3D printing of surgical instruments for long-duration space missions.

Science.gov (United States)

Wong, Julielynn Y; Pfahnl, Andreas C

2014-07-01

The first off-Earth fused deposition modeling (FDM) 3D printer will explore thermoplastic manufacturing capabilities in microgravity. This study evaluated the feasibility of FDM 3D printing 10 acrylonitrile butadiene styrene (ABS) thermoplastic surgical instruments on Earth. Three-point bending tests compared stiffness and yield strength between FDM 3D printed and conventionally manufactured ABS thermoplastic. To evaluate the relative speed of using four printed instruments compared to conventional instruments, 13 surgeons completed simulated prepping, draping, incising, and suturing tasks. Each surgeon ranked the performance of six printed instruments using a 5-point Likert scale. At a thickness of 5.75 mm or more, the FDM printing process had a less than 10% detrimental effect on the tested yield strength and stiffness of horizontally printed ABS thermoplastic relative to conventional ABS thermoplastic. Significant weakness was observed when a bending load was applied transversely to a 3D printed layer. All timed tasks were successfully performed using a printed sponge stick, towel clamp, scalpel handle, and toothed forceps. There was no substantial difference in time to completion of simulated surgical tasks with control vs. 3D printed instruments. Of the surgeons, 100%, 92%, 85%, 77%, 77%, and 69% agreed that the printed smooth and tissue forceps, curved and straight hemostats, tissue and right angle clamps, respectively, would perform adequately. It is feasible to 3D print ABS thermoplastic surgical instruments on Earth. Loadbearing structures were designed to be thicker, when possible. Printing orientations were selected so that the printing layering direction of critical structures would not be transverse to bending loads.

Research on seamless development of surgical instruments based on biological mechanisms using CAD and 3D printer.

Science.gov (United States)

Yamamoto, Ikuo; Ota, Ren; Zhu, Rui; Lawn, Murray; Ishimatsu, Takakazu; Nagayasu, Takeshi; Yamasaki, Naoya; Takagi, Katsunori; Koji, Takehiko

2015-01-01

In the area of manufacturing surgical instruments, the ability to rapidly design, prototype and test surgical instruments is critical. This paper provides a simple case study of the rapid development of two bio-mechanism based surgical instruments which are ergonomic, aesthetic and were successfully designed, prototyped and conceptually tested in a very short period of time.

The history of thoracic surgical instruments and instrumentation.

Science.gov (United States)

Hagopian, E J; Mann, C; Galibert, L A; Steichen, F M

2000-02-01

Thoracic surgical practice has evolved from the innovations of its pioneers. Beginning with the stethoscope discovered by Laënnec with his system of auscultation, to the tools we use in the dissection and control of the hilum of the lung for resection, our practice of thoracic surgery has been entwined with the development of instruments and instrumentation. The development of strategies to prevent death from the open pneumothorax began with manual control of the mediastinum and progressed through differential pressure to, finally, the technique of intubation and the methods of positive-pressure and insufflation anesthesia. The instruments we place in our hands are not enough to define our art. Entry into the chest would not be possible without the use of rib retractors, rib shears, and even periosteal elevators. Finally, to the present day of minimally invasive techniques and the application of thoracoscopy for therapeutic purposes, we find the efforts of our predecessors well developed. For the progression from the fear of the open pneumothorax to the present-day state of the ease of thoracotomy for lung resection we are indebted to those who gave so much of their time and, for some, their lives to death from tuberculosis, to allow the advancement of our practice of surgery. These great people should be remembered not only for their acceptance of novel ideas but also, more importantly, for their lack of fear of testing them.

Glioneuronal Heterotopia Presenting As a Cerebellopontine angle Tumor of the cranial Nerve VIII, Case Report.

Science.gov (United States)

Peris-Celda, M; Giannini, C; Diehn, F E; Eckel, L J; Neff, B A; Van Gompel, J J

2018-04-03

Vestibular schwannomas and meningiomas account for the great majority of lesions arising in the cerebellopontine angle (CPA). In this report, we present a case of glioneuronal heterotopia, also known as glioneuronal hamartoma, arising from the VIII cranial nerve, which is an extremely uncommon lesion. Important radiologic and surgical aspects are reviewed, which may help in early recognition and intraoperative decision making when these lesions are encountered. A healthy 29-year-old female presented with intermittent right facial numbness. Magnetic resonance imaging (MRI) showed an incidental minimally enhancing cerebellopontine angle lesion on the right VII-VIII cranial nerve complex. The patient declined serial observation and opted for operative intervention for resection. Intraoperatively, the lesion resembled neural tissue and was continuous with the VIII cranial nerve. Pathological analysis demonstrated mature glioneuronal tissue consistent with hamartomatous brain tissue. The patient maintained normal hearing and facial nerve function after surgery. Radiologic, surgical and pathological characteristics are described. Ectopic glioneuronal tissue of the VIII cranial nerve is a rare non-neoplastic lesion, and should be considered in the differential diagnosis of unusual appearing intracanalicular and cerebellopontine angle lesions. The congenital and benign nature of this entity makes observation a valid option for these cases, although they are so infrequent that they are often presumptively managed as vestibular schwannomas. Attempts to radically resect these lesions may result in higher rates of hearing loss or facial palsy due to their continuity with the cranial nerves. Copyright © 2018 Elsevier Inc. All rights reserved.

Efficacy and safety of rVIII-SingleChain: results of a phase 1/3 multicenter clinical trial in severe hemophilia A

Science.gov (United States)

Mahlangu, Johnny; Kuliczkowski, Kazimierz; Karim, Faraizah Abdul; Stasyshyn, Oleksandra; Kosinova, Marina V.; Lepatan, Lynda Mae; Skotnicki, Aleksander; Boggio, Lisa N.; Klamroth, Robert; Oldenburg, Johannes; Hellmann, Andrzej; Santagostino, Elena; Baker, Ross I.; Fischer, Kathelijn; Gill, Joan C.; P’Ng, Stephanie; Chowdary, Pratima; Escobar, Miguel A.; Khayat, Claudia Djambas; Rusen, Luminita; Bensen-Kennedy, Debra; Blackman, Nicole; Limsakun, Tharin; Veldman, Alex; St. Ledger, Katie

2016-01-01

Recombinant VIII (rVIII)-SingleChain is a novel B-domain–truncated recombinant factor VIII (rFVIII), comprised of covalently bonded factor VIII (FVIII) heavy and light chains. It was designed to have a higher binding affinity for von Willebrand factor (VWF). This phase 1/3 study investigated the efficacy and safety of rVIII-SingleChain in the treatment of bleeding episodes, routine prophylaxis, and surgical prophylaxis. Participants were ≥12 years of age, with severe hemophilia A (endogenous FVIII <1%). The participants were allocated by the investigator to receive rVIII-SingleChain in either an on-demand or prophylaxis regimen. Of the 175 patients meeting study eligibility criteria, 173 were treated with rVIII-SingleChain, prophylactically (N = 146) or on-demand (N = 27). The total cumulative exposure was 14 306 exposure days (EDs), with 120 participants reaching ≥50 EDs and 52 participants having ≥100 EDs. Hemostatic efficacy was rated by the investigator as excellent or good in 93.8% of the 835 bleeds treated and assessed. Across all prophylaxis regimens, the median annualized spontaneous bleeding rate was 0.00 (Q1, Q3: 0.0, 2.4) and the median overall annualized bleeding rate (ABR) was 1.14 (Q1, Q3: 0.0, 4.2). Surgical hemostasis was rated as excellent/good in 100% of major surgeries by the investigator. No participant developed FVIII inhibitors. In conclusion, rVIII-SingleChain is a novel rFVIII molecule showing excellent hemostatic efficacy in surgery and in the control of bleeding events, low ABR in patients on prophylaxis, and a favorable safety profile in this large clinical study. This trial was registered at www.clinicaltrials.gov as #NCT01486927. PMID:27330001

Factors determining the potential for onward transmission of variant Creutzfeldt–Jakob disease via surgical instruments

Science.gov (United States)

Garske, Tini; Ward, Hester J.T; Clarke, Paul; Will, Robert G; Ghani, Azra C

2006-01-01

While the number of variant Creutzfeldt–Jakob disease (vCJD) cases continues to decline, concern has been raised that transmission could occur directly from one person to another through routes including the transfer of blood and shared use of surgical instruments. Here we firstly present data on the surgical procedures undertaken on vCJD patients prior to onset of clinical symptoms, which supports the hypothesis that cases via this route are possible. We then apply a mathematical framework to assess the potential for self-sustaining epidemics via surgical procedures. Data from hospital episode statistics on the rates of high- and medium-risk procedures in the UK were used to estimate model parameters, and sensitivity to other unknown parameters about surgically transmitted vCJD was assessed. Our results demonstrate that a key uncertainty determining the scale of an epidemic and whether it is self-sustaining is the number of times a single instrument is re-used, alongside the infectivity of contaminated instruments and the effectiveness of cleaning. A survey into the frequency of re-use of surgical instruments would help reduce these uncertainties. PMID:17015298

Automatic localization of the da Vinci surgical instrument tips in 3-D transrectal ultrasound.

Science.gov (United States)

Mohareri, Omid; Ramezani, Mahdi; Adebar, Troy K; Abolmaesumi, Purang; Salcudean, Septimiu E

2013-09-01

Robot-assisted laparoscopic radical prostatectomy (RALRP) using the da Vinci surgical system is the current state-of-the-art treatment option for clinically confined prostate cancer. Given the limited field of view of the surgical site in RALRP, several groups have proposed the integration of transrectal ultrasound (TRUS) imaging in the surgical workflow to assist with accurate resection of the prostate and the sparing of the neurovascular bundles (NVBs). We previously introduced a robotic TRUS manipulator and a method for automatically tracking da Vinci surgical instruments with the TRUS imaging plane, in order to facilitate the integration of intraoperative TRUS in RALRP. Rapid and automatic registration of the kinematic frames of the da Vinci surgical system and the robotic TRUS probe manipulator is a critical component of the instrument tracking system. In this paper, we propose a fully automatic registration technique based on automatic 3-D TRUS localization of robot instrument tips pressed against the air-tissue boundary anterior to the prostate. The detection approach uses a multiscale filtering technique to identify and localize surgical instrument tips in the TRUS volume, and could also be used to detect other surface fiducials in 3-D ultrasound. Experiments have been performed using a tissue phantom and two ex vivo tissue samples to show the feasibility of the proposed methods. Also, an initial in vivo evaluation of the system has been carried out on a live anaesthetized dog with a da Vinci Si surgical system and a target registration error (defined as the root mean square distance of corresponding points after registration) of 2.68 mm has been achieved. Results show this method's accuracy and consistency for automatic registration of TRUS images to the da Vinci surgical system.

Surgical site infections following instrumented stabilization of the spine

Directory of Open Access Journals (Sweden)

Dapunt U

2017-09-01

Full Text Available Ulrike Dapunt,1 Caroline Bürkle,1 Frank Günther,2 Wojciech Pepke,1 Stefan Hemmer,1 Michael Akbar1 1Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 2Department for Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University, Heidelberg, Germany Background: Implant-associated infections are still a feared complication in the field of orthopedics. Bacteria attach to the implant surface and form so-called biofilm colonies that are often difficult to diagnose and treat. Since the majority of studies focus on prosthetic joint infections (PJIs of the hip and knee, current treatment options (eg, antibiotic prophylaxis of implant-associated infections have mostly been adapted according to these results. Objective: The aim of this study was to evaluate patients with surgical site infections following instrumented stabilization of the spine with regard to detected bacteria species and the course of the disease. Patients and methods: We performed a retrospective single-center analysis of implant-associated infections of the spine from 2010 to 2014. A total of 138 patients were included in the study. The following parameters were evaluated: C-reactive protein serum concentration, microbiological evaluation of tissue samples, the time course of the disease, indication for instrumented stabilization of the spine, localization of the infection, and the number of revision surgeries required until cessation of symptoms. Results: Coagulase-negative Staphylococcus spp. were most commonly detected (n=69, 50%, followed by fecal bacteria (n=46, 33.3%. In 23.2% of cases, no bacteria were detected despite clinical suspicion of an infection. Most patients suffered from degenerative spine disorders (44.9%, followed by spinal fractures (23.9%, non-degenerative scoliosis (20.3%, and spinal tumors (10.1%. Surgical site infections occurred predominantly within 3

Endoscopic vision-based tracking of multiple surgical instruments during robot-assisted surgery.

Science.gov (United States)

Ryu, Jiwon; Choi, Jaesoon; Kim, Hee Chan

2013-01-01

Robot-assisted minimally invasive surgery is effective for operations in limited space. Enhancing safety based on automatic tracking of surgical instrument position to prevent inadvertent harmful events such as tissue perforation or instrument collisions could be a meaningful augmentation to current robotic surgical systems. A vision-based instrument tracking scheme as a core algorithm to implement such functions was developed in this study. An automatic tracking scheme is proposed as a chain of computer vision techniques, including classification of metallic properties using k-means clustering and instrument movement tracking using similarity measures, Euclidean distance calculations, and a Kalman filter algorithm. The implemented system showed satisfactory performance in tests using actual robot-assisted surgery videos. Trajectory comparisons of automatically detected data and ground truth data obtained by manually locating the center of mass of each instrument were used to quantitatively validate the system. Instruments and collisions could be well tracked through the proposed methods. The developed collision warning system could provide valuable information to clinicians for safer procedures. © 2012, Copyright the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Lacerations to Zones VIII and IX: It Is Not Just a Tendon Injury

Directory of Open Access Journals (Sweden)

Charla R. Fischer

2011-01-01

Full Text Available Extensor tendon injuries are widely believed to be straightforward problems that are relatively simple to manage. However, these injuries can be complex and demand a thorough understanding of anatomy to achieve the best functional outcomes. When lacerations occur in the forearm as in Zones VIII and IX injury, the repair of the extensor tendon and muscle, and posterior interosseous nerve (PIN is often challenging. A review of the literature shows little guidance and attention for these injuries. We present four patients with injuries to Zones VIII and IX as well as a review of surgical technique, postoperative rehabilitation, and pearls that may be of benefit to those managing these injuries.

Instrument-mounted displays for reducing cognitive load during surgical navigation.

Science.gov (United States)

Herrlich, Marc; Tavakol, Parnian; Black, David; Wenig, Dirk; Rieder, Christian; Malaka, Rainer; Kikinis, Ron

2017-09-01

Surgical navigation systems rely on a monitor placed in the operating room to relay information. Optimal monitor placement can be challenging in crowded rooms, and it is often not possible to place the monitor directly beside the situs. The operator must split attention between the navigation system and the situs. We present an approach for needle-based interventions to provide navigational feedback directly on the instrument and close to the situs by mounting a small display onto the needle. By mounting a small and lightweight smartwatch display directly onto the instrument, we are able to provide navigational guidance close to the situs and directly in the operator's field of view, thereby reducing the need to switch the focus of view between the situs and the navigation system. We devise a specific variant of the established crosshair metaphor suitable for the very limited screen space. We conduct an empirical user study comparing our approach to using a monitor and a combination of both. Results from the empirical user study show significant benefits for cognitive load, user preference, and general usability for the instrument-mounted display, while achieving the same level of performance in terms of time and accuracy compared to using a monitor. We successfully demonstrate the feasibility of our approach and potential benefits. With ongoing technological advancements, instrument-mounted displays might complement standard monitor setups for surgical navigation in order to lower cognitive demands and for improved usability of such systems.

Structural Instability in Ice VIII under Pressure

International Nuclear Information System (INIS)

Besson, J.; Klotz, S.; Hamel, G.; Marshall, W.; Nelmes, R.; Loveday, J.

1997-01-01

Below 125K, tetragonal ice VIII remains in a metastable form at ambient pressure. This form has long been considered to be identical to ice VIII, although unexplained discrepancies exist between their vibrational spectra. Neutron diffraction studies reveal an isostructural phase transformation below 2GPa related to a weakening of the bonds between the two D 2 O sublattices of ice VIII. In this new phase, ice VIII ' , the tetragonal distortion is 20% larger than in ice VIII, which accounts for the differences between the vibrational frequencies of the two phases. copyright 1997 The American Physical Society

Development and characterization of recombinant ovine coagulation factor VIII.

Directory of Open Access Journals (Sweden)

Philip M Zakas

Full Text Available Animal models of the bleeding disorder, hemophilia A, have been an integral component of the biopharmaceutical development process and have facilitated the development of recombinant coagulation factor VIII (fVIII products capable of restoring median survival of persons with hemophilia A to that of the general population. However, there remain several limitations to recombinant fVIII as a biotherapeutic, including invasiveness of intravenous infusion, short half-life, immunogenicity, and lack of availability to the majority of the world's population. The recently described ovine model of hemophilia A is the largest and most accurate phenocopy. Affected sheep die prematurely due to bleeding-related pathogenesis and display robust adaptive humoral immunity to non-ovine fVIII. Herein, we describe the development and characterization of recombinant ovine fVIII (ofVIII to support further the utility of the ovine hemophilia A model. Full-length and B-domain deleted (BDD ofVIII cDNAs were generated and demonstrated to facilitate greater biosynthetic rates than their human fVIII counterparts while both BDD constructs showed greater expression rates than the same-species full-length versions. A top recombinant BDD ofVIII producing baby hamster kidney clone was identified and used to biosynthesize raw material for purification and biochemical characterization. Highly purified recombinant BDD ofVIII preparations possess a specific activity nearly 2-fold higher than recombinant BDD human fVIII and display a differential glycosylation pattern. However, binding to the carrier protein, von Willebrand factor, which is critical for stability of fVIII in circulation, is indistinguishable. Decay of thrombin-activated ofVIIIa is 2-fold slower than human fVIII indicating greater intrinsic stability. Furthermore, intravenous administration of ofVIII effectively reverses the bleeding phenotype in the murine model of hemophilia A. Recombinant ofVIII should facilitate

Influence of Problem Based Learning on Critical Thinking Skills and Competence Class VIII SMPN 1 Gunuang Omeh, 2016/2017

Science.gov (United States)

Aswan, D. M.; Lufri, L.; Sumarmin, R.

2018-04-01

This research intends to determine the effect of Problem Based Learning models on students' critical thinking skills and competences. This study was a quasi-experimental research. The population of the study was the students of class VIII SMPN 1 Subdistrict Gunuang Omeh. Random sample selection is done by randomizing the class. Sample class that was chosen VIII3 as an experimental class given that treatment study based on problems and class VIII1 as control class that treatment usually given study. Instrument that used to consist of critical thinking test, cognitive tests, observation sheet of affective and psychomotor. Independent t-test and Mann Whitney U test was used for the analysis. Results showed that there was significant difference (sig competences.

Influence of usage history, instrument complexity, and different cleaning procedures on the cleanliness of blood-contaminated dental surgical instruments

NARCIS (Netherlands)

Wu, G.; Yu, X.F.

2009-01-01

Our study assessed the factors that influence the resistance of blood residues on dental surgical instruments to washer‐disinfector-based cleaning procedures in a clinical setting. The use of 2 additional cleaning methods—presoaking and scrubbing by hand—and the use of newer and/or less structurally

Protein adsorption on low temperature alpha alumina films for surgical instruments

Energy Technology Data Exchange (ETDEWEB)

Cloud, A.N., E-mail: acloud@uark.ed [University of Arkansas, Fayetteville, AR 72701 (United States); Kumar, S. [Ian Wark Research Institute, University of South Australia, Mawson Lakes, Adelaide, SA 5095 (Australia); Kavdia, M.; Abu-Safe, H.H.; Gordon, M.H. [University of Arkansas, Fayetteville, AR 72701 (United States)

2009-08-31

Bulk alumina has been shown to exhibit reduced protein adsorption, a property that can be exploited for developing alumina-coated surgical instruments and devices. Alpha alumina thin films were deposited on surgical stainless steel substrates to investigate the adsorption of a model protein (BSA, bovine serum albumin). The films were deposited at 480 {sup o}C by AC inverted cylindrical magnetron sputtering. Films were obtained at 6 kW and 50% oxygen partial pressure by volume. The presence of alpha-phase alumina has been shown by transmission electron microscopy. Results indicate that there was a 50% reduction in protein adsorption for samples with the alumina coating compared to those with no coating.

Highly sensitive rapid fluorescence detection of protein residues on surgical instruments

International Nuclear Information System (INIS)

Kovalev, Valeri I; Bartona, James S; Richardson, Patricia R; Jones, Anita C

2006-01-01

There is a risk of contamination of surgical instruments by infectious protein residues, in particular, prions which are the agents for Creutzfeldt-Jakob Disease in humans. They are exceptionally resistant to conventional sterilization, therefore it is important to detect their presence as contaminants so that alternative cleaning procedures can be applied. We describe the development of an optimized detection system for fluorescently labelled protein, suitable for in-hospital use. We show that under optimum conditions the technique can detect ∼10 attomole/cm 2 with a scan speed of ∼3-10 cm 2 /s of the test instrument's surface. A theoretical analysis and experimental measurements will be discussed

Construction of a mouse model of factor VIII deficiency by gene targeting

Energy Technology Data Exchange (ETDEWEB)

Bi, L.; Lawler, A.; Gearhart, J. [Univ. of Pennsylvania School of Medicine, Philadelphia, PA (United States)] [and others

1994-09-01

To develop a small animal model of hemophilia A for gene therapy experiments, we set out to construct a mouse model for factor VIII deficiency by gene targeting. First, we screened a mouse liver cDNA library using a human FVIII cDNA probe. We cloned a 2.6 Kb partial mouse factor VIII cDNA which extends from 800 base pairs of the 3{prime} end of exon 14 to the 5{prime} end of exon 26. A mouse genomic library made from strain 129 was then screened to obtain genomic fragments covering the exons desired for homologous recombination. Two genomic clones were obtained, and one covering exon 15 through 22 was used for gene targeting. To make gene targeting constructs, a 5.8 Kb genomic DNA fragment covering exons 15 to 19 of the mouse FVIII gene was subcloned, and the neo expression cassette was inserted into exons 16 and 17 separately by different strategies. These two constructs were named MFVIIIC-16 and MFVIIIC-17. The constructs were linearized and transfected into strain 129 mouse ES cells by electroporation. Factor VIII gene-knockout ES cell lines were selected by G-418 and screened by genomic Southern blots. Eight exon 16 targeted cell lines and five exon 17 targeted cell lines were obtained. Three cell lines from each construct were injected into blastocysts and surgically transferred into foster mothers. Multiple chimeric mice with 70-90% hair color derived from the ES-cell genotype were seen with both constructs. Germ line transmission of the ES-cell genotype has been obtained for the MFVIIIC-16 construct, and multiple hemophilia A carrier females have been identified. Factor VIII-deficient males will be conceived soon.

Surgical infection in a videolaparoscopic cholecystectomy when using peracetic acid for the sterilization of instruments.

Science.gov (United States)

de Melo, Edluza Maria Viana Bezerra; Leão, Cristiano de Souza; Andreto, Luciana Marques; de Mello, Maria Júlia Gonçalves

2013-01-01

To determine the frequency of surgical site infection in patients undergoing laparoscopic cholecystectomy with instruments sterilized by peracetic acid. We conducted a retrospective, cohort, descriptive, cross-sectional study. Peracetic acid has been used for sterilization following the protocol recommended by the manufacturer. We observed the criteria and indicators of process and structure for preventing surgical site infection pre and intraoperatively. For epidemiological surveillance, outpatient visits were scheduled for the 15th and between the 30th and 45th days after discharge. Among the 247 patients, there were two cases of surgical site infection (0.8%). One patient was readmitted to systemic antibiotic therapy and percutaneous puncture; in the other the infection was superficial and followed at the clinic. Ethical issues prevent the conduction of a prospective study because of peracetic acid have been banned for the sterilization of instruments that penetrate organs and cavities. Nevertheless, these results encourage prospective case-control studies comparing its use (historical control) with ethylene oxide sterilization.

The influence of prophylactic factor VIII in severe hemophilia A

Science.gov (United States)

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

2013-01-01

Introduction Hemophilia A individuals displaying a similar genetic defect have heterogeneous clinical phenotypes. Aim To evaluate the underlying effect of exogenous factor (f)VIII on tissue factor (Tf)-initiated blood coagulation in severe hemophilia utilizing both empirical and computational models. Methods We investigated twenty-five clinically severe hemophilia A patients. All individuals were on fVIII prophylaxis and had not received fVIII from 0.25 to 4 days prior to phlebotomy. Coagulation was initiated by the addition of Tf to contact-pathway inhibited whole blood ± an anti-fVIII antibody. Aliquots were quenched over 20 min and analyzed for thrombin generation and fibrin formation. Coagulation factor levels were obtained and used to computationally predict thrombin generation with fVIII set to either zero or its value at the time of the draw. Results Due to prophylactic fVIII, at the time of the blood draw, the individuals had fVIII levels that ranged from hemophilia A. The combination of each individual's coagulation factors (outside of fVIII) determine each individual's baseline thrombin potential and may affect bleeding risk. PMID:21899664

Highly sensitive rapid fluorescence detection of protein residues on surgical instruments

Energy Technology Data Exchange (ETDEWEB)

Kovalev, Valeri I [School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom); Bartona, James S [School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom); Richardson, Patricia R [School of Chemistry, University of Edinburgh, Edinburgh, EH9 3JJ (United Kingdom); Jones, Anita C [School of Chemistry, University of Edinburgh, Edinburgh, EH9 3JJ (United Kingdom)

2006-07-15

There is a risk of contamination of surgical instruments by infectious protein residues, in particular, prions which are the agents for Creutzfeldt-Jakob Disease in humans. They are exceptionally resistant to conventional sterilization, therefore it is important to detect their presence as contaminants so that alternative cleaning procedures can be applied. We describe the development of an optimized detection system for fluorescently labelled protein, suitable for in-hospital use. We show that under optimum conditions the technique can detect {approx}10 attomole/cm{sup 2} with a scan speed of {approx}3-10 cm{sup 2}/s of the test instrument's surface. A theoretical analysis and experimental measurements will be discussed.

Factor VIII assay

Science.gov (United States)

... this page: //medlineplus.gov/ency/article/003678.htm Factor VIII assay To use the sharing features on ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

[Surgical Roman instruments in the Museum of History of Medicine of the University of Rome "La Sapienza"].

Science.gov (United States)

Gazzaniga, V; Serarcangeli, C

1999-01-01

The Museum of History of Medicine at the University of Rome "La Sapienza" keeps numerous roman surgical instruments, dating from the 1st century A.D. This article offers a short review of the critical literature existing on the topic, together with a temporary catalogue of the instruments.

[Ehler-Danlos syndrome type VIII].

Science.gov (United States)

Ciarloni, L; Perrigouard, C; Lipsker, D; Cribier, B

2010-03-01

Ehlers-Danlos syndrome (EDS) comprises a heterogeneous group of diseases involving genetic collagen fibre impairment. We describe a case of a patient presenting the rare type VIII, in which dermatitis ocre was associated with parodontal disease, and which was diagnosed late. A 29-year-old man consulted for a pretibial ulcer present for seven years, resulting from a post-traumatic haematoma that had failed to heal. In view of the longiliner morphology, it had previously been diagnosed as Marfan syndrome. Subsequently, edentation was observed as well as "alveolar bone fragility". Examination revealed a marfanoid morphotype, a pretibial ulcer set within long-standing bilateral dermatitis ocre and papyraceous scars, but no joint hyperlaxity or cutaneous hyperelasticity. The diagnosis was consequently corrected to EDS type VIII. Type VIII is a rare form of EDS, and the molecular mechanism is poorly understood. The involvement of parodontal connective tissue suggests impairment of collagen I and III proteins. It is important to identify this type of the disease since it involves parodontal disease for which early treatment is required in order to try to prevent edentation. The present case demonstrates the importance of diagnosis, which may be based upon appearance of bilateral dermatitis ocre from the age of 15 years associated with skin fragility. This sign is not part of the classical picture of Marfan syndrome, with which EDS type VIII is often confounded. Copyright 2009 Elsevier Masson SAS. All rights reserved.

Differential proteolytic activation of factor VIII-von Willebrand factor complex by thrombin

International Nuclear Information System (INIS)

Hill-Eubanks, D.C.; Parker, C.G.; Lollar, P.

1989-01-01

Blood coagulation factor VIII (fVIII) is a plasma protein that is decreased or absent in hemophilia A. It is isolated as a mixture of heterodimers that contain a variably sized heavy chain and a common light chain. Thrombin catalyzes the activation of fVIII in a reaction that is associated with cleavages in both types of chain. The authors isolated a serine protease from Bothrops jararacussu snake venom that catalyzes thrombin-like heavy-chain cleavage but not light-chain cleavage in porcine fVIII as judged by NaDodSO 4 /PAGE and N-terminal sequence analysis. Using a plasma-free assay of the ability of activated 125 I-fVIII to function as a cofactor in the activation of factor X by factor IXa, they found that fVIII is activated by the venom enzyme. The venom enzyme-activated fVIII was isolated in stable form by cation-exchange HPLC. von Willebrand factor inhibited venom enzyme-activated fVIII but not thrombin-activated fVIII. These results suggest that the binding of fVIII to von Willebrand factor depends on the presence of an intact light chain and that activated fVIII must dissociate from von Willebrand factor to exert its cofactor effect. Thus, proteolytic activation of fVIII-von Willebrand factor complex appears to be differentially regulated by light-chain cleavage to dissociate the complex and heavy-chain cleavage to activate the cofactor function

77 FR 64401 - Order of Succession for HUD Region VIII

Science.gov (United States)

2012-10-19

... Region VIII AGENCY: Office of Field Policy and Management, HUD. ACTION: Notice of Order of Succession... Field Offices (Region VIII). This Order of Succession supersedes all previous Orders of Succession for HUD Region VIII. DATES: Effective Date: October 9, 2012. FOR FURTHER INFORMATION CONTACT: Lawrence D...

Surgical robotics beyond enhanced dexterity instrumentation: a survey of machine learning techniques and their role in intelligent and autonomous surgical actions.

Science.gov (United States)

Kassahun, Yohannes; Yu, Bingbin; Tibebu, Abraham Temesgen; Stoyanov, Danail; Giannarou, Stamatia; Metzen, Jan Hendrik; Vander Poorten, Emmanuel

2016-04-01

Advances in technology and computing play an increasingly important role in the evolution of modern surgical techniques and paradigms. This article reviews the current role of machine learning (ML) techniques in the context of surgery with a focus on surgical robotics (SR). Also, we provide a perspective on the future possibilities for enhancing the effectiveness of procedures by integrating ML in the operating room. The review is focused on ML techniques directly applied to surgery, surgical robotics, surgical training and assessment. The widespread use of ML methods in diagnosis and medical image computing is beyond the scope of the review. Searches were performed on PubMed and IEEE Explore using combinations of keywords: ML, surgery, robotics, surgical and medical robotics, skill learning, skill analysis and learning to perceive. Studies making use of ML methods in the context of surgery are increasingly being reported. In particular, there is an increasing interest in using ML for developing tools to understand and model surgical skill and competence or to extract surgical workflow. Many researchers begin to integrate this understanding into the control of recent surgical robots and devices. ML is an expanding field. It is popular as it allows efficient processing of vast amounts of data for interpreting and real-time decision making. Already widely used in imaging and diagnosis, it is believed that ML will also play an important role in surgery and interventional treatments. In particular, ML could become a game changer into the conception of cognitive surgical robots. Such robots endowed with cognitive skills would assist the surgical team also on a cognitive level, such as possibly lowering the mental load of the team. For example, ML could help extracting surgical skill, learned through demonstration by human experts, and could transfer this to robotic skills. Such intelligent surgical assistance would significantly surpass the state of the art in surgical

Analysis of risk factors for loss of lumbar lordosis in patients who had surgical treatment with segmental instrumentation for adolescent idiopathic scoliosis.

Science.gov (United States)

Trobisch, Per D; Samdani, Amer F; Betz, Randal R; Bastrom, Tracey; Pahys, Joshua M; Cahill, Patrick J

2013-06-01

Iatrogenic flattening of lumbar lordosis in patients with adolescent idiopathic scoliosis (AIS) was a major downside of first generation instrumentation. Current instrumentation systems allow a three-dimensional scoliosis correction, but flattening of lumbar lordosis remains a significant problem which is associated with decreased health-related quality of life. This study sought to identify risk factors for loss of lumbar lordosis in patients who had surgical correction of AIS with the use of segmental instrumentation. Patients were included if they had surgical correction for AIS with segmental pedicle screw instrumentation Lenke type 1 or 2 and if they had a minimum follow-up of 24 months. Two groups were created, based on the average loss of lumbar lordosis. The two groups were then compared and multivariate analysis was performed to identify parameters that correlated to loss of lumbar lordosis. Four hundred and seventeen patients were analyzed for this study. The average loss of lumbar lordosis at 24 months follow-up was an increase of 10° lordosis for group 1 and a decrease of 15° for group 2. Risk factors for loss of lumbar lordosis included a high preoperative lumbar lordosis, surgical decrease of thoracic kyphosis, and the particular operating surgeon. The lowest instrumented vertebra or spinopelvic parameters were two of many parameters that did not seem to influence loss of lumbar lordosis. This study identified important risk factors for decrease of lumbar lordosis in patients who had surgical treatment for AIS with segmental pedicle screw instrumentation, including a high preoperative lumbar lordosis, surgical decrease of thoracic kyphosis, and factors attributable to a particular operating surgeon that were not quantified in this study.

Factoring in Factor VIII With Acute Ischemic Stroke.

Science.gov (United States)

Siegler, James E; Samai, Alyana; Albright, Karen C; Boehme, Amelia K; Martin-Schild, Sheryl

2015-10-01

There is growing research interest into the etiologies of cryptogenic stroke, in particular as it relates to hypercoagulable states. An elevation in serum levels of the procoagulant factor VIII is recognized as one such culprit of occult cerebral infarctions. It is the objective of the present review to summarize the molecular role of factor VIII in thrombogenesis and its clinical use in the diagnosis and prognosis of acute ischemic stroke. We also discuss the utility of screening for serum factor VIII levels among patients at risk for, or those who have experienced, ischemic stroke. © The Author(s) 2015.

Extended analyses of Se VII and Se VIII

International Nuclear Information System (INIS)

Vankleef, Th.A.M.; Joshi, Y.N.

1984-01-01

Joshi et al. (1984) have conducted an analysis of the 3d8 4s-3d8 4p transitions in As VII. The present investigation is concerned with an analysis of similar transitions in Se VIII. The selenium spectrum was photographed in the 400-1200-A wavelength region on a variety of normal-incidence spectrographs. Attention is given to least-squares-fit (LSF) and Hartree-Fock (HF) parameter values for the 3d9 4d configuration of Se VII, LSF and HF parameter values for the 3d8 4s and 3d8 4p configurations of Se VIII, the energy and composition of the levels of the 3d9 4d configuration of Se VII, classified lines in Se VII, energy levels and composition of the 3d8 4s configuration and the revised and newly determined levels of the 3d8 4p configuration of Se VIII, and newly classified lines of Se VIII. 15 references

Surgical instrument biocontaminant fluorescence detection in ambient lighting conditions for hospital reprocessing and sterilization department (Conference Presentation)

Science.gov (United States)

Baribeau, François; Bubel, Annie; Dumont, Guillaume; Vachon, Carl; Lépine, André; Rochefort, Stéphane; Massicotte, Martin; Buteau-Vaillancourt, Louis; Gallant, Pascal; Mermut, Ozzy

2017-03-01

Hospitals currently rely on simple human visual inspection for assessing cleanliness of surgical instruments. Studies showed that surgical site infections are in part attributed to inadequate cleaning of medical devices. Standards groups recognize the need to objectively quantify the amount of residues on surgical instruments and establish guidelines. We developed a portable technology for the detection of contaminants on surgical instruments through fluorescence following cleaning. Weak fluorescence signals are usually detected in the obscurity only with the lighting of the excitation source. The key element of this system is that it works in ambient lighting conditions, a requirement to not disturb the normal workflow of hospital reprocessing facilities. A biocompatible fluorescent dye is added to the detergent and labels the proteins of organic residues. It is resistant to the harsh environment in a washer-disinfector. Two inspection devices have been developed with a 488nm laser as the excitation source: a handheld scanner and a tabletop station using spectral-domain and time-domain ambient light cancellation schemes. The systems are eye safe and equipped with image processing and interfacing software to provide visual or audible warnings to the operator based on a set of adjustable signal thresholds. Micron-scale residues are detected by the system which can also evaluate soil size and mass. Unlike swabbing, it can inspect whole tools in real-time. The technology has been validated in an independent hospital decontamination research laboratory. It also has potential applications in the forensics, agro-food, and space fields. Technical aspects and results will be presented and discussed.

Management of Surgical Instruments Package in the Operating Room%手术室器械包的管理

Institute of Scientific and Technical Information of China (English)

刘萍; 张娟; 潘文琴; 戴榕娟

2017-01-01

Objective Cleaning, maintenance, disinfection and preoperative preparation of surgical instruments in the past are done by the operation room, but with the development of China's hospitals and national new surgical management practices, certain progress has been achieved in the integrated management of surgical instruments for the operating rooms.Practical experiences in the management were discussed in this article.MethodsIn order to improve work quality and work efficiency and to reduce cost in the management of instruments in operation room, we analyzed the current situation of the management of equipment in the operation room based on the reality and tried to find out the method of surgical instrument package innovation, including the production of classification photo album for the surgical instrument package, paper list of all equipments, and production of marking cards for the instruments that can stand the sterilization under high pressure.Results and Conclusion From the implementation point of view, the total loss rate is reduced from the original 0.43% to 0.14%,and the loss rate of the micro device from 0.725% to 0.23%, effectively reducing the device losses.Great progress has been made in the use of the new methods, the quality of the personnel, in charge of the surgical instruments, classification management and the mapping and marking of cards.%目的 手术器械包的清洗、保养、消毒灭菌和术前准备工作以往均由手术室自行完成,随着我国医院洁净手术室的发展和国家新手术管理规范的实施,手术器械管理实施手供一体化相关工作逐步取得一定的效果.方法 分析手术器械包的管理及成效,改善工作品质,提高工作效率,降低成本等情况;找出手术器械包新的管理方法,包括制作手术器械包分类相册,以及手术器械包中加入纸质的器械清单、制作能够高压灭菌的金属器械牌等手段.结果与结论 �

Tracking-by-detection of surgical instruments in minimally invasive surgery via the convolutional neural network deep learning-based method.

Science.gov (United States)

Zhao, Zijian; Voros, Sandrine; Weng, Ying; Chang, Faliang; Li, Ruijian

2017-12-01

Worldwide propagation of minimally invasive surgeries (MIS) is hindered by their drawback of indirect observation and manipulation, while monitoring of surgical instruments moving in the operated body required by surgeons is a challenging problem. Tracking of surgical instruments by vision-based methods is quite lucrative, due to its flexible implementation via software-based control with no need to modify instruments or surgical workflow. A MIS instrument is conventionally split into a shaft and end-effector portions, while a 2D/3D tracking-by-detection framework is proposed, which performs the shaft tracking followed by the end-effector one. The former portion is described by line features via the RANSAC scheme, while the latter is depicted by special image features based on deep learning through a well-trained convolutional neural network. The method verification in 2D and 3D formulation is performed through the experiments on ex-vivo video sequences, while qualitative validation on in-vivo video sequences is obtained. The proposed method provides robust and accurate tracking, which is confirmed by the experimental results: its 3D performance in ex-vivo video sequences exceeds those of the available state-of -the-art methods. Moreover, the experiments on in-vivo sequences demonstrate that the proposed method can tackle the difficult condition of tracking with unknown camera parameters. Further refinements of the method will refer to the occlusion and multi-instrumental MIS applications.

Idiopathic Acquired Hemophilia A with Undetectable Factor VIII Inhibitor

Directory of Open Access Journals (Sweden)

Nicholas B. Abt

2014-01-01

Full Text Available Objective. We present the case of a 73-year-old female, with no family or personal history of a bleeding disorder, who had a classic presentation for acquired hemophilia A. Factor VIII activity was low but detectable and a factor VIII inhibitor was undetectable. Methods. The patient’s plasma was comprehensively studied to determine the cause of the acquired coagulopathy. Using the Nijmegen modification of the Bethesda assay, no factor VIII autoantibody was measureable despite varying the incubation time from 1 to 3 hours. Results. The aPTT was prolonged at 46.8 seconds, which did not correct in the 4 : 1 mix but did with 1 : 1 mix. Using a one stage factor VIII activity assay, the FVIII activity was 16% and chromogenic FVIII activity was also 16%. The patient was treated with recombinant FVII and transfusion, significantly reducing bleeding. Long-term therapy was initiated with cyclophosphamide and prednisone with normalization of FVIII activity. Conclusions. Physicians can be presented with the challenging clinical picture of an acquired factor VIII inhibitor without a detectable inhibitor by the Bethesda assay. Standard therapy for an acquired hemophilia A should be considered.

4p-5s transitions in YVII, VIII, ZrVIII, IX, NbIX, X and MoX, XI

International Nuclear Information System (INIS)

Rahimullah, K.; Chaghtai, M.S.Z.; Khatoon, S.

1976-01-01

The spectra of Y VII, VIII, Zr VIII, IX, Nb X and Mo X, XI are studied for the first time and the 1971 analysis of Nb IX is improved. By analyses of the transitions 4s 2 4psup(k)-4s 2 4psup(k-1)5s all the levels of the configurations 4p 3 , 4p 2 5s, 4p 2 and 4p5s are established in the spectra concerned. (Auth.)

40 CFR Appendix Viii to Part 600 - Fuel Economy Label Formats

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Fuel Economy Label Formats VIII... POLICY FUEL ECONOMY AND CARBON-RELATED EXHAUST EMISSIONS OF MOTOR VEHICLES Pt. 600, App. VIII Appendix VIII to Part 600—Fuel Economy Label Formats EC01MY92.117 EC01MY92.118 EC01MY92.119 EC01MY92.120...

PENGARUH PENGUASAAN KONSEP TEOREMA PYTHAGORAS TERHADAP KEMAMPUAN MENYELESAIKAN SOAL-SOAL BANGUN RUANG SISI DATAR PADA SISWA KELAS VIII MTS NEGERI BALANG-BALANG

Directory of Open Access Journals (Sweden)

Syahrida Zaerani

2017-12-01

Abstract: This study aims to determine the impact of the mastery of Pythagoras Theorem concepts on the ability of MTs Negeri Balang-Balang grade VIII students to solve polyhedron problems. This study is a quantitative research with ex post facto design. Statistical population consists of all grade VIII students in MTs Negeri Balang-Balang which was 204 students. The number of sampling used is 102 respondents taken by simple random sampling technique. The research instrument was a test related to Pythagorean an polyhedron problems. Descriptive and inferential statistics were performed as the statistical analysis. The descriptive analysis result shows that the mastery of Pythagoras Theorem concepts is within the category of ‘high’ and the ability of solving polyhedron problems is as well. The inferential statistical analysis using simple linear regression shows that there is an impact of the mastery of Pythagoras Theorem concepts on polyhedron problem solving ability of Grade VIII students of MTs Negeri Balang-Balang.

An integrated approach to endoscopic instrument tracking for augmented reality applications in surgical simulation training.

Science.gov (United States)

Loukas, Constantinos; Lahanas, Vasileios; Georgiou, Evangelos

2013-12-01

Despite the popular use of virtual and physical reality simulators in laparoscopic training, the educational potential of augmented reality (AR) has not received much attention. A major challenge is the robust tracking and three-dimensional (3D) pose estimation of the endoscopic instrument, which are essential for achieving interaction with the virtual world and for realistic rendering when the virtual scene is occluded by the instrument. In this paper we propose a method that addresses these issues, based solely on visual information obtained from the endoscopic camera. Two different tracking algorithms are combined for estimating the 3D pose of the surgical instrument with respect to the camera. The first tracker creates an adaptive model of a colour strip attached to the distal part of the tool (close to the tip). The second algorithm tracks the endoscopic shaft, using a combined Hough-Kalman approach. The 3D pose is estimated with perspective geometry, using appropriate measurements extracted by the two trackers. The method has been validated on several complex image sequences for its tracking efficiency, pose estimation accuracy and applicability in AR-based training. Using a standard endoscopic camera, the absolute average error of the tip position was 2.5 mm for working distances commonly found in laparoscopic training. The average error of the instrument's angle with respect to the camera plane was approximately 2°. The results are also supplemented by video segments of laparoscopic training tasks performed in a physical and an AR environment. The experiments yielded promising results regarding the potential of applying AR technologies for laparoscopic skills training, based on a computer vision framework. The issue of occlusion handling was adequately addressed. The estimated trajectory of the instruments may also be used for surgical gesture interpretation and assessment. Copyright © 2013 John Wiley & Sons, Ltd.

Ehlers-Danlos Syndrome Type VIII: A Rare Cause of Leg Ulcers in Young Patients

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Sophie Ronceray

2013-01-01

Full Text Available Ehlers-Danlos syndrome type VIII (EDS-VIII is a very rare autosomal dominant disease characterized by early-onset periodontitis associated with features of Ehlers-Danlos syndrome. We report a 32-year-old man whose chronic leg ulcer led to the diagnosis of EDS-VIII. He had severe periodontitis with complete loss of permanent teeth and skin fragility with thin skin, atrophic scars, and brownish atrophic pretibial plaques. Leg ulcer is not a prominent feature of EDS-VIII. We suggest adding EDS-VIII to the list of rare diseases accounting for chronic leg ulcers, if this case report prompts others to report leg ulcers associated with EDS-VIII.

AAV5-Factor VIII Gene Transfer in Severe Hemophilia A.

Science.gov (United States)

Rangarajan, Savita; Walsh, Liron; Lester, Will; Perry, David; Madan, Bella; Laffan, Michael; Yu, Hua; Vettermann, Christian; Pierce, Glenn F; Wong, Wing Y; Pasi, K John

2017-12-28

Patients with hemophilia A rely on exogenous factor VIII to prevent bleeding in joints, soft tissue, and the central nervous system. Although successful gene transfer has been reported in patients with hemophilia B, the large size of the factor VIII coding region has precluded improved outcomes with gene therapy in patients with hemophilia A. We infused a single intravenous dose of a codon-optimized adeno-associated virus serotype 5 (AAV5) vector encoding a B-domain-deleted human factor VIII (AAV5-hFVIII-SQ) in nine men with severe hemophilia A. Participants were enrolled sequentially into one of three dose cohorts (low dose [one participant], intermediate dose [one participant], and high dose [seven participants]) and were followed through 52 weeks. Factor VIII activity levels remained at 3 IU or less per deciliter in the recipients of the low or intermediate dose. In the high-dose cohort, the factor VIII activity level was more than 5 IU per deciliter between weeks 2 and 9 after gene transfer in all seven participants, and the level in six participants increased to a normal value (>50 IU per deciliter) that was maintained at 1 year after receipt of the dose. In the high-dose cohort, the median annualized bleeding rate among participants who had previously received prophylactic therapy decreased from 16 events before the study to 1 event after gene transfer, and factor VIII use for participant-reported bleeding ceased in all the participants in this cohort by week 22. The primary adverse event was an elevation in the serum alanine aminotransferase level to 1.5 times the upper limit of the normal range or less. Progression of preexisting chronic arthropathy in one participant was the only serious adverse event. No neutralizing antibodies to factor VIII were detected. The infusion of AAV5-hFVIII-SQ was associated with the sustained normalization of factor VIII activity level over a period of 1 year in six of seven participants who received a high dose, with

Blood coagulation factor VIII

Indian Academy of Sciences (India)

Factor VIII (FVIII) functions as a co-factor in the blood coagulation cascade for the proteolytic activation of factor X by factor IXa. Deficiency of FVIII causes hemophilia A, the most commonly inherited bleeding disorder. This review highlights current knowledge on selected aspects of FVIII in which both the scientist and the ...

