoph Ansorge; Åke Andrén-Sandberg

    2015-01-01

    Objective Non-alcoholic fatty liver disease encompasses a spectrum of fatty changes in the liver ranging from simple steatosis to nonalcoholic steatohepatitis. Certain patients may develop hepatic steatosis following pancreatic resections. The aim of our study was to investigate factors possibly associated with steatosis after pancreatic resection and to see if the survival of patients was influenced by its development. Methods 182 consecutive patients that underwent pancreatic surgery (betwe...

  11. Outcome of Transsphenoidal Surgery for Cushing Disease: A Single-Center Experience Over 32 Years.

    Science.gov (United States)

    Chandler, William F; Barkan, Ariel L; Hollon, Todd; Sakharova, Alla; Sack, Jayson; Brahma, Barunashish; Schteingart, David E

    2016-02-01

    Transsphenoidal surgery is the standard approach for treating Cushing disease. Evidence is needed to document effectiveness. To analyze results of transsphenoidal surgery in 276 consecutive patients, including 19 children. Medical records were reviewed for patients treated initially with surgery for Cushing disease from 1980 to 2012. Radiographic features, pathology, remissions, recurrences, and complications were recorded. Patients were categorized for statistical analysis based on tumor size (microadenomas, macroadenomas, and negative imaging) and remission type (type 1 = morning cortisol ≤3 μg/dL; type 2 = morning cortisol normal). Females comprised 78% of patients and were older than men. Imaging showed 50% microadenomas, 13% macroadenomas, and 37% negative for tumor. Remission rates for microadenomas, macroadenomas, and negative imaging were 89%, 66%, and 71%, respectively. Patients with microadenomas were more likely to have type 1 remission. Pathology showed adrenocorticotropic hormone-secreting adenomas in 82% of microadenomas, in 100% of macroadenomas, and in 43% of negative imaging. The incidence of hyperplasia was 8%. The finding of hyperplasia or no tumor on pathology predicted treatment failure. The recurrence rate was 17%, with an average time to recurrence of 4.0 years. Patients with type 1 remission had a lower rate of recurrence (13% type 1 vs 50% type 2) and a longer time to recurrence. Children had similar imaging findings, remission rates, and pathology. There were no operative deaths. Transsphenoidal surgery provides a safe and effective treatment for Cushing disease. For both adults and children, the best outcomes occurred in patients with microadenomas and/or those with type 1 remission.

  12. Pleural Effusion in Spinal Deformity Correction Surgery- A Report of 28 Cases in a Single Center.

    Directory of Open Access Journals (Sweden)

    Weiqiang Liang

    Full Text Available To analyze the occurrence, risk factors, treatment and prognosis of postoperative pleural effusion after spinal deformity correction surgery.The clinical and imaging data of 3325 patients undergoing spinal deformity correction were collected from the database of our hospital. We analyzed the therapeutic process of the 28 patients who had postoperative pleural effusion, and we identified the potential risk factors using logistic regression.Among the 28 patients with postoperative pleural effusion, 24 (85.7% suffered from hemothorax, 2 (7.1% from chylothorax, and 2 (7.1% from subarachnoid-pleural fistula. The pleural effusion occurred on the convex side in 19 patients (67.9%, on the concave side in 4 patients (14.3%, and on both sides in 4 patients (14.3%. One patient with left hemothorax was diagnosed with kyphosis. The treatment included conservative clinical observation for 5 patients and chest tube drainage for 23 patients. One patient also underwent thoracic duct ligation and pleurodesis. All of these treatments were successful. Logistic regression analysis showed that adult patients(≥18 years old, congenital scoliosis, osteotomy and thoracoplasty were risk factors for postoperative pleural effusion in spinal deformity correction surgery.The incidence of postoperative pleural effusion in spinal deformity correction surgery was approximately 0.84% (28/3325, and hemothorax was the most common type. Chest tube drainage treatment was usually successful, and the prognosis was good. Adult patients(≥18 years old, congenital scoliosis, and had undergone osteotomy or surgery with thoracoplasty were more likely to suffer from postoperative pleural effusion.

  13. Conversion of laparoscopic surgery for perforated peptic ulcer: a single-center study.

    Science.gov (United States)

    Zimmermann, Markus; Hoffmann, Martin; Laubert, Tilman; Jung, Carlo; Bruch, Hans-Peter; Schloericke, Erik

    2015-11-01

    A perforated peptic ulcer can be managed laparoscopically in selected patients. The purpose of this study was to evaluate whether conversion of emergency laparoscopy is inferior to primary median laparotomy in terms of postoperative morbidity and mortality. We analyzed patients who underwent laparoscopic or open surgery for a perforated peptic ulcer at the Department of Surgery, University of Schleswig-Holstein, Campus Luebeck between January, 1996 and December, 2010. Perforations were graded according to the Boey classification, a preoperative risk-scoring system. Conversion to laparotomy was necessary in 20 of the 45 patients who underwent laparoscopic surgery (CG); therefore, laparoscopic operations were completed in 25 patients (LG). The third patient cohort comprised 139 patients who underwent primary laparotomy (OG). Overall minor morbidity was significantly lower (p = 0.048) in the LG patients than in the OG patients, whereas no significant differences were found in major morbidity and mortality, particularly between the OG and CG. Patients' suitability for laparoscopic management should be decided on according to Boey's clinical scoring system. Our findings demonstrated that conversion from laparoscopy to laparotomy was not associated with elevated postoperative morbidity or mortality versus initial laparotomy. Therefore, emergency operations may be commenced laparoscopically in selected patients, especially considering the postoperative advantages of this approach.

  14. Perioperative allogenic blood transfusion is a poor prognostic factor after hepatocellular carcinoma surgery: a multi-center analysis.

    Science.gov (United States)

    Wada, Hiroshi; Eguchi, Hidetoshi; Nagano, Hiroaki; Kubo, Shoji; Nakai, Takuya; Kaibori, Masaki; Hayashi, Michihiro; Takemura, Shigekazu; Tanaka, Shogo; Nakata, Yasuyuki; Matsui, Kosuke; Ishizaki, Morihiko; Hirokawa, Fumitoshi; Komeda, Koji; Uchiyama, Kazuhisa; Kon, Masanori; Doki, Yuichiro; Mori, Masaki

    2018-01-01

    The influence of allogenic blood transfusion on the postoperative outcomes of hepatocellular carcinoma (HCC) surgery remains controversial. This study aims to clarify the clinical impacts of perioperative allogenic blood transfusion on liver resection outcome in HCC patients. We analyzed data collected over 5 years for 642 patients who underwent hepatectomy for HCC at one of the five university hospitals. We investigated the impact of allogenic blood transfusion on postoperative outcome after surgery in all patients and in 74 matched pairs, using a propensity score. Of the 642 patients, 198 (30.8%) received perioperative allogenic blood transfusion (AT group) and 444 (69.2%) did not (non-AT group). Overall survival was lower in the AT group than in the non-AT group in univariate (P blood transfusion was found to be a poor prognostic factor for HCC patients. In this multi-center study, perioperative blood transfusion was an independent factor for poor prognosis after curative surgery for primary HCC in the patient group and in pairs matched by propensity scores.

  15. Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center.

    Science.gov (United States)

    Grigorie, Răzvan; Alexandrescu, Sorin; Smira, Gabriela; Ionescu, Mihnea; Hrehoreţ, Doina; Braşoveanu, Vladislav; Dima, Simona; Ciurea, Silviu; Boeţi, Patricia; Dudus, Ionut; Picu, Nausica; Zamfir, Radu; David, Leonard; Botea, Florin; Gheorghe, Liana; Tomescu, Dana; Lupescu, Ioana; Boroş, Mirela; Grasu, Mugur; Dumitru, Radu; Toma, Mihai; Croitoru, Adina; Herlea, Vlad; Pechianu, Cătălin; Năstase, Anca; Popescu, Irinel

    2017-01-01

    Background: The objective of this study is to assess the outcome of the patients treated for hepatocellular carcinoma (HCC) in a General Surgery and Liver Transplantation Center. Methods: This retrospective study includes 844 patients diagnosed with HCC and surgically treated with curative intent methods. Curative intent treatment is mainly based on surgery, consisting of liver resection (LR), liver transplantation (LT). Tumor ablation could become the choice of treatment in HCC cases not manageable for surgery (LT or LR). 518 patients underwent LR, 162 patients benefited from LT and in 164 patients radiofrequency ablation (RFA) was performed. 615 patients (73%) presented liver cirrhosis. Results: Mordidity rates of patient treated for HCC was 30% and mortality was 4,3% for the entire study population. Five year overall survival rate was 39 % with statistically significant differences between transplanted, resected, or ablated patients (p 0.05) with better results in case of LT followed by LR and RFA. Conclusions: In HCC patients without liver cirrhosis, liver resection is the treatment of choice. For early HCC occurred on cirrhosis, LT offers the best outcome in terms of overall and disease free survival. RFA colud be a curative method for HCC patients not amenable for LT of LR. Celsius.

  16. Vanderbilt Free-Electron Laser Center for Research in Surgery Medicine Photobiology and Materials Science

    National Research Council Canada - National Science Library

    Piston, David

    2004-01-01

    .... These studies involve substantial collaborations with all the other FEL centers: dermatology with the Wellman Laboratories, infection and cancer diagnosis with Stanford, bone and cartilage ablation with UC Irvine, neurosurgery with Duke...

  17. Measuring the three process segments of a customer's service experience for an out-patient surgery center.

    Science.gov (United States)

    Wicks, Angela M; Chin, Wynne W

    2008-01-01

    The purpose of this research is to develop an alternative method of measuring out-patient satisfaction where satisfaction is the central construct. The Gap Model operationalized by SERVQUAL is widely used to measure service quality. However, the SERVQUAL instrument only measures expectations (resulting from the pre-process segment of the service experience) and perceptions (resulting from the post-process segment). All three segments should be measured. The lack of proper segmentation and methodological criticisms in the literature motivated this study. A partial least squares (PLS) approach, a form of structural equation modeling, is used to develop a framework to evaluate patient satisfaction in three service process segments: pre-process, process, and post-process service experiences. Results indicate that each process stage mediates subsequent stages, that the process segment is the most important to the patient and that the antecedents have differing impacts on patient satisfaction depending where in the process the antecedent is evaluated. Only one out-patient surgery center was evaluated. Patient satisfaction criteria specific to hospital selection are not included in this study. Results indicate what is important to patients in each service process segment that focus where ambulatory surgery centers should allocate resources. This study is the first to evaluate patient satisfaction with all three process segments.

  18. Bariatric surgery and incidental gastrointestinal stromal tumors - a single-center study: VSJ Competition, 1st place.

    Science.gov (United States)

    Walędziak, Maciej; Różańska-Walędziak, Anna; Kowalewski, Piotr K; Janik, Michał R; Brągoszewski, Jakub; Paśnik, Krzysztof

    2017-09-01

    Gastrointestinal stromal tumors (GISTs), originating from Cajal cells, are most commonly located in the stomach; therefore they can be found in the specimens excised during bariatric operations. The global prevalence of GISTs is about 130 cases per million population. Morbidity differs depending on geographical latitude. Although surgery is the treatment of choice for GISTs, 40-50% of patients after radical surgical treatment will have a relapse or metastases. To analyze the incidence of GISTs in patients undergoing bariatric surgery and to verify whether an operation performed according to the bariatric protocol is oncologically radical in case of GIST. A single-center retrospective study. The study group comprised 1252 obese patients qualified for bariatric procedures, with no upper gastrointestinal tract neoplasms found during preoperative diagnostic examinations. In case of suspicious macroscopic pathologies (n = 81) present during the operation, tissue specimens underwent histopathological examination with further investigation performed if GISTs were found, including tumor size and localization, mitotic index and immunohistochemical analysis. Gastrointestinal stromal tumors were found in 16 cases, and benign tumors of various histological origin in 33 cases. All cases of GIST found came from stomach specimens, 7 from the gastric corpus vs. 9 from the fundus. Fourteen GISTs were found during laparoscopic sleeve gastrectomies (LSGs) vs. 2 during laparoscopic Roux-en-Y gastric bypasses (LRYGBs). In case of incidental findings of GISTs during bariatric surgery, tumor resection with negative margins of incision may be considered as complete oncological treatment if there was very low/low risk stratification of GIST's recurrence after surgery.

  19. Bariatric Surgery to Target Obesity in the Renal Transplant Population: Preliminary Experience in a Single Center.

    Science.gov (United States)

    Gazzetta, P G; Bissolati, M; Saibene, A; Ghidini, C G A; Guarneri, G; Giannone, F; Adamenko, O; Secchi, A; Rosati, R; Socci, C

    2017-05-01

    During the last century, obesity has become a global epidemic. The effect of obesity on renal transplantation may occur in perioperative complications and impairment of organ function. Obese patients have metabolic derangements that can be exacerbated after transplantation and obesity directly impacts most transplantation outcomes. These recipients are more likely to develop adverse graft events, such as delayed graft function and early graft loss. Furthermore, obesity is synergic to some immunosuppressive agents in triggering diabetes and hypertension. As behavioral weight loss programs show disappointing results in these patients, bariatric surgery has been considered as a means to achieve rapid and long-term weight loss. Up-to-date literature shows laparoscopic bariatric surgery is feasible and safe in transplantation candidates and increases the rate of transplantation eligibility in obese patients with end-stage organ disease. There is no evidence that restrictive procedures modify the absorption of immunosuppressive medications. From 2013 to 2016 we performed six bariatric procedures (sleeve gastrectomy) on obese patients with renal transplantation; mean preoperative body mass index (BMI) was 39.8 kg/m 2 . No postoperative complication was observed and no change in the immunosuppressive medications regimen was needed. Mean observed estimated weight loss was 27.6%, 44.1%, 74.2%, and 75.9% at 1, 3, 6, and 12 months follow-up, respectively. Our recommendation is to consider patients with BMI >30 kg/m 2 as temporarily ineligible for transplantation and as candidates to bariatric surgery if BMI >35 kg/m 2 . We consider laparoscopic sleeve gastrectomy as a feasible, first-choice procedure in this specific population. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center.

    Science.gov (United States)

    Gondim, Jackson A; Schops, Michele; de Almeida, João Paulo C; de Albuquerque, Lucas Alverne F; Gomes, Erika; Ferraz, Tânia; Barroso, Francisca Andréa C

    2010-01-01

    Pituitary tumors are challenging tumors in the sellar region. Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The introduction of the endoscope have revolutionized pituitary surgery. The aim of this study is to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach and to evaluate the efficacy and safety of this procedure. We reviewed the data of 228 consecutive patients who underwent endonasal transsphenoidal adenoma removal over an 10-year period. Pre- and post-operative hormonal status (at least 3 months after surgery) were analyzed and compared with clinical parameters presented by the patients. Tumor removal rate, endocrinological outcomes, and complications were retrospectively assessed in 228 patients with pituitary adenomas who underwent 251 procedures between December 1998 and December 2007. There were 93 nonfunctioning adenomas, 58 growth hormone-secreting, 41 prolactin-secreting, 28 adrenocorticotropin hormone secreting, 7 FSH-LH secreting and 1 thyroid-stimulating hormone-secreting adenomas. Gross total removal was achieved in 79.3% of the cases after a median follow-up of 61.5 months. The remission results for patients with nonfunctioning adenomas was 83% and for functioning adenomas were 76.3% (70.6% for GH hormone-secreting, 85.3% for prolactin hormone-secreting, 71.4% for ACTH hormone-secreting, 85.7% for FSH-LH hormone-secreting and 100% for TSH hormone-secreting), with no recurrence at the time of the last follow-up. Post-operative complications were present in 35 (13.9%) cases. The most frequent complications were temporary and permanent diabetes insipidus (six and two cases, respectively), syndrome of inappropriate antidiuretic hormone secretion (two cases) and CSF leaks (eight cases). There was no death related to the procedure in this series. The endoscopic endonasal approach for resection of pituitary adenomas, provides

  1. Cost analysis of intraoperative frozen section examinations in thyroid surgery in a Canadian tertiary center.

    Science.gov (United States)

    Lai, Philip; Segall, Lorne; de Korompay, Nevin; Witterick, Ian; Freeman, Jeremy

    2009-10-01

    To perform a cost analysis of the routine intraoperative frozen section (FS) examinations in the management of patients undergoing thyroid surgery for unilateral thyroid nodules with benign or indeterminate cytology on preoperative fine-needle aspiration biopsies (FNABs). A retrospective chart review of 190 consecutive patients with unilateral thyroid nodules undergoing thyroid surgery was undertaken between March 2006 and March 2008. The results of FNAB, FS, and final histology were obtained from the pathology report. A cost analysis was performed to compare the cost of routine FS examinations to determine malignancy with the cost of performing a second surgical procedure. Of the 169 patients evaluated, there were 53 cases of malignant nodules. Malignancy was diagnosed by FS in 16 of these 53 cases, resulting in a total thyroidectomy and thereby avoiding the need for a completion thyroidectomy. The sensitivity and specificity of FS examination were 30.2% and 100.0%, respectively. The routine use of intraoperative FS examination in cases of benign or indeterminate nodules afforded a total cost savings of $3719.27, or a cost savings of $22.01 per patient. FS examination was useful in guiding our intraoperative management for patients with unilateral thyroid nodules with benign or indeterminate preoperative FNAB. The routine use of FS was cost-effective in our Canadian health care system, even without considering the intangible costs, such as patients' anxiety, emotional stress, and the loss of productivity owing to a second surgical procedure.

  2. Experience of two trauma-centers with pancreatic injuries requiring immediate surgery.

    Science.gov (United States)

    Ouaïssi, Mehdi; Sielezneff, Igor; Chaix, Jean Baptiste; Mardion, Remi Bon; Pirrò, Nicolas; Berdah, Stéphane; Emungania, Olivier; Consentino, Bernard; Cresti, Silvia; Dahan, Laetitia; Orsoni, Pierre; Moutardier, Vincent; Brunet, C; Sastre, Bernard

    2008-01-01

    Pancreatic injury from blunt trauma is infrequent. The aim of the present study was to evaluate a simplified approach of management of pancreatic trauma injuries requiring immediate surgery consisting of either drainage in complex situation or pancreatectomy in the other cases. From January 1986 to December 2006, 40 pancreatic traumas requiring immediate surgery were performed. Mechanism of trauma, clinical and laboratories findings were noted upon admission, classification of pancreatic injury according to Lucas' classification were considered. Fifteen (100%) drainages were performed for stage I (n=15), 60% splenopancreatectomies and 40% drainage was achieved for stage II (n=18), 3 Pancreaticoduonectomies and 2 exclusion of duodenum with drainage and 2 packing were performed for stage IV (n=7). There were 30 men and 10 women with mean age of 29+/-13 years (15-65). Thirty-eight patients had multiple trauma. Overall, mortality and global morbidity rate were 17% and 65% respectively, and the rates increased with Lucas' pancreatic trauma stage. Distal pancreatectomy is indicated for distal injuries with duct involvement, and complex procedures such as pancreaticoduodenectomy should be performed in hemodynamically stable patients.

  3. Improved Early Cleft Lip and Palate Complications at a Surgery Specialty Center in the Developing World.

    Science.gov (United States)

    Park, Eugene; Deshpande, Gaurav; Schonmeyr, Bjorn; Restrepo, Carolina; Campbell, Alex

    2018-01-01

    To evaluate complication rates following cleft lip and cleft palate repairs during the transition from mission-based care to center-based care in a developing region. We performed a retrospective review of 3419 patients who underwent cleft lip repair and 1728 patients who underwent cleft palate repair in Guwahati, India between December 2010 and February 2014. Of those who underwent cleft lip repair, 654 were treated during a surgical mission and 2765 were treated at a permanent center. Of those who underwent cleft palate repair, 236 were treated during a surgical mission and 1491 were treated at a permanent center. Two large surgical missions to Guwahati, India, and the Guwahati Comprehensive Cleft Care Center (GCCCC) in Assam, India. Overall complication rates following cleft lip and cleft palate repair. Overall complication rates following cleft lip repair were 13.2% for the first mission, 6.7% for the second mission, and 4.0% at GCCCC. Overall complication rates following cleft palate repair were 28.0% for the first mission, 30.0% for the second mission, and 15.8% at GCCCC. Complication rates following cleft palate repair by the subset of surgeons permanently based at GCCCC (7.2%) were lower than visiting surgeons ( P cleft care delivery in the developing world can lead to decreased complication rates.

  4. Improving Communication Skills: A Course for Academic Medical Center Surgery Residents and Faculty.

    Science.gov (United States)

    Raper, Steven E; Gupta, Meera; Okusanya, Olugbenga; Morris, Jon B

    2015-01-01

    To improve physician/patient communication and familiarize surgeons with contemporary skills for and metrics assessing communication, courses were developed to provide academic general surgery residents and faculty with a toolkit of information, behaviors, and specific techniques. If academic faculty are expected to mentor residents in communication and residents are expected to learn good communication skills, then both should have the necessary education to accomplish such a goal. Didactic lectures introduced current concepts of physician-patient communication including information on better patient care, fewer malpractice suits, and the move toward transparency of communication metrics. Next, course participants viewed and critiqued "Surgi-Drama" videos, with actors simulating "before" and "after" physician-patient communication scenarios. Finally, participants were provided with a "toolkit" of techniques for improving physician-patient communication including "2-3-4"-a semiscripted short communication tool residents and other physicians can use in patient encounters-and a number of other acronymic approaches. Each participant was asked to complete an anonymous evaluation to assess course content satisfaction. Overall, 86% of residents participated (68/79), with a 52% response rate (35/68) for the evaluation tool. Overall, 88% of faculty participated (84/96), with an 84% response rate (71/84). Residents voiced satisfaction with all domains. For faculty, satisfaction was quantitatively confirmed (Likert score 4 or 5) in 4 of 7 domains, with the highest satisfaction in "communication of goals" and "understanding of the HCAHPS metric." The percentage of "top box" Doctor Communication Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and national percentile ranking showed a sustained increase more than 1 and 2 years from the dates of the courses. The assessment of communication skills is increasing in importance in the practice of

  5. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan part 2 mappings for the ASC software quality engineering practices, version 2.0.

    Energy Technology Data Exchange (ETDEWEB)

    Heaphy, Robert; Sturtevant, Judith E.; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Minana, Molly A.; Hackney, Patricia; Forsythe, Christi A.; Schofield, Joseph Richard, Jr. (,; .); Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2006-09-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR001.3.2 and CPR001.3.6 and to a Department of Energy document, ''ASCI Software Quality Engineering: Goals, Principles, and Guidelines''. This document also identifies ASC management and software project teams' responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  6. Recombinant activated factor VII in cardiac surgery: single-center experience.

    Science.gov (United States)

    Singh, Sarvesh Pal; Chauhan, Sandeep; Choudhury, Minati; Malik, Vishwas; Choudhary, Shiv Kumar

    2014-02-01

    The widespread off-label use of recombinant activated factor VII for the control of refractory postoperative hemorrhage continues despite a warning from the Food and Drug Administration. Although effective in reducing the need for transfusion of blood and blood products, safety concerns still prevail. To compare the dosing and efficacy of recombinant activated factor VII between pediatric and adult patients, and in the operating room and intensive care unit. The records of 69 patients (33 children and 36 adults) who underwent cardiovascular surgery and received recombinant activated factor VII were reviewed retrospectively. The dose of recombinant activated factor VII, mediastinal drainage, use of blood and blood products, incidence of thrombosis, and 28-day mortality were studied. the efficacy of recombinant activated factor VII was comparable in adults and children, despite the lower dose in adults. Prophylactic use of recombinant activated factor VII decreased the incidence of mediastinal exploration and the duration of intensive care unit stay. A 4.3% incidence of thrombotic complications was observed in this study. The efficacious dose of recombinant activated factor VII is much less in adults compared to children. Prophylactic use of recombinant activated factor VII decreases the dose required, the incidence of mediastinal exploration, and intensive care unit stay, with no survival benefit.

  7. Safety of remifentanil in transsphenoidal surgery: A single-center analysis of 540 patients.

    Science.gov (United States)

    Cote, David J; Burke, William T; Castlen, Joseph P; King, Chih H; Zaidi, Hasan A; Smith, Timothy R; Laws, Edward R; Aglio, Linda S

    2017-04-01

    Although some studies have examined the efficacy and safety of remifentanil in patients undergoing neurosurgical procedures, none has examined its safety in transsphenoidal operations specifically. In this study, all transsphenoidal operations performed by a single author from 2008 to 2015 were retrospectively reviewed to evaluate the safety of remifentanil in a consecutive series of patients. During the study period, 540 transsphenoidal operations were identified. Of these, 443 (82.0%) patients received remifentanil intra-operatively; 97 (18.0%) did not. The two groups were well-matched with regard to demographic categories, comorbidities, and pre-operative medications (p>0.05), except pre-operative tobacco use (p=0.021). Patients were also well-matched with regard to radiographic features and surgical techniques. Patients who received remifentanil were more likely to harbor a macroadenoma (78.1% vs. 67.0%, p=0.025), and had slightly longer anesthesia time on average (269.2minvs. 239.4min, p=0.024). All pathologic diagnoses were well-matched between the two groups, except that patients receiving remifentanil were more likely to harbor a non-functioning adenoma (46.5% vs. 26.8%, ptranssphenoidal surgery, remifentanil was found to be a safe anesthetic adjunct. There were no significant differences in post-operative hospital course or complications in patients who did and did not receive intra-operative remifentanil. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1 : ASC software quality engineering practices version 1.0.

    Energy Technology Data Exchange (ETDEWEB)

    Minana, Molly A.; Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Forsythe, Christi A.; Schofield, Joseph Richard, Jr.; Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2005-01-01

    The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in DOE/AL Quality Criteria (QC-1) as conformance to customer requirements and expectations. This quality plan defines the ASC program software quality practices and provides mappings of these practices to the SNL Corporate Process Requirements (CPR 1.3.2 and CPR 1.3.6) and the Department of Energy (DOE) document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines (GP&G). This quality plan identifies ASC management and software project teams' responsibilities for cost-effective software engineering quality practices. The SNL ASC Software Quality Plan establishes the signatories commitment to improving software products by applying cost-effective software engineering quality practices. This document explains the project teams opportunities for tailoring and implementing the practices; enumerates the practices that compose the development of SNL ASC's software products; and includes a sample assessment checklist that was developed based upon the practices in this document.

  9. FY17 ASC CSSE L2 Milestone 6018: Power Usage Characteristics of Workloads Running on Trinity.

    Energy Technology Data Exchange (ETDEWEB)

    Pedretti, Kevin [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-09-01

    The overall goal of this work was to utilize the Advanced Power Management (APM) capabilities of the ATS-1 Trinity platform to understand the power usage behavior of ASC workloads running on Trinity and gain insight into the potential for utilizing power management techniques on future ASC platforms.

  10. Improving results of surgery for fecal peritonitis due to perforated colorectal disease: A single center experience.

    Science.gov (United States)

    Mineccia, Michela; Zimmitti, Giuseppe; Ribero, Dario; Giraldi, Francesco; Bertolino, Franco; Brambilla, Romeo; Ferrero, Alessandro

    2016-01-01

    fecal peritonitis due to colorectal perforation is a dramatic event characterized by high mortality. Our study aims at determining how results of sigmoid resection (eventually extended to upper rectum) for colorectal perforation with fecal peritonitis changed in recent years and which factors affected eventual changes. Seventy-four patients were operated on at our institution (2005-2014) for colorectal perforation with fecal peritonitis and were divided into two numerically equal groups (operated on before (ERA1-group) and after (ERA2-group) May 2010). Mannheim Peritonitis Index (MPI) was calculated for each patient. Characteristics of two groups were compared. Predictors of postoperative outcomes were identified. Postoperative overall complications, major complications, and mortality occurred in 59%, 28%, and 18% of cases, respectively, and were less frequent in ERA2-group (51%, 16%, and 8%, respectively), compared to ERA1-group (68%, 41%, and 27%, respectively; p = .155, .02, and .032, respectively). Such results paralleled lower MPI values in ERA2-group, compared to ERA1-group (23(16-39) vs. 28(21-43), p = .006). Using receiver operating characteristic analysis, the best cut-off value for MPI for predicting postoperative complications and mortality was 28.5. MPI>28 was the only independent predictor of postoperative overall (p = .009, OR = 4.491) and major complications (p peritonitis longer than 24 h (p = .045, OR = 17.099). results of surgery for colorectal perforation with fecal peritonitis have improved over time, matching a concurrent decrease of MPI values and a better preoperative patient management. MPI value may help in selecting patients benefitting from surgical treatment. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  11. Outcomes of Primary Transsphenoidal Surgery in Cushing Disease: Experience of a Tertiary Center.

    Science.gov (United States)

    Keskin, Fatma Ela; Ozkaya, Hande Mefkure; Bolayirli, Murat; Erden, Secil; Kadioglu, Pınar; Tanriover, Necmettin; Gazioglu, Nurperi

    2017-10-01

    To report the initial and long-term remission rates and related factors, secondary treatments, and outcomes of a series of patients with Cushing disease (CD). We included 147 consecutive adult patients with CD who underwent primary transsphenoidal surgery (TSS) between 1998 and 2014 in this study. Eighty-two were followed up in the Cerrahpasa Medical Faculty Endocrinology and Metabolism outpatient clinic. Patients were requested to attend a long-term remission assessment; 55 could be contacted, and data for the remaining 27 patients' last visit to the outpatient clinics were reviewed for early and late remission. Six patients were excluded from the study. Magnetic resonance imaging (MRI) findings and pathologic results including mitosis, Ki-67 levels, and P53 in immunostaining of all patients were evaluated. Data of 82 patients with CD with an average age of 36 years [interquartile range: 29-47] were analyzed with a mean follow-up of 7.5 years [interquartile range: 5-10]. Overall initial remission rates were 72.3% after TSS. Among the 82 patients, 16 patients had Gamma Knife radiosurgery and 7 patients underwent adrenalectomy. After these additional treatments, the long-term remission rate was found as 69.7%. The highest remission rates were with microadenomas. Recurrence was most frequently seen in patients without tumor evidence on MRI. Patients with high Ki-67 levels had higher recurrence rates in long-term follow-up (P = 0.02). Life-long follow-up for patients with CD seems essential. Undetectable tumors on MRI before TSS and high Ki-67 immunopositivity were found as risk factors for tumor recurrence. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Burnout in Otolaryngology-Head and Neck Surgery: A Single Academic Center Experience.

    Science.gov (United States)

    Geelan-Hansen, Katie; Anne, Samantha; Benninger, Michael S

    2018-05-01

    Burnout in modern medicine is becoming more recognized and researched. The objective in this study is to evaluate burnout in a tertiary care academic institution and compare results among faculty, trainees, and advanced practice practitioners (APPs) in a cross-sectional survey using the Maslach Burnout Inventory. Fifty-two surveys were distributed; 44 participants completed the survey (85%): 25 staff physicians (57%), 14 resident physicians (32%), and 5 nurse practitioners (11%). Staff physicians had low emotional exhaustion, moderate depersonalization, and low result for reduced personal accomplishments; trainees reported low emotional exhaustion, high depersonalization, and moderate reduced personal accomplishment; and nurse practitioners reported moderate on all 3 dimensions. There is overall low burnout in this tertiary care academic center of otolaryngologist providers and no difference in rates among the different groups (trainees, APPs, staff). Measures addressing specific deficiencies among dimensions of burnout would be helpful to prevent disintegration of physician satisfaction into burnout.

  13. Elevated cranial ultrasound resistive indices are associated with improved neurodevelopmental outcomes one year after pediatric cardiac surgery: A single center pilot study.

    Science.gov (United States)

    Jenks, Christopher L; Hernandez, Ana; Stavinoha, Peter L; Morris, Michael C; Tian, Fenghua; Liu, Hanli; Garg, Parvesh; Forbess, Joseph M; Koch, Joshua

    To determine if a non-invasive, repeatable test can be used to predict neurodevelopmental outcomes in patients with congenital heart disease. This was a prospective study of pediatric patients less than two months of age undergoing congenital heart surgery at the Children's Health Children's Medical Center at Dallas. Multichannel near-infrared spectroscopy (NIRS) was utilized during the surgery, and ultrasound (US) resistive indices (RI) of the major cranial vessels were obtained prior to surgery, immediately post-operatively, and prior to discharge. Pearson's correlation, Fischer exact t test, and Fischer r to z transformation were used where appropriate. A total of 16 patients were enrolled. All had US data. Of the sixteen patients, two died prior to the neurodevelopmental testing, six did not return for the neurodevelopmental testing, and eight patients completed the neurodevelopmental testing. There were no significant correlations between the prior to surgery and prior to discharge US RI and neurodevelopmental outcomes. The immediate post-operative US RI demonstrated a strong positive correlation with standardized neurodevelopmental outcome measures. We were able to demonstrate qualitative differences using multichannel NIRS during surgery, but experienced significant technical difficulties implementing consistent monitoring. A higher resistive index in the major cerebral blood vessels following cardiac surgery in the neonatal period is associated with improved neurological outcomes one year after surgery. Obtaining an ultrasound with resistive indices of the major cerebral vessels prior to and after surgery may yield information that is predictive of neurodevelopmental outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. INDIVIDUO: Results from a patient-centered lifestyle intervention for obesity surgery candidates.

    Science.gov (United States)

    Camolas, José; Santos, Osvaldo; Moreira, Pedro; do Carmo, Isabel

    Preoperative nutritional counseling provides an opportunity to ameliorate patients' clinical condition and build-up adequate habits and perception of competence. Study aimed to evaluate: (a) the effect of INDIVIDUO on weight and metabolic control; (b) the impact of INDIVIDUO on psychosocial variables associated with successful weight-control. Two-arms randomised controlled single-site study, with six-month duration. Patients were recruited from an Obesity Treatment Unit's waiting list. For the intervention group (IG), an operating procedure manual was used, nutritionists received training/supervision regarding INDIVIDUO's procedures. Control group (CG) received health literacy-promoting intervention. Intention-to-treat and per-control analysis were used. Outcomes included weight, metabolic control variables (blood pressure, glycemia, insulinemia, triglycerides, cholesterol), measures of eating and physical activity patterns, hedonic hunger, autonomous/controlled regulation, perceived competence for diet (PCS-diet) and quality of life. Primary outcomes were weight and metabolic control. Effect size was estimated by odds ratio and Cohens'd coefficient. Overall, 94 patients participated (IG:45; CG:49) and 60 completed the study (IG:29; CG:31). Intervention patients lost an excess 9.68% body weight (%EWL), vs. 0.51% for CG. Adjusting for age and baseline BMI, allocation group remained an independent predictor of %EWL (B=8.43, 95%CI: 2.79-14.06). IG had a six-fold higher probability (OR: 6.35, 95%CI: 1.28-31.56) of having adequate/controlled fasting glycemia at final evaluation. PCS-diet at final evaluation was independently predicted by baseline PCS-diet (B=0.31, 95%CI: 0.06-0.64), variation in autonomous regulation (B=0.43, 95%CI: 0.15-0.71) and allocation group (B=0.26, 95%CI: 0.04-1.36). Results on weight and metabolic control support INDIVIDUO as a valuable clinical tool for obesity surgery candidates counseling. Additionally, intervention associated with perceived

  15. Minimized extracorporeal circulation system in coronary artery bypass surgery: a 10-year single-center experience with 2243 patients.

    Science.gov (United States)

    Puehler, Thomas; Haneya, Assad; Philipp, Alois; Zausig, York A; Kobuch, Reinhard; Diez, Claudius; Birnbaum, Dietrich E; Schmid, Christof

    2011-04-01

    Coronary artery bypass grafting (CABG) is the gold standard for the surgical therapy of multivessel coronary artery disease. To reduce the side effects, associated with standard extracorporeal circulation (ECC), a concept of minimal extracorporeal circulation (MECC) was devised in our center. We report on our 10-year experience with the MECC for coronary revascularization. From January 1998 to August 2009, 2243 patients underwent CABG with MECC in our center. In a retrospective observational study, we analyzed indication, preoperative patient co-morbidity, postoperative clinical course, and perioperative outcome of all patients operated on with MECC. Furthermore, the risk factors for mortality in the MECC group were assessed. Patients showed a mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 4.5±0.1%. The mean age of the patients was 66.8±9.1 years. The overall 30-day mortality after CABG with MECC was 2.3%, ranging from 1.1% for elective to 13.0% for emergent patients and was significantly better than standard ECC. Only 15.3% (n=344) of patients with MECC required intra-operative blood transfusion. Postoperative catecholamine support, red blood cell transfusion, need for hemodialysis, release of creatinine kinase, incidence of stroke, and postoperative delirium were low after MECC revascularization. Ejection fraction below 30% (odds ratio (OR): 5.1), emergent operation (OR: 9.4), and high-dose catecholamine therapy (OR: 2.6) were associated predictors for mortality. MECC until now is an established concept and has become an alternative for ECC in routine CABG in our center. The use of the MECC system is associated with low mortality and conversion rate. Excellent survival rates and low transfusion requirements in the perioperative course were achieved. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  16. Strategic response by providers to specialty hospitals, ambulatory surgery centers, and retail clinics.

    Science.gov (United States)

    Burns, Lawton R; David, Guy; Helmchen, Lorens A

    2011-04-01

    Radical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such "creative destruction" and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: single-specialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care.

  17. Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center.

    Science.gov (United States)

    Bauer, Natasha Johan

    2016-01-01

    Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of England and the British Medical Association. A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Just over half (52%) of the time, no handover took place. The majority of handovers (64%) occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient's age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. These findings were presented to the department, and a handover proforma was implemented. Recommendations included the need for a new face-to-face handover. A reaudit will evaluate the effects of these changes.

  18. Differential splicing of the apoptosis-associated speck like protein containing a caspase recruitment domain (ASC regulates inflammasomes

    Directory of Open Access Journals (Sweden)

    Rojanasakul Yon

    2010-05-01

    Full Text Available Abstract Background The apoptotic speck-like protein containing a caspase recruitment domain (ASC is the essential adaptor protein for caspase 1 mediated interleukin (IL-1β and IL-18 processing in inflammasomes. It bridges activated Nod like receptors (NLRs, which are a family of cytosolic pattern recognition receptors of the innate immune system, with caspase 1, resulting in caspase 1 activation and subsequent processing of caspase 1 substrates. Hence, macrophages from ASC deficient mice are impaired in their ability to produce bioactive IL-1β. Furthermore, we recently showed that ASC translocates from the nucleus to the cytosol in response to inflammatory stimulation in order to promote an inflammasome response, which triggers IL-1β processing and secretion. However, the precise regulation of inflammasomes at the level of ASC is still not completely understood. In this study we identified and characterized three novel ASC isoforms for their ability to function as an inflammasome adaptor. Methods To establish the ability of ASC and ASC isoforms as functional inflammasome adaptors, IL-1β processing and secretion was investigated by ELISA in inflammasome reconstitution assays, stable expression in THP-1 and J774A1 cells, and by restoring the lack of endogenous ASC in mouse RAW264.7 macrophages. In addition, the localization of ASC and ASC isoforms was determined by immunofluorescence staining. Results The three novel ASC isoforms, ASC-b, ASC-c and ASC-d display unique and distinct capabilities to each other and to full length ASC in respect to their function as an inflammasome adaptor, with one of the isoforms even showing an inhibitory effect. Consistently, only the activating isoforms of ASC, ASC and ASC-b, co-localized with NLRP3 and caspase 1, while the inhibitory isoform ASC-c, co-localized only with caspase 1, but not with NLRP3. ASC-d did not co-localize with NLRP3 or with caspase 1 and consistently lacked the ability to function as an

  19. Urinary tract infection in children after cardiac surgery: Incidence, causes, risk factors and outcomes in a single-center study

    Directory of Open Access Journals (Sweden)

    Mohamed S. Kabbani

    2016-09-01

    Full Text Available Summary: Nosocomial urinary tract infection (UTI increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU in 2012, and we divided the patients into two groups: the UTI (UTI group and the non-UTI (control group. We compared both groups for multiple peri-operative risk factors. We included 413 children in this study. Of these, 29 (7% had UTIs after cardiac surgery (UTI group, and 384 (93% were free from UTIs (control group. All UTI cases were catheter-associated UTIs (CAUTIs. A total of 1578 urinary catheter days were assessed in this study, with a CAUTI density rate of 18 per 1000 catheter days. Multivariate logistic regression analysis demonstrated the following risk factors for CAUTI development: duration of urinary catheter placement (p < 0.001, presence of congenital abnormalities of kidney and urinary tract (CAKUT (p < 0.0041 and the presence of certain syndromes (Down, William, and Noonan (p < 0.02. Gram-negative bacteria accounted for 63% of the CAUTI. The main causes of CAUTI were Klebsiella (27%, Candida (24% and Escherichia coli (21%. Resistant organisms caused 34% of CAUTI. Two patients (7% died in the UTI group compared with the one patient (0.3% who died in the control group (p < 0.05. Based on these findings, we concluded that an increased duration of the urinary catheter, the presence of CAKUT, and the presence of syndromes comprised the main risk factors for CAUTI. Gram-negative organisms were the main causes for CAUTI, and one-third of them found to be resistant in this single-center study. Keywords: Urinary tract infection, Cardiac surgery, Nosocomial

  20. Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India.

    Science.gov (United States)

    Matta, Sumathi; Park, Jiwon; Palamaner Subash Shantha, Ghanshyam; Khanna, Rohit C; Rao, Gullapalli N

    2016-01-01

    To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India. The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity gender discrimination in terms of outcome continues to be an issue and needs further investigation.

  1. Clinical features and risk assessment for cardiac surgery in adult congenital heart disease: Three years at a single Japanese center

    Directory of Open Access Journals (Sweden)

    Satoshi Kurokawa

    2014-04-01

    Conclusion: Cardiac surgery could be safely performed in most ACHD cases. Exercise tolerance testing can be useful in identifying patients at high risk of mortality or major complications. BNP can be valuable in predicting poor outcomes after cardiac surgery.

  2. High success rate and considerable adverse events of pelvic prolapse surgery with Prolift: A single center experience

    Directory of Open Access Journals (Sweden)

    Mun-Kun Hong

    2013-09-01

    Conclusions: Prolapse surgery with Prolift yielded a good anatomical outcome and satisfactory symptom improvement at different periods of follow-up, especially in uterus-sparing prolapse surgery. However, adverse events were not uncommon, and patients should be fully informed of all possible adverse events prior to surgery.

  3. Dimorfismo de ascósporos em Glomerella cingulata f.sp. phaseoli

    OpenAIRE

    Castro, Renata A.; Mendes-Costa, Maria C.; Souza, Elaine A.

    2006-01-01

    O objetivo deste trabalho foi caracterizar linhagens de Glomerella cingulata f. sp. phaseoli quanto ao crescimento micelial, formação de peritécio e dimorfismo de ascósporos. Foram avaliadas quatro linhagens nos meios de cultura de folhas de feijoeiro e meio M3 e em condições com e sem fotoperíodo. O comprimento dos ascósporos da linhagem normal e da mutante foi determinado. Houve diferença significativa quanto ao crescimento micelial e tamanho dos ascósporos. Constatou-se, pela primeira vez,...

  4. A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer: a two- centers experience.

    Science.gov (United States)

    Ghisoni, Eleonora; Katsaros, Dionyssios; Maggiorotto, Furio; Aglietta, Massimo; Vaira, Marco; De Simone, Michele; Mittica, Gloria; Giannone, Gaia; Robella, Manuela; Genta, Sofia; Lucchino, Fabiola; Marocco, Francesco; Borella, Fulvio; Valabrega, Giorgio; Ponzone, Riccardo

    2018-05-30

    Optimal cytoreduction (macroscopic Residual Tumor, RT = 0) is the best survival predictor factor in epithelial ovarian cancer (EOC). It doesn't exist a consolidated criteria to predict optimal surgical resection at interval debulking surgery (IDS). The aim of this study is to develop a predictive model of complete cytoreduction at IDS. We, retrospectively, analyzed 93 out of 432 patients, with advanced EOC, underwent neoadjuvant chemotherapy (NACT) and IDS from January 2010 to December 2016 in two referral cancer centers. The correlation between clinical-pathological variables and residual disease at IDS has been investigated with univariate and multivariate analysis. A predictive score of cytoreduction (PSC) has been created by combining all significant variables. The performance of each single variable and PSC has been reported and the correlation of all significant variables with progression free survival (PFS) has been assessed. At IDS, 65 patients (69,8%) had complete cytoreduction with no residual disease (R = 0). Three criteria independently predicted R > 0: age ≥ 60 years (p = 0.014), CA-125 before NACT > 550 UI/dl (p = 0.044), and Peritoneal Cancer Index (PCI) > 16 (p  16, a PSC ≥ 3 and the presence of R > 0 after IDS were all significantly associated with shorter PFS (p  0). The PSC should be prospectively validated in a larger series of EOC patients undergoing NACT-IDS.

  5. Urinary tract infection in children after cardiac surgery: Incidence, causes, risk factors and outcomes in a single-center study.

    Science.gov (United States)

    Kabbani, Mohamed S; Ismail, Sameh R; Fatima, Anis; Shafi, Rehana; Idris, Julinar A; Mehmood, Akhter; Singh, Reetam K; Elbarabry, Mahmoud; Hijazi, Omar; Hussein, Mohamed A

    2016-01-01

    Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in 2012, and we divided the patients into two groups: the UTI (UTI group) and the non-UTI (control group). We compared both groups for multiple peri-operative risk factors. We included 413 children in this study. Of these, 29 (7%) had UTIs after cardiac surgery (UTI group), and 384 (93%) were free from UTIs (control group). All UTI cases were catheter-associated UTIs (CAUTIs). A total of 1578 urinary catheter days were assessed in this study, with a CAUTI density rate of 18 per 1000 catheter days. Multivariate logistic regression analysis demonstrated the following risk factors for CAUTI development: duration of urinary catheter placement (purinary tract (CAKUT) (purinary catheter, the presence of CAKUT, and the presence of syndromes comprised the main risk factors for CAUTI. Gram-negative organisms were the main causes for CAUTI, and one-third of them found to be resistant in this single-center study. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  6. [ The new 2010 Ghent criteria for the indication to surgical treatment of patients affected by Marfan syndrome. Experience of a single cardiac surgery center].

    Science.gov (United States)

    Grego, Susanna; Nardi, Paolo; Gislao, Valentina; Nicolò, Francesca; D'Annolfo, Antonella; Marcucci, Rosaria; Bovio, Emanuele; Versaci, Francesco; Chiariello, Luigi

    2013-01-01

    The diagnosis and surgical treatment of patients with Marfan syndrome remain controversial. It is of utmost importance to identify patients at risk for acute aortic events to establish the correct surgical timing and the appropriate surgical treatment. From May 2008 to December 2012, 500 patients were screened at the Marfan Presidium of the Tor Vergata University Hospital of Rome (Italy). Patients were evaluated by a cardiac surgeon, including echocardiographic, orthopedic, ophthalmologic and dental examinations. All patients received genetic counseling, and genetic sampling was performed if appropriate. The diagnosis of Marfan syndrome was confirmed in 146 patients (29.2%). Fifty-four patients (37%) underwent cardiac surgery on the aortic root, 4 patients had surgery on the mitral valve, 13 patients had combined surgery; 11 cases were emergent surgery for acute aortic dissection. Twenty-eight patients (52%) were operated on at our Division: 13 underwent valve-sparing aortic root replacement (David procedure), 1 underwent Yacoub remodeling procedure and 14 underwent Bentall procedure. Following the establishment of the Marfan Center, the David aortic valve-sparing operation was the most frequently performed procedure compared to the previous period of surgical activity (63 vs 22%, psyndromes. Early surgical treatment is recommended in these patients to achieve optimal results of valve-sparing procedures and life-saving management, especially for patients who live far away from a cardiac surgery center.

  7. Liver Resections in a High-Volume Center: Form Standard Procedures to Extreme Surgery and Ultrasound-guided Resections.

    Science.gov (United States)

    Botea, Florin; Ionescu, Mihnea; Braşoveanu, Vladislav; Hrehoreţ, Doina; Alexandrescu, Sorin; Grigorie, Mihai; Stanciulea, Oana; Nicolaescu, Diana; Tomescu, Dana; Droc, Gabriela; Ungureanu, Daniela; Fota, Ruxandra; Croitoru, Adina; Gheorghe, Liana; Gheorghe, Cristian; Lupescu, Ioana; Grasu, Mugur; Boroş, Mirela; Dumitru, Radu; Toma, Mihai; Herlea, Vlad; Popescu, Irinel

    2017-01-01

    Background: Liver resection (LR) is the treatment of choice for most benign and malignant focal liver lesions, as well as in selected patients with liver trauma. Few other therapies can compete with LR in selected cases, such as liver transplantation in hepatocellular carcinoma (HCC) and ablative therapies in small HCCs or liver metastases. The present paper analyses a single center experience in LR, reviewing the indications of LR, the operative techniques and their short-term results. Between January 2000 and December 2016, in "œDan Setlacec" Center of General Surgery and Liver Transplantation were performed 3165 LRs in 3016 patients, for pathologic conditions of the liver. In the present series, liver resections for living-donor liver transplantation were excluded. The median age of the patients was 56 years (mean 58 years; range 1-88), with male/female ratio 1524/1492 and adult/pediatric patient ratio 2973/43. Results: Malignant lesions were the main indication for LR (2372 LRs; 74.9%). Among these, colorectal liver metastases were the most frequent indication (952 LRs; 30.1%), followed by hepatocellular carcinoma (575 patients, 18.2%). The highest number of resected tumors per patient was 21, and the median diameter of the largest tumor was 40 mm (mean 51 mm; range 3-250). Major resections rate was 18.6% (588 LRs) and anatomical LRs were performed in 789 patients (24.9%). The median operative time was 180 minutes (mean 204 minutes; range 45-920). The median blood loss was 500 ml (mean 850 ml; range 500-9500), with a transfusion rate of 41.6% (1316 LRs). The morbidity rate was 40.1% (1270 LRs) and the rate of major complications (Dindo-Clavien IIIa or more) was 13.2% (418 LRs). Mortality rate was 4.2% (127 pts). LRs should be performed in specialized high-volume centers to achieve the best results (low morbidity and mortality rates). Celsius.