Output control of da Vinci surgical system's surgical graspers.

Science.gov (United States)

Johnson, Paul J; Schmidt, David E; Duvvuri, Umamaheswar

2014-01-01

The number of robot-assisted surgeries performed with the da Vinci surgical system has increased significantly over the past decade. The articulating movements of the robotic surgical grasper are controlled by grip controls at the master console. The user interface has been implicated as one contributing factor in surgical grasping errors. The goal of our study was to characterize and evaluate the user interface of the da Vinci surgical system in controlling surgical graspers. An angular manipulator with force sensors was used to increment the grip control angle as grasper output angles were measured. Input force at the grip control was simultaneously measured throughout the range of motion. Pressure film was used to assess the maximum grasping force achievable with the endoscopic grasping tool. The da Vinci robot's grip control angular input has a nonproportional relationship with the grasper instrument output. The grip control mechanism presents an intrinsic resistant force to the surgeon's fingertips and provides no haptic feedback. The da Vinci Maryland graspers are capable of applying up to 5.1 MPa of local pressure. The angular and force input at the grip control of the da Vinci robot's surgical graspers is nonproportional to the grasper instrument's output. Understanding the true relationship of the grip control input to grasper instrument output may help surgeons understand how to better control the surgical graspers and promote fewer grasping errors. Copyright © 2014 Elsevier Inc. All rights reserved.

Agnostic stacking of intergalactic doublet absorption: measuring the Ne VIII population

Science.gov (United States)

Frank, Stephan; Pieri, Matthew M.; Mathur, Smita; Danforth, Charles W.; Shull, J. Michael

2018-05-01

We present a blind search for doublet intergalactic metal absorption with a method dubbed `agnostic stacking'. Using a forward-modelling framework, we combine this with direct detections in the literature to measure the overall metal population. We apply this novel approach to the search for Ne VIII absorption in a set of 26 high-quality COS spectra. We probe to an unprecedented low limit of log N>12.3 at 0.47≤z ≤1.34 over a path-length Δz = 7.36. This method selects apparent absorption without requiring knowledge of its source. Stacking this mixed population dilutes doublet features in composite spectra in a deterministic manner, allowing us to measure the proportion corresponding to Ne VIII absorption. We stack potential Ne VIII absorption in two regimes: absorption too weak to be significant in direct line studies (12.3 13.7). We do not detect Ne VIII absorption in either regime. Combining our measurements with direct detections, we find that the Ne VIII population is reproduced with a power-law column density distribution function with slope β = -1.86 ^{+0.18 }_{ -0.26} and normalization log f_{13.7} = -13.99 ^{+0.20 }_{ -0.23}, leading to an incidence rate of strong Ne VIII absorbers dn/dz =1.38 ^{+0.97 }_{ -0.82}. We infer a cosmic mass density for Ne VIII gas with 12.3 value significantly lower that than predicted by recent simulations. We translate this density into an estimate of the baryon density Ωb ≈ 1.8 × 10-3, constituting 4 per cent of the total baryonic mass.

A case study on the design of a modular surgical instrument for removing metastases using engineering design tools

OpenAIRE

Preca, George; Farrugia, Philip; Casha, Aaron; International Conference on Engineering and Product Design Education

2014-01-01

Metastatic cancer is a form of cancer stemming from a primary tumour that propagates to different organs and/or to different sites within the same organ. Studies have indicated that the chances of survival improve upon surgical removal of metastases. The overall goal of this research was to develop a modular surgical instrument that would be easy to use and manipulate and hence facilitate resection of metastases. This research forms part of a final year project carried out by a mechanical eng...

Development of the evaluation instrument use CIPP on the implementation of project assessment topic optik

Science.gov (United States)

Asfaroh, Jati Aurum; Rosana, Dadan; Supahar

2017-08-01

This research aims to develop an evaluation instrument models CIPP valid and reliable as well as determine the feasibility and practicality of an evaluation instrument models CIPP. An evaluation instrument models CIPP to evaluate the implementation of the project assessment topic optik to measure problem-solving skills of junior high school class VIII in the Yogyakarta region. This research is a model of development that uses 4-D. Subject of product trials are students in class VIII SMP N 1 Galur and SMP N 1 Sleman. Data collection techniques in this research using non-test techniques include interviews, questionnaires and observations. Validity in this research was analyzed using V'Aikens. Reliability analyzed using ICC. This research uses 7 raters are derived from two lecturers expert (expert judgment), two practitioners (science teacher) and three colleagues. The results of this research is the evaluation's instrument model of CIPP is used to evaluate the implementation of the implementation of the project assessment instruments. The validity result of evaluation instrument have V'Aikens values between 0.86 to 1, which means a valid and 0.836 reliability values into categories so well that it has been worth used as an evaluation instrument.

Systems for tracking minimally invasive surgical instruments

NARCIS (Netherlands)

Chmarra, M. K.; Grimbergen, C. A.; Dankelman, J.

2007-01-01

Minimally invasive surgery (e.g. laparoscopy) requires special surgical skills, which should be objectively assessed. Several studies have shown that motion analysis is a valuable assessment tool of basic surgical skills in laparoscopy. However, to use motion analysis as the assessment tool, it is

Surgical risks and perioperative complications of instrumented lumbar surgery in patients with liver cirrhosis

Directory of Open Access Journals (Sweden)

Tung-Yi Lin

2014-02-01

Full Text Available Background: Patients with liver cirrhosis have high surgical risks due to malnutrition, impaired immunity, coagulopathy, and encephalopathy. However, there is no information in English literature about the results of liver cirrhotic patients who underwent instrumented lumbar surgery. The purpose of this study is to report the perioperative complications, clinical outcomes and determine the surgical risk factors in cirrhotic patients. Methods: We retrospectively reviewed 29 patients with liver cirrhosis who underwent instrumented lumbar surgery between 1997 and 2009. The hepatic functional reserves of the patients were recorded according to the Child-Turcotte-Pugh scoring system. Besides, fourteen other variables and perioperative complications were also collected. To determine the risks, we divided the patients into two groups according to whether or not perioperative complications developed. Results: Of the 29 patients, 22 (76% belonged to Child class A and 7 (24% belonged to Child class B. Twelve patients developed one or more complications. Patients with Child class B carried a significantly higher incidence of complications than those with Child class A (p = 0.011. In the Child class A group, patients with 6 points had a significantly higher incidence of complications than those with 5 points (p = 0.025. A low level of albumin was significantly associated with higher risk, and a similar trend was also noted for the presence of ascites although statistical difference was not reached. Conclusion: The study concludes that patients with liver cirrhosis who have undergone instrumented lumbar surgery carry a high risk of developing perioperative complications, especially in those with a Child-Turcotte-Pugh score of 6 or more.

Achieving a predictable 24-hour return to normal activities after breast augmentation: part II. Patient preparation, refined surgical techniques, and instrumentation.

Science.gov (United States)

Tebbetts, John B

2006-12-01

The goal of this study was to develop practices that would allow patients undergoing subpectoral augmentation to predictably return to full normal activities within 24 hours after the operation, free of postoperative adjuncts. Part I of this study used motion and time study principles to reduce operative times, medication dosages, perioperative morbidity, and recovery times in augmentation mammaplasty. Part II of the study focuses on details of patient education, preoperative planning, instrumentation, and surgical technique modifications that were identified, modified, and implemented to achieve the results reported in part I. Two groups of 16 patients each (groups 1 and 2) were studied retrospectively for comparison to a third group of 627 patients (group 3) studied prospectively. Patients in group 1 had axillary partial retropectoral breast augmentations in 1982-1983, using dissociative anesthesia, blunt instrument implant pocket dissection, and Dow Corning, double-lumen implants containing 20 mg of methylprednisolone and 20 cc of saline in the outer lumen of the implants. Patients in group 2 (1990) had inframammary, retromammary augmentations by using a combination of blunt and electrocautery dissection, Surgitek Replicon polyurethane-covered, silicone gel-filled implants, and general endotracheal anesthesia. Patients in group 3 (1998 to 2001, n = 627) had inframammary partial retropectoral, inframammary retromammary, and axillary partial retropectoral augmentations under general endotracheal anesthesia. Refined practices and surgical techniques from studies of groups 1 and 2 were applied in group 3. Videotapes from operative procedures of groups 1 and 2 were analyzed with macromotion and micromotion study principles, and tables of events were formulated for each move during the operation for all personnel in the operating room. Extensive details of surgical technique were examined and reexamined in 13 different stages by using principles of motion and time

The labour ward analgesic service at King Edward VIII Hospital ...

African Journals Online (AJOL)

The labour ward analgesic service at King Edward VIII. Hospital, Durban. D. A. ROCKE, C. C. ROUT, H. D. RUSSELL, S. SINGH. Abstract The provision of analgesic services to the labour ward at King Edward VIII Hospital was studied during a I-week period. Of249 patients, 113 (45%) received no analgesia whatsoever.

Thermoelectrical properties of the compounds ScM{sup VIII}Sb and YM{sup VIII}Sb (M{sup VIII} = Ni, Pd, Pt)

Energy Technology Data Exchange (ETDEWEB)

Oestreich, J; Probst, U; Richardt, F; Bucher, E [University of Konstanz, PO Box X916, D-78457 Konstanz (Germany)

2003-02-05

The research into new materials with good thermoelectric properties has revealed new compounds consisting of metallic elements (Bando Y, Suemitsu T, Takagi K, Tokushima H, Echizen Y, Katoh K, Umeo K, Maeda Y and Takabatake T 2000 J. Alloys Compounds 313 1-6, Ghelani N, Loo S, Chung D, Sportouch S, Nardi S, Kanatzidis M, Hogan T and Nolas G 2000 Mater. Res. Soc. 626 Z8.6.1). The half-Heusler compound ZrNiSn, in particular, shows promising thermoelectric properties and has been studied by many scientists during recent years (Uher C, Hu S, Yang J, Meisner G P and Morelli D T 1997 Proc. ICT'97: 16th Int. Conf. on Thermoelectrics pp 485-8, Romaka L P, Stadnyk Yu V, Goryn A M, Gorelenko Yu K and Skolozdra R V 1997 Proc. ICT'97: 16th Int. Conf. on Thermoelectrics pp 516-19, Hohl H, Ramirez A P, Goldmann C, Ernst G, Woelfing B and Bucher E 1998 J. Phys.: Condens. Matter 11 1697-709, Oestreich J, Kaefer W, Richardt F, Probst U and Bucher E 1999 Proc. 5th European Workshop on Thermoelectrics pp 192-5). In an effort to find new thermoelectric materials, the half-Heusler compounds of the groups ScM{sup VIII}Sb and YM{sup VIII}Sb (M{sup VIII} = Ni, Pd, Pt) were synthesized by arc melting and the thermoelectric properties were examined by standard characterization methods. Doping experiments showed that it is possible to change the electrical properties of the compounds while retaining the half-Heusler structure. Within the two groups, YPtSb showed the best thermoelectrical properties. At a temperature of 400 K the electrical conductivity of YPtSb is 748{omega}{sup -1} cm{sup -1} and the Seebeck coefficient is 116.3{mu}V K{sup -1}. The thermal conductivity at 400 K extrapolated using the Wiedemann-Franz law is 2.87 W K{sup -1} m{sup -1}. This leads to a dimensionless figure of merit of 0.14.

New study on the XeVIII spectrum

International Nuclear Information System (INIS)

Gallardo, M.; Raineri, M.; Giuliani, M.; Lagorio, C.; Padilla, S.; Sarmiento, R.; Reyna Almandos, J.G.

2005-01-01

Capillary light sources were used to observe the spectrum of seven-times-ionized xenon, XeVIII, in the 300-6000 A wavelength range. Twenty-eight energy levels belonging to the 5s-9s, 5d-9d, 5g-9g, 7i-10i, 9l, 5p-9p, 4f-9f, 6h-9h and 8k-10k configurations were adjusted and 38 new spectral lines were classified. The XeVIII ionization energy was determined with improved accuracy using the polarization model. The analysis was supported by Hartree-Fock calculations. The weighted oscillator strengths for all the observed spectral lines were also calculated considering the fitted values for the energy parameters

New study on the XeVIII spectrum

Energy Technology Data Exchange (ETDEWEB)

Gallardo, M. [Centro de Investigaciones Opticas (CIOp) Casilla de Correo 124, 1900 La Plata (Argentina)]. E-mail: gallardom@ciop.unlp.edu.ar; Raineri, M. [Centro de Investigaciones Opticas (CIOp) Casilla de Correo 124, 1900 La Plata (Argentina)]. E-mail: monicar@ciop.unlp.edu.ar; Giuliani, M. [Dto. de Fisica, Fac. de C. Exactas y Naturales, Universidad Nacional de Mar del Plata Funes 3350 (7600) Mar del Plata (Argentina); Lagorio, C. [Dto. de Fisica, Fac. de C. Exactas y Naturales, Universidad Nacional de Mar del Plata Funes 3350 (7600) Mar del Plata (Argentina); Padilla, S. [Dto. de Fisica, Fac. de C. Exactas y Naturales, Universidad Nacional de Mar del Plata Funes 3350 (7600) Mar del Plata (Argentina); Sarmiento, R. [Dto. De Fisica, Universidad del Atlantico, A.A 1890 Barranquilla (Colombia); Reyna Almandos, J.G. [Centro de Investigaciones Opticas (CIOp) Casilla de Correo 124, 1900 La Plata (Argentina)]. E-mail: jreyna@ciop.unlp.edu.ar

2005-10-15

Capillary light sources were used to observe the spectrum of seven-times-ionized xenon, XeVIII, in the 300-6000 A wavelength range. Twenty-eight energy levels belonging to the 5s-9s, 5d-9d, 5g-9g, 7i-10i, 9l, 5p-9p, 4f-9f, 6h-9h and 8k-10k configurations were adjusted and 38 new spectral lines were classified. The XeVIII ionization energy was determined with improved accuracy using the polarization model. The analysis was supported by Hartree-Fock calculations. The weighted oscillator strengths for all the observed spectral lines were also calculated considering the fitted values for the energy parameters.

Improving attitudes toward mathematics learning with problem posing in class VIII

Science.gov (United States)

Vionita, Alfha; Purboningsih, Dyah

2017-08-01

This research is classroom action research which is collaborated to improve student's behavior toward math and mathematics learning at class VIII by using problem posing approach. The subject of research is all of students grade VIIIA which consist of 32 students. This research has been held on two period, first period is about 3 times meeting, and second period is about 4 times meeting. The instrument of this research is implementation of learning observation's guidance by using problem posing approach. Cycle test has been used to measure cognitive competence, and questionnaire to measure the students' behavior in mathematics learning process. The result of research shows the students' behavior has been improving after using problem posing approach. It is showed by the behavior's criteria of students that has increasing result from the average in first period to high in second period. Furthermore, the percentage of test result is also improve from 68,75% in first period to 78,13% in second period. On the other hand, the implementation of learning observation by using problem posing approach has also improving and it is showed by the average percentage of teacher's achievement in first period is 89,2% and student's achievement 85,8%. These results get increase in second period for both teacher and students' achievement which are 94,4% and 91,11%. As a result, students' behavior toward math learning process in class VIII has been improving by using problem posing approach.

Femoral Test Bed for Impedance Controlled Surgical Instrumentation

Directory of Open Access Journals (Sweden)

Christian Brendle

2012-01-01

Full Text Available The risk for patients during the standard procedure of revision of cemented artificial hip joints is unsatisfactorily highdue to its high level of invasiveness and limited access to the operative field. To reduce this risk we are developing anImpedance Controlled Surgical Instrumentation (ICOS system, which aims to establish real-time control during a BoneCement (BC milling process. For this, the relationship between the thickness of the BC and its frequency-dependentelectrical impedance is used to estimate the residual BC thickness. The aim is to avoid unintended cutting of boneby detecting the passage of the BC/bone boundary layer by the milling head. In a second step, an estimation of theresidual BC thickness will be used to improve process control. As a first step towards demonstrating the feasibility ofour approach, presented here are experimental studies to characterize the BC permittivity and to describe the process indetail. The results show that the permittivity properties of BC are dominated by its polymethyl methacrylate (PMMAfraction. Thus, PMMA can be used as a substitute for future experiments. Furthermore, a Femoral Test Bed (FTB wasdesigned. Using this setup we show it is feasible to accurately distinguish between slightly different thicknesses of BC.

Surgical Outcome of Reduction and Instrumented Fusion in Lumbar Degenerative Spondylolisthesis

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Farzad Omidi-Kashani

2016-02-01

Full Text Available Background: Lumbar degenerative spondylolisthesis (LDS is a degenerative slippage of the lumbar vertebrae. We aimed to evaluate the surgical outcome of degenerative spondylolisthesis with neural decompression, pedicular screw fixation, reduction, and posterolateral fusion. Methods: This before-after study was carried out on 45 patients (37 female and 8 male with LDS operated from August 2008 to January 2011. The patients’ pain and disability were assessed by visual analogue scale (VAS and Oswestry disability index (ODI questionnaire. In surgery, we applied distraction force to facilitate slip reduction. All the intra- and postoperative complications were recorded. The paired t-test and Pearson correlation coefficient were used for statistical analysis. Results: The mean age of patients and mean follow-up period were 58.3±3.5 years and 31.2±4.8 months, respectively. The mean slip correction rate was 52.2% with a mean correction loss of 4.8%. Preoperative VAS and ODI improved from 8.8 and 71.6 to postoperative 2.1 and 28.7, respectively. Clinical improvement was more prominent in more reduced patients, but Pearson coefficient could not find a significant correlation. Conclusion: Although spinal decompression with fusion and posterior instrumentation in surgical treatment of the patients with LDS result in satisfactory outcome, vertebral reduction cannot significantly enhance the clinical improvement.

Effectiveness of Mind Mapping in English Teaching among VIII Standard Students

Science.gov (United States)

Hallen, D.; Sangeetha, N.

2015-01-01

The aim of the study is to find out the effectiveness of mind mapping technique over conventional method in teaching English at high school level (VIII), in terms of Control and Experimental group. The sample of the study comprised, 60 VIII Standard students in Tiruchendur Taluk. Mind Maps and Achievement Test (Pretest & Posttest) were…

Population pharmacokinetics of recombinant coagulation factor VIII-SingleChain in patients with severe hemophilia A.

Science.gov (United States)

Zhang, Y; Roberts, J; Tortorici, M; Veldman, A; St Ledger, K; Feussner, A; Sidhu, J

2017-06-01

Essentials rVIII-SingleChain is a unique recombinant factor VIII (FVIII) molecule. A population pharmacokinetic model was based on FVIII activity of severe hemophilia A patients. The model was used to simulate factor VIII activity-time profiles for various dosing scenarios. The model supports prolonged dosing of rVIII-SingleChain with intervals of up to twice per week. Background Single-chain recombinant coagulation factor VIII (rVIII-SingleChain) is a unique recombinant coagulation factor VIII molecule. Objectives To: (i) characterize the population pharmacokinetics (PK) of rVIII-SingleChain in patients with severe hemophilia A; (ii) identify correlates of variability in rVIII-SingleChain PK; and (iii) simulate various dosing scenarios of rVIII-SingleChain. Patients/Methods A population PK model was developed, based on FVIII activity levels of 130 patients with severe hemophilia A (n = 91 for ≥ 12-65 years; n = 39 for  85% and > 93% of patients were predicted to maintain FVIII activity level above 1 IU dL -1 , at all times with three-times-weekly dosing (given on days 0, 2, and 4.5) at the lowest (20 IU kg -1 ) and highest (50 IU kg -1 ) doses, respectively. For twice weekly dosing (days 0 and 3.5) of 50 IU kg -1 rVIII-SingleChain, 62-80% of patients across all ages were predicted to maintain a FVIII activity level above 1 IU dL -1 at day 7. Conclusions The population PK model adequately characterized rVIII-SingleChain PK, and the model can be utilized to simulate FVIII activity-time profiles for various dosing scenarios. © 2017 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and Haemostasis.

Safety Research Experiment Facility Project. Conceptual design report. Volume VIII. Instrumentation and control

International Nuclear Information System (INIS)

1975-01-01

Included are sections dealing with the following: nuclear instrumentation system, reactor control system, plant protection system, plant annunciator system, data acquisition system, and reactor cooling system instrumentation and control

Estudo citofotométrico da expressão do marcador tumoral Fator VIII e fatores prognósticos no adenocarcinoma gástrico Cytophotometric study of the expression of the tumoral marker Factor VIII and prognostic factors in gastrci adenocarcinoma

Directory of Open Access Journals (Sweden)

Mary Tossa Nakamura

2007-12-01

ção III ou IV apresentaram índice de marcagem maiores do que aqueles com Bormann I ou II, porém sem correlação com a profundidade de invasão tumoral, grau de diferenciação, envolvimento nodal e padrão histológico. CONCLUSÕES: O presente estudo identificou e marcou 95,24% das amostras para o Fator VIII. Em relação aos fatores prognósticos não houve correlação significativa exceto entre o Fator VIII e a classificação de Bormann no qual o tipo III ou IV foi maior que o tipo I ou II.INTRODUCTION: Regarding gastric cancer, the incidence, diagnosis and therapeutic options showed improvement in the last decades, but prognosis remains gloomy, specially due the fact that most patients, already diagnosed present advanced tumors, metastatic and not liable to be surgically resected. Molecular biology is an area in science, which can give the answer to many questions and current scientific facts show that the this should be through detection of tumoral markers. The great advances in informatics refined cell image analysis by image cytophotometry makes it possible to study cell proliferation and angiogenesis in various tumor processes using immunohistochemistry and several markers. At present, studies are conducted to demonstrate the prognostic value of their expressions, however, in gastric adenocarcinoma the results have been divergent and studies are scarce. AIM: To identify and quantify the expression of cell proliferation markers using Ki-67 and of angiogenesis with Factor VIII in gastric adenocarcinoma using cytophotometry, and compare their expressions with factors such as Bormanns´ classification, tumor invasion depth, degree of differentiation, nodal involvement, histologic pattern and age. METHODS: Twenty-one patients with gastric adenocarcinoma identified between 1998 and 2006 were studied. Ki-67 and Factor VIII expressions were performed using immunohistochemistry with clone MIB-1 primary antibodies, monoclonal for Ki-67 and policlonal for Factor VIII

Acquired high titre factor VIII inhibitor with underlying polyarteritis nodosa.

Science.gov (United States)

Snowden, J A; Hutchings, M; Spearing, R; Patton, W N

1997-05-01

We here present the case of a 70-year-old woman referred to our unit for investigation of bleeding. Investigations confirmed a high titre acquired Factor VIII inhibitor. In association there was relapse of systemic illness associated with anti-neutrophil cytoplasmic antibodies (atypical pattern) for which she had been treated five years previously. Immunosuppression was attempted, but it failed to have an impact both on the inhibitor titre and on the underlying disorder. The patient died from multi-organ failure and massive chest hemorrhage. Post-mortem showed necrotizing vasculitis of medium sized vessels at several sites, including the kidney, consistent with a diagnosis of polyarteritis nodosa. Although it is well recognised that Factor VIII inhibitors are found in conjunction with autoimmune disorders, this case is significant in that it is the first associated with histologically proven polyarteritis nodosa type vasculitis. The case illustrates the difficulties in the investigation and management of patients with acquired high titre Factor VIII inhibitors.

Chromogenic Factor VIII Assays for Improved Diagnosis of Hemophilia A.

Science.gov (United States)

Rodgers, Susan; Duncan, Elizabeth

2017-01-01

Hemophilia A is an inherited bleeding disorder caused by a reduced level of factor VIII coagulant activity (FVIII:C) in blood. Bleeding episodes may occur spontaneously in the severe form of hemophilia or after trauma in the milder forms. It is important that patients are diagnosed correctly, which includes placing them into the correct severity category of the disorder so that appropriate treatment can be given. Diagnosis is made by determination of the amount of FVIII:C in the blood, usually using a one-stage factor VIII:C assay. However, approximately one third of patients with mild or moderate hemophilia will have much lower results by the chromogenic assay, with some of them having normal results by the one-stage assay. The chromogenic factor VIII assay is used in some specialized hemophilia reference centers and is recommended for the diagnosis of mild hemophilia A, as this assay is considered to better reflect the severity status of hemophilia patients than the one-stage assay.

Type VIII collagen is elevated in diseases associated with angiogenesis and vascular remodeling

DEFF Research Database (Denmark)

Hansen, N. U. B.; Willumsen, N.; Bülow Sand, Jannie Marie

2016-01-01

Objectives Type VIII collagen is involved in angiogenesis and remodeling of arteries. We hypothesized that type VIII collagen was upregulated in diseases associated with vascular remodeling, e.g. pulmonary fibrosis and cancer. In this paper we present the development and validation of a competitive...

The F309S mutation increases factor VIII secretion in human cell line

Directory of Open Access Journals (Sweden)

Daianne Maciely Carvalho Fantacini

2016-06-01

Full Text Available ABSTRACT OBJECTIVES: The capacity of a human cell line to secrete recombinant factor VIII with a F309S point mutation was investigated, as was the effect of the addition of chemical chaperones (betaine and sodium-4-phenylbutyrate on the secretion of factor VIII. METHODS: This work used a vector with a F309S mutation in the A1 domain to investigate FVIII production in the HEK 293 human cell line. Factor VIII activity was measured by chromogenic assay. Furthermore, the effects of chemical drugs on the culture were evaluated. RESULTS: The addition of the F309S mutation to a previously described FVIII variant increased FVIII secretion by 4.5 fold. Moreover, the addition of betaine or sodium-4-phenylbutyrate increased the secretion rate of FVIIIΔB proteins in HEK 293 cells, but the same effect was not seen for FVIIIΔB-F309S indicating that all the recombinant protein produced had been efficiently secreted. CONCLUSION: Bioengineering factor VIII expressed in human cells may lead to an efficient production of recombinant factor VIII and contribute toward low-cost coagulation factor replacement therapy for hemophilia A. FVIII-F309S produced in human cells can be effective in vivo.

Myosin VIII regulates protonemal patterning and developmental timing in the moss Physcomitrella patens.

Science.gov (United States)

Wu, Shu-Zon; Ritchie, Julie A; Pan, Ai-Hong; Quatrano, Ralph S; Bezanilla, Magdalena

2011-09-01

Plants have two classes of myosins. While recent work has focused on class XI myosins showing that myosin XI is responsible for organelle motility and cytoplasmic streaming, much less is known about the role of myosin VIII in plant growth and development. We have used a combination of RNAi and insertional knockouts to probe myosin VIII function in the moss Physcomitrella patens. We isolated Δmyo8ABCDE plants demonstrating that myosin VIII is not required for plant viability. However, myosin VIII mutants are smaller than wild-type plants in part due to a defect in cell size. Additionally, Δmyo8ABCDE plants produce more side branches and form gametophores much earlier than wild-type plants. In the absence of nutrient media, Δmyo8ABCDE plants exhibit significant protonemal patterning defects, including highly curved protonemal filaments, morphologically defective side branches, as well as an increase in the number of branches. Exogenous auxin partially rescues protonemal defects in Δmyo8ABCDE plants grown in the absence of nutrients. This result, together with defects in protonemal branching, smaller caulonemal cells, and accelerated development in the Δmyo8ABCDE plants, suggests that myosin VIII is involved in hormone homeostasis in P. patens.

Specific membrane binding of factor VIII is mediated by O-phospho-L-serine, a moiety of phosphatidylserine.

Science.gov (United States)

Gilbert, G E; Drinkwater, D

1993-09-21

Phosphatidylserine, a negatively charged lipid, is exposed on the platelet membrane following cell stimulation, correlating with the expression of factor VIII receptors. We have explored the importance of the negative electrostatic potential of phosphatidylserine vs chemical moieties of phosphatidylserine for specific membrane binding of factor VIII. Fluorescein-labeled factor VIII bound to membranes containing 15% phosphatidic acid, a negatively charged phospholipid, with low affinity compared to phosphatidylserine-containing membranes. Binding was not specific as it was inhibited by other proteins in plasma. Factor VIII bound to membranes containing 10% phosphatidylserine in spite of a varying net charge provided by 0-15% stearylamine, a positively charged lipid. The soluble phosphatidylserine moiety, O-phospho-L-serine, inhibited factor VIII binding to phosphatidylserine-containing membranes with a Ki of 20 mM, but the stereoisomer, O-phospho-D-serine, was 5-fold less effective. Furthermore, binding of factor VIII to membranes containing synthetic phosphatidyl-D-serine was 5-fold less than binding to membranes containing phosphatidyl-L-serine. Membranes containing synthetic phosphatidyl-L-homoserine, differing from phosphatidylserine by a single methylene, supported high-affinity binding, but it was not specific as factor VIII was displaced by other plasma proteins. O-Phospho-L-serine also inhibited the binding of factor VIII to platelet-derived microparticles with a Ki of 20 mM, and the stereoisomer was 4-fold less effective. These results indicate that membrane binding of factor VIII is mediated by a stereoselective recognition O-phospho-L-serine of phosphatidylserine and that negative electrostatic potential is of lesser importance.

Surgical smoke.

Science.gov (United States)

Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

2009-10-01

Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.

VIII Olimpíada Brasileira de Astronomia e Astronáutica

Science.gov (United States)

Garcia Canalle, João Batista; Villas da Rocha, Jaime Fernando; Wuensche de Souza, Carlos Alexandre; Pereira Ortiz, Roberto; Aguilera, Nuricel Villalonga; Padilha, Maria De Fátima Catta Preta; Pessoa Filho, José Bezerra; Soares Rodrigues, Ivette Maria

2007-07-01

Neste trabalho apresentamos as motivações pelas quais organizamos, em conjunto, pela primeira vez, a Olimpíada Brasileira de Astronomia incluindo a Astronáutica, em colaboração com a Agência Espacial Brasileira. Esta ampliação contribuiu para atrair ainda mais alunos, professores, escolas e patrocinadores para participarem desta Olimpíada. Em 2005 participaram da VIII Olimpíada Brasileira de Astronomia e Astronáutica (VIII OBA) 187.726 alunos distribuídos por 3.229 escolas, pertencentes a todos os estados brasileiros, incluindo o Distrito Federal. O crescimento em número de alunos participantes foi 52,4% maior do que em 2004. Em abril de 2005 organizamos, em Itapecerica da Serra, SP, um curso para os 50 alunos previamente selecionados e participantes da VII OBA e ao final selecionamos, dentre eles, uma equipe de 5 alunos, os quais representaram o Brasil na X Olimpíada Internacional de Astronomia, na China, em outubro de 2005. Ganhamos, pela primeira vez, uma medalha de ouro naquele evento. Em Agosto de 2005, organizamos a VIII Escola de Agosto para 50 alunos e respectivos professores, em Águas de Lindóia, SP, juntamente com a XXXI reunião anual da Sociedade Astronômica Brasileira (SAB). Em novembro de 2005 realizamos a I Jornada Espacial, em São José dos Campos, com 22 alunos e 22 professores selecionados dentre os participantes que melhores resultados obtiveram nas questões de Astronáutica da VIII OBA. Neste trabalho detalhamos os resultados da VIII OBA bem como as ações subseqüentes.

Analysis of mutations in the entire coding sequence of the factor VIII gene

Energy Technology Data Exchange (ETDEWEB)

Bidichadani, S.I.; Lanyon, W.G.; Connor, J.M. [Glascow Univ. (United Kingdom)] [and others

1994-09-01

Hemophilia A is a common X-linked recessive disorder of bleeding caused by deleterious mutations in the gene for clotting factor VIII. The large size of the factor VIII gene, the high frequency of de novo mutations and its tissue-specific expression complicate the detection of mutations. We have used a combination of RT-PCR of ectopic factor VIII transcripts and genomic DNA-PCRs to amplify the entire essential sequence of the factor VIII gene. This is followed by chemical mismatch cleavage analysis and direct sequencing in order to facilitate a comprehensive search for mutations. We describe the characterization of nine potentially pathogenic mutations, six of which are novel. In each case, a correlation of the genotype with the observed phenotype is presented. In order to evaluate the pathogenicity of the five missense mutations detected, we have analyzed them for evolutionary sequence conservation and for their involvement of sequence motifs catalogued in the PROSITE database of protein sites and patterns.

The vestibulocochlear nerve (VIII).

Science.gov (United States)

Benoudiba, F; Toulgoat, F; Sarrazin, J-L

2013-10-01

The vestibulocochlear nerve (8th cranial nerve) is a sensory nerve. It is made up of two nerves, the cochlear, which transmits sound and the vestibular which controls balance. It is an intracranial nerve which runs from the sensory receptors in the internal ear to the brain stem nuclei and finally to the auditory areas: the post-central gyrus and superior temporal auditory cortex. The most common lesions responsible for damage to VIII are vestibular Schwannomas. This report reviews the anatomy and various investigations of the nerve. Copyright © 2013. Published by Elsevier Masson SAS.

Practical experience and lessons learned through implementation of Appendix VIII performance demonstration requirements

International Nuclear Information System (INIS)

Ashwin, P.J.; Becker, F.L.; Latiolais, C.L.; Spanner, J.C.

1996-01-01

To provide the US nuclear industry with a uniform implementation of the Performance Demonstration requirements within the 1989 edition of ASME Section XI, Appendix VIII, representatives from all US nuclear utilities formed the Performance Demonstration Initiative (PDI). The PDI recognized the potential benefits that Appendix VIII offered the nuclear industry and initiated a proactive approach to implement the requirements. In doing so it was expected that performance demonstration of ultrasonic examination procedures would allow for improvement in the efficiency and credibility of inservice inspection to be realized. Explicit within the performance demonstration requirements of Appendix VIII is the need for a Performance Demonstration Administrator, a difficult requirement to fulfill. Not only must the administrator exhibit the attributes of understanding the demonstration requirements, but also have solid technical knowledge, integrity and be able to interface with the industry at all levels, from operations to regulatory. For the nuclear industry, the EPRI NDE Center is an obvious choice to fulfill this position. This paper provides a brief background of the PDI, a nuclear industry-wide initiative to implement the performance demonstration requirements of Appendix VIII. Even though the consensus approach adopted by the PDI is discussed, the paper's primary objective is to provide examples of the lessons learned by the Center through the specific requirements of Appendix VIII

Surgical navigation with QR codes

Directory of Open Access Journals (Sweden)

Katanacho Manuel

2016-09-01

Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.

Igor Zabel 14. VIII 1958 - 23. VII 2005

Index Scriptorium Estoniae

2005-01-01

Igor Zabel oli Ida-Euroopa tuntumaid kunstiteoreetikuid ja kuraatoreid. Töötas 1986. aastast Ljubljana moodsa kunsti muuseumi kuraatorina. 9. VIII avatakse seal viimane I. Zabeli kureeritud näitus "Territories, Identities, Nets-Slovene Art 1995-2005"

Home therapy with continuous infusion of factor VIII after minor surgery or serious haemorrhage.

Science.gov (United States)

Varon, D; Schulman, S; Bashari, D; Martinowitz, U

1996-10-01

Administration of factor VIII (F VIII) concentrates by continuous infusion is now routinely used at several haemophilia centers but almost exclusively for hospitalized patients. We evaluated various aspects of home therapy with continuous infusion of an immunoaffinity purified F VIII concentrate (Monoclate P®, Armour) in patients who would normally have been treated with high doses in bolus injections or with continuous infusion as in-patients. Twenty haemophilia A patients, eight after minor surgery and 12 for serious haemorrhage, received continuous infusion with undiluted F VIII by a minipump for a mean of 0.9 days in the hospital, followed by 3.3 days at home. Infusion bags were exchanged every 2.5 days. No haemorrhagic complications occurred, and five haemorrhages that had been resistant to treatment with bolus injections responded promptly to the continuous infusion. There were no technical problems and patient compliance and acceptance was good. We find this mode of therapy safe, efficacious and convenient for the patients as well as for the staff.

Is hospital information system relevant to detect surgical site infection? Findings from a prospective surveillance study in posterior instrumented spinal surgery.

Science.gov (United States)

Boetto, J; Chan-Seng, E; Lonjon, G; Pech, J; Lotthé, A; Lonjon, N

2015-11-01

Spinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system. This work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a "high definition" prospective method of surveillance was performed by the infection control (IC) department during at least 12 months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS). One hundred and fifty-four patients were included. We found no hardly difference between "high definition" and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI. Our SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Factor VIII gene (F8) mutation and risk of inhibitor development in nonsevere hemophilia a

NARCIS (Netherlands)

C.L. Eckhardt (Corien); A.S. van Velzen (Alice); M.A.D. Peters (Marjolein); J. Astermark (Jan); P.P. Brons; G. Castaman (Giancarlo); M.H. Cnossen (Marjon); N. Dors (N.); C. Escuriola-Ettingshausen (Carmen); K. Hamulyák (K.); D.P. Hart (Daniel); C.R.M. Hay (Charles R.); S. Haya (Saturnino); W.L. van Heerde; C. Hermans (Cédric); M. Holmström (Margareta); V. Jimenez-Yuste (Victor); R.D. Keenan (Russell); R. Klamroth (Robert); B.A.P. Laros-Van Gorkom (Britta); F.W.G. Leebeek (Frank); R. Liesner (Ri); A. Mäkipernaa (Anne); C. Male (Christoph); E.P. Mauser-Bunschoten (Eveline); M.G. Mazzucconi (Maria); S. McRae (Simon); K. Meijer (K.); M. Mitchell (Michael); M. Morfini (Massimo); M.R. Nijziel (Marten); J. Oldenburg (Jan); K. Peerlinck; P. Petrini (Pia); H. Platokouki (Helena); S.E. Reitter-Pfoertner (Sylvia); E. Santagostino (Elena); P. Schinco (Piercarla); F.J.W. Smiers (Frans); K.D. Siegmund (Kimberly); A. Tagliaferri (Annarita); T.T. Yee (Thynn); P.W. Kamphuisen (Pieter Willem); J.G. van der Bom (Anske); K. Fijnvandraat

2013-01-01

textabstractNeutralizing antibodies (inhibitors) toward factor VIII form a severe complication in nonsevere hemophilia A, profoundly aggravating the bleeding pattern. Identification of high-risk patients is hampered by lack of data that take exposure days to therapeutic factor VIII concentrates into

Posterior Rigid Instrumentation of C7: Surgical Considerations and Biomechanics at the Cervicothoracic Junction. A Review of the Literature.

Science.gov (United States)

Bayoumi, Ahmed B; Efe, Ibrahim E; Berk, Selim; Kasper, Ekkehard M; Toktas, Zafer Orkun; Konya, Deniz

2018-03-01

The cervicothoracic junction is a challenging anatomic transition in spine surgery. It is commonly affected by different types of diseases that may significantly impair stability in this region. The seventh cervical vertebra (C7) is an atypical cervical vertebra with unique anatomic features compared to subaxial cervical spine (C3 to C6). C7 has relatively broader laminae, larger pedicles, smaller lateral masses, and a long nonbifid spinous process. These features allow a variety of surgical methods for performing posterior rigid instrumentation in the form of different types of screws, such as lateral mass screws, pedicle screws, transfacet screws, and intralaminar screws. Many biomechanical studies on cadavers have evaluated and compared different types of implants at C7. We reviewed PubMed/Medline by using specific combinations of keywords to summarize previously published articles that examined C7 posterior rigid instrumentation thoroughly in an experimental fashion on patients or cadavers with additional descriptive radiologic parameters for evaluation of the optimum surgical technique for each type. A total of 44 articles were reported, including 22 articles that discussed anatomic considerations (entry points, sagittal and axial trajectories, and features of screws) and another 22 articles that discussed the relevant biomechanical testing at this transitional region if C7 was directly involved in terms of receiving posterior rigid implants. C7 can accommodate different types of screws, which can provide additional benefits and risks based on availability of bony purchase, awareness of surgical technique, biomechanics, and anatomic considerations. Copyright © 2017 Elsevier Inc. All rights reserved.

Characterization of five partial deletions of the factor VIII gene

International Nuclear Information System (INIS)

Youssoufian, H.; Antonarakis, S.E.; Aronis, S.; Tsiftis, G.; Phillips, D.G.; Kazazian, H.H. Jr.

1987-01-01

Hemophilia A is an X-linked disorder of coagulation caused by a deficiency of factor VIII. By using cloned DNA probes, the authors have characterized the following five different partial deletions of the factor VIII gene from a panel of 83 patients with hemophilia A: (i) a 7-kilobase (kb) deletion that eliminates exon 6; (ii) a 2.5-kb deletion that eliminates 5' sequences of exon 14; (iii) a deletion of at least 7 kb that eliminates exons 24 and 25; (iv) a deletion of at least 16 kb that eliminates exons 23-25; and (v) a 5.5-kb deletion that eliminates exon 22. The first four deletions are associated with severe hemophilia A. By contrast, the last deletion is associated with moderate disease, possibly because of in-frame splicing from adjacent exons. None of those patients with partial gene deletions had circulating inhibitors to factor VIII. One deletion occurred de novo in a germ cell of the maternal grandmother, while a second deletion occurred in a germ cell of the maternal grandfather. These observations demonstrate that de novo deletions of X-linked genes can occur in either male or female gametes

Maximizing coupling strength of magnetically anchored surgical instruments: how thick can we go?

Science.gov (United States)

Best, Sara L; Bergs, Richard; Gedeon, Makram; Paramo, Juan; Fernandez, Raul; Cadeddu, Jeffrey A; Scott, Daniel J

2011-01-01

The Magnetic Anchoring and Guidance System (MAGS) includes an external magnet that controls intra-abdominal surgical instruments via magnetic attraction forces. We have performed NOTES (Natural Orifice Transluminal Endoscopic Surgery) and LESS (Laparoendoscopic Single Site) procedures using MAGS instruments in porcine models with up to 2.5-cm-thick abdominal walls, but this distance may not be sufficient in some humans. The purpose of this study was to determine the maximal abdominal wall thickness for which the current MAGS platform is suitable. Successive iterations of prototype instruments were developed; those evaluated in this study include external (134-583 g, 38-61 mm diameter) and internal (8-39 g, 10-22 mm diameter) components using various grades, diameters, thicknesses, and stacking/shielding/focusing configurations of permanent Neodymium-iron-boron (NdFeB) magnets. Nine configurations were tested for coupling strength across distances of 0.1-10 cm. The force-distance tests across an air medium were conducted at 0.5-mm increments using a robotic arm fitted with a force sensor. A minimum theoretical instrument drop-off (decoupling) threshold was defined as the separation distance at which force decreased below the weight of the heaviest internal component (39 g). Magnetic attraction forces decreased exponentially over distance. For the nine configurations tested, the average forces were 3,334 ± 1,239 gf at 0.1 cm, 158 ± 98 gf at 2.5 cm, and 8.7 ± 12 gf at 5 cm; the drop-off threshold was 3.64 ± 0.8 cm. The larger stacking configurations and magnets yielded up to a 592% increase in attraction force at 2.5 cm and extended the drop-off threshold distance by up to 107% over single-stack anchors. For the strongest configuration, coupling force ranged from 5,337 gf at 0.1 cm to 0 gf at 6.95 cm and yielded a drop-off threshold distance of 4.78 cm. This study suggests that the strongest configuration of currently available MAGS instruments is suitable for

Hemorrhagic episodes in hemophiliacs stimulating abdominal surgical emergencies

International Nuclear Information System (INIS)

Rabie, Mohammad E.; Al-Tayeb, Abdul-Rehman E.; Zafer, Mubarak H.; Seikha, Anwar A.

2004-01-01

Hemophiliacs are subjected to develop episodes of spontaneous bleeding at different sites of the body, primarily the knees. On occasions such episodes affect the abdomen. The picture engendered in such cases may mimic that of an abdominal emergency requiring surgical intervention.Such ill advised and unwarranted intervention may end with the patient's death.With the proper emloyment of radiology, the correct diagonosis may be reached and consequently, conservative treatment, in which factor VIII plays the major role, instituted. Here we describe the clinical course of two patients with hemophilia A who suffered bleeding in the abdomen and were treated conservatively with a successfull outcome. (author)

Crystal Structure of Human Factor VIII: Implications for the Formation of the Factor IXa-Factor VIIIa Complex

Energy Technology Data Exchange (ETDEWEB)

Ngo, J.C.; Huang, M.; Roth, D.A.; Furie, B.C.; Furie, B. (Wyeth); (MBL)

2008-06-03

Factor VIII is a procofactor that plays a critical role in blood coagulation, and is missing or defective in hemophilia A. We determined the X-ray crystal structure of B domain-deleted human factor VIII. This protein is composed of five globular domains and contains one Ca{sup 2+} and two Cu{sup 2+} ions. The three homologous A domains form a triangular heterotrimer where the A1 and A3 domains serve as the base and interact with the C2 and C1 domains, respectively. The structurally homologous C1 and C2 domains reveal membrane binding features. Based on biochemical studies, a model of the factor IXa-factor VIIIa complex was constructed by in silico docking. Factor IXa wraps across the side of factor VIII, and an extended interface spans the factor VIII heavy and light chains. This model provides insight into the activation of factor VIII and the interaction of factor VIIIa with factor IXa on the membrane surface.

Crystal Structure of Human Factor VIII: Implications for the Formation of the Factor IXa-Factor VIIIa Complex

Energy Technology Data Exchange (ETDEWEB)

Chi Ki Ngo,J.; Huang, M.; Roth, D.; Furie, B.; Furie, B.

2008-01-01

Factor VIII is a procofactor that plays a critical role in blood coagulation, and is missing or defective in hemophilia A. We determined the X-ray crystal structure of B domain-deleted human factor VIII. This protein is composed of five globular domains and contains one Ca(2+) and two Cu(2+) ions. The three homologous A domains form a triangular heterotrimer where the A1 and A3 domains serve as the base and interact with the C2 and C1 domains, respectively. The structurally homologous C1 and C2 domains reveal membrane binding features. Based on biochemical studies, a model of the factor IXa-factor VIIIa complex was constructed by in silico docking. Factor IXa wraps across the side of factor VIII, and an extended interface spans the factor VIII heavy and light chains. This model provides insight into the activation of factor VIII and the interaction of factor VIIIa with factor IXa on the membrane surface.

Henry VIII, McLeod syndrome and Jacquetta's curse.

Science.gov (United States)

Stride, P; Lopes Floro, K

2013-01-01

The mental decline of King Henry VIII from being a jovial, charismatic and athletic young man into an increasingly paranoid, brutal tyrant in later life, ever more concerned at his lack of one or more male heirs, has attracted many medical diagnostic theories. Previous hypotheses have included diabetes, syphilis and hypothyroidism, among others. However, these inadequately explain Henry's failure to produce a male heir, despite multiple pairings. The latest postulated diagnoses for Henry are the coexistence of both Kell blood group antigenicity (possibly inherited from Jacquetta Woodville, Henry's maternal great grandmother) causing related impaired fertility, and McLeod syndrome, causing psychotic changes. As the mutated McLeod protein of the syndrome significantly reduces the expression, effectively inactivating the Kell antigen, we critically review this theory, examining in detail the pathophysiology of these conditions and assessing the genealogy of Henry VIII and its effect in subsequent generations.

Evidence for the formation of sodium hassate(VIII)

International Nuclear Information System (INIS)

Zweidorf, A. von; Angert, R.; Bruechle, W.; Buerger, S.; Eberhardt, K.; Eichler, R.; Hummrich, H.; Jaeger, E.; Kling, H.O.; Kratz, J.V.; Kuczewski, B.; Langrock, G.; Mendel, M.; Rieth, U.; Schaedel, M.; Schausten, B.; Schimpf, E.; Thoerle, P.; Trautmann, N.; Tsukada, K.; Wiehl, N.; Wirth, G.