  8. Surgical outcomes of robot-assisted rectal cancer surgery using the da Vinci Surgical System: a multi-center pilot Phase II study.

    Science.gov (United States)

    Tsukamoto, Shunsuke; Nishizawa, Yuji; Ochiai, Hiroki; Tsukada, Yuichiro; Sasaki, Takeshi; Shida, Dai; Ito, Masaaki; Kanemitsu, Yukihide

    2017-12-01

    We conducted a multi-center pilot Phase II study to examine the safety of robotic rectal cancer surgery performed using the da Vinci Surgical System during the introduction period of robotic rectal surgery at two institutes based on surgical outcomes. This study was conducted with a prospective, multi-center, single-arm, open-label design to assess the safety and feasibility of robotic surgery for rectal cancer (da Vinci Surgical System). The primary endpoint was the rate of adverse events during and after robotic surgery. The secondary endpoint was the completion rate of robotic surgery. Between April 2014 and July 2016, 50 patients were enrolled in this study. Of these, 10 (20%) had rectosigmoid cancer, 17 (34%) had upper rectal cancer, and 23 (46%) had lower rectal cancer; six underwent high anterior resection, 32 underwent low anterior resection, 11 underwent intersphincteric resection, and one underwent abdominoperineal resection. Pathological stages were Stage 0 in 1 patient, Stage I in 28 patients, Stage II in 7 patients and Stage III in 14 patients. Pathologically complete resection was achieved in all patients. There was no intraoperative organ damage or postoperative mortality. Eight (16%) patients developed complications of all grades, of which 2 (4%) were Grade 3 or higher, including anastomotic leakage (2%) and conversion to open surgery (2%). The present study demonstrates the feasibility and safety of robotic rectal cancer surgery, as reflected by low morbidity and low conversion rates, during the introduction period. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  9. Risk factors for bowel dysfunction after sphincter-preserving rectal cancer surgery: a prospective study using the Memorial Sloan Kettering Cancer Center bowel function instrument.

    Science.gov (United States)

    Ihn, Myong Hoon; Kang, Sung-Bum; Kim, Duck-Woo; Oh, Heung-Kwon; Lee, Soo Young; Hong, Sa Min

    2014-08-01

    Until recently, no studies have prospectively evaluated bowel function after sphincter-preserving surgery for rectal cancer with the use of a validated bowel function scoring system. The aim of this study was to investigate possible risk factors for altered bowel function after sphincter-preserving surgery. This was a prospective study. The study was conducted between January 2006 and May 2012 at the authors' institution. Patients who underwent sphincter-preserving rectal cancer surgery were recruited. Bowel function was assessed 1 day before (baseline) and at 1 year after sphincter-preserving surgery or temporary ileostomy takedown with the use of the Memorial Sloan Kettering Cancer Center questionnaire. Multivariable analysis was performed to identify the factors associated with altered bowel function after surgery. Overall, 266 patients were eligible for the analysis. The tumor was located in the upper, middle, and lower rectum in 68 (25.5%), 113 (42.5%), and 85 (32.0%) patients. Intersphincteric resection and temporary ileostomy were performed in 18 (6.8%) and 129 (48.5%) patients. The mean Memorial Sloan Kettering Cancer Center score was 64.5 ± 7.6 at 1 year after sphincter-preserving surgery or temporary ileostomy takedown. The Memorial Sloan Kettering Cancer Center score decreased in 163/266 patients (61.3%) between baseline and 1 year after surgery. Tumor location (p = 0.01), operative method (p = 0.03), anastomotic type (p = 0.01), and temporary ileostomy (p = 0.01) were associated with altered bowel function after sphincter-preserving surgery in univariate analyses. In multivariable analysis, only tumor location was independently associated with impaired bowel function after sphincter-preserving rectal cancer surgery. This study was limited by its nonrandomized design and the lack of measurement before preoperative chemoradiotherapy. We suggest that preoperative counseling should be implemented to inform patients of the risk of bowel dysfunction

  10. Aeroacoustics research in Europe : the CEAS-ASC report on 2007 highlights

    NARCIS (Netherlands)

    Brouwer, H.H.; Rienstra, S.W.

    2008-01-01

    The Council of European Aerospace Societies (CEAS) Aeroacoustics Specialists Committee (ASC) supports and promotes the interests of the scientific and industrial aeroacoustics community on a European scale and European aeronautics activities internationally. In this context, "aeroacoustics"

  11. Absence of the inflammasome adaptor ASC reduces hypoxia-induced pulmonary hypertension in mice.

    Science.gov (United States)

    Cero, Fadila Telarevic; Hillestad, Vigdis; Sjaastad, Ivar; Yndestad, Arne; Aukrust, Pål; Ranheim, Trine; Lunde, Ida Gjervold; Olsen, Maria Belland; Lien, Egil; Zhang, Lili; Haugstad, Solveig Bjærum; Løberg, Else Marit; Christensen, Geir; Larsen, Karl-Otto; Skjønsberg, Ole Henning

    2015-08-15

    Pulmonary hypertension is a serious condition that can lead to premature death. The mechanisms involved are incompletely understood although a role for the immune system has been suggested. Inflammasomes are part of the innate immune system and consist of the effector caspase-1 and a receptor, where nucleotide-binding oligomerization domain-like receptor pyrin domain-containing 3 (NLRP3) is the best characterized and interacts with the adaptor protein apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC). To investigate whether ASC and NLRP3 inflammasome components are involved in hypoxia-induced pulmonary hypertension, we utilized mice deficient in ASC and NLRP3. Active caspase-1, IL-18, and IL-1β, which are regulated by inflammasomes, were measured in lung homogenates in wild-type (WT), ASC(-/-), and NLRP3(-/-) mice, and phenotypical changes related to pulmonary hypertension and right ventricular remodeling were characterized after hypoxic exposure. Right ventricular systolic pressure (RVSP) of ASC(-/-) mice was significantly lower than in WT exposed to hypoxia (40.8 ± 1.5 mmHg vs. 55.8 ± 2.4 mmHg, P right ventricular remodeling. RVSP of NLRP3(-/-) mice exposed to hypoxia was not significantly altered compared with WT hypoxia. Whereas hypoxia increased protein levels of caspase-1, IL-18, and IL-1β in WT and NLRP3(-/-) mice, this response was absent in ASC(-/-) mice. Moreover, ASC(-/-) mice displayed reduced muscularization and collagen deposition around arteries. In conclusion, hypoxia-induced elevated right ventricular pressure and remodeling were attenuated in mice lacking the inflammasome adaptor protein ASC, suggesting that inflammasomes play an important role in the pathogenesis of pulmonary hypertension. Copyright © 2015 the American Physiological Society.

  12. Test Rack Development for Extended Operation of Advanced Stirling Convertors at NASA Glenn Research Center

    Science.gov (United States)

    Dugala, Gina M.

    2010-01-01

    The U.S. Department of Energy, Lockheed Martin Space Systems Company, Sunpower Inc., and NASA Glenn Research Center (GRC) have been developing an Advanced Stirling Radioisotope Generator (ASRG) for use as a power system on space science missions. This generator will make use of free-piston Stirling convertors to achieve higher conversion efficiency than with currently available alternatives. One part of NASA GRC's support of ASRG development includes extended operation testing of Advanced Stirling Convertors (ASCs) developed by Sunpower Inc. and GRC. The ASC consists of a free-piston Stirling engine integrated with a linear alternator. NASA GRC has been building test facilities to support extended operation of the ASCs for several years. Operation of the convertors in the test facility provides convertor performance data over an extended period of time. One part of the test facility is the test rack, which provides a means for data collection, convertor control, and safe operation. Over the years, the test rack requirements have changed. The initial ASC test rack utilized an alternating-current (AC) bus for convertor control; the ASRG Engineering Unit (EU) test rack can operate with AC bus control or with an ASC Control Unit (ACU). A new test rack is being developed to support extended operation of the ASC-E2s with higher standards of documentation, component selection, and assembly practices. This paper discusses the differences among the ASC, ASRG EU, and ASC-E2 test racks.

  13. Patterns of severe acute renal failure in a referral center in Sudan: Excluding intensive care and major surgery patients

    International Nuclear Information System (INIS)

    Kaballo, Babikir G.; Khogali, Mohamed S.; Khalifa, Eman H.; Khalil, Eltahir A.G.; El-Hasaan, Ahmad M.; Abu-Aisha, H.

    2007-01-01

    Acute renal failure (ARF) is a common health problem worldwide. There is limited data on the pattern of ARF in Sudan. Moreover, glomerular diseases, which are a well known cause of ARF, have not been accurately and adequately diagnosed previously. A retrospective study on the patterns of ARF was carried out in a general nephrology referral center in Sudan during the period from February 2003 to February 2004.Patients from intensive care units with ARF and those who developed ARF after massive surgery were excluded from the study. Renal biopsy was performed when indicated and studied with light and immunofluorescent microscopy. Eighty-nine patients (57 (64%) cases were males and mean age was 39+-19.4 years) fulfilled the criteria for the diagnosis of advanced renal failure requiring renal function replacement therapy. Acute tubular necrosis (ATN) was diagnosed in 50 (56%) patients; 33 (66%) ATN patients had renal failure as a complication of volume depletion, fulminant infections (particularly malaria and typhoid fever) or snakebites, and 12 (13.4%) patients ingested paraphenylene-diamine (PPD) (hair/Henna dye) in suicidal attempts. Eight (9%) patients of the total study group had glomerural diseases and 11 (12.3%) had obstructive uropathy associated with ARF; cause of ARF could not be determined in 17 (19%) patients. Fifty-three (60%) patients recovered their renal function, six (6.7%) patients progressed to chronic kidney disease (CKD), 16(18%) died and 14(16%) were lost to follow-up. In conclusion, patients with ARF associated with ATN had a favorable prognosis except when ATN was associated PPD poisoning. (author)

  14. Patterns of severe acute renal failure in a referral center in Sudan: Excluding intensive care and major surgery patients

    Energy Technology Data Exchange (ETDEWEB)

    Kaballo, Babikir G; Khogali, Mohamed S [Nephrology Unit, Military Hospital, Omdurman (Sudan); Khalifa, Eman H [Faculty of Medical Laboratory Sciences, Univ. of Khartoum (Sudan); Khalil, Eltahir A.G.; El-Hasaan, Ahmad M [Institute of Endemic Diseases, Univ. of Khartoum (Sudan); Abu-Aisha, H [The National Ribat Univ., Khartoum (Sudan)

    2007-07-01

    Acute renal failure (ARF) is a common health problem worldwide. There is limited data on the pattern of ARF in Sudan. Moreover, glomerular diseases, which are a well known cause of ARF, have not been accurately and adequately diagnosed previously. A retrospective study on the patterns of ARF was carried out in a general nephrology referral center in Sudan during the period from February 2003 to February 2004.Patients from intensive care units with ARF and those who developed ARF after massive surgery were excluded from the study. Renal biopsy was performed when indicated and studied with light and immunofluorescent microscopy. Eighty-nine patients (57 (64%) cases were males and mean age was 39+-19.4 years) fulfilled the criteria for the diagnosis of advanced renal failure requiring renal function replacement therapy. Acute tubular necrosis (ATN) was diagnosed in 50 (56%) patients; 33 (66%) ATN patients had renal failure as a complication of volume depletion, fulminant infections (particularly malaria and typhoid fever) or snakebites, and 12 (13.4%) patients ingested paraphenylene-diamine (PPD) (hair/Henna dye) in suicidal attempts. Eight (9%) patients of the total study group had glomerural diseases and 11 (12.3%) had obstructive uropathy associated with ARF; cause of ARF could not be determined in 17 (19%) patients. Fifty-three (60%) patients recovered their renal function, six (6.7%) patients progressed to chronic kidney disease (CKD), 16(18%) died and 14(16%) were lost to follow-up. In conclusion, patients with ARF associated with ATN had a favorable prognosis except when ATN was associated PPD poisoning. (author)

  15. Evaluation of radiation protection and technical procedures in Wad Madani Heart Diseases and Surgery Center (WHDSC) (cardiac catheterization laboratory)

    International Nuclear Information System (INIS)

    Gesmallah, A. H. A.

    2013-07-01

    The purpose of this study is conducted in order to evaluate the application of radiation protection program, evaluate the design of cardiac catheterization laboratory, evaluate the effectiveness of radiation protection devices, evaluate personal monitoring, usage of G-Arm x-ray machine, to evaluate the responsibilities of radiation protection officer (RPO), to assess monitoring devices if available, and to assess patient patient dose in Wad Madani hear disease and surgery center in a period from march 2013 to june 2013. The most data in this study was obtained from the results of the team of quality assurance and control of radiation safety institute when they visited hospital on 14/2/2011 for inspection and calibration for issue of registration and licenses, except the data of patients dose which obtained from exposure parameters and dosimetric information's in the archive of G-arm x-ray fluoroscopic machine (which were 110 of cardiac catheterization diagnostic and therapeutic cases, 60 of adult patients and 50 of children. The patient data included age, weight, kv, mAs, DAP, air kerma, and fluoro time. The results of this study show that there is radiation protection program need correction and partially applied, the design of cardiac catheterization laboratory is accepted according to radiation safety institute team of quality control. Also the study shows that the radiation protection program devices are available and good condition and enough in number. The study shows that there are no personal monitoring devices and services and the radiological technologist are well trained to dial with the G-arm x-ray machine and to apply the radiation protection program effectively. Also the study states that the radiation protection officer could apply his responsibilities partially. Finally the study shows that there is a direct linear relationship between the patient's weight and (DAP, air kerma, kv, and mAs) concludes that there is excessive radiation dose in cardiac

  16. [Orthotopic liver transplantation in adult patients with cadaveric grafts. Experience of the Fundeni Center of General Surgery and Liver Transplantation].

    Science.gov (United States)

    Popescu, I; Ionescu, M; Tulbure, D; Ciurea, S; Băilă, S; Braşoveanu, V; Hrehoreţ, D; Sârbu-Boeţi, P; Pietrăreanu, D; Alexandrescu, S; Dorobanţu, B; Gheorghe, L; Gheorghe, C; Mihăilă, M; Boroş, M; Croitoru, M; Herlea, V

    2005-01-01

    We analyze the experience of the Center of General Surgery and Liver Transplantation from the Fundeni Clinical Institute (Bucharest, Romania) regarding orthotopic liver transplantation (OLT) in adult recipients, with whole liver grafts from cadaveric donors, between April 2000 (when the first successful LT was performed in Romania) and December 2004. This series includes 37 OLTs in adult recipients (16 women and 21 men, aged between 29-57 years--average 46 years). Other two LT with whole liver cadaveric grafts and two reduced-size LT were performed in children; also, in the same period, due to the acute organ shortage, other methods of LT were performed in 28 patients (21 living donor LT, 6 split LT and one "do mino" LT), that were not included in the present series. The indications for OLT were HBV cirrhosis--10, HBV+HDV cirrhosis--4, HCV cirrhosis--11, HBV+HCV cirrhosis--2, biliary cirrhosis--5, Wilson disease--2, alcoholic cirrhosis--1, non-alcoholic liver disease--1, autoimmune cirrhosis--1. With three exceptions, in which the classical transplantation technique was used, the liver was grafted following the technique described by Belghiti. Local postoperative complications occurred in 15 patients (41%) and general complications in 17 (46%); late complications were registered in 18 patients (49%) and recurrence of the initial disease in 6 patients (16%). Intrao- and postoperative mortality was 8% (3/37). There were two patients (5%) who died because of immunosuppressive drug neurotoxicity at more than 30 days following LT. Four patients (11%) died lately because of PTLD, liver venoocclusive disease, recurrent autoimmune hepatitis and liver venoocclusive disease, myocardial infarction, respectively. Thirty-four patients survived the postoperative period (92%); according to Kaplan-Meier analysis, actuarial patient-survival rate at month 31 was 75%.

  17. Immunocytoexpression profile of ProExC in smears interpreted as ASC-US, ASC-H, and cervical intraepithelial lesion

    Directory of Open Access Journals (Sweden)

    Zeynep Tosuner

    2017-01-01

    Full Text Available Aims: We aimed to investigate the immunocytoexpression profiles of a novel assay ProEx C for topoisomerase II alpha (TOP2A and minichromosome maintenance protein 2 (MCM2 in abnormal interpreted smears. Settings and Design: Screening programs with Papanicolaou smear and high risk group human papilloma virus testing have yielded a dramatic reduction of cervical cancer incidence. However, both of these tests have limited specificity for the detection of clinically significant cervical high grade lesions. ProEx C for topoisomerase II alpha (TOP2A and minichromosome maintenance protein 2 (MCM2 has been considered to have tight association with high grade intraepithelial lesions. Materials and Methods: A total number of 54 SurePath cervical cytology specimens of patients previously interpreted as atypical squamous cells-undetermined significance (ASC-US, atypical squamous cells-cannot exclude high grade squamous intraepithelial lesion (ASC-H, low grade squamous intraepithelial lesion (LSIL, and high grade squamous intraepithelial lesion (HSIL were included in our study. Results and Conclusions: ProEx C was positive in 14 of HSILs (100%, 3 of 19 LSILs (16%, 2 of 4 ASC-Hs, and none of ASC-USs (0%. The ProEx C test showed very intense nuclear staining in all cytologically abnormal cells. Further studies are indicated to evaluate the diagnostic role of ProEx C.

  18. Clinicopathologic features and outcomes following surgery for pancreatic adenosquamous carcinoma

    Directory of Open Access Journals (Sweden)

    Hwang Tsann-Long

    2008-09-01

    Full Text Available Abstract Background Pancreatic adenosquamous carcinoma (ASC is a rare pancreatic malignancy subtype. We investigated the clinicopathological features and outcome of pancreatic ASC patients after surgery. Methods The medical records of 12 patients with pancreatic ASC undergoing surgical treatment (1993 to 2006 were retrospectively reviewed. Survival data of patients with stage IIB pancreatic adenocarcinoma and ASC undergoing surgical resection were compared. Results Symptoms included abdominal pain (91.7%, body weight loss (83.3%, anorexia (41.7% and jaundice (25.0%. Tumors were located at pancreatic head in 5 (41.7% patients, tail in 5 (41.7%, and body in 4 (33.3%. Median tumor size was 6.3 cm. Surgical resection was performed on 7 patients, bypass surgery on 3, and exploratory laparotomy with biopsy on 2. No surgical mortality was identified. Seven (58.3% and 11 (91.7% patients died within 6 and 12 months of operation, respectively. Median survival of 12 patients was 4.41 months. Seven patients receiving surgical resection had median survival of 6.51 months. Patients with stage IIB pancreatic ASC had shorter median survival compared to those with adenocarcinoma. Conclusion Aggressive surgical management does not appear effective in treating pancreatic ASC patients. Strategies involving non-surgical treatment such as chemotherapy, radiotherapy or target agents should be tested.

  19. Acute stress among adolescents and female rape victims measured by ASC-Kids: a pilot study.

    Science.gov (United States)

    Nilsson, Doris; Nordenstam, Carin; Green, Sara; Wetterhall, Annika; Lundin, Tom; Svedin, Carl Göran

    2015-01-01

    Rape is considered a stressful trauma and often with durable consequences. How the aftermath of rape is for young adolescents' girls considering acute stress is an overlooked field and remains to be studied. In this study, we wanted to investigate acute stress among adolescent victims of rape and the psychometric properties of the Acute Stress Checklist for Children (ASC-Kids). A clinical sample (n = 79) of raped girls, 13-17 years old who had turned to a special rape victim unit for treatment, answered the ASC-Kids. ASC-Kids was also given to a group of minor stressed, non-raped adolescents in the same age range (n = 154) together with the University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index (UCLA PTSD RI), and the Sense of Coherence Scale 13 (SOC-13). The scores from the groups were compared and showed significant differences in mean values on all the diagnostic criteria of acute stress disorder. In the clinical group, 36.7% obtained full ASD criteria. ASC-Kids could discriminate well between groups. Cronbach's alpha was found to be excellent, and the correlation between the UCLA PTSD RI and ASC-Kids found to be good; both ASC-Kids and UCLA PTSD RI had a good and moderate negative correlation with SOC-13. Adolescent female rape victims were shown to have a very high level of acute stress, and the ASC-Kids was found to have sound psychometrics and can be a valuable screening instrument to support clinicians in their assessments of an indication of adolescents after potentially stressful events such as rape.

  20. Proposed maximum surgical blood ordering schedule for common orthopedic surgeries in a Tertiary Health - Care Center in Northern India

    Directory of Open Access Journals (Sweden)

    Sonam Kumari

    2017-01-01

    CONCLUSIONS: MSBOS based on the past blood utilization records for different surgeries and keeping patients variables in consideration wherever required would provide an efficient way of blood utilization and appropriate management of blood bank resources.

  1. Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center.

    Science.gov (United States)

    Eisenberg, Dan; Lohnberg, Jessica A; Kubat, Eric P; Bates, Cheryl C; Greenberg, Lauren M; Frayne, Susan M

    2017-04-01

    Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m 2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. Published by

  2. Employment and Professional Outcomes in 803 Patients Undergoing Bariatric Surgery in a French Reference Center for Obesity

    Directory of Open Access Journals (Sweden)

    Q Durand-Moreau

    2015-04-01

    Full Text Available Background: Very few studies have been performed on small populations about the links between employment and bariatric surgery. Objective: To determine if rates of employment are increased among patients who have undergone bariatric surgery, to assess their post-operative health consequences (post-prandial weakness, diarrhea, and patients' ability to maintain post-operative advice (ie, 30 minutes of daily physical activity, 6 small meals daily compared to non-employed post-surgical patients. Methods: This cross-sectional study was performed in the Regional Reference Centre for Obesity, which is a partnership between the University Hospital and a clinic in Angers, France during 2012 using a self-administrated questionnaire completed by patients hospitalized for post-operative follow-ups after bariatric surgery. Issues investigated were their professional situation before and after the surgery, compliancy to post-operative advice, and any postoperative side effects. Results: Employment rates were 64.4% before and 64.7% after the surgery (p=0.94. Of these, 30.6% maintained 30 minutes of daily physical activity vs. 41.0% of non-workers (p=0.02. 50.5% of employed patients and 57.3% of non-workers maintained 6 small meals a day after surgery (p=0.09. 8% of working patients reported post-prandial weaknesses and 8% reported diarrhea that caused problems at work. Conclusion: Employment rate remained stable after surgery. Having a job seemed to be an obstacle to managing 30 minutes of daily exercise, especially among women, but not maintaining 6 small meals a day. Therefore, working environment needs to be assessed to improve job quality and retention for patients who have undergone bariatric surgery.

  3. Understanding the relationship between the Centers for Medicare and Medicaid Services' Hospital Compare star rating, surgical case volume, and short-term outcomes after major cancer surgery.

    Science.gov (United States)

    Kaye, Deborah R; Norton, Edward C; Ellimoottil, Chad; Ye, Zaojun; Dupree, James M; Herrel, Lindsey A; Miller, David C

    2017-11-01

    Both the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare star rating and surgical case volume have been publicized as metrics that can help patients to identify high-quality hospitals for complex care such as cancer surgery. The current study evaluates the relationship between the CMS' star rating, surgical volume, and short-term outcomes after major cancer surgery. National Medicare data were used to evaluate the relationship between hospital star ratings and cancer surgery volume quintiles. Then, multilevel logistic regression models were fit to examine the association between cancer surgery outcomes and both star rankings and surgical volumes. Lastly, a graphical approach was used to compare how well star ratings and surgical volume predicted cancer surgery outcomes. This study identified 365,752 patients undergoing major cancer surgery for 1 of 9 cancer types at 2,550 hospitals. Star rating was not associated with surgical volume (P cancer surgery outcomes (mortality, complication rate, readmissions, and prolonged length of stay). The adjusted predicted probabilities for 5- and 1-star hospitals were 2.3% and 4.5% for mortality, 39% and 48% for complications, 10% and 15% for readmissions, and 8% and 16% for a prolonged length of stay, respectively. The adjusted predicted probabilities for hospitals with the highest and lowest quintile cancer surgery volumes were 2.7% and 5.8% for mortality, 41% and 55% for complications, 12.2% and 11.6% for readmissions, and 9.4% and 13% for a prolonged length of stay, respectively. Furthermore, surgical volume and the star rating were similarly associated with mortality and complications, whereas the star rating was more highly associated with readmissions and prolonged length of stay. In the absence of other information, these findings suggest that the star rating may be useful to patients when they are selecting a hospital for major cancer surgery. However, more research is needed before these ratings can

  4. Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India.

    Directory of Open Access Journals (Sweden)

    Sumathi Matta

    Full Text Available To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI, India.The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs and attached vision centres (VCs that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.Mean age was 61.8 years (SD: 8.9 years and 1,133 (55.3% surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%. The most common procedure was small incision cataract surgery (SICS with intraocular lens (IOL implantation (91.8%. Intraoperative complications were seen in 29 eyes (1.4%. At the 4-11 weeks follow-up visit, based on presenting visual acuity (PVA, 61.8% had a good outcome and based on best-corrected visual acuity (BCVA, 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30, in females (OR 1.58; 95% CI 1.04, 2.41, those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57, with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04, eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25 and those undergoing extracapsular cataract extraction (OR 9

  5. Single-Molecule Fluorescence Reveals the Oligomerization and Folding Steps Driving the Prion-like Behavior of ASC.

    Science.gov (United States)

    Gambin, Yann; Giles, Nichole; O'Carroll, Ailís; Polinkovsky, Mark; Hunter, Dominic; Sierecki, Emma

    2018-02-16

    Single-molecule fluorescence has the unique ability to quantify small oligomers and track conformational changes at a single-protein level. Here we tackled one of the most extreme protein behaviors, found recently in an inflammation pathway. Upon danger recognition in the cytosol, NLRP3 recruits its signaling adaptor, ASC. ASC start polymerizing in a prion-like manner and the system goes in "overdrive" by producing a single micron-sized "speck." By precisely controlling protein expression levels in an in vitro translation system, we could trigger the polymerization of ASC and mimic formation of specks in the absence of inflammasome nucleators. We utilized single-molecule spectroscopy to fully characterize prion-like behaviors and self-propagation of ASC fibrils. We next used our controlled system to monitor the conformational changes of ASC upon fibrillation. Indeed, ASC consists of a PYD and CARD domains, separated by a flexible linker. Individually, both domains have been found to form fibrils, but the structure of the polymers formed by the full-length ASC proteins remains elusive. For the first time, using single-molecule Förster resonance energy transfer, we studied the relative positions of the CARD and PYD domains of full-length ASC. An unexpectedly large conformational change occurred upon ASC fibrillation, suggesting that the CARD domain folds back onto the PYD domain. However, contradicting current models, the "prion-like" conformer was not initiated by binding of ASC to the NLRP3 platform. Rather, using a new method, hybrid between Photon Counting Histogram and Number and Brightness analysis, we showed that NLRP3 forms hexamers with self-binding affinities around 300nM. Overall our data suggest a new mechanism, where NLRP3 can initiate ASC polymerization simply by increasing the local concentration of ASC above a supercritical level. Copyright © 2017. Published by Elsevier Ltd.

  6. Clinical outcomes of laparoscopic surgery for advanced transverse and descending colon cancer: a single-center experience.

    Science.gov (United States)

    Yamamoto, Masashi; Okuda, Junji; Tanaka, Keitaro; Kondo, Keisaku; Tanigawa, Nobuhiko; Uchiyama, Kazuhisa

    2012-06-01

    The role of laparoscopic surgery in management of transverse and descending colon cancer remains controversial. The aim of the present study is to investigate the short-term and oncologic long-term outcomes associated with laparoscopic surgery for transverse and descending colon cancer. This cohort study analyzed 245 patients (stage II disease, n = 70; stage III disease, n = 63) who underwent resection of transverse and descending colon cancers, including 200 laparoscopic surgeries (LAC) and 45 conventional open surgeries (OC) from December 1996 to December 2010. Short-term and oncologic long-term outcomes were recorded. The operative time was longer in the LAC group than in the OC group. However, intraoperative blood loss was significantly lower and postoperative recovery time was significantly shorter in the LAC group than in the OC group. The 5-year overall and disease-free survival rates for patients with stage II were 84.9% and 84.9% in the OC group and 93.7% and 90.0% in the LAC group, respectively. The 5-year overall and disease-free survival rates for patients with stage III disease were 63.4% and 54.6% in the OC group and 66.7% and 56.9% in the LAC group, respectively. Use of laparoscopic surgery resulted in acceptable short-term and oncologic outcomes in patients with advanced transverse and descending colon cancer.

  7. Comparison of Simulated Microgravity and Hydrostatic Pressure for Chondrogenesis of hASC.

    Science.gov (United States)

    Mellor, Liliana F; Steward, Andrew J; Nordberg, Rachel C; Taylor, Michael A; Loboa, Elizabeth G

    2017-04-01

    Cartilage tissue engineering is a growing field due to the lack of regenerative capacity of native tissue. The use of bioreactors for cartilage tissue engineering is common, but the results are controversial. Some studies suggest that microgravity bioreactors are ideal for chondrogenesis, while others show that mimicking hydrostatic pressure is crucial for cartilage formation. A parallel study comparing the effects of loading and unloading on chondrogenesis has not been performed. The goal of this study was to evaluate chondrogenesis of human adipose-derived stem cells (hASC) under two different mechanical stimuli relative to static culture: microgravity and cyclic hydrostatic pressure (CHP). Pellets of hASC were cultured for 14 d under simulated microgravity using a rotating wall vessel bioreactor or under CHP (7.5 MPa, 1 Hz, 4 h · d-1) using a hydrostatic pressure vessel. We found that CHP increased mRNA expression of Aggrecan, Sox9, and Collagen II, caused a threefold increase in sulfated glycosaminoglycan production, and resulted in stronger vimentin staining intensity and organization relative to microgravity. In addition, Wnt-signaling patterns were altered in a manner that suggests that simulated microgravity decreases chondrogenic differentiation when compared to CHP. Our goal was to compare chondrogenic differentiation of hASC using a microgravity bioreactor and a hydrostatic pressure vessel, two commonly used bioreactors in cartilage tissue engineering. Our results indicate that CHP promotes hASC chondrogenesis and that microgravity may inhibit hASC chondrogenesis. Our findings further suggest that cartilage formation and regeneration might be compromised in space due to the lack of mechanical loading.Mellor LF, Steward AJ, Nordberg RC, Taylor MA, Loboa EG. Comparison of simulated microgravity and hydrostatic pressure for chondrogenesis of hASC. Aerosp Med Hum Perform. 2017; 88(4):377-384.

  8. Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center.

    Science.gov (United States)

    Gondim, Jackson A; Almeida, João Paulo; de Albuquerque, Lucas Alverne F; Gomes, Erika; Schops, Michele; Ferraz, Tania

    2010-10-01

    Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas. The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%). Endoscopic transsphenoidal surgery represents an effective option for treatment of patients

  9. MicroASC instrument onboard Juno spacecraft utilizing inertially controlled imaging

    DEFF Research Database (Denmark)

    Pedersen, David Arge Klevang; Jørgensen, Andreas Härstedt; Benn, Mathias

    2016-01-01

    This contribution describes the post-processing of the raw image data acquired by the microASC instrument during the Earth-fly-by of the Juno spacecraft. The images show a unique view of the Earth and Moon system as seen from afar. The procedure utilizes attitude measurements and inter......-calibration of the Camera Head Units of the microASC system to trigger the image capturing. The triggering is synchronized with the inertial attitude and rotational phase of the sensor acquiring the images. This is essentially works as inertially controlled imaging facilitating image acquisition from unexplored...

  10. Fundamentals of civil engineering an introduction to the ASCE body of knowledge

    CERN Document Server

    McCuen, Richard H; Wong, Melanie K

    2011-01-01

    While the ASCE Body of Knowledge (BOK2) is the codified source for all technical and non-technical information necessary for those seeking to attain licensure in civil engineering, recent graduates have notoriously been lacking in the non-technical aspects even as they excel in the technical. Fundamentals of Civil Engineering: An Introduction to the ASCE Body of Knowledge addresses this shortfall and helps budding engineers develop the knowledge, skills, and attitudes suggested and implied by the BOK2. Written as a resource for all of the non-technical outcomes not specifically covered in the

  11. Required number of records for ASCE/SEI 7 ground-motion scaling procedure

    Science.gov (United States)

    Reyes, Juan C.; Kalkan, Erol

    2011-01-01

    The procedures and criteria in 2006 IBC (International Council of Building Officials, 2006) and 2007 CBC (International Council of Building Officials, 2007) for the selection and scaling ground-motions for use in nonlinear response history analysis (RHA) of structures are based on ASCE/SEI 7 provisions (ASCE, 2005, 2010). According to ASCE/SEI 7, earthquake records should be selected from events of magnitudes, fault distance, and source mechanisms that comply with the maximum considered earthquake, and then scaled so that the average value of the 5-percent-damped response spectra for the set of scaled records is not less than the design response spectrum over the period range from 0.2Tn to 1.5Tn sec (where Tn is the fundamental vibration period of the structure). If at least seven ground-motions are analyzed, the design values of engineering demand parameters (EDPs) are taken as the average of the EDPs determined from the analyses. If fewer than seven ground-motions are analyzed, the design values of EDPs are taken as the maximum values of the EDPs. ASCE/SEI 7 requires a minimum of three ground-motions. These limits on the number of records in the ASCE/SEI 7 procedure are based on engineering experience, rather than on a comprehensive evaluation. This study statistically examines the required number of records for the ASCE/SEI 7 procedure, such that the scaled records provide accurate, efficient, and consistent estimates of" true" structural responses. Based on elastic-perfectly-plastic and bilinear single-degree-of-freedom systems, the ASCE/SEI 7 scaling procedure is applied to 480 sets of ground-motions. The number of records in these sets varies from three to ten. The records in each set were selected either (i) randomly, (ii) considering their spectral shapes, or (iii) considering their spectral shapes and design spectral-acceleration value, A(Tn). As compared to benchmark (that is, "true") responses from unscaled records using a larger catalog of ground

  12. Developing the Storyline for an Advance Care Planning Video for Surgery Patients: Patient-Centered Outcomes Research Engagement from Stakeholder Summit to State Fair.

    Science.gov (United States)

    Aslakson, Rebecca A; Schuster, Anne L R; Lynch, Thomas J; Weiss, Matthew J; Gregg, Lydia; Miller, Judith; Isenberg, Sarina R; Crossnohere, Norah L; Conca-Cheng, Alison M; Volandes, Angelo E; Smith, Thomas J; Bridges, John F P

    2018-01-01

    Patient-centered outcomes research (PCOR) methods and social learning theory (SLT) require intensive interaction between researchers and stakeholders. Advance care planning (ACP) is valuable before major surgery, but a systematic review found no extant perioperative ACP tools. Consequently, PCOR methods and SLT can inform the development of an ACP educational video for patients and families preparing for major surgery. The objective is to develop and test acceptability of an ACP video storyline. The design is a stakeholder-guided development of the ACP video storyline. Design-thinking methods explored and prioritized stakeholder perspectives. Patients and family members evaluated storyboards containing the proposed storyline. The study was conducted at hospital outpatient surgical clinics, in-person stakeholder summit, and the 2014 Maryland State Fair. Measurements are done through stakeholder engagement and deidentified survey. Stakeholders evaluated and prioritized evidence from an environmental scan. A surgeon, family member, and palliative care physician team iteratively developed a script featuring 12 core themes and worked with a medical graphic designer to translate the script into storyboards. For 10 days, 359 attendees of the 2014 Maryland State Fair evaluated the storyboards and 87% noted that they would be "very comfortable" or "comfortable" seeing the storyboard before major surgery, 89% considered the storyboards "very helpful" or "helpful," and 89% would "definitely recommend" or "recommend" this story to others preparing for major surgery. Through an iterative process utilizing diverse PCOR engagement methods and informed by SLT, storyboards were developed for an ACP video. Field testing revealed the storyline to be highly meaningful for surgery patients and family members.

  13. Outcome after surgery for acute aortic dissection type A in the elderly: a single-center experience.

    Science.gov (United States)

    Berndt, Rouven; Haneya, Assad; Jussli-Melchers, Jill; Tautorat, Insa; Schmidt, Kirstin; Rahimi, Aziz; Cremer, Jochen; Schoeneich, Felix

    2015-03-01

    Despite improvements in surgical and perfusion techniques, surgery for acute aortic dissection type A (AADA) remains associated with high mortality rates. The aim of this study was to evaluate outcome after surgery for AADA in elderly in comparison with the outcome in younger patients. Between January 2004 and December 2012, 204 patients underwent operation for AADA. Of these, 65 patients were aged 70 years and older (elderly group; range, 70-85 years) and 139 were younger than 70 years (younger group; range, 18-69 years). No significant differences were detected between the groups with regard to preoperative risk factors on admission. Significantly more number of elderly patients than younger underwent supracoronary replacement of the ascending aorta (93.8% versus 80.6%, p = 0.013). In comparison to the elderly patients, younger patients more frequently received complex surgery (Bentall and David operation). The mean extracorporeal circulation time (183 ± 62 minutes versus 158 ± 3 minutes; p = 0.003) and the mean aortic cross-clamp time (100 ± 45 minute versus 82 ± 30 minute; p = 0.006) were significantly higher for younger patients. No significant differences in postoperative complications and major morbidity were observed. The operative mortality (elderly group 4.6% versus younger group 1.4%; p = 0.33) and 30-day mortality (elderly group 18.5% versus younger group 8.6%; p = 0.06) were without statistical significance between the groups. Surgery for AADA in the elderly resulted in acceptable mortality. Satisfactory outcomes should encourage the offering of surgery in these patients. Georg Thieme Verlag KG Stuttgart · New York.

  14. Emetogenicity-risk procedures in same day surgery center of an academic university hospital in United States: a retrospective cost-audit of postoperative nausea vomiting management.

    Science.gov (United States)

    Gupta, Deepak; Haber, Halim

    2014-06-01

    Despite the variable results of published studies, it is imperative for ambulatory surgery centers to self-audit local cost-implications for post-operative nausea and vomiting (PONV) management. Our retrospective cost-audit assessed if there were comparative peri-anesthesia care cost-trends among patients who had undergone Low-Emetogenicity-Risk Procedures (LERP), Moderate-Emetogenicity-Risk Procedures (MERP) and Severe-Emetogenicity-Risk Procedures (SERP). This study was a review of Same Day Surgery Center practices in an academic university hospital setting during a three-year period (2010-2012). The patient lists were accessed from CIS and CITRIX App Bar for time audit and OR (operating room) schedule reports. Subsequently, OR pharmacy department ran a search for peri-operative anti-emetics and opioids that were billed for the patients at Same Day Surgery Center for the review period. The primary outcomes were the comparative costs/charges of these medications and comparative durations/ charges for these patients' stay in the post-anesthesia care unit (PACU). Secondary outcomes analyzed in the study included peri-anesthesia durations. A total of 8,657 patient records were analyzed. Almost all analyzed variables revealed statistically significant inter-variable positive correlations. The patients' age was significantly (P < 0.001) different among LERP/MERP/SERP patients (LERP: 48.8 +/- 14.7 years; MERP: 61.8 +/- 14.6 years; SERP: 51.3 +/- 14.5 years). In regards to primary and secondary outcomes, the statistical significant differences among LERP/MERP/SERP patients (after correcting for both patients' age as well as patients' sex) were only achieved for preoperative times (P = 0.002; Power = 0.9), operating room recovery times (P = 0.003; Power = 0.9), PACU stay times (P < 0.001; Power = 1.0), and PACU charges (P < 0.001; Power = 1.0). PACU stay times and PACU charges were significantly higher in patients who had undergone SERP as compared to patients who had

  15. Profiling Autism Symptomatology: An Exploration of the Q-ASC Parental Report Scale in Capturing Sex Differences in Autism

    Science.gov (United States)

    Ormond, Sarah; Brownlow, Charlotte; Garnett, Michelle Sarah; Rynkiewicz, Agnieszka; Attwood, Tony

    2018-01-01

    The Questionnaire for Autism Spectrum Conditions (Q-ASC) was developed by Attwood et al. (2011) to identify gender-sensitive profiles of autism symptomatology; prioritise and adjust the direction of clinical interventions; and support positive psychosocial outcomes and prognosis into adulthood. The current research piloted the Q-ASC with parents…

  16. Structure and assembly of the mouse ASC inflammasome by combined NMR spectroscopy and cryo-electron microscopy

    Science.gov (United States)

    Sborgi, Lorenzo; Ravotti, Francesco; Dandey, Venkata P.; Dick, Mathias S.; Mazur, Adam; Reckel, Sina; Chami, Mohamed; Scherer, Sebastian; Huber, Matthias; Böckmann, Anja; Egelman, Edward H.; Stahlberg, Henning; Broz, Petr; Meier, Beat H.; Hiller, Sebastian

    2015-01-01

    Inflammasomes are multiprotein complexes that control the innate immune response by activating caspase-1, thus promoting the secretion of cytokines in response to invading pathogens and endogenous triggers. Assembly of inflammasomes is induced by activation of a receptor protein. Many inflammasome receptors require the adapter protein ASC [apoptosis-associated speck-like protein containing a caspase-recruitment domain (CARD)], which consists of two domains, the N-terminal pyrin domain (PYD) and the C-terminal CARD. Upon activation, ASC forms large oligomeric filaments, which facilitate procaspase-1 recruitment. Here, we characterize the structure and filament formation of mouse ASC in vitro at atomic resolution. Information from cryo-electron microscopy and solid-state NMR spectroscopy is combined in a single structure calculation to obtain the atomic-resolution structure of the ASC filament. Perturbations of NMR resonances upon filament formation monitor the specific binding interfaces of ASC-PYD association. Importantly, NMR experiments show the rigidity of the PYD forming the core of the filament as well as the high mobility of the CARD relative to this core. The findings are validated by structure-based mutagenesis experiments in cultured macrophages. The 3D structure of the mouse ASC-PYD filament is highly similar to the recently determined human ASC-PYD filament, suggesting evolutionary conservation of ASC-dependent inflammasome mechanisms. PMID:26464513

  17. Evaluation of eating habits and lifestyle in patients with obesity before and after bariatric surgery: a single Italian center experience.

    Science.gov (United States)

    Cena, Hellas; De Giuseppe, Rachele; Biino, Ginevra; Persico, Francesca; Ciliberto, Ambra; Giovanelli, Alessandro; Stanford, Fatima Cody

    2016-01-01

    The study evaluated and compared the eating habits and lifestyle of patients with moderate to severe obesity who have undergone Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG). Food frequency (FF), food habits (FH), physical activity and life style (PA) as well as smoking habits (SH) were analyzed in 50 RYGB (25 M; aged: 24-64) and 50 SG patients (25 M; aged: 22-63) by means of a validated questionnaire, before (T0) and 6 months (T1) post bariatric surgery. A score for each section (FF, FH, PA, SH) was calculated. ANOVA analysis (age/sex adjusted): FF and FH scores improved at T1 (RYGB and SG: p habits improved, patients did not change their physical activity level or their smoking habits. Patients should receive adequate lifestyle counseling to ensure the maximal benefit from bariatric surgery.

  18. 18 CFR Appendix 1 to Part 301 - ASC Utility Filing Template

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false ASC Utility Filing Template 1 Appendix 1 to Part 301 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS FOR FEDERAL POWER MARKETING ADMINISTRATIONS AVERAGE SYSTEM COST...

  19. How many records should be used in ASCE/SEI-7 ground motion scaling procedure?

    Science.gov (United States)

    Reyes, Juan C.; Kalkan, Erol

    2012-01-01

    U.S. national building codes refer to the ASCE/SEI-7 provisions for selecting and scaling ground motions for use in nonlinear response history analysis of structures. Because the limiting values for the number of records in the ASCE/SEI-7 are based on engineering experience, this study examines the required number of records statistically, such that the scaled records provide accurate, efficient, and consistent estimates of “true” structural responses. Based on elastic–perfectly plastic and bilinear single-degree-of-freedom systems, the ASCE/SEI-7 scaling procedure is applied to 480 sets of ground motions; the number of records in these sets varies from three to ten. As compared to benchmark responses, it is demonstrated that the ASCE/SEI-7 scaling procedure is conservative if fewer than seven ground motions are employed. Utilizing seven or more randomly selected records provides more accurate estimate of the responses. Selecting records based on their spectral shape and design spectral acceleration increases the accuracy and efficiency of the procedure.

  20. Aeroacoustics research in Europe : the CEAS-ASC report on 1997 highlights

    NARCIS (Netherlands)

    Rienstra, S.W.

    1998-01-01

    This paper is a report on the highlights of aeroacoustics research and development in Europe in 1997, compiled from information provided in the CEAS Aeroacoustics Specialists Committee (ASC). The Confederation of European Aerospace Societies (CEAS) comprises the national Aerospace Societies of

  1. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of advanced epithelial and recurrent ovarian carcinoma: a single center experience.

    Science.gov (United States)

    Pavlov, Maja J; Ceranic, Miljan S; Latincic, Stojan M; Sabljak, Predrag V; Kecmanovic, Dragutin M; Sugarbaker, Paul H

    2017-09-07

    With standard treatment of epithelial ovarian cancer (EOC), prognosis is very poor. The aim of this study is to show early and late results in patients who underwent cytoreductive surgery and intraperitoneal chemotherapy. This was a retrospective single centre study. All patients with advanced and recurrent ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) or modified early postoperative intraperitoneal chemotherapy (EPIC) were included in the study. In the period 1995-2014, 116 patients were treated, 55 with primary EOC and 61 with recurrent EOC. The mean age was 59 years (26-74). Statistically, median survival time was significantly longer in the group with primary advanced cancer of the ovary (41.3 months) compared to relapsed ovarian cancer (27.3 months). Survival for the primary EOC was 65 and 24% at 3 and 5 years, respectively. Survival for recurrent EOC was 33 and 16% at 3 and 5 years, respectively. Mortality was 1/116 (0.8%). Morbidity was 11/116 (9.5%). Peritoneal cancer index (PCI) was ≤20 in 59 (51%) patients and statistically, their average survival was significantly longer than in the group of 57 (49%) patients with PCI >20 (p = 0.014). In advanced or recurrent EOC, a curative therapeutic approach was pursued that combined optimal cytoreductive surgery and intraperitoneal chemotherapy. PCI and timing of the intervention (primary or recurrent) were the strongest independent prognostic factors.

  2. Evaluating the learning curve for retroperitoneoscopic adrenalectomy in a high-volume center for laparoscopic adrenal surgery

    NARCIS (Netherlands)

    Uitert, A. van; D'Ancona, F.C.H.; Deinum, J.; Timmers, H.J.L.M.; Langenhuijsen, J.F.

    2017-01-01

    BACKGROUND: Laparoscopic adrenalectomy is an effective method for benign adrenal tumor removal. In the literature, both lateral transperitoneal (TLA) and posterior retroperitoneoscopic (RPA) approaches are described. Since 2007, the number of patients increased significantly in our center.

  3. Probability-Based Design Criteria of the ASCE 7 Tsunami Loads and Effects Provisions (Invited)

    Science.gov (United States)

    Chock, G.

    2013-12-01

    Mitigation of tsunami risk requires a combination of emergency preparedness for evacuation in addition to providing structural resilience of critical facilities, infrastructure, and key resources necessary for immediate response and economic and social recovery. Critical facilities would include emergency response, medical, tsunami refuges and shelters, ports and harbors, lifelines, transportation, telecommunications, power, financial institutions, and major industrial/commercial facilities. The Tsunami Loads and Effects Subcommittee of the ASCE/SEI 7 Standards Committee is developing a proposed new Chapter 6 - Tsunami Loads and Effects for the 2016 edition of the ASCE 7 Standard. ASCE 7 provides the minimum design loads and requirements for structures subject to building codes such as the International Building Code utilized in the USA. In this paper we will provide a review emphasizing the intent of these new code provisions and explain the design methodology. The ASCE 7 provisions for Tsunami Loads and Effects enables a set of analysis and design methodologies that are consistent with performance-based engineering based on probabilistic criteria. . The ASCE 7 Tsunami Loads and Effects chapter will be initially applicable only to the states of Alaska, Washington, Oregon, California, and Hawaii. Ground shaking effects and subsidence from a preceding local offshore Maximum Considered Earthquake will also be considered prior to tsunami arrival for Alaska and states in the Pacific Northwest regions governed by nearby offshore subduction earthquakes. For national tsunami design provisions to achieve a consistent reliability standard of structural performance for community resilience, a new generation of tsunami inundation hazard maps for design is required. The lesson of recent tsunami is that historical records alone do not provide a sufficient measure of the potential heights of future tsunamis. Engineering design must consider the occurrence of events greater than

  4. Development of Telecommunications of Prao ASC Lpi RAS

    Science.gov (United States)

    Isaev, E. A.; Dumskiy, D. V.; Likhachev, S. F.; Shatskaya, M. V.; Pugachev, V. D.; Samodurov, V. A.