2004-01-01

Hassium, element 108, was produced in the fusion reaction between 26 Mg and 248 Cm. The hassium recoils were oxidized in-situ to a highly volatile oxide, presumably HsO 4 , and were transported in a mixture of He and O 2 to a deposition and detection system. The latter consisted of 16 silicon PIN-photodiodes facing a layer of NaOH, which served, in the presence of a certain partial pressure of water in the transport gas, as reactive surface for the deposition of the volatile tetroxides. Six correlated α-decay chains of Hs were detected in the first 5 detectors centred around detection position 3. In analogy to OsO 4 , which forms Na 2 [OsO 4 (OH) 2 ], an osmate(VIII), with aqueous NaOH, HsO 4 presumably was deposited as Na 2 [HsO 4 (OH) 2 ], a hassate(VIII). (orig.)

The spectrum and term system of S VIII

International Nuclear Information System (INIS)

Bengtsson, P.; Jupen, C.; Engstroem, L.; Redfors, A.; Westerlind, M.

1993-01-01

The spectrum of seven times ionized sulfur, S VIII, has been observed in the wavelength range 50-1200 A. Both beam-foil and laser-produced plasma light sources have been used. 71 new lines representing the transitions 2p 5 -2p 4 3d, 2p 4 3s-3p, 3p-3d, 3d-4f, 4f-5g and 5g-6h have been identified and 100 energy levels, of which 46 are new, are now accurately established. The spectral analysis is supported by isoelectronic comparisons along the F I-sequence and by parametric least-squares fits of Slater integrals to the observed levels. The ionization potential in S VIII is determined to 2 651 899 ± 60 cm -1 and estimated ionization energies are derived for the isoelectronic elements between F I and Ar X. (orig.)

Purification and characterization of factor VIII 1,689-Cys: a nonfunctional cofactor occurring in a patient with severe hemophilia A.

Science.gov (United States)

O'Brien, D P; Tuddenham, E G

1989-06-01

We have purified the factor VIII from a CRM+ Hemophilia A plasma (90 U/dL VIII:Ag but 0 U/dL VIII:C) and analyzed the protein before and after thrombin activation by Western blotting with monoclonal antibodies (MoAbs). Normal or patient citrated plasma was ultracentrifuged, cryo-ethanol-precipitated and chromatographed on Sepharose 6B. The void volume fractions were reduced and subjected to ion exchange chromatography yielding material of specific activity approximately 1,000 U/mg protein (VIII:C or VIII:Ag). Factor VIII purified in this way from normal plasma is fully activatable by thrombin with proteolytic fragmentation as previously described by F. Rotblat et al (Biochemistry 24: 4294, 1985). Factor VIII 1,689-Cys has the normal distribution of factor VIII light and heavy chains prior to thrombin activation. After exposure to thrombin the heavy chain polypeptides were fully proteolysed but the light chain was totally resistant to cleavage. This is consistent with the demonstration in the patient's leucocyte DNA of a C to T transition in codon 1,689 converting Arg to Cys at the light chain thrombin cleavage site as previously described by J. Gitschier et al (Blood 72:1022, 1988). Uncleaved light chain of Factor VIII 1,689-Cys is not released from von Willebrand factor (vWF) by thrombin, but this is not the sole cause of the functional defect since the protein purified free of vWF has no coagulant activity. We conclude that the functional defect in factor VIII 1,689-Cys is a consequence of failure to release the acidic peptide from the light chain upon thrombin activation.

A study on factors of dissatisfaction and stress of the blacksmiths resulting from the organizational culture in the surgical instrument industry of India.

Science.gov (United States)

Ghosh, Tirthankar; Das, Banibrata; Gangopadhyay, Somnath

2011-07-01

It is important to understand what motivates workers and the extent to which the organization and other contextual variables satisfy them. The aim of the study was to determine factors of dissatisfaction resulting from the organizational culture among the blacksmiths involved in the surgical instrument industry. Fifty male surgical blacksmiths each of the skilled and unskilled groups of the forging section were selected. Organizational Role Stress Scale was used to measure the individuals' role stress and several forms of conflict within an organization. Also, the organizational culture and personal involvement in an organization was measured among the surgical blacksmiths. The mean score for total role stress for Skilled was 71.7 and for unskilled was 77.2. The most frequent type of organizational culture was reported to be hierarchy, both by skilled and unskilled surgical blacksmiths, followed by market and clan culture. This study shows that the skilled surgical blacksmiths have lower level of stress and conflicts in comparison with unskilled surgical blacksmiths. Both skilled and unskilled surgical blacksmiths estimated their level of personal involvement as low and indicated insufficient involvement in work teams. The satisfaction of the employees with their status and role in the organizational culture was also poor for both skilled and unskilled surgical blacksmiths.

40 CFR Appendix Viii to Part 266 - Organic Compounds for Which Residues Must Be Analyzed

Science.gov (United States)

2010-07-01

... AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR THE MANAGEMENT OF SPECIFIC HAZARDOUS WASTES AND SPECIFIC TYPES OF HAZARDOUS WASTE MANAGEMENT FACILITIES Pt. 266, App. VIII Appendix VIII to Part 266... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Organic Compounds for Which Residues...

40 CFR Appendix Viii to Part 268 - LDR Effective Dates of Injected Prohibited Hazardous Wastes

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 26 2010-07-01 2010-07-01 false LDR Effective Dates of Injected Prohibited Hazardous Wastes VIII Appendix VIII to Part 268 Protection of Environment ENVIRONMENTAL PROTECTION... to Part 268—LDR Effective Dates of Injected Prohibited Hazardous Wastes National Capacity LDR...

Structural characterization of the novel aminoglycoside phosphotransferase AphVIII from Streptomyces rimosus with enzymatic activity modulated by phosphorylation

Energy Technology Data Exchange (ETDEWEB)

Boyko, Konstantin M., E-mail: kmb@inbi.ras.ru [Bach Institute of Biochemistry, Federal Research Centre of Biotechnology of the Russian Academy of Sciences, Leninsky Prospekt. 33, Bld. 2, 119071, Moscow (Russian Federation); National Research Center “Kurchatov Institute”, Kurchatov Complex of NBICS-technologies, Akad. Kurchatova sqr., 1, Moscow, 123182 (Russian Federation); Gorbacheva, Marina A.; Korzhenevskiy, Dmitry A. [National Research Center “Kurchatov Institute”, Kurchatov Complex of NBICS-technologies, Akad. Kurchatova sqr., 1, Moscow, 123182 (Russian Federation); Alekseeva, Maria G.; Mavletova, Dilara A.; Zakharevich, Natalia V.; Elizarov, Sergey M.; Rudakova, Natalia N.; Danilenko, Valery N. [Vavilov Institute of General Genetics, Russian Academy of Sciences, Gubkina str. 3, Moscow, 119333 (Russian Federation); Popov, Vladimir O. [Bach Institute of Biochemistry, Federal Research Centre of Biotechnology of the Russian Academy of Sciences, Leninsky Prospekt. 33, Bld. 2, 119071, Moscow (Russian Federation); National Research Center “Kurchatov Institute”, Kurchatov Complex of NBICS-technologies, Akad. Kurchatova sqr., 1, Moscow, 123182 (Russian Federation)

2016-09-02

Aminoglycoside phosphotransferases represent a broad class of enzymes that promote bacterial resistance to aminoglycoside antibiotics via the phosphorylation of hydroxyl groups in the latter. Here we report the spatial structure of the 3′-aminoglycoside phosphotransferase of novel VIII class (AphVIII) solved by X-ray diffraction method with a resolution of 2.15 Å. Deep analysis of APHVIII structure and its comparison with known structures of aminoglycoside phosphotransferases of various types reveals that AphVIII has a typical two-domain fold and, however, possesses some unique characteristics that distinguish the enzyme from its known homologues. The most important difference is the presence of the activation loop with unique Ser146 residue. We demonstrate that in the apo-state of the enzyme the activation loop does not interact with other parts of the enzyme and seems to adopt catalytically competent state only after substrate binding. - Highlights: • 3D structure of the novel aminoglycoside phosphotransferase AphVIII was obtained. • AphVIII activation loop is clearly identified in the electron density. • AphVIII has some unique structural features in its substrate C-ring binding pocket.

Hemodialysis in a patient with severe hemophilia A and factor VIII inhibitor.

Science.gov (United States)

Gopalakrishnan, Natarajan; Usha, Thiruvengadam; Thopalan, Balasubramaniyan; Dhanapriya, Jeyachandran; Dineshkumar, Thanigachalam; Thirumalvalavan, Kaliaperumal; Sakthirajan, Ramanathan

2016-10-01

Hemophilia A is a hereditary X-linked recessive disease caused by mutations in the gene encoding factor VIII (FVIII), occurring in 1 out of 10,000 persons. Life expectancy and quality of life have dramatically improved recently in patients with hemophilia. Chronic kidney disease and need for renal replacement therapy in these patients are rare. The development of inhibitors to FVIII is the most serious complication of hemophilia and makes treatment of bleeds very challenging. We describe here a 28-year-old male patient with severe hemophilia A with presence of factor VIII inhibitor, who had end stage renal disease. Central venous access device was inserted along with infusion of factor eight inhibitor bypass activity before and after the procedure. He is currently on thrice weekly hemodialysis and doing well for 6 months without bleeding episodes. To our knowledge, hemophilia A with factor VIII inhibitor managed with hemodialysis has not been reported so far. © 2016 International Society for Hemodialysis.

Spectrophotometric determination of hydrogen peroxide with osmium(VIII) and m-carboxyphenylfluorone.

Science.gov (United States)

Hoshino, Mitsuru; Kamino, Shinichiro; Doi, Mitsunobu; Takada, Shingo; Mitani, Shota; Yanagihara, Rika; Asano, Mamiko; Yamaguchi, Takako; Fujita, Yoshikazu

2014-01-03

Spectrophotometric determination of hydrogen peroxide was accomplished with osmium(VIII) and m-carboxyphenylfluorone (MCPF) in the presence of cetyltrimethylammonium chloride (CTAC). In the determination of hydrogen peroxide based on the fading of the color of osmium(VIII)-MCPF complex, Beer's law was obeyed in the range 20-406 ng mL(-1), with an effective molar absorption coefficient (at 580 nm) of 5.21×10(4) L mol(-1) cm(-1) and a relative standard deviation of 0.33% (n=6). Further, we performed the characterization of MCPF and obtained the crystal structure. Copyright © 2013 Elsevier B.V. All rights reserved.

A study on factors of dissatisfaction and stress of the blacksmiths resulting from the organizational culture in the surgical instrument industry of India

Directory of Open Access Journals (Sweden)

Tirthankar Ghosh

2011-01-01

Full Text Available Background: It is important to understand what motivates workers and the extent to which the organization and other contextual variables satisfy them. The aim of the study was to determine factors of dissatisfaction resulting from the organizational culture among the blacksmiths involved in the surgical instrument industry. Materials and Methods: Fifty male surgical blacksmiths each of the skilled and unskilled groups of the forging section were selected. Organizational Role Stress Scale was used to measure the individuals′ role stress and several forms of conflict within an organization. Also, the organizational culture and personal involvement in an organization was measured among the surgical blacksmiths. Results: The mean score for total role stress for Skilled was 71.7 and for unskilled was 77.2. The most frequent type of organizational culture was reported to be hierarchy, both by skilled and unskilled surgical blacksmiths, followed by market and clan culture. Conclusion: This study shows that the skilled surgical blacksmiths have lower level of stress and conflicts in comparison with unskilled surgical blacksmiths. Both skilled and unskilled surgical blacksmiths estimated their level of personal involvement as low and indicated insufficient involvement in work teams. The satisfaction of the employees with their status and role in the organizational culture was also poor for both skilled and unskilled surgical blacksmiths.

Freeman's transorbital lobotomy as an anomaly: A material culture examination of surgical instruments and operative spaces.

Science.gov (United States)

Collins, Brianne M; Stam, Henderikus J

2015-05-01

In 1946, Walter Freeman introduced the transorbital ice pick lobotomy. Touted as a procedure that could be learned and subsequently performed by psychiatrists outside of the operating room, the technique was quickly criticized by neurosurgeons. In this article, we take a material culture approach to consider 2 grounds upon which neurosurgeons based their objections-surgical instruments and operative spaces. On both counts, Freeman was in contravention of established normative neurosurgical practices and, ultimately, his technique was exposed as an anomaly by neurosurgeons. Despite its rejection, the transorbital lobotomy became entrenched in contemporary memory and remains the emblematic procedure of the psychosurgery era. (c) 2015 APA, all rights reserved).

Factor VIII-associated antigen in human lymphatic endothelium.

Science.gov (United States)

Nagle, R B; Witte, M H; Martinez, A P; Witte, C L; Hendrix, M J; Way, D; Reed, K

1987-03-01

Lymphatic vascular endothelium both on tissue section and in culture exhibits positivity for Factor VIII-associated antigen although staining is generally less intense and more spotty than in comparable blood vascular endothelium. Lymphatic endothelium also exhibits Weibel-Palade bodies. Neither marker, therefore, reliably distinguishes blood vascular endothelium from lymphatic endothelium.

手术污染器械保湿过程中的污染控制%Contamination control during wetting of contaminated surgical instruments

Institute of Scientific and Technical Information of China (English)

龚珊; 许多朵; 董薪

2015-01-01

目的：分析手术污染器械保湿以提高器械的清洗效果，确保手术安全。方法选择2014年3－6月污染的医疗器械1200件，分为保湿组与未保湿组，每组各600件，通过对手术污染器械处理过程中技术规范的实践，分析器械保湿对于提高器械清洗效果的重要性。结果在器械回收、转运、预清洗、正式清洗等环节中，不同时间保湿组细菌菌落数低于未保湿组，使用专用保湿剂抑制了细菌生长；保湿组目测及5倍放大镜下监测器械清洁合格率分别为100．0％、99．5％，均高于未保湿组的98．7％、97．8％；保湿组污染器械清洗后隐血试验合格率100．0％，高于未保湿组的98．7％。结论适当的保湿处理能提高器械清洗合格率，确保清洗质量，对于手术污染器械的感染控制有重要作用，为杜绝由于器械清洗不彻底引起医源性感染提供保证。%OBJECTIVE To analyze the wetting process of contaminated surgical instruments and improve cleanlinessso as to ensure the safety of surgical operation .METHODS Totally 1 200 contaminated items of surgical instruments during Mar .2014 to Jun .2014 were divided into two groups ,the wetted group and the non‐wetted group with 600 items in each group .The technical standard was implemented during the wetting management of contaminated surgical instruments .The results were analyzed to illustrate the importance of a wet condition for the benefit of improving sterilization .RESULTS During the processes of instrument recollection ,transfer ,pre‐cleaning and formal cleaning ,the bacterial colony count was less in the wetted group than in the non‐wetted group at each time point ,indicating that the use of specific humectant inhibited bacterial growth .The cleaning qualified rate reached 100 .0% by visual inspection and 99 .5% by magnifying glass in the wetted group ,higher than 98 .7% and 97 .8% in the non‐wetted group .The

Face, content, and construct validity of four, inanimate training exercises using the da Vinci ® Si surgical system configured with Single-Site ™ instrumentation.

Science.gov (United States)

Jarc, Anthony M; Curet, Myriam

2015-08-01

Validated training exercises are essential tools for surgeons as they develop technical skills to use robot-assisted minimally invasive surgical systems. The purpose of this study was to show face, content, and construct validity of four, inanimate training exercises using the da Vinci (®) Si surgical system configured with Single-Site (™) instrumentation. New (N = 21) and experienced (N = 6) surgeons participated in the study. New surgeons (11 Gynecology [GYN] and 10 General Surgery [GEN]) had not completed any da Vinci Single-Site cases but may have completed multiport cases using the da Vinci system. They participated in this study prior to attending a certification course focused on da Vinci Single-Site instrumentation. Experienced surgeons (5 GYN and 1 GEN) had completed at least 25 da Vinci Single-Site cases. The surgeons completed four inanimate training exercises and then rated them with a questionnaire. Raw metrics and overall normalized scores were computed using both video recordings and kinematic data collected from the surgical system. The experienced surgeons significantly outperformed new surgeons for many raw metrics and the overall normalized scores derived from video review (p da Vinci Single-Site surgery and actually testing the technical skills used during da Vinci Single-Site surgery. In summary, the four training exercises showed face, content, and construct validity. Improved overall scores could be developed using additional metrics not included in this study. The results suggest that the training exercises could be used in an overall training curriculum aimed at developing proficiency in technical skills for surgeons new to da Vinci Single-Site instrumentation.

Potential role of a new PEGylated recombinant factor VIII for hemophilia A

Directory of Open Access Journals (Sweden)

Wynn TT

2016-06-01

Full Text Available Tung Thanh Wynn,1 Burak Gumuscu,2,3 1Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Florida, Gainesville, FL, 2Pediatric Hematology-Oncology, Bon Secours Health System, St. Mary’s Hospital, Richmond, VA, 3Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Virginia, Charlottesville, VA, USA Abstract: Hemophilia A, a deficiency in the activity of coagulation factor (F VIII, is an X-linked bleeding disorder with an approximate incidence of one in 5,000 male infants. Bleeding-related complications often result in greater severity of disease, poor quality of life, surgical interventions for severe joint destruction, and shortened life span. With the availability of plasma-derived and recombinant FVIII products, the benefits of primary prophylaxis were demonstrated and is now the standard of care for patients with severe factor deficiencies. Current hemophilia research is focusing on the creation of new factor replacement therapies with longer half-lives; accessing alternative mechanisms to achieve desired hemostasis and enhance bypassing ­activity; and limiting the immunogenicity of the protein. PEGylation involves the covalent attachment of polyethylene glycol (PEG to a protein, peptide, or a small molecule drug. PEG effectively increases the molecular weight and size of the protein by creating a hydrophilic cloud around the molecule. This molecular change may reduce susceptibility of the molecule to proteolytic activity and degradation. It is also believed that PEGylation changes the surface charge of the protein that ultimately interferes with some receptor-mediated clearance processes. The half-life of PEGylated factor is more prolonged when compared to non-PEGylated full-length recombinant FVIII. The dawn of a new era in the care of hemophilia patients is upon us with the release of recombinant FVIII products with extended half-lives, and products with even more extended half

Time Transfer Experiment by TCE on the ETS-VIII Satellite

National Research Council Canada - National Science Library

Nakagawa, Fumimaru; Takahashi, Yasuhiro; Amagai, Jun; Tabuchi, Ryo; Hama, Shin'ichi; Hosokawa, Mizuhiko

2007-01-01

.... At NICT, we developed Time Comparison Equipment (TCE) both onboard ETS-VIII and in the Earth station for precise time transfer between the atomic clocks on the satellite and a ground reference clock...

Shortened OR time and decreased patient risk through use of a modular surgical instrument with artificial intelligence.

Science.gov (United States)

Miller, David J; Nelson, Carl A; Oleynikov, Dmitry

2009-05-01

With a limited number of access ports, minimally invasive surgery (MIS) often requires the complete removal of one tool and reinsertion of another. Modular or multifunctional tools can be used to avoid this step. In this study, soft computing techniques are used to optimally arrange a modular tool's functional tips, allowing surgeons to deliver treatment of improved quality in less time, decreasing overall cost. The investigators watched University Medical Center surgeons perform MIS procedures (e.g., cholecystectomy and Nissen fundoplication) and recorded the procedures to digital video. The video was then used to analyze the types of instruments used, the duration of each use, and the function of each instrument. These data were aggregated with fuzzy logic techniques using four membership functions to quantify the overall usefulness of each tool. This allowed subsequent optimization of the arrangement of functional tips within the modular tool to decrease overall time spent changing instruments during simulated surgical procedures based on the video recordings. Based on a prototype and a virtual model of a multifunction laparoscopic tool designed by the investigators that can interchange six different instrument tips through the tool's shaft, the range of tool change times is approximately 11-13 s. Using this figure, estimated time savings for the procedures analyzed ranged from 2.5 to over 32 min, and on average, total surgery time can be reduced by almost 17% by using the multifunction tool.

Mechanistic aspects of Os(VIII) catalysed oxidation of loop diuretic ...

Indian Academy of Sciences (India)

furosemide by Ag(III) periodate complex in aqueous alkaline medium. SHWETA J .... Os(VIII) catalysed DPA oxidation, the order in [OH. −. ] ... Victoria-3170, Australia) connected to a rapid ..... follows. The furosemide, periodate and hydroxide ion.

PERSEPSI SISWA KELAS VIII TENTANG KESEHATAN REPRODUKSI REMAJA DAN PENYAKIT MENULAR SEKSUAL

Directory of Open Access Journals (Sweden)

Omega Rianda Rustian

2015-06-01

This study is based on interviews conducted in one of the BK school teacher. This study aimed to determine the perception class VIII student perceptions on adolescent reproductive health and sexually transmitted diseases in SMP Islam Sultan Agung 1 Semarang. The method used in this research is descriptive quantitative survey methods. Population in this research is class VIII SMP Islam Sultan Agung 1 Semarang totaling 151 students with a sampling technique used is accidental to obtain a sample of 60. Data collection tools in the form of a psychological scale with data analysis techniques using descriptive analysis percentage. The average result of students' perceptions on adolescent reproductive health in the high category (74% and perceptions of students about sexually transmitted diseases in the very high category (76%. That class VIII SMP Islam Sultan Agung 1 Semarang already have an idea of the meaning of adolescent reproductive health is a state of good health both physically healthy, functioning, as well as reproductive performance in adolescent and the  meaning of sexually transmitted diseases are caused by viruses, parasites, or function as a result of sexual intercourse.

Factor VIII levels and the risk of pre-eclampsia, HELLP syndrome, pregnancy related hypertension and severe intrauterine growth retardation.

Science.gov (United States)

Witsenburg, C P J; Rosendaal, F R; Middeldorp, J M; Van der Meer, F J M; Scherjon, S A

2005-01-01

Recently, acquired as well as genetic prothrombotic factors are associated with thrombotic events. These factors have also been related to conditions of uteroplacental insufficiency such as pre-eclampsia, HELLP syndrome and severe intrauterine growth restriction (IUGR). The aim of this study was to determine whether elevated factor VIII levels are associated with uteroplacental insufficiency, in particular pre-eclampsia, HELLP syndrome or pregnancy-induced hypertension and intrauterine growth retardation. Plasma samples of 75 women with a history of pregnancy complicated by pre-eclampsia, HELLP syndrome, pregnancy induced hypertension or intrauterine growth restriction were tested for factor VIII:C (FVIII:C) levels at a minimum of 10 weeks post-partum. Laboratory results were compared to factor VIII:C levels found in a healthy control group of 272 women. Mean factor VIII:C levels were similar at 123 IU/dl in both the patient group and the controls. In a logistic regression model, after adjusting for age and blood group, no effect of factor VIII:C levels on the risk of pregnancy complications was observed, with the exception of IUGR with (OR 2.9, CI 1.0-8.7) or without hypertension (OR 2.0, CI 0.7-6.4). If the elevated level of factor VIII would be the sole factor responsible for the increased risk observed, one would expect to find an effect of blood group on risk as well (blood group being an important determinant of FVIII:C). While no such effect could be shown a causal relationship between elevated levels of factor VIII and conditions of uteroplacental insufficiency such as pre-eclampsia, HELLP syndrome, pregnancy-induced hypertension and IUGR is not very likely.

Class VIII Medical Materiel Controls in the U.S. European Command

National Research Council Canada - National Science Library

1991-01-01

.... Class VIII medical materiel inventories are maintained as part of the U.S. war reserve stocks to ensure military readiness and to provide needed health care during wartime or contingencies. The U.S...

RELATIONSHIP OF INTEREST, LEARNING MOTIVATION AND ATTITUDE WITH RESULTS LEARNING CLASS VIII SMP STATE 13 MAKASSAR

Directory of Open Access Journals (Sweden)

Putri Athirah Azis

2016-12-01

Full Text Available The study aims at examining (1 the correlation of learning interest towards learning result of grade students, (2 the correlation of learning motivation towards learning result of grade students, (3 the correlation of students attitude towards learning result, (4 the correlationof interest, learning motivation, and attitude collaboratively towards learning result. The study is an ex post facto. The population of the study was grade VIII at SMPN 13 Makassar. Samples were 105 students taken by employing random sampling technique. Data were collected through questionnaire and documentation. Data were analyzed using regression test. The result of study reveal that (1 there is significant correlation (p<0,01 of interest towards learning result of grade VIII students at SMPN 13 Makassar. Co-efficient correlation (r is 0,718 and its effectiveness contribution (R2 is 51,5%, (2 there is significant correlation (p<0,01 of motivation towards learning result of grade VIII students at SMPN 13 Makassar. Co-efficient correlation (r is 0,775 and its effectiveness contribution (R2 is 60,1%, (3 there is significant correlation (p<0,01 of attitude towards learning result of grade VIII students at SMPN 13 Makassar. Co-efficient correlation (r is 0,737 and its effectiveness contribution (R2 is 54,4%, (4 there is significant correlation (p<0,01 of interest, motivation and attitude collaboratively towards learning result of grade VIII students at SMPN 13 Makassar. Co-efficient correlation (r is 0,861 and its effectiveness contribution (R2 is 74,1%,

Compact invariant sets of the Bianchi VIII and Bianchi IX Hamiltonian systems

International Nuclear Information System (INIS)

Starkov, Konstantin E.

2011-01-01

In this Letter we prove that all compact invariant sets of the Bianchi VIII Hamiltonian system are contained in the set described by several simple linear equalities and inequalities. Moreover, we describe invariant domains in which the phase flow of this system has no recurrence property and show that there are no periodic orbits and neither homoclinic, nor heteroclinic orbits contained in the zero level set of its Hamiltonian. Similar results are obtained for the Bianchi IX Hamiltonian system. -- Highlights: → Zero level set of Hamiltonian of Bianchi VIII/IX systems contains no periodic orbits. → Similar conditions for homoclinic/heteroclinic orbits are given. → General nonexistence conditions of compact invariant sets are got.

Compact invariant sets of the Bianchi VIII and Bianchi IX Hamiltonian systems

Energy Technology Data Exchange (ETDEWEB)

Starkov, Konstantin E., E-mail: konst@citedi.mx [CITEDI-IPN, Av. del Parque 1310, Mesa de Otay, Tijuana, BC (Mexico)

2011-08-22

In this Letter we prove that all compact invariant sets of the Bianchi VIII Hamiltonian system are contained in the set described by several simple linear equalities and inequalities. Moreover, we describe invariant domains in which the phase flow of this system has no recurrence property and show that there are no periodic orbits and neither homoclinic, nor heteroclinic orbits contained in the zero level set of its Hamiltonian. Similar results are obtained for the Bianchi IX Hamiltonian system. -- Highlights: → Zero level set of Hamiltonian of Bianchi VIII/IX systems contains no periodic orbits. → Similar conditions for homoclinic/heteroclinic orbits are given. → General nonexistence conditions of compact invariant sets are got.

[Evaluation of Medical Instruments Cleaning Effect of Fluorescence Detection Technique].

Science.gov (United States)

Sheng, Nan; Shen, Yue; Li, Zhen; Li, Huijuan; Zhou, Chaoqun

2016-01-01

To compare the cleaning effect of automatic cleaning machine and manual cleaning on coupling type surgical instruments. A total of 32 cleaned medical instruments were randomly sampled from medical institutions in Putuo District medical institutions disinfection supply center. Hygiena System SUREII ATP was used to monitor the ATP value, and the cleaning effect was evaluated. The surface ATP values of the medical instrument of manual cleaning were higher than that of the automatic cleaning machine. Coupling type surgical instruments has better cleaning effect of automatic cleaning machine before disinfection, the application is recommended.

21 CFR 872.4565 - Dental hand instrument.

Science.gov (United States)

2010-04-01

... chisel, endodontic broach, dental wax carver, endodontic pulp canal file, hand instrument for calculus... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Dental hand instrument. 872.4565 Section 872.4565...) MEDICAL DEVICES DENTAL DEVICES Surgical Devices § 872.4565 Dental hand instrument. (a) Identification. A...

Successful Pregnancy in a Patient with Combined Deficiency of Factor V and Factor VIII.

Science.gov (United States)

El Adib, Ahmed Ghassan; Majdi, Farah; Dilai, Mohamed Othmane; Asmouki, Hamid; Bassir, Ahlam; Harou, Karam; Soumani, Abderraouf; Younous, Said; Mahmal, Lahoucine

2014-01-01

Inherited combined factor V and factor VIII deficiency (F5F8D) is autosomal recessive transmission disorder. Epistaxis, postsurgical bleeding, and menorrhagia are the most common symptoms. The risk of miscarriage and placental abruption is consequent. We report a case of successful pregnancy in a patient with F5F8D. 20-year-old woman, born of consanguineous parents, third gestate, first parity, two miscarriages, admitted for child birth of a spontaneous pregnancy estimated at 38 weeks and was diagnosed with F5F8D. At admission, patient was hemodynamically stable, with good obstetric conditions. The biologic results showed low levels of PT (52%), factor V (7%), and factor VIII (5%), and the activated partial thromboplastin time was prolonged (68,6%). Parturient was admitted in intensive care unit, maternal and fetal monitoring was performed. Fresh frozen plasma (FFP) and factor VIII concentrates were perfused at the induction of labor. Analgesia used fentanyl titration. The delivery gave birth to a newborn male, with Apgar 10/10 and 3000 g. The puerperium was simple without any important bleeding. Laboratory tests for the newborn were acceptable. Little literature is available on this subject and there are no guidelines available concerning pregnancy; we chose to prescribe a combination of factor VIII concentrate and FFP in pre-, per- and postpartum. The same protocol was successfully used in a patient before dental extraction and prostatectomy. Vaginal delivery is possible, as our case. Management by multidisciplinary team is recommended.

A close insight to factor VIII inhibitor in the congenital hemophilia A.

Science.gov (United States)

Tabriznia-Tabrizi, Shamsoreza; Gholampour, Marzie; Mansouritorghabeh, Hassan

2016-09-01

Hemophilia A (HA) has an X-linked pattern of inheritance and is the most common of the hemorrhagic disorders. HA is caused by a decreased or deficiency of the functional clotting factor VIII (FVIII) and effects 1 in 5000-10,000 male births. The common treatment for hemophilia is replacement therapy by plasma-derived or recombinant FVIII. Approximately 20-30% of people with a severe type of HA develop an inhibitor and this phenomenon is the main challenge in the management of these patients. Genetic factors and environmental determinants contribute to inhibitor development. Here, the roles of various genetic and environmental factors such as the type of FVIII concentrate used, the number of exposure days, and peak treatment time will be discussed in detail. It seems this information is helpful for hematologists. A literature review was done in January 2016 on PubMed and Scopus using the following keywords:' h(a)emophilia A & factor VIII inhibitor', 'h(a)emophilia A & factor VIII alloantibody', 'h(a)emophilia A & inhibitor'. There was no time limitation; however, there was an English language limitation placed on the articles selected. Expert commentary: Influential genetic and environmental factors in developing inhibitors have been discussed. Most of the risk factors are related to previously untreated patients with hemophili.

VIII International Congress of Engineering Physics

International Nuclear Information System (INIS)

2017-01-01

The Physicist Engineering is a multidisciplinary profession in which an undergraduate student integrates and applies their knowledge of Physics, Mathematics, and Computing to adapt and innovate all kind of technologies, as well as to development and apply theoretical knowledge to different fields of science and engineering. A Physicist Engineer, supported by a solid preparation in science and engineering is available to study, analyze, identify, and solve problems in different fields of science and technology for industries, hospitals, research laboratories, institutes and governmental organizations focused on metrology, optics, energy, materials, instrumentation of sophisticated equipment. The Physicist Engineering bachelor degree is a national and international reference to encouraging all those students to apply knowledge through active participation in the operation, planning, and management of projects. The technological and scientific impact of a Physicist Engineering undergraduate and graduate students, as well as the tutorial of the research professor that are interested in Physics and Physics Engineering, may be found in a biennial event like the International Conference on Physicist Engineering, through the diffusion of both experimental and theoretical research and teaching. In order to promote and encourage strength academic goals among universities and research institutions, the International Conference on Physics Engineering Committee, integrated by a faculty meeting of the Universidad Autónoma Metropolitana, Campus Azcapotzalco, has decided to grant the VIII International Congress of Physics Engineering to the Universidad Autónoma de Yucatán, which is going to take place on Mérida, November 7 th to 11 th , 2016. This conference considers different topics as: Renewables Energies Engineering Materials Technology Nanotechnology Medical Physics Education in Physics Engineering Nuclear Engineering High Precision Instrumentation Atmosphere Physics

Effectiveness of Adaptive Contextual Learning Model of Integrated Science by Integrating Digital Age Literacy on Grade VIII Students

Science.gov (United States)

Asrizal, A.; Amran, A.; Ananda, A.; Festiyed, F.

2018-04-01

Educational graduates should have good competencies to compete in the 21st century. Integrated learning is a good way to develop competence of students in this century. Besides that, literacy skills are very important for students to get success in their learning and daily life. For this reason, integrated science learning and literacy skills are important in 2013 curriculum. However, integrated science learning and integration of literacy in learning can’t be implemented well. Solution of this problem is to develop adaptive contextual learning model by integrating digital age literacy. The purpose of the research is to determine the effectiveness of adaptive contextual learning model to improve competence of grade VIII students in junior high school. This research is a part of the research and development or R&D. Research design which used in limited field testing was before and after treatment. The research instruments consist of three parts namely test sheet of learning outcome for assessing knowledge competence, observation sheet for assessing attitudes, and performance sheet for assessing skills of students. Data of student’s competence were analyzed by three kinds of analysis, namely descriptive statistics, normality test and homogeneity test, and paired comparison test. From the data analysis result, it can be stated that the implementation of adaptive contextual learning model of integrated science by integrating digital age literacy is effective to improve the knowledge, attitude, and literacy skills competences of grade VIII students in junior high school at 95% confidence level.

21 CFR 882.4275 - Dowel cutting instrument.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Dowel cutting instrument. 882.4275 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4275 Dowel cutting instrument. (a) Identification. A dowel cutting instrument is a device used to cut dowels of bone for bone grafting. (b...

Instrument care: everyone's responsibility

Directory of Open Access Journals (Sweden)

Renée du Toit

2011-12-01

Full Text Available Everyone working in an ophthalmic operating theatre must be competent in the care, handling, storage, and maintenance of instruments. This will help to improve surgical outcomes, maintain an economic and affordable service for patients, and provide a safe environment for the wellbeing of patients and staff.Including instrument care in theatre courses and in-service training is one way of ensuring staff competence.

Pneumatic-type surgical robot end-effector for laparoscopic surgical-operation-by-wire.

Science.gov (United States)

Lee, Chiwon; Park, Woo Jung; Kim, Myungjoon; Noh, Seungwoo; Yoon, Chiyul; Lee, Choonghee; Kim, Youdan; Kim, Hyeon Hoe; Kim, Hee Chan; Kim, Sungwan

2014-09-05

Although minimally invasive surgery (MIS) affords several advantages compared to conventional open surgery, robotic MIS systems still have many limitations. One of the limitations is the non-uniform gripping force due to mechanical strings of the existing systems. To overcome this limitation, a surgical instrument with a pneumatic gripping system consisting of a compressor, catheter balloon, micro motor, and other parts is developed. This study aims to implement a surgical instrument with a pneumatic gripping system and pitching/yawing joints using micro motors and without mechanical strings based on the surgical-operation-by-wire (SOBW) concept. A 6-axis external arm for increasing degrees of freedom (DOFs) is integrated with the surgical instrument using LabVIEW® for laparoscopic procedures. The gripping force is measured over a wide range of pressures and compared with the simulated ideal step function. Furthermore, a kinematic analysis is conducted. To validate and evaluate the system's clinical applicability, a simple peg task experiment and workspace identification experiment are performed with five novice volunteers using the fundamentals of laparoscopic surgery (FLS) board kit. The master interface of the proposed system employs the hands-on-throttle-and-stick (HOTAS) controller used in aerospace engineering. To develop an improved HOTAS (iHOTAS) controller, 6-axis force/torque sensor was integrated in the special housing. The mean gripping force (after 1,000 repetitions) at a pressure of 0.3 MPa was measured to be 5.8 N. The reaction time was found to be 0.4 s, which is almost real-time. All novice volunteers could complete the simple peg task within a mean time of 176 s, and none of them exceeded the 300 s cut-off time. The system's workspace was calculated to be 11,157.0 cm3. The proposed pneumatic gripping system provides a force consistent with that of other robotic MIS systems. It provides near real-time control. It is more durable than the

Teaching Surgical Hysteroscopy with a Computer

Science.gov (United States)

Lefebvre; Cote; Lefebvre

1996-08-01

Using a hysteroscope can be simulated on a computer. It will improve physician training by measuring basic knowledge and abilities, allow different interventions and anatomic variations, minimize the trauma of surgical intervention, and reduce operative casualties. An integrated questionnaire covers instrumentation, fluid infusion, power source, indications and preparation for endometrial ablation, surgical techniques, and complications to evaluate the user's knowledge. The operation simulation then proceeds. In the endometrial cavity, by virtual simulation, the operating field should appear in real time to allow physicians to adapt the trajectory of the instruments. The computer is an IBM PC compatible. We use a modified joystick with optical encoders to know the instrument position. The simulation can be repeated as desired. An evaluation system is integrated in the software to keep the user informed on the amount of burn area(s) that have been completed. This prototype model is available.

Role of VI/II ratio on the growth of ZnO nanostructures using chemical bath deposition

Energy Technology Data Exchange (ETDEWEB)

Urgessa, Z.N., E-mail: zelalem.urgessa@nmmu.ac.za [Department of Physics, P.O. Box 77000, Nelson Mandela Metropolitan University, Port Elizabeth 6031 (South Africa); Oluwafemi, O.S. [Department of Chemistry and Chemical Technology, Walter Sisulu University, Mthatha Campus, Private Bag XI, 5117 (South Africa); Botha, J.R. [Department of Physics, P.O. Box 77000, Nelson Mandela Metropolitan University, Port Elizabeth 6031 (South Africa)

2012-05-15

In this paper the growth process and morphological evolution of ZnO nanostructures were investigated in a series of experiments using chemical bath deposition. The experimental results indicate that the morphological evolution depends on the reaction conditions, particularly on OH{sup -} to Zn{sup 2+} ratio (which directly affects the pH). For low VI/II ratios, quasi-spherical nanoparticles of an average diameter 30 nm are obtained, whereas for larger VI/II ratios, nanorods with an average diameter less than 100 nm are produced, which indicates that by systematically controlling the VI/II ratio, it is possible to produce different shapes and sizes of ZnO nanostructures. A possible mechanism for the nanostructural change of the as-synthesized ZnO from particle to rod was elucidated based on the relative densities of H{sup +} and OH{sup -} in the solution.

Role of VI/II ratio on the growth of ZnO nanostructures using chemical bath deposition

International Nuclear Information System (INIS)

Urgessa, Z.N.; Oluwafemi, O.S.; Botha, J.R.

2012-01-01

In this paper the growth process and morphological evolution of ZnO nanostructures were investigated in a series of experiments using chemical bath deposition. The experimental results indicate that the morphological evolution depends on the reaction conditions, particularly on OH − to Zn 2+ ratio (which directly affects the pH). For low VI/II ratios, quasi-spherical nanoparticles of an average diameter 30 nm are obtained, whereas for larger VI/II ratios, nanorods with an average diameter less than 100 nm are produced, which indicates that by systematically controlling the VI/II ratio, it is possible to produce different shapes and sizes of ZnO nanostructures. A possible mechanism for the nanostructural change of the as-synthesized ZnO from particle to rod was elucidated based on the relative densities of H + and OH − in the solution.

PENGEMBANGAN KARAKTER KEDISIPLINAN DAN KEMAMPUAN PEMECAHAN MASALAH MELALUI MODEL LAPS-HEURISTIK MATERI LINGKARAN KELAS-VIII

Directory of Open Access Journals (Sweden)

Sri Wahyuni

2015-08-01

Full Text Available Tujuan penelitian ini adalah untuk mengetahui (1 apakah pembelajaran dengan model pembelajaran LAPS-Heuristik pada materi lingkaran kelas-VIII dapat mengembangkan karakter kedisiplinan peserta didik, (2 apakah pembelajaran dengan model pembelajaran LAPS-Heuristik pada materi lingkaran kelas-VIII dapat meningkatkan kemampuan pemecahan masalah peserta didik, (3 apakah kemampuan pemecahan masalah matematika peserta didik yang diajar dengan model pembelajaran LAPS-Heuristik pada materi lingkaran kelas-VIII dapat mencapai kriteria ketuntasan minimal yang ditentukan. Desain penelitian ini adalah kualitatif deskriptif, artinya menggambarkan atau mendeskripsikan kejadian-kejadian yang menjadi pusat perhatian secara kualitatif dan berdasar data kualitatif. Penentuan sumber data dalam penelitian ini menggunakan teknik purposive sampling, yaitu dipilih dengan pertimbangan dan tujuan tertentu. Data diperoleh dengan observasi, wawancara, dan tes yang kemudian dianalisis menggunakan analisis kualitatif dan analisis gain untuk mengukur peningkatan. Analisis kualitatif menunjukkan karakter kedisiplinan dan kemampuan pemecahan masalah peserta didik meningkat, serta kemampuan pemecahan masalah peserta didik mencapai KKM melalui model pembelajaran LAPS-Heuristik.

Chromosome VIII disomy influences the nonsense suppression efficiency and transition metal tolerance of the yeast Saccharomyces cerevisiae.

Science.gov (United States)

Zadorsky, S P; Sopova, Y V; Andreichuk, D Y; Startsev, V A; Medvedeva, V P; Inge-Vechtomov, S G

2015-06-01

The SUP35 gene of the yeast Saccharomyces cerevisiae encodes the translation termination factor eRF3. Mutations in this gene lead to the suppression of nonsense mutations and a number of other pleiotropic phenotypes, one of which is impaired chromosome segregation during cell division. Similar effects result from replacing the S. cerevisiae SUP35 gene with its orthologues. A number of genetic and epigenetic changes that occur in the sup35 background result in partial compensation for this suppressor effect. In this study we showed that in S. cerevisiae strains in which the SUP35 orthologue from the yeast Pichia methanolica replaces the S. cerevisiae SUP35 gene, chromosome VIII disomy results in decreased efficiency of nonsense suppression. This antisuppressor effect is not associated with decreased stop codon read-through. We identified SBP1, a gene that localizes to chromosome VIII, as a dosage-dependent antisuppressor that strongly contributes to the overall antisuppressor effect of chromosome VIII disomy. Disomy of chromosome VIII also leads to a change in the yeast strains' tolerance of a number of transition metal salts. Copyright © 2015 John Wiley & Sons, Ltd.

Progress toward inducing immunologic tolerance to factor VIII

OpenAIRE

Scott, David W.; Pratt, Kathleen P.; Miao, Carol H.

2013-01-01

A major problem in treating hemophilia A patients with therapeutic factor VIII (FVIII) is that 20% to 30% of these patients produce neutralizing anti-FVIII antibodies. These antibodies block (inhibit) the procoagulant function of FVIII and thus are termed “inhibitors.” The currently accepted clinical method to attempt to eliminate inhibitors is immune tolerance induction (ITI) via a protocol requiring intensive FVIII treatment until inhibitor titers drop. Although often successful, ITI is ext...

Retained Surgical Foreign Bodies after Surgery

Directory of Open Access Journals (Sweden)

Valon A. Zejnullahu

2017-01-01

Full Text Available The problem of retained surgical bodies (RSB after surgery is an issue for surgeons, hospitals and the entire medical team. They have potentially harmful consequences for the patient as they can be life threatening and usually, a further operation is necessary. The incidence of RSB is between 0.3 to 1.0 per 1,000 abdominal operations, and they occur due to a lack of organisation and communication between surgical staff during the process. Typically, the RSB are surgical sponges and instruments located in the abdomen, retroperitoneum and pelvis.

Fluid-phase immunoradiometric assay for the detection of qualitative abnormalities of factor VIII/von Willebrand factor in variants of von Willebrand's disease

International Nuclear Information System (INIS)

Girma, J.P.; Ardaillou, N.; Meyer, D.; Lavergne, J.M.; Larrieu, M.J.

1979-01-01

Antigenic reactivity of F.VIII/WF in variants of von Willebrand's disease (vWd) was studied with both fluid-phase and solid-phase immunoradiometric assays. Two different (rabbit and goat) 125 I-labeled specific antibodies against purified F.VIII/WF were used in both their divalent (lgG) and their monovalent (Fab fragment) forms. Dose-response curves obtained by reacting a constant amount of antibody with serial dilutions of plasmas from normal or homozygous vWd demonstrated the specificity of the test. The accuracy was significantly higher with 125 I-Fab fragments of goat anti-F.VIII/WF antiserum than intact goat lgG or rabbit lgG or Fab fragments. The significant decrease of the slope of the dose-response curves obtained with plasma from variants of vWd has been interpreted as due to the presence of abnormal F.VIII/WF molecules with decreased antigenic reactivity. A similar anomaly was found in cryosupernatant prepared from normal plasma, paralleling similarities demonstrated between variants of vWd and cryosupernatant. Results of experiments performed by reacting constant plasma dilutions from control or variants of vWd and varying concentrations of anti-F.VIII/WF Fab fragments (rabbit or goat) confirmed the decreased antigenic reactivity of variant F.VIII/WF

Characterization of a thrombin cleavage site mutation (Arg 1689 to Cys) in the factor VIII gene of two unrelated patients with cross-reacting material-positive hemophilia A.

Science.gov (United States)

Arai, M; Higuchi, M; Antonarakis, S E; Kazazian, H H; Phillips, J A; Janco, R L; Hoyer, L W

1990-01-15

The molecular defect responsible for moderate and severe hemophilia A has been identified for two unrelated patients with the CRM-positive form of this disorder (factor VIII activity of 0.02 and 0.05 U/mL with factor VIII antigen of 0.87 and 2.20 U/mL). In both cases, the immunopurified dysfunctional factor VIII protein is abnormal, in that the 80 Kd light chain is not cleaved by thrombin at arginine-1689. The basis for this failure was identified by polymerase chain reaction amplification of exon 14 of the variant factor VIII genes and direct sequencing of the amplified products. In both cases, a single base substitution (C to T) was identified that produces an arginine to cysteine substitution at amino acid residue 1689. These data identify the molecular defects of the two identical factor VIII variant proteins. The dysfunctional factor VIII has been designated "Factor VIII-East Hartford," the residence of the patient in whom the defect was first identified.

PENGARUH KEMANDIRIAN BELAJAR DAN PENGGUNAAN UANG SAKU TERHADAP PRESTASI BELAJAR KOMPETENSI DASAR EKONOMI KELAS VII DAN VIII

OpenAIRE

Apri Dwi Astuti

2012-01-01

Kemandirian belajar membantu siswa untuk bertanggung jawab dan menumbuhkan kesadaran belajar. Penggunaan uang saku menumbuhkan jiwa mandiri, jujur dan komitmen. Adapun hasil observasi awal menunjukkan masih ada siswa kels VII dan VIII SMP Semesta untuk kompetensi dasar ekonomi dibawah KKM. Tujuan penelitian ini untuk mengetahui pengaruh kemandirian belajar dn penggunaan uang saku terhadap prestasi belajar kompetensi dasar ekonomi kelas VII dan VIII SMP Semesta. Populasi penelitian ini adalah ...

Factor VIII and von Willebrand factor co-delivery by endothelial cells

NARCIS (Netherlands)

Bouwens, E.A.M.|info:eu-repo/dai/nl/314061894

2011-01-01

A defect in coagulation factor VIII (FVIII) results in the inherited bleeding disorder hemophilia A. Current treatment of hemophilia A is hampered by the need of frequent administration of costly FVIII products. Therefore gene therapy is an attractive alternative for protein replacement to treat

Historical intensity VIII earthquakes along the Rhone valley (Valais, Switzerland): primary and secondary effects

Energy Technology Data Exchange (ETDEWEB)

Fritsche, S.; Faeh, D.; Schwarz-Zanetti, G.