    The new modern and reliable data storage system was acquired in 2010 in order to develop internal telecommunication resources of the Observatory. The system is designed for store large amounts of observation data obtained from the three radio-astronomy complexes (PT-22, DKR-1000 and BSA). The digital switching system - "Elcom" is installed in the Pushchino Radio Astronomy Observatory to ensure the observatory by phone communications. The phone communication between buildings of the observatory carried out over fiber-optic data links by using the ip-telephony. The direct optical channel from tracking station RT-22 in Pushchino to Moscow processing center has been created and put into operation to transfer large amounts of data at the final stage of the establishment of ground infrastructure for the international space project "Radioastron". A separate backup system for processing and storing data is organized in Pushchino Radio Astronomy Observatory to eliminate data loss during communication sessions with the Space Telescope.

  5. Revisional bariatric surgery after failed laparoscopic adjustable gastric banding - a single-center, long-term retrospective study.

    Science.gov (United States)

    Kowalewski, Piotr K; Olszewski, Robert; Kwiatkowski, Andrzej P; Paśnik, Krzysztof

    2017-01-01

    Laparoscopic adjustable gastric banding (LAGB) used to be one of the most popular bariatric procedures. To present our institution's experience with LAGB, its complications, causes of failure and revisional bariatric procedures, in a long-term follow-up. Records of patients who underwent pars flaccida LAGB from 2003 to 2006 were gathered. We selected data on patients with a history of additional bariatric procedures. Their initial demographic data, body mass index and causes of revision were gathered. We analyzed length of stay and early perioperative complications. 60% of patients (n = 57) who underwent LAGB in our institution between 2003 and 2006 had their band removed (out of 107, 11% lost to follow-up). Median time to revisional surgery was 50 months. The main reasons for removal were: weight regain (n = 23; 40%), band slippage (n = 14; 25%), and pouch dilatation (n = 9; 16%). Thirty (53%) patients required additional bariatric surgery, 10 (33%) of which were simultaneous with band removal. The most popular procedures were: laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 15; 50%), open gastric bypass (n = 8; 27%), and laparoscopic sleeve gastrectomy (LSG) - (n = 3; 10%). Mean length of stay (LOS) was 5.4 ±2.0. One (3%) perioperative complication was reported. The results show that LAGB is not an effective bariatric procedure in long-term follow-up due to the high rate of complications causing band removal and the high rate of obesity recurrence. Revisional bariatric surgery after failed LAGB may be performed in a one-stage approach with band removal.

  6. Incidence, Etiology and Outcomes of Hyponatremia after Transsphenoidal Surgery: Experience with 344 Consecutive Patients at a Single Tertiary Center

    Science.gov (United States)

    Barber, Sean M.; Liebelt, Brandon D.; Baskin, David S.

    2014-01-01

    Hyponatremia is often seen after transsphenoidal surgery and is a source of considerable economic burden and patient-related morbidity and mortality. We performed a retrospective review of 344 patients who underwent transsphenoidal surgery at our institution between 2006 and 2012. Postoperative hyponatremia was seen in 18.0% of patients at a mean of 3.9 days postoperatively. Hyponatremia was most commonly mild (51.6%) and clinically asymptomatic (93.8%). SIADH was the primary cause of hyponatremia in the majority of cases (n = 44, 71.0%), followed by cerebral salt wasting (n = 15, 24.2%) and desmopressin over-administration (n = 3, 4.8%). The incidence of postoperative hyponatremia was significantly higher in patients with cardiac, renal and/or thyroid disease (p = 0.0034, Objective Risk (OR) = 2.60) and in female patients (p = 0.011, OR = 2.18) or patients undergoing post-operative cerebrospinal fluid drainage (p = 0.0006). Treatment with hypertonic saline (OR = −2.4, p = 0.10) and sodium chloride tablets (OR = −1.57, p = 0.45) was associated with a non-significant trend toward faster resolution of hyponatremia. The use of fluid restriction and diuretics should be de-emphasized in the treatment of post-transsphenoidal hyponatremia, as they have not been shown to significantly alter the time-course to the restoration of sodium balance. PMID:26237599

  7. Incidence, Etiology and Outcomes of Hyponatremia after Transsphenoidal Surgery: Experience with 344 Consecutive Patients at a Single Tertiary Center

    Directory of Open Access Journals (Sweden)

    Sean M. Barber

    2014-10-01

    Full Text Available Hyponatremia is often seen after transsphenoidal surgery and is a source of considerable economic burden and patient-related morbidity and mortality. We performed a retrospective review of 344 patients who underwent transsphenoidal surgery at our institution between 2006 and 2012. Postoperative hyponatremia was seen in 18.0% of patients at a mean of 3.9 days postoperatively. Hyponatremia was most commonly mild (51.6% and clinically asymptomatic (93.8%. SIADH was the primary cause of hyponatremia in the majority of cases (n = 44, 71.0%, followed by cerebral salt wasting (n = 15, 24.2% and desmopressin over-administration (n = 3, 4.8%. The incidence of postoperative hyponatremia was significantly higher in patients with cardiac, renal and/or thyroid disease (p = 0.0034, Objective Risk (OR = 2.60 and in female patients (p = 0.011, OR = 2.18 or patients undergoing post-operative cerebrospinal fluid drainage (p = 0.0006. Treatment with hypertonic saline (OR = −2.4, p = 0.10 and sodium chloride tablets (OR = −1.57, p = 0.45 was associated with a non-significant trend toward faster resolution of hyponatremia. The use of fluid restriction and diuretics should be de-emphasized in the treatment of post-transsphenoidal hyponatremia, as they have not been shown to significantly alter the time-course to the restoration of sodium balance.

  8. Domestic Travel and Regional Migration for Parathyroid Surgery Among Patients Receiving Care at Academic Medical Centers in the United States, 2012-2014.

    Science.gov (United States)

    Hinson, Andrew M; Hohmann, Samuel F; Stack, Brendan C

    2016-07-01

    To improve outcomes after parathyroidectomy, several organizations advocate for selective referral of patients to high-volume academic medical centers with dedicated endocrine surgery programs. The major factors that influence whether patients travel away from their local community and support system for perceived better care remain elusive. To assess how race/ethnicity and insurance status influence domestic travel patterns and selection of high- vs low-volume hospitals in different regions of the United States for parathyroid surgery. A retrospective study was conducted of 36 750 inpatients and outpatients discharged after undergoing parathyroidectomy identified in the University HealthSystem Consortium database from January 1, 2012, to December 31, 2014 (12 quarters total). Each US region (Northeast, Mid-Atlantic, Great Lakes, Central Plains, Southeast, Gulf Coast, and West) contained 20 or more low-volume hospitals (1-49 cases annually), 5 or more mid-volume hospitals (50-99 cases annually), and multiple high-volume hospitals (≥100 cases annually). Domestic medical travelers were defined as patients who underwent parathyroidectomy at a hospital in a different US region from which they resided and traveled more than 150 miles to the hospital. Distance traveled, regional destination, and relative use of high- vs low-volume hospitals. A total of 23 268 of the 36 750 patients (63.3%) had parathyroidectomy performed at high-volume hospitals. The mean (SD) age of the study cohort was 71.5 (16.2) years (95% CI, 71.4-71.7 years). The female to male ratio was 3:1. Throughout the study period, mean (SD) distance traveled was directly proportional to hospital volume (high-volume hospitals, 208.4 [455.1] miles; medium-volume hospitals, 50.5 [168.4] miles; low-volume hospitals, 27.7 [89.5] miles; P < .001). From 2012 to 2014, the annual volume of domestic medical travelers increased by 15.0% (from 961 to 1105), while overall volume increased by 4.9% (from 11

  9. Small Radioisotope Power System Testing at NASA Glenn Research Center

    Science.gov (United States)

    Dugala, Gina; Bell, Mark; Oriti, Salvatore; Fraeman, Martin; Frankford, David; Duven, Dennis

    2013-01-01

    In April 2009, NASA Glenn Research Center (GRC) formed an integrated product team (IPT) to develop a Small Radioisotope Power System (SRPS) utilizing a single Advanced Stirling Convertor (ASC) with passive balancer. A single ASC produces approximately 80 We making this system advantageous for small distributed lunar science stations. The IPT consists of Sunpower, Inc., to provide the single ASC with a passive balancer, The Johns Hopkins University Applied Physics Laboratory (JHUAPL) to design an engineering model Single Convertor Controller (SCC) for an ASC with a passive balancer, and NASA GRC to provide technical support to these tasks and to develop a simulated lunar lander test stand. The single ASC with a passive balancer, simulated lunar lander test stand, and SCC were delivered to GRC and were tested as a system. The testing sequence at GRC included SCC fault tolerance, integration, electromagnetic interference (EMI), vibration, and extended operation testing. The SCC fault tolerance test characterized the SCCs ability to handle various fault conditions, including high or low bus power consumption, total open load or short circuit, and replacing a failed SCC card while the backup maintains control of the ASC. The integrated test characterized the behavior of the system across a range of operating conditions, including variations in cold-end temperature and piston amplitude, including the emitted vibration to both the sensors on the lunar lander and the lunar surface. The EMI test characterized the AC and DC magnetic and electric fields emitted by the SCC and single ASC. The vibration test confirms the SCCs ability to control the single ASC during launch. The extended operation test allows data to be collected over a period of thousands of hours to obtain long term performance data of the ASC with a passive balancer and the SCC. This paper will discuss the results of each of these tests.

  10. MRI-tracking of transplanted human ASC in a SCID mouse model

    Energy Technology Data Exchange (ETDEWEB)

    Siegmund, Birte J.; Kasten, Annika [Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Rostock University Medical Center (Germany); Kühn, Jens-Peter [Institute of Diagnostic Radiology and Neuroradiology, Greifswald University Medical Center (Germany); Winter, Karsten [Institute of Anatomy, Faculty of Medicine, University of Leipzig (Germany); Grüttner, Cordula [Micromod Partikeltechnologie GmbH, Rostock (Germany); Frerich, Bernhard, E-mail: bernhard.frerich@med.uni-rostock.de [Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Rostock University Medical Center (Germany)

    2017-04-01

    Background: Regarding strategies improving the efficacy of stem cell transplantation in adipose tissue engineering, cell tracking might be useful. Here we report the in vivo tracking of adipose tissue derived stem cells (ASC) by means of nanoparticle labeling and magnetic resonance imaging (MRI). Here we report the in vivo tracking of adipose tissue derived stromal cells (ASC) by means of nanoparticle labeling and magnetic resonance imaging (MRI). Materials and methods: Human ASC were amplified and labeled with two types of magnetic nanoparticles (MNP), BNF starch and nanomag®-D-spio. Adipose tissue constructs were fabricated by seeding collagen scaffolds with labeled and unlabeled ASCs. Constructs were implanted subcutaneously in the back of severe combined immunodeficient (SCID) mice (n =69, group 1: control with cells w/o label, group 2: BNF starch labeled cells, group 3: nanomag®-D-spio labeled cells). MRI scans were performed at 24 hours, four, twelve and 28 days and four months in a 7.1 T animal device. Explanted constructs were analyzed histomorphometrically. Results: MRI scans showed high contrast of the labeled cells in t2-tse-sequence compared to unlabeled controls. Loss of volume of the implants was observed over time due to partial loss for transplanted cells without significant difference (level of significance p<0.017). Compared to histomorphometry, there was found a positiv correlations in measurement of implant size with a significant at day four (correlation coefficient =0.643; p=0.024) and day twelve (correlation coefficient =0.687; p=0.010). Additional Prussian blue stain showed iron in all implants. Significant differences between the three groups (significance level p<0.017) were found after twelve days between control group and group 3 (p=0.008) and after 28 days between control group and group 2 and 3 (p=0.011). Conclusion: Both MNPs might be suitable for tracking of ASC in vivo and show long term stability over 4 months. - Highlights:

  11. Antidepressant-Like Effects of Central BDNF Administration in Mice of Antidepressant Sensitive Catalepsy (ASC) Strain.

    Science.gov (United States)

    Tikhonova, Maria; Kulikov, Alexander V

    2012-08-31

    Although numerous data evidence the implication of brain-derived neurotrophic factor (BDNF) in the pathophysiology of depression, the potential for BDNF to correct genetically defined depressive-like states is poorly studied. This study was aimed to reveal antidepressant-like effects of BDNF (300 ng, 2×, i.c.v.) on behavior and mRNA expression of genes associated with depression-like state in the brain in mice of antidepressant sensitive catalepsy (ASC) strain characterized by high hereditary predisposition to catalepsy and depressive-like features. Behavioral tests were held on the 7th-16th days after the first (4th-13th after the second) BDNF injection. Results showed that BDNF normalized impaired sexual motivation in the ASC males, and this BDNF effect differed, with advantageous effects, from that of widely used antidepressants. The anticataleptic effect of two BDNF injections was enhanced compared with a single administration. A tendency to decrease the immobility duration in tail-suspension test was observed in BDNF-treated ASC mice. The effects on catalepsy and sexual motivation were specific since BDNF did not alter locomotor and exploratory activity or social interest in the ASC mice. Along with behavioral antidepressant-like effects on the ASC mice, BDNF increased hippocampal mRNA levels of Bdnf and Creb1 (cAMP response element-binding protein gene). BDNF also augmented mRNA levels of Arc gene encoding Arc (Activity-regulated cytoskeleton-associated) protein involved in BDNF-induced processes of neuronal and synaptic plasticity in hippocampus and prefrontal cortex. The data suggest that: [1] BDNF is effective in the treatment of some genetically defined behavioral disturbances; [2] BDNF influences sexually-motivated behavior; [3] Arc mRNA levels may serve as a molecular marker of BDNF physiological activity associated with its long-lasting behavioral effects; [4] ASC mouse strain can be used as a suitable model to study mechanisms of BDNF effects on

  12. [Effects of chronic fluoxetine treatment on manifestation of sexual motivation and social behavior in mice of ASC line].

    Science.gov (United States)

    Tikhonova, M A; Otroshchenko, E A; Kulikov, A V

    2010-02-01

    Sexual dysfunctions are the typical symptoms accompanying depressive disorders. However antidepressants which improve general state of the patients have no effect on sexual disorders. Mice of ASC (Antidepressant Sensitive Catalepsy) line with high hereditary predisposition to catalepsy were proposed as a model of genetically associated depressive-like condition. The work was aimed at comparison of behavioral indices of sexual motivation and social interest of ASC mice with those of mice of parental inbred AKR and CBA strains, and at the study of the effects of chronic fluoxetine treatment in doses of 10 and 20 mg/kg on these parameters in ASC mice. ASC males demonstrated reduced sexual motivation which was not corrected by fluoxetine. ASC mice did not differ in the expression of social interest and aggression towards juvenile intruder from mice of parental strains. Fluoxetine failed to alter social behavior of ASC mice in social interaction test but its higher dose decreased percentage of aggressors. ASC mouse line seems to be a perspective model to study genetic mechanisms of sexual dysfunctions associated with depressive conditions.

  13. Procedural Portfolio Planning in Plastic Surgery, Part 2: Collaboration Between Surgeons and Hospital Administrators to Develop a Funds Flow Model for Procedures Performed at an Academic Medical Center.

    Science.gov (United States)

    Hultman, Charles Scott

    2016-06-01

    Although plastic surgeons make important contributions to the clinical, educational, and research missions of academic medical centers (AMCs), determining the financial value of a plastic surgery service can be difficult, due to complex cost accounting systems. We analyzed the financial impact of plastic surgery on an AMC, by examining the contribution margins and operating income of surgical procedures. We collaborated with hospital administrators to implement 3 types of strategic changes: (1) growth of areas with high contribution margin, (2) curtailment of high-risk procedures with negative contribution margin, (3) improved efficiency of mission-critical services with high resource consumption. Outcome measures included: facility charges, hospital collections, contribution margin, operating margin, and operating room times. We also studied the top 50 Current Procedural Terminology codes (total case number × charge/case), ranking procedures for profitability, as determined by operating margin. During the 2-year study period, we had no turnover in faculty; did not pursue any formal marketing; did not change our surgical fees, billing system, or payer mix; and maintained our commitment to indigent care. After rebalancing our case mix, through procedural portfolio planning, average hospital operating income/procedure increased from $-79 to $+816. Volume and diversity of cases increased, with no change in payer mix. Although charges/case decreased, both contribution margin and operating margin increased, due to improved throughput and decreased operating room times. The 5 most profitable procedures for the hospital were hernia repair, mandibular osteotomy, hand skin graft, free fibula flap, and head and neck flap, whereas the 5 least profitable were latissimus breast reconstruction, craniosynostosis repair, free-flap breast reconstruction, trunk skin graft, and cutaneous free flap. Total operating income for the hospital, from plastic surgery procedures, increased

  14. Over-expression, purification and characterization of an Asc-1 homologue from Gloeobacter violaceus

    DEFF Research Database (Denmark)

    Wang, Xiaole; Hald, Helle; Ernst, Heidi Asschenfeldt

    2010-01-01

    The human alanine-serine-cysteine transporter 1 (Asc-1) belongs to the slc7a family of solute carrier transporters. Asc-1 mediates the uptake of D-serine in an exchanger-type fashion, coupling the process to the release of alanine and cysteine. Among the bacterial Asc-1 homologues, one transporter...... of auto-induction was crucial for obtaining high yields and purity of the transporter. The transporter was purified with yields in the range of 0.2-0.4 mg per L culture and eluted in a single peak from a size-exclusion column. The circular dichroism spectrum revealed a folded and apparently all...

  15. NASA Glenn Research Center Support of the Advanced Stirling Radioisotope Generator Project

    Science.gov (United States)

    Wilson, Scott D.; Wong, Wayne A.

    2015-01-01

    A high-efficiency radioisotope power system was being developed for long-duration NASA space science missions. The U.S. Department of Energy (DOE) managed a flight contract with Lockheed Martin Space Systems Company to build Advanced Stirling Radioisotope Generators (ASRGs), with support from NASA Glenn Research Center. DOE initiated termination of that contract in late 2013, primarily due to budget constraints. Sunpower, Inc., held two parallel contracts to produce Advanced Stirling Convertors (ASCs), one with Lockheed Martin to produce ASC-F flight units, and one with Glenn for the production of ASC-E3 engineering unit "pathfinders" that are built to the flight design. In support of those contracts, Glenn provided testing, materials expertise, Government-furnished equipment, inspection capabilities, and related data products to Lockheed Martin and Sunpower. The technical support included material evaluations, component tests, convertor characterization, and technology transfer. Material evaluations and component tests were performed on various ASC components in order to assess potential life-limiting mechanisms and provide data for reliability models. Convertor level tests were conducted to characterize performance under operating conditions that are representative of various mission conditions. Despite termination of the ASRG flight development contract, NASA continues to recognize the importance of high-efficiency ASC power conversion for Radioisotope Power Systems (RPS) and continues investment in the technology, including the continuation of the ASC-E3 contract. This paper describes key Government support for the ASRG project and future tests to be used to provide data for ongoing reliability assessments.

  16. ASC Tri-lab Co-design Level 2 Milestone Report 2015

    Energy Technology Data Exchange (ETDEWEB)

    Hornung, Rich [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Jones, Holger [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Keasler, Jeff [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Neely, Rob [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Pearce, Olga [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hammond, Si [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Trott, Christian [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Lin, Paul [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Vaughan, Courtenay [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Cook, Jeanine [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hoekstra, Rob [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Bergen, Ben [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Payne, Josh [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Womeldorff, Geoff [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-09-23

    In 2015, the three Department of Energy (DOE) National Laboratories that make up the Advanced Sci- enti c Computing (ASC) Program (Sandia, Lawrence Livermore, and Los Alamos) collaboratively explored performance portability programming environments in the context of several ASC co-design proxy applica- tions as part of a tri-lab L2 milestone executed by the co-design teams at each laboratory. The programming environments that were studied included Kokkos (developed at Sandia), RAJA (LLNL), and Legion (Stan- ford University). The proxy apps studied included: miniAero, LULESH, CoMD, Kripke, and SNAP. These programming models and proxy-apps are described herein. Each lab focused on a particular combination of abstractions and proxy apps, with the goal of assessing performance portability using those. Performance portability was determined by: a) the ability to run a single application source code on multiple advanced architectures, b) comparing runtime performance between \

  17. A Fast-Track Referral System for Skin Lesions Suspicious of Melanoma: Population-Based Cross-Sectional Study from a Plastic Surgery Center

    Directory of Open Access Journals (Sweden)

    Reem Dina Jarjis

    2016-01-01

    Full Text Available Introduction. To minimize delay between presentation, diagnosis, and treatment of cutaneous melanoma (CM, a national fast-track referral system (FTRS was implemented in Denmark. The aim of this study was to analyze the referral patterns to our department of skin lesions suspicious of melanoma in the FTRS. Methods. Patients referred to the Department of Plastic Surgery and Breast Surgery in Zealand University Hospital were registered prospectively over a 1-year period in 2014. A cross-sectional study was performed analyzing referral patterns, including patient and tumor characteristics. Results. A total of 556 patients were registered as referred to the center in the FTRS for skin lesions suspicious of melanoma. Among these, a total of 312 patients (56.1% were diagnosed with CM. Additionally, 41 (7.4% of the referred patients were diagnosed with in situ melanoma. Conclusion. In total, 353 (63.5% patients had a malignant or premalignant melanocytic skin lesion. When only considering patients who where referred without a biopsy, the diagnostic accuracy for GPs and dermatologists was 29% and 45%, respectively. We suggest that efforts of adequate training for the referring physicians in diagnosing melanocytic skin lesions will increase diagnostic accuracy, leading to larger capacity in secondary care for the required treatment of malignant skin lesions.

  18. Impact of surgical experience on management and outcome of pancreatic surgery performed in high- and low-volume centers.

    Science.gov (United States)

    Stella, Marco; Bissolati, Massimiliano; Gentile, Daniele; Arriciati, Alessandro

    2017-09-01

    Pancreaticoduodenectomy (PD) is one of the procedures in general surgery with the highest rate of life-threatening complications. The positive impact of the volume-outcome ratio on outcomes and mortality in pancreatic surgery (PS) has led to policy-level efforts toward centralization of care for PS that is currently under evaluation by some Regional Health Services. The role of the surgeon's experience and training is still under debate. The aim of this paper is to compare the outcomes of PS by the same surgeon in a high volume (HV) and in a low volume (LV) hospital to assess whether a specific training in PS could outdo the benefits of hospital volume. 124 pancreatic resections (98 PD) were conducted by a single surgeon from 2004 to 2014 in two different Italian hospitals with different PS volumes as well as in general surgical activities. The results were retrospectively analyzed. All data regarding demographics, oncological characteristics, surgical parameters and post-operative outcomes were compared between patients operated on in the HV (group A) and LV hospital (group B). The surgical experience in the LV hospital has been then divided into a first period (group B1) and in a second period (group B2). χ 2 test or Fisher's exact test (when variables were dichotomous) was used. The unpaired t test was used to compare continuous data between the two groups. Values are expressed as n. of cases (percent) for categorical data or as mean (standard deviation) for continuous data. A p value less than 0.05 was considered as significant. From 2004 to 2014, 124 patients underwent pancreatic resection by the same surgeon: 69 in an HV hospital (group A) and 55 in an LV hospital (group B). We focused our attention on PD outcomes, 54 in group A and 44 in group B (22 in group B1 and 22 in group B2, accordingly to the aforementioned criteria). A higher incidence of ASA 3 patients, although not statistically significant, was found in group B than in group A (34 vs. 18%; p

  19. Effects of Metal Micro and Nano-Particles on hASCs: An In Vitro Model

    OpenAIRE

    Palombella, Silvia; Pirrone, Cristina; Rossi, Federica; Armenia, Ilaria; Cherubino, Mario; Valdatta, Luigi; Raspanti, Mario; Bernardini, Giovanni; Gornati, Rosalba

    2017-01-01

    As the knowledge about the interferences of nanomaterials on human staminal cells are scarce and contradictory, we undertook a comparative multidisciplinary study based on the size effect of zero-valent iron, cobalt, and nickel microparticles (MPs) and nanoparticles (NPs) using human adipose stem cells (hASCs) as a model, and evaluating cytotoxicity, morphology, cellular uptake, and gene expression. Our results suggested that the medium did not influence the cell sensitivity but, surprisingly...

  20. Intracellular invasion of Orientia tsutsugamushi activates inflammasome in asc-dependent manner.

    Directory of Open Access Journals (Sweden)

    Jung-Eun Koo

    Full Text Available Orientia tsutsugamushi, a causative agent of scrub typhus, is an obligate intracellular bacterium, which escapes from the endo/phagosome and replicates in the host cytoplasm. O. tsutsugamushi infection induces production of pro-inflammatory mediators including interleukin-1β (IL-1β, which is secreted mainly from macrophages upon cytosolic stimuli by activating cysteine protease caspase-1 within a complex called the inflammasome, and is a key player in initiating and maintaining the inflammatory response. However, the mechanism for IL-1β maturation upon O. tsutsugamushi infection has not been identified. In this study, we show that IL-1 receptor signaling is required for efficient host protection from O. tsutsugamushi infection. Live Orientia, but not heat- or UV-inactivated Orientia, activates the inflammasome through active bacterial uptake and endo/phagosomal maturation. Furthermore, Orientia-stimulated secretion of IL-1β and activation of caspase-1 are ASC- and caspase-1- dependent since IL-1β production was impaired in Asc- and caspase-1-deficient macrophages but not in Nlrp3-, Nlrc4- and Aim2-deficient macrophages. Therefore, live O. tsutsugamushi triggers ASC inflammasome activation leading to IL-1β production, which is a critical innate immune response for effective host defense.

  1. A Comparison of ASCE and FAO56 Reference Evapotranspiration at Different Subdaily Timescales: a Numerical Study

    Directory of Open Access Journals (Sweden)

    Farzin Parchami-Araghi

    2017-01-01

    Full Text Available Introduction: Subdaily estimates of reference evapotranspiration (ETo are needed in many applications such as dynamic agro-hydrological modeling. The ASCE and FAO56 Penman–Monteith models (ASCE-PM and FAO56-PM, respectively has received favorable acceptance and application over much of the world, including the United States, for establishing a reference evapotranspiration (ETo index as a function of weather parameters. In the past several years various studies have evaluated ASCE-PM and FAO56-PM models for calculating the commonest hourly or 15-min ETo either by comparing them with lysimetric measurements or by comparison with one another (2, 3, 5, 9, 10, 11, 16, 17, 19. In this study, sub-daily ET o estimates made by the ASCE-PM and FAO56-PM models at different timescales (1-360 min were compared through conduction of a computational experiment, using a daily to sub-daily disaggregation framework developed by Parchami-Araghi et al. (14. Materials and Methods: Daily and sub-daily weather data at different timescales (1-360 min were generated via a daily-to-sub-daily weather data disaggregation framework developed by Parchami-Araghi et al. (14, using long-term (59 years daily weather data obtained from Abadan synoptic weather station. Daily/sub-daily net long wave radiation (Rnl was estimated through 6 different approaches, including using two different criteria for identifying the daytime/nighttime periods : 1 the standard criteria implemented in both ASCE-PM and FAO56-PM models and 2 criterion of actual time of sunset and sunrise in combination with 1 estimation of clear-sky radiation (Rso based on the standard approach implemented in both ASCE-PM and FAO56-PM models (1st and 2nd Rnl estimation approaches, respectively, 2 integral of the Rso estimates derived via a physically based solar radiation model developed by Yang et al. (25, YNG model, for one-second time-steps (3rd and 4th Rnl estimation approaches, respectively, and 3 integral of

  2. Patients' quality of life and role of the ambulatory in after-surgery stoma care. A single center experience.

    Science.gov (United States)

    Magistri, Paolo; Scordamaglia, Maria Rosa; Giulitti, Diego; Papaspyropoulos, Vassilios; Eleuteri, Edoardo; Coppola, Marcello

    2014-01-01

    The aim is to assess on which aspects of everyday-life the post surgery stoma-care ambulatory should physically and psychologically assist the patients. Seventy patients (33 male, 37 female, mean age 68 years) accepted to fill-in the Stoma-QoL questionnaire from January to December 2011. The questionnaire consists of 20 questions addressing different possible discomforts of everyday life. Our results demonstrate that patients with temporary ileostomy have a mean score of quality of life index of 63. Patients with ileostomy demonstrated a higher quality of life score compared to patients with colostomy. Our results confirmed that patients with ileostomy have a better perception of quality of life compared to patients with colostomy. Moreover, our data clearly show that patients are more concerned on stoma management compared to the hypothetical prejudice of society. The stoma care ambulatory have a crucial role, offering to the patient and his/her family an adequate psychological support, and teaching the management of the stoma and the pouch.

  3. Skin and Soft Tissue Surgery in the Office Versus Operating Room Setting: An Analysis Based on Individual-Level Medicare Data.

    Science.gov (United States)

    Kantor, Jonathan

    2018-03-23

    The relative volume of skin and soft tissue excision and reconstructive procedures performed in the outpatient office versus facility (ambulatory surgical center or hospital) differs by specialty, and has major implications for quality of care, outcomes, development of guidelines, resident education, health care economics, and patient perception. To assess the relative volume of surgical procedures performed in each setting (office vs ambulatory surgery center [ASC]/hospital) by dermatologists and nondermatologists. A cross-sectional analytical study was performed using the Medicare public use file (PUF) for 2014, which includes every patient seen in an office, ASC, or hospital in the United States billed to Medicare part B. Data were divided by physician specialty and setting. A total of 9,316,307 individual encounters were included in the Medicare PUF. Dermatologists account for 195,001 (2.1%) of the total. Dermatologists were more likely to perform surgical procedures in an office setting only (odds ratio 5.48 [95% confidence interval 5.05-5.95], p office setting, and dermatologists are more than 5 times as likely as other specialists to operate in an office setting.

  4. Long-Term Results of Aortic Root Surgery in Marfan Syndrome Patients: A Single-Center Experience.

    Science.gov (United States)

    Nicolo, Francesco; Romeo, Francesco; Lio, Antonio; Bovio, Emanuele; Scafuri, Antonio; Bassano, Carlo; Polisca, Patrizio; Pellegrino, Antonio; Nardi, Paolo; Chiariello, Luigi; Ruvolo, Giovanni

    2017-07-01

    The study aim was to compare long-term results of Marfan syndrome (MFS) patients affected by aortic root disease undergoing aortic root replacement with the Bentall or David operation. Since 1994, a total of 59 patients has been followed at the authors' Marfan Center, having undergone either a Bentall operation (Bentall group, n = 30) or a David operation (David group, n = 29). No operative mortality was recorded. After 20 years (mean follow up 97 ± 82 months; range 1 to 369 months) no prosthesis-related major bleeding or thromboembolic events had been observed; the 20-year survival was 94 ± 6% in the Bentall group, and 100% in the David group (p = 0.32). Freedom from reintervention for aortic valve dysfunction was 100% in the Bentall group, and 75 ± 13% in the David group (p = 0.04). This inter-group difference became relevant after the first eight-year period of follow-up, and was mainly associated with a particular familiar genetic phenotype involving three out of four reoperated patients. Freedom from all-cause death, myocardial infarction, stroke, prosthetic valve-related complications, and reintervention on any aortic segment was 69 ± 12% in the Bentall group, and 67 ± 14% in the David group (p = 0.33). The Bentall and David operations are both associated with satisfactory long-term results in MFS patients. The low rate of valve prosthesis-related complications suggested that the Bentall operation would continue to be a standard surgical treatment. The reimplantation technique, adopted for less-dilated aortas, provides satisfactory freedom from reoperation. Careful attention should be paid to the reimplantation technique in patients affected by a serious familiar genetic phenotype.

  5. Visual and Refractive Outcomes in Manual versus Femtosecond Laser-Assisted Cataract Surgery: A Single-Center Retrospective Cohort Analysis of 1838 Eyes.

    Science.gov (United States)

    Berk, Thomas A; Schlenker, Matthew B; Campos-Möller, Xavier; Pereira, Austin M; Ahmed, Iqbal Ike K

    2018-03-06

    Femtosecond laser-assisted cataract surgery (FLACS) has emerged as an alternative to manual cataract surgery (MCS) for corneal incision and capsulorhexis creation, as well as nuclear fragmentation. This study compares postoperative refractive and visual outcomes in eyes receiving MCS or FLACS. Single-center, comparative, retrospective cohort analysis. Consecutive eyes receiving FLACS and MCS from July 1, 2012, to July 31, 2015, at a single tertiary care center. Demographic data, ocular history, preoperative measurements and biometry, and postoperative surgical results were retrospectively obtained and statistically analyzed using a generalized linear mixed model adjusting for differences in baseline characteristics and within-patient correlation. A 2-tailed P value <0.05 was considered statistically significant throughout the study. Percentage of eyes achieving absolute error (AE) ≤0.5 diopters (D). Secondary outcomes included percentage of eyes with AE ≤0.25 D and ≤1.0 D, and percentage of distance-targeted eyes achieving uncorrected distance visual acuity (UDVA) of 20/20 or better, 20/25 or better, and 20/30 or better. A total of 883 eyes received MCS and 955 received FLACS among 1089 patients. Some 82.6% of FLACS eyes and 78.8% of MCS eyes had ≤0.5 D of AE at 3 weeks, representing an adjusted odds ratio (OR) of 1.28 (95% confidence interval [CI], 0.98-1.66) of FLACS relative to MCS being within target. Some 97.1% of FLACS and 97.2% of MCS eyes had ≤1.0 D of AE (OR, 0.96; 95% CI, 0.57-1.60) and 49.3% of FLACS and 46.3% of MCS eyes, ≤0.25 D of AE (OR, 1.13; 95% CI, 0.91-1.39). Factors predictive of a favorable refractive outcome included axial length between 22 and 24.8 mm, receiving a toric intraocular lens, less preoperative cylinder, and greater preoperative average keratometry. There was no significant difference in the percentage of patients targeted for distance who achieved UDVA of 20/20 or better (P = 0.30), 20/25 or better (P = 0.06), or 20

  6. Antiproliferative effect of ASC-J9 delivered by PLGA nanoparticles against estrogen-dependent breast cancer cells.

    Science.gov (United States)

    Verderio, Paolo; Pandolfi, Laura; Mazzucchelli, Serena; Marinozzi, Maria Rosaria; Vanna, Renzo; Gramatica, Furio; Corsi, Fabio; Colombo, Miriam; Morasso, Carlo; Prosperi, Davide

    2014-08-04

    Among polymeric nanoparticles designed for cancer therapy, PLGA nanoparticles have become one of the most popular polymeric devices for chemotherapeutic-based nanoformulations against several kinds of malignant diseases. Promising properties, including long-circulation time, enhanced tumor localization, interference with "multidrug" resistance effects, and environmental biodegradability, often result in an improvement of the drug bioavailability and effectiveness. In the present work, we have synthesized 1,7-bis(3,4-dimethoxyphenyl)-5-hydroxyhepta-1,4,6-trien-3-one (ASC-J9) and developed uniform ASC-J9-loaded PLGA nanoparticles of about 120 nm, which have been prepared by a single-emulsion process. Structural and morphological features of the nanoformulation were analyzed, followed by an accurate evaluation of the in vitro drug release kinetics, which exhibited Fickian law diffusion over 10 days. The intracellular degradation of ASC-J9-bearing nanoparticles within estrogen-dependent MCF-7 breast cancer cells was correlated to a time- and dose-dependent activity of the released drug. A cellular growth inhibition associated with a specific cell cycle G2/M blocking effect caused by ASC-J9 release inside the cytosol allowed us to put forward a hypothesis on the action mechanism of this nanosystem, which led to the final cell apoptosis. Our study was accomplished using Annexin V-based cell death analysis, MTT assessment of proliferation, radical scavenging activity, and intracellular ROS evaluation. Moreover, the intracellular localization of nanoformulated ASC-J9 was confirmed by a Raman optical imaging experiment designed ad hoc. PLGA nanoparticles and ASC-J9 proved also to be safe for a healthy embryo fibroblast cell line (3T3-L1), suggesting a possible clinical translation of this potential nanochemotherapeutic to expand the inherently poor bioavailability of hydrophobic ASC-J9 that could be proposed for the treatment of malignant breast cancer.

  7. Function of microRNAs in the Osteogenic Differentiation and Therapeutic Application of Adipose-Derived Stem Cells (ASCs

    Directory of Open Access Journals (Sweden)

    Walter M. Hodges

    2017-12-01

    Full Text Available Traumatic wounds with segmental bone defects represent substantial reconstructive challenges. Autologous bone grafting is considered the gold standard for surgical treatment in many cases, but donor site morbidity and associated post-operative complications remain a concern. Advances in regenerative techniques utilizing mesenchymal stem cell populations from bone and adipose tissue have opened the door to improving bone repair in the limbs, spine, and craniofacial skeleton. The widespread availability, ease of extraction, and lack of immunogenicity have made adipose-derived stem cells (ASCs particularly attractive as a stem cell source for regenerative strategies. Recently it has been shown that small, non-coding miRNAs are involved in the osteogenic differentiation of ASCs. Specifically, microRNAs such as miR-17, miR-23a, and miR-31 are expressed during the osteogenic differentiation of ASCs, and appear to play a role in inhibiting various steps in bone morphogenetic protein-2 (BMP2 mediated osteogenesis. Importantly, a number of microRNAs including miR-17 and miR-31 that act to attenuate the osteogenic differentiation of ASCs are themselves stimulated by transforming growth factor β-1 (TGFβ-1. In addition, transforming growth factor β-1 is also known to suppress the expression of microRNAs involved in myogenic differentiation. These data suggest that preconditioning strategies to reduce TGFβ-1 activity in ASCs may improve the therapeutic potential of ASCs for musculoskeletal application. Moreover, these findings support the isolation of ASCs from subcutaneous fat depots that tend to have low endogenous levels of TGFβ-1 expression.

  8. NLRP3 and ASC suppress lupus-like autoimmunity by driving the immunosuppressive effects of TGF-β receptor signalling.

    Science.gov (United States)

    Lech, Maciej; Lorenz, Georg; Kulkarni, Onkar P; Grosser, Marian O O; Stigrot, Nora; Darisipudi, Murthy N; Günthner, Roman; Wintergerst, Maximilian W M; Anz, David; Susanti, Heni Eka; Anders, Hans-Joachim

    2015-12-01

    The NLRP3/ASC inflammasome drives host defence and autoinflammatory disorders by activating caspase-1 to trigger the secretion of mature interleukin (IL)-1β/IL-18, but its potential role in autoimmunity is speculative. We generated and phenotyped Nlrp3-deficient, Asc-deficient, Il-1r-deficient and Il-18-deficient C57BL/6-lpr/lpr mice, the latter being a mild model of spontaneous lupus-like autoimmunity. While lack of IL-1R or IL-18 did not affect the C57BL/6-lpr/lpr phenotype, lack of NLRP3 or ASC triggered massive lymphoproliferation, lung T cell infiltrates and severe proliferative lupus nephritis within 6 months, which were all absent in age-matched C57BL/6-lpr/lpr controls. Lack of NLRP3 or ASC increased dendritic cell and macrophage activation, the expression of numerous proinflammatory mediators, lymphocyte necrosis and the expansion of most T cell and B cell subsets. In contrast, plasma cells and autoantibody production were hardly affected. This unexpected immunosuppressive effect of NLRP3 and ASC may relate to their known role in SMAD2/3 phosphorylation during tumour growth factor (TGF)-β receptor signalling, for example, Nlrp3-deficiency and Asc-deficiency significantly suppressed the expression of numerous TGF-β target genes in C57BL/6-lpr/lpr mice and partially recapitulated the known autoimmune phenotype of Tgf-β1-deficient mice. These data identify a novel non-canonical immunoregulatory function of NLRP3 and ASC in autoimmunity. 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/

  9. Optimizing the ASC WAN: evaluating network performance tools for comparing transport protocols.

    Energy Technology Data Exchange (ETDEWEB)

    Lydick, Christopher L.

    2007-07-01

    The Advanced Simulation & Computing Wide Area Network (ASC WAN), which is a high delay-bandwidth network connection between US Department of Energy National Laboratories, is constantly being examined and evaluated for efficiency. One of the current transport-layer protocols which is used, TCP, was developed for traffic demands which are different from that on the ASC WAN. The Stream Control Transport Protocol (SCTP), on the other hand, has shown characteristics which make it more appealing to networks such as these. Most important, before considering a replacement for TCP on any network, a testing tool that performs well against certain criteria needs to be found. In order to try to find such a tool, two popular networking tools (Netperf v.2.4.3 & v.2.4.6 (OpenSS7 STREAMS), and Iperf v.2.0.6) were tested. These tools implement both TCP and SCTP and were evaluated using four metrics: (1) How effectively can the tool reach a throughput near the bandwidth? (2) How much of the CPU does the tool utilize during operation? (3) Is the tool freely and widely available? And, (4) Is the tool actively developed? Following the analysis of those tools, this paper goes further into explaining some recommendations and ideas for future work.

  10. Clinical significance of HPV DNA cotesting in Korean women with ASCUS or ASC-H.

    Science.gov (United States)

    Lee, Sanghoon; Kim, Jae Won; Hong, Jin Hwa; Song, Jae Yun; Lee, Jae Kwan; Kim, In Sun; Lee, Nak Woo

    2014-12-01

    The purpose of this study was to evaluate the clinical significance of Human papillomavirus (HPV) DNA cotesting in Korean women with abnormal Papanicolaou (Pap) smear results based on colposcopic pathology. A total of 1012 women underwent liquid-based Pap smears and hybrid capture II HPV DNA tests followed by colposcopy at the Korea University Hospital from January 2007 to May 2012. Of these women, 832 women were included in this retrospective study. The mean patient age was 45.4 ± 13.7 years (range:15-80). The distribution of Pap smear results was normal (4.7%), atypical squamous cells of uncertain significance (ASCUS) (42.1%), low-grade squamous intraepithelial lesion (26.8%), ASC-H (7.0%), and high-grade squamous intraepithelial lesion (HSIL) (19.5%). In women with ASCUS, none of the 87 HPV-negative had ≥cervical intraepithelial neoplasia (CIN2) (P age groups: ASCUS and ASC-H furnish healthcare providers with informative data. There is a lower proportion of ≥CIN2 in HPV-negative women and a higher proportion of ≥CIN2 in HPV-positive. When HPV data were further evaluated by age group, the risk of ≥CIN2 was lower in HPV-negative women, especially in women ≥30. © 2014 Wiley Periodicals, Inc.

  11. Comparison of lysimeter based and calculated ASCE reference evapotranspiration in a subhumid climate

    Science.gov (United States)

    Nolz, Reinhard; Cepuder, Peter; Eitzinger, Josef

    2016-04-01

    The standardized form of the well-known FAO Penman-Monteith equation, published by the Environmental and Water Resources Institute of the American Society of Civil Engineers (ASCE-EWRI), is recommended as a standard procedure for calculating reference evapotranspiration (ET ref) and subsequently plant water requirements. Applied and validated under different climatic conditions it generally achieved good results compared to other methods. However, several studies documented deviations between measured and calculated reference evapotranspiration depending on environmental and weather conditions. Therefore, it seems generally advisable to evaluate the model under local environmental conditions. In this study, reference evapotranspiration was determined at a subhumid site in northeastern Austria from 2005 to 2010 using a large weighing lysimeter (ET lys). The measured data were compared with ET ref calculations. Daily values differed slightly during a year, at which ET ref was generally overestimated at small values, whereas it was rather underestimated when ET was large, which is supported also by other studies. In our case, advection of sensible heat proved to have an impact, but it could not explain the differences exclusively. Obviously, there were also other influences, such as seasonal varying surface resistance or albedo. Generally, the ASCE-EWRI equation for daily time steps performed best at average weather conditions. The outcomes should help to correctly interpret ET ref data in the region and in similar environments and improve knowledge on the dynamics of influencing factors causing deviations.

  12. Effects of Metal Micro and Nano-Particles on hASCs: An In Vitro Model.

    Science.gov (United States)

    Palombella, Silvia; Pirrone, Cristina; Rossi, Federica; Armenia, Ilaria; Cherubino, Mario; Valdatta, Luigi; Raspanti, Mario; Bernardini, Giovanni; Gornati, Rosalba

    2017-08-03

    As the knowledge about the interferences of nanomaterials on human staminal cells are scarce and contradictory, we undertook a comparative multidisciplinary study based on the size effect of zero-valent iron, cobalt, and nickel microparticles (MPs) and nanoparticles (NPs) using human adipose stem cells (hASCs) as a model, and evaluating cytotoxicity, morphology, cellular uptake, and gene expression. Our results suggested that the medium did not influence the cell sensitivity but, surprisingly, the iron microparticles (FeMPs) resulted in being toxic. These data were supported by modifications in mRNA expression of some genes implicated in the inflammatory response. Microscopic analysis confirmed that NPs, mainly internalized by endocytosis, persist in the vesicles without any apparent cell damage. Conversely, MPs are not internalized, and the effects on hASCs have to be ascribed to the release of ions in the culture medium, or to the reduced oxygen and nutrient exchange efficiency due to the presence of MP agglomerating around the cells. Notwithstanding the results depicting a heterogeneous scene that does not allow drawing a general conclusion, this work reiterates the importance of comparative investigations on MPs, NPs, and corresponding ions, and the need to continue the thorough verification of NP and MP innocuousness to ensure unaffected stem cell physiology and differentiation.

  13. Long-term Outcomes and Quality of Life of 186 Patients With Primary Parotid Carcinoma Treated With Surgery and Radiotherapy at the Daniel den Hoed Cancer Center

    Energy Technology Data Exchange (ETDEWEB)

    Al-Mamgani, Abrahim, E-mail: a.al-mamgani@erasmusmc.nl [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Rooij, Peter van [Department of Biostatistics, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Verduijn, Gerda M. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Meeuwis, Cees A. [Department of Otorhinolaryngology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Levendag, Peter C. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2012-09-01

    Purpose: To assess the outcomes, toxicity, and quality of life (QOL) of patients with primary parotid carcinoma treated with surgery and postoperative radiotherapy at the Daniel den Hoed Cancer Center. Methods and Materials: Between 1995 and 2010, 186 patients with parotid carcinoma were treated with parotidectomy with or without neck dissection, followed by radiotherapy. Elective nodal irradiation (ENI) was applied to high-risk, node-negative disease. End points were locoregional control (LRC), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS), late toxicity, and QOL. Results: After a median follow-up of 58 months (range, 4-172 months), the 5-year Kaplan-Meier estimates for LRC, DFS, CSS, and OS were 89%, 83%, 80%, and 68%, respectively. Forty-five events were reported: 24 distant metastases (DM) and 21 locoregional failures (LRF). Event-free survival rates by histological types were 89%, 78%, 76%, 74%, and 70% for acinic cell, mucoepidermoid, adenoid cystic, adenocarcinoma, and squamous cell carcinoma, respectively. More LRF were reported in patients with squamous cell and high-grade mucoepidermoid carcinoma (21% and 19%, respectively) than in patients with other histological types (p = 0.04) and more DM in patients with adenoid cystic and adenocarcinoma (20% and 19%, respectively) than in patients with other types (p = 0.03). None of the high-risk node-negative patients who received ENI developed regional failure. On multivariate analysis, T stage, N stage, grade, and presence of perineural invasion and facial paralysis correlated significantly with DFS. The 5-year cumulative incidence of grade {>=}2 late toxicity was 8%. QOL scores deteriorate during and shortly after treatment but returned in almost all scales to baseline scores within 6 months. Conclusions: Of the entire group, surgery and postoperative radiotherapy resulted in excellent outcomes with minimal side effects and preservation of good QOL scores. However, in

  14. Long-term Outcomes and Quality of Life of 186 Patients With Primary Parotid Carcinoma Treated With Surgery and Radiotherapy at the Daniel den Hoed Cancer Center

    International Nuclear Information System (INIS)

    Al-Mamgani, Abrahim; Rooij, Peter van; Verduijn, Gerda M.; Meeuwis, Cees A.; Levendag, Peter C.

    2012-01-01

    Purpose: To assess the outcomes, toxicity, and quality of life (QOL) of patients with primary parotid carcinoma treated with surgery and postoperative radiotherapy at the Daniel den Hoed Cancer Center. Methods and Materials: Between 1995 and 2010, 186 patients with parotid carcinoma were treated with parotidectomy with or without neck dissection, followed by radiotherapy. Elective nodal irradiation (ENI) was applied to high-risk, node-negative disease. End points were locoregional control (LRC), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS), late toxicity, and QOL. Results: After a median follow-up of 58 months (range, 4–172 months), the 5-year Kaplan-Meier estimates for LRC, DFS, CSS, and OS were 89%, 83%, 80%, and 68%, respectively. Forty-five events were reported: 24 distant metastases (DM) and 21 locoregional failures (LRF). Event-free survival rates by histological types were 89%, 78%, 76%, 74%, and 70% for acinic cell, mucoepidermoid, adenoid cystic, adenocarcinoma, and squamous cell carcinoma, respectively. More LRF were reported in patients with squamous cell and high-grade mucoepidermoid carcinoma (21% and 19%, respectively) than in patients with other histological types (p = 0.04) and more DM in patients with adenoid cystic and adenocarcinoma (20% and 19%, respectively) than in patients with other types (p = 0.03). None of the high-risk node-negative patients who received ENI developed regional failure. On multivariate analysis, T stage, N stage, grade, and presence of perineural invasion and facial paralysis correlated significantly with DFS. The 5-year cumulative incidence of grade ≥2 late toxicity was 8%. QOL scores deteriorate during and shortly after treatment but returned in almost all scales to baseline scores within 6 months. Conclusions: Of the entire group, surgery and postoperative radiotherapy resulted in excellent outcomes with minimal side effects and preservation of good QOL scores. However, in

  15. The role of colposcopy and typization of human papillomavirus in further diagnostic proceedings in patients with ASC-US cytological finding of the uterine cervix

    Directory of Open Access Journals (Sweden)

    Živadinović Radomir

    2009-01-01

    Full Text Available Background/Aim. Bethesda system of classification of cytological findings was introduced in 2001 two subcategories in the category of atypical squamous cells (ASC findings: ASC of undetermined significance (ASC-US and ASC which cannot exclude high-grade intraepithelial lesions (ASC-H. The aim of our study was to assess a possible association of these two subcategories with pathologic biopsy finding and to find out the best further diagnostic proceedings. Methods. At the Clinic of Gynecology and Obstetrics, Niš 130 patients with ASC findings were analyzed. Colposcopy was performed in all study participants. Patients with pathological colposcopic findings underwent cervical biopsy. In 10 patients with pathologic histologic and 15 with benign findings human papilloma virus (HPV typization was done using the Hybrid Capture method. Results. Patients with ASC-H finding had significantly more pathologic biopsies compared with patients with ASC-US finding (57.84: 20.72. Conclusion. Colposcopy was exhibited somewhat higher sensitivity compared to HPV typization (94.7 : 90, but lower sensitivity (79.27 : 86.6. The usage of HPV typization in the triage of patients with ASC cytologic smear induces statistically significant reduction of unnecessary percentage of cervical biopsies.