2012-06-15

In recent years the upper Rhone Valley has been one of the most intensively investigated regions by the Swiss Seismological Service. The high seismicity in the region encourages research in the seismological field and one main focus has been historical seismology. This report presents the state of the art of our historical investigations by giving an overview of the effects of four damaging earthquakes with intensity larger than VII, for which a fairly large number of documents could be found and analyzed. The overview includes the events of 1584 (Aigle, epicentral intensity VIII), 1755 (Brig, epicentral intensity VIII), 1855 (Visp, epicentral intensity VIII), and 1946 (Sierre, epicentral intensity VIII for the main shock and intensity VII for the largest aftershock). The paper focuses mainly on primary and secondary effects in the epicentral region, providing the key data and a general characterization of the event. Generally, primary effects such as the reaction of the population and impact on buildings took more focus in the past. Thus building damage is more frequently described in historic documents. However, we also found a number of sources describing secondary effects such as landslides, snow avalanches, and liquefaction. Since the sources may be useful, we include citations of these documents. The 1584 Aigle event, for example, produced exceptional movements in the Lake of Geneva, which can be explained by an expanded sub aquatic slide with resultant tsunami and seiche. The strongest of the aftershocks of the 1584 event triggered a destructive landslide covering the villages Corbeyrier and Yvorne, Vaud. All macroseismic data on the discussed events are accessible through the web page of the Swiss Seismological Service (http://www.seismo.ethz.ch). (authors)

Effects of Mg/Ga and V/III source ratios on hole concentration of N-polar (000\\bar{1}) p-type GaN grown by metalorganic vapor phase epitaxy

Science.gov (United States)

Nonoda, Ryohei; Shojiki, Kanako; Tanikawa, Tomoyuki; Kuboya, Shigeyuki; Katayama, Ryuji; Matsuoka, Takashi

2016-05-01

The effects of growth conditions such as Mg/Ga and V/III ratios on the properties of N-polar (000\\bar{1}) p-type GaN grown by metalorganic vapor phase epitaxy were studied. Photoluminescence spectra from Mg-doped GaN depended on Mg/Ga and V/III ratios. For the lightly doped samples, the band-to-acceptor emission was observed at 3.3 eV and its relative intensity decreased with increasing V/III ratio. For the heavily doped samples, the donor-acceptor pair emission was observed at 2.8 eV and its peak intensity monotonically decreased with V/III ratio. The hole concentration was maximum for the Mg/Ga ratio. This is the same tendency as in group-III polar (0001) growth. The V/III ratio also reduced the hole concentration. The higher V/III ratio reduced the concentration of residual donors such as oxygen by substituting nitrogen atoms. The surface became rougher with increasing V/III ratio and the hillock density increased.

Idiopathic factor VIII inhibitor autoantibody in a man presented after accident.

NARCIS (Netherlands)

Mansouritorghabeh, H.; Lak, M.; Heerde, W.L. van

2009-01-01

Acquired hemophilia A is a rare but severe autoimmune bleeding disorder caused by autoantibodies against factor VIII activity and is a potentially life-threatening hemorrhagic disorder. The incidence of acquired hemophilia A has been estimated as 1.48 cases per million per year. The overall rate of

One-electron spectrum of Xe VIII

International Nuclear Information System (INIS)

Roberts, J.R.; Knystautas, E.J.; Sugar, J.

1979-01-01

The spectrum of Xe VIII has been observed in a theta-pinch discharge. New line identifications were made that determine the energies of the 6s, 7s, 6p, and 5f terms relative to the 5s 2 S ground state and confirm the previously known 5p and 5d terms. An independent system of levels derived from the observed 4f-ng (n = 5,6) transitions was found. Its position relative to the ground state is obtained from a predicted value for the 5g effective quantum number n*. From the ns series (n=5--7) a value for the ionization enegy of 105.91 +- 0.05 eV was derived

[Surgical manipulators in ear surgery: a future vision?].

Science.gov (United States)

Hofer, M; Dietz, A; Strauss, G

2011-04-01

Middle ear surgery bears a high risk for injury of difficult to differentiate risk structures. Thus, a precise preparation in this area must be the surgical task. However, there are human (tremor) and systematic limitations (OR setup, narrow access). Assistance systems in terms of manipulators are so far not part of the clinical routine. Although, they could compensate for the above mentioned limitations. MANIPULATORS: This work reviews existing surgical manipulator systems. The expected value is an elevated patient safety through improving surgical accuracy and the reduction of ergonomic deficits. CLINICAL APPLICATION AND DEVELOPMENT: In clinical application there are simply modified industrial robots, highly complex master slave systems and small miniature master slave systems which are directly located at the patient. A disadvantage of most systems is the limited number of applicable instruments. Often, only especially designed instruments can be used. The goal in development should be to create a compact, short distance operated master slave system. The usability of standard (already available) instruments with an easy integration into the surgical and sterilisation procedure would lower the threshold for acceptance of such systems.The surgeon will remain the key player. He can only work efficiently in an ergonomic environment and will always have the responsibility for the intervention. From the authors perspective, highly automated systems should not be the research goal. © Georg Thieme Verlag KG Stuttgart · New York.

Adherence to the use of the surgical checklist for patient safety

Directory of Open Access Journals (Sweden)

Eliane Cristina Sanches Maziero

Full Text Available Objective: Evaluate adherence to the checklist of the Programa Cirurgias Seguras (safe surgery programme at a teaching hospital. Methods: Evaluative study conducted at a teaching hospital in the south of Brazil in 2012. Data were collected by means of non-participant observation in 20 hip and knee replacement surgeries and an instrument that was created for research based on the checklist and used by the institution. Results: In the observed procedures (n = 20 there was significant adhesion (p<0.05 to the instrument in relation to the verification of documentation, fasting, hair removal in the surgical site, absence of nail varnish and accessories, identification of the patient and surgical site on admission to the surgical unit, availability of blood and functionality of materials. However, there was no significant adherence to the checklist in the operating room in relation to patient identification, procedure and laterality, team introduction, surgical break and materials count. Conclusion: The results showed that the items on the checklist were verified nonverbally and there was no significant adherence to the instrument.

21 CFR 872.4120 - Bone cutting instrument and accessories.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bone cutting instrument and accessories. 872.4120... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Surgical Devices § 872.4120 Bone cutting instrument and accessories. (a) Identification. A bone cutting instrument and accessories is a metal device intended for use...

Robotic technologies in surgical oncology training and practice.

Science.gov (United States)

Orvieto, Marcelo A; Marchetti, Pablo; Castillo, Octavio A; Coelho, Rafael F; Chauhan, Sanket; Rocco, Bernardo; Ardila, Bobby; Mathe, Mary; Patel, Vipul R

2011-09-01

The modern-day surgeon is frequently exposed to new technologies and instrumentation. Robotic surgery (RS) has evolved as a minimally invasive technique aimed to improve clinical outcomes. RS has the potential to alleviate the inherent limitations of laparoscopic surgery such as two dimensional imaging, limited instrument movement and intrinsic human tremor. Since the first reported robot-assisted surgical procedure performed in 1985, the technology has dramatically evolved and currently multiple surgical specialties have incorporated RS into their daily clinical armamentarium. With this exponential growth, it should not come as a surprise the ever growing requirement for surgeons trained in RS as well as the interest from residents to receive robotic exposure during their training. For this reason, the establishment of set criteria for adequate and standardized training and credentialing of surgical residents, fellows and those trained surgeons wishing to perform RS has become a priority. In this rapidly evolving field, we herein review the past, present and future of robotic technologies and its penetration into different surgical specialties. Copyright © 2010 Elsevier Ltd. All rights reserved.

Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation in surgical treatment for single-segment lumbar spinal tuberculosis

OpenAIRE

Zeng, Hao; Wang, Xiyang; Zhang, Penghui; Peng, Wei; Zhang, Yupeng; Liu, Zheng

2015-01-01

Objective: The aim of this study is to determine the feasibility and efficacy of surgical management of single-segment lumbar spinal tuberculosis (TB) by using single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation.Methods: Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reco...

Surgical Emphysema: A Rare Complication of a Simple Surgical Dental Extraction Without the Use of an Air-Driven Rotor.

Science.gov (United States)

Gowans, Keegan; Patel, Muneer; Lewis, Khari

2017-03-01

Surgical emphysema is a rare complication of dental extractions, often associated with the use of high-speed air rotors. This report describes a case of extensive surgical emphysema following a simple surgical extraction of a LL6 under local anaesthetic. There was no use of air-driven handpieces during the procedure. The patient developed extensive surgical emphysema bi-laterally in both cervical neck and facial planes. After prophylactic antibiotics with careful monitoring in a secondary care setting, the patient made a full unremarkable recovery. Clinical relevance: Simple extraction of teeth is a procedure carried out daily by most general dental practitioners. However, the risk of surgical emphysema without the use of high-speed air rotors or instruments using pressurized air/water is not well known or documented.

46 CFR 54.01-2 - Adoption of division 1 of section VIII of the ASME Boiler and Pressure Vessel Code.

Science.gov (United States)

2010-10-01

... Boiler and Pressure Vessel Code. 54.01-2 Section 54.01-2 Shipping COAST GUARD, DEPARTMENT OF HOMELAND... division 1 of section VIII of the ASME Boiler and Pressure Vessel Code. (a) Pressure vessels shall be designed, constructed, and inspected in accordance with section VIII of the ASME Boiler and Pressure Vessel...

Safety, efficacy and pharmacokinetics of rVIII-SingleChain in children with severe hemophilia A: results of a multicenter clinical trial.

Science.gov (United States)

Stasyshyn, O; Djambas Khayat, C; Iosava, G; Ong, J; Abdul Karim, F; Fischer, K; Veldman, A; Blackman, N; St Ledger, K; Pabinger, I

2017-04-01

Essentials rVIII-SingleChain is a novel recombinant factor VIII with covalently bonded heavy and light chains. Efficacy, safety and pharmacokinetics were studied in pediatric patients with severe hemophilia A. Across all prophylaxis regimens, the median annualized spontaneous bleeding rate was 0.00. rVIII-SingleChain showed excellent hemostatic efficacy and a favorable safety profile. Background rVIII-SingleChain is a novel B-domain truncated recombinant factor VIII (rFVIII) comprised of covalently bonded FVIII heavy and light chains, demonstrating a high binding affinity to von Willebrand factor. Objectives This phase III study investigated the safety, efficacy and pharmacokinetics of rVIII-SingleChain in previously treated pediatric patients hemophilia A. Patients/Methods Patients could be assigned to prophylaxis or on-demand therapy by the investigator. For patients assigned to prophylaxis, the treatment regimen and dose were based on the bleeding phenotype. For patients receiving on-demand therapy, dosing was guided by World Federation of Hemophilia recommendations. The primary endpoint was treatment success, defined as a rating of 'excellent' or 'good' on the investigator's clinical assessment of hemostatic efficacy for all treated bleeding events. Results The study enrolled 84 patients (0 to 50 EDs. In the 347 bleeds treated and evaluated by the investigator, hemostatic efficacy was rated as excellent or good in 96.3%. The median annualized spontaneous bleeding rate was 0.00 (Q1, Q3: 0.00, 2.20), and the median annualized bleeding rate was 3.69 (Q1, Q3: 0.00, 7.20) across all prophylaxis regimens. No participant developed an inhibitor. Conclusions rVIII-SingleChain is a novel rFVIII molecule showing excellent hemostatic efficacy and a favorable safety profile in a clinical study in children hemophilia A. © 2017 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and

Chaos in long-term behavior of some Bianchi-type VIII models

Energy Technology Data Exchange (ETDEWEB)

Halpern, P

1987-01-01

The long-term behavior of Bianchi-type VIII models with three different types of stress-energy tensors are examined and compared. The vacuum model, a matter-filled model, and a model with an electromagnetic field are considered. In each case the existence of chaotic behavior and transitions to chaotic behavior are discussed.

Severe Hemophilia A in a Male Old English Sheep Dog with a C→T Transition that Created a Premature Stop Codon in Factor VIII

Science.gov (United States)

Lozier, Jay N; Kloos, Mark T; Merricks, Elizabeth P; Lemoine, Nathaly; Whitford, Margaret H; Raymer, Robin A; Bellinger, Dwight A; Nichols, Timothy C

2016-01-01

Animals with hemophilia are models for gene therapy, factor replacement, and inhibitor development in humans. We have actively sought dogs with severe hemophilia A that have novel factor VIII mutations unlike the previously described factor VIII intron 22 inversion. A male Old English Sheepdog with recurrent soft-tissue hemorrhage and hemarthrosis was diagnosed with severe hemophilia A (factor VIII activity less than 1% of normal). We purified genomic DNA from this dog and ruled out the common intron 22 inversion; we then sequenced all 26 exons. Comparing the results with the normal canine factor VIII sequence revealed a C→T transition in exon 12 of the factor VIII gene that created a premature stop codon at amino acid 577 in the A2 domain of the protein. In addition, 2 previously described polymorphisms that do not cause hemophilia were present at amino acids 909 and 1184. The hemophilia mutation creates a new TaqI site that facilitates rapid genotyping of affected offspring by PCR and restriction endonuclease analyses. This mutation is analogous to the previously described human factor VIII mutation at Arg583, which likewise is a CpG dinucleotide transition causing a premature stop codon in exon 12. Thus far, despite extensive treatment with factor VIII, this dog has not developed neutralizing antibodies (‘inhibitors’) to the protein. This novel mutation in a dog gives rise to severe hemophilia A analogous to a mutation seen in humans. This model will be useful for studies of the treatment of hemophilia. PMID:27780008

Synthesis of dispersive iron or iron–silver nanoparticles on engineered capsid pVIII of M13 virus with electronegative terminal peptides

Energy Technology Data Exchange (ETDEWEB)

Zhang, Shuai; Nakano, Kazuhiko; Zhang, Shu-liang; Yu, Hui-min, E-mail: yuhm@tsinghua.edu.cn [Tsinghua University, Key Laboratory of Industrial Biocatalysis of the Ministry of Education, Department of Chemical Engineering (China)

2015-10-15

M13 is a filamentous Escherichia coli virus covered with five types of capsid proteins, in which pVIII with ∼2700 copies was around the cylindered surface and pIII with five copies located at one end of the phage particle. The pIII-engineered M13 phages with enhanced binding specificity toward Fe were screened after five rounds of biopanning, and the one containing ATPTVAMSLSPL peptide at pIII-terminus was selected for mediated synthesis of zero valent (ZV) Fe nanoparticles (NPs) with the wild M13 as control. Under a reducing environment, uniformly dispersed ZVFeNPs with diameter of 5–10 nm were both synthesized and the morphologies after annealing were confirmed to be face-centered cubic type. The synthesized FeNPs mediated by the two phages showed no significant difference, revealing that the pVIII capsid did dominant contribution to metal binding in comparison with the pIII. A novel pVIII-engineered M13 containing AAEEEDPAK at terminus, named as 4ED-pVIII-M13, was constructed and it carried one more negatively charged residue than the wild one (AEGDDPAK). Metal adsorption quantification showed that the binding affinity of the 4ED-pVIII-M13 toward Ag and Ni ions improved to 62 and 18 % from original 21 and 6 %, respectively. The binding affinity toward Fe remained constant (∼85 %). ZVFe–Ag bi-NPs were successfully synthesized through mediation of 4ED-pVIII-M13. Particularly, the Fe:Ag ratio in the bi-NPs was conveniently controlled through changing the molar concentration of FeCl{sub 2} and AgNO{sub 3} solution before reduction.

Storage and regulated secretion of factor VIII in blood outgrowth endothelial cells

NARCIS (Netherlands)

van den Biggelaar, M.; Bouwens, E.A.M.; Kootstra, N.A.; Hebbel, R.P.; Voorberg, J.; Mertens, K.

2009-01-01

Background Gene therapy provides an attractive alternative for protein replacement therapy in hemophilia A patients. Recent studies have shown the potential benefit of directing factor (F)VIII gene delivery to cells that also express its natural carrier protein von Willebrand factor (VWF). In this

Storage and regulated secretion of factor VIII in blood outgrowth endothelial cells

NARCIS (Netherlands)

van den Biggelaar, Maartje; Bouwens, Eveline A. M.; Kootstra, Neeltje A.; Hebbel, Robert P.; Voorberg, Jan; Mertens, Koen

2009-01-01

Gene therapy provides an attractive alternative for protein replacement therapy in hemophilia A patients. Recent studies have shown the potential benefit of directing factor (F)VIII gene delivery to cells that also express its natural carrier protein von Willebrand factor (VWF). In this study, we

Evaluation of the Factors Affecting the Loss of Lumbar Lordosis in Surgical Treatment of Patients with Adolescent Idiopathic Scoliosis Using Segmental Instrumentation

Directory of Open Access Journals (Sweden)

Farshad Nikouei

2016-12-01

Full Text Available Background The identification of independent factors affecting the loss of lumbar lordosis can facilitate programmed surgery in adolescent idiopathic scoliosis (AIS patients especially with considering the importance of sagittal characteristics. Objectives This study aimed to investigate the factors affecting the amount of the loss of lumbar lordosis in surgical treatment of the patients with AIS using segmental instrumentation. Methods In this study which was conducted in three years, 91 AIS patients who underwent segmental instrumentation were studied and 63 patients remained in the study according to the inclusion criteria. All patients’ information was recorded on admission in separate forms and radiography results were coded and archived before the surgery for more evaluation. All patients were subject to standing whole spine radiograph again 12 months after the surgery. Ultimately, the information was put into predetermined forms and was used for a statistical analysis after the completion of forms. Results The mean age of the patients was 15.62 ± 3.09 years. The mean preoperative lumbar lordosis was 45.25 ± 12.17 degrees and the mean preoperative thoracic kyphosis was 41.54 ± 16.31 degrees. The mean postoperative lumbar lordosis was 34.37 ± 10.26 degrees. The mean postoperative thoracic kyphosis was obtained 26.56 ± 9.17. The mean surgical correction of thoracic kyphotic deformity and lumbar lordosis were correlated with each other with the correlation coefficient of 0.71 (P < 0.001. Men have more (16.62 ± 8.74 loss of lumbar lordosis than women (10.05 ± 8.53 (P < 0.001. There was not any significant correlation between the type (hook/hybrid of the instrumentation with the loss of lumbar lordosis (P = 0.07, P = 0.41. Conclusions Considering the findings of this study, the most important factor affecting the amount of post-operative loss of lumbar lordosis in segmental instrumentation in AIS patients is the amount of the

The Effect of Growth Temperature and V/III Flux Ratio of MOCVD Antimony Based Semiconductors on Growth Rate and Surface Morphology

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Ramelan Ari Handono

2017-01-01

Full Text Available Epitaxial Alx Ga1-x Sb layers on GaSb and GaAs substrates have been grown by atmospheric pressure metalorganic chemical vapor deposition using TMAl, TMGa and TMSb. Nomarski microscope and a profiler were employed to examine the surface morphology and growth rate of the samples. We report the effect of growth temperature and V/III flux ratio on growth rate and surface morphology. Growth temperatures in the range of 520°C and 680°C and V/III ratios from 1 to 5 have been investigated. A growth rate activation energy of 0.73 eV was found. At low growth temperatures between 520 and 540°C, the surface morphology is poor due to antimonide precipitates associated with incomplete decomposition of the TMSb. For layers grown on GaAs at 580°C and 600°C with a V/III ratio of 3 a high quality surface morphology is typical, with a mirror-like surface and good composition control. It was found that a suitable growth temperature and V/III flux ratio was beneficial for producing good AlGaSb layers. Undoped AlGaSb grown at 580°C with a V/III flux ratio of 3 at the rate of 3.5 μm/hour shows p-type conductivity with smooth surface morphology

Cost assessment of instruments for single-incision laparoscopic cholecystectomy

DEFF Research Database (Denmark)

Henriksen, Nadia A; Al-Tayar, Haytham; Rosenberg, Jacob

2012-01-01

Specially designed surgical instruments have been developed for single-incision laparoscopic surgery, but high instrument costs may impede the implementation of these procedures. The aim of this study was to compare the cost of operative implements used for elective cholecystectomy performed...

Living in a physical world VIII. Gravity and life in water

Indian Academy of Sciences (India)

2006-07-31

Jul 31, 2006 ... Home; Journals; Journal of Biosciences; Volume 31; Issue 3. Living in a physical world VIII. Gravity and life in water. Steven Vogel. Series Volume 31 Issue 3 September 2006 pp 309-322. Fulltext. Click here to view fulltext PDF. Permanent link: https://www.ias.ac.in/article/fulltext/jbsc/031/03/0309-0322 ...

Absorption signatures of warm-hot gas at low redshift : Ne VIII

NARCIS (Netherlands)

Tepper-García, T

2013-01-01

At z {lt} 1 a large fraction of the baryons is thought to reside in diffuse gas that has been shock-heated to high temperatures (10$^{5}$-10$^{6}$ K). Absorption by the 770.41, 780.32 å doublet of Ne VIII in quasar spectra represents a unique tool to study this elusive warm-hot phase. We have

Factor VIII S373L: mutation at P1' site confers thrombin cleavage resistance, causing mild haemophilia A.

Science.gov (United States)

Johnson, D J; Pemberton, S; Acquila, M; Mori, P G; Tuddenham, E G; O'Brien, D P

1994-04-01

A novel CRM+ mutation, factor VIII position 373 serine to leucine substitution (FVIII 373-Leu) was identified during a survey of Factor VIII (FVIII) mutations. We have purified the variant protein from the patient's plasma in order to allow further characterisation of the molecule. The CRM+ plasma contained 120% Factor VIII antigen (FVIII:Ag) and 6% Factor VIII coagulant activity (FVIII:C). After purification the mutant FVIII was subjected to thrombin proteolysis, and was thereby activated 5.6-fold compared with 7-fold for wild type molecule. Subsequently, spontaneous inactivation of the mutant was much slower than noted for wild type FVIII. Western blot analysis using monoclonal antibodies demonstrated that thrombin cleavage of FVIII 373-Leu at positions 740 and 1689 were normal but that cleavage at position 372 was completely absent. Crystallographic coordinates of the active site of thrombin complexed to fibrinopeptide A were used to explore possible mechanistic reasons for the failure of thrombin to cleave the mutant FVIII at position 372. Steric hindrance between the mutant side chain and the side chain of the P1 residue was apparent. We conclude that the functional defect of FVIII 373-Leu results from the inability of thrombin to cleave the mutant at position 372-373, and propose that this is due to steric hindrance by the side chain of leucine 373, preventing correct formation of the enzyme substrate complex.

The new albumin-free recombinant factor VIII concentrates for treatment of hemophilia: do they represent an actual incremental improvement?

Science.gov (United States)

Josephson, Cassandra D; Abshire, Thomas

2004-07-01

The goal of eliminating the low levels of infectious disease risk from hemophilia treatment has resulted in the development of multiple generations of recombinant factor VIII (rFVIII) products. The ideal product should be devoid of human and animal proteins, which may transmit infectious agents. These products should also maintain molecular integrity, hemostatic efficacy, similar immunogenicity, and acceptable side effect profiles as compared to plasma-derived factor VIII. Currently available first-, second-, and third-generation rFVIII products include Recombinate; Kogenate FS/Helixate FS and ReFacto; and Advate, respectively. During the evolution of rFVIII products, either full-length or B-domain-deleted factor VIII were transfected into immortalized cell lines. The B-domain-deleted product, ReFacto, has resulted in an additional method to monitor factor VIII levels. The third-generation products offer the theoretical advantage of being produced without human and/or animal proteins. Upon initial introduction into the marketplace, the newer products have a higher cost. However, when analyzing historical trends, the prices of these products are almost equivalent to first-generation products within 3 years of licensure. Thus, the initial cost of the product may be a minimal issue in the medical decision process when selecting rFVIII replacement therapy.

Quark matter coupled to domain walls in Bianchi types II, VIII and IX ...

Indian Academy of Sciences (India)

In this study of Bianchi types II, VIII and IX Universes, quark matter coupled to domain walls in the ... The self-bound state appears to be at ρ ... The observations suggest that the Hubble expansion of the Universe ... Taking motivation from.

PENGARUH KEMANDIRIAN BELAJAR DAN PENGGUNAAN UANG SAKU TERHADAP PRESTASI BELAJAR KOMPETENSI DASAR EKONOMI KELAS VII DAN VIII

Directory of Open Access Journals (Sweden)

Apri Dwi Astuti

2012-10-01

Full Text Available Kemandirian belajar membantu siswa untuk bertanggung jawab dan menumbuhkan kesadaran belajar. Penggunaan uang saku menumbuhkan jiwa mandiri, jujur dan komitmen. Adapun hasil observasi awal menunjukkan masih ada siswa kels VII dan VIII SMP Semesta untuk kompetensi dasar ekonomi dibawah KKM. Tujuan penelitian ini untuk mengetahui pengaruh kemandirian belajar dn penggunaan uang saku terhadap prestasi belajar kompetensi dasar ekonomi kelas VII dan VIII SMP Semesta. Populasi penelitian ini adalah semua siswa kelas VII dan VIII SMP Semesta Boarding School Semarang. Variabel penelitian ini adalah kemandirian belajar dan penggunaan uang saku sebagai variabel bebas, sedangkan untuk� variabel terikat adalah prestasi belajar kompetensi dasar ekonomi. Data diambil dengan metode wawancara, kuesioner dan dokumentasi guru. Analisis data menggunakan analisis regresi linear berganda.Berdasarkan penelitian secara simultan menunjukkan adanya pengaruh antara kemandirian belajar dan penggunaan uang saku terhadap prestasi belajar kompetensi dasar ekonomi sebesar 51,3%. Secara parsial, pengaruh kemandirian belajar terhadap prestasi belajar kompetensi dasar ekonomi sebesar 66,2% dan pengaruh penggunaan uang saku terhadap prestasi belajar kompetensi dasar ekonomi sebesar 62,5%.Berdasarkan hasil penelitian diatas disimpulkan bahwa kemandirian belajar dan penggunaan uang saku berpengaruh positif baik secara simultan maupun parsial terhadap prestasi belajar kompetensi dasar ekonomi kelas VII dan VIII SMP Semesta Boarding school semarang tahun pelajaran 2011/2012. Saran yang berkaitan dengan penelitian ini yaitu : 1 Sekolah disarankan untuk memberikan batasan siswa pulang ke rumah agar dapat membantu siswa beradaptasi dengan cepat dan mudah tinggal di asrama. 2 Orang tua disarankan untuk memberikan uang saku yang disesuaikan dengan kebutuhan siswa. 3 Siswa disarankan untuk meningkatkan kemandirian dalam aspek belajar terutama bagi mata pelajaran yang masih kurang dari

Computer-Assisted Technique for Surgical Tooth Extraction

Directory of Open Access Journals (Sweden)

Hosamuddin Hamza

2016-01-01

Full Text Available Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut. Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome. In addition, the conventional surgical cutting tools (surgical burs are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures.

Leonor Plantagenet y la consolidación castellana en el reinado de Alfonso VIII

Directory of Open Access Journals (Sweden)

Cerda, José Manuel

2012-12-01

Full Text Available The kingdom of Castile experienced a process of political and territorial consolidation between the death of Sancho III in 1158 and the Curia of Carrión de los Condes in 1188, leaving behind the troublesome minority of Alfonso VIII and the subordination to the kingdom of Leon, and thus becoming a dominant power within the peninsula, and one that achieved considerable success in the Reconquest. The following article is part of a biographical approach to Eleanor Plantagenet, queen consort of Alfonso VIII, and by means of a specifi c focus offers an analysis of the role played by the English queen in this process of political consolidation of Castile. As we approach the eighth centenary of her death, the life and work of this little-studied woman emerges as a testimony to the important diplomatic and cultural tasks assumed by queens in twelfth-century Europe.

Desde la muerte de Sancho III en 1158 a la Curia de Carrión de los Condes en 1188, el reino castellano experimentó una consolidación política y territorial que dejó atrás la problemática minoría de Alfonso VIII y la subordinación al reino de León, que lo constituyó en un poder dominante dentro de la península y que logró un avance importante en la empresa reconquistadora. El presente trabajo es parte de un acercamiento biográfico a Leonor Plantagenet, consorte de Alfonso VIII, y que por medio de un enfoque particular ofrece un análisis de la incidencia que tuvo la reina inglesa en este proceso de afianzamiento político de Castilla. En las vísperas del octavo centenario de su muerte, la vida y obra de esta mujer hasta ahora poco estudiada, surge como un testimonio importante a la labor diplomática y cultural que asumían las reinas en la Europa del siglo XII.

VIII Brazilian Meeting on Simulational Physics (BMSP)

International Nuclear Information System (INIS)

Branco, N. S.; Figueiredo, W.; Plascak, J. A.; Santos, M.

2016-01-01

This special issue includes invited and selected articles of the VIII Brazilian Meeting on Simulational Physics (BMSP), held in Florianópolis, Santa Catarina, Brazil, from 3rd to 8th August, 2015. This is the eighth such meeting, and the second one to have contributed papers published in Journal of Physics: Conference Series (the other was the VII BMSP). The previous meetings in the BMSP series took place in the mountains of Minas Gerais, in the region of the Brazilian Pantanal, and in the shores of Paraíba. Now, for the first time, the Meeting was held in Florianópolis, with its pleasing shores, the capital of Santa Catarina state. The VIII BMSP brought together about 50 researchers from all over the world for a vibrant and productive conference. As in the previous meetings, the talks and posters highlighted recent advances in applications, algorithms, and implementation of computer simulation methods for the study of condensed matter, materials, and out of equilibrium, quantum and biologically motivated systems. We are sure that this meeting series will continue to be an important occasion for people working in simulational physics to exchange ideas and discuss the state of the art of this always expanding field. We are very glad to put together this special issue, and are most appreciative of the efforts of the editors of the Journal of Physics: Conference Series for making this publication possible. We are grateful for the outstanding work of the Florianopolis team, for the financial support of the Brazilian agencies CAPES and CNPq, and of the Federal Universities UFPB and UFSC. At last, but not least, we would like to acknowledge all of the authors for their written submissions. (paper)

Surgical Robotics Research in Cardiovascular Disease

Energy Technology Data Exchange (ETDEWEB)

Pohost, Gerald M; Guthrie, Barton L; Steiner, Charles

2008-02-29

This grant is to support a research in robotics at three major medical centers: the University of Southern California-USC- (Project 1); the University of Alabama at Birmingham-UAB-(Project 2); and the Cleveland Clinic Foundation-CCF-(Project 3). Project 1 is oriented toward cardiovascular applications, while projects 2 and 3 are oriented toward neurosurgical applications. The main objective of Project 1 is to develop an approach to assist patients in maintaining a constant level of stress while undergoing magnetic resonance imaging or spectroscopy. The specific project is to use handgrip to detect the changes in high energy phosphate metabolism between rest and stress. The high energy phosphates, ATP and phosphocreatine (PCr) are responsible for the energy of the heart muscle (myocardium) responsible for its contractile function. If the blood supply to the myocardium in insufficient to support metabolism and contractility during stress, the high energy phosphates, particularly PCr, will decrease in concentration. The high energy phosphates can be tracked using phosphorus-31 magnetic resonance spectroscopy ({sup 31}P MRS). In Project 2 the UAB Surgical Robotics project focuses on the use of virtual presence to assist with remote surgery and surgical training. The goal of this proposal was to assemble a pilot system for proof of concept. The pilot project was completed successfully and was judged to demonstrate that the concept of remote surgical assistance as applied to surgery and surgical training was feasible and warranted further development. The main objective of Project 3 is to develop a system to allow for the tele-robotic delivery of instrumentation during a functional neurosurgical procedure (Figure 3). Instrumentation such as micro-electrical recording probes or deep brain stimulation leads. Current methods for the delivery of these instruments involve the integration of linear actuators to stereotactic navigation systems. The control of these delivery

Surgical Robotics Research in Cardiovascular Disease

International Nuclear Information System (INIS)

Pohost, Gerald M; Guthrie, Barton L; Steiner, Charles

2008-01-01

This grant is to support a research in robotics at three major medical centers: the University of Southern California-USC- (Project 1); the University of Alabama at Birmingham-UAB-(Project 2); and the Cleveland Clinic Foundation-CCF-(Project 3). Project 1 is oriented toward cardiovascular applications, while projects 2 and 3 are oriented toward neurosurgical applications. The main objective of Project 1 is to develop an approach to assist patients in maintaining a constant level of stress while undergoing magnetic resonance imaging or spectroscopy. The specific project is to use handgrip to detect the changes in high energy phosphate metabolism between rest and stress. The high energy phosphates, ATP and phosphocreatine (PCr) are responsible for the energy of the heart muscle (myocardium) responsible for its contractile function. If the blood supply to the myocardium in insufficient to support metabolism and contractility during stress, the high energy phosphates, particularly PCr, will decrease in concentration. The high energy phosphates can be tracked using phosphorus-31 magnetic resonance spectroscopy ( 31 P MRS). In Project 2 the UAB Surgical Robotics project focuses on the use of virtual presence to assist with remote surgery and surgical training. The goal of this proposal was to assemble a pilot system for proof of concept. The pilot project was completed successfully and was judged to demonstrate that the concept of remote surgical assistance as applied to surgery and surgical training was feasible and warranted further development. The main objective of Project 3 is to develop a system to allow for the tele-robotic delivery of instrumentation during a functional neurosurgical procedure (Figure 3). Instrumentation such as micro-electrical recording probes or deep brain stimulation leads. Current methods for the delivery of these instruments involve the integration of linear actuators to stereotactic navigation systems. The control of these delivery devices

Intensity of factor VIII treatment and the development of inhibitors in non-severe hemophilia A patients: results of the INSIGHT case-control study.

Science.gov (United States)

van Velzen, A S; Eckhardt, C L; Peters, M; Leebeek, F W G; Escuriola-Ettingshausen, C; Hermans, C; Keenan, R; Astermark, J; Male, C; Peerlinck, K; le Cessie, S; van der Bom, J G; Fijnvandraat, K

2017-07-01

Essentials Research suggests that intensive treatment episodes may increase the risk to develop inhibitors. We performed an international nested case-control study with 298 non-severe hemophilia A patients. Surgery and a high dose of factor VIII concentrate were associated with increased inhibitor risk. Physicians need to review arguments for factor VIII dose and elective surgery extra critically. Background Inhibitor development is a major complication of treatment with factor VIII concentrates in hemophilia. Findings from studies among severe hemophilia A patients suggest that intensive treatment episodes increase the risk of developing inhibitors. Objectives We set out to assess whether intensive treatment is also associated with an increased risk of inhibitor development among non-severe hemophilia A patients. Patients/Methods We performed a nested case-control study. A total of 75 inhibitor patients (cases) and 223 control patients were selected from 2709 non-severe hemophilia A patients (FVIII:C, 2-40%) of the INSIGHT cohort study. Cases and controls were matched for date of birth and cumulative number of exposure days (EDs) to FVIII concentrates. Conditional logistic regression was used to calculate both unadjusted and adjusted odds ratios (aOR); the latter were adjusted for a priori specified confounders. Results Peak treatment of 5 or 10 consecutive EDs did not increase inhibitor risk (aOR, 1.0; 95% confidence interval (CI), 0.4-2.5; and aOR, 1.8; CI, 0.6-5.5, respectively). Both surgical intervention (aOR, 4.2; CI, 1.7-10.3) and a high mean dose (> 45 IU kg -1 /ED) of FVIII concentrate (aOR, 7.5; CI, 1.6-35.6) were associated with an increased inhibitor risk. Conclusions Our findings suggest that high-dose FVIII treatment and surgery increase the risk of inhibitor development in non-severe hemophilia A. Together with the notion that non-severe hemophilia A patients are at a lifelong risk of inhibitor development, we suggest that in the future physicians

Planck 2015 results: VIII. High Frequency Instrument data processing: Calibration and maps

DEFF Research Database (Denmark)

Adam, R.; Ade, P. A R; Aghanim, N.

2016-01-01

This paper describes the processing applied to the cleaned, time-ordered information obtained from the Planck High Frequency Instrument (HFI) with the aim of producing photometrically calibrated maps in temperature and (for the first time) in polarization. The data from the entire 2.5-year HFI....... Using a CMB temperature of TCMB = 2.7255 ± 0.0006 K, it permits an independent measurement of the amplitude of the CMB solar dipole (3364.3 ± 1.5 μK), which is approximatively 1σ higher than the WMAP measurement with a direction that is consistent between the two experiments. We describe the pipeline...... used to produce the maps ofintensity and linear polarization from the HFI timelines, and the scheme used to set the zero level of the maps a posteriori. We also summarize the noise characteristics of the HFI maps in the 2015 Planck data release and present some null tests to assess their quality...

Planck 2015 results. VIII. High Frequency Instrument data processing: Calibration and maps

CERN Document Server

Adam, R.; Aghanim, N.; Arnaud, M.; Ashdown, M.; Aumont, J.; Baccigalupi, C.; Banday, A.J.; Barreiro, R.B.; Bartolo, N.; Battaner, E.; Benabed, K.; Benoît, A.; Benoit-Lévy, A.; Bernard, J.-P.; Bersanelli, M.; Bertincourt, B.; Bielewicz, P.; Bock, J.J.; Bonavera, L.; Bond, J.R.; Borrill, J.; Bouchet, F.R.; Boulanger, F.; Bucher, M.; Burigana, C.; Calabrese, E.; Cardoso, J.-F.; Catalano, A.; Challinor, A.; Chamballu, A.; Chiang, H.C.; Christensen, P.R.; Clements, D.L.; Colombi, S.; Colombo, L.P.L.; Combet, C.; Couchot, F.; Coulais, A.; Crill, B.P.; Curto, A.; Cuttaia, F.; Danese, L.; Davies, R.D.; Davis, R.J.; de Bernardis, P.; de Rosa, A.; de Zotti, G.; Delabrouille, J.; Delouis, J.-M.; Désert, F.-X.; Diego, J.M.; Dole, H.; Donzelli, S.; Doré, O.; Douspis, M.; Ducout, A.; Dupac, X.; Efstathiou, G.; Elsner, F.; Enßlin, T.A.; Eriksen, H.K.; Falgarone, E.; Fergusson, J.; Finelli, F.; Forni, O.; Frailis, M.; Fraisse, A.A.; Franceschi, E.; Frejsel, A.; Galeotta, S.; Galli, S.; Ganga, K.; Ghosh, T.; Giard, M.; Giraud-Héraud, Y.; Gjerløw, E.; González-Nuevo, J.; Górski, K.M.; Gratton, S.; Gruppuso, A.; Gudmundsson, J.E.; Hansen, F.K.; Hanson, D.; Harrison, D.L.; Henrot-Versillé, S.; Herranz, D.; Hildebrandt, S.R.; Hivon, E.; Hobson, M.; Holmes, W.A.; Hornstrup, A.; Hovest, W.; Huffenberger, K.M.; Hurier, G.; Jaffe, A.H.; Jaffe, T.R.; Jones, W.C.; Juvela, M.; Keihänen, E.; Keskitalo, R.; Kisner, T.S.; Kneissl, R.; Knoche, J.; Kunz, M.; Kurki-Suonio, H.; Lagache, G.; Lamarre, J.-M.; Lasenby, A.; Lattanzi, M.; Lawrence, C.R.; Le Jeune, M.; Leahy, J.P.; Lellouch, E.; Leonardi, R.; Lesgourgues, J.; Levrier, F.; Liguori, M.; Lilje, P.B.; Linden-Vørnle, M.; López-Caniego, M.; Lubin, P.M.; Macías-Pérez, J.F.; Maggio, G.; Maino, D.; Mandolesi, N.; Mangilli, A.; Maris, M.; Martin, P.G.; Martínez-González, E.; Masi, S.; Matarrese, S.; McGehee, P.; Melchiorri, A.; Mendes, L.; Mennella, A.; Migliaccio, M.; Mitra, S.; Miville-Deschênes, M.-A.; Moneti, A.; Montier, L.; Moreno, R.; Morgante, G.; Mortlock, D.; Moss, A.; Mottet, S.; Munshi, D.; Murphy, J.A.; Naselsky, P.; Nati, F.; Natoli, P.; Netterfield, C.B.; Nørgaard-Nielsen, H.U.; Noviello, F.; Novikov, D.; Novikov, I.; Oxborrow, C.A.; Paci, F.; Pagano, L.; Pajot, F.; Paoletti, D.; Pasian, F.; Patanchon, G.; Pearson, T.J.; Perdereau, O.; Perotto, L.; Perrotta, F.; Pettorino, V.; Piacentini, F.; Piat, M.; Pierpaoli, E.; Pietrobon, D.; Plaszczynski, S.; Pointecouteau, E.; Polenta, G.; Pratt, G.W.; Prézeau, G.; Prunet, S.; Puget, J.-L.; Rachen, J.P.; Reinecke, M.; Remazeilles, M.; Renault, C.; Renzi, A.; Ristorcelli, I.; Rocha, G.; Rosset, C.; Rossetti, M.; Roudier, G.; Rusholme, B.; Sandri, M.; Santos, D.; Sauvé, A.; Savelainen, M.; Savini, G.; Scott, D.; Seiffert, M.D.; Shellard, E.P.S.; Spencer, L.D.; Stolyarov, V.; Stompor, R.; Sudiwala, R.; Sutton, D.; Suur-Uski, A.-S.; Sygnet, J.-F.; Tauber, J.A.; Terenzi, L.; Toffolatti, L.; Tomasi, M.; Tucci, M.; Tuovinen, J.; Valenziano, L.; Valiviita, J.; Van Tent, B.; Vibert, L.; Vielva, P.; Villa, F.; Wade, L.A.; Wandelt, B.D.; Watson, R.; Wehus, I.K.; Yvon, D.; Zacchei, A.

2016-01-01

This paper describes the processing applied to the Planck High Frequency Instrument (HFI) cleaned, time-ordered information to produce photometrically calibrated maps in temperature and (for the first time) in polarization. The data from the 2.5 year full mission include almost five independent full-sky surveys. HFI observes the sky over a broad range of frequencies, from 100 to 857 GHz. To get the best accuracy on the calibration over such a large range, two different photometric calibration schemes have been used. The 545 and 857 GHz data are calibrated using models of planetary atmospheric emission. The lower frequencies (from 100 to 353 GHz) are calibrated using the time-variable cosmological microwave background dipole which we call the orbital dipole. This source of calibration only depends on the satellite velocity with respect to the solar system and permits an independent measurement of the amplitude of the CMB solar dipole (3364.5 +/- 0.8 \\mu K) which is 1\\sigma\\ higher than the WMAP measurement wit...

[ANALYSIS OF THE SURGICAL TREATMENT RESULTS IN THE THYROID GLAND DISEASES].

Science.gov (United States)

Tarashchenko, Yu N; Bolgov, M Yu

2015-08-01

The results of surgical treatment of the thyroid gland diseases were analyzed, including the specific morbidity rate, cosmetic effect of the operation, stationary treatment of patients duration, the operation radicalism. Improvement of the operation methods and introduction of modern electric surgical instruments have permitted to reduce the operation duration, the surgical access length, the rate of postoperative hypocalcaemia occurrence, duration of the patients stationary treatment.

THE DEVELOPMENT OF INSTRUMENTS OF SUSTAINABLE DEVELOPMENT OF THE ENTERPRISES SECTOR

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Leszek KAŹMIERCZAK‐PIWKO

2012-10-01

Full Text Available The paper prepared within the PhD grant (Sub‐Action 8.2.2 „Regional Innovation Strategies”, Activity 8.2 „Know‐How Transfer”, Priority VIII „Regional Business Personnel” of the Human Capital Operational Programme, co‐funded from the EU resources within the European Social Fund as well as the state budget and the Lubuskie Voivodship undertakes the problem of universal instruments of sustainable development of companies such as environmental management BS7750, ISO 14000 standards, EMAS and CP strategies as well as CSR. It focuses on comprehensive presentation of their genesis, evolution and current situation in the entities operating in Poland.

RESULTS OF SURGICAL TREATMENT OF INFANTILE AND JUVENILE SCOLIOSIS USING VARIOUS INSTRUMENTATION

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M. V. Mikhailovsky

2015-01-01

Full Text Available Introduction. The analysis Results of surgical treatment of growing children with infantile and juvenile scoliosis (IS can the optimal method of treatment select. In young children with significant growth potential spinal fusion may not be the best option as it limits further longitudinal growth of the spine and may to the thoracic insufficiency syndrome result. To address this problem recently several techniques focused, their have advantages and drawbacks.Material and methods. Since 2008 year 127 patients (64 girls, 63 boys aged (4.5 ± 2.1 years were operated on. In group I 65 patients were operated on using VEPTR (Vertical Expandable Prosthetic Titanium Rib instrumentation, in group II 42 patients using various spinal instrumentation. 20 patients with congenital kyphosis were excluded. The average follow-up time was (5.6 ± 1.1 years.Results. In group I average value of the primary scoliotic curve before surgery was (74.7 ± 22.9, secondary curve (42.8 ± 16.0, thoracic kyphosis (46.3 ± 27.4, lumbar lordosis (54.6 ± 14. Average value of the primary scoliotic curve after surgery was reduced to (51 ± 20 (correction 31.7%, at followup to (56.5 ± 18.5, secondary curve (31.8 ± 12.8 (25.7%, at follow-up to (32.4 ± 18.4, thoracic kyphosis (36.8 ± 20.8 (20,5%, at follow-up to (41.8 ± 21.0, lumbar lordosis (45.4 ± 12.7 (16,9%, at follow-up to (48.2 ± 11.7 (p < 0.05. Space available for lung before surgery was (84.5 ± 8.7 %, after surgery was (94.8 ± 6.7%, at follow-up increased to (98.6 ± 5.4 % (p < 0.05. Complications included 11 implant dislocations and 1 infection. In group II average value of the primary scoliotic curve before surgery was (87.6 ± 6.6, secondary curve (47.8 ± 4.6, thoracic kyphosis (61.4 ± 10.4, lumbar lordosis (61.8 ± 4.9. Average value of the primary scoliotic curve after surgery was reduced to 50.6 ± 5.3 (correction 42.3%, at follow-up to (66.1 ± 6.3�

Compact teleoperated laparoendoscopic single-site robotic surgical system: Kinematics, control, and operation.

Science.gov (United States)

Isaac-Lowry, Oran Jacob; Okamoto, Steele; Pedram, Sahba Aghajani; Woo, Russell; Berkelman, Peter

2017-12-01

To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. Trajectory following results from an optical motion tracker and sample task performance results are presented. Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost. Copyright © 2017 John Wiley & Sons, Ltd.

Complexation of the cesium cation with lithium ionophore VIII: extraction and DFT study

Czech Academy of Sciences Publication Activity Database

Makrlík, E.; Novák, Vít; Vaňura, P.; Bouř, Petr

2013-01-01

Roč. 298, č. 3 (2013), s. 2065-2068 ISSN 0236-5731 Institutional support: RVO:61388963 Keywords : cesium cation * lithium ionophore VIII * complexation * extraction and stability constants * water-nitrobenzene system * DFT calculations * structures Subject RIV: CB - Analytical Chemistry , Separation Impact factor: 1.415, year: 2013

The 1.7 Å X-ray crystal structure of the porcine factor VIII C2 domain and binding analysis to anti-human C2 domain antibodies and phospholipid surfaces.