  16. ASC ATDM Level 2 Milestone #5325: Asynchronous Many-Task Runtime System Analysis and Assessment for Next Generation Platforms.

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Gavin Matthew; Bettencourt, Matthew Tyler; Bova, Steven W.; Franko, Ken; Gamell, Marc; Grant, Ryan; Hammond, Simon David; Hollman, David S; Knight, Samuel; Kolla, Hemanth; Lin, Paul; Olivier, Stephen Lecler; Sjaardema, Gregory D.; Slattengren, Nicole Lemaster; Teranishi, Keita; Wilke, Jeremiah J; Bennett, Janine Camille; Clay, Robert L.; Kale, Laxkimant; Jain, Nikhil; Mikida, Eric; Aiken, Alex; Bauer, Michael; Lee, Wonchan; Slaughter, Elliott; Treichler, Sean; Berzins, Martin; Harman, Todd; Humphreys, Alan; Schmidt, John; Sunderland, Dan; Mccormick, Pat; Gutierrez, Samuel; Shulz, Martin; Gamblin, Todd; Bremer, Peer-Timo

    2015-09-01

    This report provides in-depth information and analysis to help create a technical road map for developing next- generation Orogramming mocleN and runtime systemsl that support Advanced Simulation and Computing (ASC) work- load requirements. The focus herein is on 4synchronous many-task (AMT) model and runtime systems, which are of great interest in the context of "Oriascale7 computing, as they hold the promise to address key issues associated with future extreme-scale computer architectures. This report includes a thorough qualitative and quantitative examination of three best-of-class AIM] runtime systemsHCharm-HE, Legion, and Uintah, all of which are in use as part of the Centers. The studies focus on each of the runtimes' programmability, performance, and mutability. Through the experiments and analysis presented, several overarching Predictive Science Academic Alliance Program II (PSAAP-II) Ascl findings emerge. From a performance perspective, AIVT11runtimes show tremendous potential for addressing extreme- scale challenges. Empirical studies show an AM11 runtime can mitigate performance heterogeneity inherent to the machine itself and that Message Passing Interface (MP1) and AM11runtimes perform comparably under balanced con- ditions. From a programmability and mutability perspective however, none of the runtimes in this study are currently ready for use in developing production-ready Sandia ASCIapplications. The report concludes by recommending a co- design path forward, wherein application, programming model, and runtime system developers work together to define requirements and solutions. Such a requirements-driven co-design approach benefits the community as a whole, with widespread community engagement mitigating risk for both application developers developers. and high-performance computing inntime systein

  17. Atypical squamous cells, cannot exclude high grade squamous intraepithelial (ASC-H in HIV-positive women

    Directory of Open Access Journals (Sweden)

    Michelow Pam

    2010-01-01

    Full Text Available Objective: South Africa has very high rates of both HIV infection and cervical pathology. The management of ASC-H is colposcopy and directed biopsy, but with so many women diagnosed with HSIL and a dearth of colposcopy centres in South Africa, women with cytologic diagnosis of ASC-H may not be prioritized for colposcopy. The aim of this study was to determine if HIV-positive women with a cytologic diagnosis of ASC-H should undergo immediate colposcopy or whether colposcopy can be delayed, within the context of an underfunded health care setting with so many competing health needs. Materials and Methods: A computer database search was performed from the archives of an NGO-administered clinic that offers comprehensive HIV care. All women with a cytologic diagnosis of ASC-H on cervical smears from September 2005 until August 2009 were identified. Histologic follow up was sought in all patients. Results: A total of 2111 cervical smears were performed and 41 diagnosed as ASC-H (1.94%. No histologic follow up data was available in 15 cases. Follow up histologic results were as follows: three negative (11.5%, five koilocytosis and/ or CIN1 (19.2%, ten CIN2 (38.5% and eight CIN3 (30.8%. There were no cases of invasive carcinoma on follow up. Conclusion: The current appropriate management of HIV-positive women in low-resource settings with a diagnosis of ASC-H on cervical smear is colposcopy, despite the costs involved. In the future and if cost-effective in developing nations, use of novel markers may help select which HIV-positive women can be managed conservatively and which ones referred for more active treatment. More research in this regard is warranted.

  18. Contemporary management of rectal injuries at Level I trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study.

    Science.gov (United States)

    Brown, Carlos V R; Teixeira, Pedro G; Furay, Elisa; Sharpe, John P; Musonza, Tashinga; Holcomb, John; Bui, Eric; Bruns, Brandon; Hopper, H Andrew; Truitt, Michael S; Burlew, Clay C; Schellenberg, Morgan; Sava, Jack; VanHorn, John; Eastridge, Pa-C Brian; Cross, Alicia M; Vasak, Richard; Vercruysse, Gary; Curtis, Eleanor E; Haan, James; Coimbra, Raul; Bohan, Phillip; Gale, Stephen; Bendix, Peter G

    2018-02-01

    Rectal injuries have been historically treated with a combination of modalities including direct repair, resection, proximal diversion, presacral drainage, and distal rectal washout. We hypothesized that intraperitoneal rectal injuries may be selectively managed without diversion and the addition of distal rectal washout and presacral drainage in the management of extraperitoneal injuries are not beneficial. This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004 to 2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers. Demographics, mechanism, location and grade of injury, and management of rectal injury were collected. The primary outcome was abdominal complications (abdominal abscess, pelvic abscess, and fascial dehiscence). After exclusions, there were 785 patients in the cohort. Rectal injuries were intraperitoneal in 32%, extraperitoneal in 58%, both in 9%, and not documented in 1%. Rectal injury severity included the following grades I, 28%; II, 41%; III, 13%; IV, 12%; and V, 5%. Patients with intraperitoneal injury managed with a proximal diversion developed more abdominal complications (22% vs 10%, p = 0.003). Among patients with extraperitoneal injuries, there were more abdominal complications in patients who received proximal diversion (p = 0.0002), presacral drain (p = 0.004), or distal rectal washout (p = 0.002). After multivariate analysis, distal rectal washout [3.4 (1.4-8.5), p = 0.008] and presacral drain [2.6 (1.1-6.1), p = 0.02] were independent risk factors to develop abdominal complications. Most patients with intraperitoneal injuries undergo direct repair or resection as well as diversion, although diversion is not associated with improved outcomes. While 20% of patients with extraperitoneal injuries still receive a presacral drain and/or distal rectal washout, these additional maneuvers are independently associated with a three

  19. Visualization on supercomputing platform level II ASC milestone (3537-1B) results from Sandia.

    Energy Technology Data Exchange (ETDEWEB)

    Geveci, Berk (Kitware, Inc., Clifton Park, NY); Fabian, Nathan; Marion, Patrick (Kitware, Inc., Clifton Park, NY); Moreland, Kenneth D.

    2010-09-01

    This report provides documentation for the completion of the Sandia portion of the ASC Level II Visualization on the platform milestone. This ASC Level II milestone is a joint milestone between Sandia National Laboratories and Los Alamos National Laboratories. This milestone contains functionality required for performing visualization directly on a supercomputing platform, which is necessary for peta-scale visualization. Sandia's contribution concerns in-situ visualization, running a visualization in tandem with a solver. Visualization and analysis of petascale data is limited by several factors which must be addressed as ACES delivers the Cielo platform. Two primary difficulties are: (1) Performance of interactive rendering, which is most computationally intensive portion of the visualization process. For terascale platforms, commodity clusters with graphics processors(GPUs) have been used for interactive rendering. For petascale platforms, visualization and rendering may be able to run efficiently on the supercomputer platform itself. (2) I/O bandwidth, which limits how much information can be written to disk. If we simply analyze the sparse information that is saved to disk we miss the opportunity to analyze the rich information produced every timestep by the simulation. For the first issue, we are pursuing in-situ analysis, in which simulations are coupled directly with analysis libraries at runtime. This milestone will evaluate the visualization and rendering performance of current and next generation supercomputers in contrast to GPU-based visualization clusters, and evaluate the performance of common analysis libraries coupled with the simulation that analyze and write data to disk during a running simulation. This milestone will explore, evaluate and advance the maturity level of these technologies and their applicability to problems of interest to the ASC program. Scientific simulation on parallel supercomputers is traditionally performed in four

  20. The effects of vaginal prolapse surgery using synthetic mesh on vaginal wall sensibility, vaginal vasocongestion, and sexual function: a prospective single-center study

    NARCIS (Netherlands)

    Weber, Maaike A.; Lakeman, Marielle M. E.; Laan, Ellen; Roovers, Jan-Paul W. R.

    2014-01-01

    Vaginal mesh surgery in patients with pelvic organ prolapse (POP) has been associated with sexual dysfunction. Implantation of synthetic mesh might damage vaginal innervation and vascularization, which could cause sexual dysfunction. We aim to evaluate the effects of vaginal mesh surgery on vaginal

  1. Evaluation and Validation of Organic Materials for Advanced Stirling Convertors (ASCs): Overview

    Science.gov (United States)

    Shin, Euy-Sik Eugene

    2015-01-01

    Various organic materials are used as essential parts in Stirling Convertors for their unique properties and functionalities such as bonding, potting, sealing, thread locking, insulation, and lubrication. More efficient Advanced Stirling Convertors (ASC) are being developed for future space applications especially with a long mission cycle, sometimes up to 17 years, such as deep space exploration or lunar surface power or Mars rovers, and others. Thus, performance, durability, and reliability of those organics should be critically evaluated in every possible material-process-fabrication-service environment relations based on their mission specifications. In general, thermal stability, radiation hardness, outgassing, and material compatibility of the selected organics have been systematically evaluated while their process and fabrication conditions and procedures were being optimized. Service environment-simulated long term aging tests up to 4 years were performed as a function of temperature for durability assessment of the most critical organic material systems.

  2. Sliding and Rocking of Unanchored Components and Structures: Chapter 7.6 ASCE 4 Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    S. R. Jensen

    2011-04-01

    Chapter 7.6 of ASCE 4-Rev 2, Seismic Analysis of Safety-Related Nuclear Structures: Standard and Commentary, provides updated guidance for analysis of rocking and sliding of unanchored structures and components subjected to seismic load. This guidance includes provisions both for simplified approximate energy-based approaches, and for detailed probabilistic time history analysis using nonlinear methods. Factors to be applied to the analytical results are also provided with the intent of ensuring achievement of the 80% non-exceedence probability target of the standard. The present paper surveys the published literature supporting these provisions. The results of available testing and analysis are compared to results produced by both simplified and probabilistic approaches. In addition, adequacy of the standard's provisions for analysis methods and factors is assessed. A comparison is made between the achieved level of conservatism and the standard's non-exceedence probability target.

  3. Genetic and physical analysis of a YAC contig spanning the fungal disease resistance locus Asc of tomato (Lycopersicon esculentum)

    NARCIS (Netherlands)

    Mesbah, L.A.; Kneppers, T.J.A.; Takken, F.L.W.; Laurent, P.; Hille, J.; Nijkamp, H.J.J.

    1998-01-01

    The Alternaria stem canker disease of tomato is caused by the necrotrophic fungal pathogen Alternaria alternata f. sp. lycopersici (AAL). The fungus produces AAL toxins that kill the plant tissue. Resistance to the fungus segregates as a single locus, called Asc, and has been genetically mapped on

  4. Genetic and physical analysis of a YAC contig spannig the fungal disease resistance locus Asc of tomato (Lycopersicon esculentum)

    NARCIS (Netherlands)

    Mesbah, L.A.; Kneppers, T.J.A.; Takken, F.L.W.; Laurent, P.J.F.; Hille, J.; Nijkamp, H.J.J.

    1999-01-01

    The Alternaria in stem canker disease of tomato is caused by the necrotrophic fungal pathogen Alternaria alternata f. sp. lycopersici (AAL). The fungus produces AAL toxins that kill the plant tissue. Resistance to the fungus segregates as a single locus, called Asc, and has been genetically mapped

  5. Characterization of a novel variant of amino acid transport system asc in erythrocytes from Przewalski's horse (Equus przewalskii).

    Science.gov (United States)

    Fincham, D A; Ellory, J C; Young, J D

    1992-08-01

    In thoroughbred horses, red blood cell amino acid transport activity is Na(+)-independent and controlled by three codominant genetic alleles (h, l, s), coding for high-affinity system asc1 (L-alanine apparent Km for influx at 37 degrees C congruent to 0.35 mM), low-affinity system asc2 (L-alanine Km congruent to 14 mM), and transport deficiency, respectively. The present study investigated amino acid transport mechanisms in red cells from four wild species: Przewalski's horse (Equus przewalskii), Hartmann's zebra (Zebra hartmannae), Grevy's zebra (Zebra grevyi), and onager (Equus hemonius). Red blood cell samples from different Przewalski's horses exhibited uniformly high rates of L-alanine uptake, mediated by a high-affinity asc1-type transport system. Mean apparent Km and Vmax values (+/- SE) for L-alanine influx at 37 degrees C in red cells from 10 individual animals were 0.373 +/- 0.068 mM and 2.27 +/- 0.11 mmol (L cells.h), respectively. As in thoroughbreds, the Przewalski's horse transporter interacted with dibasic as well as neutral amino acids. However, the Przewalski asc1 isoform transported L-lysine with a substantially (6.4-fold) higher apparent affinity than its thoroughbred counterpart (Km for influx 1.4 mM at 37 degrees C) and was also less prone to trans-stimulation effects. The novel high apparent affinity of the Przewalski's horse transporter for L-lysine provides additional key evidence of functional and possible structural similarities between asc and the classical Na(+)-dependent system ASC and between these systems and the Na(+)-independent dibasic amino acid transport system y+. Unlike Przewalski's horse, zebra red cells were polymorphic with respect to L-alanine transport activity, showing high-affinity or low-affinity saturable mechanisms of L-alanine uptake. Onager red cells transported this amino acid with intermediate affinity (apparent Km for influx 3.0 mM at 37 degrees C). Radiation inactivation analysis was used to estimate the target

  6. Prevalence of Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infections Among Transgender Persons Referred to an Italian Center for Total Sex Reassignment Surgery.

    Science.gov (United States)

    Luzzati, Roberto; Zatta, Marta; Pavan, Nicola; Serafin, Maurizia; Maurel, Cristina; Trombetta, Carlo; Barbone, Fabio

    2016-07-01

    The burden of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections in transgender population is an underestimated issue. We performed a study to evaluate the prevalence of such infections in transgender persons addressed our center for total sex reassignment surgery (SRS). All transgender persons undergoing SRS from 2000 to 2014 were evaluated retrospectively. Participant characteristics and results of HIV, HBV, and HCV testing were collected. Exact Fisher test, Cochran-Armitage tests for trend and correct prevalence ratios were estimated. Among 498 transgender persons, 243 had confirmed serological data. Of them, 25 were female-to-male and 218 male-to-female (MtF) subjects. The prevalence of HIV, HBV and HCV infections was 0%, 4.0%, and 8.0% in female-to-male, and 12.1%, 4.6%, and 3.7% in MtF. Among MtF, younger age and earlier year of SRS were associated with lower HIV prevalence. From the multivariate model, the mutually adjustment prevalence ratios were 1.9 (95% confidence interval [95% CI], 1.2-3.1) for SRS in 2005-2010 and 3.6 (95% CI, 1.3-9.4) in 2010-2014, as compared with SRS in 2000-2004; and 4.7 (95% CI, 2.4-9.4) for South Americans as compared with others. Among the HCV-positive MtF, 57.1% were also HIV-positive. Regarding HBV, the immunity was 38.5% and, after mutual adjustment, the prevalence ratios were 2.1 (95% CI, 1.3-3.4) for South Americans versus others and 2.2 (95% CI, 1.6-3.1) for year of birth ≥ 1980. The prevalence of HBV and HCV infections among our transgender persons overlaps that reported in the general population, but HCV prevalence was much higher in HIV-infected MtF. The high burden of HIV infection among MtF and its recent incremented prevalence points out that social and medical support should be strongly promoted in such population.

  7. Safety and feasibility of laparoscopic colo-rectal surgery for cancer at a tertiary center in a developing country: Egypt as an

    Directory of Open Access Journals (Sweden)

    Anwar Tawfik Amin

    2015-06-01

    Conclusion: Laparoscopic colorectal surgery for cancer in developing countries could be safe and feasible. Safe reuse of disposable expensive parts of some laparoscopic instruments could help in propagation of this technique in developing countries.

  8. Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center

    DEFF Research Database (Denmark)

    Rubek, Niclas; Channir, Hani Ibrahim; Charabi, Birgitte Wittenborg

    2017-01-01

    (RT) with or without concomitant chemotherapy. This is the first study in Scandinavia from a head and neck cancer centre that aims to demonstrate the feasibility of performing primary transoral robotic surgery (TORS) and concurrent neck dissection for patients with early stage OPSCC. Between September...... bilateral neck dissection. Due to an upstaging following surgery, 13 patients were referred to adjuvant therapy. Four of these patients received RT and two patients received concomitant chemo-radiation (CCR) therapy. Seven patients declined the recommended adjuvant therapy one of whom later developed an N......-site recurrence and received salvage surgery with postoperative RT. In summary, 43% of the patients were referred to adjuvant therapy following primary surgery which was mainly due to N-site stage migration and ECE. Primary TORS and concurrent neck dissection is a safe and feasible procedure that may...

  9. Supplementation of fat grafts with adipose-derived regenerative cells in reconstructive surgery [Stammzellangereicherte Fetttransplantation in der rekonstruktiven Chirurgie

    Directory of Open Access Journals (Sweden)

    Herold, C.

    2012-09-01

    Full Text Available [english] Introduction: The fraction of regenerative cells in adipose tissue has been described to be even higher than in bone marrow. Adipose tissue itself is excessively available in most patients. Given that adipose tissue is abundant in majority of patients adipose derrived stem cells (ASCs have come under scrutiny for regenerative procedures in reconstructive surgery.Material and methods: ASCs were extracted by the Celution system for enrichment of fat grafts that were administered in patients with decreased wound healing, soft tissue or scar defects.Results: All patients were satisfied after reconstruction with ASCs augmented fat grafts and no side effects were observed. Discussion: The Celution system provides fast recovery of ASCs which can be immediately utilized for appropriate application. Since a high number of stem cells are harvested from fat tissue no expansion of cells is needed as described for bone marrow derived stem cells. Enrichment of fat graft with ASCs is of great interest due to their reported angiogenetic effect. The reported cases demonstrate the potential of ASCs in the field of regenerative medicine and encourage further application in reconstructive surgery.[german] Einleitung: Es konnte gezeigt werden, dass der Anteil regenerativer Zellen im Fettgewebe höher als im Knochenmark ist. Fettgewebe hingegen ist bei den meisten Patienten exzessiv vorhanden. Das legt den Einsatz von ASCs (adipose derived stem cells bei regenerativen Anwendungen in der rekonstruktiven Chirurgie nahe.Material und Methoden: Mit dem Celution System von Cytori Therapeutics Inc. prozessierte, ASC angereicherte Fetttransplantate werden an vier Patienten mit Weichteildefiziten und störenden Narben sowie Wundheilungsstörungen angewendet.Ergebnisse: Insbesondere bei Patienten mit Weichteildefiziten und Narben konnte eine suffiziente Volumenaugmentation und ansprechende Verbesserung der Narben erzielt werden. Es wurden keine Nebenwirkungen

  10. Epidural Hematoma and Abscess Related to Thoracic Epidural Analgesia: A Single-Center Study of 2,907 Patients Who Underwent Lung Surgery.

    Science.gov (United States)

    Kupersztych-Hagege, Elisa; Dubuisson, Etienne; Szekely, Barbara; Michel-Cherqui, Mireille; François Dreyfus, Jean; Fischler, Marc; Le Guen, Morgan

    2017-04-01

    To report the major complications (epidural hematoma and abscess) of postoperative thoracic epidural analgesia in patients who underwent lung surgery. Prospective, monocentric study. A university hospital. All lung surgical patients who received postoperative thoracic epidural analgesia between November 2007 and November 2015. Thoracic epidural analgesia for patients who underwent lung surgery. During the study period, data for 2,907 patients were recorded. The following 3 major complications were encountered: 1 case of epidural hematoma (0.34 case/1,000; 95% confidence interval 0.061-1.946), for which surgery was performed, and 2 cases of epidural abscesses (0.68 case/1,000; 95% confidence interval 0.189-2.505), which were treated medically. The risk range of serious complications was moderate; only the patient who experienced an epidural hematoma also experienced permanent sequelae. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: a single center experience in a developing economy.

    Science.gov (United States)

    Balachandran, Rakhi; Kappanayil, Mahesh; Sen, Amitabh Chanchal; Sudhakar, Abhish; Nair, Suresh G; Sunil, G S; Raj, R Benedict; Kumar, Raman Krishna

    2015-01-01

    The International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world. We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution. The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU) stay, bacterial sepsis and surgical site infection. The 1702 patients included 771(45.3%) females. The median age was 8 months (0.03-216) and the median weight was 6.1Kg (1-100). The overall in-hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001), surgical site infection (11.1% to 2.4%, P < 0.001) and duration of ICU stay from 114(8-999) hours to 72 (18-999) hours (P < 0.001) The decline in mortality from (4.3% to 2.2%) did not reach statistical significance. The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.

  12. Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: A single center experience in a developing economy

    Directory of Open Access Journals (Sweden)

    Rakhi Balachandran

    2015-01-01

    Full Text Available Background: The International Quality Improvement Collaborative (IQIC for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world. Objective: We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution. Methods: The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU stay, bacterial sepsis and surgical site infection. Results: The 1702 patients included 771(45.3% females. The median age was 8 months (0.03-216 and the median weight was 6.1Kg (1-100. The overall in-hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001, surgical site infection (11.1% to 2.4%, P < 0.001 and duration of ICU stay from 114(8-999 hours to 72 (18-999 hours (P < 0.001 The decline in mortality from (4.3% to 2.2% did not reach statistical significance. Conclusions: The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.

  13. Does Low-Field Intraoperative Magnetic Resonance Improve the Results of Endoscopic Pituitary Surgery? Experience of the Implementation of a New Device in a Referral Center.

    Science.gov (United States)

    García, Sergio; Reyes, Luis; Roldán, Pedro; Torales, Jorge; Halperin, Irene; Hanzu, Felicia; Langdon, Cristobal; Alobid, Isam; Enseñat, Joaquim

    2017-06-01

    To assess the contribution of low-field intraoperative magnetic resonance (iMRI) to endoscopic pituitary surgery. We analyzed a prospective series of patients undergoing endoscopic endonasal surgery for pituitary macroadenomas assisted with a low-field iMRI (PoleStarN30, 0.15 T [Medtronic]). Clinical, radiologic, and surgical variables were analyzed and compared with our fully endoscopic historic cohort operated on without iMRI assistance. A bibliographic review of pituitary surgery assisted with iMRI was conducted. Thirty patients (57% female; mean age, 55 years) were prospectively analyzed. The most frequent tumor subtype was nonfunctioning macroadenoma (50%). The average Knosp grade was 2.3 and mean tumor size was 18 mm. Surgical and positioning time were 102 and 47 minutes, respectively. Hospital stay and complication rates were similar to our historical cohort for pituitary surgery. Mean follow-up was 10 months. Complete resection (CR) was achieved in 83% of patients. Seven patients (23%) benefited from iMRI assistance and achieved a CR in their surgeries. All patients except 1 experienced hormonal activity remission. iMRI sensitivity and specificity was 0.8 and 1, respectively. Although not statistically significant, CR rates were globally 11.5% superior in iMRI series compared with our historical cohort. This difference was independent of cavernous sinus invasiveness grade (CR rate increased 12.5% for Knosp grade 0-2 and 8.1% for Knosp grade 3-4). Low-field iMRI is a useful and safe assistance even in advanced surgical techniques such as endoscopy. Its contribution is limited by the intrinsic features of the tumor. Further randomized studies are required to confirm the cost-effectiveness of iMRI in pituitary surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. [Doctor Albéric Pont (1870-1960). Dental surgeon, doctor and creator of the center of maxillo-facial surgery of Lyon in 1914].

    Science.gov (United States)

    Riaud, Xavier

    2008-01-01

    As Stomatologist and Dental Surgeon Albéric Pont founded with six other Dental Surgeons the School of Dentistry in Lyons which he ran for a long time. When he enlisted in the French Army in 1914 he soon became aware of the extent of facial damage that occurred among the injured soldiers. His subsequent decision was to create and run a Centre for maxillofacial surgery in Lyons. He died in 1960 and left a significant scientific work as well as technical elements of surgery, dental index and devices which still bear his name.

  15. Association of BRAFV600E Mutation and MicroRNA Expression with Central Lymph Node Metastases in Papillary Thyroid Cancer: A Prospective Study from Four Endocrine Surgery Centers

    Science.gov (United States)

    Aragon Han, Patricia; Kim, Hyun-seok; Cho, Soonweng; Fazeli, Roghayeh; Najafian, Alireza; Khawaja, Hunain; McAlexander, Melissa; Dy, Benzon; Sorensen, Meredith; Aronova, Anna; Sebo, Thomas J.; Giordano, Thomas J.; Fahey, Thomas J.; Thompson, Geoffrey B.; Gauger, Paul G.; Somervell, Helina; Bishop, Justin A.; Eshleman, James R.; Schneider, Eric B.; Witwer, Kenneth W.; Umbricht, Christopher B.

    2016-01-01

    Background: Studies have demonstrated an association of the BRAFV600E mutation and microRNA (miR) expression with aggressive clinicopathologic features in papillary thyroid cancer (PTC). Analysis of BRAFV600E mutations with miR expression data may improve perioperative decision making for patients with PTC, specifically in identifying patients harboring central lymph node metastases (CLNM). Methods: Between January 2012 and June 2013, 237 consecutive patients underwent total thyroidectomy and prophylactic central lymph node dissection (CLND) at four endocrine surgery centers. All tumors were tested for the presence of the BRAFV600E mutation and miR-21, miR-146b-3p, miR-146b-5p, miR-204, miR-221, miR-222, and miR-375 expression. Bivariate and multivariable analyses were performed to examine associations between molecular markers and aggressive clinicopathologic features of PTC. Results: Multivariable logistic regression analysis of all clinicopathologic features found miR-146b-3p and miR-146b-5p to be independent predictors of CLNM, while the presence of BRAFV600E almost reached significance. Multivariable logistic regression analysis limited to only predictors available preoperatively (molecular markers, age, sex, and tumor size) found miR-146b-3p, miR-146b-5p, miR-222, and BRAFV600E mutation to predict CLNM independently. While BRAFV600E was found to be associated with CLNM (48% mutated in node-positive cases vs. 28% mutated in node-negative cases), its positive and negative predictive values (48% and 72%, respectively) limit its clinical utility as a stand-alone marker. In the subgroup analysis focusing on only classical variant of PTC cases (CVPTC), undergoing prophylactic lymph node dissection, multivariable logistic regression analysis found only miR-146b-5p and miR-222 to be independent predictors of CLNM, while BRAFV600E was not significantly associated with CLNM. Conclusion: In the patients undergoing prophylactic CLNDs, miR-146b-3p, miR-146b-5p, and mi

  16. Implications of the center of rotation concept for the reconstruction of anterior column lordosis and axial preloads in spinal deformity surgery.

    Science.gov (United States)

    Koller, Heiko; Mayer, Michael; Zenner, Juliane; Resch, Herbert; Niederberger, Alfred; Fierlbeck, Johann; Hitzl, Wolfgang; Acosta, Frank L

    2012-07-01

    In thoracolumbar deformity surgery, anterior-only approaches are used for reconstruction of anterior column failures. It is generally advised that vertebral body replacements (VBRs) should be preloaded by compression. However, little is known regarding the impact of different techniques for generation of preloads and which surgical principle is best for restoration of lordosis. Therefore, the authors analyzed the effect of different surgical techniques to restore spinal alignment and lordosis as well as the ability to generate axial preloads on VBRs in anterior column reconstructions. The authors performed a laboratory study using 7 fresh-frozen specimens (from T-3 to S-1) to assess the ability for lordosis reconstruction of 5 techniques and their potential for increasing preloads on a modified distractable VBR in a 1-level thoracolumbar corpectomy. The testing protocol was as follows: 1) Radiographs of specimens were obtained. 2) A 1-level corpectomy was performed. 3) In alternating order, lordosis was applied using 1 of the 5 techniques. Then, preloads during insertion and after relaxation using the modified distractable VBR were assessed using a miniature load-cell incorporated in the modified distractable VBR. The modified distractable VBR was inserted into the corpectomy defect after lordosis was applied using 1) a lamina spreader; 2) the modified distractable VBR only; 3) the ArcoFix System (an angular stable plate system enabling in situ reduction); 4) a lordosizer (a customized instrument enabling reduction while replicating the intervertebral center of rotation [COR] according to the COR method); and 5) a lordosizer and top-loading screws ([LZ+TLS], distraction with the lordosizer applied on a 5.5-mm rod linked to 2 top-loading pedicle screws inserted laterally into the vertebra). Changes in the regional kyphosis angle were assessed radiographically using the Cobb method. The bone mineral density of specimens was 0.72 ± 22.6 g/cm(2). The maximum regional

  17. The Role of Wellbeing and Wellness: A Positive Psychological Model in Supporting Young People With ASCs

    Directory of Open Access Journals (Sweden)

    Irina Roncaglia

    2017-04-01

    Full Text Available In the last 10 years sport psychology expanded its applicability in a variety of fields which have helped to address some of the challenges related to high level performance and sport competition. When we talk about performance in its wider sense, sport psychology is able to help develop a better understanding on how strategies can be adopted in improving general human performance levels. This includes increasing the knowledge of key concepts such as motivation, self-confidence and resilience. Furthermore performance in its wider sense helps in the understanding of the impact of stress and arousal and how these can affect both positively and negatively performance levels including appreciating individual differences as well as dynamics between groups of individuals. In this paper performance rather than solely be related to the field of competitive or professional sport has been discussed in people with ASCs and aims to explore how by adopting a positive psychological model in the formulation of individual assessments and subsequent interventions have led to improvement in individual skills, participation, engagement and ultimately quality of life. Positive psychological principles, such as the role of wellbeing and wellness, the PERMA Model has increased our understanding of human potentials, performance and wellbeing. The aim of this paper is to present and reflect on the applicability and benefits of adopting sport psychology models, the PERMA model and positive psychological principles in special education and care settings with the presentation and discussion of their theoretical and some practical implementation in two case studies.

  18. Tipo de respuesta según el genotipado del virus del papiloma humano según cobas 4800 en las lesiones asc-us HPV positivas

    OpenAIRE

    Kanjou Augé, Nadwa

    2016-01-01

    Objetivos: Evaluar el riesgo de patología subyacente en las pacientes ASC-US HPV positivas de nuestra área de influencia analizadas por el método COBAS 4800. Se estudió el riesgo de CIN2+ en el momento del diagnóstico de las mujeres ASC-US HPV positivas según el genotipo del virus del papiloma: HPV16, HPV18 ( ambos incluyendo coinfecciones) u otros HPV de alto riesgo (HR-HPV). El objetivo es detectar aquellas mujeres con citologías ASC-US HPV positivo con un mayor riesgo de progresión y por l...

  19. Completion Report for Multi-Site Incentive MRT 2779 Implement ASC Tripod Initiative by 30SEP08

    Energy Technology Data Exchange (ETDEWEB)

    East, D; Cerutti, J; Noe, J; Cupps, K; Loncaric, J; Sturtevant, J

    2008-09-22

    This report provides documentation and evidence for the completion of the deployment of the Tripod common operating system (TripodOS, also known as and generally referred to below as TOSS). Background documents for TOSS are provided in Appendices A and B, including the initial TOSS proposal accepted by ASC HQ and Executives in July 2007 and a Governance Model defined by a Tri-Lab working group in September 2007. Appendix C contains a document that clarifies the intent and requirements for the completion criteria associated with MRT 2779. The deployment of TOSS is a Multi-Site Incentive from the ASC FY08-09 Implementation Plan due at the end of Quarter 4 in FY08.

  20. Estabilidade de ácido ascórbico em sucos de frutas frescos sob diferentes formas de armazenamento

    OpenAIRE

    Cunha, Kelly Damasceno; Silva, Priscila Ribeiro da; Costa, Ana Lígia Faria e Silva da Fonseca; Teodoro, Anderson Junger; Koblitz, Maria Gabriela Bello

    2014-01-01

    O ácido ascórbico é uma vitamina hidrossolúvel de importância nutricional há muito estabelecida, por sua atuação como cofator em diversos processos fisiológicos e como antioxidante. O ser humano depende da ingestão diária desse micronutriente, cujas principais fontes são as frutas e hortaliças. Por ser um nutriente menos estável, o ácido ascórbico sofre perdas no processamento e no armazenamento, influenciadas por diversos fatores, como pH, temperatura, presença de íons, etc. A literatura apr...

  1. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  2. Bariatric Surgery

    Science.gov (United States)

    ... often. Each type of surgery has advantages and disadvantages. Bariatric Surgery Benefits Bariatric surgery can improve many ... Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

  3. Plastic Surgery

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Plastic Surgery KidsHealth / For Teens / Plastic Surgery What's in ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  4. Differential regulation of caspase-1 activation, pyroptosis, and autophagy via Ipaf and ASC in Shigella-infected macrophages.

    Directory of Open Access Journals (Sweden)

    Toshihiko Suzuki

    2007-08-01

    Full Text Available Shigella infection, the cause of bacillary dysentery, induces caspase-1 activation and cell death in macrophages, but the precise mechanisms of this activation remain poorly understood. We demonstrate here that caspase-1 activation and IL-1beta processing induced by Shigella are mediated through Ipaf, a cytosolic pattern-recognition receptor of the nucleotide-binding oligomerization domain (NOD-like receptor (NLR family, and the adaptor protein apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain (ASC. We also show that Ipaf was critical for pyroptosis, a specialized form of caspase-1-dependent cell death induced in macrophages by bacterial infection, whereas ASC was dispensable. Unlike that observed in Salmonella and Legionella, caspase-1 activation induced by Shigella infection was independent of flagellin. Notably, infection of macrophages with Shigella induced autophagy, which was dramatically increased by the absence of caspase-1 or Ipaf, but not ASC. Autophagy induced by Shigella required an intact bacterial type III secretion system but not VirG protein, a bacterial factor required for autophagy in epithelial-infected cells. Treatment of macrophages with 3-methyladenine, an inhibitor of autophagy, enhanced pyroptosis induced by Shigella infection, suggesting that autophagy protects infected macrophages from pyroptosis. Thus, Ipaf plays a critical role in caspase-1 activation induced by Shigella independently of flagellin. Furthermore, the absence of Ipaf or caspase-1, but not ASC, regulates pyroptosis and the induction of autophagy in Shigella-infected macrophages, providing a novel function for NLR proteins in bacterial-host interactions.

  5. Bartonella and Coxiella infective endocarditis in Brazil: molecular evidence from excised valves from a cardiac surgery referral center in Rio de Janeiro, Brazil, 1998 to 2009.

    Science.gov (United States)

    Lamas, Cristiane da Cruz; Ramos, Rosana Grandelle; Lopes, Gabriel Quintino; Santos, Marisa Silva; Golebiovski, Wilma Felix; Weksler, Clara; Ferraiuoli, Giovanna Ianini D'Almeida; Fournier, Pierre-Edouard; Lepidi, Hubert; Raoult, Didier

    2013-01-01

    PCR was used to detect Coxiella burnetii and Bartonella spp in heart valves obtained during the period 1998-2009 from patients operated on for blood culture-negative endocarditis in a cardiac surgery hospital in Brazil. Of the 51 valves tested, 10 were PCR-positive; two were positive for Bartonella and one for C. burnetii. Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  6. ASCS online fault detection and isolation based on an improved MPCA

    Science.gov (United States)

    Peng, Jianxin; Liu, Haiou; Hu, Yuhui; Xi, Junqiang; Chen, Huiyan

    2014-09-01

    Multi-way principal component analysis (MPCA) has received considerable attention and been widely used in process monitoring. A traditional MPCA algorithm unfolds multiple batches of historical data into a two-dimensional matrix and cut the matrix along the time axis to form subspaces. However, low efficiency of subspaces and difficult fault isolation are the common disadvantages for the principal component model. This paper presents a new subspace construction method based on kernel density estimation function that can effectively reduce the storage amount of the subspace information. The MPCA model and the knowledge base are built based on the new subspace. Then, fault detection and isolation with the squared prediction error (SPE) statistic and the Hotelling ( T 2) statistic are also realized in process monitoring. When a fault occurs, fault isolation based on the SPE statistic is achieved by residual contribution analysis of different variables. For fault isolation of subspace based on the T 2 statistic, the relationship between the statistic indicator and state variables is constructed, and the constraint conditions are presented to check the validity of fault isolation. Then, to improve the robustness of fault isolation to unexpected disturbances, the statistic method is adopted to set the relation between single subspace and multiple subspaces to increase the corrective rate of fault isolation. Finally fault detection and isolation based on the improved MPCA is used to monitor the automatic shift control system (ASCS) to prove the correctness and effectiveness of the algorithm. The research proposes a new subspace construction method to reduce the required storage capacity and to prove the robustness of the principal component model, and sets the relationship between the state variables and fault detection indicators for fault isolation.

  7. An Alternative Optimization Model and Robust Experimental Design for the Assignment Scheduling Capability for Unmanned Aerial Vehicles (ASC-U) Simulation

    National Research Council Canada - National Science Library

    Oliver, Derek M

    2007-01-01

    .... TRAC selected ASC-U to provide insight into the programmatic decisions addressed in the U.S. Army UAV-Mix Analysis that directly affects future development and fielding of UAVs to include the Future Combat System...

  8. A study of HPV typing for the management of HPV-positive ASC-US cervical cytologic results.

    Science.gov (United States)

    Schiffman, Mark; Vaughan, Laurence M; Raine-Bennett, Tina R; Castle, Philip E; Katki, Hormuzd A; Gage, Julia C; Fetterman, Barbara; Befano, Brian; Wentzensen, Nicolas

    2015-09-01

    In US cervical screening, immediate colposcopy is recommended for women with HPV-positive ASC-US (equivocal) cytology. We evaluated whether partial typing by Onclarity™ (BD) might identify HPV-positive women with low enough CIN3+ risk to permit 1-year follow-up instead. The NCI-Kaiser Permanente Northern California Persistence and Progression cohort includes a subset of 13,890 women aged 21+ with HC2 (Qiagen)-positive ASC-US at enrollment; current median follow-up is 3.0years. Using stratified random sampling, we typed 2079 archived enrollment specimens including 329 women subsequently diagnosed with CIN3+, 563 with CIN2, and 1187 with ASC-US was 5.2%; this establishes the "benchmark" risk for colposcopic referral. Hierarchically, 3-year cumulative risks for each typing channel were 16.0% for HPV16, 7.4% for HPV18, 7.0% for HPV31, 7.1% for grouped HPV33/58, 4.3% for HPV52, 3.9% for HPV45, 2.7% for HPV51, 1.6% for HPV39/68/35, and 1.3% for HPV59/56/66. ASC-US linked to HPV16, HPV18, HPV31, or HPV33/58 warrants immediate colposcopy. Optimal management of women with HPV52 or HPV45 is uncertain. Risk of women with only HPV51, HPV39/68/35, or HPV59/56/66 might be low enough to recommend 1-year retesting permitting viral clearance. This strategy would defer colposcopy for 40% of women with HPV-positive ASC-US, half of whom would be cotest-negative at 1-year return. Approximately 10% of those with CIN3 diagnosable at enrollment would be delayed 1year instead. Cost-effectiveness analyses are needed. Published by Elsevier Inc.

  9. Seek and you shall find--but then what do you do? Cold agglutinins in cardiopulmonary bypass and a single-center experience with cold agglutinin screening before cardiac surgery.

    Science.gov (United States)

    Jain, Michael D; Cabrerizo-Sanchez, Rosa; Karkouti, Keyvan; Yau, Terrence; Pendergrast, Jacob M; Cserti-Gazdewich, Christine M

    2013-04-01

    Cardiopulmonary bypass (CPB) during cardiac surgery can involve deliberate hypothermia of the systemic (22-36 °C) and coronary circulations (as low as 8-12 °C). Adverse sequelae of cold-active antibodies have been feared and reported under such conditions, and some centers thus elect to screen for cold agglutinins before CPB. We reviewed the literature on cold agglutinins in cardiac surgery and described the yields and effects of cold agglutinin screening (CAS) in 14,900 cardiac surgery patients undergoing CPB over 8 years at a single institution. Cold agglutinin screening was positive in 47 cases (0.3%), at an annual testing cost of $17,000 CAD. The response of the surgical team to the preoperative discovery of a cold agglutinin was variable, with CPB modified to avoid hypothermia in approximately one-third of cases. In patients discovered to have a positive CAS, postoperative intensive care unit and hospital length of stay were marginally increased (54.6 vs. 42.8 hours, P = .02; 7 [6-14] vs. 7 [5-9] days, P = .04). However, the composite of mortality or severe morbidity (stroke, myocardial infarction, dialysis, low output syndrome, sepsis, and deep vein thrombosis) was not significantly different (14.9% vs. 9.2%, P = .2). Antibody verification found that only 43% of positive CAS patients had true cold agglutinins (20 patients). Furthermore, the rate of adverse events was low in both CAS-positive and true-positive cold agglutinin patients undergoing CPB and cardiac surgery. Finally, modification of CPB to attenuate hypothermia did not decrease adverse events. Based upon historical and local data, preclinical CAS is cost-substantial and nonspecific. Cold agglutinin screening does not promote an algorithm of care that meaningfully improves patient CPB outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Having faith in each other: not-for-profit giant Ascension Health hooks up with United Surgical Partners for ASC joint venture.

    Science.gov (United States)

    Romano, Michael

    2004-09-13

    In the biggest deal of its kind, not-for-profit giant Ascension is going to build ambulatory surgery centers with for-profit United Surgical Partners, which already has a deal with Baylor, left. "Hospitals are realizing that outpatient services are the future. This strategy is sound," one healthcare consultant said.

  11. Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial.

    Directory of Open Access Journals (Sweden)

    Lijian Pei

    Full Text Available The contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery.Patients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121 or fentanyl with sevoflurane general anesthesia (GA group, n = 126. Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests.Patients in the PPA group required less sevoflurane than those in the GA group (median [interquartile range] of 0 [0, 0] vs. 0.4 [0.3, 0.6] minimum alveolar concentration [MAC]-hours, less intraoperative fentanyl requirements (100 [50, 100] vs. 250 [200, 300]μg,, less intense postoperative pain (median visual analog scale score 2 [1, 3.5] vs. 3 [2, 4.5], but more propofol (median 529 [424, 672] vs. 100 [100, 130] mg. Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions.The combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer surgery.ClinicalTrial.gov NCT00418457.

  12. Prognostic factors in adult soft tissue sarcoma treated with surgery combined with radiotherapy: a retrospective single-center study on 164 patients

    Directory of Open Access Journals (Sweden)

    Ling Cai

    2013-10-01

    Full Text Available The aim of the present study is to assess the disease profile, outcome and prognostic factors in patients treated with surgery combined with radiotherapy (RT, with or without chemotherapy (CXT, for soft-tissue sarcoma (STS in a multidisciplinary setting. One hundred and sixty-four patients with STS treated between 1980 and 2010 at the Centre Hospitalier Universitaire Vaudois were enrolled in this retrospective study. Seventy-six percent of patients underwent postoperative RT with (24%, or without (52% CXT, 15% preoperative RT with (5%, or without (10% CXT, surgery alone (7%, or RT alone (2% with or without CXT. The median follow-up was 60 months (range 6-292. Local failure was observed in 18%, and distant failure in 21% of the patients. Overall survival (OS, disease-free survival (DFS, local control (LC and distant metastases-free survival (DMFS were 88%, 68%, 83%, and 79% at 5 years, and 80%, 56%, 76%, and 69% at 10 years, respectively. In univariate analyses, favorable prognostic factors for OS, DFS, and DMFS were tumor size 6 cm or less, World Health Organization (WHO/Zubrod score 0, and stage 2 or less. Age and superficial tumors were favorable only for OS and DMFS respectively. STS involving the extremities had a better outcome regarding DFS and LC. Histological grade 2 or less was favorable for DFS, DMFS, and LC. Radical surgery was associated with better LC and DMFS. RT dose more than 60 Gy was favorable for OS, DFS, and LC. In multivariate analyses, independent factors were age for OS; tumor size for OS, DFS and DMFS; WHO/Zubrod score for OS, DFS and LC; hemoglobin level for DFS; site for DFS and LC; tumor depth for DMFS; histological grade for DFS and LC; surgical procedure for LC and DMFS; and RT dose for OS. This study confirms that in a multidisciplinary setting, STS have a fairly good prognosis. A number of prognostic and predictive factors, including the role of surgery combined with RT, were identified. Regarding RT, a dose of

  13. Prognostic Factors in Adult Soft Tissue Sarcoma Treated with Surgery Combined with Radiotherapy: A Retrospective Single-Center Study on 164 Patients

    Science.gov (United States)

    Cai, Ling; Mirimanoff, René-Olivier; Mouhsine, Elyazid; Guillou, Louis; Leyvraz, Pierre-Francois; Leyvraz, Serge; Gay, Beatrice; Matzinger, Oscar; Ozsahin, Mahmut; Zouhair, Abderrahim

    2013-01-01

    The aim of the present study is to assess the disease profile, outcome and prognostic factors in patients treated with surgery combined with radiotherapy (RT), with or without chemotherapy (CXT), for soft-tissue sarcoma (STS) in a multidisciplinary setting. One hundred and sixty-four patients with STS treated between 1980 and 2010 at the Centre Hospitalier Universitaire Vaudois were enrolled in this retrospective study. Seventy-six percent of patients underwent postoperative RT with (24%), or without (52%) CXT, 15% preoperative RT with (5%), or without (10%) CXT, surgery alone (7%), or RT alone (2%) with or without CXT. The median follow-up was 60 months (range 6-292). Local failure was observed in 18%, and distant failure in 21% of the patients. Overall survival (OS), diseasefree survival (DFS), local control (LC) and distant metastases-free survival (DMFS) were 88%, 68%, 83%, and 79% at 5 years, and 80%, 56%, 76%, and 69% at 10 years, respectively. In univariate analyses, favorable prognostic factors for OS, DFS, and DMFS were tumor size 6 cm or less, World Health Organization (WHO)/Zubrod score 0, and stage 2 or less. Age and superficial tumors were favorable only for OS and DMFS respectively. STS involving the extremities had a better outcome regarding DFS and LC. Histological grade 2 or less was favorable for DFS, DMFS, and LC. Radical surgery was associated with better LC and DMFS. RT dose more than 60 Gy was favorable for OS, DFS, and LC. In multivariate analyses, independent factors were age for OS; tumor size for OS, DFS and DMFS; WHO/Zubrod score for OS, DFS and LC; hemoglobin level for DFS; site for DFS and LC; tumor depth for DMFS; histological grade for DFS and LC; surgical procedure for LC and DMFS; and RT dose for OS. This study confirms that in a multidisciplinary setting, STS have a fairly good prognosis. A number of prognostic and predictive factors, including the role of surgery combined with RT, were identified. Regarding RT, a dose of more than

  14. Medicare program; update of ratesetting methodology, payment rates, payment policies, and the list of covered procedures for ambulatory surgical centers effective October 1, 1998; reopening of comment period and delay in adoption of the proposed rule as final--HCFA. Notice of reopening of comment period for proposed rule and delay in adoption of provisions of the proposed rule as final.

    Science.gov (United States)

    1998-10-01

    This notice reopens the comment period for a proposed rule affecting Medicare payments to ambulatory surgical centers (ASCs) that was originally published in the Federal Register on June 12, 1998 (63 FR 32290). This document gives notice of a delay in the adoption of the provisions of the June 12, 1998 ASC proposed rule as a final rule to be concurrent with the adoption as final of the hospital outpatient prospective payment system (PPS) that is the subject of a proposed rule published in the Federal Register on September 8, 1998 (63 FR 47551). In addition this document confirms that the current ASC payment rates that are effective for services furnished on or after October 1, 1998, will remain in effect until rebased ASC rates and the provisions of the June 12, 1998 ASC proposed rule are adopted as final to be concurrent with the adoption as final of the Medicare hospital PPS.

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  16. Hardware-related infections after deep brain stimulation surgery: review of incidence, severity and management in 212 single-center procedures in the first year after implantation.

    Science.gov (United States)

    Piacentino, Massimo; Pilleri, Manuela; Bartolomei, Luigi

    2011-12-01

    Device-related infection is a common occurrence after deep brain stimulation (DBS) surgery, and may result in additional interventions and a loss of efficacy of therapy. This retrospective review aimed to evaluate the incidence, severity and management of device-related infections in 212 DBS procedures performed in our institute. Data on 106 patients, in whom 212 DBS procedures were performed between 2001 and 2011 at our institute by a single neurosurgeon (M.P.), were reviewed to assess the incidence, severity, management and clinical characteristics of infections in the first year after the implantation of a DBS system. Infections occurred in 8.5% of patients and 4.2% of procedures. Of the nine infections, eight involved the neurostimulator and extensions, and one the whole system. The infections occurred 30.7 days after implantation: 7 within 30 days and 2 within 6 months. Infected and uninfected patients were comparable in terms of age, sex, indication for DBS implantation and neurostimulator location. In eight cases, the system components involved were removed and re-implanted after 3 months, while in one case the complete hardware was removed and not re-implanted. The overall incidence of postoperative infections after DBS system implantation was 4.2%; this rate decreased over time. All infections required further surgery. Correct and timely management of partial infections may result in successful salvage of part of the system.

  17. Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H cannot be ruled out

    Directory of Open Access Journals (Sweden)

    Andréa Cytryn

    Full Text Available CONTEXT AND OBJECTIVE: The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS into ASC-US (undetermined significance and ASC-H (high-grade intraepithelial lesion cannot be ruled out. The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF with ASC-H cytology, and compare them with ASC-US cases. DESIGN AND SETTING: Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic. METHODS: ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest. The histological diagnosis (or cytocolposcopic follow-up in cases without such diagnosis was taken as the gold standard. RESULTS: The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55% and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764. Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83; P = 0.2786998. There were no uterine cervical cancer cases. CONCLUSION: The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions.

  18. Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out.

    Science.gov (United States)

    Cytryn, Andréa; Russomano, Fábio Bastos; Camargo, Maria José de; Zardo, Lucília Maria Gama; Horta, Nilza Maria Sobral Rebelo; Fonseca, Rachel de Carvalho Silveira de Paula; Tristão, Maria Aparecida; Monteiro, Aparecida Cristina Sampaio

    2009-09-01

    The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases. Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic. ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest. The histological diagnosis (or cytocolposcopic follow-up in cases without such diagnosis) was taken as the gold standard. The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55%) and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764). Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83); P = 0.2786998). There were no uterine cervical cancer cases. The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions.

  19. The promise and problems of non-physician practitioners in general surgery education: Results of a multi-center, mixed-methods study of faculty.

    Science.gov (United States)

    Coverdill, James E; Shelton, Jeff Scott; Alseidi, Adnan; Borgstrom, David C; Dent, Daniel L; Dumire, Russell; Fryer, Jonathan; Hartranft, Thomas H; Holsten, Steven B; Nelson, M Timothy; Shabahang, Mohsen M; Sherman, Stanley R; Termuhlen, Paula M; Woods, Randy J; Mellinger, John D

    2018-02-01

    Nurse Practitioners and Physician Assistants - called non-physician practitioners or NPPs - are common, but little is known about their educational promise and problems. General surgery faculty in 13 residency programs were surveyed (N = 279 with a 71% response rate) and interviewed (N = 43) about experiences with NPPs. The survey documents overall patterns and differences by program type and primary service; interviews point to deeper rationales and concerns. NPPs reduce faculty and resident workloads and teach residents. NPPs also reduce resident exposure to educationally valuable activities, and faculty sometimes round, make decisions, and operate with NPPs instead of residents. Interviews indicate that NPPs can overly reduce resident involvement in patient care, diminish resident responsibility and decision making, disrupt team dynamics, and compete for procedures. NPPs both enhance and hinder surgical education and highlight the need to more clearly articulate learning outcomes for residents and activities necessary to achieve those outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Analysis of Margin Index as a Method for Predicting Residual Disease After Breast-Conserving Surgery in a European Cancer Center.

    LENUS (Irish Health Repository)

    Bolger, Jarlath C

    2011-06-03

    INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) × 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

  1. Analysis of margin index as a method for predicting residual disease after breast-conserving surgery in a European cancer center.

    LENUS (Irish Health Repository)

    Bolger, Jarlath C

    2012-02-01

    INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) x 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

  2. Positive regulatory effects of perioperative probiotic treatment on postoperative liver complications after colorectal liver metastases surgery: a double-center and double-blind randomized clinical trial.

    Science.gov (United States)

    Liu, Zhihua; Li, Chao; Huang, Meijin; Tong, Chao; Zhang, Xingwei; Wang, Lei; Peng, Hui; Lan, Ping; Zhang, Peng; Huang, Nanqi; Peng, Junsheng; Wu, Xiaojian; Luo, Yanxing; Qin, Huanlong; Kang, Liang; Wang, Jianping

    2015-03-20

    Colorectal liver metastases (CLM) occur frequently and postoperative intestinal infection is a common complication. Our previous study showed that probiotics could decrease the rate of infectious complications after colectomy for colorectal cancer. To determine the effects of the perioperative administration of probiotics on serum zonulin levels which is a marker of intestinal permeability and the subsequent impact on postoperative infectious complications in patients with CLM. 150 patients with CLM were randomly divided into control group (n = 68) and probiotics group (n = 66). Probiotics and placebo were given orally for 6 days preoperatively and 10 days postoperatively to control group and probiotics group respectively. We used the local resection for metastatic tumor ,while for large tumor, the segmental hepatectomy. Postoperative outcome were recorded. Furthermore, complications in patients with normal intestinal barrier function and the relation with serum zonulin were analyzed to evaluate the impact on the liver barrier dysfunction. The incidence of infectious complications in the probiotics group was lower than control group. Analysis of CLM patients with normal postoperative intestinal barrier function paralleled with the serum zonulin level. And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway. We recommend the preoperative oral intake of probiotics combined with postoperative continued probiotics treatment in patients who undergo CLM surgery. ChiCTR-TRC- 12002841 . 2012/12/21.

  3. Androgen receptor (AR) degradation enhancer ASC-J9® in an FDA-approved formulated solution suppresses castration resistant prostate cancer cell growth.

    Science.gov (United States)

    Cheng, Max A; Chou, Fu-Ju; Wang, Keliang; Yang, Rachel; Ding, Jie; Zhang, Qiaoxia; Li, Gonghui; Yeh, Shuyuan; Xu, Defeng; Chang, Chawnshang

    2018-03-28

    ASC-J9 ® is a recently-developed androgen receptor (AR)-degradation enhancer that effectively suppresses castration resistant prostate cancer (PCa) cell proliferation and invasion. The optimal half maximum inhibitory concentrations (IC 50 ) of ASC-J9 ® at various PCa cell confluences (20%, 50%, and 100%) were assessed via both short-term MTT growth assays and long-term clonogenic proliferation assays. Our results indicate that the IC 50 values for ASC-J9 ® increased with increasing cell confluency. The IC 50 values were significantly decreased in PCa AR-positive cells compared to PCa AR-negative cells or in normal prostate cells. This suggests that ASC-J9 ® may function mainly via targeting the AR-positive PCa cells with limited unwanted side-effects to suppress the surrounding normal prostate cells. Mechanism dissection indicated that ASC-J9 ® might function via altering the apoptosis signals to suppress the PCa AR-negative PC-3 cells. Preclinical studies using multiple in vitro PCa cell lines and an in vivo mouse model with xenografted castration-resistant PCa CWR22Rv1 cells demonstrated that ASC-J9 ® has similar AR degradation effects when dissolved in FDA-approved solvents, including DMSO, PEG-400:Tween-80 (95:5), DMA:Labrasol:Tween-80 (10:45:45), and DMA:Labrasol:Tween-20 (10:45:45). Together, results from preclinical studies suggest a potential new therapy with AR-degradation enhancer ASC-J9 ® may potentially be ready to be used in human clinical trials in order to better suppress PCa at later castration resistant stages. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Human adipose stem cell and ASC-derived cardiac progenitor cellular therapy improves outcomes in a murine model of myocardial infarction

    Directory of Open Access Journals (Sweden)

    Davy PMC

    2015-10-01

    Full Text Available Philip MC Davy,1 Kevin D Lye,2,3 Juanita Mathews,1 Jesse B Owens,1 Alice Y Chow,1 Livingston Wong,2 Stefan Moisyadi,1 Richard C Allsopp1 1Institute for Biogenesis Research, 2John A. Burns School of Medicine, University of Hawaii at Mānoa, 3Tissue Genesis, Inc., Honolulu, HI, USA Background: Adipose tissue is an abundant and potent source of adult stem cells for transplant therapy. In this study, we present our findings on the potential application of adipose-derived stem cells (ASCs as well as induced cardiac-like progenitors (iCPs derived from ASCs for the treatment of myocardial infarction. Methods and results: Human bone marrow (BM-derived stem cells, ASCs, and iCPs generated from ASCs using three defined cardiac lineage transcription factors were assessed in an immune-compromised mouse myocardial infarction model. Analysis of iCP prior to transplant confirmed changes in gene and protein expression consistent with a cardiac phenotype. Endpoint analysis was performed 1 month posttransplant. Significantly increased endpoint fractional shortening, as well as reduction in the infarct area at risk, was observed in recipients of iCPs as compared to the other recipient cohorts. Both recipients of iCPs and ASCs presented higher myocardial capillary densities than either recipients of BM-derived stem cells or the control cohort. Furthermore, mice receiving iCPs had a significantly higher cardiac retention of transplanted cells than all other groups. Conclusion: Overall, iCPs generated from ASCs outperform BM-derived stem cells and ASCs in facilitating recovery from induced myocardial infarction in mice. Keywords: adipose stem cells, myocardial infarction, cellular reprogramming, cellular therapy, piggyBac, induced cardiac-like progenitors

  5. Robotic surgery

    Science.gov (United States)

    ... with this type of surgery give it some advantages over standard endoscopic techniques. The surgeon can make ... Elsevier Saunders; 2015:chap 87. Muller CL, Fried GM. Emerging technology in surgery: Informatics, electronics, robotics. In: ...

  6. Nose Surgery

    Science.gov (United States)

    ... Patient Health Home Copyright © 2018 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly ... Terms of Use © Copyright 2018. American Academy of Otolaryngology — Head and Neck Surgery 1650 Diagonal Rd Alexandria, ...

  7. After Surgery

    Science.gov (United States)

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  8. Aortic valve surgery - minimally invasive

    Science.gov (United States)

    ... The surgeon uses a special computer to control robotic arms during the surgery. A 3D view of ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

  9. Mitral valve surgery - minimally invasive

    Science.gov (United States)

    ... The surgeon uses a special computer to control robotic arms during the surgery. A 3D view of ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

  10. A novel method for reproducibly measuring the effects of interventions to improve emotional climate, indices of team skills and communication, and threat to patient outcome in a high-volume thoracic surgery center.

    Science.gov (United States)

    Nurok, Michael; Lipsitz, Stuart; Satwicz, Paul; Kelly, Andrea; Frankel, Allan

    2010-05-01

    To create and test a reproducible method for measuring emotional climate, surgical team skills, and threats to patient outcome by conducting an observational study to assess the impact of a surgical team skills and communication improvement intervention on these measurements. Observational study. Operating rooms in a high-volume thoracic surgery center from September 5, 2007, through June 30, 2008. Thoracic surgery operating room teams. Two 90-minute team skills training sessions focused on findings from a standardized safety culture survey administered to all participants and highlighting positive and problematic aspects of team skills, communication, and leadership. The sessions created an interactive forum to educate team members on the importance of communication and to role-play optimal interactive and communication strategies. Calculated indices of emotional climate, team skills, and threat to patient outcome. The calculated communication and team skills score improved from the preintervention to postintervention periods, but the improvement extinguished during the 3 months after the intervention (P skills and communication and decrease a calculated score of threats to patient outcome. However, the effect is only durable for threats to patient outcome.

  11. Laparoendoscopic single-site surgery (LESS) for the treatment of different urologic pathologies in pediatrics: single-center single-surgeon experience.

    Science.gov (United States)

    Abdel-Karim, Aly M; Elmissery, Mostafa; Elsalmy, Salah; Moussa, Ahmed; Aboelfotoh, Ahmed

    2015-02-01

    Recently LESS has been reported as a valid minimally option for treatment of some urologic pathologies in pediatrics. However, the initial reports of pediatric LESS are still limited to case reports and initial case series. This may be due to the inherent technical difficulty of LESS and the currently available LESS instruments. In this report, we present the largest case series of pediatric LESS for treatment of different urologic pathologies in pediatrics. Included in this study are children who had LESS during the period of January 2011 to June 2013. Both Olympus TriPort (Olympus, New York, USA and Advance Surgical Concept, Wicklow, Ireland) and Covedien SILS access port (Covedien, Chicopec, Massachusetts, USA) were used and were inserted through the umbilicus. Exclusion criteria included children less than 3 years old, history of previous transperitoneal abdominal surgery, malignant indications, and complex urogenital congenital anomalies. All LESS procedures were done by a single experienced laparoscopist and data were reviewed retrospectively. Twenty-two children had 39 LESS procedures without conversion to conventional laparoscopy or open surgery. No intraoperative or postoperative complications were reported and no extra-port was added in any of the patients. The following table shows the mean age, operative time, hospital stay, VAS as well as the overall mean of different LESS procedures. In all patients the umbilical scar was invisible and all patients and their parents had high wound satisfaction. At a mean follow up of 18.6 ± 6.4 months, all patients with UPJO had successful repair. Our study included 13 boys with undescended testis who were managed in different ways according to the length of spermatic vessels and the size of the testis. One of the arguments against LESS management of undescended testis is that it requires a 2.5-cm incision, which is collectively larger than a 5-mm camera and two 3-mm working ports of conventional laparoscopy. However

  12. Thyroid Surgery

    Science.gov (United States)

    ... Hypothyroidism in Children and Adolescents Pediatric Differentiated Thyroid Cancer Thyroid Nodules in Children and Adolescents Thyroid Surgery Resources Thyroid Surgery Brochure PDF Thyroid Surgery FAQs PDF En Español Cirugia De La Tiroides El folleto de Cirugia De La Tiroides Search Thyroid ...

  13. Cataract surgery among Medicare beneficiaries.

    Science.gov (United States)

    Schein, Oliver D; Cassard, Sandra D; Tielsch, James M; Gower, Emily W

    2012-10-01

    To present descriptive epidemiology of cataract surgery among Medicare recipients in the United States. Cataract surgery performed on Medicare beneficiaries in 2003 and 2004. Medicare claims data were used to identify all cataract surgery claims for procedures performed in the United States in 2003-2004. Standard assumptions were used to limit the claims to actual cataract surgery procedures performed. Summary statistics were created to determine the number of procedures performed for each outcome of interest: cataract surgery rates by age, sex, race and state; surgical volume by facility type and surgeon characteristics; time interval between first- and second-eye cataract surgery. The national cataract surgery rate for 2003-2004 was 61.8 per 1000 Medicare beneficiary person-years. The rate was significantly higher for females and for those aged 75-84 years. After adjustment for age and sex, blacks had approximately a 30% lower rate of surgery than whites. While only 5% of cataract surgeons performed more than 500 cataract surgeries annually, these surgeons performed 26% of the total cataract surgeries. Increasing surgical volume was found to be highly correlated with use of ambulatory surgical centers and reduced time interval between first- and second-eye surgery in the same patient. The epidemiology of cataract surgery in the United States Medicare population documents substantial variation in surgical rates by race, sex, age, and by certain provider characteristics.

  14. Low-frequency, low-magnitude vibrations (LFLM enhances chondrogenic differentiation potential of human adipose derived mesenchymal stromal stem cells (hASCs

    Directory of Open Access Journals (Sweden)

    Krzysztof Marycz

    2016-02-01

    Full Text Available The aim of this study was to evaluate if low-frequency, low-magnitude vibrations (LFLM could enhance chondrogenic differentiation potential of human adipose derived mesenchymal stem cells (hASCs with simultaneous inhibition of their adipogenic properties for biomedical purposes. We developed a prototype device that induces low-magnitude (0.3 g low-frequency vibrations with the following frequencies: 25, 35 and 45 Hz. Afterwards, we used human adipose derived mesenchymal stem cell (hASCS, to investigate their cellular response to the mechanical signals. We have also evaluated hASCs morphological and proliferative activity changes in response to each frequency. Induction of chondrogenesis in hASCs, under the influence of a 35 Hz signal leads to most effective and stable cartilaginous tissue formation through highest secretion of Bone Morphogenetic Protein 2 (BMP-2, and Collagen type II, with low concentration of Collagen type I. These results correlated well with appropriate gene expression level. Simultaneously, we observed significant up-regulation of α3, α4, β1 and β3 integrins in chondroblast progenitor cells treated with 35 Hz vibrations, as well as Sox-9. Interestingly, we noticed that application of 35 Hz frequencies significantly inhibited adipogenesis of hASCs. The obtained results suggest that application of LFLM vibrations together with stem cell therapy might be a promising tool in cartilage regeneration.

  15. Impact of one-to-one tutoring on fundamentals of laparoscopic surgery (FLS) passing rate in a single center experience outside the United States: a randomized controlled trial.

    Science.gov (United States)

    Gheza, Federico; Raimondi, Paolo; Solaini, Leonardo; Coccolini, Federico; Baiocchi, Gian Luca; Portolani, Nazario; Tiberio, Guido Alberto Massimo

    2018-04-11

    Outside the US, FLS certification is not required and its teaching methods are not well standardized. Even if the FLS was designed as "stand alone" training system, most of Academic Institution offer support to residents during training. We present the first systematic application of FLS in Italy. Our aim was to evaluate the role of mentoring/coaching on FLS training in terms of the passing rate and global performance in the search for resource optimization. Sixty residents in general surgery, obstetrics & gynecology, and urology were selected to be enrolled in a randomized controlled trial, practicing FLS with the goal of passing a simulated final exam. The control group practiced exclusively with video material from SAGES, whereas the interventional group was supported by a mentor. Forty-six subjects met the requirements and completed the trial. For the other 14 subjects no results are available for comparison. One subject for each group failed the exam, resulting in a passing rate of 95.7%, with no obvious differences between groups. Subgroup analysis did not reveal any difference between the groups for FLS tasks. We confirm that methods other than video instruction and deliberate FLS practice are not essential to pass the final exam. Based on these results, we suggest the introduction of the FLS system even where a trained tutor is not available. This trial is the first single institution application of the FLS in Italy and one of the few experiences outside the US. Trial Number: NCT02486575 ( https://www.clinicaltrials.gov ).

  16. Engineering Foundation Conference: Advances in optics for biotechnology, medicine, and surgery, Kona Surf Resort and Conference Center, Kailua-Kona, Hawaii, August 1-6, 1999. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Yodh, Arjun; Sevick-Muraca, Eva; Benaron, David

    2001-09-01

    The intent of the conference was to gather a group of cross-disciplinary investigators from universities, medical schools, national laboratories, industry, and government in order to highlight future applications and technology of the optical sciences in biotechnology, medicine, and surgery. The session chairs brought new participants and speakers to the conference who were not regular attendees of the OSA and SPIE conferences. Attendees included a good number of graduate and post-doctoral students who tended to join the more senior members in organized and spontaneous afternoon activities. A critique of the conference is given which discusses things that worked well and things that could have been better, focusing on costs, funding, and speaker cancellations. Sessions were held on the following topics: Photodynamic therapy: fundamental and clinical studies; Frontiers in spectroscopy; Photon migration; Advances in tissue microscopy, dyes and reporters; Advances in cell microscopy: spectroscopy and micromanipulation; Laser-tissue interactions: therapeutic interventions; and Optics for biotechnology. Along with the program and participant lists, nearly 50 poster presentations are included.

  17. Emergency cardiac surgery during transfemoral and transapical transcatheter aortic valve implantation: incidence, reasons, management, and outcome of 411 patients from a single center.

    Science.gov (United States)

    Griese, Daniel P; Reents, Wilko; Kerber, Sebastian; Diegeler, Anno; Babin-Ebell, Jörg

    2013-11-01

    Transcatheter aortic valve implantation (TAVI) is increasingly performed in high-risk patients with severe aortic valve stenosis. Incidence and impact of emergency cardiac surgery (ECS) during TAVI is unclear. Two-hundred twenty one transapical (TA) and 190 transfemoral (TF) TAVIs were performed at our hospital between 01/2009 and 12/2012. Twenty patients (4.9%) required ECS, more frequently in the TF- (n = 11; 5.8%) than in the TA-group (n = 9; 4.1%; P = 0.017). ECS-cases were evenly distributed throughout the 4 years. Baseline characteristics of the ECS-patients were not different from the non-ECS-patients. Reasons were acute cardiac failure, coronary obstruction, annular rupture, valve migration, right- and left-ventricular perforation, severe paravalvular leakage, aortic dissection, and mitral valve damage. Surgical intervention consisted of peripheral CPB, switch to TA, thoracotomy and suture of perforated cardiac chambers and conventional aortic valve replacement with concomitant repair of associated cardiovascular injury. Thirty-day mortality was 35.0%, and 55.0% could be salvaged to hospital discharge. Kaplan-Meier 1-year survival curves were significantly impaired for patients requiring ECS (TF: P proportion during TAVI. ECS dramatically affects early and late outcome after TAVI. Under optimal conditions more than half of the ECS-patients can be salvaged. With the current technology of THV-systems ECS should be an integral part of the logistic conditions surrounding TAVI and is far from being futile in this patient population. Copyright © 2013 Wiley Periodicals, Inc.

  18. Interferência do ácido ascórbico na dosagem glicêmica - doi: 10.5102/ucs.v6i2.722

    OpenAIRE

    Aline Cardoso Barbosa; Tania Cristina Andrade

    2009-01-01

    Sabe-se que exames laboratoriais estão sujeitos a fatores interferentes. A literatura científica cita interferência do ácido ascórbico em dosagens que envolvam oxirredução, como a glicêmica. Devido a isto, buscou-se avaliar o efeito do ácido ascórbico sobre a dosagem glicêmica em dois tipos de soro controle submetidos a diferentes concentrações de ácido ascórbico, variando de 2,5 a 100 mg/dL. Utilizou-se um soro controle com valores normais de glicemia e outro com valores patológicos. Observo...

  19. Outcome of Stable Patients With Acute Myocardial Infarction and Coronary Artery Bypass Surgery Within 48 Hours: A Single-Center, Retrospective Experience.

    Science.gov (United States)

    Grothusen, Christina; Friedrich, Christine; Loehr, Johannes; Meinert, Jette; Ohnewald, Eva; Ulbricht, Ulysses; Attmann, Tim; Haneya, Assad; Huenges, Katharina; Freitag-Wolf, Sandra; Schoettler, Jan; Cremer, Jochen

    2017-10-03

    The optimal timing of coronary artery bypass grafting (CABG) in clinically stable patients with acute myocardial infarction who are unsuitable for percutaneous coronary intervention is unclear. We report our experience with early CABG in these patients. Between January 2001 and May 2015, 766 patients with ST-segment-elevation myocardial infarction (STEMI, n=305) or non-STEMI (NSTEMI, n=461) not including cardiogenic shock underwent CABG within 48 hours at our department. STEMI patients were younger than non-STEMI patients (age 65 years [range: 58-72] versus 70 years [range: 62-75], P <0.001) with a lower EuroSCORE II (4.12 [range: 2.75-5.81] versus 4.58 [range: 2.80-7.74], P =0.009). STEMI patients had undergone preoperative percutaneous coronary intervention more often (20.3% versus 7.8%, P <0.001). Time to surgery was shorter in STEMI compared with non-STEMI patients (5.0 hours [range: 3.2-8.8] versus 11.7 hours [range: 6.4-22.0], P <0.001). No significant differences concerning arterial graft use (93.8% versus 94.8%, P =0.540) or complete revascularization (87.5% versus 83.4%, P =0.121) were observed. The rate of strokes did not differ between the groups (2.0% versus 3.9%, P =0.134). Thirty-day mortality was lower in STEMI patients (2.7% versus 6.6% P =0.018), especially when CABG was performed within 6 hours (1.8% versus 7.1%, P =0.041). Survival of STEMI and non-STEMI patients was 94% versus 88% after 1 year ( P <0.001), 87% versus 73% after 5 years ( P <0.001), and 74% versus 57% after 10 years ( P <0.001). Independent predictors of 30-day and long-term mortality included preoperatively increased lactate values, age, atrial fibrillation, and reduced left ventricular function. Stable STEMI patients showed a lower rate of perioperative complications and better survival compared with non-STEMI patients when CABG was performed within 48 hours. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  20. Observaciones histopatologicas de juveniles penaeus vannamei sometidos a dietas artificiales con diferentes concentraciones de una sal de ácido ascórbico (vitamina c)

    OpenAIRE

    Vera Muñoz, L.

    1995-01-01

    Observaciones histopatologicas de juveniles Penaeus Vannamei sometidos a dietas artificiales con diferentes concentraciones de una sal de ácido ascórbico (vitamina C) Se realizaron análisis histológicos y comprobación mediante métodos histoquímicos de la presencia de melanina, a juveniles Penaeus vannamei sometidos a cinco dietas experimentales con diferentes concentraciones de una sal de L-Ascorbato-2-Fosfato de Mg (APM) usada como fuente de ácido ascórbico (AA).

  1. How formative courses about damage control surgery and non-operative management improved outcome and survival in unstable politrauma patients in a Mountain Trauma Center.

    Science.gov (United States)

    Bellanova, Giovanni; Buccelletti, Francesco; Berletti, Riccardo; Cavana, Marco; Folgheraiter, Giorgio; Groppo, Francesca; Marchetti, Chiara; Marzano, Amelia; Massè, Alessandro; Musetti, Antonio; Pelanda, Tina; Ricci, Nicola; Tugnoli, Gregorio; Papadia, Damiano; Ramponi, Claudio

    2016-01-01

    Aim of this study is to analyze how the starting of Course of Trauma in our hospital improved survival and organization in management of polytraumatized patients. We analysed all major trauma patients (Injury Severity Score (Injury Severity Score (ISS)> 15) treated at Emergency Department of the Santa Chiara Hospital between January 2011 and December 2014. The training courses (TC) were named "management of polytrauma" (MP) and "clinical cases discussion" (CCD), and started in November 2013. We divided the patients between two groups: before November 2013 (pre-TC group) and after November 2013 (post-TC group). MTG's courses (EMC accredited), CCD and MP courses started in November 2013. The target of these courses was the multidisciplinary management of polytrauma patient; the courses were addressed to general surgeons, anaesthesiologists, radiologists, orthopaedics and emergency physicians. Respectively 110 and 78 doctors were formed in CCD's and MP's courses. Patients directly transported to our trauma centre rose from 67.5% to 83% (pOperative Management, Trauma Course, Trauma Team, Trauma Center.

  2. Inflammasome components ASC and AIM2 modulate the acute phase of biomaterial implant-induced foreign body responses

    Science.gov (United States)

    Christo, Susan N.; Diener, Kerrilyn R.; Manavis, Jim; Grimbaldeston, Michele A.; Bachhuka, Akash; Vasilev, Krasimir; Hayball, John D.

    2016-01-01

    Detailing the inflammatory mechanisms of biomaterial-implant induced foreign body responses (FBR) has implications for revealing targetable pathways that may reduce leukocyte activation and fibrotic encapsulation of the implant. We have adapted a model of poly(methylmethacrylate) (PMMA) bead injection to perform an assessment of the mechanistic role of the ASC-dependent inflammasome in this process. We first demonstrate that ASC−/− mice subjected to PMMA bead injections had reduced cell infiltration and altered collagen deposition, suggesting a role for the inflammasome in the FBR. We next investigated the NLRP3 and AIM2 sensors because of their known contributions in recognising damaged and apoptotic cells. We found that NLRP3 was dispensable for the fibrotic encapsulation; however AIM2 expression influenced leukocyte infiltration and controlled collagen deposition, suggesting a previously unexplored link between AIM2 and biomaterial-induced FBR. PMID:26860464

  3. MiDAS I (mild Decompression Alternative to Open Surgery): a preliminary report of a prospective, multi-center clinical study.

    Science.gov (United States)

    Chopko, Bohdan; Caraway, David L

    2010-01-01

    Neurogenic claudication due to lumbar spinal stenosis is a common problem that can be caused by many factors including hypertrophic ligamentum flavum, facet hypertrophy, and disc protrusion. When standard medical therapies such as pain medication, epidural steroid injections, and physical therapy fail, or when the patient is unwilling, unable, or not severe enough to advance to more invasive surgical procedures, both physicians and patients are often left with a treatment dilemma. Patients in this study were treated with mild, an ultra-minimally invasive lumbar decompression procedure using a dorsal approach. The mild procedure is performed under fluoroscopic imaging to resect bone adjacent to, and achieve partial resection of, the hypertrophic ligamentum flavum with minimal disruption of surrounding muscular and skeletal structure. To assess the clinical application and patient safety and functional outcomes of the mild lumbar decompression procedure in the treatment of symptomatic central canal spinal stenosis. Multi-center, non-blinded, prospective clinical study. Fourteen US spine specialist practices. Between July 2008 and January 2010, 78 patients were enrolled in the MiDAS I Study and treated with the mild procedure for lumbar decompression. Of these patients, 6-week follow-up was available for 75 patients. Visual Analog Score (VAS), Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and SF-12v2 Health Survey. Outcomes were assessed at baseline and 6 weeks post-treatment. There were no major device or procedure-related complications reported in this patient cohort. At 6 weeks, the MiDAS I Study showed statistically and clinically significant reduction of pain as measured by VAS, ZCQ, and SF-12v2. In addition, improvement in physical function and mobility as measured by ODI, ZCQ, and SF-12v2 was statistically and clinically significant in this study. This is a preliminary report encompassing 6-week follow-up. There was no control group

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ...

  5. GENERAL SURGERY

    African Journals Online (AJOL)

    in the endoscopy room. GENERAL SURGERY. T du Toit, O C Buchel, S J A Smit. Department of Surgery, University of the Free State, Bloemfontein, ... The lack of video instrumentation in developing countries: Redundant fibre-optic instruments (the old. “eye scope”) are still being used. This instrument brings endoscopists ...

  6. GENERAL SURGERY

    African Journals Online (AJOL)

    mean time to first surgery post burn was 11.5 days with a median volume of 0.73 mls/kg/% ..... Mode. Mean (SD). Upper limit. 95% CI. Lower limit. 95% CI. Mode. Elective surgery .... evaluating single-unit red blood cell transfusions in reducing.

  7. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed......ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

  8. Pangasius in the EU market; Prospects for the position of (ASC-certified) pangasius in the EU retail and food service sector

    NARCIS (Netherlands)

    Beukers, R.; Pijl, van der W.; Duijn, van A.P.

    2014-01-01

    The objective of this market study is to investigate the potential short- and long-term benefits for investors to invest in the production of pangasius with a trademark based on ASC certification, for the retail and food service market segments in the EU market.

  9. The effect of magnetic stimulation on the osteogenic and chondrogenic differentiation of human stem cells derived from the adipose tissue (hASCs)

    Energy Technology Data Exchange (ETDEWEB)

    Lima, João; Gonçalves, Ana I.; Rodrigues, Márcia T.; Reis, Rui L. [3Bs Research Group–Biomaterials, Biodegradables and Biomimetics, University of Minho, Guimarães (Portugal); ICVS/3Bs–PT Government Associate Laboratory, Braga/Guimarães (Portugal); Gomes, Manuela E., E-mail: megomes@dep.uminho.pt [3Bs Research Group–Biomaterials, Biodegradables and Biomimetics, University of Minho, Guimarães (Portugal); ICVS/3Bs–PT Government Associate Laboratory, Braga/Guimarães (Portugal)

    2015-11-01

    The use of magnetic nanoparticles (MNPs) towards the musculoskeletal tissues has been the focus of many studies, regarding MNPs ability to promote and direct cellular stimulation and orient tissue responses. This is thought to be mainly achieved by mechano-responsive pathways, which can induce changes in cell behavior, including the processes of proliferation and differentiation, in response to external mechanical stimuli. Thus, the application of MNP-based strategies in tissue engineering may hold potential to propose novel solutions for cell therapy on bone and cartilage strategies to accomplish tissue regeneration. The present work aims at studying the influence of MNPs on the osteogenic and chondrogenic differentiation of human adipose derived stem cells (hASCs). MNPs were incorporated in hASCs and cultured in medium supplemented for osteogenic and chondrogenic differentiation. Cultures were maintained up to 28 days with/without an external magnetic stimulus provided by a magnetic bioreactor, to determine if the MNPs alone could affect the osteogenic or chondrogenic phenotype of the hASCs. Results indicate that the incorporation of MNPs does not negatively affect the viability nor the proliferation of hASCs. Furthermore, Alizarin Red staining evidences an enhancement in extracellular (ECM) mineralization under the influence of an external magnetic field. Although not as evident as for osteogenic differentiation, Toluidine blue and Safranin-O stainings also suggest the presence of a cartilage-like ECM with glycosaminoglycans and proteoglycans under the magnetic stimulus provided. Thus, MNPs incorporated in hASCs under the influence of an external magnetic field have the potential to induce differentiation towards the osteogenic and chondrogenic lineages. - Highlights: • Cellular viability was not negatively influenced by the nanoparticles. • Chondrogenic medium influences more the synthesis of cartilage-like ECM than MNPs. • Synergetic effect among

  10. Genomic presence of gadD1 glutamate decarboxylase correlates with the organization of ascB-dapE internalin cluster in Listeria monocytogenes.

    Science.gov (United States)

    Chen, Jianshun; Fang, Chun; Zheng, Tianlun; Zhu, Ningyu; Bei, Yijiang; Fang, Weihuan

    2012-02-01

    The ability to survive and proliferate in acidic environments is a prerequisite for the infection of Listeria monocytogenes. The glutamate decarboxylase (GAD) system is responsible for acid resistance, and three GAD homologs have been identified in L. monocytogenes: gadD1, gadD2, and gadD3. To examine whether GAD genes are specific to lineage, serovar, or certain subpopulation, we performed a systematic investigation on the prevalence of GAD genes in 164 L. monocytogenes. In contrast to gadD2 and gadD3 conserved in all L. monocytogenes strains, gadD1 was identified in 36.6% (60/164) of L. monocytogenes strains, including all serovar 1/2c and 68.5% (37/54) of serovar 1/2a strains, as well as a small fraction of serovar 1/2b (3.4%, 1/29) and lineage III (13.8%, 4/29) strains. All serovar 4b and lineage IV strains lacked this gene. According to the ascB-dapE structure, L. monocytogenes strains were classified into four subpopulations, carrying inlC2DE, inlGC2DE, inlGHE, or no internalin cluster, respectively. All L. monocytogenes strains with inlGC2DE or inlGHE pattern harbored gadD1, whereas those bearing inlC2DE or no internalin cluster between ascB and dapE lacked gadD1. In addition, other five non-monocytogenes Listeria species lacking ascB-dapE internalin cluster were gadD1-negative. Overall, the presence of gadD1 is not fully dependent on lineages or serovars but correlates with ascB-dapE internalin profiles, suggesting gadD1 might have co-evolved with the ascB-dapE internalin cluster in the primitive L. monocytogenes before divergence of serovars.

  11. The effect of magnetic stimulation on the osteogenic and chondrogenic differentiation of human stem cells derived from the adipose tissue (hASCs)

    International Nuclear Information System (INIS)

    Lima, João; Gonçalves, Ana I.; Rodrigues, Márcia T.; Reis, Rui L.; Gomes, Manuela E.

    2015-01-01

    The use of magnetic nanoparticles (MNPs) towards the musculoskeletal tissues has been the focus of many studies, regarding MNPs ability to promote and direct cellular stimulation and orient tissue responses. This is thought to be mainly achieved by mechano-responsive pathways, which can induce changes in cell behavior, including the processes of proliferation and differentiation, in response to external mechanical stimuli. Thus, the application of MNP-based strategies in tissue engineering may hold potential to propose novel solutions for cell therapy on bone and cartilage strategies to accomplish tissue regeneration. The present work aims at studying the influence of MNPs on the osteogenic and chondrogenic differentiation of human adipose derived stem cells (hASCs). MNPs were incorporated in hASCs and cultured in medium supplemented for osteogenic and chondrogenic differentiation. Cultures were maintained up to 28 days with/without an external magnetic stimulus provided by a magnetic bioreactor, to determine if the MNPs alone could affect the osteogenic or chondrogenic phenotype of the hASCs. Results indicate that the incorporation of MNPs does not negatively affect the viability nor the proliferation of hASCs. Furthermore, Alizarin Red staining evidences an enhancement in extracellular (ECM) mineralization under the influence of an external magnetic field. Although not as evident as for osteogenic differentiation, Toluidine blue and Safranin-O stainings also suggest the presence of a cartilage-like ECM with glycosaminoglycans and proteoglycans under the magnetic stimulus provided. Thus, MNPs incorporated in hASCs under the influence of an external magnetic field have the potential to induce differentiation towards the osteogenic and chondrogenic lineages. - Highlights: • Cellular viability was not negatively influenced by the nanoparticles. • Chondrogenic medium influences more the synthesis of cartilage-like ECM than MNPs. • Synergetic effect among

  12. The effect of magnetic stimulation on the osteogenic and chondrogenic differentiation of human stem cells derived from the adipose tissue (hASCs)

    Science.gov (United States)

    Lima, João; Gonçalves, Ana I.; Rodrigues, Márcia T.; Reis, Rui L.; Gomes, Manuela E.

    2015-11-01

    The use of magnetic nanoparticles (MNPs) towards the musculoskeletal tissues has been the focus of many studies, regarding MNPs ability to promote and direct cellular stimulation and orient tissue responses. This is thought to be mainly achieved by mechano-responsive pathways, which can induce changes in cell behavior, including the processes of proliferation and differentiation, in response to external mechanical stimuli. Thus, the application of MNP-based strategies in tissue engineering may hold potential to propose novel solutions for cell therapy on bone and cartilage strategies to accomplish tissue regeneration. The present work aims at studying the influence of MNPs on the osteogenic and chondrogenic differentiation of human adipose derived stem cells (hASCs). MNPs were incorporated in hASCs and cultured in medium supplemented for osteogenic and chondrogenic differentiation. Cultures were maintained up to 28 days with/without an external magnetic stimulus provided by a magnetic bioreactor, to determine if the MNPs alone could affect the osteogenic or chondrogenic phenotype of the hASCs. Results indicate that the incorporation of MNPs does not negatively affect the viability nor the proliferation of hASCs. Furthermore, Alizarin Red staining evidences an enhancement in extracellular (ECM) mineralization under the influence of an external magnetic field. Although not as evident as for osteogenic differentiation, Toluidine blue and Safranin-O stainings also suggest the presence of a cartilage-like ECM with glycosaminoglycans and proteoglycans under the magnetic stimulus provided. Thus, MNPs incorporated in hASCs under the influence of an external magnetic field have the potential to induce differentiation towards the osteogenic and chondrogenic lineages.

  13. Cataract Surgery

    Science.gov (United States)

    ... Oncology Oculoplastics/Orbit Refractive Management/Intervention Retina/Vitreous Uveitis Focus On Pediatric Ophthalmology ... Are Cataracts? Pediatric Cataracts Cataract Diagnosis and Treatment Cataract Surgery IOL Implants: Lens Replacement After Cataracts ...

  14. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  15. Foot Surgery

    Science.gov (United States)

    ... coding trends along with compliance guidelines and practice marketing materials, APMA has you covered whether you are ... crutches after the surgery or in a cast. Fusions: Fusions are usually performed to treat arthritic or ...

  16. Hemorrhoid surgery

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002939.htm Hemorrhoid surgery To use the sharing features on this page, please enable JavaScript. Hemorrhoids are swollen veins around the anus. They may ...

  17. PLASTIC SURGERY

    African Journals Online (AJOL)

    Department of Plastic and Reconstructive Surgery Sefako Makgatho Health Science University, ... We report on a pilot study on the use of a circumareolar excision and the use of .... and 1 gynecomastia patient) requested reduction in NAC size.

  18. GENERAL SURGERY

    African Journals Online (AJOL)

    influence medical students in pursuing a career in surgery. ... training, females reported significantly higher levels of agreement that surgical training would be better overseas when ..... mentoring surgical research or educational lectures and.

  19. GENERAL SURGERY

    African Journals Online (AJOL)

    1 Department of Surgery, Nelson R Mandela School of Medicine, University of ... in 51 reports. Four reports were illegible; one was conducted by a junior consultant, two by a fourth year trainee specialist ... The study period was 12 months from.

  20. Sinus Surgery

    Science.gov (United States)

    ... sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected ... altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult. Image ...

  1. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  2. Tennis elbow surgery

    Science.gov (United States)

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is often an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

  3. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  4. Mohs micrographic surgery

    Science.gov (United States)

    Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

  5. The deoxyhypusine synthase mutant dys1-1 reveals the association of eIF5A and Asc1 with cell wall integrity.

    Directory of Open Access Journals (Sweden)

    Fabio Carrilho Galvão

    Full Text Available The putative eukaryotic translation initiation factor 5A (eIF5A is a highly conserved protein among archaea and eukaryotes that has recently been implicated in the elongation step of translation. eIF5A undergoes an essential and conserved posttranslational modification at a specific lysine to generate the residue hypusine. The enzymes deoxyhypusine synthase (Dys1 and deoxyhypusine hydroxylase (Lia1 catalyze this two-step modification process. Although several Saccharomyces cerevisiae eIF5A mutants have importantly contributed to the study of eIF5A function, no conditional mutant of Dys1 has been described so far. In this study, we generated and characterized the dys1-1 mutant, which showed a strong depletion of mutated Dys1 protein, resulting in more than 2-fold decrease in hypusine levels relative to the wild type. The dys1-1 mutant demonstrated a defect in total protein synthesis, a defect in polysome profile indicative of a translation elongation defect and a reduced association of eIF5A with polysomes. The growth phenotype of dys1-1 mutant is severe, growing only in the presence of 1 M sorbitol, an osmotic stabilizer. Although this phenotype is characteristic of Pkc1 cell wall integrity mutants, the sorbitol requirement from dys1-1 is not associated with cell lysis. We observed that the dys1-1 genetically interacts with the sole yeast protein kinase C (Pkc1 and Asc1, a component of the 40S ribosomal subunit. The dys1-1 mutant was synthetically lethal in combination with asc1Δ and overexpression of TIF51A (eIF5A or DYS1 is toxic for an asc1Δ strain. Moreover, eIF5A is more associated with translating ribosomes in the absence of Asc1 in the cell. Finally, analysis of the sensitivity to cell wall-perturbing compounds revealed a more similar behavior of the dys1-1 and asc1Δ mutants in comparison with the pkc1Δ mutant. These data suggest a correlated role for eIF5A and Asc1 in coordinating the translational control of a subset of m

  6. Engineering anatomically shaped vascularized bone grafts with hASCs and 3D-printed PCL scaffolds.

    Science.gov (United States)

    Temple, Joshua P; Hutton, Daphne L; Hung, Ben P; Huri, Pinar Yilgor; Cook, Colin A; Kondragunta, Renu; Jia, Xiaofeng; Grayson, Warren L

    2014-12-01

    The treatment of large craniomaxillofacial bone defects is clinically challenging due to the limited availability of transplantable autologous bone grafts and the complex geometry of the bones. The ability to regenerate new bone tissues that faithfully replicate the anatomy would revolutionize treatment options. Advances in the field of bone tissue engineering over the past few decades offer promising new treatment alternatives using biocompatible scaffold materials and autologous cells. This approach combined with recent advances in three-dimensional (3D) printing technologies may soon allow the generation of large, bioartificial bone grafts with custom, patient-specific architecture. In this study, we use a custom-built 3D printer to develop anatomically shaped polycaprolactone (PCL) scaffolds with varying internal porosities. These scaffolds are assessed for their ability to support induction of human adipose-derived stem cells (hASCs) to form vasculature and bone, two essential components of functional bone tissue. The development of functional tissues is assessed in vitro and in vivo. Finally, we demonstrate the ability to print large mandibular and maxillary bone scaffolds that replicate fine details extracted from patient's computed tomography scans. The findings of this study illustrate the capabilities and potential of 3D printed scaffolds to be used for engineering autologous, anatomically shaped, vascularized bone grafts. © 2014 Wiley Periodicals, Inc.

  7. ASCE application guide for recommended practice for fiber-reinforced polymer products for overhead utility line structures

    Energy Technology Data Exchange (ETDEWEB)

    Gnandt, E. [T and D High Voltage Consulting, Vancouver, BC (Canada)

    2002-07-01

    The participants to the American Society of Civil Engineers (ASCE) prepared an application guide to provide guidelines to utilities and manufacturers on topics ranging from design to manufacture, testing and installation of fiber-reinforced polymer (FRP) products. The intent was also to help utilities with a possible replacement material for wood, steel and pre-stressed concrete. FRP products are constructed from fiber and resin and offer several advantages such as light weight and high strength-to-weight ratio, low maintenance, dimensional stability, resistance to rot, corrosion, chemicals and pest damage. FRP products can be used for lighting poles, ladders and grating, transformer pads, pole line hardware and crossarms, and other applications. There are five structural configurations: (1) cantilevered structures (single pole), (2) guyed structures, framed structures (H-Frame), (4) a combination of (1), (2), and (3), and (5) lattice structures (transmission class). The author listed some of the initial considerations: physical characteristics, guying and grounding, deflection and load testing, attached items, and durability to name only a few. The materials and manufacturing processes were briefly explained, namely the pultrusion method, the filament winding method, and the centrifugal casting method. Design loads considerations are discussed, as are performance-based criteria such as mechanical, coating durability and electrical. Quality control, assembly erection and storage, and in-service considerations are also discussed. The author concluded the presentation with a section dealing with field inspections. figs.

  8. Transcriptional signature of human adipose tissue-derived stem cells (hASCs) preconditioned for chondrogenesis in hypoxic conditions

    International Nuclear Information System (INIS)

    Pilgaard, L.; Lund, P.; Duroux, M.; Lockstone, H.; Taylor, J.; Emmersen, J.; Fink, T.; Ragoussis, J.; Zachar, V.

    2009-01-01

    Hypoxia is an important factor involved in the control of stem cells. To obtain a better insight into the phenotypical changes brought about by hypoxic preconditioning prior to chondrogenic differentiation; we have investigated growth, colony-forming and chondrogenic capacity, and global transcriptional responses of six adipose tissue-derived stem cell lines expanded at oxygen concentrations ranging from ambient to 1%. The assessment of cell proliferation and colony-forming potential revealed that the hypoxic conditions corresponding to 1% oxygen played a major role. The chondrogenic inducibility, examined by high-density pellet model, however, did not improve on hypoxic preconditioning. While the microarray analysis revealed a distinctive inter-donor variability, the exposure to 1% hypoxia superseded the biological variability and produced a specific expression profile with 2581 significantly regulated genes and substantial functional enrichment in the pathways of cell proliferation and apoptosis. Additionally, exposure to 1% oxygen resulted in upregulation of factors related to angiogenesis and cell growth. In particular, leptin (LEP), the key regulator of body weight and food intake was found to be highly upregulated. In conclusion, the results of this investigation demonstrate the significance of donor demographics and the importance of further studies into the use of regulated oxygen tension as a tool for preparation of ASCs in order to exploit their full potential.

  9. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik

    2016-01-01

    The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were...... in beauty than women (P = 0.030). Sixty-four percent replied that their attractiveness had been increased after OS. Eighty-six percent were happy with the results and 89% would recommend the surgery to others in need. No significant differences in esthetic results and satisfaction were seen with regard...

  10. Consumo de ácido ascórbico y niveles séricos en hombres adultos fumadores y no fumadores de la CD. de Hermosillo, Sonora, México

    OpenAIRE

    Méndez E, Rosa Olivia; Wyatt, C. Jane; Saavedra, Javier; Ornelas, Alicia

    2002-01-01

    El ácido ascórbico es uno de las antioxidantes más importantes a nivel extracelular, sin embargo su papel preventivo de enfermedades degenerativas se puede comprometer al disminuir sus niveles séricos. Bajos valores de ácido ascórbico sérico se han reportado en hombres fumadores. En el presente estudio se estimó la ingestión de ácido ascórbico en 25 hombres adultos sanos de Hermosillo, Sonora, México, divididos en dos grupos: fumadores y no fumadores; se compararon los niveles séricos de ácid...

  11. Epilepsy surgery: Recommendations for India

    Directory of Open Access Journals (Sweden)

    Chandra P

    2010-01-01

    Full Text Available The following article recommends guidelines for epilepsy surgery for India. This article reviews the indications, the various surgical options available and the outcome of surgery for drug resistant epilepsy based on current evidence. Epilepsy surgery is a well-established option for patients who have been diagnosed to have drug resistant epilepsy (DRE (on at least two appropriate, adequate anti-epileptic drugs (AEDs (either in monotherapy or in combination with continuing seizures, where the presurgical work-up has shown concordance of structural imaging (magnetic resonance imaging and electrical mapping data (electroencephalography (EEG, video EEG. There may be a requirement of functional imaging techniques in a certain number of DRE like positron emission tomography (PET, single photon emission tomography, (SPECT. Invasive monitoring should be restricted to a few when all noninvasive investigations are inconclusive, there is a dual pathology or there is a discordance of noninvasive data. The types of surgery could be curative (resective surgeries: amygdalo hippocampectomy, lesionectomy and multilobar resections; functional surgeries: hemispherotomy and palliative (multiple subpial transaction, corpus callosotomy, vagal nerve stimulation. Epilepsy surgery in indicated cases has a success range from 50 to 86% in achieving seizure freedom as compared with < 5% success rate with AEDs only in persons with DRE. Centers performing surgery should be categorized into Level I and Level II.