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Caileen M Brison

Full Text Available The factor VIII C2 domain is essential for binding to activated platelet surfaces as well as the cofactor activity of factor VIII in blood coagulation. Inhibitory antibodies against the C2 domain commonly develop following factor VIII replacement therapy for hemophilia A patients, or they may spontaneously arise in cases of acquired hemophilia. Porcine factor VIII is an effective therapeutic for hemophilia patients with inhibitor due to its low cross-reactivity; however, the molecular basis for this behavior is poorly understood. In this study, the X-ray crystal structure of the porcine factor VIII C2 domain was determined, and superposition of the human and porcine C2 domains demonstrates that most surface-exposed differences cluster on the face harboring the "non-classical" antibody epitopes. Furthermore, antibody-binding results illustrate that the "classical" 3E6 antibody can bind both the human and porcine C2 domains, although the inhibitory titer to human factor VIII is 41 Bethesda Units (BU/mg IgG versus 0.8 BU/mg IgG to porcine factor VIII, while the non-classical G99 antibody does not bind to the porcine C2 domain nor inhibit porcine factor VIII activity. Further structural analysis of differences between the electrostatic surface potentials suggest that the C2 domain binds to the negatively charged phospholipid surfaces of activated platelets primarily through the 3E6 epitope region. In contrast, the G99 face, which contains residue 2227, should be distal to the membrane surface. Phospholipid binding assays indicate that both porcine and human factor VIII C2 domains bind with comparable affinities, and the human K2227A and K2227E mutants bind to phospholipid surfaces with similar affinities as well. Lastly, the G99 IgG bound to PS-immobilized factor VIII C2 domain with an apparent dissociation constant of 15.5 nM, whereas 3E6 antibody binding to PS-bound C2 domain was not observed.

Structure and stability of hexa-aqua V(III) cations in vanadium redox flow battery electrolytes.

Science.gov (United States)

Vijayakumar, M; Li, Liyu; Nie, Zimin; Yang, Zhenguo; Hu, JianZhi

2012-08-07

The vanadium(III) cation structure in mixed acid based electrolyte solution from vanadium redox flow batteries is studied by (17)O and (35/37)Cl nuclear magnetic resonance (NMR) spectroscopy, electronic spectroscopy and density functional theory (DFT) based computational modelling. Both computational and experimental results reveal that the V(III) species can complex with counter anions (sulfate/chlorine) depending on the composition of its solvation sphere. By analyzing the powder precipitate it was found that the formation of sulfate complexed V(III) species is the crucial process in the precipitation reaction. The precipitation occurs through nucleation of neutral species formed through deprotonation and ion-pair formation process. However, the powder precipitate shows a multiphase nature which warrants multiple reaction pathways for precipitation reaction.

KEANEKARAGAMAN HYMENOPTERA PARASITOID PADA PERKEBUNAN KELAPA SAWIT PTPN VIII CINDALI, BOGOR

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Ichsan Luqmana Indra Putra

2016-09-01

Full Text Available Diversity of parasitic Hymenoptera in PTPN VIII oil palm plantation Cindali, Bogor. One group of important natural enemies in oil palm plantation is parasitic Hymenoptera. The purpose of this research is to know the diversity and fluctuation of parasitic Hymenoptera PTPN VIII Cindali oil palm plantation. This research was conducted in 6 blocks of oil palm in September 2014 – June 2015. There were 5 plots in every observation blocks 39.2 x 39.2 m in size, and used direct and indirect method. Direct method done by 5 plants in every plots was taken randomized to observed and taken the herbivore insects to reared until the parasitic Hymenoptera came out. Observation of cover crops conducted by 3 subplots determined diagonally in every plots 9.8 x 9.8 m in size and herbivore insects was observed and collected. Indirect methods used sweep net and yellow pan trap. The result of this research, 26 parasitic Hymenoptera families was found, with the Braconidae was the most morphospecies found and the most individual amount was Scelionidae. The abundance of parasitoid in every month fluctuated.

VIII International Meeting on Lorentzian Geometry

CERN Document Server

Flores, José; Palomo, Francisco; GeLoMa 2016; Lorentzian geometry and related topics

2017-01-01

This volume contains a collection of research papers and useful surveys by experts in the field which provide a representative picture of the current status of this fascinating area. Based on contributions from the VIII International Meeting on Lorentzian Geometry, held at the University of Málaga, Spain, this volume covers topics such as distinguished (maximal, trapped, null, spacelike, constant mean curvature, umbilical...) submanifolds, causal completion of spacetimes, stationary regions and horizons in spacetimes, solitons in semi-Riemannian manifolds, relation between Lorentzian and Finslerian geometries and the oscillator spacetime. In the last decades Lorentzian geometry has experienced a significant impulse, which has transformed it from just a mathematical tool for general relativity to a consolidated branch of differential geometry, interesting in and of itself. Nowadays, this field provides a framework where many different mathematical techniques arise with applications to multiple parts of mathem...

Automatic data-driven real-time segmentation and recognition of surgical workflow.

Science.gov (United States)

Dergachyova, Olga; Bouget, David; Huaulmé, Arnaud; Morandi, Xavier; Jannin, Pierre

2016-06-01

With the intention of extending the perception and action of surgical staff inside the operating room, the medical community has expressed a growing interest towards context-aware systems. Requiring an accurate identification of the surgical workflow, such systems make use of data from a diverse set of available sensors. In this paper, we propose a fully data-driven and real-time method for segmentation and recognition of surgical phases using a combination of video data and instrument usage signals, exploiting no prior knowledge. We also introduce new validation metrics for assessment of workflow detection. The segmentation and recognition are based on a four-stage process. Firstly, during the learning time, a Surgical Process Model is automatically constructed from data annotations to guide the following process. Secondly, data samples are described using a combination of low-level visual cues and instrument information. Then, in the third stage, these descriptions are employed to train a set of AdaBoost classifiers capable of distinguishing one surgical phase from others. Finally, AdaBoost responses are used as input to a Hidden semi-Markov Model in order to obtain a final decision. On the MICCAI EndoVis challenge laparoscopic dataset we achieved a precision and a recall of 91 % in classification of 7 phases. Compared to the analysis based on one data type only, a combination of visual features and instrument signals allows better segmentation, reduction of the detection delay and discovery of the correct phase order.

Debridement of vaginal radiation ulcers using the surgical Ultrasonic Aspirator

International Nuclear Information System (INIS)

Vanderburgh, E.; Nahhas, W.A.

1990-01-01

The surgical Ultrasonic Aspirator (USA) is a fairly new surgical instrument used for an increasingly wide range of procedures. This paper introduces a new application: debridement of vulvovaginal necrotic ulcers resulting from intracavitary radiation therapy. The ultrasonic aspirator allowed removal of the soft, necrotic tissue while preserving underlying healthy, firm tissue and blood vessels

Expressão citofotométrica dos marcadores tumorais CD-34 e fator VIII no câncer de cólon

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Cacilda Joyce Ferreira da Silva Garcia

Full Text Available OBJETIVOS: Verificar a posssibilidade de quantificar a expressão dos marcadores tumorais CD-34 e Fator VIII no câncer de cólon; verificar se existe superioridade entre um marcador e outro para estudo da angiogênese; verificar se há correlação na análise do índice de marcagem e a densidade óptica média nos marcadores utilizados. MÉTODOS: Dezessete casos de adenocarcinoma colorretal recuperados de blocos de parafina e confirmados pela hematoxilina-eosina, foram submetidos à coloração imunoistoquímica pelo método da estreptoavidina-biotina-peroxidase e utilizados os marcadores tumorais CD-34 e Fator VIII. Após este processo as lâminas foram submetidas à leitura no sistema Samba 4000® e avaliadas pelo software Immuno®. Os parâmetros estudados foram: índice de marcagem e densidade óptica, expressos por médias, medianas, valores mínimos, valores máximos e desvios-padrão, analisados estatisticamente. RESULTADOS: Para o marcador CD-34 não houve normalidade dos dados em relação ao índice de marcagem e houve para a densidade óptica. Para o Fator VIII, houve normalidade de dados em relação ao índice de marcagem e para a densidade óptica. CONCLUSÃO: Foi possível quantificar a expressão dos marcadores tumorais CD-34 e Fator VIII através do índice de marcagem e da densidade óptica média; não houve diferença entre os marcadores em relação à média do índice de marcagem e da densidade óptica, não sendo possível definir superioridade entre um e outro; não foi observada tendência à correlação quando comparados densidade óptica e índice de marcagem do Fator VIII e do CD-34 isoladamente estudados; não houve correlação entre o índice de marcagem do Fator VIII quando comparado com o CD-34, bem como a densidade óptica do Fator VIII com o CD-34.

Quark matter coupled to domain walls in Bianchi types II, VIII and IX ...

Indian Academy of Sciences (India)

In this study of Bianchi types II, VIII and IX Universes, quark matter coupled to domain walls in the context of general relativity are explored. To obtain deterministic solution of the Einstein's field equations, various techniques are adopted. The features of the obtained solution are discussed.

Safety and Efficacy of BAY 94-9027, a Prolonged-Half-Life Factor VIII

DEFF Research Database (Denmark)

Reding, M T; Ng, H J; Poulsen, Lone Hvitfeldt

2017-01-01

BACKGROUND: BAY 94-9027 is a B-domain-deleted prolonged-half-life recombinant factor VIII (FVIII) conjugates in a site-specific manner with polyethylene glycol. OBJECTIVE: Assess efficacy and safety of BAY 94-9027 for prophylaxis and treatment of bleeds in patients with severe hemophilia A PATIEN...

Modern spinal instrumentation. Part 1: Normal spinal implants

International Nuclear Information System (INIS)

Davis, W.; Allouni, A.K.; Mankad, K.; Prezzi, D.; Elias, T.; Rankine, J.; Davagnanam, I.

2013-01-01

The general radiologist frequently encounters studies demonstrating spinal instrumentation, either as part of the patient's postoperative evaluation or as incidental to a study performed for another purpose. There are various surgical approaches and devices used in spinal surgery with an increased understanding of spinal and spinal implant biomechanics drives development of modern fixation devices. It is, therefore, important that the radiologist can recognize commonly used devices and identify their potential complications demonstrated on imaging. The aim of part 1 of this review is to familiarize the reader with terms used to describe surgical approaches to the spine, review the function and normal appearances of commonly used instrumentations, and understand the importance of the different fixation techniques. The second part of this review will concentrate on the roles that the different imaging techniques play in assessing the instrumented spine and the recognition of complications that can potentially occur.

Keefektifan Experiential Learning Berbantuan Origami Terhadap Kemampuan Keruangan Siswa Kelas VIII

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Isnaeni Umi Machromah

2014-11-01

Full Text Available AbstrakPenelitian eksperimen ini bertujuan untuk mengetahui keefektifan pembelajaran Experiential Learning berbantuan origami terhadap kemampuan keruangan siswa dengan kualifikasi keefektifan yang telah ditentukan. Populasi yaitu siswa kelas VIII SMP Negeri 3 Colomadu tahun pelajaran 2012/2013. Sampel diambil secara simple random sampling. Hasil penelitian ini yaitu: (1 Uji proporsi ketuntasan belajar menunjukkan siswa kelompok eksperimen telah mencapai ketuntasan belajar; (2 Uji perbedaan dua rata-rata menghasilkan simpulan bahwa rata-rata hasil post-test kemam-puan keruangan siswa kelompok eksperimen lebih dari kelompok kontrol; (3 Analisis re-gresi menunjukkan bahwa motivasi belajar siswa memberikan pengaruh positif sebesar 49,3% terhadap kemampuan keruangan siswa; (4 Uji gain ternormalisasi menunjukkan terdapat peningkatan kemampuan keruangan siswa secara signifikan pada kategaori sedang untuk kelompok eksperimen dan kategori rendah untuk kelompok kontrol. Simpulan yang diperoleh yaitu Experiential Learning berbantuan origami efektif terhadap kemampuan keruangan siswa kelas VIII. AbstractThis experiment research aims to determine the effectiveness of Experiential Learning with Origami to the students’s spatial abilities by the criteria of effectiveness. The population of this research is students of grade VIII of SMP Negeri 3 Colomadu 2012/2013 academic year. Independent variables used in this research are learning by Experiential Learning with origami and student’s motivation. While the dependent variable is the student’s spatial abilities. This research is using documentation, spatial abilities’s test, dan motivation’s scale for collecting data method. Result of this research are: (1 proportion test show that the experiment group has reached mastering of learning clasically and personally; (2 result of spatial ablities’s post test in experiment group better than control group; (3 result of regretion shows that student�

[Value of a novel categorization of congenital double-outlet right ventricle on guiding the choice of surgical approaches].

Science.gov (United States)

Pang, Kunjing; Meng, Hong; Wang, Hao; Hu, Shengshou; Hua, Zhongdong; Pan, Xiangbin; Li, Shoujun

2015-11-01

To explore the feasibility and value of a new categorization of double outlet right ventricular (DORV) on guiding the optimal choices of surgical approaches. Five hundred and twenty one DORV patients diagnosed by echocardiography, angiocardiography and CT at Fuwai Hospital from May 2003 to September 2014 were enrolled in this retrospective study. Congenital DORV was categorized according to three basic factors as follows: the positional relationships of great arteries (normal relation or abnormal relation), the relationships of the ventricular septal defect (VSD) to the great arteries (committed VSD or remote VSD), the presence or absence of pulmonary outflow tract obstruction (POTO). Eight types of DORV were established: type I (normal relation, committed VSD, without POTO), type II (normal relation, committed VSD, POTO), type III (normal relation, remote VSD, without POTO), type IV (normal relation, remote VSD, POTO), type V (abnormal relation, committed VSD, without POTO), type VI (abnormal relation, committed VSD, POTO), type VII (abnormal relation, remote VSD, without POTO), type VIII (abnormal relation, remote VSD, POTO). Feasibility of this classification and the value of this classification on guiding the choice of surgical approaches were analyzed. Among the five hundred and twenty one patients, there were 90 patients (17.3%) with type I DORV, 94 patients (18.0%) with type II, 33 patients (6.3%) with type III, 34 patients (6.5%) with type IV, 64 patients (12.3%) with type V, 61 patients (11.7%) with type VI, 33 patients (6.3%) with type VII, 112 patients (21.5%) with type VIII. Thus, all patients could be typed by this classification method. The echocardiography diagnosis was consistent with the intra-operative and or cardiac catheterization/CT findings. Excluding the contraindications of bi-ventricular repair, different surgical approaches were performed in every subtype of DORV according the classification, which indicated that this novel categorization

Design and implementation of a wireless instrument adapter

DEFF Research Database (Denmark)

Laino, Kaori V.; Saathoff, Thore; Savarimuthu, Thiusius R.

2018-01-01

The evaluation of new methods for control and manipulation in minimally invasive robotic surgery requires a realistic setup. To decouple the evaluation of methods from overall clinical systems, we propose an instrument adapter for the S line EndoWrist\\c{opyright} instruments of the da Vinci...... surgical system. The adapter is small and lightweight and can be mounted to any robot to mimic motion. We describe its design and implementation, as well as a setup to calibrate instruments to study precise motion control. Our results indicate that each instrument requires individual calibration...

Neurotology findings in patients with diagnosis of vascular loop of cranial nerves VIII in magnetic resonance imaging

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Grocoske, Francisco Luiz Busato

Full Text Available Introduction: The vascular compression by redundant vessels under the VIII cranial nerves has been studied since the 80's, and many authors proposed correlations between the compression and the otoneurological findings (vertigo, tinnitus, hypoacusis, audiometry and electrophysiological findings. Objective: Analyze and correlate the different signs and otoneurological symptoms, the audiological findings and its incidence over individuals with Vascular Loop (VL diagnosis of VIII cranial nerves by magnetic resonance imaging (MRI. Method: Retrospective study through the analysis of medical records of 47 patients attended in the otoneurology clinic of Clinical Hospital of UFPR. All the patients have MRI exams with compatible pictures of VL of the VIII cranial nerves. Results: The tinnitus was the most frequent symptom, in 83% of the patients, followed by hypoacusis (60% and vertigo (36%. The audiometry presented alterations in 89%, the brainstem evoked auditory potential in 33% and the vecto-electronystagmography in 17% of the patients. Was not found statistically significant relation between the buzz or hypoacusis, and the presence of VL in MRI. Only 36% of patients had complaints of vertigo, the main symptom described in theory of vascular compression of the VIII pair of nerve. As in the audiometry and in brainstem evoked auditory potential was not found a statistically significant relation between the exam and the presence of the VL in the RMI. Conclusion: The results show independence between the findings of the RMI, clinical picture and audiological results (p>0,05 suggesting that there are no exclusive and direct relation between the diagnosis of vascular loop in the MRI and the clinical picture matching.

Load evaluation of the da Vinci surgical system for transoral robotic surgery.

Science.gov (United States)

Fujiwara, Kazunori; Fukuhara, Takahiro; Niimi, Koji; Sato, Takahiro; Kitano, Hiroya

2015-12-01

Transoral robotic surgery, performed with the da Vinci surgical system (da Vinci), is a surgical approach for benign and malignant lesions of the oral cavity and laryngopharynx. It provides several unique advantages, which include a 3-dimensional magnified view and ability to see and work around curves or angles. However, the current da Vinci surgical system does not provide haptic feedback. This is problematic because the potential risks specific to the transoral use of the da Vinci include tooth injury, mucosal laceration, ocular injury and mandibular fracture. To assess the potential for intraoperative injuries, we measured the load of the endoscope and the instrument of the da Vinci Si surgical system. We pressed the endoscope and instrument of the da Vinci Si against Load cell six times each and measured the dynamic load and the time-to-maximum load. We also struck the da Vinci Si endoscope and instrument against the Load cell six times each and measured the impact load. The maximum dynamic load was 7.27 ± 1.31 kg for the endoscope and 1.90 ± 0.72 for the instrument. The corresponding time-to-maximum loads were 1.72 ± 0.22 and 1.29 ± 0.34 s, but the impact loads were significantly lower than the dynamic load. It remains possible that a major load is exerted on adjacent structures by continuous contact with the endoscope and instrument of da Vinci Si. However, there is a minor delay in reaching the maximum load. Careful monitoring by an on-site assistant may, therefore, help prevent contiguous injury.

Valor preditivo da expressão dos anticorpos Antifator VIII no carcinoma epidermóide do esôfago Predictive value of antifactor VIII antibody expression in squamous cell carcinoma of the esophagus

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Sebastião Gonzaga Barbosa-Neto

2007-12-01

Full Text Available RACIONAL: O carcinoma epidermóide do esôfago apresenta alta mortalidade, baixo índice de diagnóstico precoce e altos custos nos tratamentos, com resultados freqüentemente desapontadores e prognóstico sombrio. O melhor entendimento das técnicas de biologia molecular com citofotometria de imagem, permitiu avançar no conhecimento das alterações na expressão das proteínas desse câncer. OBJETIVOS: Quantificar a expressão das proteínas envolvidas na angiogênese e correlacioná-las com variáveis clínico-patológicas. MÉTODOS: Com o uso da técnica de imunoistoquímica, citofotometria de imagem pelo sistema SAMBA, foram analisadas 29 amostras de carcinoma epidermóide do esôfago incluídas em blocos de parafina. Critérios clínicos como idade, sexo e histopatológicos do grau de diferenciação tumoral, tamanho e localização do tumor foram analisados. Os parâmetros analisados foram o índice de marcagem e a densidade óptica. O marcador utilizado foi o anticorpo anti-Fator VIII. RESULTADOS: Foi possível verificar que as expressões médias do marcador no índice de marcagem foram maiores que as da densidade óptica. Fator VIII apresentou leituras homogêneas. O índice de marcagem foi de 80,17+/-10,40 com P=0,073 e a densidade óptica 51,25+/-11,02 com P=0,245. CONCLUSÃO: A análise quantificação da expressão das proteínas envolvidas na angiogênese permite definir subgrupos de acordo com a diferenciação do carcinoma, estágio tumoral, tamanho e localização do tumor, porém não associa-se com o sexo e a idade dos pacientes, e a densidade óptica do Fator VIII não tem expressão significativa em nenhum dos subgrupos analisados.BACKGROUND: Squamous cell carcinoma of the esophagus exhibits high mortality rate, rare precocious diagnosis, and expensive treatments, presenting frequently disappointed results and poor prognosis. The better understanding about Molecular Biology techniques using cytophotometric imaging allowed

Three-Dimensional Printing Surgical Applications.

Science.gov (United States)

AlAli, Ahmad B; Griffin, Michelle F; Butler, Peter E

2015-01-01

Three-dimensional printing, a technology used for decades in the industrial field, gains a lot of attention in the medical field for its potential benefits. With advancement of desktop printers, this technology is accessible and a lot of research is going on in the medical field. To evaluate its application in surgical field, which may include but not limited to surgical planning, surgical education, implants, and prosthesis, which are the focus of this review. Research was conducted by searching PubMed, Web of science, and other reliable sources. We included original articles and excluded articles based on animals, those more than 10 years old, and those not in English. These articles were evaluated, and relevant studies were included in this review. Three-dimensional printing shows a potential benefit in surgical application. Printed implants were used in patient in a few cases and show successful results; however, longer follow-up and more trials are needed. Surgical and medical education is believed to be more efficient with this technology than the current practice. Printed surgical instrument and surgical planning are also believed to improve with three-dimensional printing. Three-dimensional printing can be a very powerful tool in the near future, which can aid the medical field that is facing a lot of challenges and obstacles. However, despite the reported results, further research on larger samples and analytical measurements should be conducted to ensure this technology's impact on the practice.

Penggunaan Media Presentase Microsoft Power Point Untuk Meningkatkan Hasil Belajar IPS Terpadu Pada Siswa Kelas VIII a SMP Negeri 2 Tanantovea

OpenAIRE

Hitler, Ahmad

2014-01-01

Permasalahan yang diangkat dalam penelitian adalah apakah dengan penggunaan media Presentase Microsoft Power Point pada mata pembelajaran IPS Terpadu dapat meningkatkan hasil belajar siswa kelas VIII A di SMP Negeri 2 Tanantovea. Penelitian ini bertujuan untuk meningkatkan hasil belajar siswa pada pokok bahasan Kolonialisme dan Imperialisme Barat di kelas VIII A SMP Negeri 2 Tanantovea. Penelitian ini dilakukan dalam 2 siklus, setiap siklus terdiri dari perencanaan, pelaksanaan tindakan, obs...

Surgical management of Gerhardt syndrome.

Science.gov (United States)

Chirilă, M; Mureşan, R; Cosgarea, M; Tomescu, E

2010-01-01

Adduction bilateral vocal fold immobility syndrome may be due by both recurrent laryngeal nerves paralysis--Gerhardt syndrome--and all intrinsic laryngeal muscles paralysis--Riegel syndrome. Etiology of Gerhardt syndrome is thyroid surgery, intubation's maneuver, trauma, neurological disorders, extrala-ryngeal malignancies. The manifestations of Gerhardt syndrome are inspiratory dyspnea and slightly influenced voicing by paramedian vocal folds paralysis with an important narrowing of the airway at the glottic level. The surgical procedures for enlargement of the glottic space can be classified in many ways and their major characteristics are: changes at the glottic level; surgical approach: open neck or endoscopic, with or without opening of the mucosal lining; the need for tracheostomy; the equipment used. The aim of this review is to expound the variety of interventions through the last century marked by the development of the diagnostic methods, the anesthesia and the surgical armament with sophisticated instruments and technologies.

The methodological quality of systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment

Directory of Open Access Journals (Sweden)

Vasconcelos Belmiro CE

2008-09-01

Full Text Available Abstract Background Temporomandibular joint disorders (TMJD are multifactor, complex clinical problems affecting approximately 60–70% of the general population, with considerable controversy about the most effective treatment. For example, reports claim success rates of 70% and 83% for non-surgical and surgical treatment, whereas other reports claim success rates of 40% to 70% for self-improvement without treatment. Therefore, the purpose of this study was to (1 identify systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment, (2 evaluate their methodological quality, and (3 evaluate the evidence grade within the systematic reviews. Methods A search strategy was developed and implemented for MEDLINE, Cochrane Library, LILACS, and Brazilian Dentistry Bibliography databases. Inclusion criteria were: systematic reviews (± meta-analysis comparing surgical and non-surgical TMJD treatment, published in English, Spanish, Portuguese, Italian, or German between the years 1966 and 2007(up to July. Exclusion criteria were: in vitro or animal studies; narrative reviews or editorials or editorial letters; and articles published in other languages. Two investigators independently selected and evaluated systematic reviews. Three different instruments (AMSTAR, OQAQ and CASP were used to evaluate methodological quality, and the results averaged. The GRADE instrument was used to evaluate the evidence grade within the reviews. Results The search strategy identified 211 reports; of which 2 were systematic reviews meeting inclusion criteria. The first review met 23.5 ± 6.0% and the second met 77.5 ± 12.8% of the methodological quality criteria (mean ± sd. In these systematic reviews between 9 and 15% of the trials were graded as high quality, and 2 and 8% of the total number of patients were involved in these studies. Conclusion The results indicate that in spite of the widespread impact of TMJD, and the multitude of

The impact of the use of different types of gloves and bare hands for preparation of clean surgical instruments.

Science.gov (United States)

Bruna, Camila Quartim de Moraes; Souza, Rafael Queiroz de; Massaia, Irineu Francisco Silva; Cruz, Áurea Silveira; Graziano, Kazuko Uchikawa

2016-10-10

to determine if there are differences on the safety of the preparation of clean surgical instruments using different types of gloves and bare hands and evaluate the microbiological load of these preparations without gloves. laboratory procedure with a pragmatic approach, in which the samples were handled with different types of gloves and bare hands. In addition, cytotoxicity assays were carried out by means of the agar diffusion method. Further samples were subjected to microbiological analysis after being handled without gloves. none of the samples showed cytotoxic effect. All microbiological cultures showed growth of microorganisms, but no microorganism has been recovered after autoclaving. there were no differences in the cytotoxic responses regarding the use of different types of gloves and bare hands in the handling of clean surgical instruments, which could entail iatrogenic risk. It is noteworthy that the use of gloves involves increase in the costs of process and waste generation, and the potential allergenic risk to latex. determinar se existe diferenças na segurança do preparo de instrumentais cirúrgicos relacionada ao uso de distintos tipos de luvas e das mãos nuas no preparo, e avaliar a carga microbiológica destes preparados sem luvas. experimento laboratorial com abordagem pragmática, onde amostras foram manipuladas com diferentes tipos de luvas e com as mãos nuas, elaborado teste de citotoxicidade por meio da difusão em ágar. Outras Amostras sofreram análise microbiológica após serem manipuladas sem luvas. nenhuma das amostras apresentou efeito citotóxico. Todas as culturas microbiológicas apresentaram crescimento de microrganismos, embora nenhum microrganismo tenha sido recuperado após a autoclavação. não houve diferenças nas respostas citotóxicas relacionadas ao uso de diferentes tipos de luvas e das mãos nuas na manipulação do instrumental cirúrgico limpo que sinalizasse risco de iatrogenia. Ressalta-se que o uso de luvas

Comparison between carbondioxide laser and cold instruments in treatment of vocal nodule

International Nuclear Information System (INIS)

Kundi, N.A.; Qayyum, A.; Ahmed, B.; Raza, M.

2013-01-01

Background: Vocal cord nodules are one of the most frequent disorders in both children and adults who use their voice excessively. Main symptom with which patient presents is hoarseness of voice. The treatment in early stages is voice therapy. Various methods are used for its treatment e.g. surgical removal with cold instruments and carbon dioxide laser ablation. Response to the treatment is measured by improvement in voice quality. Objective: To compare the results of Carbon dioxide laser and cold instruments in the treatment of vocal nodule. Study Design: Quasi-experimental study. Place and Duration of Study: This study was conducted at Otolaryngology Department Combined Military Hospital Rawalpindi. Patients and Methods: In this study 50 patients undergoing treatment of vocal cord nodule were included, 25 patients were treated by surgical removal with cold instruments and 25 patients were treated with carbon dioxide laser ablation. The main comparative outcomes were measured by patients' perception of voice quality (worse, same, improved) one week post operatively. Results: Improvement in voice quality with carbon dioxide laser was found to be clinically superior. Voice quality was significantly improved as compared to cold surgical instruments. Conclusion: Carbon dioxide laser causes early improvement in quality of voice as compared to cold instruments in the treatment of vocal nodules. (author)

Significantly improved surface morphology of N-polar GaN film grown on SiC substrate by the optimization of V/III ratio

Science.gov (United States)

Deng, Gaoqiang; Zhang, Yuantao; Yu, Ye; Yan, Long; Li, Pengchong; Han, Xu; Chen, Liang; Zhao, Degang; Du, Guotong

2018-04-01

In this paper, N-polar GaN films with different V/III ratios were grown on vicinal C-face SiC substrates by metalorganic chemical vapor deposition. During the growth of N-polar GaN film, the V/III ratio was controlled by adjusting the molar flow rate of ammonia while keeping the trimethylgallium flow rate unchanged. The influence of the V/III ratio on the surface morphology of N-polar GaN film has been studied. We find that the surface root mean square roughness of N-polar GaN film over an area of 20 × 20 μm2 can be reduced from 8.13 to 2.78 nm by optimization of the V/III ratio. Then, using the same growth conditions, N-polar InGaN/GaN multiple quantum wells (MQWs) light-emitting diodes (LEDs) were grown on the rough and the smooth N-polar GaN templates, respectively. Compared with the LED grown on the rough N-polar GaN template, dramatically improved interface sharpness and luminescence uniformity of the InGaN/GaN MQWs are achieved for the LED grown on the smooth N-polar GaN template.

Compact instrument for fluorescence image-guided surgery

Science.gov (United States)

Wang, Xinghua; Bhaumik, Srabani; Li, Qing; Staudinger, V. Paul; Yazdanfar, Siavash

2010-03-01

Fluorescence image-guided surgery (FIGS) is an emerging technique in oncology, neurology, and cardiology. To adapt intraoperative imaging for various surgical applications, increasingly flexible and compact FIGS instruments are necessary. We present a compact, portable FIGS system and demonstrate its use in cardiovascular mapping in a preclinical model of myocardial ischemia. Our system uses fiber optic delivery of laser diode excitation, custom optics with high collection efficiency, and compact consumer-grade cameras as a low-cost and compact alternative to open surgical FIGS systems. Dramatic size and weight reduction increases flexibility and access, and allows for handheld use or unobtrusive positioning over the surgical field.

Synthesization of the Ar VIII 3s-3p beam-foil decay curve

International Nuclear Information System (INIS)

Lindgaard, A.; Veje, E.

1981-01-01

The beam-foil decay curve for the 3s-3p transition in Ar VIII has been simulated from experimentally determined relative initial level populations and transition probabilities calculated in the numerical Coulomb approximation. Good agreement is observed between simulated and measured decay curves. A discussion of the simulation is given. (Auth.)

Haemophilia A: Database of nucleotide substitutions, deletions, insertions and rearrangements of the factor VIII gene

Energy Technology Data Exchange (ETDEWEB)

Tuddenham, E.G.D. (Clinical Research Centre, Harrow (United Kingdom)); Cooper, D.N. (Thrombosis Research Inst., London (United Kingdom)); Gitschier, J. (Univ. of California, San Francisco (United States)); Higuchi, M.; Kazazian, H.H.; Antonarakis, S.E. (Johns Hopkins Univ., Baltimore (United States)); Hoyer, L.W. (American Red Cross, Rockville (United States)); Yoshioka, A. (Nara Medical Coll., Kashihara City (Japan)); Peake, I.R. (Royal Hallamshire Hospital, Sheffield (United Kingdom)); Schwaab, R. (Inst. fuer Klinische Biochemie der Univ. Bonn (West Germany)); Lavergne, J.M. (Hopital de Bicetre (France)); Giannelli, F. (Guy' s Hospital, London (United Kingdom))

1991-09-25

Mutations at the factor VIII gene locus causing Haemophilia A have now been identified in many patients from a many ethnic groups. Earlier studies used biased methods which detected repetitive mutations at a few CG dinucleotides. More recently rapid gene scanning methods have uncovered an extreme diversity of mutations. Over 80 different point mutations, 6 insertions, 7 small deletions, and 60 large deletions have been characterized. Repetitive mutation has been proved for at least 16 CpG sites. All nonsense mutations cause severe disease. Most missense mutations appear to cause instability of the protein, but some are associated with production of dysfunctional factor VIII molecules, thereby localizing functionally critical regions of the cofactor. Variable phenotype has been observed in association with three of the latter class of genotype. This catalogue of gene lesions in Haemophilia A will be updated annually.

Adjacent segment infection after surgical treatment of spondylodiscitis.

Science.gov (United States)

Siam, Ahmed Ezzat; El Saghir, Hesham; Boehm, Heinrich

2016-03-01

This is the first case series to describe adjacent segment infection (ASI) after surgical treatment of spondylodiscitis (SD). Patients with SD, spondylitis who were surgically treated between 1994 and 2012 were included. Out of 1187 cases, 23 (1.94 %) returned to our institution (Zentralklinik Bad Berka) with ASI: 10 males, 13 females, with a mean age of 65.1 years and a mean follow-up of 69 months. ASI most commonly involved L3-4 (seven patients), T12-L1 (five) and L2-3 (four). The mean interval between operations of primary infection and ASI was 36.9 months. All cases needed surgical intervention, debridement, reconstruction and fusion with longer instrumentation, with culture and sensitivity-based postoperative antimicrobial therapy. At last follow-up, six patients (26.1 %) were mobilized in a wheelchair with a varying degree of paraplegia (three had pre-existing paralysis). Three patients died within 2 months after the ASI operation (13 %). Excellent outcomes were achieved in five patients, and good in eight. Adjacent segment infection after surgical treatment of spondylodiscitis is a rare complication (1.94 %). It is associated with multimorbidity and shows a high mortality rate and a high neurological affection rate. Possible explanations are: haematomas of repeated micro-fractures around screw loosening, haematogenous spread, direct inoculation or a combination of these factors. ASI may also lead to proximal junctional kyphosis, as found in this series. We suggest early surgical intervention with anterior debridement, reconstruction and fusion with posterior instrumentation, followed by antimicrobial therapy for 12 weeks. Level IV retrospective uncontrolled case series.

Detection of Intracellular Factor VIII Protein in Peripheral Blood Mononuclear Cells by Flow Cytometry

Directory of Open Access Journals (Sweden)

Gouri Shankar Pandey

2013-01-01

Full Text Available Flow cytometry is widely used in cancer research for diagnosis, detection of minimal residual disease, as well as immune monitoring and profiling following immunotherapy. Detection of specific host proteins for diagnosis predominantly uses quantitative PCR and western blotting assays. In this study, we optimized a flow cytometry-based detection assay for Factor VIII protein in peripheral blood mononuclear cells (PBMCs. An indirect intracellular staining (ICS method was standardized using monoclonal antibodies to different domains of human Factor VIII protein. The FVIII protein expression level was estimated by calculating the mean and median fluorescence intensities (MFI values for each monoclonal antibody. ICS staining of transiently transfected cell lines supported the method's specificity. Intracellular FVIII protein expression was also detected by the monoclonal antibodies used in the study in PBMCs of five blood donors. In summary, our data suggest that intracellular FVIII detection in PBMCs of hemophilia A patients can be a rapid and reliable method to detect intracellular FVIII levels.

[Organising an instrumental elective abortion].

Science.gov (United States)

Brûlé, Annie

2015-12-01

Family planning centres are structures designed to receive and care for women requesting elective abortions. Here the specially trained, dedicated teams offer personalised care. The instrumental elective abortion is prepared in the same way as a surgical procedure and is subject to the same monitoring. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Evolution of surgical skills training

Science.gov (United States)

Roberts, Kurt E; Bell, Robert L; Duffy, Andrew J

2006-01-01

Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients. Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated “tissue” in a box trainer. More advanced, virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. The Accreditation Council of Graduate Medical Education’s (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent. Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery. An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training, ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients. PMID:16718842

Analysis of factor VIII gene inversions in 164 unrelated hemophilia A families

Energy Technology Data Exchange (ETDEWEB)

Vnencak-Jones, L.; Phillips, J.A. III; Janco, R.L. [Vanderbilt Univ. School of Medicine, Nashville, TN (United States)] [and others

1994-09-01

Hemophilia A is an X-linked recessive disease with variable phenotype and both heterogeneous and wide spread mutations in the factor VIII (F8) gene. As a result, diagnostic carrier or prenatal testing often relies upon laborious DNA linkage analysis. Recently, inversion mutations resulting from an intrachromosomal recombination between DNA sequences in one of two A genes {approximately}500 kb upstream from the F8 gene and a homologous A gene in intron 22 of the F8 gene were identified and found in 45% of severe hemophiliacs. We have analyzed banked DNA collected since 1986 from affected males or obligate carrier females representing 164 unrelated hemophilia A families. The disease was sporadic in 37%, familial in 54% and in 10% of families incomplete information was given. A unique deletion was identified in 1/164, a normal pattern was observed in 110/164 (67%), and 53/164 (32%) families had inversion mutations with 43/53 (81%) involving the distal A gene (R3 pattern) and 10/53 (19%) involving the proximal A gene (R2 pattern). While 19% of all rearrangements were R2, in 35 families with severe disease (< 1% VIII:C activity) all 16 rearrangements seen were R3. In 18 families with the R3 pattern and known activities, 16 (89%) had levels < 1%, with the remaining 2 families having {le} 2.4% activity. Further, 18 referrals specifically noted the production of inhibitors and 8/18 (45%) had the R3 pattern. Our findings demonstrate that the R3 inversion mutation patterns is (1) only seen with VIII:C activity levels of {le} 2.4%, (2) seen in 46% of families with severe hemophilia, (3) seen in 45% of hemophiliacs known to have inhibitors, (4) not correlated with sporadic or familial disease and (5) not in disequilibrium with the Bcl I or Taq I intron 18 or ST14 polymorphisms. Finally, in families positive for an inversion mutation, direct testing offers a highly accurate and less expensive alternative to DNA linkage analysis.

Design and implementation of a PC-based image-guided surgical system.

Science.gov (United States)

Stefansic, James D; Bass, W Andrew; Hartmann, Steven L; Beasley, Ryan A; Sinha, Tuhin K; Cash, David M; Herline, Alan J; Galloway, Robert L

2002-11-01

In interactive, image-guided surgery, current physical space position in the operating room is displayed on various sets of medical images used for surgical navigation. We have developed a PC-based surgical guidance system (ORION) which synchronously displays surgical position on up to four image sets and updates them in real time. There are three essential components which must be developed for this system: (1) accurately tracked instruments; (2) accurate registration techniques to map physical space to image space; and (3) methods to display and update the image sets on a computer monitor. For each of these components, we have developed a set of dynamic link libraries in MS Visual C++ 6.0 supporting various hardware tools and software techniques. Surgical instruments are tracked in physical space using an active optical tracking system. Several of the different registration algorithms were developed with a library of robust math kernel functions, and the accuracy of all registration techniques was thoroughly investigated. Our display was developed using the Win32 API for windows management and tomographic visualization, a frame grabber for live video capture, and OpenGL for visualization of surface renderings. We have begun to use this current implementation of our system for several surgical procedures, including open and minimally invasive liver surgery.

functional outcome and quality of life after surgical management

African Journals Online (AJOL)

Objective: To determine the functional outcome and quality of life of acetabular ... Outcome measures: Modified Merle d'Aubigne scale and “Squat and Smile” test for functional outcome. ..... limited number of implants, few surgical instruments.

Influence Model Assisted Learning Cycle Mind Map to Achievement Physics Laboratory Judging from the performance Grade VIII SMPN 1 Rejoso Pasuruan

OpenAIRE

Ary Analisa Rahma

2014-01-01

Pengaruh Model Siklus Belajar Berbantuan Mind Map terhadap Prestasi Belajar Fisika Ditinjau dari Kinerja Laboratorium Siswa Kelas VIII SMPN 1 Rejoso Kabupaten Pasuruan Abstract: This study aimed to examine the effect of the learning cycle models aided the mind map on the learning achievement in terms of the performance of laboratory physics class VIII student on light material in SMP Negeri 1 Rejoso Pasuruan. This study is a quasi-experimental research. The research design used is a 2 x 2...

The effect of music on robot-assisted laparoscopic surgical performance.

Science.gov (United States)

Siu, Ka-Chun; Suh, Irene H; Mukherjee, Mukul; Oleynikov, Dmitry; Stergiou, Nick

2010-12-01

Music is often played in the operating room to increase the surgeon's concentration and to mask noise. It could have a beneficial effect on surgical performance. Ten participants with limited experience with the da Vinci robotic surgical system were recruited to perform two surgical tasks: suture tying and mesh alignment when classical, jazz, hip-hop, and Jamaican music were presented. Kinematics of the instrument tips of the surgical robot and surface electromyography of the subjects were recorded. Results revealed that a significant music effect was found for both tasks with decreased time to task completion (P = .005) and total travel distance (P = .021) as well as reduced muscle activations ( P = .016) and increased median muscle frequency (P = .034). Subjects improved their performance significantly when they listened to either hip-hop or Jamaican music. In conclusion, music with high rhythmicity has a beneficial effect on robotic surgical performance. Musical environment may benefit surgical training and make acquisition of surgical skills more efficient.

Efeitos de humor no poema VIII de Catulo

Directory of Open Access Journals (Sweden)

Paulo Sérgio Vasconcellos

1997-12-01

Full Text Available Neste artigo apresenta-se uma contribuição ao estudo dos efeitos de humor no poema VIII de Catulo; de fato, além do metro dessa composição e de outros elementos criadores de distanciamento irônico que os estudiosos têm apontado, um outro aspecto de sua forma, ainda pouco percebido, guia a leitura para essa interpretação: o jogo, a maneira de anagrama imperfeito (o “hipograma”, ou, mais precisamente, “criptograma”, de Saussure, com os sons do nome da amada, aparentemente calado. E mais uma das maneiras com que o poeta elabora a jocosa diferença entre o que se diz e o que, sentido e reprimido, deixa-se, porém, transparecer.

Consistency of performance of robot-assisted surgical tasks in virtual reality.

Science.gov (United States)

Suh, I H; Siu, K-C; Mukherjee, M; Monk, E; Oleynikov, D; Stergiou, N

2009-01-01

The purpose of this study was to investigate consistency of performance of robot-assisted surgical tasks in a virtual reality environment. Eight subjects performed two surgical tasks, bimanual carrying and needle passing, with both the da Vinci surgical robot and a virtual reality equivalent environment. Nonlinear analysis was utilized to evaluate consistency of performance by calculating the regularity and the amount of divergence in the movement trajectories of the surgical instrument tips. Our results revealed that movement patterns for both training tasks were statistically similar between the two environments. Consistency of performance as measured by nonlinear analysis could be an appropriate methodology to evaluate the complexity of the training tasks between actual and virtual environments and assist in developing better surgical training programs.

Clinical Performance of Emergency Surgical Officers in Southern ...

African Journals Online (AJOL)

GB

The proportion of cesarean and instrumental deliveries over the total deliveries were 13% and 0.7%, respectively. Explorative laparotomies and appendectomies were the majority of the non-obstetric emergency operations. Interviewed staff in the respective hospitals stated that ESOs' clinical decision making, surgical skill ...

Study of Individual Characteristic Abdominal Wall Thickness Based on Magnetic Anchored Surgical Instruments

Directory of Open Access Journals (Sweden)

Ding-Hui Dong

2015-01-01

Full Text Available Background: Magnetic anchored surgical instruments (MASI, relying on magnetic force, can break through the limitations of the single port approach in dexterity. Individual characteristic abdominal wall thickness (ICAWT deeply influences magnetic force that determines the safety of MASI. The purpose of this study was to research the abdominal wall characteristics in MASI applied environment to find ICAWT, and then construct an artful method to predict ICAWT, resulting in better safety and feasibility for MASI. Methods: For MASI, ICAWT is referred to the thickness of thickest point in the applied environment. We determined ICAWT through finding the thickest point in computed tomography scans. We also investigated the traits of abdominal wall thickness to discover the factor that can be used to predict ICAWT. Results: Abdominal wall at C point in the middle third lumbar vertebra plane (L3 is the thickest during chosen points. Fat layer thickness plays a more important role in abdominal wall thickness than muscle layer thickness. "BMI-ICAWT" curve was obtained based on abdominal wall thickness of C point in L3 plane, and the expression was as follow: f(x = P1 × x 2 + P2 × x + P3, where P1 = 0.03916 (0.01776, 0.06056, P2 = 1.098 (0.03197, 2.164, P3 = −18.52 (−31.64, −5.412, R-square: 0.99. Conclusions: Abdominal wall thickness of C point at L3 could be regarded as ICAWT. BMI could be a reliable predictor of ICAWT. In the light of "BMI-ICAWT" curve, we may conveniently predict ICAWT by BMI, resulting a better safety and feasibility for MASI.

Building a framework for ergonomic research on laparoscopic instrument handles.

Science.gov (United States)

Li, Zheng; Wang, Guohui; Tan, Juan; Sun, Xulong; Lin, Hao; Zhu, Shaihong

2016-06-01

Laparoscopic surgery carries the advantage of minimal invasiveness, but ergonomic design of the instruments used has progressed slowly. Previous studies have demonstrated that the handle of laparoscopic instruments is vital for both surgical performance and surgeon's health. This review provides an overview of the sub-discipline of handle ergonomics, including an evaluation framework, objective and subjective assessment systems, data collection and statistical analyses. Furthermore, a framework for ergonomic research on laparoscopic instrument handles is proposed to standardize work on instrument design. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Staining for factor VIII related antigen and Ulex europaeus agglutinin I (UEA-I) in 230 tumours. An assessment of their specificity for angiosarcoma and Kaposi's sarcoma.

Science.gov (United States)

Leader, M; Collins, M; Patel, J; Henry, K

1986-11-01

In this study we examined the staining reactivity of commercially available antisera to factor VIII related antigen (F VIII RAg) and Ulex europaeus agglutinin I (UEA-I) on sections from 230 formalin fixed paraffin embedded tumours. These included 196 sarcomas, 20 carcinomas and 14 angiomas. All angiomas showed positive staining for F VIII RAg; all carcinomas showed negative staining; the vasoformative areas of all angiosarcomas stained positively but only four of six angiosarcomas showed positive staining of their solid areas; of seven Kaposi's sarcomas, all showed positive staining of vessels and six showed positive staining of the spindle cell component. In the remaining 181 non-vascular sarcomas there was a false positive result in four tumours (2.2%), three of which had a history of irradiation. Pre-radiotherapy biopsies of these three tumours stained negatively with anti-F VIII RAg. UEA-I was demonstrated in all the angiomas studied, in all angiosarcomas (including the solid components) and in well-formed vessels of all Kaposi's sarcomas, but only in the spindle cell component of 3/6. However, there was an unacceptably high rate of false positive staining amongst the carcinomas and non-vascular sarcomas. In conclusion, F VIII RAg is a specific but not a sensitive marker of angiosarcomas; UEA-I is a sensitive but not a specific marker of angiosarcomas.

Anterior Inferior Cerebellar Arteries Juxtaposed with the Internal Acoustic Meatus and Their Relationship to the Cranial Nerve VII/VIII Complex.

Science.gov (United States)

Alonso, Fernando; Kassem, Mohammad W; Iwanaga, Joe; Oskouian, Rod J; Loukas, Marios; Demerdash, Amin; Tubbs, R Shane

2017-08-16

Vascular loops in the cerebellopontine angle (CPA) and their relationship to cranial nerves have been used to explain neurological symptoms. The anterior inferior cerebellar artery (AICA) has variable branches producing vascular loops that can compress the facial cranial nerve (CN) VII and vestibulocochlear (CN VIII) nerves. AICA compression of the facial-vestibulocochlear nerve complex can lead to various clinical presentations, including hemifacial spasm (HFS), tinnitus, and hemiataxia. The formation of arterial loops inside or outside of the internal auditory meatus (IAM) can cause abutment or compression of CN VII and CN VIII. Twenty-five (50 sides) fresh adult cadavers underwent dissection of the cerebellopontine angle in the supine position. In regard to relationships between the AICA and the nerves of the facial/vestibulocochlear complex, 33 arteries (66%) traveled in a plane between the facial/nervus intermedius nerves and the cochlear and vestibular nerves. Five arteries (10%) traveled below the CN VII/VIII complex, six (12%) traveled posterior to the nerve complex, four (8%) formed a semi-circle around the upper half of the nerve complex, and two (4%) traveled between and partially separated the nervus intermedius and facial nerve proper. Our study found that the majority of AICA will travel in a plane between the facial/nervus intermedius nerves and the cochlear and vestibular nerves. Although the relationship between the AICA and porus acusticus and AICA and the nerves of the CN VII/VIII complex are variable, based on our findings, some themes exist. Surgeons should consider these with approaches to the cerebellopontine angle.