  12. Robotic assisted minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Palep Jaydeep

    2009-01-01

    Full Text Available The term "robot" was coined by the Czech playright Karel Capek in 1921 in his play Rossom′s Universal Robots. The word "robot" is from the check word robota which means forced labor.The era of robots in surgery commenced in 1994 when the first AESOP (voice controlled camera holder prototype robot was used clinically in 1993 and then marketed as the first surgical robot ever in 1994 by the US FDA. Since then many robot prototypes like the Endoassist (Armstrong Healthcare Ltd., High Wycombe, Buck, UK, FIPS endoarm (Karlsruhe Research Center, Karlsruhe, Germany have been developed to add to the functions of the robot and try and increase its utility. Integrated Surgical Systems (now Intuitive Surgery, Inc. redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System ® classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist ® . It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration. The advent of robotics has increased the use of minimally invasive surgery among laparoscopically naοve surgeons and expanded the repertoire of experienced surgeons to include more advanced and complex reconstructions.

  13. Intestinal Surgery.

    Science.gov (United States)

    Desrochers, André; Anderson, David E

    2016-11-01

    A wide variety of disorders affecting the intestinal tract in cattle may require surgery. Among those disorders the more common are: intestinal volvulus, jejunal hemorrhage syndrome and more recently the duodenal sigmoid flexure volvulus. Although general principles of intestinal surgery can be applied, cattle has anatomical and behavior particularities that must be known before invading the abdomen. This article focuses on surgical techniques used to optimize outcomes and discusses specific disorders of small intestine. Diagnoses and surgical techniques presented can be applied in field conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Genetic diversity of internalin genes in the ascB-dapE locus among Listeria monocytogenes lineages III and IV strains.

    Science.gov (United States)

    Chen, Jianshun; Cheng, Changyong; Lv, Yonghui; Fang, Weihuan

    2013-09-01

    Listeria monocytogenes is an important foodborne pathogen encompassing four phylogenetic lineages. Lineages III and IV are rare, but have been reported to show considerable biodiversity, providing important clues for the evolutionary history in Listeria. In this study, analysis of the ascB-dapE locus reveals genetic diversity in lineages III and IV, and is consistent with the classification of sublineages. Four of the six genetic patterns (two of sublineage IIIC and two of lineage IV) are specific to these two lineages. The ascB-dapE locus suggests a hot spot for genome diversification, and serves as an attractive molecular marker for better understanding of the biodiversity and population structure of lineages III and IV strains. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  15. Network protocol changes can improve DisCom WAN performance : evaluating TCP modifications and SCTP in the ASC tri-lab environment.

    Energy Technology Data Exchange (ETDEWEB)

    Tolendino, Lawrence F.; Hu, Tan Chang

    2005-06-01

    The Advanced Simulation and Computing (ASC) Distance Computing (DisCom) Wide Area Network (WAN) is a high performance, long distance network environment that is based on the ubiquitous TCP/IP protocol set. However, the Transmission Control Protocol (TCP) and the algorithms that govern its operation were defined almost two decades ago for a network environment vastly different from the DisCom WAN. In this paper we explore and evaluate possible modifications to TCP that purport to improve TCP performance in environments like the DisCom WAN. We also examine a much newer protocol, SCTP (Stream Control Transmission Protocol) that claims to provide reliable network transport while also implementing multi-streaming, multi-homing capabilities that are appealing in the DisCom high performance network environment. We provide performance comparisons and recommendations for continued development that will lead to network communications protocol implementations capable of supporting the coming ASC Petaflop computing environments.

  16. ASC-J9 Suppresses Castration-Resistant Prostate Cancer Growth through Degradation of Full-length and Splice Variant Androgen Receptors

    Directory of Open Access Journals (Sweden)

    Shinichi Yamashita

    2012-01-01

    Full Text Available Early studies suggested androgen receptor (AR splice variants might contribute to the progression of prostate cancer (PCa into castration resistance. However, the therapeutic strategy to target these AR splice variants still remains unresolved. Through tissue survey of tumors from the same patients before and after castration resistance, we found that the expression of AR3, a major AR splice variant that lacks the AR ligand-binding domain, was substantially increased after castration resistance development. The currently used antiandrogen, Casodex, showed little growth suppression in CWR22Rv1 cells. Importantly, we found that AR degradation enhancer ASC-J9 could degrade both full-length (fAR and AR3 in CWR22Rv1 cells as well as in C4-2 and C81 cells with addition of AR3. The consequences of such degradation of both fAR and AR3 might then result in the inhibition of AR transcriptional activity and cell growth in vitro. More importantly, suppression of AR3 specifically by short-hairpin AR3 or degradation of AR3 by ASC-J9 resulted in suppression of AR transcriptional activity and cell growth in CWR22Rv1-fARKD (fAR knockdown cells in which DHT failed to induce, suggesting the importance of targeting AR3. Finally, we demonstrated the in vivo therapeutic effects of ASC-J9 by showing the inhibition of PCa growth using the xenografted model of CWR22Rv1 cells orthotopically implanted into castrated nude mice with undetectable serum testosterone. These results suggested that targeting both fAR- and AR3-mediated PCa growth by ASC-J9 may represent the novel therapeutic approach to suppress castration-resistant PCa. Successful clinical trials targeting both fAR and AR3 may help us to battle castration-resistant PCa in the future.

  17. GENERAL SURGERY

    African Journals Online (AJOL)

    surgery. Since the first laparoscopic treatment of hydatid disease was described in 1992,14 there has been a steady growth in reports of the laparoscopic treatment of hydatid cysts of liver. Although early reported laparoscopic treatment of liver hydatid disease was confined to simple drainage, more advanced laparoscopic ...

  18. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  19. TRAUMA SURGERY

    African Journals Online (AJOL)

    meet the criteria for damage control surgery, and ligation of the AVC is a .... There were two vertebral body fractures, one penetrating brain injury from a gunshot wound to the head, one ... two hand fractures, three haemothoraces, one pelvic fracture, .... One patient with an intimal flap injury to his left common iliac artery ...

  20. GENERAL SURGERY

    African Journals Online (AJOL)

    Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...

  1. Rodding Surgery

    Science.gov (United States)

    ... Physical activity prior to surgery,  Length of the operation; anesthesia issues,  Reason for the choice of rod,  Time in the hospital,  Length of recovery time at home,  Pain management including control of muscle spasms,  The rehabilitation plan. ...

  2. Robotic surgery update.

    Science.gov (United States)

    Jacobsen, G; Elli, F; Horgan, S

    2004-08-01

    Minimally invasive surgical techniques have revolutionized the field of surgery. Telesurgical manipulators (robots) and new information technologies strive to improve upon currently available minimally invasive techniques and create new possibilities. A retrospective review of all robotic cases at a single academic medical center from August 2000 until November 2002 was conducted. A comprehensive literature evaluation on robotic surgical technology was also performed. Robotic technology is safely and effectively being applied at our institution. Robotic and information technologies have improved upon minimally invasive surgical techniques and created new opportunities not attainable in open surgery. Robotic technology offers many benefits over traditional minimal access techniques and has been proven safe and effective. Further research is needed to better define the optimal application of this technology. Credentialing and educational requirements also need to be delineated.

  3. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  4. Predictors of Lymphedema Following Breast Cancer Surgery

    National Research Council Canada - National Science Library

    Swenson, Karen K

    2006-01-01

    .... Cases will be identified in the physical therapy or cancer centers. Controls will be identified using the oncology registry and include patients with breast cancer surgery who have not developed lymphedema...

  5. Report of experiments and evidence for ASC L2 milestone 4467 : demonstration of a legacy application's path to exascale.

    Energy Technology Data Exchange (ETDEWEB)

    Curry, Matthew L.; Ferreira, Kurt Brian; Pedretti, Kevin Thomas Tauke; Leung, Vitus Joseph; Moreland, Kenneth D.; Lofstead, Gerald Fredrick, II; Gentile, Ann C. (Sandia National Laboratories, Livermore, CA); Klundt, Ruth Ann; Ward, H. Lee; Laros, James H., III; Hemmert, Karl Scott; Fabian, Nathan D.; Levenhagen, Michael J.; Barrett, Brian W.; Brightwell, Ronald Brian; Barrett, Richard; Wheeler, Kyle Bruce; Kelly, Suzanne Marie; Rodrigues, Arun F.; Brandt, James M. (Sandia National Laboratories, Livermore, CA); Thompson, David (Sandia National Laboratories, Livermore, CA); VanDyke, John P.; Oldfield, Ron A.; Tucker, Thomas (Open Grid Computing, Inc., Austin, TX); Vaughan, Courtenay Thomas

    2012-03-01

    This report documents thirteen of Sandia's contributions to the Computational Systems and Software Environment (CSSE) within the Advanced Simulation and Computing (ASC) program between fiscal years 2009 and 2012. It describes their impact on ASC applications. Most contributions are implemented in lower software levels allowing for application improvement without source code changes. Improvements are identified in such areas as reduced run time, characterizing power usage, and Input/Output (I/O). Other experiments are more forward looking, demonstrating potential bottlenecks using mini-application versions of the legacy codes and simulating their network activity on Exascale-class hardware. The purpose of this report is to prove that the team has completed milestone 4467-Demonstration of a Legacy Application's Path to Exascale. Cielo is expected to be the last capability system on which existing ASC codes can run without significant modifications. This assertion will be tested to determine where the breaking point is for an existing highly scalable application. The goal is to stretch the performance boundaries of the application by applying recent CSSE RD in areas such as resilience, power, I/O, visualization services, SMARTMAP, lightweight LWKs, virtualization, simulation, and feedback loops. Dedicated system time reservations and/or CCC allocations will be used to quantify the impact of system-level changes to extend the life and performance of the ASC code base. Finally, a simulation of anticipated exascale-class hardware will be performed using SST to supplement the calculations. Determine where the breaking point is for an existing highly scalable application: Chapter 15 presented the CSSE work that sought to identify the breaking point in two ASC legacy applications-Charon and CTH. Their mini-app versions were also employed to complete the task. There is no single breaking point as more than one issue was found with the two codes. The results were

  6. Adipose-Derived Stem Cells in Aesthetic Surgery: A Mixed Methods Evaluation of the Current Clinical Trial, Intellectual Property, and Regulatory Landscape.

    Science.gov (United States)

    Arshad, Zeeshaan; Halioua-Haubold, Celine-Lea; Roberts, Mackenna; Urso-Baiarda, Fulvio; Branford, Oliver A; Brindley, David A; Davies, Benjamin M; Pettitt, David

    2018-02-17

    Adipose tissue, which can be readily harvested via a number of liposuction techniques, offers an easily accessible and abundant source of adipose-derived stem cells (ASCs). Consequently, ASCs have become an increasingly popular reconstructive option and a novel means of aesthetic soft tissue augmentation. This paper examines recent advances in the aesthetic surgery field, extending beyond traditional review formats to incorporate a comprehensive analysis of current clinical trials, adoption status, and the commercialization pathway. Keyword searches were carried out on clinical trial databases to search for trials using ASCs for aesthetic indications. An intellectual property landscape was created using commercial software (Thomson Reuters Thomson Innovation, New York, NY). Analysis of who is claiming what in respect of ASC use in aesthetic surgery for commercial purposes was analyzed by reviewing the patent landscape in relation to these techniques. Key international regulatory guidelines were also summarized. Completed clinical trials lacked robust controls, employed small sample sizes, and lacked long-term follow-up data. Ongoing clinical trials still do not address such issues. In recent years, claims to intellectual property ownership have increased in the "aesthetic stem cell" domain, reflecting commercial interest in the area. However, significant translational barriers remain including regulatory challenges and ethical considerations. Further rigorous randomized controlled trials are required to delineate long-term clinical efficacy and safety. Providers should consider the introduction of patient reported outcome metrics to facilitate clinical adoption. Robust regulatory and ethical policies concerning stem cells and aesthetic surgery should be devised to discourage further growth of "stem cell tourism." © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  7. Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery.

    Science.gov (United States)

    Herrinton, Lisa J; Altschuler, Andrea; McMullen, Carmit K; Bulkley, Joanna E; Hornbrook, Mark C; Sun, Virginia; Wendel, Christopher S; Grant, Marcia; Baldwin, Carol M; Demark-Wahnefried, Wendy; Temple, Larissa K F; Krouse, Robert S

    2016-09-01

    For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter-sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. CA Cancer J Clin 2016;66:387-397. © 2016 American Cancer Society. © 2016 American Cancer Society.

  8. Conversations for Providers Caring for Rectal Cancer Patients: Comparison of Long-Term Patient-Centered Outcomes for Low Rectal Cancer Patients Facing Ostomy or Sphincter-Sparing Surgery

    Science.gov (United States)

    Herrinton, Lisa J.; Altschuler, Andrea; McMullen, Carmit K.; Bulkley, Joanna E.; Hornbrook, Mark C.; Sun, Virginia; Wendel, Christopher S.; Grant, Marcia; Baldwin, Carol M.; Demark-Wahnefried, Wendy; Temple, Larissa K.F.; Krouse, Robert S.

    2017-01-01

    For some low rectal cancer patients, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients eligible for sphincter-sparing surgery may not be well served by the surgery and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries, or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects following the two surgeries has not been synthesized. We therefore conducted a systematic review to examine this ? This systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. Our goals are: 1) improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) increase the patient’s participation in the decision; (3) alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, improve patients’ long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery, as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. PMID:26999757

  9. Metabolic Surgery

    DEFF Research Database (Denmark)

    Pareek, Manan; Schauer, Philip R; Kaplan, Lee M

    2018-01-01

    The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown...... the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity....... Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further...

  10. Preparing for Surgery

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Preparing for Surgery Home For Patients Search FAQs Preparing for Surgery ... Surgery FAQ080, August 2011 PDF Format Preparing for Surgery Gynecologic Problems What is the difference between outpatient ...

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  12. Corrective Jaw Surgery

    Science.gov (United States)

    ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  13. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  14. Facial Cosmetic Surgery

    Science.gov (United States)

    ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  15. Heart bypass surgery

    Science.gov (United States)

    Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...

  16. ASC Weekly News Notes

    Energy Technology Data Exchange (ETDEWEB)

    Womble, David E.

    2016-05-01

    Unified collision operator demonstrated for both radiation transport and PIC-DSMC. A side-by-side comparison between the DSMC method and the radiation transport method was conducted for photon attenuation in the atmosphere over 2 kilometers in physical distance with a reduction of photon density of six orders of magnitude. Both DSMC and traditional radiation transport agreed with theory to two digits. This indicates that PIC-DSMC operators can be unified with the radiation transport collision operators into a single code base and that physics kernels can remain unique to the actual collision pairs. This simulation example provides an initial validation of the unified collision theory approach that will later be implemented into EMPIRE.

  17. Maze Surgery

    Science.gov (United States)

    ... Rounds Seminar Series & Daily Conferences Fellowships and Residencies School of Perfusion Technology Education Resources Library & Learning Resource Center CME Resources THI Journal THI Cardiac Society Register for the Cardiac Society ...

  18. ASC Predictive Science Academic Alliance Program (PSAAP) II Review of the Carbon Capture Multidisciplinary Science Center (CCMSC) at the University of Utah

    Energy Technology Data Exchange (ETDEWEB)

    Still, C. H. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Ferencz, R. M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hoekstra, R. J. [Sandia National Lab. (SNL-CA), Livermore, CA (United States); Hungerford, A. L. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Kuhl, A. L. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Montoya, D. R. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Wagner, J. [Sandia National Lab. (SNL-CA), Livermore, CA (United States)

    2015-06-08

    The review was conducted on March 31 – April 1, 2015 at the University of Utah. Overall the review team was impressed with the work presented and found that the CCMSC had met or exceeded all of their Year 1 milestones. Specific details, comments and recommendations are included in this document.

  19. Bureau of Indian Education (BIE), Albuquerque Service Center (ASC) Dispute Resolution in Special Education through Mediation. Parent/School and Mediator's Manual. Revised

    Science.gov (United States)

    Copenhaver, John

    2007-01-01

    Parents and school staff usually agree upon issues regarding evaluation, eligibility, program, and placement of students with disabilities. However, there are times when disagreement occurs. Disagreements and conflict are often inevitable, but they need not produce negative results. Mediation in special education is a process to assist parents and…

  20. Efeitos do ácido ascórbico nos biomarcadores de estresse oxidativo em nadadores de elite

    Directory of Open Access Journals (Sweden)

    Monike Garlipp-Picchi

    2013-12-01

    Full Text Available OBJETIVO: O objetivo do estudo foi verificar os efeitos da oferta de vitamina C através de um suplemento alimentar e dieta rica em ácido ascórbico (AA no estresse oxidativo induzido pelo exercício. MÉTODOS: A amostra foi composta por 13 nadadores de elite (seis homens e sete mulheres com idades entre 18 e 26 anos. Os mesmos atletas foram submetidos a sessão de exercício agudo em três fases, com diferentes tratamentos: controle (C, dieta rica em AA (D e suplemento de AA (S, nas quais amostras de sangue foram colhidas antes, imediatamente após e 24 horas depois do exercício. Para comparação entre as fases e etapas foi utilizado o modelo de regressão linear com efeitos mistos. RESULTADOS: O consumo alimentar habitual de antioxidantes não foi diferente entre as fases, apenas a ingestão de AA foi maior na fase D e S em relação à fase C. O uso de dieta rica em AA favoreceu uma menor peroxidação lipídica, devido aos menores valores de hidroperóxidos lipídicos (FOX, diminuição da peroxidação após exercício, pela diminuição de substâncias reativas ao ácido tiobarbitúrico (TBARS e aumento dos níveis de vitamina C logo após o exercício. O uso de suplemento de AA também conteve a peroxidação lipídica após exercício e aumentou o poder antioxidante, devido aos maiores níveis de glutationa reduzida (GSH. Sem adição de AA os nadadores tiveram um maior dano hepático, pois apresentaram maiores níveis de transaminase-glutâmico-oxalacética (TGO, menores níveis de antioxidantes (vitamina C e GSH e aumento do ácido úrico. CONCLUSÃO: Assim, as mudanças observadas com a adição de AA à dieta de nadadores sugerem um importante papel deste micronutriente na defesa contra o estresse oxidativo induzido pelo exercício.

  1. Antocianinas, ácido ascórbico, polifenoles totales y actividad antioxidante, en la cáscara de camu-camu (Myrciaria dubia (H.B.K McVaugh Antocianinas, ácido ascórbico, polifenóis totais e atividade antioxidante na casca do camu-camu (Myrciaria dubia (H.B.K McVaugh

    Directory of Open Access Journals (Sweden)

    Juan Edson Villanueva-Tiburcio

    2010-05-01

    Full Text Available Este trabajo fue realizado en la UNAS, Tingo María, Perú. Los objetivos fueron evaluar el contenido de antocianinas, ácido ascórbico, y polifenoles totales, en la cáscara fresca y seca de camu-camu (Myrciaria dubia (H.B.K McVaugh en diferentes estados de madurez; evaluar la actividad antioxidante en la cáscara seca, usando diferentes tipos de radicales (DPPH, ABTS+ y Peroxilo y correlacionar el valor de ácido ascórbico y polifenoles totales con la actividad antioxidante. La extracción fue realizada en medio acuoso, y los resultados de las evaluaciones de cada experimento fueron analizados por un diseño completamente al azar (DCA, según la prueba de t-student (p A pesquisa foi realizada na UNAS em Tingo Maria, Peru, teve como objetivos: avaliar o teor de antocianinas, ácido ascórbico e polifenóis totais, na casca fresca e na casca seca do camu-camu (Myrciaria dubia (HBK McVaugh em diferentes tempos de maturação; avaliar a atividade antioxidante na casca seca utilizando diferentes tipos de radicais (DPPH, ABTS+ e Peroxilo e correlacionar o teor de ácido ascórbico e polifenóis totais com a atividade antioxidante. A extraç��o foi realizada em meio aquoso, os resultados das avaliações de cada experiência são analisados no delineamento inteiramente casualizado (DIC, pelo teste de t-student (p < 0,05. O extrato da casca da amostra madura fresca apresentou as concentrações mais elevadas de ácido ascórbico e de antocianinas em relação a meio madura e verde, com 21,95 mg.g-1 de casca e 46,42 mg.L-1 de cianidin-3-glucosídeo, respectivamente, enquanto que o extrato da casca seca meio madura apresentou o maior teor de ácido ascórbico em relação a madura e verde (53,49 mg.g-1 e de polifenóis totais: 7,70 mg Ác. Gálico/g. A maior atividade antioxidante foi encontrada no extrato da casca seca da amostra meio madura com IC50 = 46,20; 20,25 e 8,30 μg.mL-1, em comparação com DPPH radical, ABTS+ e Perox

  2. Comparison of mediastinal lymph node status and relapse pattern in clinical stage IIIA non-small cell lung cancer patients treated with neoadjuvant chemotherapy versus upfront surgery: A single center experience.

    Science.gov (United States)

    Savic, Milan; Kontic, Milica; Ercegovac, Maja; Stojsic, Jelena; Bascarevic, Slavisa; Moskovljevic, Dejan; Kostic, Marko; Vesovic, Radomir; Popevic, Spasoje; Laban, Marija; Markovic, Jelena; Jovanovic, Dragana

    2017-09-01

    In spite of the progress made in neoadjuvant therapy for operable non small-cell lung cancer (NSCLC), many issues remain unsolved, especially in locally advanced stage IIIA. Retrospective data of 163 patients diagnosed with stage IIIA NSCLC after surgery was analyzed. The patients were divided into two groups: a preoperative chemotherapy group including 59 patients who received platinum-etoposide doublet treatment before surgery, and an upfront surgery group including 104 patients for whom surgical resection was the first treatment step. Adjuvant chemotherapy or/and radiotherapy was administered to 139 patients (85.3%), while 24 patients (14.7%) were followed-up only. The rate of N2 disease was significantly higher in the upfront surgery group ( P   0.05). There was significant difference in preoperative chemotherapy group regarding relapse rate and treatment outcomes related to the lymph node status comparing to the upfront surgery group. Neoadjuvant/adjuvant chemo-therapy is a part of treatment for patients with stage IIIA NSCLC, but further investigation is required to determine optimal treatment. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

  3. Encuesta nacional sobre manejo preoperatorio y criterios de selección de pacientes en las unidades de cirugía mayor ambulatoria españolas National survey of preoperative management and patient selection in ambulatory surgery centers

    Directory of Open Access Journals (Sweden)

    J. Papaceit

    2003-10-01

    ón preoperatoria y el manejo perioperatorio de las diferentes enfermedades, así como para la utilización racional de las pruebas de laboratorio. Se constata la necesidad de la consulta anestésica para la evaluación preoperatoria. Los resultados de nuestra encuesta apuntan hacia unos mejores resultados en los indicadores de funcionamiento en las UCMA autónomas frente a las integradas. Existe la posibilidad de definir estándares de calidad y validarlos, para lo cual serán necesarios futuros estudios multicéntricos.Background: The objective of this study was to determine both the selection and preparation criteria in patients in various Spanish ambulatory surgery centers, as well as the impact of these criteria on their results. The results were compared according to the type of functional structure of the units (autonomous or integrated. Material and methods: We performed a cross sectional, descriptive study through postal survey. The survey contained the following items: type of unit, surgical procedures, selection criteria, preoperative assessment and management, and qualitative and quantitative indexes of the activity performed in 2000. A total of 123 units were included with a response rate of 39%. Results: The selection criteria showed a high degree of consensus. The outpatient anesthesia clinic was used for preoperative assessment by 97.9% of the units. Most units routinely requested preoperative tests (hemostasis and hemogram by 89%; biochemical parameters by 72.9% and to a lesser extent chest X-ray (33.3% and electrocardiogram (35.4%. The introduction of procedures for the management of coexisting diseases was scarce (25-64.6%. Units using the outpatient anesthesia clinic in all patients had a lower cancellation rate (1.5% vs 4.4%. Autonomous units were significantly more likely to accept patients with high surgical-anesthetic risk than integrated units. Autonomous units also showed a significantly lower number of admissions (1.2% vs 1.9%, p = 0.003, mean stay (240

  4. Should LSIL with ASC-H (LSIL-H in cervical smears be an independent category? A study on SurePath™ specimens with review of literature

    Directory of Open Access Journals (Sweden)

    Shidham Vinod B

    2007-03-01

    Full Text Available Abstract Background Cervical smears exhibiting unequivocal features of 'low grade squamous intraepithelial lesion' (LSIL are occasionally also admixed with some cells suspicious for, but not diagnostic of, 'high grade squamous intraepithelial lesion' (HSIL. Only a few studies, mostly reported as abstracts, have evaluated this concurrence. In this study, we evaluate the current evidence that favors a distinct category for "LSIL, cannot exclude HSIL" (LSIL-H, and suggest a management algorithm based on combinations of current ASCCP guidelines for related interpretations. Methods We studied SurePath™ preparations of cervical specimens from various institutions during one year period. Cytohisto correlation was performed in cases with cervical biopsies submitted to our institution. The status of HPV DNA testing was also noted in some LSIL-H cases with biopsy results. Results Out of 77,979 cases 1,970 interpreted as LSIL (1,523, LSIL-H (146, 'atypical squamous cells, cannot exclude HSIL' (ASC-H (109, and HSIL (192 were selected. Concurrent biopsy results were available in 40% (Total 792 cases: 557 LSIL, 88 LSIL-H, 38 ASCH, and 109 HSIL. Biopsy results were grouped into A. negative for dysplasia (ND, B. low grade (HPV, CIN1, CIN1 with HPV, and C. high grade (CIN 2 and above. The positive predictive values for various biopsy results in relation to initial cytopathologic interpretation were: a. LSIL: (557 cases: ND 32% (179, low grade- 58% (323, high grade- 10% (55; b. LSIL-H: (88 cases: ND 24% (21, low grade- 43% (38, high grade- 33% (29; c. ASCH: (38 cases: ND 32% (12, low grade- 37% (14, high grade- 31% (12; d. HSIL (109 cases: ND 5% (6, low grade 26% (28, high grade 69% (75. The patterns of cervical biopsy results in cases reported as LSIL-H were compared with that observed in cases with LSIL, ASC-H, and HSIL. 94% (32 of 34 of LSIL-H were positive for high risk (HR HPV, 1 was negative for HR HPV but positive for low risk (LR, and 1 LSIL-H was

  5. [The role of antiarrhythmic surgery in 2004].

    Science.gov (United States)

    Guiraudon, G M

    2004-11-01

    In 2004, surgery for cardiac arrhythmias addresses essentially atrial fibrillation. Surgery is only a rare alternative for other cardiac arrhythmias in center that still have the surgical skill. Surgery for atrial fibrillation has the definite advantage of concomitant exclusion of the left atrial appendage which is the predominant site of intra-atrial thrombi with the associated risk of severe thrombo-embolic events. Our experience with surgery for lone atrial fibrillation, using the Corridor III operation, shows that surgery is associated with high efficacy and long term control of arrhythmia when the surgical technique is well performed. Failures were associated with incomplete line of block or exclusion. This experience shows the necessity of postoperative EP testing. Initially performed using open heart technique, surger for atrial fibrillation is now performed using mini-invasive technique. Indications for surgery for lone atrial fibrillation will decreased while other strategies are developing. To remain competitive surgery must have high efficacy and use mini-invasive techniques. i.e.: closed off pump beating heart via port access. Surgery for atrial fibrillation concomitant with other cardiac surgical repairs yields remarkable results, without increased surgical risk. Their indications go beyond mitral valve pathology. Future developments imply the following conditions: atrial surgery must not increase morbidity, and its cost-effectiveness must be documented. Combined surgery must be testable and tested to gain valid pathophysiological data to improve surgical rationales. Its impact in terms of survival, prevention of thrombo-embolic events and quality of life will be documented by clinical trials.

  6. Genetic organization of ascB-dapE internalin cluster serves as a potential marker for Listeria monocytogenes sublineages IIA, IIB, and IIC.

    Science.gov (United States)

    Chen, Jianshun; Fang, Chun; Zhu, Ningyu; Lv, Yonghui; Cheng, Changyong; Bei, Yijiang; Zheng, Tianlun; Fang, Weihuan

    2012-05-01

    Listeria monocytogenes is an important foodborne pathogen that comprises four genetic lineages: I, II, III, and IV. Of these, lineage II is frequently recovered from foods and environments and responsible for the increasing incidence of human listeriosis. In this study, the phylogenetic structure of lineage II was determined through sequencing analysis of the ascB-dapE internalin cluster. Fifteen sequence types proposed by multilocus sequence typing based on nine housekeeping genes were grouped into three distinct sublineages, IIA, IIB, and IIC. Organization of the ascBdapE internalin cluster could serve as a molecular marker for these sublineages, with inlGHE, inlGC2DE, and inlC2DE for IIA, IIB, and IIC, respectively. These sublineages displayed specific genetic and phenotypic characteristics. IIA and IIC showed a higher frequency of recombination (rho/theta). However, recombination events had greater effect (r/m) on IIB, leading to its high nucleotide diversity. Moreover, IIA and IIB harbored a wider range of internalin and stress-response genes, and possessed higher nisin tolerance, whereas IIC contained the largest portion of low-virulent strains owing to premature stop codons in inlA. The results of this study indicate that IIA, IIB, and IIC might occupy different ecological niches, and IIB might have a better adaptation to a broad range of environmental niches.

  7. HPV genotype profile in a Norwegian cohort with ASC-US and LSIL cytology with three year cumulative risk of high grade cervical neoplasia.

    Science.gov (United States)

    Lie, A K; Tropé, A; Skare, G B; Bjørge, T; Jonassen, C M; Brusegard, K; Lönnberg, S

    2018-01-01

    To explore the HPVgenotype profile in Norwegian women with ASC-US/LSIL cytology and the subsequent risk of high-grade cervical neoplasia (CIN 3+). In this observational study delayed triage of ASC-US/LSIL of 6058 women were included from 2005 to 2010. High-risk HPV detection with Hybrid Capture 2 (HC2) was used and the HC2+ cases were genotyped with in-house nmPCR. Women were followed-up for histologically confirmed CIN3+ within three years of index HPV test by linkage to the screening databases at the Cancer Registry of Norway. HC2 was positive in 45% (2756/6058) of the women. Within 3years CIN3+ was diagnosed in 26% of womenrisk for CIN3+. Among older women, all 13 high-risk genotypes as single infection were associated with >20% risk of CIN3+. Further studies are necessary to risk stratify the individual genotypes to reduce the number of colposcopies in Norway. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Modification of Displacement Coefficient Method in Estimation of Target Displacement for Regular Concrete Bridges Based on ASCE 41-06 Standard

    Directory of Open Access Journals (Sweden)

    Seyed Bahram Beheshti-Aval

    2015-06-01

    Full Text Available Displacement Coefficient Method (DCM stipulated in the ASCE 41-06 standard is becoming the preferred method for seismic rehabilitation of buildings in many high-seismic-hazard countries. Applications of the method for non-building constructions such as bridges are beyond the scope of this standard. Thus its application to this kind of structure should be approached with care. Target displacement has reasonable accuracy for buildings with strong columns and weak beams, where there is the development of plastic hinges. Due to high stiffness and strength of the deck relative to the piers in most bridges, this mechanism does not occur, and it is necessary to evaluate the accuracy of DCM for such structures. In this research, an attempt is made to evaluate the credibility of DCM in the ASCE/SEI 41-06 standard for estimating target drifts in concrete regular bridges under strong ground motions. To apply the extension of the method to bridge structures, the definition of new correction factor CB, which should be multiplied to previous coefficients, is required. This novel coefficient can improve the accuracy of the mentioned method in accessing seismic displacement demands. The coefficient is presented for soil types A to D based on NEHRP soil classification. The validity of the modified DCM is examined for several bridges with use of nonlinear dynamic analysis. Good correlation is found between both procedures.

  9. Tennis elbow surgery - discharge

    Science.gov (United States)

    ... epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... long as you are told. This helps ensure tennis elbow will not return. You may be prescribed a ...

  10. Lung surgery - discharge

    Science.gov (United States)

    ... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...

  11. Gastric Sleeve Surgery

    Science.gov (United States)

    ... Videos for Educators Search English Español Gastric Sleeve Surgery KidsHealth / For Teens / Gastric Sleeve Surgery What's in ... or buying healthy food ) Preparing for Gastric Sleeve Surgery Preparing for this major operation takes months of ...

  12. Hip Replacement Surgery

    Science.gov (United States)

    ... Outreach Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB ... PDF What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or ...

  13. Dental Implant Surgery

    Science.gov (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  14. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  16. Advanced laparoscopic bariatric surgery Is safe in general surgery training.

    Science.gov (United States)

    Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

    2017-05-01

    Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

  17. Elective surgery cancelation on day of surgery: An endless dilemma

    Directory of Open Access Journals (Sweden)

    A Fayed

    2016-01-01

    Full Text Available Background: Cancelation of surgery is a constant agonizing dilemma for nearly all healthcare services that has been intensively investigated to find out its roots, consequences, and possible solutions. The rates of cancelation of surgery vary between centers and more so among surgical specialties with numerous reasons standing behind this phenomenon. Patients and Methods: In the current study, analysis of monthly cancelation rates from January 2009 to December 2012, and assessment of establishing new operating rooms (ORs using statistical process control charts was conducted. A detailed review of a total of 1813 cases canceled on the day of surgery from January to December 2012, to examine the various reasons of cancelation among surgical specialties. Results: The average cancelation rate was 11.1%, which dropped to 9.0% after launching of new theaters. Four reasons explained about 80% of cancelations; Patients "no show" was the leading cause of cancelation (27%. One-fourth of cancelations (24.3% were due to the need for further optimization, and the third most prominent cause of cancelation was a lack of OR time (19.5%. Unavailability of staff/equipment/implants accounted for only 0.7% of cancelations. The "no show" was the most common cause of cancelation among all surgical specialties ranging from 21% for plastic surgery to 32% in ophthalmic surgeries. Conclusion: It was confirmed that there is a unique profile of cancelation of surgery problem for every institute, an extension of infrastructure may not be the only solution. Control charts helped to enhance the general picture and are functional in monitoring and evaluating changes in the cancelation of surgery.

  18. Surgery for post-operative entero-cutaneous fistulas: is bowel resection plus primary anastomosis without stoma a safe option to avoid early recurrence? Report on 20 cases by a single center and systematic review of the literature.

    Science.gov (United States)

    Lauro, A; Cirocchi, R; Cautero, N; Dazzi, A; Pironi, D; Di Matteo, F M; Santoro, A; Faenza, S; Pironi, L; Pinna, A D

    2017-01-01

    A review was performed on entero-cutaneous fistula (ECF) repair and early recurrence, adding our twenty adult patients (65% had multiple fistulas). The search yielded 4.098 articles but only 15 were relevant: 1.217 patients underwent surgery. The interval time between fistula's diagnosis and operative repair was between 3 months and 1 year. A bowel resection with primary anastomosis was performed in 1.048 patients, 192 (18.3%) underwent a covering stoma: 856 patients (81.7%) had a fistula takedown in one procedure. The patients had 14.3% recurrence and 13.1% mortality rate. In our experience 75% were surgically treated after a period equal or above one year from fistula occurrence: surgery was very demolitive (in 40% remnant small bowel was less than 100 cm). We performed a bowel resection with a hand-sewn anastomosis (95%) without temporary stoma. In-hospital mortality was 0% and at discharge all were back to oral intake with 0% early re-fistulisation. Literature supports our experience: ECF takedown could be safely performed after an adequate period of recovery from 3 months to one year from fistula occurrence. In our series primary repair (bowel resection plus reconnection surgery without temporary stoma) avoided an early recurrence without mortality.

  19. Breast Reduction Surgery

    Science.gov (United States)

    ... considering breast reduction surgery, consult a board-certified plastic surgeon. It's important to understand what breast reduction surgery entails — including possible risks and complications — as ...

  20. Apparatus for stereotactic surgery

    International Nuclear Information System (INIS)

    Koslow, M.A.M.

    1982-01-01

    Apparatus for stereotactic surgery consisting of a probe and a computerized tomographic scanning system is described. The scanning system comprises a display and means for reconstructing cross-sectional images on the display using data from partial circumferential scans of source and detectors. It operates on the data with an algorithm that provides the difference between the local values of the linear attenuation coefficient and average of these values within a circle centered at each reconstruction point. The scanning system includes a means of maintaining the frames of reference of the probe and scanning system rigid with respect to one another. The position of the probe, which may be a cryogenic probe, with respect to the actual anatomical structure of the body, particularly a human head, may thus be viewed by the surgeon. (author)

  1. Hernia inguinal laparoscopic surgery

    International Nuclear Information System (INIS)

    Morelli Brum, R. . E mail: raulmorelli@hotmail.com

    2005-01-01

    The purpose of this paper is to enhance treatment of inguinal hernia through a bibliographic study of its main complications and the analysis of a retrospective series of laparoscopic restorations performed by the author in the same private medical care center. From December 1994 through July 2003, ninety-nine patients were operated in 108 procedures.The technique employed was trans-abdominal peritoneal (TAPP)Follow-up covered over 2 years in 80% of patients with a relapse of 2.8%. Main morbidity was neuralgia due to a nerve being trapped, which fact required re-intervention.There was no mortality.The conclusion arrived at is that it is and excellent technique which requires a long learning curve and its main indication would be relapse of conventional surgery, bilateralism, coexistence with another laparoscopic abdominal pathology and doubts concerning contra lateral hernia

  2. Future of robotic surgery.

    Science.gov (United States)

    Lendvay, Thomas Sean; Hannaford, Blake; Satava, Richard M

    2013-01-01

    In just over a decade, robotic surgery has penetrated almost every surgical subspecialty and has even replaced some of the most commonly performed open oncologic procedures. The initial reports on patient outcomes yielded mixed results, but as more medical centers develop high-volume robotics programs, outcomes appear comparable if not improved for some applications. There are limitations to the current commercially available system, and new robotic platforms, some designed to compete in the current market and some to address niche surgical considerations, are being developed that will change the robotic landscape in the next decade. Adoption of these new systems will be dependent on overcoming barriers to true telesurgery that range from legal to logistical. As additional surgical disciplines embrace robotics and open surgery continues to be replaced by robotic approaches, it will be imperative that adequate education and training keep pace with technology. Methods to enhance surgical performance in robotics through the use of simulation and telementoring promise to accelerate learning curves and perhaps even improve surgical readiness through brief virtual-reality warm-ups and presurgical rehearsal. All these advances will need to be carefully and rigorously validated through not only patient outcomes, but also cost efficiency.

  3. Anaesthetic Management of Conjoined Twins′ Separation Surgery

    Directory of Open Access Journals (Sweden)

    Kolli S Chalam

    2009-01-01

    Full Text Available Anaesthesia for conjoined twins, either for separation surgery, or for MRI or other evaluation procedures is an enormous challenge to the paediatric anaesthesiologist. This is an extra challenging surgery because we the anaesthesiologists need to care for two patients at the same time instead of just one. Anaesthesia for conjoined twins ′separation surgery mainly centered on the following concerns: 1.Conjoined Twins′ physiology like crossed circulation. distribution of blood volume and organ sharing with their anaesthetic implications. 2.Long marathon surgery with massive fluid shifts and loss of blood & blood components and their rapid replenishment. 3.Meticulous planning for organized management of long hours of anaesthetic administration in two paediatric subjects simultaneously with multi surgical specialties involvement and their unique requirements.We report the anaesthetic and intensive care management of one pair of Pygopagus separation surgery and also the review of literature and world statistics.

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  5. Complications of laryngeal framework surgery (phonosurgery).

    Science.gov (United States)

    Tucker, H M; Wanamaker, J; Trott, M; Hicks, D

    1993-05-01

    The rising popularity of surgery involving the laryngeal framework (surgical medialization of immobile vocal folds, vocal fold tightening, pitch variation, etc.) has resulted in increasing case experience. Little has appeared in the literature regarding complications or long-term results of this type of surgery. Several years' experience in a major referral center with various types of laryngeal framework surgery has led to a small number of complications. These have included late extrusion of the prosthesis and delayed hemorrhage. A review of these complications and recommendations for modification of technique to minimize them in the future are discussed.

  6. 75 FR 73088 - Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery...

    Science.gov (United States)

    2010-11-29

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare and Medicaid Services [CMS-2332-PN] Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery... Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) for recognition as a national...

  7. Avaliação dos efeitos da radiação gama nos teores de carotenóides, ácido ascórbico e açúcares do futo buriti do brejo (Mauritia flexuosa L. Evaluation of gamma irradiation rffects on carotenoids, ascorbic acid and sugar contents of buriti fruit (Mauritia flexuosa L.

    Directory of Open Access Journals (Sweden)

    Antonio Luís dos Santos Lima

    2009-09-01

    Full Text Available Buriti do Brejo (Mauritia flexuosa L. é um típico fruto da Amazônia, Nordeste e Centro-Oeste brasileiro, muito utilizado na culinária para produção de sucos, doces e vinhos. É considerado uma excelente fonte de carotenóides precursores da vitamina A, apresentando maior concentração de β-caroteno. Além dos carotenóides também encontramos ácido ascórbico e açúcares. O ácido ascórbico administrado em quantidades suficientes pode prevenir os sinais clínicos de deficiência conhecida como escorbuto. O emprego da radiação ionizante gama tem mostrado um potencial efeito na redução de perdas pós-colheita, mantendo a qualidade nutricional dos alimentos. O presente trabalho teve como objetivo avaliar os efeitos da radiação gama, nas doses de 0,5 kGy e 1,0 kGy, na concentração de carotenóides totais, ácido ascórbico e açúcares do buriti. A determinação dos carotenos (α, β e luteína, ácido ascórbico e açúcares foi realizada por cromatografia líquida de alta eficiência (CLAE e os carotenóides totais por espectrofotometria. Os resultados demonstraram que o Buriti é uma excelente fonte de carotenóides totais (44600μg/100g, podendo ser utilizado no combate à hipovitaminose A. A irradiação dos frutos de buriti na dose de 0,5 kGy não alterou significativamente os teores de carotenóides e açúcares. Entretanto, houve uma redução na concentração do ácido ascórbico com o aumento da dose, que pode ter sido causada pela irradiação ou por fatores intrínsecos e extrínsecos que alteram a estabilidade do ácido ascórbico nos alimentos, podendo converter o ácido ascórbico a dehidroascórbico, mantendo ainda a forma ativa da vitamina C.Buriti (Mauritia flexuosa L., a typical fruit from the Northeast and Center-West Amazon of Brazil, is used in many regional dishes. It is considered an excellent source of carotenoids that are A vitamin precursors, showing a majority of β-carotene. It also presents ascorbic

  8. Succinct history of Greek cardiac surgery.

    Science.gov (United States)

    Apostolakis, Efstratios; Koletsis, Efstratios; Dougenis, Dimitrios

    2008-01-01

    The development and evolution of Greek Cardiac Surgery (GCS) has followed the international cardiothoracic surgery after the invention of cardiopulmonary bypass machine by John Gibbon in 1953. Chronologically, the development of GCS could be divided in four periods: (a) the first or essay period (1950-1960) characterized by the lack of organization, the experimentation and hesitation from the surgeons' side, and the reluctance from the patients' side to have an operation in Greece. (b) The second or stabilization period (1960-1970) is the period during which several separate cardiovascular departments were organized and performed the first valve replacement in 1964. (c) The third or "strengthening" period (1970-1985), during which Greek surgeons were trained abroad and adopted new methods and techniques of surgical therapy. The first operations of coronary artery bypass grafting and aortic aneurysm were performed (1973-1975). Various purely Cardiothoracic Centers were founded in Athens and Thessalonica and cardiac surgery became a routine operation. However, these centers were numerically not enough to cover the demand of patients in need of cardiac surgery. (d) The fourth or maturity period (1985 till today). It is characterized by the creation of private cardiac surgery departments and the gradual establishment of new university centers at the periphery, which along with the Onassis Cardiac Center, eliminated any need for patients to leave the country.

  9. Robotic surgery in Italy national survey (2011).

    Science.gov (United States)

    Santoro, Eugenio; Pansadoro, Vito

    2013-03-01

    Robotic surgery in Italy has become a clinical reality that is gaining increasing acceptance. As of 2011 after the United States, Italy together with Germany is the country with the largest number of active Robotic centers, 46, and da Vinci Robots installed, with at least 116 operators already trained. The number of interventions performed in Italy in 2011 exceeded 6,000 and in 2010 were 4,784, with prevalence for urology, general surgery and gynecology, however these interventions have also begun to be applied in other fields such as cervicofacial, cardiothoracic and pediatric surgery. In Italy Robotic centers are mostly located in Northern Italy, while in the South there are only a few centers, and four regions are lacking altogether. Of the 46 centers which were started in 1999, the vast majority is still operational and almost half handle over 200 cases a year. The quality of the work is also especially high with large diffusion of radical prostatectomy in urology and liver resection and colic in general surgery. The method is very well accepted among operators, over 80 %, and among patients, over 95 %. From the analysis of world literature and a survey carried out in Italy, Robotic surgery, which at the moment could be better defined as telesurgery, represents a significant advantage for operators and a consistent gain for the patient. However, it still has important limits such as high cost and non-structured training of operators.

  10. Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center Fístula liquórica após cirurgia transesfenoidal endoscópica: experiência de um centro espanhol

    Directory of Open Access Journals (Sweden)

    Alicia Del Carmen Becerra Romero

    2010-06-01

    Full Text Available BACKGROUND: Postoperative cerebrospinal fluid (CSF fistula is the most serious complication after transsphenoidal surgery. OBJECTIVE: To analyze the incidence of CSF fistula after endoscopic transsphenoidal surgery for tumor removal in sellar region; to discuss associated factors and methods used for sellar closure. METHOD: Retrospective study of 67 patients (73 surgeries operated via transsphenoidal endoscopy at Hospital Vall D'Hebron and Hospital Clinic of the Universidad de Barcelona, Spain. The data collected included: age, sex, hospitalization stay, suprasellar extension of the lesion, type of tumor, evidence of intraoperative CSF fistula, complications of postoperative CSF fistula, previous surgery and radiotherapy. RESULTS: Six patients (8.2% had postoperative CSF fistula, and their average hospitalization was 5 days longer with resulting complications: two of whom had pneumoencephalus and two with meningitis. No association was found between the data collected and postoperative CSF fistula. CONCLUSION: The rate of CSF fistula after endoscopic transsphenoidal surgery from the present study is contained within the literature. Unlike other reports, no association between the variables and postoperative CSF fistula was found in this report.A fístula liquórica pós-operatória é a complicação mais séria após cirurgia transesfenoidal. OBJETIVO: Analisar a incidência de fístula liquórica após cirurgia endoscópica transesfenoidal para remoção de tumores selares, discutir fatores associados e método utilizado para fechamento selar. MÉTODO: Estudo retrospectivo de 67 pacientes (73 cirurgias operados via endoscopia transesfenoidal no Hospital Vall D'Hebron e Hospital Clínic da Universidad de Barcelona, Espanha. Os dados coletados foram: idade, sexo, dias de internação, extensão supra-selar da lesão, tipo de tumor, evidência de fístula liquórica intra-operatória, complicações da fístula liquórica p

  11. Revalidação do método titulométrico para determinação do ácido ascórbico

    OpenAIRE

    Aline Inacio Alves; Luciano José Quintão Teixeira; Sergio Henriques Saraiva; Joel de Souza Carneiro

    2014-01-01

    Este estudo teve como objetivo revalidar o método de determinação de ácido ascórbico por titulometria, para ser aplicado no laboratório de Química de Alimentos, do Centro de Ciências Agrárias da Universidade Federal do Espírito Santo. O processo de revalidação foi realizado por meio da avaliação de parâmetros como linearidade, precisão (repetitividade), exatidão (teste de recuperação) e limites de detecção, considerando-se os critérios de aceitabilidade determinados. A significância adotada n...

  12. Efeito do resveratrol e do ácido ascórbico na criopreservação de sêmen humano

    OpenAIRE

    Garcez, Márcia Esteves Silva

    2011-01-01

    A criopreservação de sêmen humano é de grande importância para a medicina reprodutiva, porém esse processo pode causar danos ao espermatozóide devido, entre outros aspectos, à produção de espécies reativas de oxigênio, as quais podem lesar as biomoléculas. Tanto o resveratrol quanto o ácido ascórbico são compostos com reconhecida capacidade antioxidante, porém ainda pouco estudados em relação à prevenção de criodanos em espermatozóides humanos. Desta forma, o objetivo deste est...

  13. Summary Report for ASC L2 Milestone #4782: Assess Newly Emerging Programming and Memory Models for Advanced Architectures on Integrated Codes

    Energy Technology Data Exchange (ETDEWEB)

    Neely, J. R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hornung, R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Black, A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Robinson, P. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2014-09-29

    This document serves as a detailed companion to the powerpoint slides presented as part of the ASC L2 milestone review for Integrated Codes milestone #4782 titled “Assess Newly Emerging Programming and Memory Models for Advanced Architectures on Integrated Codes”, due on 9/30/2014, and presented for formal program review on 9/12/2014. The program review committee is represented by Mike Zika (A Program Project Lead for Kull), Brian Pudliner (B Program Project Lead for Ares), Scott Futral (DEG Group Lead in LC), and Mike Glass (Sierra Project Lead at Sandia). This document, along with the presentation materials, and a letter of completion signed by the review committee will act as proof of completion for this milestone.