In vivo recovery and safety of human factor VIII product AAFACT in patients with haemophilia A

NARCIS (Netherlands)

Vossebeld, P. J. M.; Tissing, M. H.; van den Berg, H. M.; Leebeek, F. W. G.; de Goede-Bolder, A.; Novakova, I. R. O.; Gerrits, W. B. J.; Peters, M.; Koopman, M. M. W.; Faber, A.; Hiemstra, H.; Grob, P.; Strengers, P. F. W.

2003-01-01

AAFACT, a monoclonal purified, solvent/detergent treated human plasma-derived coagulation factor VIII concentrate obtained from plasma of voluntary, non-remunerated blood donors, is manufactured and marketed in the Netherlands by Sanquin Plasma Products since 1995. In a postmarketing surveillance

Innovative Approaches for Immune Tolerance to Factor VIII in the Treatment of Hemophilia A

Science.gov (United States)

Sherman, Alexandra; Biswas, Moanaro; Herzog, Roland W.

2017-01-01

Hemophilia A (coagulation factor VIII deficiency) is a debilitating genetic disorder that is primarily treated with intravenous replacement therapy. Despite a variety of factor VIII protein formulations available, the risk of developing anti-dug antibodies (“inhibitors”) remains. Overall, 20–30% of patients with severe disease develop inhibitors. Current clinical immune tolerance induction protocols to eliminate inhibitors are not effective in all patients, and there are no prophylactic protocols to prevent the immune response. New experimental therapies, such as gene and cell therapies, show promising results in pre-clinical studies in animal models of hemophilia. Examples include hepatic gene transfer with viral vectors, genetically engineered regulatory T cells (Treg), in vivo Treg induction using immune modulatory drugs, and maternal antigen transfer. Furthermore, an oral tolerance protocol is being developed based on transgenic lettuce plants, which suppressed inhibitor formation in hemophilic mice and dogs. Hopefully, some of these innovative approaches will reduce the risk of and/or more effectively eliminate inhibitor formation in future treatment of hemophilia A. PMID:29225598

Review of emerging surgical robotic technology.

Science.gov (United States)

Peters, Brian S; Armijo, Priscila R; Krause, Crystal; Choudhury, Songita A; Oleynikov, Dmitry

2018-04-01

The use of laparoscopic and robotic procedures has increased in general surgery. Minimally invasive robotic surgery has made tremendous progress in a relatively short period of time, realizing improvements for both the patient and surgeon. This has led to an increase in the use and development of robotic devices and platforms for general surgery. The purpose of this review is to explore current and emerging surgical robotic technologies in a growing and dynamic environment of research and development. This review explores medical and surgical robotic endoscopic surgery and peripheral technologies currently available or in development. The devices discussed here are specific to general surgery, including laparoscopy, colonoscopy, esophagogastroduodenoscopy, and thoracoscopy. Benefits and limitations of each technology were identified and applicable future directions were described. A number of FDA-approved devices and platforms for robotic surgery were reviewed, including the da Vinci Surgical System, Sensei X Robotic Catheter System, FreeHand 1.2, invendoscopy E200 system, Flex® Robotic System, Senhance, ARES, the Single-Port Instrument Delivery Extended Research (SPIDER), and the NeoGuide Colonoscope. Additionally, platforms were reviewed which have not yet obtained FDA approval including MiroSurge, ViaCath System, SPORT™ Surgical System, SurgiBot, Versius Robotic System, Master and Slave Transluminal Endoscopic Robot, Verb Surgical, Miniature In Vivo Robot, and the Einstein Surgical Robot. The use and demand for robotic medical and surgical platforms is increasing and new technologies are continually being developed. New technologies are increasingly implemented to improve on the capabilities of previously established systems. Future studies are needed to further evaluate the strengths and weaknesses of each robotic surgical device and platform in the operating suite.

Intrasurgical Human Retinal Imaging With Manual Instrument Tracking Using a Microscope-Integrated Spectral-Domain Optical Coherence Tomography Device.

Science.gov (United States)

Hahn, Paul; Carrasco-Zevallos, Oscar; Cunefare, David; Migacz, Justin; Farsiu, Sina; Izatt, Joseph A; Toth, Cynthia A

2015-07-01

To characterize the first in-human intraoperative imaging using a custom prototype spectral-domain microscope-integrated optical coherence tomography (MIOCT) device during vitreoretinal surgery with instruments in the eye. Under institutional review board approval for a prospective intraoperative study, MIOCT images were obtained at surgical pauses with instruments held static in the vitreous cavity and then concurrently with surgical maneuvers. Postoperatively, MIOCT images obtained at surgical pauses were compared with images obtained with a high-resolution handheld spectral-domain OCT (HHOCT) system with objective endpoints, including acquisition of images acceptable for analysis and identification of predefined macular morphologic or pathologic features. Human MIOCT images were successfully obtained before incision and during pauses in surgical maneuvers. MIOCT imaging confirmed preoperative diagnoses, such as epiretinal membrane, full-thickness macular hole, and vitreomacular traction and demonstrated successful achievement of surgical goals. MIOCT and HHOCT images obtained at surgical pauses in two cohorts of five patients were comparable with greater than or equal to 80% correlation in 80% of patients. Real-time video-imaging concurrent with surgical manipulations enabled, for the first time using this device, visualization of dynamic instrument-retina interaction with targeted OCT tracking. MIOCT is successful for imaging at surgical pauses and for real-time image guidance with implementation of targeted OCT tracking. Even faster acquisition speeds are currently being developed with incorporation of a swept-source MIOCT engine. Further refinements and investigations will be directed toward continued integration for real-time volumetric imaging of surgical maneuvers. Ongoing development of seamless MIOCT systems will likely transform surgical visualization, approaches, and decision-making.

Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation in surgical treatment for single-segment lumbar spinal tuberculosis.

Science.gov (United States)

Zeng, Hao; Wang, Xiyang; Zhang, Penghui; Peng, Wei; Liu, Zheng; Zhang, Yupeng

2015-01-01

The aim of this study is to determine the feasibility and efficacy of surgical management of single-segment lumbar spinal tuberculosis (TB) by using single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. The mean follow-up was 36.9 months (range: 24-62 months). The kyphotic angle ranged from 15.2-35.1° preoperatively, with an average measurement of 27.8°. The American Spinal Injury Association (ASIA) score system was used to evaluate the neurological deficits and erythrocyte sedimentation rate (ESR) used to judge the activity of TB. Spinal TB was completely cured in all 17 patients. There was no recurrent TB infection. The postoperative kyphotic angle was 6.6-10.2°, 8.1° in average, and there was no significant loss of the correction at final follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation can be a feasible and effective method the in treatment of single-segment lumbar spinal TB.

Lithium ionophore VIII as an extraordinarily effective receptor for the strontium cation: Experimental and theoretical study

Czech Academy of Sciences Publication Activity Database

Makrlík, E.; Novák, Vít; Vaňura, P.; Bouř, Petr

2014-01-01

Roč. 1061, Mar 5 (2014), s. 110-113 ISSN 0022-2860 Institutional support: RVO:61388963 Keywords : strontium cation * lithium ionophore VIII * complexation * extraction and stability constants * DFT calculations * structures Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 1.602, year: 2014

Measuring patient participation in surgical treatment decision-making from healthcare professionals' perspective.

Science.gov (United States)

Heggland, Liv-Helen; Mikkelsen, Aslaug; Øgaard, Torvald; Hausken, Kjell

2014-02-01

To develop, empirical test, and validate an instrument measuring patient participation in surgical treatment decision-making from healthcare professionals' perspective. Since the advent of New Public Management in many Western countries, patient participation in healthcare decision-making has been considered to be a best practice. A common notion is that well-educated and well-informed public want to choose their own treatments and providers and want to ask questions about the quality of their health services. Survey. A self-report-measuring instrument was designed and administered to 620 healthcare professionals. Items were developed, validated and tested by 451 nurses and physicians working in six surgical wards in a University Hospital in Norway. A 16-item scale with the following four dimensions was developed: information dissemination, formulation of options, integration of information and control. Factor analysis procedures and reliability testing were performed. A one-way, between-groups analysis of variance was conducted to compare doctors' and nurses' opinions on four dimensions of patient participation in surgical treatment decision-making. This article shows that patient participation in surgical treatment decision-making can be measured by a 16-item scale and four distinct dimensions. The analysis demonstrated a reasonable level of construct validity and reliability. Nurses and physicians have a positive attitude towards patient participation overall, but the two groups differ in the extent to which they accept the idea of patient participation in treatment decision-making. The instrument can be a tool for managers and healthcare professionals in the implementation of patient participation in clinical practice. Data from the instrument can be useful to identify health services being provided and what areas that could strengthen patient participation. © 2013 Blackwell Publishing Ltd.

Development of an Educational Game to Set Up Surgical Instruments on the Mayo Stand or Back Table: Applied Research in Production Technology.

Science.gov (United States)

Paim, Crislaine Pires Padilha; Goldmeier, Silvia

2017-01-10

Existing research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nursing educators can use games to complement curricula, in guidance and staff development programs, to foster team collaboration, and to give support to critical thinking in nursing practice because it is a complex environment. To describe the process of developing an educational game to set up surgical instruments on the Mayo stand or back table as a resource to assist the instructor in surgical instrumentation training for students and nursing health professionals in continued education. The study was characterized by applied research in production technology. It included the phases of analysis and design, development, and evaluation. The objectives of the educational game were developed through Bloom's taxonomy. Parallel to the physical development of the educational game, a proposed model for the use of digital elements in educational game activities was applied to develop the game content. The development of the game called "Playing with Tweezers" was carried out in 3 phases and was evaluated by 15 participants, comprising students and professional experts in various areas of knowledge such as nursing, information technology, and education. An environment was created with an initial screen, menu buttons containing the rules of the game, and virtual tour modes for learning and assessment. The "digital" nursing student needs engagement, stimulation, reality, and entertainment, not just readings. "Playing with Tweezers" is an example of educational gaming as an innovative teaching strategy in nursing that encourages the strategy of involving the use of educational games to support theoretical or practical classroom teaching. Thus, the teacher does not work with only 1 type of teaching methodology, but with a combination of different methodologies. In addition, we cannot forget that skill training in an educational game does not

Partial correction of a severe molecular defect in hemophilia A, because of errors during expression of the factor VIII gene

Energy Technology Data Exchange (ETDEWEB)

Young, M.; Antonarakis, S.E. [Univ. of Geneva (Switzerland); Inaba, Hiroshi [Tokyo Medical College (Japan)] [and others

1997-03-01

Although the molecular defect in patients in a Japanese family with mild to moderately severe hemophilia A was a deletion of a single nucleotide T within an A{sub 8}TA{sub 2} sequence of exon 14 of the factor VIII gene, the severity of the clinical phenotype did not correspond to that expected of a frameshift mutation. A small amount of functional factor VIII protein was detected in the patient`s plasma. Analysis of DNA and RNA molecules from normal and affected individuals and in vitro transcription/translation suggested a partial correction of the molecular defect, because of the following: (i) DNA replication/RNA transcription errors resulting in restoration of the reading frame and/or (ii) {open_quotes}ribosomal frameshifting{close_quotes} resulting in the production of normal factor VIII polypeptide and, thus, in a milder than expected hemophilia A. All of these mechanisms probably were promoted by the longer run of adenines, A{sub 10} instead of A{sub 8}TA{sub 2}, after the delT. Errors in the complex steps of gene expression therefore may partially correct a severe frameshift defect and ameliorate an expected severe phenotype. 36 refs., 6 figs.

Prospects and Challenges of Implementing the Hydrographic Region VIII Basin Plan

Directory of Open Access Journals (Sweden)

Nathalia Silva Duarte

2011-12-01

Full Text Available The current “National Water Law” states that water resources plans must be elaborated by basins, states, and for the country. This essay discusses the water management process considering federal and state legislations and their interrelations, for the purpose of elucidating the gaps found in them , aiming at their applicability to the system of water resources management within the CBH- Macaé and Ostras scope. It also discusses the construction and evolution process of the above-mentioned committee, and developments in the implementation of the Basin Plan of Hydrographic Region VIII.

Influence of V/III growth flux ratio on trap states in m-plane GaN grown by ammonia-based molecular beam epitaxy

International Nuclear Information System (INIS)

Zhang, Z.; Arehart, A. R.; Hurni, C. A.; Speck, J. S.; Ringel, S. A.

2012-01-01

Deep level transient spectroscopy (DLTS) and deep level optical spectroscopy (DLOS) were utilized to investigate the behavior of deep states in m-plane, n-type GaN grown by ammonia-based molecular beam epitaxy (NH 3 -MBE) as a function of systematically varied V/III growth flux ratios. Levels were detected at E C - 0.14 eV, E C - 0.21 eV, E C - 0.26 eV, E C - 0.62 eV, E C - 0.67 eV, E C - 2.65 eV, and E C - 3.31 eV, with the concentrations of several traps exhibiting systematic dependencies on V/III ratio. The DLTS spectra are dominated by traps at E C - 0.14 eV and E C - 0.67 eV, whose concentrations decreased monotonically with increasing V/III ratio and decreasing oxygen impurity concentration, and by a trap at E C - 0.21 eV that revealed no dependence of its concentration on growth conditions, suggestive of different physical origins. Higher concentrations of deeper trap states detected by DLOS with activation energies of E C - 2.65 eV and E C - 3.31 eV in each sample did not display measureable sensitivity to the intentionally varied V/III ratio, necessitating further study on reducing these deep traps through growth optimization for maximizing material quality of NH 3 -MBE grown m-plane GaN.

Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery

Directory of Open Access Journals (Sweden)

Youri P. A. Tan

2018-03-01

Full Text Available Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet  benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within  this surgical subspeciality.

Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery

Science.gov (United States)

Tan, Youri P. A.; Liverneaux, Philippe; Wong, Jason K. F.

2018-01-01

Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet  benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within  this surgical subspeciality. PMID:29740585

Augmented reality in laparoscopic surgical oncology.

Science.gov (United States)

Nicolau, Stéphane; Soler, Luc; Mutter, Didier; Marescaux, Jacques

2011-09-01

Minimally invasive surgery represents one of the main evolutions of surgical techniques aimed at providing a greater benefit to the patient. However, minimally invasive surgery increases the operative difficulty since the depth perception is usually dramatically reduced, the field of view is limited and the sense of touch is transmitted by an instrument. However, these drawbacks can currently be reduced by computer technology guiding the surgical gesture. Indeed, from a patient's medical image (US, CT or MRI), Augmented Reality (AR) can increase the surgeon's intra-operative vision by providing a virtual transparency of the patient. AR is based on two main processes: the 3D visualization of the anatomical or pathological structures appearing in the medical image, and the registration of this visualization on the real patient. 3D visualization can be performed directly from the medical image without the need for a pre-processing step thanks to volume rendering. But better results are obtained with surface rendering after organ and pathology delineations and 3D modelling. Registration can be performed interactively or automatically. Several interactive systems have been developed and applied to humans, demonstrating the benefit of AR in surgical oncology. It also shows the current limited interactivity due to soft organ movements and interaction between surgeon instruments and organs. If the current automatic AR systems show the feasibility of such system, it is still relying on specific and expensive equipment which is not available in clinical routine. Moreover, they are not robust enough due to the high complexity of developing a real-time registration taking organ deformation and human movement into account. However, the latest results of automatic AR systems are extremely encouraging and show that it will become a standard requirement for future computer-assisted surgical oncology. In this article, we will explain the concept of AR and its principles. Then, we

Validation of a virtual reality-based robotic surgical skills curriculum.

Science.gov (United States)

Connolly, Michael; Seligman, Johnathan; Kastenmeier, Andrew; Goldblatt, Matthew; Gould, Jon C

2014-05-01

The clinical application of robotic-assisted surgery (RAS) is rapidly increasing. The da Vinci Surgical System™ is currently the only commercially available RAS system. The skills necessary to perform robotic surgery are unique from those required for open and laparoscopic surgery. A validated laparoscopic surgical skills curriculum (fundamentals of laparoscopic surgery or FLS™) has transformed the way surgeons acquire laparoscopic skills. There is a need for a similar skills training and assessment tool specific for robotic surgery. Based on previously published data and expert opinion, we developed a robotic skills curriculum. We sought to evaluate this curriculum for evidence of construct validity (ability to discriminate between users of different skill levels). Four experienced surgeons (>20 RAS) and 20 novice surgeons (first-year medical students with no surgical or RAS experience) were evaluated. The curriculum comprised five tasks utilizing the da Vinci™ Skills Simulator (Pick and Place, Camera Targeting 2, Peg Board 2, Matchboard 2, and Suture Sponge 3). After an orientation to the robot and a period of acclimation in the simulator, all subjects completed three consecutive repetitions of each task. Computer-derived performance metrics included time, economy of motion, master work space, instrument collisions, excessive force, distance of instruments out of view, drops, missed targets, and overall scores (a composite of all metrics). Experienced surgeons significantly outperformed novice surgeons in most metrics. Statistically significant differences were detected for each task in regards to mean overall scores and mean time (seconds) to completion. The curriculum we propose is a valid method of assessing and distinguishing robotic surgical skill levels on the da Vinci Si™ Surgical System. Further study is needed to establish proficiency levels and to demonstrate that training on the simulator with the proposed curriculum leads to improved robotic

Obtenção e caracterização de anticorpo monoclonal murino anti-fator VIII da coagulação sangüínea Attainment and characterization of murine monoclonal anti-factor VIII antibodies

Directory of Open Access Journals (Sweden)

Rosana Rossi-Ferreira

2006-06-01

Full Text Available Entre os avanços da engenharia celular e biotecnologia nas últimas décadas, destaca-se a produção de anticorpos monoclonais murinos (AcMm utilizados no aprimoramento diagnóstico nas rotinas laboratoriais. A produção de fator VIII de alta pureza sempre foi o desejo e a preocupação das indústrias de hemoderivados para tratamento de pacientes portadores de hemofilia A, porém este produto inexiste no Brasil, sendo necessária sua obtenção no mercado internacional a custos elevados. O trabalho tem por objetivo a produção de AcMm anti-fator VIII humano (FVIII H através da expansão dos clones e caracterização imunoquímica do anticorpo. Camundongos Balb/c foram imunizados com FVIII H purificado como também proveniente de crioprecipitado e as células esplênicas dos animais foram fusionadas com células mielomatosas murinas segundo o método descrito por Kohler e Milstein para produção de híbridos em cultura. Foram testados 1.983 híbridos dos quais 105 foram submetidos à clonagem. Destes, 39 obtiveram monoclonalidade e 7 destes clones foram caracterizados através de técnicas de immunoblotting. Foram submetidas à purificação por cromatografia três imunoglobulinas de diferentes classes pertencentes aos clones LAMB1-10A1A4, LAMB1-17A1A1 e LAMB1-24A2A1. A imunoglobulina purificada pertencente ao clone LAMB1-10A1A4 foi adsorvida em coluna de imunoafinidade para purificação de concentrado de FVIII proveniente de crioprecipitado plasmático.Among the advances in cellular engineering and biotechnology over the last decades, the production of murine monoclonal antibodies (AcMm, used to improve laboratory diagnoses, stands out. The production of very pure factor VIII has always been a concern of suppliers of blood products to treat patients with hemophilia A and this product is still not produced in Brazil. Hence, it can only be attained on the international market at a high cost. The aim of this work was to produce AcMm anti

Analysis of the learning curve for transurethral resection of the prostate. Is there any influence of musical instrument and video game skills on surgical performance?

Science.gov (United States)

Yamaçake, Kleiton Gabriel Ribeiro; Nakano, Elcio Tadashi; Soares, Iva Barbosa; Cordeiro, Paulo; Srougi, Miguel; Antunes, Alberto Azoubel

2015-09-01

To evaluate the learning curve for transurethral resection of the prostate (TURP) among urology residents and study the impact of video game and musical instrument playing abilities on its performance. A prospective study was performed from July 2009 to January 2013 with patients submitted to TURP for benign prostatic hyperplasia. Fourteen residents operated on 324 patients. The following parameters were analyzed: age, prostate-specific antigen levels, prostate weight on ultrasound, pre- and postoperative serum sodium and hemoglobin levels, weight of resected tissue, operation time, speed of resection, and incidence of capsular lesions. Gender, handedness, and prior musical instrument and video game playing experience were recorded using survey responses. The mean resection speed in the first 10 procedures was 0.36 g/min and reached a mean of 0.51 g/min after the 20(th) procedure. The incidence of capsular lesions decreased progressively. The operation time decreased progressively for each subgroup regardless of the difference in the weight of tissue resected. Those experienced in playing video games presented superior resection speed (0.45 g/min) when compared with the novice (0.35 g/min) and intermediate (0.38 g/min) groups (p=0.112). Musical instrument playing abilities did not affect the surgical performance. Speed of resection, weight of resected tissue, and percentage of resected tissue improve significantly and the incidence of capsular lesions reduces after the performance of 10 TURP procedures. Experience in playing video games or musical instruments does not have a significant effect on outcomes.

Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women

OpenAIRE

El Ayadi, Alison; Nalubwama, Hadija; Barageine, Justus; Neilands, Torsten B.; Obore, Susan; Byamugisha, Josaphat; Kakaire, Othman; Mwanje, Haruna; Korn, Abner; Lester, Felicia; Miller, Suellen

2017-01-01

Background Obstetric fistula is a debilitating and traumatic birth injury affecting 2?3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. Metho...

Structural Mimics of the [Fe]-Hydrogenase: A Complete Set for Group VIII Metals.

Science.gov (United States)

Barik, Chandan Kr; Ganguly, Rakesh; Li, Yongxin; Leong, Weng Kee

2018-06-18

A set of structural mimics of the [Fe]-hydrogenase active site comprising all the group VIII metals, viz., [M(2-NHC(O)C 5 H 4 N)(CO) 2 (2-S-C 5 H 4 N)], has been synthesized. They exist as a mixture of isomers in solution, and the relative stability of the isomers depends on the nature of the metal and the substituent at the 6-position of the pyridine ligand.

Minimally invasive surgical treatment of valvular heart disease.

Science.gov (United States)

Goldstone, Andrew B; Joseph Woo, Y

2014-01-01

Cardiac surgery is in the midst of a practice revolution. Traditionally, surgery for valvular heart disease consisted of valve replacement via conventional sternotomy using cardiopulmonary bypass. However, over the past 20 years, the increasing popularity of less-invasive procedures, accompanied by advancements in imaging, surgical instrumentation, and robotic technology, has motivated and enabled surgeons to develop and perform complex cardiac surgical procedures through small incisions, often eliminating the need for sternotomy or cardiopulmonary bypass. In addition to the benefits of improved cosmesis, minimally invasive mitral valve surgery was pioneered with the intent of reducing morbidity, postoperative pain, blood loss, hospital length of stay, and time to return to normal activity. This article reviews the current state-of-the-art of minimally invasive approaches to the surgical treatment of valvular heart disease. Copyright © 2014 Elsevier Inc. All rights reserved.

Voice tuning with new instruments for type II thyroplasty in the treatment of adductor spasmodic dysphonia.

Science.gov (United States)

Sanuki, Tetsuji; Yumoto, Eiji; Toya, Yutaka; Kumai, Yoshihiko

2016-10-01

Adductor spasmodic dysphonia is a rare voice disorder characterized by strained and strangled voice quality with intermittent phonatory breaks and adductory vocal fold spasms. Type II thyroplasty differs from previous treatments in that this surgery does not involve any surgical intervention into the laryngeal muscle, nerve or vocal folds. Type II thyroplasty intervenes in the thyroid cartilage, which is unrelated to the lesion. This procedure, conducted with the aim of achieving lateralization of the vocal folds, requires utmost surgical caution due to the extreme delicacy of the surgical site, critically sensitive adjustment, and difficult procedures to maintain the incised cartilages at a correct position. During surgery, the correct separation of the incised cartilage edges with voice monitoring is the most important factor determining surgical success and patient satisfaction. We designed new surgical instruments: a thyroid cartilage elevator for undermining the thyroid cartilage, and spacer devices to gauge width while performing voice monitoring. These devices were designed to prevent surgical complications, and to aid in selecting the optimal size of titanium bridges while temporally maintaining a separation during voice monitoring. We designed new surgical instruments, including a thyroid cartilage elevator and spacer devices. Precise surgical procedures and performing voice tuning during surgery with the optimal separation width of the thyroid cartilage are key points for surgical success. We introduce the technique of voice tuning using these surgical tools in order to achieve a better outcome with minimal surgical complications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Surface Modification of AISI 440B Stainless Steel and its Influence on Surgical Drill Bits Performance

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Łępicka M.

2016-09-01

Full Text Available The development of modern invasive surgery is highly dependent on the performance of surgical instruments, understood as long-term efficiency arising from high resistance to wear and corrosion. In order to maintain sufficient reliability, surgical cutting instruments are often made of martensitic stainless steels. Nevertheless, the use of ferrous alloys in medical applications is still a concern due to their questionable corrosion and wear resistance. To extend their biocompatibility, improve stability in variable environmental conditions, improve ease of handling, and maximize their performance, diffusion layers and coatings are applied to the surface. The aim of this work was to evaluate the effect of TiN and diamond-like carbon (DLC surface modification on the performance of surgical drill bits, that is, wear and corrosion resistance, measured in model and field tests. Based on the findings presented, DLC layers can be recommended as anti-wear and anti-corrosion coatings for surgical drill bits.

Mentoring console improves collaboration and teaching in surgical robotics.

Science.gov (United States)

Hanly, Eric J; Miller, Brian E; Kumar, Rajesh; Hasser, Christopher J; Coste-Maniere, Eve; Talamini, Mark A; Aurora, Alexander A; Schenkman, Noah S; Marohn, Michael R

2006-10-01

One of the most significant limitations of surgical robots has been their inability to allow multiple surgeons and surgeons-in-training to engage in collaborative control of robotic surgical instruments. We report the initial experience with a novel two-headed da Vinci surgical robot that has two collaborative modes: the "swap" mode allows two surgeons to simultaneously operate and actively swap control of the robot's four arms, and the "nudge" mode allows them to share control of two of the robot's arms. The utility of the mentoring console operating in its two collaborative modes was evaluated through a combination of dry laboratory exercises and animal laboratory surgery. The results from surgeon-resident collaborative performance of complex three-handed surgical tasks were compared to results from single-surgeon and single-resident performance. Statistical significance was determined using Student's t-test. Collaborative surgeon-resident swap control reduced the time to completion of complex three-handed surgical tasks by 25% compared to single-surgeon operation of a four-armed da Vinci (P nudge mode was particularly useful for guiding a resident's hands during crucially precise steps of an operation (such as proper placement of stitches). The da Vinci mentoring console greatly facilitates surgeon collaboration during robotic surgery and improves the performance of complex surgical tasks. The mentoring console has the potential to improve resident participation in surgical robotics cases, enhance resident education in surgical training programs engaged in surgical robotics, and improve patient safety during robotic surgery.

IMPLIKASI YURIDIS PUTUSAN MK NOMOR 46/PUU- VIII/ 2010 TERHADAP AKTA KELAHIRAN ANAK LUAR KAWIN

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Djumikasih Djumikasih

2014-08-01

Full Text Available Abstract This paper aims to identify and analyze what the juridical implications of the publication of the decision of the Constitutional Court No. 46/PUU-VIII / 2010 on Child Outside Marriage Deed which has been published by the Department of Population and Civil Registration prior to the establishment of the Constitutional Court's decision . The method used in this study is a normative juridical approach legislation. From the discussion, it can be concluded that the Constitutional Court 46/PUU-VIII/2010 Number of Tests on Article 43 paragraph ( 1 Marriage Act ( Act No. 1 of 1974 when viewed from the angle of legal certainty it will lead to legal certainty . But the decision will not have any juridical implications of the child's birth certificate that has been published outside of marriage and illegitimate child who was born before the date of February 17, 2012, as if enacted would be contrary to the principle of legality is interpreted Article 47 of the Law on the Constitutional Court and Article 28 ( i of the 1945 Constitution . Likewise, if the terms of the fairness and usefulness , especially for justice seekers / applicant , the timing of this decision is not fair and not useful , because although the Court granted the petition but the Constitutional Court can not be applied to her .   Key words: yuridical implication, birth certificate, children who are born outside of marriage   Abstrak   Tulisan ini bertujuan untuk mengetahui dan menganalisis apa implikasi yuridis dari terbitnya putusan MK Nomor 46/PUU-VIII/ 2010 terhadap Akta Anak Luar Kawin yang sudah diterbitkan oleh Dinas Kependudukan dan Catatan Sipil sebelum lahirnya putusan MK tersebut. Metode yang digunakan dalam penelitian ini adalah yuridis normative dengan pendekatan perundang-undangan. Dari pembahasan dapat disimpulkan bahwa Putusan MK Nomer 46/PUU-VIII/2010 tentang Pengujian terhadap Pasal 43 ayat (1 UU Perkawinan (UU NO 1 Tahun 1974 jika dilihat dari sudut kepastian

Tranexamic acid combined with recombinant factor VIII increases clot resistance to accelerated fibrinolysis in severe hemophilia A

DEFF Research Database (Denmark)

Hvas, Anne-Mette; Sørensen, Hanne Thykjær; Norengaard, Lisbeth

2007-01-01

examined whether the clot stability in hemophiliacs could be improved by treatment with tranexamic acid (TXA) in combination with recombinant factor VIII (rFVIII). PATIENTS/METHODS: Baseline blood samples were obtained from eight males with severe hemophilia A. Thereafter, a bolus injection of r...

Hemophilia as a defect of the tissue factor pathway of blood coagulation: Effect of factors VIII and IX on factor X activation in a continuous-flow reactor

International Nuclear Information System (INIS)

Repke, D.; Gemmell, C.H.; Guha, A.; Turitto, V.T.; Nemerson, Y.; Broze, G.J. Jr.

1990-01-01

The effect of factors VIII and IX on the ability of the tissue factor-factor VIIa complex to activate factor X was studied in a continuous-flow tubular enzyme reactor. Tissue factor immobilized in a phospholipid bilayer on the inner surface of the tube was exposed to a perfusate containing factors VIIa, VIII, IX, and X flowing at a wall shear rate of 57, 300, or 1130 sec -1 . The addition of factors VIII and IX at their respective plasma concentrations resulted in a further 2 endash-to 3 endash fold increase. The direct activation of factor X by tissue factor-factor VIIa could be virtually eliminated by the lipoprotein-associated coagulation inhibitor. These results suggest that the tissue factor pathway, mediated through factors VIII and IX, produces significant levels of factor Xa even in the presence of an inhibitor of the tissue factor-factor VIIa complex; moreover, the activation is dependent on local shear conditions. These findings are consistent both with a model of blood coagulation in which initiation of the system results from tissue factor and with the bleeding observed in hemophilia

FY1995 development of a endoscopic surgical system utilizing multi-modal functional images; 1995 nendo tashu kino gazo wo mochiiru teishinshu naishikyo shujutsu system no kaihatsu

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-05-01

The purpose of this study is to develop an endoscope system for neurosurgery that can provide not only conventional endoscopic images but also ultraviolet-visible spectra, fluorescence spectra, near infrared spectra, and ultra-soundimages of tissue aiming for real-time identification of pathological tissue. The system also incorporates surgical manipulator and devices such as micro forceps and laser surgical instruments for endoscopic image guided surgery. Surgical Manipulator should be a high performance and easy to operate surgical instrument as well as conventional surgical tools such as scissors and knife. Since living tissue deforms during surgical operation, pre-operative three dimensional information for registration of pathological tissue should be modified based on information obtained during surgery. Thus surgical manipulator should be operated under guidance of surgeon's observation. Consequently, surgical manipulator should have various types of imaging and measurement devices such as an endoscope and an ultrasound imaging probe at its end effectors. Based on this concept, a prototype of a new multi channel surgical manipulator system CM cube (CM3, Computer aided Micro Multichannel Manipulator) that has various types of imaging and measurement devices such as ultra-violet-visible camera for spectroscopic measurement, ultra-sound imaging probe, three dimensional endoscope, together with micro surgical instruments and laser surgical systems has been developed. Its performance was evaluated through in vitro/in vivo experiments and clinical application. (NEDO)

Quantitative analysis of residual protein contamination of podiatry instruments reprocessed through local and central decontamination units.

Science.gov (United States)

Smith, Gordon Wg; Goldie, Frank; Long, Steven; Lappin, David F; Ramage, Gordon; Smith, Andrew J

2011-01-10

The cleaning stage of the instrument decontamination process has come under increased scrutiny due to the increasing complexity of surgical instruments and the adverse affects of residual protein contamination on surgical instruments. Instruments used in the podiatry field have a complex surface topography and are exposed to a wide range of biological contamination. Currently, podiatry instruments are reprocessed locally within surgeries while national strategies are favouring a move toward reprocessing in central facilities. The aim of this study was to determine the efficacy of local and central reprocessing on podiatry instruments by measuring residual protein contamination of instruments reprocessed by both methods. The residual protein of 189 instruments reprocessed centrally and 189 instruments reprocessed locally was determined using a fluorescent assay based on the reaction of proteins with o-phthaldialdehyde/sodium 2-mercaptoethanesulfonate. Residual protein was detected on 72% (n = 136) of instruments reprocessed centrally and 90% (n = 170) of instruments reprocessed locally. Significantly less protein (p podiatry instruments when protein contamination is considered, though no significant difference was found in residual protein between local decontamination unit and central decontamination unit processes for Blacks files. Further research is needed to undertake qualitative identification of protein contamination to identify any cross contamination risks and a standard for acceptable residual protein contamination applicable to different instruments and specialities should be considered as a matter of urgency.

Adjacent segment disease in degenerative pathologies with posterior instrumentation

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Ana Guadalupe Ramírez Olvera

2015-03-01

Full Text Available OBJECTIVE: To establish the real incidence of adjacent segment disease after fusion, and to identify the levels and predisposing factors for the pathology, as well as the functional results. METHODS: a retrospective case series study with level of evidence IIB, in a sample of 179 patients diagnosed with stenosis of the lumbar spine, spondylolisthesis and degenerative scoliosis, submitted to surgery in the period 2005 to December 2013, with posterior instrumentation and posterolateral fusion, with follow-up from 2007 until May 2014, in which the symptomology and radiographic findings were evaluated, to establish the diagnosis and treatment. RESULTS: the study included 179 patients diagnosed with stenosis of the lumbar spine (n=116, isthmic and degenerative spondylolisthesis (n=50 and degenerative scoliosis (n=13; during the study, 20 cases of adjacent level segment were identified, 80% of which were treated surgically with extension of the instrumentation, while 20% were treated conservatively with NSAIDs and therapeutic blocks. CONCLUSION: An incidence of 11% was found, with an average of 3.25 years in diagnosis and treatment, a prevalence of females and diagnosis of stenosis of the lumbar canal on posterior instrumentation, a predominance of levels L4-L5; 80% were treated with extension of the instrumentation. The complications were persistent radiculopathy, infection of the surgical wound, and one death due to causes not related to the lumbar pathology.

Visualizing the Life and Legacy of Henry VIII: Guiding Students with Eight Types of Graphic Organizers

Science.gov (United States)

Gallavan, Nancy P.; Kottler, Ellen

2010-01-01

Delving into the life and legacy of Henry VIII is both complex and captivating. People seem compelled to learn more abut his critical contributions and controversial conduct that range from the significant to the scandalous. Reflecting on the history of the world would be incomplete without investigating the events and escapades associated with…

Acquired factor VIII inhibitor syndrome: A rare cause of hematuria

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Muthuvel Seral Kannan

2015-01-01

Full Text Available A 50-year-old woman presented with gross hematuria for 1 month. Clinical examinations, laboratory investigations, ultrasound and contrast computed tomography were normal, except anemia. Cystoscopy revealed bloody efflux from the right side. Retrograde pyelogram showed filling defect in the renal pelvis and biopsy was inconclusive. Renal angiogram was normal. She developed ecchymosis on the right thigh and arm with elevated activated partial thromboplastin time. The partial thromboplastin time correction study and Bethesda study confirmed the presence of acquired factor VIII inhibitor (acquired hemophilia. With flexible ureterorenoscopy, the mass in the renal pelvis was removed and its histopathology revealed clotted blood. The patient was subsequently managed with steroids and Factor eight inhibitor bypass activity.

Rehabilitation with 4 zygomatic implants with a new surgical protocol using ultrasonic technique.

Science.gov (United States)

Mozzati, Marco; Mortellaro, Carmen; Arata, Valentina; Gallesio, Giorgia; Previgliano, Valter

2015-05-01

When the residual bone crest cannot allow the placement of standard implants, the treatment for complete arch rehabilitation of severely atrophic maxillae can be performed with 4 zygomatic implants (ZIs) and immediate function with predictable results in terms of aesthetics, function, and comfort for the patient. However, even if ZIs' rehabilitations showed a good success rate, this surgery is difficult and need a skillful operator. Complications in this kind of rehabilitation are not uncommon; the main difficulties can be related to the reduced surgical visibility and instrument control in a critical anatomic area. All the surgical protocols described in the literature used drilling techniques. Furthermore, the use of ultrasonic instruments in implant surgery compared with drilling instruments have shown advantages in many aspects of surgical procedures, tissues management, enhancement of control, surgical visualization, and healing. The aim of this study was to report on the preliminary experience using ultrasound technique for ZIs surgery in terms of safety and technical improvement. Ten consecutive patients with severely atrophic maxilla have been treated with 4 ZIs and immediate complete arch acrylic resin provisional prostheses. The patients were followed up from 30 to 32 months evaluating implant success, prosthetic success, and patient satisfaction with a questionnaire. No implants were lost during the study period, with a 100% implant and prosthetic success rate. Within the limitations of this preliminary study, these data indicate that ultrasonic implant site preparation for ZIs can be a good alternative to the drilling technique and an improvement for the surgeon.

VIII All-Russian symposium on molecular liquid chromatography and capillary electrophoresis. Program. Summary of reports

International Nuclear Information System (INIS)

2001-01-01

Program and summary of reports of the VIII All-Russian symposium on molecular liquid chromatography and capillary electrophoresis are performed. The meeting took place 15-19 October, 2001 in Moscow. Many problems of liquid and ion exchange chromatography, capillary electrophoresis, thin-layer chromatography have been discussed extensively. Reports covering properties of sorbents and devices for chromatography are incorporated in the collection [ru

MENINGKATKAN AKTIVITAS BELAJAR SISWA DENGAN MENGGUNAKAN METODE GROUP INVESTIGATION (GI PADA POKOK BAHASAN PASAR DI KELAS VIII SMP 5 KUDUS

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Mutthofiyah Mutthofiyah

2016-03-01

Full Text Available Penelitian ini bertujuan untukmeningkatkan aktivitas belajar siswa dengan menggunakan metode group investigation (GI pada pokok bahasan pasar pada penelitian ini menggunakan penelitian tindakan kelas (PTK. Dalam penelitian ini dirancang menggunakan siklus, masing-masing siklus dengan tahapan perencanaan, pelaksanaan tindakan, observasi dan refleksi. Teknik pengumpulan data pada penelitian ini adalah dokumentasi, observasi dan tes.Hasil penelitian menunjukkan melalui meningkatkan metode group investigation (GI aktivitas siswa SMP 5 Kudus ada peningkatan yang sigifikan, dari siklus I kelas VIII F 15,8 (41,62% meningkat di siklus II menjadi 24,8 (72,9%, sedangkan di kelas VIII G siklus I 18,5 (47,04% meningkat menjadi 26,2 (74,7%; melalui penerapan metode group investigation hasil belajar siswa SMP 5 kudus meningkat sangat signifkan, ketuntasan belajar secara klasikal dari kelas VIII F pra siklus sebesar 17,64% terjadi peningkatan 47% ke siklus I dan meningkat menjadi 82,35% di siklus II. Sedangkan di kelas VII G pra siklus sebesar 22,85% meningkat 54,28% di siklus I dan meningkat menjadi 94,28% di siklus II. Saran yang peneliti berikan adalah sebagai berikut:1Kepada para guru diharapkan dapat menerapkan pembelajaran kooperatif khususnya pembelajaran kooperatif tipe Group Investigation (GI dalam proses pembelajaran ekonomi dan mata pelajaran lainya dan mengembangkannya; 2 Kepada para peneliti selanjutnya diharapkan dapat melakukan penelitian tentang penerapan model pembelajaran yang dapat membangkitkan keaktifan siswa untuk belajar ekonomi. This study aims to improve students' learning activities using group investigation (GI on the subject of markets in class VIII SMP 5 Kudus. In this study is designed to use cycles, with each cycle stages of planning, action, observation and reflection. Data collection techniques in this study is documentation, observation and tests. Results showed through improved methods of group investigation (GI junior 5 high

Isidore of Seville and comici ueteres. Ad Isid., Orig. VIII 7.7

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Krzysztof Rzepkowski

2012-12-01

Full Text Available In chapter 7 of book VIII of Etymologies dedicated to Roman poets (De poetis, Isidore draws a dividing line between the so-called ueteres and noui comici. Among ueteres he counts Plautus, Accius, Terentius, although Accius, according to our knowledge, composed only tragedies and can hardly be considered a comic playwright. In this paper I try to prove that all the palaeographic, phonetic, historical, and literary arguments speak in favour of emending in the discussed passage the peculiar «Accius» to the expected «Caecilius» (i.e. Caecilius Statius.

Manual Control for Medical Instruments in Minimally Invasive Surgery

NARCIS (Netherlands)

Fan, C.

2014-01-01

With the introduction of new technologies, surgical procedures have been varying from free access in open surgery towards limited access in minimal invasive surgery. During such procedures, surgeons have to manoeuver the instruments from outside the patient while looking at the monitor. Long and

AKTIVITAS FISIK, ASUPAN ENERGI DAN STATUS GIZI WANITA PEMETIK TEH DI PTPN VIII BANDUNG, JAWA BARAT

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Venny Agustiani Mahardikawati

2012-03-01

Full Text Available 800x600 Normal 0 false false false IN X-NONE X-NONE MicrosoftInternetExplorer4 Quality of human resources is very important to improve productivity. The worker productivity is correlated with nutritional status and health status. The objective of the research is to analyze physical activity, energy intake, nutritional status, of women workers at Tea Plantation PTPN VIII Bandung, West Java. The cross sectional design was used in this study to elaborate physical activity, nutritional status, and productivity of tea picker’s women. The criteria of study sample were tea picker’s women at cluster area of Malabar tea plantation of PTPN VIII Bandung, having infant and they were willing to be interviewed. The total number of 92 women sample was chosen randomly. Primary data consisted of physical activity recall (2x24 hours, food consumption recall (2x24 hours, anthropometry data (weight and height, and productivity (passage of tea sprout. Secondary data were included data of PT Perkebunan Nusantara VIII Bandung, West Java. The result showed that more than a half of samples having active or moderate physical activity level (PAL. The physical activity level of samples during work day (average PAL=1.87 was higher than holiday (average PAL=1.69 (p2362 kcal and 2134 kcal. The average energy adequacy level during workday and day off according to Schofield and Oxford equation were not significantly different, respectively 97,2% and 103,3%. The majority of samples had normal nutritional status, and 30.4% of the sample was overweight. The energy adequacy level according to Schofield and Oxford equation are related to nutritional status of women workers. Keywords: physical activity, energy expenditure, nutritional status, plantation women

21 CFR 888.3150 - Elbow joint metal/polymer constrained cemented prosthesis.

Science.gov (United States)

2010-04-01

... (viii) ISO 14630:1997 “Non-active Surgical Implants—General Requirements,” (3) American Society for... Biomaterials (Nonporous) for Surgical Implant with Respect to Effect of Material on Muscle and Bone,” (v) F...

Multimodality instrument for tissue characterization

Science.gov (United States)

Mah, Robert W. (Inventor); Andrews, Russell J. (Inventor)

2004-01-01

A system with multimodality instrument for tissue identification includes a computer-controlled motor driven heuristic probe with a multisensory tip. For neurosurgical applications, the instrument is mounted on a stereotactic frame for the probe to penetrate the brain in a precisely controlled fashion. The resistance of the brain tissue being penetrated is continually monitored by a miniaturized strain gauge attached to the probe tip. Other modality sensors may be mounted near the probe tip to provide real-time tissue characterizations and the ability to detect the proximity of blood vessels, thus eliminating errors normally associated with registration of pre-operative scans, tissue swelling, elastic tissue deformation, human judgement, etc., and rendering surgical procedures safer, more accurate, and efficient. A neural network program adaptively learns the information on resistance and other characteristic features of normal brain tissue during the surgery and provides near real-time modeling. A fuzzy logic interface to the neural network program incorporates expert medical knowledge in the learning process. Identification of abnormal brain tissue is determined by the detection of change and comparison with previously learned models of abnormal brain tissues. The operation of the instrument is controlled through a user friendly graphical interface. Patient data is presented in a 3D stereographics display. Acoustic feedback of selected information may optionally be provided. Upon detection of the close proximity to blood vessels or abnormal brain tissue, the computer-controlled motor immediately stops probe penetration. The use of this system will make surgical procedures safer, more accurate, and more efficient. Other applications of this system include the detection, prognosis and treatment of breast cancer, prostate cancer, spinal diseases, and use in general exploratory surgery.

Modelling and evaluation of surgical performance using hidden Markov models.

Science.gov (United States)

Megali, Giuseppe; Sinigaglia, Stefano; Tonet, Oliver; Dario, Paolo

2006-10-01

Minimally invasive surgery has become very widespread in the last ten years. Since surgeons experience difficulties in learning and mastering minimally invasive techniques, the development of training methods is of great importance. While the introduction of virtual reality-based simulators has introduced a new paradigm in surgical training, skill evaluation methods are far from being objective. This paper proposes a method for defining a model of surgical expertise and an objective metric to evaluate performance in laparoscopic surgery. Our approach is based on the processing of kinematic data describing movements of surgical instruments. We use hidden Markov model theory to define an expert model that describes expert surgical gesture. The model is trained on kinematic data related to exercises performed on a surgical simulator by experienced surgeons. Subsequently, we use this expert model as a reference model in the definition of an objective metric to evaluate performance of surgeons with different abilities. Preliminary results show that, using different topologies for the expert model, the method can be efficiently used both for the discrimination between experienced and novice surgeons, and for the quantitative assessment of surgical ability.

Clinical, laboratory and instrumental methods of pre-surgical diagnosis of the parathyroid glands cancer

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Natalia G. Mokrysheva

2017-12-01

Full Text Available Backgraund. When defining symptomatic primary hyperparathyroidism (PHPT, differential diagnosis between a benign and malignant neoplasm of parathyroid glands (PG may be challenging. The diagnosis of carcinoma or a benign tumor determines the extent of the surgical intervention and further observation tactics. Aims. The purpose of the study is to determine the clinical and laboratory and instrumental predictors of PG cancer. Materials and methods. A retrospective study included 385 patients with PHPT (273 with adenomas of the PG, 66 with hyperplasia, and 19 patients with cancer of the PG, who had been examined and operated from 2000 to 2014. The primary goal of the study was to define the level of ionized calcium (Ca++, parathyroid hormone (PTH, and the volume of the tumor PG specific for cancer of the PG. The level of parathyroid hormone (PTH was determined by electrochemoluminescent method on the Roche analyzer Cobas 6000; ionized calcium (Ca++ ion-selective method. The size of the PG was determined by the ellipse formula: V(cm3 = (A × B × C × 0.49 by ultrasound investigation using the Valuson E8 device from General Electric. Results. The group of patients with PG carcinoma showed the increased level of Ca++ of more than 1.60 mmol/l (p = 0.004 and increased level of PTH of more than 600 pg/ml (p = 0.03. The size of tumors of more than 6 cm3 is more typical to malignant neoplasm compared to the adenoma of the PG (p = 0.01. Conclusions. The group of patients with PHPT that are at risk of having PG carcinoma include individuals that have a combination of the following indicators: PTH levels of more than 600 pg/ml, an increase in ionized calcium of more than 1.60 mmol/l, the tumor size of more than 6 cm3.