  14. Cinética de la degradación del ácido ascórbico en jugo de parchita

    OpenAIRE

    Páez, Gisela; Freay, Jenny; Moreno, Mónica; Mármol, Zulay; Araujo, Karelen; Rincón, Marisela

    2008-01-01

    Se evaluó la cinética de la degradación del ácido ascórbico en el jugo de parchita maracuyá (Passiflora edulis f. flavicarpa) fresco y pasteurizado a diferentes temperaturas de almacenamiento (0 ºC, 10 ºC, 25 ºC, 40 ºC, 60 ºC).El jugo se caracterizó en términos de pH, acidez titulable,sólidos solubles totales, relación grados Brix acidez y azucares totales. Las muestras de jugo fresco y pasteurizado se almacenaron a temperaturas de 0 ºC y 10 ºC durante un periodo de 60 y 15 días respectivamen...

  15. Degradación del ácido ascórbico en la pasteurización de bebidas tipo néctar de durazno

    OpenAIRE

    Espol; Cedeño Sares, Luis Alberto

    2015-01-01

    El presente proyecto tiene como objetivo evaluar la pérdida de ácido ascórbico en el proceso de pasteurización en la elaboración de bebidas tipo néctar de durazno, mediante un estudio cinético de la pérdida de vitamina C a tres temperaturas de procesamiento térmico. Se realizó un diseño de experimento donde la variable dependiente fue la pérdida de vit. C y las variables independientes fueron la temperatura y tiempos de exposición establecidos. También se estudió la pérdida del componente enf...

  16. Do ideal ascético ao ideal estético: a evolução histórica da Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Cybelle Weinberg

    2010-06-01

    Full Text Available O estudo da anorexia nervosa sob uma perspectiva histórica visa contribuir para a investigação daquilo que se configura como influência cultural na gênese e manutenção do quadro, além de questionar posições segundo as quais a anorexia nervosa seria um "mal da modernidade" ou decorrente de um único fator. Uma análise da vida das santas da Idade Média, por exemplo, mostra quanto o comportamento perseverante as aproxima das anoréxicas de hoje, ainda que a motivação e os ideais (ascético nas primeiras e estético nas últimas sejam diferentes.

  17. Fibroblast growth factor 21 improves insulin sensitivity and synergizes with insulin in human adipose stem cell-derived (hASC adipocytes.

    Directory of Open Access Journals (Sweden)

    Darwin V Lee

    Full Text Available Fibroblast growth factor 21 (FGF21 has evolved as a major metabolic regulator, the pharmacological administration of which causes weight loss, insulin sensitivity and glucose control in rodents and humans. To understand the molecular mechanisms by which FGF21 exerts its metabolic effects, we developed a human in vitro model of adipocytes to examine crosstalk between FGF21 and insulin signaling. Human adipose stem cell-derived (hASC adipocytes were acutely treated with FGF21 alone, insulin alone, or in combination. Insulin signaling under these conditions was assessed by measuring tyrosine phosphorylation of insulin receptor (InsR, insulin receptor substrate-1 (IRS-1, and serine 473 phosphorylation of Akt, followed by a functional assay using 14C-2-deoxyglucose [14C]-2DG to measure glucose uptake in these cells. FGF21 alone caused a modest increase of glucose uptake, but treatment with FGF21 in combination with insulin had a synergistic effect on glucose uptake in these cells. The presence of FGF21 also effectively lowered the insulin concentration required to achieve the same level of glucose uptake compared to the absence of FGF21 by 10-fold. This acute effect of FGF21 on insulin signaling was not due to IR, IGF-1R, or IRS-1 activation. Moreover, we observed a substantial increase in basal S473-Akt phosphorylation by FGF21 alone, in contrast to the minimal shift in basal glucose uptake. Taken together, our data demonstrate that acute co-treatment of hASC-adipocytes with FGF21 and insulin can result in a synergistic improvement in glucose uptake. These effects were shown to occur at or downstream of Akt, or separate from the canonical insulin signaling pathway.

  18. Lactobacillus rhamnosus GR-1 Ameliorates Escherichia coli-Induced Inflammation and Cell Damage via Attenuation of ASC-Independent NLRP3 Inflammasome Activation.

    Science.gov (United States)

    Wu, Qiong; Liu, Ming-Chao; Yang, Jun; Wang, Jiu-Feng; Zhu, Yao-Hong

    2016-02-15

    Escherichia coli is a major environmental pathogen causing bovine mastitis, which leads to mammary tissue damage and cell death. We explored the effects of the probiotic Lactobacillus rhamnosus GR-1 on ameliorating E. coli-induced inflammation and cell damage in primary bovine mammary epithelial cells (BMECs). Increased Toll-like receptor 4 (TLR4), NOD1, and NOD2 mRNA expression was observed following E. coli challenge, but this increase was attenuated by L. rhamnosus GR-1 pretreatment. Immunofluorescence and Western blot analyses revealed that L. rhamnosus GR-1 pretreatment decreased the E. coli-induced increases in the expression of the NOD-like receptor family member pyrin domain-containing protein 3 (NLRP3) and the serine protease caspase 1. However, expression of the adaptor protein apoptosis-associated speck-like protein (ASC, encoded by the Pycard gene) was decreased during E. coli infection, even with L. rhamnosus GR-1 pretreatment. Pretreatment with L. rhamnosus GR-1 counteracted the E. coli-induced increases in interleukin-1β (IL-1β), -6, -8, and -18 and tumor necrosis factor alpha mRNA expression but upregulated IL-10 mRNA expression. Our data indicate that L. rhamnosus GR-1 reduces the adhesion of E. coli to BMECs, subsequently ameliorating E. coli-induced disruption of cellular morphology and ultrastructure and limiting detrimental inflammatory responses, partly via promoting TLR2 and NOD1 synergism and attenuating ASC-independent NLRP3 inflammasome activation. Although the residual pathogenic activity of L. rhamnosus, the dosage regimen, and the means of probiotic supplementation in cattle remain undefined, our data enhance our understanding of the mechanism of action of this candidate probiotic, allowing for development of specific probiotic-based therapies and strategies for preventing pathogenic infection of the bovine mammary gland. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  19. Complications After Cosmetic Surgery Tourism.

    Science.gov (United States)

    Klein, Holger J; Simic, Dario; Fuchs, Nina; Schweizer, Riccardo; Mehra, Tarun; Giovanoli, Pietro; Plock, Jan A

    2017-04-01

    Cosmetic surgery tourism characterizes a phenomenon of people traveling abroad for aesthetic surgery treatment. Problems arise when patients return with complications or need of follow-up care. To investigate the complications of cosmetic surgery tourism treated at our hospital as well as to analyze arising costs for the health system. Between 2010 and 2014, we retrospectively included all patients presenting with complications arising from cosmetic surgery abroad. We reviewed medical records for patients' characteristics including performed operations, complications, and treatment. Associated cost expenditure and Diagnose Related Groups (DRG)-related reimbursement were analyzed. In total 109 patients were identified. All patients were female with a mean age of 38.5 ± 11.3 years. Most procedures were performed in South America (43%) and Southeast (29.4%) or central Europe (24.8%), respectively. Favored procedures were breast augmentation (39.4%), abdominoplasty (11%), and breast reduction (7.3%). Median time between the initial procedure abroad and presentation was 15 days (interquartile range [IQR], 9) for early, 81.5 days (IQR, 69.5) for midterm, and 4.9 years (IQR, 9.4) for late complications. Main complications were infections (25.7%), wound breakdown (19.3%), and pain/discomfort (14.7%). The majority of patients (63.3%) were treated conservatively; 34.8% became inpatients with a mean hospital stay of 5.2 ± 3.8 days. Overall DRG-related reimbursement premiums approximately covered the total costs. Despite warnings regarding associated risks, cosmetic surgery tourism has become increasingly popular. Efficient patients' referral to secondary/tertiary care centers with standardized evaluation and treatment can limit arising costs without imposing a too large burden on the social healthcare system. 4. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  20. Usage Center

    DEFF Research Database (Denmark)

    Kleinaltenkamp, Michael; Plewa, Carolin; Gudergan, Siegfried

    2017-01-01

    Purpose: The purpose of this paper is to advance extant theorizing around resourceintegration by conceptualizing and delineating the notion of a usage center. Ausage center consists of a combination of interdependent actors that draw onresources across their individual usage processes to create v...

  1. Stellar aberration correction and thermoelastic compensation of Swarm μASC attitude observations: A comment to the Express Letter “Mysterious misalignments between geomagnetic and stellar reference frames seen in CHAMP and Swarm satellite measurements”, by Stefan Maus

    DEFF Research Database (Denmark)

    Herceg, M.; Jørgensen, P. S.; Jørgensen, J. L.

    2017-01-01

    . However, comparison of the Inter Boresight Angle shows a relative attitude variation between the μASC Camera Head Units. These misalignments between Camera Head Units and a geomagnetic reference frame cannot be explained by incorrect aberration correction (as theorized by Maus). Herceg et al. found them...... and clean from any variation caused by thermoelastic effects....

  2. Comparison of the clinical performance of an HPV mRNA test and an HPV DNA test in triage of atypical squamous cells of undetermined significance (ASC-US)

    DEFF Research Database (Denmark)

    Waldstrom, M; Ornskov, D

    2012-01-01

    The effect of triaging women with atypical squamous cells of undetermined significance (ASC-US) with human papillomavirus (HPV) DNA testing has been well documented. New tests detecting HPV E6/E7 mRNA are emerging, claiming to be more specific for detecting high-grade disease. We evaluated the cl...

  3. Prediction of cervical intraepithelial neoplasia grade 2+ (CIN2+ using HPV DNA testing after a diagnosis of atypical squamous cell of undetermined significance (ASC-US in Catalonia, Spain

    Directory of Open Access Journals (Sweden)

    Ibáñez Raquel

    2012-01-01

    Full Text Available Abstract Background A protocol for cervical cancer screening among sexually active women 25 to 65 years of age was introduced in 2006 in Catalonia, Spain to increase coverage and to recommend a 3-year-interval between screening cytology. In addition, Human Papillomavirus (HPV was offered as a triage test for women with a diagnosis of atypical squamous cells of undetermined significance (ASC-US. HPV testing was recommended within 3 months of ASC-US diagnosis. According to protocol, HPV negative women were referred to regular screening including a cytological exam every 3 years while HPV positive women were referred to colposcopy and closer follow-up. We evaluated the implementation of the protocol and the prediction of HPV testing as a triage tool for cervical intraepithelial lesions grade two or worse (CIN2+ in women with a cytological diagnosis of ASC-US. Methods During 2007-08 a total of 611 women from five reference laboratories in Catalonia with a novel diagnosis of ASC-US were referred for high risk HPV (hrHPV triage using high risk Hybrid Capture version 2. Using routine record linkage data, women were followed for 3 years to evaluate hrHPV testing efficacy for predicting CIN2+ cases. Logistic regression analysis was used to estimate the odds ratio for CIN2 +. Results Among the 611 women diagnosed with ASC-US, 493 (80.7% had at least one follow-up visit during the study period. hrHPV was detected in 48.3% of the women at study entry (mean age 35.2 years. hrHPV positivity decreased with increasing age from 72.6% among women younger than 25 years to 31.6% in women older than 54 years (p At the end of the 3 years follow-up period, 37 women with a diagnosis of CIN2+ (18 CIN2, 16 CIN3, 2 cancers, and 1 with high squamous intraepithelial lesions -HSIL were identified and all but one had a hrHPV positive test at study entry. Sensitivity to detect CIN2+ of hrHPV was 97.2% (95%confidence interval (CI = 85.5-99.9 and specificity was 68.3% (95%CI

  4. Prediction of cervical intraepithelial neoplasia grade 2+ (CIN2+) using HPV DNA testing after a diagnosis of atypical squamous cell of undetermined significance (ASC-US) in Catalonia, Spain.

    Science.gov (United States)

    Ibáñez, Raquel; Moreno-Crespi, Judit; Sardà, Montserrat; Autonell, Josefina; Fibla, Montserrat; Gutiérrez, Cristina; Lloveras, Belen; Alejo, María; Català, Isabel; Alameda, Francesc; Casas, Miquel; Bosch, F Xavier; de Sanjosé, Silvia

    2012-01-26

    A protocol for cervical cancer screening among sexually active women 25 to 65 years of age was introduced in 2006 in Catalonia, Spain to increase coverage and to recommend a 3-year-interval between screening cytology. In addition, Human Papillomavirus (HPV) was offered as a triage test for women with a diagnosis of atypical squamous cells of undetermined significance (ASC-US). HPV testing was recommended within 3 months of ASC-US diagnosis. According to protocol, HPV negative women were referred to regular screening including a cytological exam every 3 years while HPV positive women were referred to colposcopy and closer follow-up. We evaluated the implementation of the protocol and the prediction of HPV testing as a triage tool for cervical intraepithelial lesions grade two or worse (CIN2+) in women with a cytological diagnosis of ASC-US. During 2007-08 a total of 611 women from five reference laboratories in Catalonia with a novel diagnosis of ASC-US were referred for high risk HPV (hrHPV) triage using high risk Hybrid Capture version 2. Using routine record linkage data, women were followed for 3 years to evaluate hrHPV testing efficacy for predicting CIN2+ cases. Logistic regression analysis was used to estimate the odds ratio for CIN2 +. Among the 611 women diagnosed with ASC-US, 493 (80.7%) had at least one follow-up visit during the study period. hrHPV was detected in 48.3% of the women at study entry (mean age 35.2 years). hrHPV positivity decreased with increasing age from 72.6% among women younger than 25 years to 31.6% in women older than 54 years (p < 0.01). At the end of the 3 years follow-up period, 37 women with a diagnosis of CIN2+ (18 CIN2, 16 CIN3, 2 cancers, and 1 with high squamous intraepithelial lesions--HSIL) were identified and all but one had a hrHPV positive test at study entry. Sensitivity to detect CIN2+ of hrHPV was 97.2% (95%confidence interval (CI) = 85.5-99.9) and specificity was 68.3% (95%CI = 63.1-73.2). The odds ratio for CIN2

  5. Studies using wind tunnel to simulate the Atmospheric Boundary Layer at the Alcântara Space Center

    Directory of Open Access Journals (Sweden)

    Luciana P. Bassi Marinho

    2009-01-01

    Full Text Available The Alcântara Space Center (ASC region has a peculiar topography due to the existence of a coastal cliff, which modifies the atmospheric boundary layer characteristic in a way that can affect rocket launching operations. Wind tunnel measurements can be an important tool for the understanding of turbulence and wind flow pattern characteristics in the ASC neighborhood, along with computational fluid dynamics and observational data. The purpose of this paper is to describe wind tunnel experiments that have been carried out by researchers from the Brazilian Institutions IAE, ITA and INPE. The technologies of Hot-Wire Anemometer and Particle Image Velocimetry (PIV have been used in these measurements, in order to obtain information about wind flow patterns as velocity fields and vorticity. The wind tunnel measurements are described and the results obtained are presented.

  6. [Thymus surgery in a general surgery department].

    Science.gov (United States)

    Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

    2005-01-01

    Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

  7. Outcome of Endoscopic Transsphenoidal Surgery for Acromegaly.

    Science.gov (United States)

    Kim, Jung Hee; Hur, Kyu Yeon; Lee, Jung Hyun; Lee, Ji Hyun; Se, Young-Bem; Kim, Hey In; Lee, Seung Hoon; Nam, Do-Hyun; Kim, Seong Yeon; Kim, Kwang-Won; Kong, Doo-Sik; Kim, Yong Hwy

    2017-08-01

    Endoscopic transsphenoidal surgery has recently been introduced in pituitary surgery. We investigated outcomes and complications of endoscopic surgery in 2 referral centers in Korea. We enrolled 134 patients with acromegaly (microadenomas, n = 15; macroadenomas, n = 119) who underwent endoscopic transsphenoidal surgery at Seoul National University Hospital (n = 74) and Samsung Medical Center (n = 60) between January 2009 and March 2016. Remission was defined as having a normal insulin-like growth factor-1 and a suppressed growth hormone (GH) surgery, normal pituitary function was maintained in 34 patients (25.4%). Sixty-four patients (47.7%) presented complete (n = 59, 44.0%) or incomplete (n = 5, 3.7%) recovery of pituitary function. Hypopituitarism persisted in 20 patients (14.9%) and worsened in 16 patients (11.9%). Postoperatively, transient diabetes insipidus was reported in 52 patients (38.8%) but only persisted in 2 patients (1.5%). Other postoperative complications were epistaxis (n = 2), cerebral fluid leakage (n = 4), infection (n = 1), and intracerebral hemorrhage (n = 1). Endoscopic transsphenoidal surgery for acromegaly presented high remission rates and a low incidence of endocrine deficits and complications. Regardless of surgical techniques, invasive pituitary tumors were associated with poor outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Pain prevalence and trajectories following pediatric spinal fusion surgery

    OpenAIRE

    Sieberg, Christine B.; Simons, Laura E.; Edelstein, Mark R.; DeAngelis, Maria R.; Pielech, Melissa; Sethna, Navil; Hresko, M. Timothy

    2013-01-01

    Factors contributing to pain following surgery are poorly understood with previous research largely focused on adults. With approximately 6 million children undergoing surgery each year8, there is a need to study pediatric persistent postsurgical pain. The present study includes patients with adolescent idiopathic scoliosis undergoing spinal fusion surgery enrolled in a prospective, multi-centered registry examining post-surgical outcomes. The Scoliosis Research Society Questionnaire- Version...

  9. 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.

  10. The effects of perioperative probiotic treatment on serum zonulin concentration and subsequent postoperative infectious complications after colorectal cancer surgery: a double-center and double-blind randomized clinical trial.

    Science.gov (United States)

    Liu, Zhi-Hua; Huang, Mei-Jin; Zhang, Xing-Wei; Wang, Lei; Huang, Nan-Qi; Peng, Hui; Lan, Pin; Peng, Jun-Sheng; Yang, Zhen; Xia, Yang; Liu, Wei-Jie; Yang, Jun; Qin, Huan-Long; Wang, Jian-Ping

    2013-01-01

    Zonulin is a newly discovered protein that has an important role in the regulation of intestinal permeability. Our previous study showed that probiotics can decrease the rate of infectious complications in patients undergoing colectomy for colorectal cancer. The objective was to determine the effects of the perioperative administration of probiotics on serum zonulin concentrations and the subsequent effect on postoperative infectious complications in patients undergoing colorectal surgery. A total of 150 patients with colorectal carcinoma were randomly assigned to the control group (n = 75), which received placebo, or the probiotics group (n = 75). Both the probiotics and placebo were given orally for 6 d preoperatively and 10 d postoperatively. Outcomes were measured by assessing bacterial translocation, postoperative intestinal permeability, serum zonulin concentrations, duration of postoperative pyrexia, and cumulative duration of antibiotic therapy. The postoperative infection rate, the positive rate of blood microbial DNA, and the incidence of postoperative infectious complications-including septicemia, central line infection, pneumonia, urinary tract infection, and diarrhea-were also assessed. The infection rate was lower in the probiotics group than in the control group (P zonulin concentration (P zonulin concentrations in patients undergoing colectomy. We propose a clinical regulatory model that might explain this association. This trial was registered at http://www.chictr.org/en/ as ChiCTR-TRC-00000423.

  11. Nutrition Following Pancreatic Surgery

    Science.gov (United States)

    ... BACK Contact Us DONATE NOW GENERAL DONATION PURPLESTRIDE Nutrition Following Pancreatic Surgery Home Facing Pancreatic Cancer Living with Pancreatic Cancer Diet and Nutrition Nutrition Following Pancreatic Surgery Ver esta página en ...

  12. Blood donation before surgery

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000367.htm Blood donation before surgery To use the sharing features on ... team. Related MedlinePlus Health Topics Blood Transfusion and Donation Surgery Browse the Encyclopedia A.D.A.M., ...

  13. Cosmetic ear surgery

    Science.gov (United States)

    Otoplasty; Ear pinning; Ear surgery - cosmetic; Ear reshaping; Pinnaplasty ... Cosmetic ear surgery may be done in the surgeon's office, an outpatient clinic, or a hospital. It can be performed under ...

  14. Open heart surgery

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002950.htm Open heart surgery To use the sharing features on this ... large arteries connected to the heart. The term "open heart surgery" means that you are connected to a ...

  15. Pediatric heart surgery - discharge

    Science.gov (United States)

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... misalignment of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient's appearance may ... indicate the need for corrective jaw surgery: Difficulty chewing, or biting food Difficulty swallowing Chronic jaw or ...

  17. Refractive corneal surgery - discharge

    Science.gov (United States)

    ... surgery. Avoid contact sports (such as boxing and football) for the first 4 weeks after surgery. DO ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

  18. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ...

  20. Surgery for pancreatic cancer

    Science.gov (United States)

    ... laparoscopically (using a tiny video camera) or using robotic surgery depends on: The extent of the surgery ... by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is ...

  1. Anti-reflux surgery

    Science.gov (United States)

    ... surgery. You may need another surgery in the future if you develop new reflux symptoms or swallowing ... Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: ...

  2. Blepharoplasty (Eyelid Surgery)

    Science.gov (United States)

    ... Blepharoplasty (BLEF-uh-roe-plas-tee) is a type of surgery that repairs droopy eyelids and may involve ... tobacco and drugs. Your expectations. An honest discussion of your hopes and motivation for surgery will help set the stage for ...

  3. Smoking and surgery

    Science.gov (United States)

    Surgery - quitting smoking; Surgery - quitting tobacco; Wound healing - smoking ... Tar, nicotine, and other chemicals from smoking can increase your risk of many health problems. These include heart and blood vessel problems, such as: Blood clots and aneurysms in ...

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Jaw Surgery Download Download the ebook for further information Corrective jaw, or orthognathic surgery is performed by ... your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided here is not intended as a substitute ...

  5. Cosmetic breast surgery - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000273.htm Cosmetic breast surgery - discharge To use the sharing features on this page, please enable JavaScript. You had cosmetic breast surgery to change the size or shape ...

  6. Shoulder surgery - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000179.htm Shoulder surgery - discharge To use the sharing features on this page, please enable JavaScript. You had shoulder surgery to repair the tissues inside or around your ...

  7. Weight Loss Surgery

    Science.gov (United States)

    Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight ... obesity. There are different types of weight loss surgery. They often limit the amount of food you ...

  8. The Early vs. Late Infantile Strabismus Surgery Study: Monitoring Report

    NARCIS (Netherlands)

    H.J. Simonsz (Huib)

    1995-01-01

    textabstractAbstract: The Early vs. Late Infantile Strabismus Surgery Study Group is a group of strabismologists and orthoptists who investigate whether early or late surgery is preferable in infantile strabismus, in a non-randomized, prospective, multi-center trial. Infants between six and 18

  9. Rivaroxaban for Thromboprophylaxis After Nonelective Orthopedic Trauma Surgery in Switzerland

    DEFF Research Database (Denmark)

    Hoffmeyer, Pierre; Simmen, Hanspeter; Jakob, Marcel

    2017-01-01

    This study investigated the effectiveness and the outcomes of rivaroxaban vs the standard of care for venous thromboembolic prophylaxis in patients undergoing fracture-related surgery. A total of 413 patients undergoing fracture-related surgery from 9 Swiss orthopedic and trauma centers were enro...

  10. Robotic liver surgery

    Science.gov (United States)

    Leung, Universe

    2014-01-01

    Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

  11. An overview of surgery-first approach: Recent advances in orthognathic surgery.

    Science.gov (United States)

    Sharma, Vipul Kumar; Yadav, Kirti; Tandon, Pradeep

    2015-01-01

    The disadvantages of having orthodontic interventions both before and after orthognathic surgery include a long treatment time of 7-47 months and temporary worsening of facial appearance. Nowadays, the concept of surgery-first, followed by orthodontic treatment is applied to orthognathic surgery cases in different orthodontic centers in the world. This concept and technique is called "surgery-first-orthognathic-approach" or "surgery-first approach" (SFA) rigid fixation (skeletal anchorage system) of the bony segments and regional acceleratory phenomenon were keys to broad implementation of the SFA. This article is intended to provide an overview of SFA including indications, general and specific guidelines, different protocol variations, success rate and potential problems.

  12. Florida specific NTCIP MIB development for actuated signal controller (ASC), closed-circuit television (CCTV), and center-to-center (C2C) communications with SunGuideSM software and ITS device test procedure development : summary of final report.

    Science.gov (United States)

    2009-06-01

    To provide hardware, software, network, systems research, and testing for multi-million dollar traffic : operations, Intelligent Transportation Systems (ITS), and statewide communications investments, the : Traffic Engineering and Operations Office h...

  13. Florida specific NTCIP MIB development for actuated signal controller (ASC), closed-circuit television (CCTV), and center-to-center (C2C) communications with SunGuideSM software and ITS device test procedure development : technical report documentation pa

    Science.gov (United States)

    2009-06-30

    The project has been focused on National Transportation Communications for ITS Protocol : (NTCIP) research and testing across the entire life cycle of traffic operations, ITS, and statewide : communications deployments. This life cycle includes desig...

  14. Florida specific NTCIP MIB development for actuated signal controller (ASC), closed-circuit television (CCTV), and center-to-center (C2C) communications with SunGuideSM software and ITS device test procedure development : executive summary.

    Science.gov (United States)

    2009-06-01

    To provide hardware, software, network, systems research, and testing for multi-million : dollar traffic operations, Intelligent Transportation Systems (ITS), and statewide : communications investments, the Traffic Engineering and Operations Office h...

  15. High-resolution global grids of revised Priestley-Taylor and Hargreaves-Samani coefficients for assessing ASCE-standardized reference crop evapotranspiration and solar radiation

    Science.gov (United States)

    Aschonitis, Vassilis G.; Papamichail, Dimitris; Demertzi, Kleoniki; Colombani, Nicolo; Mastrocicco, Micol; Ghirardini, Andrea; Castaldelli, Giuseppe; Fano, Elisa-Anna

    2017-08-01

    The objective of the study is to provide global grids (0.5°) of revised annual coefficients for the Priestley-Taylor (P-T) and Hargreaves-Samani (H-S) evapotranspiration methods after calibration based on the ASCE (American Society of Civil Engineers)-standardized Penman-Monteith method (the ASCE method includes two reference crops: short-clipped grass and tall alfalfa). The analysis also includes the development of a global grid of revised annual coefficients for solar radiation (Rs) estimations using the respective Rs formula of H-S. The analysis was based on global gridded climatic data of the period 1950-2000. The method for deriving annual coefficients of the P-T and H-S methods was based on partial weighted averages (PWAs) of their mean monthly values. This method estimates the annual values considering the amplitude of the parameter under investigation (ETo and Rs) giving more weight to the monthly coefficients of the months with higher ETo values (or Rs values for the case of the H-S radiation formula). The method also eliminates the effect of unreasonably high or low monthly coefficients that may occur during periods where ETo and Rs fall below a specific threshold. The new coefficients were validated based on data from 140 stations located in various climatic zones of the USA and Australia with expanded observations up to 2016. The validation procedure for ETo estimations of the short reference crop showed that the P-T and H-S methods with the new revised coefficients outperformed the standard methods reducing the estimated root mean square error (RMSE) in ETo values by 40 and 25 %, respectively. The estimations of Rs using the H-S formula with revised coefficients reduced the RMSE by 28 % in comparison to the standard H-S formula. Finally, a raster database was built consisting of (a) global maps for the mean monthly ETo values estimated by ASCE-standardized method for both reference crops, (b) global maps for the revised annual coefficients of the P

  16. Breast Cancer Surgery

    Science.gov (United States)

    FACTS FOR LIFE Breast Cancer Surgery The goal of breast cancer surgery is to remove the whole tumor from the breast. Some lymph nodes ... might still be in the body. Types of breast cancer surgery There are two types of breast cancer ...

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... their surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on many aspects of life. Following are some of the conditions that may ... front, or side Facial injury Birth defects Receding lower jaw and ...

  18. Pediatric heart surgery

    Science.gov (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

  19. Perioperative Vision Loss in Cervical Spinal Surgery.

    Science.gov (United States)

    Gabel, Brandon C; Lam, Arthur; Chapman, Jens R; Oskouian, Rod J; Nassr, Ahmad; Currier, Bradford L; Sebastian, Arjun S; Arnold, Paul M; Hamilton, Steven R; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective multicenter case series. To assess the rate of perioperative vision loss following cervical spinal surgery. Medical records for 17 625 patients from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify occurrences of vision loss following surgery. Of the 17 625 patients in the registry, there were 13 946 patients assessed for the complication of blindness. There were 9591 cases that involved only anterior surgical approaches; the remaining 4355 cases were posterior and/or circumferential fusions. There were no cases of blindness or vision loss in the postoperative period reported during the sampling period. Perioperative vision loss following cervical spinal surgery is exceedingly rare.

  20. Heart Surgery Waiting Time: Assessing the Effectiveness of an Action

    OpenAIRE

    Badakhshan, Abbas; Arab, Mohammad; Gholipour, Mahin; Behnampour, Naser; Saleki, Saeid

    2015-01-01

    Background: Waiting time is an index assessing patient satisfaction, managerial effectiveness and horizontal equity in providing health care. Although heart surgery centers establishment is attractive for politicians. They are always faced with the question of to what extent they solve patient’s problems. Objectives: The objective of this study was to evaluate factors influencing waiting time in patients of heart surgery centers, and to make recommendations for health-care policy-makers for r...

  1. A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery.

    Science.gov (United States)

    Dy, Christopher J; Baty, Jack; Saeed, Mohammed J; Olsen, Margaret A; Osei, Daniel A

    2016-09-01

    Despite the importance of timely evaluation for patients with brachial plexus injuries (BPIs), in clinical practice we have noted delays in referral. Because the published BPI experience is largely from individual centers, we used a population-based approach to evaluate the delivery of care for patients with BPI. We used statewide administrative databases from Florida (2007-2013), New York (2008-2012), and North Carolina (2009-2010) to create a cohort of patients who underwent surgery for BPI (exploration, repair, neurolysis, grafting, or nerve transfer). Emergency department and inpatient records were used to determine the time interval between the injury and surgical treatment. Distances between treating hospitals and between the patient's home ZIP code and the surgical hospital were recorded. A multivariable logistic regression model was used to determine predictors for time from injury to surgery exceeding 365 days. Within the 222 patients in our cohort, median time from injury to surgery was 7.6 months and exceeded 365 days in 29% (64 of 222 patients) of cases. Treatment at a smaller hospital for the initial injury was significantly associated with surgery beyond 365 days after injury. Patient insurance type, travel distance for surgery, distance between the 2 treating hospitals, and changing hospitals between injury and surgery did not significantly influence time to surgery. Nearly one third of patients in Florida, New York, and North Carolina underwent BPI surgery more than 1 year after the injury. Patients initially treated at smaller hospitals are at risk for undergoing delayed BPI surgery. These findings can inform administrative and policy efforts to expedite timely referral of patients with BPI to experienced centers. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  2. Advantages of robotics in benign gynecologic surgery.

    Science.gov (United States)

    Truong, Mireille; Kim, Jin Hee; Scheib, Stacey; Patzkowsky, Kristin

    2016-08-01

    The purpose of this article is to review the literature and discuss the advantages of robotics in benign gynecologic surgery. Minimally invasive surgery has become the preferred route over abdominal surgery. The laparoscopic or robotic approach is recommended when vaginal surgery is not feasible. Thus far, robotic gynecologic surgery data have demonstrated feasibility, safety, and equivalent clinical outcomes in comparison with laparoscopy and better clinical outcomes compared with laparotomy. Robotics was developed to overcome challenges of laparoscopy and has led to technological advantages such as improved ergonomics, visualization with three-dimensional capabilities, dexterity and range of motion with instrument articulation, and tremor filtration. To date, applications of robotics in benign gynecology include hysterectomy, myomectomy, endometriosis surgery, sacrocolpopexy, adnexal surgery, tubal reanastomosis, and cerclage. Though further data are needed, robotics may provide additional benefits over other approaches in the obese patient population and in higher complexity cases. Challenges that arose in the earlier adoption stage such as the steep learning curve, costs, and operative times are becoming more optimized with greater experience, with implementation of robotics in high-volume centers and with improved training of surgeons and robotic teams. Robotic laparoendoscopic single-site surgery, albeit still in its infancy where technical advantages compared with laparoscopic single-site surgery are still unclear, may provide a cost-reducing option compared with multiport robotics. The cost may even approach that of laparoscopy while still conferring similar perioperative outcomes. Advances in robotic technology such as the single-site platform and telesurgery, have the potential to revolutionize the field of minimally invasive gynecologic surgery. Higher quality evidence is needed to determine the advantages and disadvantages of robotic surgery in benign

  3. Using your shoulder after surgery

    Science.gov (United States)

    Shoulder surgery - using your shoulder; Shoulder surgery - after ... rotator cuff surgery or other ligament or labral surgery, you need to be careful with your shoulder. Ask the surgeon what arm movements are safe ...

  4. Efecto del ácido ascórbico sobre crecimiento, pigmentos fotosintéticos y actividad peroxidasa de plantas de rosal

    Directory of Open Access Journals (Sweden)

    Silvia Lizbeth Herrera Martínez

    2013-07-01

    Full Text Available El ácido ascórbico (AA participa en muchos procesos fisiológicos tales como: fotosíntesis, cofactor enzimático, homeostasis del sistema redox, precursor en las rutas de síntesis de moléculas del metabolismo primario y secundario, entre otras funciones. En el presente trabajo, se evaluó el efecto del AA en plantas de rosal variedad Fetera® en condiciones de invernadero. El objetivo fue evaluar el efecto de la molécula antioxidante AA como un compuesto alternativo involucrado en las respuestas de crecimiento, contenido de pigmentos fotosintéticos y actividad enzimática de la peroxidasa (POX, en el cultivo de rosal variedad Fetera®. Las plantas se asperjaron dos veces por semana con 0, 600 y 1200 mg L-1 de AA durante cinco meses. El tratamiento de AA incrementó la longitud y el diámetro del tallo, así como el número de brotes laterales en las plantas de rosal. Las plantas asperjadas con AA mostraron incremento de los pigmentos fotosintéticos y la actividad enzimática de la POX. Los avances de este trabajo indican que el AA puede ser un compuesto potencialmente útil para incrementar el crecimiento del cultivo de rosal.

  5. ATP Induces IL-1β Secretion in Neisseria gonorrhoeae-Infected Human Macrophages by a Mechanism Not Related to the NLRP3/ASC/Caspase-1 Axis

    Directory of Open Access Journals (Sweden)

    Killen García

    2016-01-01

    Full Text Available Neisseria gonorrhoeae (Ngo has developed multiple immune evasion mechanisms involving the innate and adaptive immune responses. Recent findings have reported that Ngo reduces the IL-1β secretion of infected human monocyte-derived macrophages (MDM. Here, we investigate the role of adenosine triphosphate (ATP in production and release of IL-1β in Ngo-infected MDM. We found that the exposure of Ngo-infected MDM to ATP increases IL-1β levels about ten times compared with unexposed Ngo-infected MDM (P0.05 and caspase-1 (CASP1, P>0.05. In addition, ATP was not able to modify caspase-1 activity in Ngo-infected MDM but was able to increase pyroptosis (P>0.01. Notably ATP treatment defined an increase of positive staining for IL-1β with a distinctive intracellular pattern of distribution. Collectively, these data demonstrate that ATP induces IL-1β secretion by a mechanism not related to the NLRP3/ASC/caspase-1 axis and likely is acting at the level of vesicle trafficking or pore formation.

  6. DEVELOPMENT OF PLASTIC SURGERY.

    Science.gov (United States)

    Pećanac, Marija Đ

    2015-01-01

    Plastic surgery is a medical specialty dealing with corrections of defects, improvements in appearance and restoration of lost function. Ancient times. The first recorded account of reconstructive plastic surgery was found in ancient Indian Sanskrit texts, which described reconstructive surgeries of the nose and ears. In ancient Greece and Rome, many medicine men performed simple plastic cosmetic surgeries to repair damaged parts of the body caused by war mutilation, punishment or humiliation. In the Middle Ages, the development of all medical braches, including plastic surgery was hindered. New age. The interest in surgical reconstruction of mutilated body parts was renewed in the XVIII century by a great number of enthusiastic and charismatic surgeons, who mastered surgical disciplines and became true artists that created new forms. Modern era. In the XX century, plastic surgery developed as a modern branch in medicine including many types of reconstructive surgery, hand, head and neck surgery, microsurgery and replantation, treatment of burns and their sequelae, and esthetic surgery. Contemporary and future plastic surgery will continue to evolve and improve with regenerative medicine and tissue engineering resulting in a lot of benefits to be gained by patients in reconstruction after body trauma, oncology amputation, and for congenital disfigurement and dysfunction.

  7. Cinnamaldehyde and eugenol change the expression folds of AKT1 and DKC1 genes and decrease the telomere length of human adipose-derived stem cells (hASCs: An experimental and in silico study

    Directory of Open Access Journals (Sweden)

    Abdorrahim Absalan

    2017-03-01

    Full Text Available Objective(s: To investigate the effect of cinnamaldehyde and eugenol on the telomere-dependent senescence of stem cells. In addition, to search the probable targets of mentioned phytochemicals between human telomere interacting proteins (TIPs using in silico studies. Materials and Methods: Human adipose derived stem cells (hASCs were studied under treatments with 2.5 µM/ml cinnamaldehyde, 0.1 µg/ml eugenol, 0.01% DMSO or any additive. The expression of TERT, AKT1 and DKC1 genes and the telomere length were assessed over 48-hr treatment. In addition, docking study was conducted to show probable ways through which phytochemicals interact with TIPs. Results: Treated and untreated hASCs had undetectable TERT expression, but they did affect the AKT1 and DKC1 expression levels (CI=0.95; P

  8. Simultaneous Versus Sequential Ptosis and Strabismus Surgery in Children.

    Science.gov (United States)

    Revere, Karen E; Binenbaum, Gil; Li, Jonathan; Mills, Monte D; Katowitz, William R; Katowitz, James A

    The authors sought to compare the clinical outcomes of simultaneous versus sequential ptosis and strabismus surgery in children. Retrospective, single-center cohort study of children requiring both ptosis and strabismus surgery on the same eye. Simultaneous surgeries were performed during a single anesthetic event; sequential surgeries were performed at least 7 weeks apart. Outcomes were ptosis surgery success (margin reflex distance 1 ≥ 2 mm, good eyelid contour, and good eyelid crease); strabismus surgery success (ocular alignment within 10 prism diopters of orthophoria and/or improved head position); surgical complications; and reoperations. Fifty-six children were studied, 38 had simultaneous surgery and 18 sequential. Strabismus surgery was performed first in 38/38 simultaneous and 6/18 sequential cases. Mean age at first surgery was 64 months, with mean follow up 27 months. A total of 75% of children had congenital ptosis; 64% had comitant strabismus. A majority of ptosis surgeries were frontalis sling (59%) or Fasanella-Servat (30%) procedures. There were no significant differences between simultaneous and sequential groups with regards to surgical success rates, complications, or reoperations (all p > 0.28). In the first comparative study of simultaneous versus sequential ptosis and strabismus surgery, no advantage for sequential surgery was seen. Despite a theoretical risk of postoperative eyelid malposition or complications when surgeries were performed in a combined manner, the rate of such outcomes was not increased with simultaneous surgeries. Performing ptosis and strabismus surgery together appears to be clinically effective and safe, and reduces anesthesia exposure during childhood.

  9. Quantificação de compostos fenólicos e ácido ascórbico em frutos e polpas congeladas de acerola, caju, goiaba e morango

    Directory of Open Access Journals (Sweden)

    Juliana Mesquita Freire

    2013-12-01

    Full Text Available O crescente interesse da população pela promoção da saúde vem despertando a atenção dos consumidores por alimentos ricos em antioxidantes, combinado com a praticidade do consumo de sucos de frutos processados. O presente trabalho objetivou quantificar e avaliar a capacidade antioxidante de compostos fenólicos e ácido ascórbico em frutas in natura e polpas congeladas. As frutas in natura e polpas congeladas obtidas na região de Lavras - MG foram submetidas à quantificação de compostos fenólicos e ácido ascórbico e os respectivos extratos acetônico-etanólico e acetônico-metanólico. Foram determinadas suas atividades antioxidantes pelos métodos radicalares DPPH e ABTS. O extrato acetônico-metanólico foi mais efetivo para extrair os compostos antioxidantes das amostras. Apenas as polpas congeladas de acerola apresentaram uma redução do teor de compostos fenólicos em relação ao fruto. Para o teor de ácido ascórbico, houve uma redução nas polpas congeladas de acerola e goiaba. As amostras de acerola apresentaram os maiores teores de compostos fenólicos, ácido ascórbico e atividade antioxidante em relação aos demais frutos analisados.

  10. Immunostaining of p16INK4a/Ki-67 and L1 Capsid Protein on Liquid-based Cytology Specimens Obtained from ASC-H and LSIL-H Cases

    OpenAIRE

    Byun, Seung Won; Lee, Ahwon; Kim, Suyeon; Choi, Yeong Jin; Lee, Youn Soo; Park, Jong Sup

    2013-01-01

    Background: Atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and low-grade intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion (LSIL-H) are ambiguous diagnostic entities for the prediction of high-grade cervical lesion. Objective and reproducible tests for predicting high-grade cervical lesions are needed to reduce unnecessary colposcopic referrals or follow-ups. Objective: We aimed to identify an adequate set of adjunctive ...

  11. Center for Adaptive Optics | Center

    Science.gov (United States)

    Astronomy, UCSC's CfAO and ISEE, and Maui Community College, runs education and internship programs in / Jacobs Retina Center Department of Psychology University of California, San Francisco Department of University School of Optometry Maui Community College Maui Community College Space Grant Program Montana

  12. Morbidity and mortality of complex spine surgery

    DEFF Research Database (Denmark)

    Karstensen, Sven; Bari, Tanvir; Gehrchen, Martin

    2016-01-01

    requiring revision. METHODS: All patients undergoing spinal surgery at an academic tertiary referral center in the study period were prospectively included. The newest version of SAVES system was used, and a research coordinator collected all intraoperative and perioperative data prospectively. Once a week...... adverse events (AEs). PURPOSE: This study aimed to determine the mortality and examine the incidence of morbidity in patients undergoing complex spinal surgery, including pediatric patients, and to validate the SAVES system in a European population. STUDY DESIGN: A prospective, consecutive cohort study...

  13. Advanced Stirling Convertor Dual Convertor Controller Testing at NASA Glenn Research Center in the Radioisotope Power Systems System Integration Laboratory

    Science.gov (United States)

    Dugala, Gina M.; Taylor, Linda M.; Bell, Mark E.; Dolce, James L.; Fraeman, Martin; Frankford, David P.

    2015-01-01

    NASA Glenn Research Center developed a nonnuclear representation of a Radioisotope Power System (RPS) consisting of a pair of Advanced Stirling Convertors (ASCs), Dual Convertor Controller (DCC) EMs (engineering models) 2 and 3, and associated support equipment, which were tested in the Radioisotope Power Systems System Integration Laboratory (RSIL). The DCC was designed by the Johns Hopkins University Applied Physics Laboratory (JHU/APL) to actively control a pair of ASCs. The first phase of testing included a Dual Advanced Stirling Convertor Simulator (DASCS), which was developed by JHU/APL and simulates the operation and electrical behavior of a pair of ASCs in real time via a combination of hardware and software. RSIL provides insight into the electrical interactions between a representative radioisotope power generator, its associated control schemes, and realistic electric system loads. The first phase of integration testing included the following spacecraft bus configurations: capacitive, battery, and super-capacitor. A load profile, created based on data from several missions, tested the RPS's and RSIL's ability to maintain operation during load demands above and below the power provided by the RPS. The integration testing also confirmed the DCC's ability to disconnect from the spacecraft when the bus voltage dipped below 22 volts or exceeded 36 volts. Once operation was verified with the DASCS, the tests were repeated with actual operating ASCs. The goal of this integration testing was to verify operation of the DCC when connected to a spacecraft and to verify the functionality of the newly designed RSIL. The results of these tests are presented in this paper.

  14. Ergonomics in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Supe Avinash

    2010-01-01

    Full Text Available Laparoscopic surgery provides patients with less painful surgery but is more demanding for the surgeon. The increased technological complexity and sometimes poorly adapted equipment have led to increased complaints of surgeon fatigue and discomfort during laparoscopic surgery. Ergonomic integration and suitable laparoscopic operating room environment are essential to improve efficiency, safety, and comfort for the operating team. Understanding ergonomics can not only make life of surgeon comfortable in the operating room but also reduce physical strains on surgeon.

  15. Gastric and intestinal surgery.

    Science.gov (United States)

    Fossum, Theresa W; Hedlund, Cheryl S

    2003-09-01

    Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.

  16. The Cladophora glomerata Enriched by Biosorption Process in Cr(III Improves Viability, and Reduces Oxidative Stress and Apoptosis in Equine Metabolic Syndrome Derived Adipose Mesenchymal Stromal Stem Cells (ASCs and Their Extracellular Vesicles (MV’s

    Directory of Open Access Journals (Sweden)

    Krzysztof Marycz

    2017-12-01

    Full Text Available This study investigated in vitro effects of freshwater alga Cladophora glomerata water extract enriched during a biosorption process in Cr(III trivalent chromium and chromium picolinate on adipose-derived mesenchymal stromal stem cells (ASCs and extracellular microvesicles (MVs in equine metabolic syndrome-affected horses. Chemical characterisation of natural Cladophora glomerata was performed with special emphasis on: vitamin C, vitamin E, total phenols, fatty acids, free and protein-bound amino acids as well as measured Cr in algal biomass. To examine the influence of Cladophora glomerata water extracts, in vitro viability, oxidative stress factor accumulation, apoptosis, inflammatory response, biogenesis of mitochondria, autophagy in ASCs of EMS and secretory activity manifested by MV release were investigated. For this purpose, various methods of molecular biology and microscopic observations (i.e., immunofluorescence staining, SEM, TEM, FIB observations, mRNA and microRNA expression by RT-qPCR were applied. The extract of Cladophora glomerata enriched with Cr(III ions reduced apoptosis and inflammation in ASCs of EMS horses through improvement of mitochondrial dynamics, decreasing of PDK4 expression and reduction of endoplastic reticulum stress. Moreover, it was found, that Cladophora glomerata and Cr(III induce antioxidative protection coming from enhanced SOD activity Therefore, Cladophora glomerata enriched with Cr(III ions might become an interesting future therapeutic agent in the pharmacological treatment of EMS horses.

  17. Spirulina platensis Improves Mitochondrial Function Impaired by Elevated Oxidative Stress in Adipose-Derived Mesenchymal Stromal Cells (ASCs) and Intestinal Epithelial Cells (IECs), and Enhances Insulin Sensitivity in Equine Metabolic Syndrome (EMS) Horses.

    Science.gov (United States)

    Nawrocka, Daria; Kornicka, Katarzyna; Śmieszek, Agnieszka; Marycz, Krzysztof

    2017-08-03

    Equine Metabolic Syndrome (EMS) is a steadily growing life-threatening endocrine disorder linked to insulin resistance, oxidative stress, and systemic inflammation. Inflammatory microenvironment of adipose tissue constitutes the direct tissue milieu for various cell populations, including adipose-derived mesenchymal stromal cells (ASCs), widely considered as a potential therapeutic cell source in the course of the treatment of metabolic disorders. Moreover, elevated oxidative stress induces inflammation in intestinal epithelial cells (IECs)-the first-line cells exposed to dietary compounds. In the conducted research, we showed that in vitro application of Spirulina platensis contributes to the restoration of ASCs' and IECs' morphology and function through the reduction of cellular oxidative stress and inflammation. Enhanced viability, suppressed senescence, and improved proliferation of ASCs and IECs isolated from metabolic syndrome-affected individuals were evident following exposition to Spirulina. A protective effect of the investigated extract against mitochondrial dysfunction and degeneration was also observed. Moreover, our data demonstrate that Spirulina extract effectively suppressed LPS-induced inflammatory responses in macrophages. In vivo studies showed that horses fed with a diet based on Spirulina platensis supplementation lost weight and their insulin sensitivity improved. Thus, our results indicate the engagement of Spirulina platensis nourishing as an interesting alternative approach for supporting the conventional treatment of equine metabolic syndrome.

  18. The Cladophora glomerata Enriched by Biosorption Process in Cr(III) Improves Viability, and Reduces Oxidative Stress and Apoptosis in Equine Metabolic Syndrome Derived Adipose Mesenchymal Stromal Stem Cells (ASCs) and Their Extracellular Vesicles (MV's).

    Science.gov (United States)

    Marycz, Krzysztof; Michalak, Izabela; Kocherova, Ievgeniia; Marędziak, Monika; Weiss, Christine

    2017-12-08

    This study investigated in vitro effects of freshwater alga Cladophora glomerata water extract enriched during a biosorption process in Cr(III) trivalent chromium and chromium picolinate on adipose-derived mesenchymal stromal stem cells (ASCs) and extracellular microvesicles (MVs) in equine metabolic syndrome-affected horses. Chemical characterisation of natural Cladophora glomerata was performed with special emphasis on: vitamin C, vitamin E, total phenols, fatty acids, free and protein-bound amino acids as well as measured Cr in algal biomass. To examine the influence of Cladophora glomerata water extracts, in vitro viability, oxidative stress factor accumulation, apoptosis, inflammatory response, biogenesis of mitochondria, autophagy in ASCs of EMS and secretory activity manifested by MV release were investigated. For this purpose, various methods of molecular biology and microscopic observations (i.e., immunofluorescence staining, SEM, TEM, FIB observations, mRNA and microRNA expression by RT-qPCR) were applied. The extract of Cladophora glomerata enriched with Cr(III) ions reduced apoptosis and inflammation in ASCs of EMS horses through improvement of mitochondrial dynamics, decreasing of PDK4 expression and reduction of endoplastic reticulum stress. Moreover, it was found, that Cladophora glomerata and Cr(III) induce antioxidative protection coming from enhanced SOD activity Therefore, Cladophora glomerata enriched with Cr(III) ions might become an interesting future therapeutic agent in the pharmacological treatment of EMS horses.

  19. The Cladophora glomerata Enriched by Biosorption Process in Cr(III) Improves Viability, and Reduces Oxidative Stress and Apoptosis in Equine Metabolic Syndrome Derived Adipose Mesenchymal Stromal Stem Cells (ASCs) and Their Extracellular Vesicles (MV’s)

    Science.gov (United States)

    Marycz, Krzysztof; Marędziak, Monika; Weiss, Christine

    2017-01-01

    This study investigated in vitro effects of freshwater alga Cladophora glomerata water extract enriched during a biosorption process in Cr(III) trivalent chromium and chromium picolinate on adipose-derived mesenchymal stromal stem cells (ASCs) and extracellular microvesicles (MVs) in equine metabolic syndrome-affected horses. Chemical characterisation of natural Cladophora glomerata was performed with special emphasis on: vitamin C, vitamin E, total phenols, fatty acids, free and protein-bound amino acids as well as measured Cr in algal biomass. To examine the influence of Cladophora glomerata water extracts, in vitro viability, oxidative stress factor accumulation, apoptosis, inflammatory response, biogenesis of mitochondria, autophagy in ASCs of EMS and secretory activity manifested by MV release were investigated. For this purpose, various methods of molecular biology and microscopic observations (i.e., immunofluorescence staining, SEM, TEM, FIB observations, mRNA and microRNA expression by RT-qPCR) were applied. The extract of Cladophora glomerata enriched with Cr(III) ions reduced apoptosis and inflammation in ASCs of EMS horses through improvement of mitochondrial dynamics, decreasing of PDK4 expression and reduction of endoplastic reticulum stress. Moreover, it was found, that Cladophora glomerata and Cr(III) induce antioxidative protection coming from enhanced SOD activity Therefore, Cladophora glomerata enriched with Cr(III) ions might become an interesting future therapeutic agent in the pharmacological treatment of EMS horses. PMID:29292726

  20. Polyurethane/Polylactide-Blend Films Doped with Zinc Ions for the Growth and Expansion of Human Olfactory Ensheathing Cells (OECs and Adipose-Derived Mesenchymal Stromal Stem Cells (ASCs for Regenerative Medicine Applications

    Directory of Open Access Journals (Sweden)

    Krzysztof Marycz

    2016-04-01

    Full Text Available Polymeric biomaterials based on polyurethane and polylactide blends are promising candidates for regenerative medicine applications as biocompatible, bioresorbable carriers. In current research we showed that 80/20 polyurethane/polylactide blends (PU/PLDL with confirmed biological properties in vitro may be further improved by the addition of ZnO nanoparticles for the delivery of bioactive zinc oxide for cells. The PU/PLDL blends were doped with different concentrations of ZnO (0.001%, 0.01%, 0.05% and undertaken for in vitro biological evaluation using human adipose stromal stem cells (ASCs and olfactory ensheathing cells (OECs. The addition of 0.001% of ZnO to the biomaterials positively influenced the morphology, proliferation, and phenotype of cells cultured on the scaffolds. Moreover, the analysis of oxidative stress markers revealed that 0.001% of ZnO added to the material decreased the stress level in both cell lines. In addition, the levels of neural-specific genes were upregulated in OECs when cultured on sample 0.001 ZnO, while the apoptosis-related genes were downregulated in OECs and ASCs in the same group. Therefore, we showed that PU/PLDL blends doped with 0.001% of ZnO exert beneficial influence on ASCs and OECs in vitro and they may be considered for future applications in the field of regenerative medicine.

  1. Surgery: a risky business.

    Science.gov (United States)

    Vats, Amit; Nagpal, Kamal; Moorthy, Krishna

    2009-10-01

    The advancement of surgical technology has made surgery an increasingly suitable management option for an increasing number of medical conditions. Yet there is also a growing concern about the number of patients coming to harm as a result of surgery. Studies show that this harm can be prevented by better teamwork and communication in operating theatres. This article discusses the extent of adverse events in surgery and how effective teamwork and communication can improve patient safety. It also highlights the role checklists and briefing in improving teamwork and reducing human error in surgery.

  2. Heart valve surgery

    Science.gov (United States)

    ... replacement; Valve repair; Heart valve prosthesis; Mechanical valves; Prosthetic valves ... surgery. Your heart valve has been damaged by infection ( endocarditis ). You have received a new heart valve ...

  3. Pap Smear Abnormalities in Women Admitted to a Tertiary Health Center in Southeast Turkey

    Directory of Open Access Journals (Sweden)

    Alev Ozer

    2014-12-01

    Full Text Available Aim: To analyze the cervical cytological abnormalities which are detected in women undergoing Pap screening in a tertiary health care center within Siirt, a southeastern province of Turkey. Material and Method: A total of 3000 women who underwent Pap screening at the study center between January 1, 2009 and December 31, 2009 were recruited for the study. The women who were diagnosed with benign epithelial changes, infectious alterations, as well as atypical squamous cells with undetermined significance (ASC-US, atypical squamous cells of high significance (ASC-H, and low-grade squamous intraepithelial lesion (LSIL were included. Results: Benign epithelial alterations, infectious changes, ASCUS, ASC-H, and LSIL were detected in 83.7%, 15.3%, 0.8%, 0.1% and 0.1% of the Pap smears respectively. A significant correlation was found between the patient age and the histopathological alterations in the Pap smears (r=0.072, p=0.001. Although no correlation could be detected between gravidity and Pap smear results (r=0.033, p=0.067, a significant correlation existed between parity and the histopathological findings within the Pap smears (r=0.051, p=0.005. Interestingly, the Pap smear results were found to be unrelated to socioeconomic status (r=0.088, p=0.168, education level (r=0.048, p=0.257, and smoking habit (r=0.086, p=0.077. Discussion: The present study has reported a value of 1.0% for the overall prevalence of cervical cytological abnormalities, which is much lower than in western countries. Thus, rather than being dependent on the data reported by clinical studies that have been conducted in western countries, Turkish health care policy should be based on the data obtained from national studies.

  4. Transgender Surgery in Denmark From 1994 to 2015

    DEFF Research Database (Denmark)

    Aydin, Dogu; Buk, Liv Johanne; Partoft, Søren

    2016-01-01

    INTRODUCTION: Gender dysphoria is a mismatch between a person's biological sex and gender identity. The best treatment is believed to be hormonal therapy and gender-confirming surgery that will transition the individual toward the desired gender. Treatment in Denmark is covered by public health...... identity disorders from January 1994 through March 2015. Patients were excluded from the study if they were pseudohermaphrodites or if their gender was not reported. MAIN OUTCOME MEASURES: Gender distribution, age trends, and surgeries performed for Danish patients who underwent gender-confirming surgery...... care, and gender-confirming surgery in Denmark is centralized at a single-center with few specialized plastic surgeons conducting top surgery (mastectomy or breast augmentation) and bottom surgery (vaginoplasty or phalloplasty and metoidioplasty). AIMS: To report the first nationwide single...

  5. Less extensive surgery compared to extensive surgery

    DEFF Research Database (Denmark)

    Lauszus, Finn F; Petersen, Astrid C; Neumann, Gudrun

    2014-01-01

    -up by hospital data files, general practitioner, death certificate, and autopsy report. Revision of histopathology by a single pathologist. Main outcome measures: Survival and relapse by clinical data, stage, and type of surgery. RESULTS: The incidence of AGCT was 1.37 per year per 100,000 women (95% CI: 1.08, 1.......68). The median follow-up time was 15 years and for the 79 surviving women 22 years. Stage I was found in 94% of cases. Relapse occurred in 24% of women in stage I and 100% of the other stages. Survival in stage I was 95%, 89% and 84% after 5, 10 and 20 years respectively. Increased survival of stage I......: The survival of women was better in AGCT than in epithelial ovarian tumor. Age and type of surgery, besides stage, influenced survival. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the recommended treatment with advancing age. At younger age less extensive surgery was associated...

  6. Does previous abdominal surgery affect the course and outcomes of laparoscopic bariatric surgery?

    Science.gov (United States)

    Major, Piotr; Droś, Jakub; Kacprzyk, Artur; Pędziwiatr, Michał; Małczak, Piotr; Wysocki, Michał; Janik, Michał; Walędziak, Maciej; Paśnik, Krzysztof; Hady, Hady Razak; Dadan, Jacek; Proczko-Stepaniak, Monika; Kaska, Łukasz; Lech, Paweł; Michalik, Maciej; Duchnik, Michał; Kaseja, Krzysztof; Pastuszka, Maciej; Stepuch, Paweł; Budzyński, Andrzej

    2018-03-26

    Global experiences in general surgery suggest that previous abdominal surgery may negatively influence different aspects of perioperative care. As the incidence of bariatric procedures has recently increased, it is essential to assess such correlations in bariatric surgery. To assess whether previous abdominal surgery influences the course and outcomes of laparoscopic bariatric surgery. Seven referral bariatric centers in Poland. We conducted a retrospective analysis of 2413 patients; 1706 patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) matched the inclusion criteria. Patients with no history of abdominal surgery were included as group 1, while those who had undergone at least 1 abdominal surgery were included as group 2. Group 2 had a significantly prolonged median operation time for RYGB (P = .012), and the longest operation time was observed in patients who had previously undergone surgeries in both the upper and lower abdomen (P = .002). Such a correlation was not found in SG cases (P = .396). Groups 1 and 2 had similar rates of intraoperative adverse events and postoperative complications (P = .562 and P = .466, respectively). Group 2 had a longer median duration of hospitalization than group 1 (P = .034), while the readmission rate was similar between groups (P = .079). There was no significant difference between groups regarding the influence of the long-term effects of bariatric treatment on weight loss (percentage of follow-up was 55%). Previous abdominal surgery prolongs the operative time of RYGB and the duration of postoperative hospitalization, but does not affect the long-term outcomes of bariatric treatment. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  7. Suscetibilidade de linhagens de frangos de corte à síndrome ascítica Ascites syndrome effects in different commercial broilers

    Directory of Open Access Journals (Sweden)

    Manoel Garcia Neto

    2004-08-01

    Full Text Available O objetivo deste trabalho foi estudar a suscetibilidade à síndrome ascítica de machos e fêmeas em linhagens comerciais de frango de corte. Todas as aves receberam ração ad libitum com 3.050 kcal/ME. Foram comparadas as linhagens comerciais representadas pela Cobb, Hubbard e Ross, machos e fêmeas. O delineamento utilizado foi o inteiramente casualizado, em esquema fatorial. As aves foram aleatoriamente alojadas em um galpão experimental de 8x76 m, com 18 boxes de 3x3,5 m cada e 100 aves por divisão, num total de 1.800 aves. Os resultados revelaram que a incidência de ascite independe da linhagem comercial dos frangos de corte, entretanto, os machos foram mais suscetíveis.The objective of this work was to verify the incidence of ascites in males and females on commercial lines of broilers. All birds received ration ad libitum with 3,050 kcal/ME. The commercial lines Cobb, Hubbard and Ross, males and females, were compared. A factorial design was used with three replications per treatment. A total of 1,800 birds were housed at random in an experimental shed of 8x76 m, with 18 compartments of 3x3.5 m each and 100 birds per division. The results showed that the incidence of ascites was independent of the commercial broiler line, however, males were more susceptible.

  8. Robotic bariatric surgery: a systematic review.

    Science.gov (United States)

    Fourman, Matthew M; Saber, Alan A

    2012-01-01

    Obesity is a nationwide epidemic, and the only evidence-based, durable treatment of this disease is bariatric surgery. This field has evolved drastically during the past decade. One of the latest advances has been the increased use of robotics within this field. The goal of our study was to perform a systematic review of the recent data to determine the safety and efficacy of robotic bariatric surgery. The setting was the University Hospitals Case Medical Center (Cleveland, OH). A PubMed search was performed for robotic bariatric surgery from 2005 to 2011. The inclusion criteria were English language, original research, human, and bariatric surgical procedures. Perioperative data were then collected from each study and recorded. A total of 18 studies were included in our review. The results of our systematic review showed that bariatric surgery, when performed with the use of robotics, had similar or lower complication rates compared with traditional laparoscopy. Two studies showed shorter operative times using the robot for Roux-en-Y gastric bypass, but 4 studies showed longer operative times in the robotic arm. In addition, the learning curve appears to be shorter when robotic gastric bypass is compared with the traditional laparoscopic approach. Most investigators agreed that robotic laparoscopic surgery provides superior imaging and freedom of movement compared with traditional laparoscopy. The application of robotics appears to be a safe option within the realm of bariatric surgery. Prospective randomized trials comparing robotic and laparoscopic outcomes are needed to further define the role of robotics within the field of bariatric surgery. Longer follow-up times would also help elucidate any long-term outcomes differences with the use of robotics versus traditional laparoscopy. Copyright © 2012 American Society for Metabolic and Bariatric Surgery. All rights reserved.

  9. Determinação das constantes cinéticas de degradação do ácido ascórbico em purê de pêssego: efeito da temperatura e concentração

    OpenAIRE

    Toralles,Ricardo Peraça; Vendruscolo,João Luiz; Vendruscolo,Claire Tondo; Del Pino,Francisco Augusto Burkert; Antunes,Pedro Luiz

    2008-01-01

    O ácido ascórbico, vitamina C, é usado extensivamente na indústria de alimentos, não só devido ao seu valor nutricional, mas devido a suas contribuições funcionais na qualidade do produto. Existem muitos estudos sobre a estabilidade cinética do ácido ascórbico em bebidas, mas nenhum estudo foi encontrado sobre as constantes cinéticas de degradação do ácido ascórbico adicionado em purê de pêssego. Neste trabalho, estudou-se a cinética de degradação do ácido ascórbico em purê de pêssego da cult...

  10. Vitreoretinal complications and vitreoretinal surgery in osteo-odonto-keratoprosthesis surgery.

    Science.gov (United States)

    Lim, Laurence S; Ang, Chong Lye; Wong, Edmund; Wong, Doric W K; Tan, Donald T H

    2014-02-01

    To describe the indications for and approaches to vitreoretinal surgery in patients with osteo-odonto-keratoprosthesis (OOKP). Retrospective case series. This was a retrospective review of all patients who had undergone OOKP surgery between 2003 and 2012 at our center. OOKP procedures were performed for severe ocular surface disease according to the indications and techniques described in the patient demographics of the Rome-Vienna Protocol. Indications for retinal surgery, surgical outcomes, and intraoperative and postoperative complications were documented. Operative techniques were reviewed from the surgical records, and any subsequent surgeries were also recorded. Thirty-six patients underwent OOKP, and retinal surgery was indicated in 13 (36%). The indications for and approaches to surgery were retinal detachment repair using an Eckardt temporary keratoprosthesis; assessment of retina and optic nerve health prior to OOKP surgery, using either a temporary keratoprosthesis or an endoscope; endoscopic cyclophotocoagulation for intractable glaucoma; endoscopic trimming of a retroprosthetic membrane; or vitrectomy for endophthalmitis with visualization through the OOKP optic using the binocular indirect viewing system. In all cases, retinal surgical aims were achieved with a single procedure. Postoperative vitreous hemorrhage occurred in 16 patients (44%), but all resolved spontaneously. OOKPs represent the last hope for restoration of vision in severe ocular surface disease, and the retinal surgeon is frequently called upon in the assessment and management of these patients. Temporary keratoprostheses and endoscopic vitrectomies are valuable surgical tools in these challenging cases, improving functional outcomes without compromising OOKP success. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    The Annals of Pediatric Surgery is striving to fill an important niche that provides focus to clinical care, technical innovation and clinical research. The Annals of Pediatric Surgery has the responsibility to serve not only pediatric surgeons in the Middle East and North Africa but also should be an important conduit for scientific ...

  12. Safety in cardiac surgery

    NARCIS (Netherlands)

    Siregar, S.

    2013-01-01

    The monitoring of safety in cardiac surgery is a complex process, which involves many clinical, practical, methodological and statistical issues. The objective of this thesis was to measure and to compare safety in cardiac surgery in The Netherlands using the Netherlands Association for

  13. What Is Heart Surgery?

    Science.gov (United States)

    ... kidneys, liver, and lungs. Stroke , which may cause short-term or permanent damage. Death. (Heart surgery is more likely to be life threatening in people who are very sick before the surgery.) Memory loss and other issues, such as problems concentrating or ...

  14. Annals of African Surgery

    African Journals Online (AJOL)

    The goal of the Annals of African Surgery is to provide a medium for the exchange of current information between surgeons in the African region. The journal embraces surgery in all its aspects; basic science, clinical research, experimental research, surgical education. It will assist surgeons in the region to keep abreast of ...

  15. About Hand Surgery

    Science.gov (United States)

    ... Find a hand surgeon near you. © 2009 American Society for Surgery of the Hand. Definition developed by ASSH Council. Other Links CME Mission Statement and Disclaimer Policies and Technical Requirements Exhibits and Partners ASSH 822 W. Washington Blvd. ... 2018 by American Society for Surgery of the Hand × Search Tips Tip ...

  16. Lasik eye surgery - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100206.htm Lasik eye surgery - series—Normal anatomy To use the ... A.M. Editorial team. Related MedlinePlus Health Topics Laser Eye Surgery A.D.A.M., Inc. is accredited by ...

  17. LASIK - Laser Eye Surgery

    Science.gov (United States)

    ... Refractive Surgery Procedures What Is Photorefractive Keratectomy (PRK)? LASIK — Laser Eye Surgery Leer en Español: LASIK—Cirugía ocular con láser ... loss of close-up focusing power. How the LASIK procedure works LASIK is performed while the patient ...

  18. [Gases in vitreoretinal surgery].

    Science.gov (United States)

    Janco, L; Vida, R; Bartos, M; Villémová, K; Izák, M

    2012-02-01

    To evaluate the importance and benefits of using gases in vitreoretinal surgery. The gases represent a wide group of substances used in eye surgery for more than 100 years. The role of intraocular gases in vitreoretinal surgery is irreplaceable. Their use is still considered to be the "gold standard". An important step in eye surgery was the introduction of expanding gases--sulfur hexafluoride and perfluorocarbons into routine clinical practice. The most common indications for the use of intraocular gases are: retinal detachment, idiopathic macular hole, complications of vitreoretinal surgery and others. The introduction of intraocular gases into routine clinical practice, along with other modern surgical techniques resulted in significant improvement of postoperative outcomes in a wide range of eye diseases. Understanding the principles of intraocular gases use brings the benefits to the patient and physician as well. Due to their physical and chemical properties they pose far the best and most appropriate variant of intraocular tamponade. Gases also bring some disadvantages, such as difficulties in detailed fundus examination, visual acuity testing, ultrasonographic examination, difficulties in application of intravitreal drugs or reduced possibility of retina laser treatment. The gases significantly change optical system properties of the eye. The use of gases in vitreoretinal surgery has significantly increased success rate of retinal detachment surgery, complicated posterior segment cases, trauma, surgery of the macula and other diseases.

  19. Robust surgery loading

    NARCIS (Netherlands)

    Hans, Elias W.; Wullink, Gerhard; van Houdenhoven, Mark; Kazemier, Geert

    2008-01-01

    We consider the robust surgery loading problem for a hospital’s operating theatre department, which concerns assigning surgeries and sufficient planned slack to operating room days. The objective is to maximize capacity utilization and minimize the risk of overtime, and thus cancelled patients. This

  20. [Cognitive deterioration after surgery

    DEFF Research Database (Denmark)

    Steinmetz, J.; Rasmussen, L.S.

    2008-01-01

    Delirium and postoperative cognitive dysfunction are important and common complications after surgery. Risk factors are first of all increasing age and type of surgery, whereas the type of anaesthesia does not seem to play an important role. Mortality is higher among patients with cognitive...

  1. Hand Surgery: Anesthesia

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Hand Surgery Anesthesia Email to a friend * required ...

  2. Penile enlargement surgery.

    Science.gov (United States)

    Alter, G J

    1998-06-01

    Aesthetic surgery to improve the appearance of the penis, scrotum, and pubic region has successfully evolved. Penile lengthening is performed by releasing the suspensory ligament of the penis followed by use of penile weights. Girth is increased by wrapping a dermal-fat graft around the penile circumference. The choice of surgery is determined by the patient's anatomy and desires.

  3. Gastrointestinal robot-assisted surgery. A current perspective.

    Science.gov (United States)

    Lunca, Sorinel; Bouras, George; Stanescu, Alexandru Calin

    2005-12-01

    Minimally invasive techniques have revolutionized operative surgery. Computer aided surgery and robotic surgical systems strive to improve further on currently available minimally invasive surgery and open new horizons. Only several centers are currently using surgical robots and publishing data. In gastrointestinal surgery, robotic surgery is applied to a wide range of procedures, but is still in its infancy. Cholecystectomy, Nissen fundoplication and Heller myotomy are among the most frequently performed operations. The ZEUS (Computer Motion, Goleta, CA) and the da Vinci (Intuitive Surgical, Mountain View, CA) surgical systems are today the most advanced robotic systems used in gastrointestinal surgery. Most studies reported that robotic gastrointestinal surgery is feasible and safe, provides improved dexterity, better visualization, reduced fatigue and high levels of precision when compared to conventional laparoscopic surgery. Its main drawbacks are the absence of force feedback and extremely high costs. At this moment there are no reports to clearly demonstrate the superiority of robotics over conventional laparoscopic surgery. Further research and more prospective randomized trials are needed to better define the optimal application of this new technology in gastrointestinal surgery.

  4. Bariatric surgery and the changing current scope of general surgery practice: implications for general surgery residency training.

    Science.gov (United States)

    Mostaedi, Rouzbeh; Ali, Mohamed R; Pierce, Jonathan L; Scherer, Lynette A; Galante, Joseph M

    2015-02-01

    The scope of general surgery practice has evolved tremendously in the last 20 years. However, clinical experience in general surgery residency training has undergone relatively little change. To evaluate the current scope of academic general surgery and its implications on surgical residency. The University HealthSystem Consortium and Association of American Medical Colleges established the Faculty Practice Solution Center (FPSC) to characterize physician productivity. The FPSC is a benchmarking tool for academic medical centers created from revenue data collected from more than 90,000 physicians who practice at 95 institutions across the United States. The FPSC database was queried to evaluate the annual mean procedure frequency per surgeon (PFS) in each calendar year from 2006 through 2011. The associated work relative value units (wRVUs) were also examined to measure physician effort and skill. During the 6-year period, 146 distinct Current Procedural Terminology codes were among the top 100 procedures, and 16 of these procedures ranked in the top 10 procedures in at least 1 year. The top 10 procedures accounted for more than half (range, 52.5%-57.2%) of the total 100 PFS evaluated for each year. Laparoscopic Roux-en-Y gastric bypass was consistently among the top 10 procedures in each year (PFS, 18.2-24.6). The other most frequently performed procedures included laparoscopic cholecystectomy (PFS, 30.3-43.5), upper gastrointestinal tract endoscopy (PFS, 26.5-34.3), mastectomy (PFS, 16.5-35.0), inguinal hernia repair (PFS, 15.5-22.1), and abdominal wall hernia repair (PFS, 21.6-26.1). In all years, laparoscopic Roux-en-Y gastric bypass generated the highest number of wRVUs (wRVUs, 491.0-618.2), and laparoscopic cholecystectomy was regularly the next highest (wRVUs, 335.8-498.7). A significant proportion of academic general surgery is composed of bariatric surgery, yet surgical training does not sufficiently emphasize the necessary exposure to technical expertise

  5. Minimally invasive orthognathic surgery.

    Science.gov (United States)

    Resnick, Cory M; Kaban, Leonard B; Troulis, Maria J

    2009-02-01

    Minimally invasive surgery is defined as the discipline in which operative procedures are performed in novel ways to diminish the sequelae of standard surgical dissections. The goals of minimally invasive surgery are to reduce tissue trauma and to minimize bleeding, edema, and injury, thereby improving the rate and quality of healing. In orthognathic surgery, there are two minimally invasive techniques that can be used separately or in combination: (1) endoscopic exposure and (2) distraction osteogenesis. This article describes the historical developments of the fields of orthognathic surgery and minimally invasive surgery, as well as the integration of the two disciplines. Indications, techniques, and the most current outcome data for specific minimally invasive orthognathic surgical procedures are presented.

  6. DOE Centers of Excellence Performance Portability Meeting

    Energy Technology Data Exchange (ETDEWEB)

    Neely, J. R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2016-04-21

    Performance portability is a phrase often used, but not well understood. The DOE is deploying systems at all of the major facilities across ASCR and ASC that are forcing application developers to confront head-on the challenges of running applications across these diverse systems. With GPU-based systems at the OLCF and LLNL, and Phi-based systems landing at NERSC, ACES (LANL/SNL), and the ALCF – the issue of performance portability is confronting the DOE mission like never before. A new best practice in the DOE is to include “Centers of Excellence” with each major procurement, with a goal of focusing efforts on preparing key applications to be ready for the systems coming to each site, and engaging the vendors directly in a “shared fate” approach to ensuring success. While each COE is necessarily focused on a particular deployment, applications almost invariably must be able to run effectively across the entire DOE HPC ecosystem. This tension between optimizing performance for a particular platform, while still being able to run with acceptable performance wherever the resources are available, is the crux of the challenge we call “performance portability”. This meeting was an opportunity to bring application developers, software providers, and vendors together to discuss this challenge and begin to chart a path forward.

  7. The ASC Sequoia Programming Model

    Energy Technology Data Exchange (ETDEWEB)

    Seager, M

    2008-08-06

    In the late 1980's and early 1990's, Lawrence Livermore National Laboratory was deeply engrossed in determining the next generation programming model for the Integrated Design Codes (IDC) beyond vectorization for the Cray 1s series of computers. The vector model, developed in mid 1970's first for the CDC 7600 and later extended from stack based vector operation to memory to memory operations for the Cray 1s, lasted approximately 20 years (See Slide 5). The Cray vector era was deemed an extremely long lived era as it allowed vector codes to be developed over time (the Cray 1s were faster in scalar mode than the CDC 7600) with vector unit utilization increasing incrementally over time. The other attributes of the Cray vector era at LLNL were that we developed, supported and maintained the Operating System (LTSS and later NLTSS), communications protocols (LINCS), Compilers (Civic Fortran77 and Model), operating system tools (e.g., batch system, job control scripting, loaders, debuggers, editors, graphics utilities, you name it) and math and highly machine optimized libraries (e.g., SLATEC, and STACKLIB). Although LTSS was adopted by Cray for early system generations, they later developed COS and UNICOS operating systems and environment on their own. In the late 1970s and early 1980s two trends appeared that made the Cray vector programming model (described above including both the hardware and system software aspects) seem potentially dated and slated for major revision. These trends were the appearance of low cost CMOS microprocessors and their attendant, departmental and mini-computers and later workstations and personal computers. With the wide spread adoption of Unix in the early 1980s, it appeared that LLNL (and the other DOE Labs) would be left out of the mainstream of computing without a rapid transition to these 'Killer Micros' and modern OS and tools environments. The other interesting advance in the period is that systems were being developed with multiple 'cores' in them and called Symmetric Multi-Processor or Shared Memory Processor (SMP) systems. The parallel revolution had begun. The Laboratory started a small 'parallel processing project' in 1983 to study the new technology and its application to scientific computing with four people: Tim Axelrod, Pete Eltgroth, Paul Dubois and Mark Seager. Two years later, Eugene Brooks joined the team. This team focused on Unix and 'killer micro' SMPs. Indeed, Eugene Brooks was credited with coming up with the 'Killer Micro' term. After several generations of SMP platforms (e.g., Sequent Balance 8000 with 8 33MHz MC32032s, Allian FX8 with 8 MC68020 and FPGA based Vector Units and finally the BB&N Butterfly with 128 cores), it became apparent to us that the killer micro revolution would indeed take over Crays and that we definitely needed a new programming and systems model. The model developed by Mark Seager and Dale Nielsen focused on both the system aspects (Slide 3) and the code development aspects (Slide 4). Although now succinctly captured in two attached slides, at the time there was tremendous ferment in the research community as to what parallel programming model would emerge, dominate and survive. In addition, we wanted a model that would provide portability between platforms of a single generation but also longevity over multiple--and hopefully--many generations. Only after we developed the 'Livermore Model' and worked it out in considerable detail did it become obvious that what we came up with was the right approach. In a nutshell, the applications programming model of the Livermore Model posited that SMP parallelism would ultimately not scale indefinitely and one would have to bite the bullet and implement MPI parallelism within the Integrated Design Code (IDC). We also had a major emphasis on doing everything in a completely standards based, portable methodology with POSIX/Unix as the target environment. We decided against specialized libraries like STACKLIB for performance, but kept as many general purpose, portable math libraries as were needed by the codes. Third, we assumed that the SMPs in clusters would evolve in time to become more powerful, feature rich and, in particular, offer more cores. Thus, we focused on OpenMP, and POSIX PThreads for programming SMP parallelism. These code porting efforts were lead by Dale Nielsen, A-Division code group leader, and Randy Christensen, B-Division code group leader. Most of the porting effort revolved removing 'Crayisms' in the codes: artifacts of LTSS/NLTSS, Civic compiler extensions beyond Fortran77, IO libraries and dealing with new code control languages (we switched to Perl and later to Python). Adding MPI to the codes was initially problematic and error prone because the programmers used MPI directly and sprinkled the calls throughout the code.

  8. Cleft Lip and Palate Surgery

    Science.gov (United States)

    ... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery is ... the carefully orchestrated, multiple-stage correctional program for cleft lip and palate patients. The goal is to help restore the ...

  9. Gamma knife surgery for craniopharyngioma

    International Nuclear Information System (INIS)

    Prasad, D.; Steiner, M.; Steiner, L.

    1995-01-01

    We present our results of Gamma Knife surgery for craniopharyngioma in nine patients. The current status of surgery, radiation therapy, intracavitary instillation of radionuclides and Gamma Knife surgery in the management of craniopharyngiomas is discussed. (author)

  10. Heart failure - surgeries and devices

    Science.gov (United States)

    ... surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure ... problem may cause heart failure or make heart failure worse. Heart valve surgery may be needed to repair or ...

  11. Epiretinal membrane surgery

    DEFF Research Database (Denmark)

    Hamoudi, Hassan; Correll Christensen, Ulrik; La Cour, Morten

    2017-01-01

    Purpose: To assess the impact of combined phacoemulsification-vitrectomy and sequential surgery for idiopathic epiretinal membrane (ERM) on refractive error (RE) and macular morphology. Methods: In this prospective clinical trial, we allocated phakic eyes with ERM to (1) cataract surgery and subs......Purpose: To assess the impact of combined phacoemulsification-vitrectomy and sequential surgery for idiopathic epiretinal membrane (ERM) on refractive error (RE) and macular morphology. Methods: In this prospective clinical trial, we allocated phakic eyes with ERM to (1) cataract surgery...... and achieved spherical equivalent); secondary outcomes were best-corrected visual acuity (BCVA), and incidence of cystoid macular oedema (CME) defined as >10% increment of central subfield macular thickness (CSMT). Results: Sixty-two eyes were enrolled. The mean RE showed a small myopic shift of -0.36D in all...... between the groups. Four cases (17%) in the CAT group had resolved visual complaints and improved BCVA after cataract surgery resulting in no need for PPV within the follow-up period. Conclusion: Surgery for idiopathic ERM in phakic eyes with either phaco-vitrectomy or sequential surgery are equal...

  12. Craniofacial Surgery Fellowship Websites.

    Science.gov (United States)

    Silvestre, Jason; Agarwal, Divyansh; Taylor, Jesse A

    2016-06-01

    Applicants for craniofacial surgery fellowships utilize Internet-based resources like the San Francisco (SF) Match to manage applications. The purpose of this study was to evaluate the accessibility and content of craniofacial surgery fellowship websites (CSFWs). A list of available craniofacial surgery fellowships was compiled from directories of the American Society of Craniofacial Surgery (ACSFS) and SF Match. Accessibility of CSFWs was assessed via links from these directories and a Google search. Craniofacial surgery fellowship websites were evaluated on education and recruitment content and compared via program characteristics. Twenty-four of the 28 US-based craniofacial surgery fellowship programs had a CSFW (86%). The ACSFS and SF Match databases had limited CSFW accessibility, but a Google search revealed most CSFWs had the top search result (76%). In total, CSFWs provided an average of 39% of education and recruitment variables. While most programs provided fellowship program descriptions (96%), application links (96%), and faculty listings (83%), relatively few provided rotation schedules (13%), fellow selection process information (13%), or interview dates (8%). CSFW content did not vary by program location, faculty size, accreditation status, or institutional affiliations (P > 0.05). Craniofacial surgery fellowships often lack readily accessible websites from national program lists and have limited information for interested applicants. The consistent lack of online information across programs suggests future opportunities exist to improve these educational resources.

  13. Surgery for chronic subdural hematoma in nonagenarians

    DEFF Research Database (Denmark)

    Bartek, J; Sjåvik, K; Ståhl, F

    2017-01-01

    OBJECTIVE: Chronic subdural hematoma (cSDH) is a prevalent condition often seen in the elderly, with surgery being the treatment of choice when symptomatic. So far, few have explored the surgical outcomes in patients 90 years or older. The aim of this study was to investigate outcome after c...... neurosurgical centers. In a comparative analysis, the primary end-point was difference in hematoma recurrence rates between the ≥90 y/o and

  14. Emergency thoracic surgery in elderly patients

    OpenAIRE

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants ...

  15. Preoperative lifestyle intervention in bariatric surgery: a randomized clinical trial.

    Science.gov (United States)

    Kalarchian, Melissa A; Marcus, Marsha D; Courcoulas, Anita P; Cheng, Yu; Levine, Michele D

    2016-01-01

    Studies on the impact of presurgery weight loss and lifestyle preparation on outcomes following bariatric surgery are needed. To evaluate whether a presurgery behavioral lifestyle intervention improves weight loss through a 24-month postsurgery period. Bariatric Center of Excellence at a large, urban medical center. Candidates for bariatric surgery were randomized to a 6-month behavioral lifestyle intervention or to 6 months of usual presurgical care. The lifestyle intervention consisted of 8 weekly face-to-face sessions, followed by 16 weeks of face-to-face and telephone sessions before surgery; the intervention also included 3 monthly telephone contacts after surgery. Assessments were conducted 6, 12, and 24 months after surgery. Participants who underwent surgery (n = 143) were 90.2% female and 86.7% White. Average age was 44.9 years, and average body mass index was 47.5 kg/m(2) at study enrollment. At follow-up, 131 (91.6%), 126 (88.1%), 117 (81.8%) patients participated in the 6-, 12-, and 24-month assessments, respectively. Percent weight loss from study enrollment to 6 and 12 months after surgery was comparable for both groups, but at 24 months after surgery, the lifestyle group had significantly smaller percent weight loss compared with the usual care group (26.5% versus 29.5%, respectively, P = .02). Presurgery lifestyle intervention did not improve weight loss at 24 months after surgery. The findings from this study raise questions about the utility and timing of adjunctive lifestyle interventions for bariatric surgery patients. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  16. Surveys on surgery theory

    CERN Document Server

    Cappell, Sylvain; Rosenberg, Jonathan

    2014-01-01

    Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. The sixtieth birthday (on December 14, 1996) of C.T.C. Wall, a leading member of the subject''s founding generation, led the editors of this volume to reflect on the extraordinary accomplishments of surgery theory as well as its current enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source surveying surgery theory and its applications. Because no one person could write such a survey, the editors ask

  17. Surveys on surgery theory

    CERN Document Server

    Cappell, Sylvain; Rosenberg, Jonathan

    2014-01-01

    Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. There have been some extraordinary accomplishments in that time, which have led to enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source that surveys surgery theory and its applications. Indeed, no one person could write such a survey. The sixtieth birthday of C. T. C. Wall, one of the leaders of the founding generation of surgery theory, provided an opportunity to rectify the situation and produce a

  18. Surgery of malignant pancreatic tumors

    International Nuclear Information System (INIS)

    Loos, M.; Friess, H.; Kleeff, J.

    2009-01-01

    Ductal adenocarcinoma is the most common malignant tumor of the pancreas. Despite great efforts in basic and clinical pancreatic cancer research, the prognosis remains poor with an overall 5-year survival rate of less than 5%. Complete surgical resection represents the only curative treatment option and 5-year survival rates of 20-25% can be achieved following curative resection and adjuvant chemotherapy. Although pancreatic surgery is considered one of the most technically demanding and challenging procedures, there has been constant progress in surgical techniques and advances in perioperative care with a modern interdisciplinary approach including anesthesiology, oncology, radiology and nursing. This has reduced morbidity and especially mortality rates in high-volume centers. Among extended resection procedures multivisceral and venous resections are technically feasible and should be considered if a complete tumor resection can be achieved. Multimodal regimens have shown promising results, however, only adjuvant chemotherapy is supported by solid evidence from randomized controlled trials. (orig.) [de

  19. Constipation after thoraco-lumbar fusion surgery.

    Science.gov (United States)

    Stienen, Martin N; Smoll, Nicolas R; Hildebrandt, Gerhard; Schaller, Karl; Tessitore, Enrico; Gautschi, Oliver P

    2014-11-01

    Thoraco-lumbar posterior fusion surgery is a frequent procedure used for patients with spinal instability due to tumor, trauma or degenerative disease. In the perioperative phase, many patients may experience vomiting, bowel irritation, constipation, or may even show symptoms of adynamic ileus possibly due to immobilization and high doses of opioid analgesics and narcotics administered during and after surgery. Retrospective single-center study on patients undergoing thoraco-lumbar fusion surgery for degenerative lumbar spine disease with instability in 2012. Study groups were built according to presence/absence of postoperative constipation, with postoperative constipation being defined as no bowel movement on postoperative days 0-2. Ninety-nine patients (39 males, 60 females) with a mean age of 57.1 ± 17.3 years were analyzed, of which 44 patients with similar age, gender, BMI and ASA-grades showed constipation (44.4%). Occurrence of constipation was associated with longer mean operation times (247 ± 62 vs. 214 ± 71 min; p=0.012), higher estimated blood loss (545 ± 316 vs. 375 ± 332 ml; pconstipation. One patient with constipation developed a sonographically confirmed paralytic ileus. Patients with constipation showed a tendency toward longer postoperative hospitalization (7.6 vs. 6.7 days, p=0.136). The rate of constipation was high after thoraco-lumbar fusion surgery. Moreover, it was associated with longer surgery time, higher blood loss, and higher postoperative morphine doses. Further trials are needed to prove if the introduction of faster and less invasive surgery techniques may have a positive side effect on bowel movement after spine surgery as they may reduce operation times, blood loss and postoperative morphine use. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. Should bariatric surgery be performed in adolescents?

    Science.gov (United States)

    Beamish, Andrew J; Reinehr, Thomas

    2017-04-01

    Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications. © 2017 European Society of Endocrinology.

  1. Robotic liver surgery: results for 70 resections.

    Science.gov (United States)

    Giulianotti, Pier Cristoforo; Coratti, Andrea; Sbrana, Fabio; Addeo, Pietro; Bianco, Francesco Maria; Buchs, Nicolas Christian; Annechiarico, Mario; Benedetti, Enrico

    2011-01-01

    Robotic surgery is gaining popularity for digestive surgery; however, its use for liver surgery is reported scarcely. This article reviews a surgeon's experience with the use of robotic surgery for liver resections. From March 2002 to March 2009, 70 robotic liver resections were performed at 2 different centers by a single surgeon. The surgical procedure and postoperative outcome data were reviewed retrospectively. Malignant tumors were indications for resections in 42 (60%) patients, whereas benign tumors were indications in 28 (40%) patients. The median age was 60 years (range, 21-84) and 57% of patients were female. Major liver resections (≥ 3 liver segments) were performed in 27 (38.5%) patients. There were 4 conversions to open surgery (5.7%). The median operative time for a major resection was 313 min (range, 220-480) and 198 min (range, 90-459) for minor resection. The median blood loss was 150 mL (range, 20-1,800) for minor resection and 300 mL (range, 100-2,000) for major resection. The mortality rate was 0%, and the overall rate of complications was 21%. Major morbidity occurred in 4 patients in the major hepatectomies group (14.8%) and in 4 patients in the minor hepatectomies group (9.3%). All complications were managed conservatively and none required reoperation. This preliminary experience shows that robotic surgery can be used safely for liver resections with a limited conversion rate, blood loss, and postoperative morbidity. Robotics offers a new technical option for minimally invasive liver surgery. Copyright © 2011 Mosby, Inc. All rights reserved.

  2. Reengineering a cardiovascular surgery service.

    Science.gov (United States)

    Tunick, P A; Etkin, S; Horrocks, A; Jeglinski, G; Kelly, J; Sutton, P

    1997-04-01

    Reengineering, involving the radical redesign of business processes, has been used successfully in a variety of health care settings. In 1994 New York University (NYU) Medical Center (MC) launched its first reengineering team, whose purpose was to redesign the entire process of caring for patients-from referral to discharge-on the cardiovascular (CV) surgery service. REENIGINEERING TEAM: The multidisciplinary CV Surgery Reengineering Team was charged with two goals: improving customer (patient, family, and referring physician) satisfaction and improving profitability. The methodology to be used was based on a reengineering philosophy-discarding basic assumptions and designing the patient care process from the ground up. THE TRANSFER-IN INITIATIVE: A survey of NYU cardiologists, distributed in April 1994, suggested that the organization was considered a difficult place to transfer patients. The team's recommendations led to a new, streamlined transfer-in policy. The average waiting time from when a referring physician requested a patient transfer and the time when an NYUMC physician accepted the transfer decreased from an average of 9 hours under the old system to immediate acceptance. Three customer satisfaction task forces implemented multiple programs to make the service more user friendly. In addition, referrals increased and length of stay decreased, without an adverse impact on the mortality rate. For the first time at NYUMC, a multidisciplinary team was given the mandate to achieve major changes in an entire patient care process. Similar projects are now underway.

  3. A Yersinia effector with enhanced inhibitory activity on the NF-κB pathway activates the NLRP3/ASC/caspase-1 inflammasome in macrophages.

    Directory of Open Access Journals (Sweden)

    Ying Zheng

    2011-04-01

    Full Text Available A type III secretion system (T3SS in pathogenic Yersinia species functions to translocate Yop effectors, which modulate cytokine production and regulate cell death in macrophages. Distinct pathways of T3SS-dependent cell death and caspase-1 activation occur in Yersinia-infected macrophages. One pathway of cell death and caspase-1 activation in macrophages requires the effector YopJ. YopJ is an acetyltransferase that inactivates MAPK kinases and IKKβ to cause TLR4-dependent apoptosis in naïve macrophages. A YopJ isoform in Y. pestis KIM (YopJ(KIM has two amino acid substitutions, F177L and K206E, not present in YopJ proteins of Y. pseudotuberculosis and Y. pestis CO92. As compared to other YopJ isoforms, YopJ(KIM causes increased apoptosis, caspase-1 activation, and secretion of IL-1β in Yersinia-infected macrophages. The molecular basis for increased apoptosis and activation of caspase-1 by YopJ(KIM in Yersinia-infected macrophages was studied. Site directed mutagenesis showed that the F177L and K206E substitutions in YopJ(KIM were important for enhanced apoptosis, caspase-1 activation, and IL-1β secretion. As compared to YopJ(CO92, YopJ(KIM displayed an enhanced capacity to inhibit phosphorylation of IκB-α in macrophages and to bind IKKβ in vitro. YopJ(KIM also showed a moderately increased ability to inhibit phosphorylation of MAPKs. Increased caspase-1 cleavage and IL-1β secretion occurred in IKKβ-deficient macrophages infected with Y. pestis expressing YopJ(CO92, confirming that the NF-κB pathway can negatively regulate inflammasome activation. K+ efflux, NLRP3 and ASC were important for secretion of IL-1β in response to Y. pestis KIM infection as shown using macrophages lacking inflammasome components or by the addition of exogenous KCl. These data show that caspase-1 is activated in naïve macrophages in response to infection with a pathogen that inhibits IKKβ and MAPK kinases and induces TLR4-dependent apoptosis. This pro

  4. Outcome of intracranial aneurysm surgery: single center experience

    Directory of Open Access Journals (Sweden)

    Murat Ulutas

    2016-12-01

    Conclusion: Multiple aneurysms, poor grade and intracerebral hematomas are poor prognostic factors. The patients who have subarachnoid hemorrhage should be monitored by an experienced team of neurosurgery and intensive care and should be operated on as soon as possible because of rehemorrhage risk. The surgical clipping as a gold standard is still an affective and successful method. [Cukurova Med J 2016; 41(4.000: 732-743

  5. NBME subject examination in surgery scores correlate with surgery clerkship clinical experience.

    Science.gov (United States)

    Myers, Jonathan A; Vigneswaran, Yalini; Gabryszak, Beth; Fogg, Louis F; Francescatti, Amanda B; Golner, Christine; Bines, Steven D

    2014-01-01

    Most medical schools in the United States use the National Board of Medical Examiners Subject Examinations as a method of at least partial assessment of student performance, yet there is still uncertainty of how well these examination scores correlate with clinical proficiency. Thus, we investigated which factors in a surgery clerkship curriculum have a positive effect on academic achievement on the National Board of Medical Examiners Subject Examination in Surgery. A retrospective analysis of 83 third-year medical students at our institution with 4 unique clinical experiences on the general surgery clerkship for the 2007-2008 academic year was conducted. Records of the United States Medical Licensing Examination Step 1 scores, National Board of Medical Examiners Subject Examination in Surgery scores, and essay examination scores for the groups were compared using 1-way analysis of variance testing. Rush University Medical Center, Chicago IL, an academic institution and tertiary care center. Our data demonstrated National Board of Medical Examiners Subject Examination in Surgery scores from the group with the heavier clinical loads and least time for self-study were statistically higher than the group with lighter clinical services and higher rated self-study time (p = 0.036). However, there was no statistical difference of National Board of Medical Examiners Subject Examination in Surgery scores between the groups with equal clinical loads (p = 0.751). Students experiencing higher clinical volumes on surgical services, but less self-study time demonstrated statistically higher academic performance on objective evaluation, suggesting clinical experience may be of higher value than self-study and reading. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  6. Corrective Jaw Surgery

    Medline Plus

    Full Text Available AAOMS - Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who ... surgeons surgically treat the soft tissues of the face, mouth and gums to improve function, appearance and ...

  7. COMPUTERS IN SURGERY

    African Journals Online (AJOL)

    BODE

    Key words: Computers, surgery, applications. Introduction ... With improved memory, speed and processing power in an ever more compact ... with picture and voice embedment to wit. With the ... recall the tedium of anatomy, physiology and.

  8. HEAD AND NECK SURGERY

    African Journals Online (AJOL)

    simple and well tolerated, and can be used selectively or as a ... up clinical information was obtained from a review of the patients' .... When a mass is clinically malignant, and facial nerve ... extension of surgery and closer attention to tumour.

  9. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... surgery. It is important to understand that your treatment, which will probably include orthodontics before and after ... to realistically estimate the time required for your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided ...

  10. Aortic valve surgery - open

    Science.gov (United States)

    ... gov/ency/article/007408.htm Aortic valve surgery - open To use the sharing features on this page, ... separates the heart and aorta. The aortic valve opens so blood can flow out. It then closes ...

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who We ... surgically treat the soft tissues of the face, mouth and gums to improve function, appearance and oral ...

  12. Spine surgery - discharge

    Science.gov (United States)

    ... milk). This means you should not lift a laundry basket, grocery bags, or small children. You should ... Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. ...

  13. Pain Medications After Surgery

    Science.gov (United States)

    ... be used for outpatient procedures or more-involved inpatient surgery. For pain relief lasting several hours, an ... surgical care, such as rest, ice packs, rehabilitative exercises and wound care. Ask to have written instructions ...

  14. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... in face, mouth and jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively ...

  15. Scoliosis surgery - child

    Science.gov (United States)

    ... from getting worse. But, when they no longer work, the child's health care provider will recommend surgery. There are several reasons to treat scoliosis: Appearance is a major concern. Scoliosis often causes back pain. If the curve is severe enough, ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... performs the actual surgery. It is important to understand that your treatment, which will probably include orthodontics ... several years to complete. Your OMS and orthodontist understand that this is a long-term commitment for ...

  17. Ambulatory paediatric surgery

    African Journals Online (AJOL)

    reminder and instructions 24 - 48 hours before surgery. Effective communication with ... patients, no abnormal postoperative behaviour patterns were recorded by the ... nursing and administration staff - less desirable is a day- stay ward with ...

  18. Aids and Surgery

    African Journals Online (AJOL)

    user

    2004-12-02

    Dec 2, 2004 ... The correlation between HIV infection and surgery began to be highlighted only two ... expect greater clinical exposure to patients with. HIV/AIDS. .... fractures in HIV patient, although too little is known about the relationship ...

  19. HEAD AND NECK SURGERY

    African Journals Online (AJOL)

    +/-symptoms and signs), intravenous calcium gluconate and oral calcium lactate is .... facilitated by surgical stress, Vitamin D deficiency and hungry .... recurrence after thyroid surgery, excluding cancer. Chirurgie. ... Crea C, Alesina P, et al.

  20. Hip fracture surgeries

    Science.gov (United States)

    ... clearly. Sometimes, surgery can make this problem worse. Pressure sores ( pressure ulcers or bed sores) from being in bed or ... the hospital for 3 to 5 days. Full recovery will take from 3 to 4 months to ...