Molecular characterization of a novel family VIII esterase from burkholderia multivorans UWC10

CSIR Research Space (South Africa)

Rashamuse, KJ

2007-02-01

Full Text Available et al., 1992). Here we report the cloning, purification, and 3D model of a novel family VIII esterase from Burkholderia multivorans UWC10. To our knowledge no report of esterolytic activity from B. multivorans is currently available. METHODOLOGY... stream_source_info Rashamuse1_2007_d.pdf.txt stream_content_type text/plain stream_size 9884 Content-Encoding UTF-8 stream_name Rashamuse1_2007_d.pdf.txt Content-Type text/plain; charset=UTF-8 Molecular Characterization...

Pisanello’s hat. The costume and weapons depicted in Pisanello’s medal for John VIII Palaeologus. A discussion of the saber and related weapons

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Alexander, David

2004-12-01

Full Text Available A group of six drawings by the Veronese artist Antonio Pisano depicted the Bizantine Emperor John VIII Paleologus wearing costumes and weapons according to islamic types. This paper studies these objects in relation to other contemporary islamic weapons.

Un grupo de seis dibujos del artista veronés Antonio Pisano representa al emperador bizantino Juan VIII Paleólogo vestido y armado según modelos islámicos. Este trabajo estudia dichos objetos en relación a otras armas islámicas contemporáneas.

Evaluating the Impact of Radio Frequency Identification Retained Surgical Instruments Tracking on Patient Safety: Literature Review.

Science.gov (United States)

Schnock, Kumiko O; Biggs, Bonnie; Fladger, Anne; Bates, David W; Rozenblum, Ronen

2017-02-22

Retained surgical instruments (RSI) are one of the most serious preventable complications in operating room settings, potentially leading to profound adverse effects for patients, as well as costly legal and financial consequences for hospitals. Safety measures to eliminate RSIs have been widely adopted in the United States and abroad, but despite widespread efforts, medical errors with RSI have not been eliminated. Through a systematic review of recent studies, we aimed to identify the impact of radio frequency identification (RFID) technology on reducing RSI errors and improving patient safety. A literature search on the effects of RFID technology on RSI error reduction was conducted in PubMed and CINAHL (2000-2016). Relevant articles were selected and reviewed by 4 researchers. After the literature search, 385 articles were identified and the full texts of the 88 articles were assessed for eligibility. Of these, 5 articles were included to evaluate the benefits and drawbacks of using RFID for preventing RSI-related errors. The use of RFID resulted in rapid detection of RSI through body tissue with high accuracy rates, reducing risk of counting errors and improving workflow. Based on the existing literature, RFID technology seems to have the potential to substantially improve patient safety by reducing RSI errors, although the body of evidence is currently limited. Better designed research studies are needed to get a clear understanding of this domain and to find new opportunities to use this technology and improve patient safety.

Penerapan Model Learning Cycle 5E untuk Meningkatkan Keterampilan Berpikir Kritis Siswa Pada Materi Fluida Statis Kelas VIII

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Irhamna Irhamna

2017-08-01

Full Text Available Penerapan model learning cycle 5E telah dilakukan pada siswa kelas VIII dengan materi fluida statis. Penelitian ini bertujuan untuk mendapatkan gambaran mengenai peningkatan keterampilan berpikir kritis siswa setelah diterapkan model learning cycle 5E pada materi fluida statis. Bentuk desain penelitian yang digunakan adalah pre-experimental dengan one group pre-test post-test design. Populasi pada penelitian ini adalah seluruh siswa kelas VIII di SMP Torsina Singkawang. Teknik pengambilan sampel menggunakan sampling purposive yang berjumlah 23 orang. Hasil penelitian menunjukkan bahwa model learning cyle 5E dapat meningkatkan keterampilan berpikir kritis siswa yaitu pada indikator pemecahan masalah dengan skor N-gain sebesar 0,43 dengan kategori sedang, indikator membuat keputusan dengan skor N-gain sebesar 0,42 dengan kategori sedang, indikator penyelidikan percobaan dengan skor N-gain sebesar 0,33 dengan kategori sedang dan indikator menyimpulkan dengan skor N-gain sebesar 0,37 dengan kategori sedang.

The influence of growth temperature and input V/III ratio on the initial nucleation and material properties of InN on GaN by MOCVD

International Nuclear Information System (INIS)

Wang, H; Jiang, D S; Zhu, J J; Zhao, D G; Liu, Z S; Wang, Y T; Zhang, S M; Yang, H

2009-01-01

The effects of growth temperature and V/III ratio on the InN initial nucleation of islands on the GaN (0 0 0 1) surface were investigated. It is found that InN nuclei density increases with decreasing growth temperature between 375 and 525 °C. At lower growth temperatures, InN thin films take the form of small and closely packed islands with diameters of less than 100 nm, whereas at elevated temperatures the InN islands can grow larger and well separated, approaching an equilibrium hexagonal shape due to enhanced surface diffusion of adatoms. At a given growth temperature of 500 °C, a controllable density and size of separated InN islands can be achieved by adjusting the V/III ratio. The larger islands lead to fewer defects when they are coalesced. Comparatively, the electrical properties of the films grown under higher V/III ratio are improved

Insight into resistance mechanism of anaplastic lymphoma kinase to alectinib and JH-VIII-157-02 caused by G1202R solvent front mutation

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Wang H

2018-05-01

Full Text Available Han Wang,1–3 Yao Wang,1–3 Wentao Guo,4 Bin Du,1–3 Xiaobing Huang,1–3 Riping Wu,1–3 Baoyu Yang,1–3 Xiaoyan Lin,1–3,5 Yilan Wu6 1Department of Medical Oncology, Fujian Medical University Union Hospital, Fuzhou, People’s Republic of China; 2Stem Cell Research Institute, Fujian Medical University, Fuzhou, People’s Republic of China; 3Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, People’s Republic of China; 4School of Pharmacy, Wenzhou Medical University, Wenzhou, People’s Republic of China; 5Graduate School of Education, Fujian Medical University, Fuzhou, People’s Republic of China; 6School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, People’s Republic of China Background: Mutated anaplastic lymphoma kinase (ALK drives the development of advanced non-small cell lung cancer (NSCLC. Most reported small-molecule inhibitors targeting the ALK domain do not display good inhibition of the G1202R solvent front mutation. The solvent front mutation was assumed to hinder drug binding. However, a different fact could be uncovered by the simulations reported in this study through a structural analog of alectinib (JH-VIII-157-02, which demonstrated potent effects against the G1202R mutation. Methods: Molecular docking, conventional molecular dynamics (MD simulations, free energy calculations, and umbrella sampling (US simulations were carried out to make clear the principles of the binding preferences of alectinib and JH-VIII-157-02 toward ALKWT and the ALK G1202R (ALKG1202R mutation. Results: JH-VIII-157-02 has similar binding affinities to both ALKWT and ALKG1202R whereas it has has a much lower binding affinity for alectinib to ALKG1202R. Analysis of individual energy terms indicate the major variation involves the van der Waals and entropy terms. Structural analysis reveals that the conformational change of the ATP-binding glycine-rich loop was primarily responsible for the alectinib

Grotrian diagrams for highly ionized cobalt Co VIII through Co XXVII

Energy Technology Data Exchange (ETDEWEB)

Shirai, Toshizo [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment; Sugar, J.; Wiese, W.L.

1997-07-01

Grotrian diagrams are presented to provide graphical overviews for 1,247 spectral lines of highly ionized cobalt, Co VIII through Co XXVII. In the usual diagram display such as that by Bashkin and Stoner (North-Holland, Amsterdam, 1975), the density of transitions is often too high to allow each transition to be drawn separately. Here in our modified diagrams, the transitions are also represented by lines connecting the upper and lower energy levels, but the lower energy levels are extended and repeated for successive configurations as needed. As a sequence, dense packing is avoided and all lines in a multiplet can be accommodated. (author)

Comercio Internacional mediterráneo en el siglo VIII a.C.

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Paloma Cabrera Bonet

2018-01-01

Full Text Available The VIII century B.C. saw, for the first time after the breakdown of the system in the Late Bronze Age, the revival of a true intemational trade at a growing scale, especíally protagonized by Phoenicians and Greeks. In this article we analyze sorne aspects of this phenomenon, from the Aegean to the Far West, which made possíble, through a vaste network of trading routes, a large multinational ínteractíon. We understand the international trade as a key factor in the proccess of economic, social and political changes of the Mediterranean areas submerged in this complex "world-system".

Quantitative analysis of residual protein contamination of podiatry instruments reprocessed through local and central decontamination units

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Ramage Gordon

2011-01-01

Full Text Available Abstract Background The cleaning stage of the instrument decontamination process has come under increased scrutiny due to the increasing complexity of surgical instruments and the adverse affects of residual protein contamination on surgical instruments. Instruments used in the podiatry field have a complex surface topography and are exposed to a wide range of biological contamination. Currently, podiatry instruments are reprocessed locally within surgeries while national strategies are favouring a move toward reprocessing in central facilities. The aim of this study was to determine the efficacy of local and central reprocessing on podiatry instruments by measuring residual protein contamination of instruments reprocessed by both methods. Methods The residual protein of 189 instruments reprocessed centrally and 189 instruments reprocessed locally was determined using a fluorescent assay based on the reaction of proteins with o-phthaldialdehyde/sodium 2-mercaptoethanesulfonate. Results Residual protein was detected on 72% (n = 136 of instruments reprocessed centrally and 90% (n = 170 of instruments reprocessed locally. Significantly less protein (p Conclusions Overall, the results show the superiority of central reprocessing for complex podiatry instruments when protein contamination is considered, though no significant difference was found in residual protein between local decontamination unit and central decontamination unit processes for Blacks files. Further research is needed to undertake qualitative identification of protein contamination to identify any cross contamination risks and a standard for acceptable residual protein contamination applicable to different instruments and specialities should be considered as a matter of urgency.

The Safety and Feasibility of Three-Dimensional Visualization Technology Assisted Right Posterior Lobe Allied with Part of V and VIII Sectionectomy for Right Hepatic Malignancy Therapy.

Science.gov (United States)

Hu, Min; Hu, Haoyu; Cai, Wei; Mo, Zhikang; Xiang, Nan; Yang, Jian; Fang, Chihua

2018-05-01

Hepatectomy is the optimal method for liver cancer; the virtual liver resection based on three-dimensional visualization technology (3-DVT) could provide better preoperative strategy for surgeon. We aim to introduce right posterior lobe allied with part of V and VIII sectionectomy assisted by 3-DVT as a promising treatment for massive or multiple right hepatic malignancies to retain maximum residual liver volume on the basis of R0 resection. Among 126 consecutive patients who underwent hepatectomy, 9 (7%) underwent right posterior lobe allied with part of V and VIII sectionectomy. 21 (17%) underwent right hemihepatectomy (RH). The virtual RH was performed with 3-DVT, which provided better observation of spatial position relationship between tumor and vessels, and the more accurate estimation of the remnant liver volume. If remnant liver volume was right posterior lobe allied with part of V and VIII sectionectomy should be undergone. Then, the precut line ought to be planned on the basis of protecting the portal branch of subsegment 5 and 8. The postoperative outcome of patients was compared before and after propensity score matching. Nine patients meeting the eligibility criteria received right posterior lobe allied with part of V and VIII sectionectomy. The variables, including the overall mean operation time, blood transfusion, operation length, liver function, and postoperative complications, were similar between two groups before and after propensity matching. The postoperative first, third, fifth, and seventh days mean value of aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), and total bilirubin had no significant difference compared with preoperative value. One patient in each group had recurrence six months after surgery. Right posterior lobe allied with part of V and VIII sectionectomy based on 3-DVT is safe and feasible surgery way, and can be a very promising method in massive or multiple right hepatic malignancy therapy.

Surgical Treatment of Tattoo Complications.

Science.gov (United States)

Sepehri, Mitra; Jørgensen, Bo

2017-01-01

With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases. The methods allow fundamental treatment with removal of the culprit pigment from the dermis. The different instruments, surgical methods, and treatment schedules are reviewed, and a guide to surgeons is presented. Postoperative treatments and the long-term outcomes are described in detail. An algorithm on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented. © 2017 S. Karger AG, Basel.

Comparison of different sets of instruments for laparoendoscopic single-site surgery in a surgical simulator with novices.

Science.gov (United States)

Wang, Dong; Shi, Long-Qing; Wang, Jing-Min; Jiang, Xiao-Hua; Ji, Zhen-Ling

2016-04-01

Given the parallel entry of working instruments through a single incision in laparoendoscopic single-site surgery, loss of triangulation in the abdominal cavity and counteracting movements of the instruments are inevitable obstacles. Some specially designed devices have emerged to ameliorate these challenges. Twenty-four novice participants were randomized into four groups using assigned instruments, conventional straight instruments, single-curved instruments, double-curved instruments and articulating instruments, respectively, to perform two basic tasks (peg transferring and pattern cutting) 14 times in a modified simulator. A test of the tasks and a resection of the intestine segment of a rat were performed. The task scores and evaluation of intraoperative skills during the resection of the intestine segment were recorded. The instrument of modified National Aeronautics and Space Administration Task Load Index (NASA-TLX) was completed. The task scores of the groups using single-curved instruments and articulating instruments were better than the other two groups on the simulator tasks, consistent with the evaluation of intraoperative skills during the resection of intestine segment. As the proficiency with the instruments increased, the task scores improved, as demonstrated by the learning curve. The workload measured by the modified NASA-TLX tool demonstrated that the groups using articulating instruments and double-curved instruments had a heavier workload in most of the categories compared with the other two groups. Single-curved and articulating instruments are more effective than conventional straight and double-curved devices, and are favourable in laparoendoscopic single-site surgery for novice learners. © 2013 Royal Australasian College of Surgeons.

Prior video game exposure does not enhance robotic surgical performance.

Science.gov (United States)

Harper, Jonathan D; Kaiser, Stefan; Ebrahimi, Kamyar; Lamberton, Gregory R; Hadley, H Roger; Ruckle, Herbert C; Baldwin, D Duane

2007-10-01

Prior research has demonstrated that counterintuitive laparoscopic surgical skills are enhanced by experience with video games. A similar relation with robotic surgical skills has not been tested. The purpose of this study was to determine whether prior video-game experience enhances the acquisition of robotic surgical skills. A series of 242 preclinical medical students completed a self-reported video-game questionnaire detailing the frequency, duration, and peak playing time. The 10 students with the highest and lowest video-game exposure completed a follow-up questionnaire further quantifying video game, sports, musical instrument, and craft and hobby exposure. Each subject viewed a training video demonstrating the use of the da Vinci surgical robot in tying knots, followed by 3 minutes of proctored practice time. Subjects then tied knots for 5 minutes while an independent blinded observer recorded the number of knots tied, missed knots, frayed sutures, broken sutures, and mechanical errors. The mean playing time for the 10 game players was 15,136 total hours (range 5,840-30,000 hours). Video-game players tied fewer knots than nonplayers (5.8 v 9.0; P = 0.04). Subjects who had played sports for at least 4 years had fewer mechanical errors (P = 0.04), broke fewer sutures (P = 0.01), and committed fewer total errors (P = 0.01). Similarly, those playing musical instruments longer than 5 years missed fewer knots (P = 0.05). In the extremes of video-game experience tested in this study, game playing was inversely correlated with the ability to learn robotic suturing. This study suggests that advanced surgical skills such as robotic suturing may be learned more quickly by athletes and musicians. Prior extensive video-game exposure had a negative impact on robotic performance.

Real time noninvasive assessment of external trunk geometry during surgical correction of adolescent idiopathic scoliosis

Directory of Open Access Journals (Sweden)

Mac-Thiong Jean-Marc

2009-02-01

Full Text Available Abstract Background The correction of trunk deformity is crucial in scoliosis surgery, especially for the patient's self-image. However, direct visualization of external scoliotic trunk deformity during surgical correction is difficult due to the covering draping sheets. Methods An optoelectronic camera system with 10 passive markers is used to track the trunk geometry of 5 scoliotic patients during corrective surgery. The position of 10 anatomical landmarks and 5 trunk indices computed from the position of the passive markers are compared during and after instrumentation of the spine. Results Internal validation of the accuracy of tracking was evaluated at 0.41 +/- 0.05 mm RMS. Intra operative tracking during surgical maneuvers shows improvement of the shoulder balance during and after correction of the spine. Improvement of the overall patient balance is observed. At last, a minor increase of the spinal length can be noticed. Conclusion Tracking of the external geometry of the trunk during surgical correction is useful to monitor changes occurring under the sterile draping sheets. Moreover, this technique can used be used to reach the optimal configuration on the operating frame before proceeding to surgery. The current tracking technique was able to detect significant changes in trunk geometry caused by posterior instrumentation of the spine despite significant correction of the spinal curvature. It could therefore become relevant for computer-assisted guidance of surgical maneuvers when performing posterior instrumentation of the scoliotic spine, provide important insights during positioning of patients.

Analysis of inversions in the factor VIII gene in Spanish hemophilia A patients and families

Energy Technology Data Exchange (ETDEWEB)

Domenech, M.; Tizzano, E.; Baiget, M. [Hospital de Sant Pau, Barcelona (Spain); Altisent, C. [Hospital Vall d`Hebron, Barcelona (Spain)

1994-09-01

Intron 22 is the largest intron of the factor VIII gene and contains a CpG island from which two additional transcripts originate. One of these transcripts corresponds to the F8A gene which have telomeric extragenic copies in the X chromosome. An inversion involving homologous recombination between the intragenic and the distal or proximal copies of the F8A gene has been recently described as a common cause of severe hemophilia A (HA). We analyzed intron 22 rearrangements in 195 HA patients (123 familial and 72 sporadic cases). According to factor VIII levels, our sample was classified as severe in 114 cases, moderate in 29 cases and mild in 52 cases. An intron 22 (F8A) probe was hybridized to Southern blots of BcII digested DNA obtained from peripheral blood. A clear pattern of altered bands identifies distal or proximal inversions. We detected an abnormal pattern identifying an inversion in 49 (25%) of the analyzed cases. 43% of severe HA patients (49 cases) showed an inversion. As expected, no inversion was found in the moderate and mild group of patients. We found a high proportion (78%) of the distal rearrangement. From 49 identified inversions, 33 were found in familial cases (27%), while the remaining 15 were detected in sporadic patients (22%) in support that this mutational event occurs with a similar frequency in familial or sporadic cases. In addition, we detected a significant tendency of distal inversion to occur more frequently in familial cases than in sporadic cases. Inhibitor development to factor VIII was documented in approximately 1/3 of the patients with inversion. The identification of such a frequent molecular event in severe hemophilia A patients has been applied in our families to carrier and prenatal diagnosis, to determine the origin of the mutation in the sporadic cases and to detect the presence of germinal mosaicism.

Comparison of impact of four surgical methods on surgical outcomes in endoscopic dacryocystorhinostomy.

Science.gov (United States)

Roh, Hyun Cheol; Baek, Sehyun; Lee, Hwa; Chang, Minwook

2016-06-01

To evaluate differences in the surgical outcomes of endoscopic dacryocystorhinostomy (DCR) according to four different surgical methods. This retrospective study included 222 patients who underwent endoscopic DCR from 2011 to 2013. All patients were assigned to one of four groups according to instruments for incision of nasal mucosa and the formation of mucosal flap: group 1, a sickle knife with mucosal flap; group 2, a sickle knife without mucosal flap; group 3, electrocautery with mucosal flap; and group 4, electrocautery without mucosal flap. The follow up period was at least 6 months. There were 33 eyes in group 1, 44 eyes in group 2, 49 eyes in group 3, and 97 eyes in group 4. There were no significant differences in success rate between groups (P = 0.878). Wound healing time was significantly different between groups (P knife may be more helpful and effective for shortening wound healing time rather than making mucosal flaps in endoscopic DCR. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Development of Integrated Natural Science Teaching Materials Webbed Type with Applying Discourse Analysis on Students Grade VIII in Physics Class

Science.gov (United States)

Sukariasih, Luh

2017-05-01

This study aims to produce teaching materials integrated natural science (IPA) webbed type of handout types are eligible for use in integrated science teaching. This type of research IS a kind of research and development / Research and Development (R & D) with reference to the 4D development model that is (define, design, develop, and disseminate). Data analysis techniques used to process data from the results of the assessment by the validator expert, and the results of the assessment by teachers and learners while testing is limited (12 students of class VIII SMPN 10 Kendari) using quantitative descriptive data analysis techniques disclosed in the distribution of scores on the scale of five categories grading scale that has been determined. The results of due diligence material gain votes validator material in the category of “very good” and “good”, of the data generated in the feasibility test presentation obtained the category of “good” and “excellent”, from the data generated in the feasibility of graphic test obtained the category of “very good “and” good “, as well as of the data generated in the test the feasibility of using words and language obtained the category of“very good “and” good “, so with qualifications gained the teaching materials IPA integrated type webbed by applying discourse analysis on the theme of energy and food for Junior High School (SMP) grade VIII suitable as teaching materials. In limited testing, data generated in response to a science teacher at SMPN 10 Kendari to product instructional materials as “excellent”, and from the data generated while testing is limited by the 12 students of class VIII SMPN 10 Kendari are more students who score indicates category “very good”, so that the qualification obtained by the natural science (IPA) teaching material integrated type webbed by applying discourse analysis on the theme of energy and food for SMP / class VIII fit for use as teaching material.

Multi-Institutional Development of a Mastoidectomy Performance Evaluation Instrument.

Science.gov (United States)

Kerwin, Thomas; Hittle, Brad; Stredney, Don; De Boeck, Paul; Wiet, Gregory

A method for rating surgical performance of a mastoidectomy procedure that is shown to apply universally across teaching institutions has not yet been devised. This work describes the development of a rating instrument created from a multi-institutional consortium. Using a participatory design and a modified Delphi approach, a multi-institutional group of expert otologists constructed a 15-element task-based checklist for evaluating mastoidectomy performance. This instrument was further refined into a 14-element checklist focusing on the concept of safety after using it to rate a large and varied population of performances. Twelve otolaryngological surgical training programs in the United States. A total of 14 surgeons from 12 different institutions took part in the construction of the instrument. By using 14 experts from 12 different institutions and a literature review, individual metrics were identified, rated as to the level of importance and operationally defined to create a rating scale for mastoidectomy performance. Initial use of the rating scale showed modest rater agreement. The operational definitions of individual metrics were modified to emphasize "safe" as opposed to "proper" technique. A second rating instrument was developed based on this feedback. Using a consensus-building approach with multiple rounds of communication between experts is a feasible way to construct a rating instrument for mastoidectomy. Expert opinion alone using a Delphi method provides face and content validity evidence, however, this is not sufficient to develop a universally acceptable rating instrument. A continued process of development and experimentation to demonstrate evidence for reliability and validity making use of a large population of raters and performances is necessary to achieve universal acceptance. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Modeling and evaluation of hand-eye coordination of surgical robotic system on task performance.

Science.gov (United States)

Gao, Yuanqian; Wang, Shuxin; Li, Jianmin; Li, Aimin; Liu, Hongbin; Xing, Yuan

2017-12-01

Robotic-assisted minimally invasive surgery changes the direct hand and eye coordination in traditional surgery to indirect instrument and camera coordination, which affects the ergonomics, operation performance, and safety. A camera, two instruments, and a target, as the descriptors, are used to construct the workspace correspondence and geometrical relationships in a surgical operation. A parametric model with a set of parameters is proposed to describe the hand-eye coordination of the surgical robot. From the results, optimal values and acceptable ranges of these parameters are identified from two tasks. A 90° viewing angle had the longest completion time; 60° instrument elevation angle and 0° deflection angle had better performance; there is no significant difference among manipulation angles and observing distances on task performance. This hand-eye coordination model provides evidence for robotic design, surgeon training, and robotic initialization to achieve dexterous and safe manipulation in surgery. Copyright © 2017 John Wiley & Sons, Ltd.

Virtual reality in surgical education.

Science.gov (United States)

Ota, D; Loftin, B; Saito, T; Lea, R; Keller, J

1995-03-01

Virtual reality (VR) is an emerging technology that can teach surgeons new procedures and can determine their level of competence before they operate on patients. Also VR allows the trainee to return to the same procedure or task several times later as a refresher course. Laparoscopic surgery is a new operative technique which requires the surgeon to observe the operation on a video-monitor and requires the acquisition of new skills. VR simulation could duplicate the operative field and thereby enhance training and reduce the need for expensive animal training models. Our preliminary experience has shown that we have the technology to model tissues and laparoscopic instruments and to develop in real time a VR learning environment for surgeons. Another basic need is to measure competence. Surgical training is an apprenticeship requiring close supervision and 5-7 years of training. Technical competence is judged by the mentor and has always been subjective. If VR surgical simulators are to play an important role in the future, quantitative measurement of competence would have to be part of the system. Because surgical competence is "vague" and is characterized by such terms as "too long, too short" or "too close, too far," it is possible that the principles of fuzzy logic could be used to measure competence in a VR surgical simulator. Because a surgical procedure consists of a series of tasks and each task is a series of steps, we will plan to create two important tasks in a VR simulator and validate their use. These tasks consist of laparoscopic knot tying and laparoscopic suturing. Our hypothesis is that VR in combination with fuzzy logic can educate surgeons and determine when they are competent to perform these procedures on patients.

Trends in the Surgical Correction of Gynecomastia.

Science.gov (United States)

Brown, Rodger H; Chang, Daniel K; Siy, Richard; Friedman, Jeffrey

2015-05-01

Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited in their inability to address significant skin excess and ptosis. For mild to moderate gynecomastia, newer techniques using arthroscopic morcellation and endoscopic techniques promise to address the fibrous component, while minimizing scar burden by utilizing liposuction incisions. Nevertheless, direct excision through periareolar incisions remains a mainstay in treatment algorithms for its simplicity and avoidance of additional instrumentation. This is particularly true for more severe cases of gynecomastia requiring skin resection. In the most severe cases with significant skin redundancy and ptosis, breast amputation with free nipple grafting remains an effective option. Surgical treatment should be individualized to each patient, combining techniques to provide adequate resection and optimize aesthetic results.

Circumventing furin enhances factor VIII biological activity and ameliorates bleeding phenotypes in hemophilia models

OpenAIRE

Siner, Joshua I.; Samelson-Jones, Benjamin J.; Crudele, Julie M.; French, Robert A.; Lee, Benjamin J.; Zhou, Shanzhen; Merricks, Elizabeth; Raymer, Robin; Nichols, Timothy C.; Camire, Rodney M.; Arruda, Valder R.

2016-01-01

Processing by the proprotein convertase furin is believed to be critical for the biological activity of multiple proteins involved in hemostasis, including coagulation factor VIII (FVIII). This belief prompted the retention of the furin recognition motif (amino acids 1645–1648) in the design of B-domain–deleted FVIII (FVIII-BDD) products in current clinical use and in the drug development pipeline, as well as in experimental FVIII gene therapy strategies. Here, we report that processing by fu...

PENGARUH MODEL PEMBELAJARAN KOOPERATIF TIPE STAD BERBANTUAN PEMETAAN PIKIRAN (MIND MAPPING TERHADAP KEMAMPUAN MENULIS TEKS BERITA SISWA KELAS VIII SMP NEGERI 1 PANTI

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Ricci Gemarni Tatalia, M.Pd

2017-05-01

Full Text Available This study was generated from the problem of students’ ability in writing news texts ini class VIII, SMPN 1 Panti. Some of the problem were (1 lack of the students’ response towards news writing teaching and learning process, (2 lack of teacher’s creativity in designing interesting news sriting learning model, (3 no appropriate creative techniques applied by the teacher which could train the students to develop their skill in writing news texts and (4 lack of the students’ motivation in participating in teaching and learning process because of their lack of understanding in the elements of news. Thus, this study was aimed at escribing the effect of the students’ ability ini writing news texts in class VIII SMP N 1 Panti. This was a quantitative research with factorial 2x2 experimental design. The population was the students in class VIII SMPN 1 Panti. Sampling technique was done by using random sampling and the data was collected through test. The result of the study revealed that cooperative learning model with STAD mind mapping type affected the students’ ability in writing news texts

An immunoradiometric assay for procoagulant factor VIII antigen: results in haemophilia, von Willebrand's disease and fetal plasma and serum

International Nuclear Information System (INIS)

Peake, I.R.; Bloom, A.L.; Giddings, J.C.; Ludlam, C.A.

1979-01-01

An immunoradiometric assay (IRMA) has been developed based on the inhibitor which arose in a polytransfused severe haemophiliac. The two-site IRMA measured antigens closely associated with the procoagulant parts of the factor VIII complex, which are termed FVIIIC antigens or FVIIICAG. FVIIICAG was present in normal plasma and also, at a slightly lower concentration, in normal serum. In 37 patients with haemophilia A, 36 had FVIIICAG levels of less than 10% of the normal plasma pool. In patients with von Willebrand's disease the levels of FVIIIC and FVIIICAG were in good agreement, both before and after treatment with cryoprecipitate or DDAVP. FVIIICAG was relatively stable in plasma at 37 0 C and could also be detected in cord and fetal serum. The assay is of potential value for detecting reduced levels of factor VIII, for carrier detection and for the prenatal diagnosis of haemophilia. (author)

Estudo da articulação temporomandibular em camundongos deficientes de fator VIII

OpenAIRE

Patricia do Socorro Queiroz Feio

2010-01-01

Resumo: A hemofilia é uma doença hemorrágica hereditária ligada ao cromossomo X, decorrente da ausência ou da baixa quantidade no plasma dos fatores de coagulação Fator VIII (hemofilia A) ou do Fator IX (hemofilia B). Clinicamente, a hemofilia se caracteriza por episódios recorrentes de sangramentos profundos, que podem ocorrer espontaneamente ou em decorrência de traumatismos. O sistema músculo-esquelético é freqüentemente afetado pelos eventos hemorrágicos nos pacientes portadores de hemofi...

Surgical and procedural skills training at medical school - a national review.

Science.gov (United States)

Davis, Christopher R; Toll, Edward C; Bates, Anthony S; Cole, Matthew D; Smith, Frank C T

2014-01-01

This national study quantifies procedural and surgical skills training at medical schools in the United Kingdom (UK), a stipulated requirement of all graduates by the General Medical Council (GMC). A questionnaire recorded basic procedural and surgical skills training provided by medical schools and surgical societies in the UK. Skills were extracted from (1) GMC Tomorrows Doctors and (2) The Royal College of Surgeons Intercollegiate Basic Surgical Skills (BSS) course. Data from medical school curricula and extra-curricular student surgical societies were compared against the national GMC guidelines and BSS course content. Data were analysed using Mann-Whitney U tests. Representatives from 23 medical schools completed the survey (71.9% response). Thirty one skills extracted from the BSS course were split into 5 categories, with skills content cross referenced against GMC documentation. Training of surgical skills by medical schools was as follows: Gowning and gloving (72.8%), handling instruments (29.4%), knot tying (17.4%), suturing (24.7%), other surgical techniques (4.3%). Surgical societies provided significantly more training of knot tying (64.4%, P = 0.0013) and suturing (64.5%, P = 0.0325) than medical schools. Medical schools provide minimal basic surgical skills training, partially supplemented by extracurricular student surgical societies. Our findings suggest senior medical students do not possess simple surgical and procedural skills. Newly qualified doctors are at risk of being unable to safely perform practical procedures, contradicting GMC Guidelines. We propose a National Undergraduate Curriculum in Surgery and Surgical Skills to equip newly qualified doctors with basic procedural skills to maximise patient safety. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

The surgical stress response: should it be prevented?

DEFF Research Database (Denmark)

Kehlet, H

1991-01-01

clinical trials have demonstrated a reduction in various aspects of postoperative morbidity by such a nociceptive blockade. Although a causal relationship has still to be demonstrated, these findings strongly argue the concept of "stress-free anesthesia and surgery" as an important instrument in improving......Postoperative complications such as myocardial infarction, pulmonary infection, thromboembolism and fatigue are probably related to increased demands, hypermetabolism, catabolism and other physiologic changes included in the global "surgical stress response." Strategies have been developed...... to suppress the detrimental components of the stress response so as to improve postoperative outcome. Of the various techniques to reduce the surgical stress response, afferent neural blockade with regional anesthesia to relieve pain is the most effective, although not optimal. Data from numerous controlled...

EFFECT OF INFORMATION SERVICES USING THE MEDIA FILM TO SELF-CONFIDENCE STUDENT OF CLASS VIII SMP NEGERI 8 METRO

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MUDAIM MUDAIM

2015-06-01

Full Text Available Abstract: Pessimism and attitudes that consider themselves weak and does not have the ability when facing a problem will make individual impediment in the task of development. Problems confidence that underlies the research are: a Students are less confident in the ability it has, b Students feel pessimistic when faced with an issue, c Student perception subjectively, d Students still do not do the work independently, and e negative minded students with a state-owned. The problems of this study are whether there is an influence of information services using the medium of film to the confidence of eighth-grade students of SMP Negeri 8 Metro. The purpose of this study was to determine whether there is an influence of information services using the medium of film to the self-confidence of students in class VIII SMP Negeri 8 Metro. Subject participant is graders VIII-E total 30 students. Data were collected by questionnaire self-confidence and analyzed the data used is the t-test. The results of this study, shown by the difference in change scores of confidence from the pre-test and post-test of 17.1. Testing the hypothesis obtained calculation results thitung6,036> table = 1.699. The conclusion is that the information services implemented using the film medium can be a positive influence on self-esteem, especially students of class VIII. The advice given is to use the medium of film should be done intensively and more creative by BK teachers in giving information service. Keywords: Confidence, Service Information Using Media Film.

75 FR 36426 - Legislative Changes to Nursing Student Loan Program Authorized Under Title VIII of the Public...

Science.gov (United States)

2010-06-25

... Changes to Nursing Student Loan Program Authorized Under Title VIII of the Public Health Service Act....) 111-148. Section 5202 of the ACA changes the Nursing Student Loan (NSL) program by: (1) Increasing the... degree in nursing. Below are details on how the ACA changes Sections 836(a), 836(b)(1), and 836(b)(3) of...

Modifications to LLNL Plutonium Packaging Systems (PuPS) to achieve ASME VIII UW-13.2(d) Requirements for the DOE Standard 3013-00 Outer Can Weld

International Nuclear Information System (INIS)

Riley, D; Dodson, K

2001-01-01

The Lawrence Livermore National Laboratory (LLNL) Plutonium Packaging System (PuPS) prepares packages to meet the DOE Standard 3013 (Reference 1). The PuPS equipment was supplied by the British Nuclear Fuels Limited (BNFL). The DOE Standard 3013 requires that the welding of the Outer Can meets ASME Section VIII Division 1 (Reference 2). ASME Section VIII references to ASME Section IX (Reference 3) for most of the welding requirements, but UW-13.2 (d) of Section VIII requires a certain depth and width of the weld. In this document the UW-13.2(d) requirement is described as the (a+b)/2t s ratio. This ratio has to be greater than or equal to one to meet the requirements of UW-13.2(d). The Outer Can welds had not been meeting this requirement. Three methods are being followed to resolve this issue: (1) Modify the welding parameters to achieve the requirement, (2) Submit a weld case to ASME that changes the UW-13.2(d) requirement for their review and approval, and (3) Change the requirements in the DOE-STD-3013. Each of these methods are being pursued. This report addresses how the first method was addressed for the LLNL PuPS. The experimental work involved adjusting the Outer Can rotational speed and the power applied to the can. These adjustments resulted in being able to achieve the ASME VIII, UW-13.2(d) requirement

Effects on instruments of the World Health Organization--recommended protocols for decontamination after possible exposure to transmissible spongiform encephalopathy-contaminated tissue.

Science.gov (United States)

Brown, Stanley A; Merritt, Katharine; Woods, Terry O; Busick, Deanna N

2005-01-15

It has been recommended by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) that rigorous decontamination protocols be used on surgical instruments that have been exposed to tissue possibly contaminated with Creutzfeldt-Jakob disease (CJD). This study was designed to examine the effects of these protocols on various types of surgical instruments. The most important conclusions are: (1) autoclaving in 1N NaOH will cause darkening of some instruments; (2) soaking in 1N NaOH at room temperature damages carbon steel but not stainless steel or titanium; (3) soaking in chlorine bleach will badly corrode gold-plated instruments and will damage some, but not all, stainless-steel instruments, especially welded and soldered joints. Damage became apparent after the first exposure and therefore long tests are not necessary to establish which instruments will be damaged. Copyright 2004 Wiley Periodicals, Inc.

PENINGKATAN AKTIVITAS DAN HASIL BELAJAR POKOK BAHASAN PASAR DENGAN METODE RESITASI PADA SISWA KELAS VIII SMP NEGERI 24 SEMARANG TAHUN AJARAN 2013/2014

Directory of Open Access Journals (Sweden)

Diinul Qoyyimah

2013-11-01

Full Text Available Aktivitas siswa kelas VIII pada mata pelajaran ekonomi SMP Negeri 24 Semarang pada pokok bahasan pasar masih rendah sehingga berdampak pada hasil belajar siswa yang masih dibawah KKM. Salah satu penyebabnya karena guru masih menerapkan metode belajar yang sama dalam waktu yang lama sehingga mengakibatkan rendahnya perolehan hasil belajar. Melalui penerapan metode ceramah bervariasi dan resitasi diharapkan siswa dapat belajar dengan santai dan senang dalam mengikuti proses pembelajaran. Penelitian ini bertujuan untuk mengetahui penerapan metode resitasi, dapat meningkatkan aktivitas dan hasil belajar siswa. Metode penelitian menggunakan penelitian tindakan kelas. Prosedur penelitian dilakukan dimulai dengan perencanaan, pelaksanaan, observasi dan refleksi. Metode pengumpulan data dengan dokumentasi dan tes. Hasil penelitian menyatakan bahwa ada peningkatan aktivitas siswa dan hasil belajar siswa materi pasar pada kelas VIII SMP Negeri 24 Semarang tahun 2013/2014. The students’ activity in VIII class of economic subject in SMP Negeri 24 Semarang in the subject matter of market topic is still low so it has the impact on the students’ learning outcome which is still under KKM requirements. One of the causes is because the teachers are still apply the same learning method in a long time so it resulted in low learning outcomes acquisition.through the application of various conventional methods and recitation are expected that students can learn easily and pleasure in participating of learning process. This study aims to determine the application of recitation method which can improve the activity and students’ learning outcomes. The research method using classroom action research. The research procedure begins with planning, implementation, observation and reflection. Methods of data collection carried out by documentation and test. The result of research states that there is an increasing activity and students’ learning outcomes in the

Surgical ergonomics. Analysis of technical skills, simulation models and assessment methods.

Science.gov (United States)

Papaspyros, Sotiris C; Kar, Ashok; O'Regan, David

2015-06-01

Over the past two centuries the surgical profession has undergone a profound evolution in terms of efficiency and outcomes. Societal concerns in relation to quality assurance, patient safety and cost reduction have highlighted the issue of training expert surgeons. The core elements of a training model build on the basic foundations of gross and fine motor skills. In this paper we provide an analysis of the ergonomic principles involved and propose relevant training techniques. We have endeavored to provide both the trainer and trainee perspectives. This paper is structured into four sections: 1) Pre-operative preparation issues, 2) technical skills and instrument handling, 3) low fidelity simulation models and 4) discussion of current concepts in crew resource management, deliberate practice and assessment. Rehearsal, warm-up and motivation-enhancing techniques aid concentration and focus. Appropriate posture, comprehension of ergonomic principles in relation to surgical instruments and utilisation of the non-dominant hand are essential skills to master. Low fidelity models can be used to achieve significant progress through the early stages of the learning curve. Deliberate practice and innate ability are complementary to each other and may be considered useful adjuncts to surgical skills development. Safe medical care requires that complex patient interventions be performed by highly skilled operators supported by reliable teams. Surgical ergonomics lie at the heart of any training model that aims to produce professionals able to function as leaders of a patient safety oriented culture. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Design local exhaust ventilation on sieve machine at PT.Perkebunan Nusantara VIII Ciater using design for assembly (DFA) approach with Boothroyd and Dewhurst method

Science.gov (United States)

Khalqihi, K. I.; Rahayu, M.; Rendra, M.

2017-12-01

PT Perkebunan Nusantara VIII Ciater is a company produced black tea orthodox more or less 4 tons every day. At the production section, PT Perkebunan Nusantara VIII will use local exhaust ventilation specially at sortation area on sieve machine. To maintain the quality of the black tea orthodox, all machine must be scheduled for maintenance every once a month and takes time 2 hours in workhours, with additional local exhaust ventilation, it will increase time for maintenance process, if maintenance takes time more than 2 hours it will caused production process delayed. To support maintenance process in PT Perkebunan Nusantara VIII Ciater, designing local exhaust ventilation using design for assembly approach with Boothroyd and Dewhurst method, design for assembly approach is choosen to simplify maintenance process which required assembly process. There are 2 LEV designs for this research. Design 1 with 94 components, assembly time 647.88 seconds and assembly efficiency level 23.62%. Design 2 with 82 components, assembly time 567.84 seconds and assembly efficiency level 24.83%. Design 2 is choosen for this research based on DFA goals, minimum total part that use, optimization assembly time, and assembly efficiency level.

Management of wound infection after lumbar arthrodesis maintaining the instrumentation

Directory of Open Access Journals (Sweden)

Asdrubal Falavigna

2015-06-01

Full Text Available OBJECTIVE: To determinate whether a surgical protocol with immediate extensive debridement, closed irrigation system and antibiotic therapy would be effective to achieve healing of deep wound infection without removing the instrumentation.METHODS: Prospective cohort study with 19 patients presenting degenerative spinal stenosis or degenerative spondylolisthesis, who developed infection after posterior lumbar arthrodesis. The diagnosis was confirmed by a microbial culture from subfascial lumbar fluid and/or blood. Patients were treated with a protocol of wound exploration, extensive flushing and debridement, placement of a closed irrigation system that was maintained for five days and intravenous antibiotics. The instrumentation system was not removed.RESULTS: Mean age was 59.31 (±13.17 years old and most patients were female (94.7%; 18/19. The mean period for the identification of the infection was 2 weeks and 57.9% underwent a single wound exploration. White blood count, erythrocyte sedimentation rate and C-reactive protein showed a significant decrease post-treatment when compared to pre-treatment values. A significant reduction of erythrocyte sedimentation rate and C-reactive protein was also observed at the final evaluation. No laboratory test was useful to predict the need for more than one debridement.CONCLUSION: Patients with wound infection after instrumentation can be treated without removal of the instrumentation through wound exploration, extensive flushing, debridement of necrotic tissue, closed irrigation system during 5 days and proper antibiotic therapy. The blood tests were not useful to predict surgical re-interventions.

Surgical implantation techniques for electronic tags in fish

Energy Technology Data Exchange (ETDEWEB)

Wagner, Glenn N.; Cooke, Steven J.; Brown, Richard S.; Deters, Katherine A.

2011-01-01

Intracoelomic implantation of transmitters into fish requires making a surgical incision, incision closure, and other surgery related techniques; however, the tools and techniques used in the surgical process vary widely. We review the available literature and focus on tools and techniques used for conducting surgery on juvenile salmonids because of the large amount of research that is conducted on them. The use of sterilized surgical instruments properly selected for a given size of fish will minimize tissue damage and infection rates, and speed the wound healing of fish implanted with transmitters. For the implantation of transmitters into small fish, the optimal surgical methods include making an incision on the ventral midline along the linea alba (for studies under 1 month), protecting the viscera (by lifting the skin with forceps while creating the incision), and using absorbable monofilament suture with a small-swaged-on swaged-on tapered or reverse-cutting needle. Standardizing the implantation techniques to be used in a study involving particular species and age classes of fish will improve survival and transmitter retention while allowing for comparisons to be made among studies and across multiple years. This review should be useful for researchers working on juvenile salmonids and other sizes and species of fish.

Motorization of a surgical microscope for intra-operative navigation and intuitive control.

Science.gov (United States)

Finke, M; Schweikard, A

2010-09-01

During surgical procedures, various medical systems, e.g. microscope or C-arm, are used. Their precise and repeatable manual positioning can be very cumbersome and interrupts the surgeon's work flow. Robotized systems can assist the surgeon but they require suitable kinematics and control. However, positioning must be fast, flexible and intuitive. We describe a fully motorized surgical microscope. Hardware components as well as implemented applications are specified. The kinematic equations are described and a novel control concept is proposed. Our microscope combines fast manual handling with accurate, automatic positioning. Intuitive control is provided by a small remote control mounted to one of the surgical instruments. Positioning accuracy and repeatability are system assists the surgeon, so that he can position the microscope precisely and repeatedly without interrupting the clinical workflow. The combination of manual und automatic control guarantees fast and flexible positioning during surgical procedures. Copyright 2010 John Wiley & Sons, Ltd.

Microscope-integrated optical coherence tomography: A new surgical tool in vitreoretinal surgery.

Science.gov (United States)

Jayadev, Chaitra; Dabir, Supriya; Vinekar, Anand; Shah, Urmil; Vaid, Tania; Yadav, Naresh Kumar

2015-05-01

Optical coherence tomography (OCT) has revolutionized imaging of ocular structures and various disease conditions. Though it has been used in the clinic for some decades, the OCT has only recently found its way into the operating theater. Early attempts at intraoperative OCT, hand-held and microscope mounted, have already improved our understanding of the surgical pathology and the role it might play in surgical decision-making. The microscope-integrated OCT now allows seamless, high-resolution, real-time imaging of surgical maneuvers from the incision to wound closure. Visualization of instruments and intraoperative tissue manipulation are possible with this in vivo modality and, therefore, help improve the outcome of surgery. In this article, we describe the advantages it offers during various vitreoretinal procedures.

Pengembangan Perangkat Pembelajaran Matematika Berbasis Problem Based Learning (PBL untuk Meningkatkan Kemampuan Pemecahan Masalah Peserta Didik Kelas VIII

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Rizza Yustianingsih

2017-09-01

Full Text Available Abstrak. Berdasarkan hasil penelitian pendahuluan pada kelas VIII SMP di lapangan, masih ditemukan kemampuan pemecahan masalah matematis siswa dalam masalah nyata yang belum optimal dan aktivitas siswa tidak mendukung proses belajar mereka. Salah satu faktornya adalah tidak cocoknya perangkat pembelajaran yang dapat memudahkan pembelajar untuk memperbaiki pemecahan kemampuan matematika dan kemampuan belajar siswa. Dari situ, untuk mendasari melakukan pengembangan perangkat pembelajaran matematika, ada rencana rencana pembelajaran (RPP dan lembar kerja siswa (LKPD berbasis Problem Based Learning (PBL, yang dapat memberikan pengalaman belajar untuk belajar pemecahan masalah dan dapat memberikan efek potensial yang baik pada aktivitas siswa selama proses belajar. Data dikumpulkan melalui observasi, kuesioner, wawancara, dan uji kemampuan pemecahan masalah. Subyek penelitian ini adalah siswa kelas VIII SMP N 3 Sawahlunto. Pengembangan penelitian ini yang digunakan adalah mode Plomp yang terdiri dari tahap awal penelitian, tahap prototipe, dan tahap penilaian. Berdasarkan hasil analisis data, terlihat bahwa alat pembelajaran berdasarkan PBL telah memenuhi kriteria yang valid dalam hal isi dan konstruksi. Peralatan pelajaran telah dianggap praktis dalam hal pelaksanaan dan efisiensi penggunaan waktu oleh guru dan siswa. Alat pelajaran juga efektif dalam hal proses penguasaan presentasi siswa belajar setelah menggunakan pembelajaran berbasis perangkat berbasis pembelajaran lebih besar dari atau sama dengan 75% sedangkan dalam hal hasil rata-rata siswa telah aktif dalam belajar. Kata kunci: Perangkat Pelajaran Matematika, Pemecahan Masalah, PBL.   Abstract. Based on the results of preliminary studies at grade VIII SMP in the field, it is still  found a mathematical problem solving ability of students in real problem who have not optimally and students activities do not support their learning process. One of the  factor is unsuitable of learning tools

Trends in the Surgical Correction of Gynecomastia

Science.gov (United States)

Brown, Rodger H.; Chang, Daniel K.; Siy, Richard; Friedman, Jeffrey

2015-01-01

Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited in their inability to address significant skin excess and ptosis. For mild to moderate gynecomastia, newer techniques using arthroscopic morcellation and endoscopic techniques promise to address the fibrous component, while minimizing scar burden by utilizing liposuction incisions. Nevertheless, direct excision through periareolar incisions remains a mainstay in treatment algorithms for its simplicity and avoidance of additional instrumentation. This is particularly true for more severe cases of gynecomastia requiring skin resection. In the most severe cases with significant skin redundancy and ptosis, breast amputation with free nipple grafting remains an effective option. Surgical treatment should be individualized to each patient, combining techniques to provide adequate resection and optimize aesthetic results. PMID:26528088

Reducing healthcare costs facilitated by surgical auditing: a systematic review.

Science.gov (United States)

Govaert, Johannes Arthuur; van Bommel, Anne Charlotte Madeline; van Dijk, Wouter Antonie; van Leersum, Nicoline Johanneke; Tollenaar, Robertus Alexandre Eduard Mattheus; Wouters, Michael Wilhemus Jacobus Maria

2015-07-01

Surgical auditing has been developed in order to benchmark and to facilitate quality improvement. The aim of this review is to determine if auditing combined with systematic feedback of information on process and outcomes of care results in lower costs of surgical care. A systematic search of published literature before 21-08-2013 was conducted in Pubmed, Embase, Web of Science, and Cochrane Library. Articles were selected if they met the inclusion criteria of describing a surgical audit with cost-evaluation. The systematic search resulted in 3608 papers. Six studies were identified as relevant, all showing a positive effect of surgical auditing on quality of healthcare and therefore cost savings was reported. Cost reductions ranging from $16 to $356 per patient were seen in audits evaluating general or vascular procedures. The highest potential cost reduction was described in a colorectal surgical audit (up to $1,986 per patient). All six identified articles in this review describe a reduction in complications and thereby a reduction in costs due to surgical auditing. Surgical auditing may be of greater value when high-risk procedures are evaluated, since prevention of adverse events in these procedures might be of greater clinical and therefore of greater financial impact. This systematic review shows that surgical auditing can function as a quality instrument and therefore as a tool to reduce costs. Since evidence is scarce so far, further studies should be performed to investigate if surgical auditing has positive effects to turn the rising healthcare costs around. In the future, incorporating (actual) cost analyses and patient-related outcome measures would increase the audits' value and provide a complete overview of the value of healthcare.

Break-through bleeding in relation to predicted factor VIII levels in patients receiving prophylactic treatment for severe hemophilia A

NARCIS (Netherlands)

Collins, P. W.; Blanchette, V. S.; Fischer, K.; Bjorkman, S.; Oh, M.; Fritsch, S.; Schroth, P.; Spotts, G.; Astermark, J.; Ewenstein, B.

Background: The role of prophylactic factor VIII (FVIII) to decrease hemophilic bleeding and arthropathy is well established. The rationale for this strategy is to convert patients with severe hemophilia A to a moderate clinical phenotype by reducing time spent with a FVIII level <1 IU dL(-1).

New developments for the surgical treatment of shoulder problems

International Nuclear Information System (INIS)

Anderl, W.

2004-01-01

Tremendous advancement has been made in the surgical treatment of the shoulder within the last years. Arthroscopic techniques for treatment of rotator cuff lesions, instability problems and biceps tendon lesions are today established because of significant improvement of instruments, suture materials and anchor techniques. The 4th generation of shoulder prosthesis systems guarantee today anatomical and biomechanical advantages with significant functional improvement for the patient. (orig.) [de

Evaluation of the biological differences of canine and human factor VIII in gene delivery: Implications in human hemophilia treatment

Science.gov (United States)

The canine is the most important large animal model for testing novel hemophilia A(HA) treatment. It is often necessary to use canine factor VIII (cFIII) gene or protein for the evaluation of HA treatment in the canine model. However, the different biological properties between cFVIII and human FVII...

Two, four, six, eight... stop and count before it is too late! An audit on swab, needle and instrument counts in theatre.

LENUS (Irish Health Repository)

Donnelly, T.

2014-07-01

A concurrent audit was conducted over a four week period to determine if the counting of swabs, needles and instruments for surgery adhered to local policy and recommended guidelines. Data were collected on 30 abdominal surgical procedures. This audit highlighted failings in the count process. It identified poor communication within the multidisciplinary team. There needs to be an increased awareness about local policy, national and international guidelines regarding the counting of swabs, needles and instruments for all surgical procedures.

28 CFR 552.13 - X-ray, major instrument, fluoroscope, or surgical intrusion.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false X-ray, major instrument, fluoroscope, or... INSTITUTIONAL MANAGEMENT CUSTODY Searches of Housing Units, Inmates, and Inmate Work Areas § 552.13 X-ray, major... reasons only, with the inmate's consent. (b) The institution physician may authorize use of an X-ray for...

WHO Safety Surgical Checklist implementation evaluation in public hospitals in the Brazilian Federal District

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Heiko T. Santana

2016-09-01

Full Text Available Summary: The World Health Organization (WHO created the WHO Surgical Safety Checklist to prevent adverse events in operating rooms. The aim of this study was to analyze WHO checklist implementation in three operating rooms of public hospitals in the Brazilian Federal District. A prospective cross-sectional study was performed with pre- (Period I and post (Period II-checklist intervention evaluations. A total of 1141 patients and 1052 patients were studied in Periods I and II for a total of 2193 patients. Period I took place from December 2012 to March 2013, and Period II took place from April 2013 to August 2014. Regarding the pre-operatory items, most surgeries were classified as clean-contaminated in both phases, and team attire improved from 19.2% to 71.0% in Period II. Regarding checklist adherence in Period II, “Patient identification” significantly improved in the stage “Before induction of anesthesia”. “Allergy verification”, “Airway obstruction verification”, and “Risk of blood loss assessment” had low adherence in all three hospitals. The items in the stage “Before surgical incision” showed greater than 90.0% adherence with the exception of “Anticipated critical events: Anesthesia team review” (86.7% and “Essential imaging display” (80.0%. Low adherence was noted in “Instrument counts” and “Equipment problems” in the stage “Before patient leaves operating room”. Complications and deaths were low in both periods. Despite the variability in checklist item compliance in the surveyed hospitals, WHO checklist implementation as an intervention tool showed good adherence to the majority of the items on the list. Nevertheless, motivation to use the instrument by the surgical team with the intent of improving surgical patient safety continues to be crucial. Keywords: Surgical checklist, Adverse events, Patient safety, Surgical team, Infection control

Utilization of the NASA Robonaut as a Surgical Avatar in Telemedicine

Science.gov (United States)

Dean, Marc; Diftler, Myron

2015-01-01

The concept of teleoperated robotic surgery is not new; however, most of the work to date has utilized specialized robots designed for specific set of surgeries. This activity explores the use of a humanoid robot to perform surgical procedures using the same hand held instruments that a human surgeon employs. For this effort, the tele-operated Robonaut (R2) was selected due to its dexterity, its ability to perform a wide range of tasks, and its adaptability to changing environments. To evaluate this concept, a series of challenges was designed with the goal of assessing the feasibility of utilizing Robonaut as a telemedicine based surgical avatar.

Spinal instrumentation for unstable C1-2 injury.

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Mizuno, J; Nakagawa, H

1999-06-01

Seventeen patients with unstable C1-2 injuries were treated between 1990 and 1997. Various methods of instrumentation surgery were performed in 16 patients, excluding a case of atlantoaxial rotatory fixation. Posterior stabilization was carried out in 14 cases using Halifax interlaminar clamp, Sof'wire or Danek cable, or more recently, transarticular screws. Transodontoid anterior screw fixation was performed in four cases of odontoid process fractures, with posterior instrumentation in two cases because of malunion. Rigid internal fixation by instrumentation surgery for the unstable C1-2 injury avoids long-term application of a Halo brace and facilitates early rehabilitation. However, the procedure is technically demanding with the risk of neural and vascular injuries, particularly with posterior screw fixation. Sagittal reconstruction of thin-sliced computed tomography scans at the C1-2 region, neuronavigator, and intraoperative fluoroscopy are essential to allow preoperative surgical planning and intraoperative guidance.

Retention of fundamental surgical skills learned in robot-assisted surgery.

Science.gov (United States)

Suh, Irene H; Mukherjee, Mukul; Shah, Bhavin C; Oleynikov, Dmitry; Siu, Ka-Chun

2012-12-01

Evaluation of the learning curve for robotic surgery has shown reduced errors and decreased task completion and training times compared with regular laparoscopic surgery. However, most training evaluations of robotic surgery have only addressed short-term retention after the completion of training. Our goal was to investigate the amount of surgical skills retained after 3 months of training with the da Vinci™ Surgical System. Seven medical students without any surgical experience were recruited. Participants were trained with a 4-day training program of robotic surgical skills and underwent a series of retention tests at 1 day, 1 week, 1 month, and 3 months post-training. Data analysis included time to task completion, speed, distance traveled, and movement curvature by the instrument tip. Performance of the participants was graded using the modified Objective Structured Assessment of Technical Skills (OSATS) for robotic surgery. Participants filled out a survey after each training session by answering a set of questions. Time to task completion and the movement curvature was decreased from pre- to post-training and the performance was retained at all the corresponding retention periods: 1 day, 1 week, 1 month, and 3 months. The modified OSATS showed improvement from pre-test to post-test and this improvement was maintained during all the retention periods. Participants increased in self-confidence and mastery in performing robotic surgical tasks after training. Our novel comprehensive training program improved robot-assisted surgical performance and learning. All trainees retained their fundamental surgical skills for 3 months after receiving the training program.

Abortion - surgical

Science.gov (United States)

Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

Developing Process Maps as a Tool for a Surgical Infection Prevention Quality Improvement Initiative in Resource-Constrained Settings.

Science.gov (United States)

Forrester, Jared A; Koritsanszky, Luca A; Amenu, Demisew; Haynes, Alex B; Berry, William R; Alemu, Seifu; Jiru, Fekadu; Weiser, Thomas G

2018-06-01

Surgical infections cause substantial morbidity and mortality in low-and middle-income countries (LMICs). To improve adherence to critical perioperative infection prevention standards, we developed Clean Cut, a checklist-based quality improvement program to improve compliance with best practices. We hypothesized that process mapping infection prevention activities can help clinicians identify strategies for improving surgical safety. We introduced Clean Cut at a tertiary hospital in Ethiopia. Infection prevention standards included skin antisepsis, ensuring a sterile field, instrument decontamination/sterilization, prophylactic antibiotic administration, routine swab/gauze counting, and use of a surgical safety checklist. Processes were mapped by a visiting surgical fellow and local operating theater staff to facilitate the development of contextually relevant solutions; processes were reassessed for improvements. Process mapping helped identify barriers to using alcohol-based hand solution due to skin irritation, inconsistent administration of prophylactic antibiotics due to variable delivery outside of the operating theater, inefficiencies in assuring sterility of surgical instruments through lack of confirmatory measures, and occurrences of retained surgical items through inappropriate guidelines, staffing, and training in proper routine gauze counting. Compliance with most processes improved significantly following organizational changes to align tasks with specific process goals. Enumerating the steps involved in surgical infection prevention using a process mapping technique helped identify opportunities for improving adherence and plotting contextually relevant solutions, resulting in superior compliance with antiseptic standards. Simplifying these process maps into an adaptable tool could be a powerful strategy for improving safe surgery delivery in LMICs. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The surgical management of the rheumatoid spine: Has the evolution of surgical intervention changed outcomes?

Directory of Open Access Journals (Sweden)

Robin Bhatia

2014-01-01

Full Text Available Context: Surgery for the rheumatoid cervical spine has been shown to stabilize the unstable spine; arrest/improve the progression of neurological deficit, help neck pain, and possibly decelerate the degenerative disease process. Operative intervention for the rheumatoid spine has significantly changed over the last 30 years. Aims: The purpose of this study was to review all cases of cervical rheumatoid spine requiring surgical intervention in a single unit over the last 30 years. Materials and Methods: A prospectively-maintained spine database was retrospectively searched for all cases of rheumatoid spine, leading to a review of indications, imaging, Ranawat and Myelopathy Disability Index measures, surgical morbidity, and survival curve analysis. Results: A total of 224 cases were identified between 1981 and 2011. Dividing the data into three time-epochs, there has been a significant increase in the ratio of segment-saving Goel-Harms C1-C2: Occipitocervical fixation (OCF surgery and survival has increased between 1981 and 2011 from 30% to 51%. Patients undergoing C1-C2 fixation were comparatively less myelopathic and in a better Ranawat class preoperatively, but postoperative outcome measures were well-preserved with favorable mortality rates over mean 39.6 months of follow-up. However, 11% of cases required OCF at mean 28 months post-C1-C2 fixation, largely due to instrumentation failure (80%. Conclusion: We present the largest series of surgically managed rheumatoid spines, revealing comparative data on OCF and C1-C2 fixation. Although survival has improved over the last 30 years, there have been changes in medical, surgical and perioperative management over that period of time too confounding the interpretation; however, the analysis presented suggests that rheumatoid patients presenting early in the disease process may benefit from C1 to C2 fixation, albeit with a proportion requiring OCF at a later time.

Technical and instrumental prerequisites for single-port laparoscopic solo surgery: state of art.

Science.gov (United States)

Kim, Say-June; Lee, Sang Chul

2015-04-21

With the aid of advanced surgical techniques and instruments, single-port laparoscopic surgery (SPLS) can be accomplished with just two surgical members: an operator and a camera assistant. Under these circumstances, the reasonable replacement of a human camera assistant by a mechanical camera holder has resulted in a new surgical procedure termed single-port solo surgery (SPSS). In SPSS, the fixation and coordinated movement of a camera held by mechanical devices provides fixed and stable operative images that are under the control of the operator. Therefore, SPSS primarily benefits from the provision of the operator's eye-to-hand coordination. Because SPSS is an intuitive modification of SPLS, the indications for SPSS are the same as those for SPLS. Though SPSS necessitates more actions than the surgery with a human assistant, these difficulties seem to be easily overcome by the greater provision of static operative images and the need for less lens cleaning and repositioning of the camera. When the operation is expected to be difficult and demanding, the SPSS process could be assisted by the addition of another instrument holder besides the camera holder.

Energies and lifetimes of excited states in copperlike Kr VIII

International Nuclear Information System (INIS)

Livingston, A.E.; Curtis, L.J.; Schectman, R.M.; Berry, H.G.

1980-01-01

The spectrum of Kr VIII has been observed between 180 and 2000 A by using foil excitation of 2.5--3.5-MeV krypton ions. Twenty new transitions have been classified and eleven new excited-state energies have been determined within the n=4 --7 shells. The ionization potential is derived to be 1 015 800 +- 200 cm -1 . The excited-state energies and fine structures are compared with recent relativistic Hartree-Fock calculations. The 4p-state lifetime has been measured by performing a simultaneous analysis of decay data for the 4p level and for its dominant cascade-repopulating levels. The 4p lifetime is found to be 30% shorter than previously measured values and is in excellent agreement with the result of a recent multiconfiguration Hartree-Fock calculation. The source of the discrepancy between this result and earlier measurements is discussed

Descripción de un inmunoensayo enzimático que reconoce anticuerpos anti-factor VIII/von Willebrand obtenidos a partir de hibridomas múridos Description of an enzime immunoassay that recognizes anti-factor VIII/von Willebrand antibodies obtained from murine hybridomas

Directory of Open Access Journals (Sweden)

Renée González Sampedro

1999-04-01

Full Text Available Se describe un inmunoensayo enzimático (ELISA que detecta anticuerpos anti-Factor-VIII/von Willebrand (FVIII/vW, con una relación de enlace > 5, que permite reconocer dichos anticuerpos tempranamente en los cultivos de hibridomas múridos. Para la adsorción de las placas del inmunoensayo se utilizaron preparados semipurificados de FVIII/vW obtenidos en Cuba. Se inmunizaron ratones Balb/c con la finalidad de generar los anticuerpos monoclonales detectados por este ELISA. Se obtuvo un clon con crecimiento estable y varios subclones positivos por el ELISA con actividad biológica específica de anticuerpos inhibidores de FVIIIAn enzime immunoassay (ELISA that detects anti-Factor VIII/von Willebrand (FVIII/vw antibodies with a binding relationship > 5 that allows the early recognition of such antibodies in the cultures of murine hybridomas is described. Semipurified preparations of FVIII/vw obtained in Cuba were used for the adsorption of the immunoassay plates. Balb/c mice were immunized in order to generate the monoclonal antibodies detected by this ELISA. A clone with stable growth and several positive subclones were obtained by ELISA with specific biological activity of FVIII-inhibiting antibodies

Can surgical simulation be used to train detection and classification of neural networks?

Science.gov (United States)

Zisimopoulos, Odysseas; Flouty, Evangello; Stacey, Mark; Muscroft, Sam; Giataganas, Petros; Nehme, Jean; Chow, Andre; Stoyanov, Danail

2017-10-01

Computer-assisted interventions (CAI) aim to increase the effectiveness, precision and repeatability of procedures to improve surgical outcomes. The presence and motion of surgical tools is a key information input for CAI surgical phase recognition algorithms. Vision-based tool detection and recognition approaches are an attractive solution and can be designed to take advantage of the powerful deep learning paradigm that is rapidly advancing image recognition and classification. The challenge for such algorithms is the availability and quality of labelled data used for training. In this Letter, surgical simulation is used to train tool detection and segmentation based on deep convolutional neural networks and generative adversarial networks. The authors experiment with two network architectures for image segmentation in tool classes commonly encountered during cataract surgery. A commercially-available simulator is used to create a simulated cataract dataset for training models prior to performing transfer learning on real surgical data. To the best of authors' knowledge, this is the first attempt to train deep learning models for surgical instrument detection on simulated data while demonstrating promising results to generalise on real data. Results indicate that simulated data does have some potential for training advanced classification methods for CAI systems.

Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women.

Science.gov (United States)

El Ayadi, Alison; Nalubwama, Hadija; Barageine, Justus; Neilands, Torsten B; Obore, Susan; Byamugisha, Josaphat; Kakaire, Othman; Mwanje, Haruna; Korn, Abner; Lester, Felicia; Miller, Suellen

2017-09-02

Obstetric fistula is a debilitating and traumatic birth injury affecting 2-3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov's ρ and Pearson's correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs. Themes central to women's experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled 'Mobility and social engagement', 'Meeting family needs', 'Comfort with relationships', and 'General life

Post surgical complications from students' large animal surgical ...

African Journals Online (AJOL)

A retrospective study of post surgical complications was conducted on records of students' Large Animal Surgical Laboratories in the Faculty of Veterinary Medicine (F.V.M.), Ahmadu Bello University (A.B.U), Zaria from 1989 to 1993. Three hundred and eleven surgical complications were recorded from five surgical ...

Report on corrections and future considerations for Appendices II–VIII of the International Code of Nomenclature for Algae, Fungi, and Plants

Science.gov (United States)

For the first time, the main text and Appendices II–VIII of the International Code of Nomenclature were separately published following decisions of the Melbourne Nomenclature Section, which contributed to subsequent development of an online resource capable of producing the Appendices in real time. ...

[Changing surgical therapy because of clinical studies?].

Science.gov (United States)

Schwenk, W; Haase, O; Müller, J M

2002-04-01

The randomised controlled clinical trial (RCT) is a powerful instrument to evaluate different therapeutic regimens. In a survey among 115 physicians visiting the 25th annual meeting of the Surgical Society of Berlin and Brandenburg, the RCT was judged to be very important when changes of therapeutic strategies are discussed. 90 % of all participants claimed to use data from RCTs in the clinical routine and 89 % would participate in such a trial. In official (e. g. discussions during coffee breaks at scientific meetings) or non-medical (e. g. non-scientific press or media) sources of information were assessed as irrelevant for decisions regarding therapeutic strategies. However, in contrast to this view laparoscopic cholecystectomy was introduced into clinical practice rapidly because patients informed by external (non-medical) sources preferred to be operated on with the "modern" technique. Clinical trials with a high level of evidence had no relevant influence on the rapid distribution of laparoscopic cholecystectomy. Controversial discussions concerning the extent of lymphadenectomy with gastric resection for carcinoma demonstrate that the value of excellent clinical RCTs is low if their results challenge a stable paradigma of the surgical scientific society. To allow a rational judgement, new surgical technologies should undergo a scientific gradual evaluation in agreement with the principles of evidence based medicine.

Instrumented fusion in a 12-month-old with atlanto-occipital dislocation: case report and literature review of infant occipitocervical fusion.

Science.gov (United States)

Hale, Andrew T; Dewan, Michael C; Patel, Bhairav; Geck, Matthew J; Tomycz, Luke D

2017-08-01

The treatment of atlantoaxial dislocation in very young children is challenging and lacks a consensus management strategy. We review the literature on infantile occipitocervical (OC) fusion is appraised and technical considerations are organized for ease of reference. Surgical decisions such as graft type and instrumentation details are summarized, along with the use of bone morphogenic protein and post-operative orthoses. We present the case of a 12-month-old who underwent instrumented occipitocervical (OC) fusion in the setting of traumatic atlanto-occipital dislocation (AOD). Occipitocervical (OC) arthrodesis is obtainable in very young infants and children. Surgical approaches are variable and use a combination of autologous grafting and creative screw and/or wire constructs. The heterogeneity of pathologic etiology leading to OC fusion makes it difficult to make definitive recommendations for surgical management.

Effect of Surgical Approach on Pulmonary Function in Adolescent Idiopathic Scoliosis Patients: A Systemic Review and Meta-analysis.

Science.gov (United States)

Lee, Andy C H; Feger, Mark A; Singla, Anuj; Abel, Mark F

2016-11-15

Systemic review and meta-analysis. To analyze the effect of spinal fusion and instrumentation for adolescent idiopathic scoliosis (AIS) on absolute pulmonary function test (PFTs). Pulmonary function is correlated with severity of deformity in AIS patients and studies that have analyzed the effect of spinal fusion and instrumentation on PFTs for AIS have reported inconsistent results. There is a need to analyze the effect of spinal fusion on PFTs with stratification by surgical approach. Our analysis included 22 studies. Cohen's d effect sizes were calculated for absolute PFT outcome measures with 95% confidence intervals (CI). Meta-analyses were performed at each postoperative time frame for six homogeneous surgical approaches: (i) combined anterior release and posterior fusion with instrumentation; (ii) combined video assisted anterior release and posterior fusion with instrumentation without thoracoplasty; (iii) posterior fusion with instrumentation without thoracoplasty; (iv) anterior fusion with instrumentation and without thoracoplasty; (v) video assisted anterior fusion with instrumentation without thoracoplasty; and (vi) any scoliosis surgery with additional thoracoplasty. Anterior spinal fusion with instrumentation, any scoliosis surgery with concomitant thoracoplasty, or video-assisted anterior fusion with instrumentation for AIS had similar absolute PFTs at their 2 year postoperative follow up compared with their preoperative PFTs (effect sizes ranging from -0.2-0.2 with all CI crossing "0"). Posterior spinal fusion with instrumentation (with or without an anterior release) demonstrated small to moderate increases in PFTs 2 years postoperatively (effect sizes ranging from 0.35-0.65 with all CI not crossing "0"). Anterior fusion with instrumentation, regardless of the approach, and any scoliosis surgery with concomitant thoracoplasty do not lead to significant change in pulmonary functions 2 year after surgery. Posterior spinal fusion with instrumentation

Portable Chemical Sterilizer for Microbial Decontamination of Surgical Instruments, Fruits and Vegetables, and Field Feeding Equipment

National Research Council Canada - National Science Library

Doona, C. J; Feeherry, F. E; Kustin, K; Curtin, M. A; Baer, D. G

2006-01-01

The Portable Chemical Sterilizer (PCS) is a revolutionary biomedical sterilization technology that provides the capability for portable, power-free, point-of-use sterilization to meet the Army's Far-Forward Surgical Teams (FSTs...

X-ray spectral line coincidences between fluorine VIII (and IX) and transition metal lines

International Nuclear Information System (INIS)

Charatis, G.; Rockett, P.D.; Burkhalter, P.G.

1983-01-01

X-ray spectroscopy was performed in the 12 to 15 A region, recording L-shell lines from selected laser-irradiated transition metals. Line coincidences and near coincidences were identified between Fe, Cr, Mn, and Ni L-spectra, and F VIII and F IX K-shell lines. Wavelengths were determined to accuracies of 1 to 3 mA and will be utilized in selecting potential pumping candidates in future x-ray lasing schemes. High-resolution x-ray spectra were collected under controlled illumination and target conditions using 1.05 μm and 0.527 μm laser excitation with the KMS CHROMA laser

PENERAPAN MODEL PEMBELAJARAN BAKULIKAN UNTUK MENINGKATKAN KEMAMPUAN BERSIKAP ILMIAH PADA KONSEP PEMANTULAN CAHAYA KELAS VIII

Directory of Open Access Journals (Sweden)

N. A. Shofiah

2012-01-01

Full Text Available Penelitian tindakan kelas yang bertujuan untuk meningkatkan kemampuan bersikap ilmiah, telah dilakukan di kelas VIII semester IIpada sub pokok bahasan pemantulan cahaya. Untuk meningkatkan kemampuan bersikap ilmiah diterapkan model pembelajaranbakulikan. Penelitian tindakan kelas ini terdiri dari tiga sikus, dengan masing-masing siklus terdiri dari empat tahapan yaituperencanaan, pelaksanaan, observasi dan refleksi. Data sikap ilmiah siswa diambil dari lembar angket dan lembar observasi. Datahasil belajar kognitif diambil dari evaluasi yang ada di LKS tiap akhir siklus dan data hasil belajar psikomotorik diambil dari lembarobservasi tiap akhir siklus. Hasil penelitian menyatakan bahwa sikap ilmiah siswa mengalami peningkatan walaupun tidaksignifikan. Hasil belajar kognitif dan keterampilan psikomotorik siswa mengalami peningkatan tiap siklus dan mencapai ketuntasanpada siklus III. A classroom action research aimed to improve scientific attitude skill had been done in second semester of grade VIII MTs on thesubtopic light reflection. The 'bakulikan' learning model was chosen for improving the scientific attitude skills of the students. Thisaction research consisted of three cycles, and each cycle has four stages, namely, planning, conducting, observation andreflection. The data obtained through questionnaire and observation sheets. The cognitive achievement drawn from the evaluationon each worksheet at the end of each cycle, and the psychometrics recorded from observation sheet. The study concludes that thescientific attitude skill improved significantly. The achievement on cognitive and psychometrics increase gradually on each cycleand get mastery at the end of the last cycle.Keywords: bakulikan; classroom action research; scientific attitude

40 CFR 92.121 - Oxides of nitrogen analyzer calibration and check.

Science.gov (United States)

2010-07-01

... to be used in the equation below: (i) Follow the manufacturer's instructions for instrument startup...−b)/(c−d))(100) where: a=concentration obtained in paragraph (b)(2)(viii) of this section. b... calibration gas by: Percent L=(100)(z−x)/(Full-scale chart deflection) (viii) The linearity criterion is met...

Quality appraisal of generic self-reported instruments measuring health-related productivity changes: a systematic review

Science.gov (United States)

2014-01-01

Background Health impairments can result in disability and changed work productivity imposing considerable costs for the employee, employer and society as a whole. A large number of instruments exist to measure health-related productivity changes; however their methodological quality remains unclear. This systematic review critically appraised the measurement properties in generic self-reported instruments that measure health-related productivity changes to recommend appropriate instruments for use in occupational and economic health practice. Methods PubMed, PsycINFO, Econlit and Embase were systematically searched for studies whereof: (i) instruments measured health-related productivity changes; (ii) the aim was to evaluate instrument measurement properties; (iii) instruments were generic; (iv) ratings were self-reported; (v) full-texts were available. Next, methodological quality appraisal was based on COSMIN elements: (i) internal consistency; (ii) reliability; (iii) measurement error; (iv) content validity; (v) structural validity; (vi) hypotheses testing; (vii) cross-cultural validity; (viii) criterion validity; and (ix) responsiveness. Recommendations are based on evidence syntheses. Results This review included 25 articles assessing the reliability, validity and responsiveness of 15 different generic self-reported instruments measuring health-related productivity changes. Most studies evaluated criterion validity, none evaluated cross-cultural validity and information on measurement error is lacking. The Work Limitation Questionnaire (WLQ) was most frequently evaluated with moderate respectively strong positive evidence for content and structural validity and negative evidence for reliability, hypothesis testing and responsiveness. Less frequently evaluated, the Stanford Presenteeism Scale (SPS) showed strong positive evidence for internal consistency and structural validity, and moderate positive evidence for hypotheses testing and criterion validity. The

Surgeon-tool force/torque signatures--evaluation of surgical skills in minimally invasive surgery.

Science.gov (United States)

Rosen, J; MacFarlane, M; Richards, C; Hannaford, B; Sinanan, M

1999-01-01

The best method of training for laparoscopic surgical skills is controversial. Some advocate observation in the operating room, while others promote animal and simulated models or a combination of surgical related tasks. The mode of proficiency evaluation common to all of these methods has been subjective evaluation by a skilled surgeon. In order to define an objective means of evaluating performance, an instrumented laparoscopic grasper was developed measuring the force/torque at the surgeon hand/tool interface. The measured database demonstrated substantial differences between experienced and novice surgeon groups. Analyzing forces and torques combined with the state transition during surgical procedures allows an objective measurement of skill in MIS. Teaching the novice surgeon to limit excessive loads and improve movement efficiency during surgical procedures can potentially result in less injury to soft tissues and less wasted time during laparoscopic surgery. Moreover the force/torque database measured in this study may be used for developing realistic virtual reality simulators and optimization of medical robots performance.

Preoperative and perioperative factors effect on adolescent idiopathic scoliosis surgical outcomes.

Science.gov (United States)

Sanders, James O; Carreon, Leah Y; Sucato, Daniel J; Sturm, Peter F; Diab, Mohammad

2010-09-15

Prospective multicenter database. To identify factors associated with outcomes from adolescent idiopathic scoliosis (AIS) surgery outcomes and especially poor results. Because AIS is rarely symptomatic during adolescence, excellent surgical results are expected. However, some patients have poor outcomes. This study seeks to identify factors correlating with results and especially those making poor outcomes more likely. Demographic, surgical, and radiographic parameters were compared to 2-year postoperative Scoliosis Research Society (SRS) scores in 477 AIS surgical patients using stepwise linear regression to identify factors predictive of 2-year domain and total scores. Poor postoperative score patients (>2 SD below mean) were compared using t tests to those with better results. The SRS instrument exhibited a strong ceiling effect. Two-year scores showed more improvement with greater curve correction (self-image, pain, and total), and were worse with larger body mass index (pain, mental, total), larger preoperative trunk shift (mental and total), larger preoperative Cobb (self-image), and preoperative symptoms (function). Poor results were more common in those with Lenke 3 curve pattern (pain), less preoperative coronal imbalance, trunk shift and rib prominence (function), preoperative bracing (self-image), and anterior procedures (mental). Poor results also had slightly less average curve correction (50% vs. 60%) and larger curve residuals (31° vs. 23°). Complications, postoperative curve magnitude, and instrumentation type did not significantly contribute to postoperative scores, and no identifiable factors contributed to satisfaction. Curve correction improves patient's self-image whereas pain and poor function before surgery carry over after surgery. Patients with less spinal appearance issues (higher body mass index, Lenke 3 curves) are less happy with their results. Except in surgical patient selection, many of these factors are beyond physician control.

Prolonged activity of a recombinant factor VIII-Fc fusion protein in hemophilia A mice and dogs

Science.gov (United States)

Dumont, Jennifer A.; Liu, Tongyao; Low, Susan C.; Zhang, Xin; Kamphaus, George; Sakorafas, Paul; Fraley, Cara; Drager, Douglas; Reidy, Thomas; McCue, Justin; Franck, Helen W. G.; Merricks, Elizabeth P.; Nichols, Timothy C.; Bitonti, Alan J.; Pierce, Glenn F.

2012-01-01

Despite proven benefits, prophylactic treatment for hemophilia A is hampered by the short half-life of factor VIII. A recombinant factor VIII-Fc fusion protein (rFVIIIFc) was constructed to determine the potential for reduced frequency of dosing. rFVIIIFc has an ∼ 2-fold longer half-life than rFVIII in hemophilia A (HemA) mice and dogs. The extension of rFVIIIFc half-life requires interaction of Fc with the neonatal Fc receptor (FcRn). In FcRn knockout mice, the extension of rFVIIIFc half-life is abrogated, and is restored in human FcRn transgenic mice. The Fc fusion has no impact on FVIII-specific activity. rFVIIIFc has comparable acute efficacy as rFVIII in treating tail clip injury in HemA mice, and fully corrects whole blood clotting time (WBCT) in HemA dogs immediately after dosing. Furthermore, consistent with prolonged half-life, rFVIIIFc shows 2-fold longer prophylactic efficacy in protecting HemA mice from tail vein transection bleeding induced 24-48 hours after dosing. In HemA dogs, rFVIIIFc also sustains partial correction of WBCT 1.5- to 2-fold longer than rFVIII. rFVIIIFc was well tolerated in both species. Thus, the rescue of FVIII by Fc fusion to provide prolonged protection presents a novel pathway for FVIII catabolism, and warrants further investigation. PMID:22246033

The impact of missing sensor information on surgical workflow management.

Science.gov (United States)

Liebmann, Philipp; Meixensberger, Jürgen; Wiedemann, Peter; Neumuth, Thomas

2013-09-01

Sensor systems in the operating room may encounter intermittent data losses that reduce the performance of surgical workflow management systems (SWFMS). Sensor data loss could impact SWFMS-based decision support, device parameterization, and information presentation. The purpose of this study was to understand the robustness of surgical process models when sensor information is partially missing. SWFMS changes caused by wrong or no data from the sensor system which tracks the progress of a surgical intervention were tested. The individual surgical process models (iSPMs) from 100 different cataract procedures of 3 ophthalmologic surgeons were used to select a randomized subset and create a generalized surgical process model (gSPM). A disjoint subset was selected from the iSPMs and used to simulate the surgical process against the gSPM. The loss of sensor data was simulated by removing some information from one task in the iSPM. The effect of missing sensor data was measured using several metrics: (a) successful relocation of the path in the gSPM, (b) the number of steps to find the converging point, and (c) the perspective with the highest occurrence of unsuccessful path findings. A gSPM built using 30% of the iSPMs successfully found the correct path in 90% of the cases. The most critical sensor data were the information regarding the instrument used by the surgeon. We found that use of a gSPM to provide input data for a SWFMS is robust and can be accurate despite missing sensor data. A surgical workflow management system can provide the surgeon with workflow guidance in the OR for most cases. Sensor systems for surgical process tracking can be evaluated based on the stability and accuracy of functional and spatial operative results.

EK(b)P Keskkomitee VIII pleenumi stenogramm / tõlk. Mart Arold, tõlk. Jaan Isotamm

Index Scriptorium Estoniae

1999-01-01

EK(b)P Keskkomitee VIII pleenum, 21.-23. märts 1950. Sõnavõtud: N. Karotamm, P. Ponomarenko, I. Käbin, V. Kuusik, A. Jaanus, V. Hiznjakov, E. Ristimägi, I. Suija, H. Ajo, A. Meri, G. Abels, M. Assin, G. Latõshov, Rumjantsev, Müürisepp. Kommenteerinud Viktor Niitsoo. Algus: Akadeemia (1998) nr. 12, lk. 2655-2683 ; Järg nr.2;3;4;5;6;7;8;9;10 lk.415-446;639-670;863-894;1087-1118;1310-1342;1534-1566;1759-1790;2017-2048;2220-2256

Surgical lighting

NARCIS (Netherlands)

Knulst, A.J.

2017-01-01

The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago,

Low-dose factor VIII infusion in Chinese adult haemophilia A patients: pharmacokinetics evidence that daily infusion results in higher trough level than with every-other-day infusion with similar factor VIII consumption.

Science.gov (United States)

Hua, B; Lee, A; Fan, L; Li, K; Zhang, Y; Poon, M-C; Zhao, Y

2017-05-01

Pharmacokinetics (PK) modelling suggests improvement of trough levels are achieved by using more frequent infusion strategy. However, no clinical study data exists to confirm or quantify improvement in trough level, particularly for low-dose prophylaxis in patients with haemophilia A. To provide evidence that low dose daily (ED) prophylaxis can increase trough levels without increasing FVIII consumption compared to every-other-day (EOD) infusion. A cross-over study on 5 IU kg -1 FVIII daily vs. 10 IU kg -1 EOD infusions, each for 14 days was conducted at the PUMCH-HTC. On the ED schedule, trough (immediate prior to infusion), and peak FVIII:C levels (30 min after infusion) were measured on days 1-5; and trough levels alone on days 7, 9, 11 and 13. For the EOD schedule, troughs, peaks and 4-h postinfusion were measured on day 1; troughs and peaks on days 3, 5, and 7; troughs alone on days 9, 11 and 13 and 24-h postinfusion on days 2, 4 and 6. FVIII inhibitors were assessed on days 0 and 14 during both infusion schedules. Six patients were enrolled. PK evidence showed that daily prophylaxis achieved higher (~2 times) steady-state FVIII trough levels compared to EOD with the same total factor consumption. The daily prophylaxis had good acceptability among patients and reduced chronic pain in the joints in some patients. Our PK study shows low-dose factor VIII daily infusion results in higher trough level than with EOD infusion with similar factor VIII consumption in Chinese adult haemophilia A patients. © 2017 John Wiley & Sons Ltd.

A software-based tool for video motion tracking in the surgical skills assessment landscape

NARCIS (Netherlands)

Ganni, S.; Botden, Sanne M.B.I.; Chmarra, M.K.; Goossens, R.H.M.; Jakimowicz, J.J.

2018-01-01

Background: The use of motion tracking has been proved to provide an objective assessment in surgical skills training. Current systems, however, require the use of additional equipment or specialised laparoscopic instruments and cameras to extract the data. The aim of this study was to determine

Modern spinal instrumentation. Part 2: Multimodality imaging approach for assessment of complications

International Nuclear Information System (INIS)

Allouni, A.K.; Davis, W.; Mankad, K.; Rankine, J.; Davagnanam, I.

2013-01-01

Radiologists frequently encounter studies demonstrating spinal instrumentation, either as part of the patient's postoperative evaluation, or as incidental to a study performed for another purpose. It is important for the reporting radiologist to identify potential complications of commonly used spinal implants. Part 1 of this review examined both the surgical approaches used and the normal appearances of these spinal implants and bone grafting techniques. This second part of the review will focus on the multimodal imaging strategy adopted in the assessment of the instrumented spine and the demonstration of imaging findings of common postoperative complications.

A novel technique for preventing skin pressure sores using a rubber tube during surgical treatment of mandibular condyle fractures.

Science.gov (United States)

Kawase-Koga, Yoko; Mori, Yoshiyuki; Hoshi, Kazuhito; Takato, Tsuyoshi

2013-11-01

Craniofacial surgery occasionally results in sores and necrosis of the facial skin because of pressure from surgical instruments. During surgical treatment of mandibular condylar process fractures, the main mandibular fragment is routinely retracted downward using a wire to achieve a satisfactory anatomic reduction. This procedure may injure the facial skin. This potential complication is easily overlooked by medical staff, but it is easily preventable. We herein describe a method of using a rubber tube to avoid causing pressure sores of the facial skin during surgical treatment of mandibular condylar process fractures.

The clinical outcomes of surgical treatment of noncontiguous spinal tuberculosis: a retrospective study in 23 cases.

Directory of Open Access Journals (Sweden)

Jia Huang

Full Text Available STUDY DESIGN: A retrospective clinical study. OBJECTIVE: To evaluate the clinical efficacy of the surgical treatment of noncontiguous spinal tuberculosis (NSTB, and to discuss its therapeutic strategies. METHODS: We performed a retrospective review of clinical and radiographic data that were prospectively collected on 550 consecutive spinal tubercular patients including 27 patients who were diagnosed and treated as NSTB in our institution from June 2005 to June 2011. Apart from 4 patients being treated conservatively, the remainder received surgery by posterior transforaminal debridement, interbody fusion with instrumentation, posterior instrumentation and anterior debridement with fusion in a single or two-stage operation. The clinical outcomes were evaluated before and after treatment in terms of hematologic and radiographic examinations, bone fusion and neurologic status. The Oswestry Disability Index score was determined before treatment and at the last follow-up visit. RESULTS: 23 patients (15 M/8F, averaged 44.6 ± 14.2 years old (range, 19 to 70 yd, who received surgical treatment, were followed up after surgery for a mean of 52.5 ± 19.5 months (range, 24 to 72 months. The kyphotic angle was changed significantly between pre- and postoperation (P<0.05. The mean amount of correction was 12.6 ± 7.2 degrees, with a small loss of correction at last follow-up. All patients achieved solid bone fusion. No patients with neurological deficit deteriorated postoperatively. Neither mortalities nor any major complications were found. There was a significant difference of Oswestry Disability Index scores between preoperation and the final follow-up. CONCLUSION: The outcomes of follow-up showed that posterior and posterior-anterior surgical treatment methods were both viable surgical options for NSTB. Posterior transforaminal debridement, interbody fusion and posterior instrumentation, as a less invasive technique, was feasible and effective to treat

Intraocular robotic interventional surgical system (IRISS): Mechanical design, evaluation, and master-slave manipulation.

Science.gov (United States)

Wilson, Jason T; Gerber, Matthew J; Prince, Stephen W; Chen, Cheng-Wei; Schwartz, Steven D; Hubschman, Jean-Pierre; Tsao, Tsu-Chin

2018-02-01

Since the advent of robotic-assisted surgery, the value of using robotic systems to assist in surgical procedures has been repeatedly demonstrated. However, existing technologies are unable to perform complete, multi-step procedures from start to finish. Many intraocular surgical steps continue to be manually performed. An intraocular robotic interventional surgical system (IRISS) capable of performing various intraocular surgical procedures was designed, fabricated, and evaluated. Methods were developed to evaluate the performance of the remote centers of motion (RCMs) using a stereo-camera setup and to assess the accuracy and precision of positioning the tool tip using an optical coherence tomography (OCT) system. The IRISS can simultaneously manipulate multiple surgical instruments, change between mounted tools using an onboard tool-change mechanism, and visualize the otherwise invisible RCMs to facilitate alignment of the RCM to the surgical incision. The accuracy of positioning the tool tip was measured to be 0.205±0.003 mm. The IRISS was evaluated by trained surgeons in a remote surgical theatre using post-mortem pig eyes and shown to be effective in completing many key steps in a variety of intraocular surgical procedures as well as being capable of performing an entire cataract extraction from start to finish. The IRISS represents a necessary step towards fully automated intraocular surgery and demonstrated accurate and precise master-slave manipulation for cataract removal and-through visual feedback-retinal vein cannulation. Copyright © 2017 John Wiley & Sons, Ltd.

Surgical Assisting

Science.gov (United States)

... instruction, including: Microbiology Pathophysiology Pharmacology Anatomy and physiology Medical terminology Curriculum . Course content includes: Advanced surgical anatomy Surgical microbiology Surgical pharmacology Anesthesia methods and agents Bioscience Ethical ...

Paediatric Abdominal Surgical Emergencies in a General Surgical ...

African Journals Online (AJOL)

... organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country. Key Words: Paediatric Abdominal Surgical Emergencies; Paediatric Surgeons, General Surgeons. Journal of College of Medicine ...

Recurrent myocardial infarctions in a young football player secondary to thrombophilia, associated with elevated factor VIII activity

Directory of Open Access Journals (Sweden)

Vacek TP

2014-10-01

Full Text Available Thomas P Vacek, Shipeng Yu, Shahnaz Rehman, Blair P Grubb, Daniel Kosinski, Cherian Verghese, Ehab A Eltahawy, Shafiq Qaiser Department of Medicine, University of Toledo Medical Center, Toledo, OH, USAAbstract: Myocardial infarction (MI due to coronary atherosclerosis in young adults is uncommon; rare causes such as cocaine abuse, arterial dissection, and thromboembolism should be considered. A 21-year-old football player, and otherwise healthy African American man, developed chest pain during exercise while bench-pressing 400 lbs. Acute MI was diagnosed based on physical examination, electrocardiography findings, and elevated cardiac enzymes. Coronary arteriography showed a thrombus occluding the proximal left anterior descending artery (LAD. Aggressive antiplatelet therapy with aspirin, clopidogrel, and eptifibatide was pursued, in addition to standard post-MI care. This led to the successful resolution of symptoms and dissolution of the thrombus, demonstrated by repeat coronary arteriography. Five months later, he presented with similar symptoms during exercise after lifting heavy weights, and was found to have another acute MI. Coronary arteriography again showed a thrombus occluding the LAD. No evidence of coronary artery dissection or vasospasm was found. Only mild atherosclerotic plaque burden was observed on both occasions by intravascular ultrasound. A bare metal stent was placed at the site as it was thought this site had acted as a nidus for small plaque rupture and thrombus formation. Elevated serum factor VIII activity at 205% (reference range 60%–140% was found, a rare cause of hypercoagulability. Further workup revealed a patent foramen ovale during a Valsalva maneuver by transesophageal echocardiography. Both events occurred during weight lifting, which can transiently increase right heart pressure in a similar way to the Valsalva maneuver. In light of all the findings, we concluded that an exercise-related increase in factor

Toward the Development of Virtual Surgical Tools to Aid Orthopaedic FE Analyses

Directory of Open Access Journals (Sweden)

Srinivas C. Tadepalli

2010-01-01

Full Text Available Computational models of joint anatomy and function provide a means for biomechanists, physicians, and physical therapists to understand the effects of repetitive motion, acute injury, and degenerative diseases. Finite element models, for example, may be used to predict the outcome of a surgical intervention or to improve the design of prosthetic implants. Countless models have been developed over the years to address a myriad of orthopaedic procedures. Unfortunately, few studies have incorporated patient-specific models. Historically, baseline anatomic models have been used due to the demands associated with model development. Moreover, surgical simulations impose additional modeling challenges. Current meshing practices do not readily accommodate the inclusion of implants. Our goal is to develop a suite of tools (virtual instruments and guides which enable surgical procedures to be readily simulated and to facilitate the development of all-hexahedral finite element mesh definitions.

Una frontera casi invisible: los territorios al norte del Sistema Central en la Alta Edad Media (siglos VIII-XI

Directory of Open Access Journals (Sweden)

Iñaki MARTÍN VISO

2009-12-01

Full Text Available RESUMEN: Los territorios al norte del Sistema Central no estuvieron sujetos a un dominio por parte de una autoridad centralizada entre los siglos VIII a XI. Los instrumentos del poder central, en especial la tributación y la organización episcopal, se descompusieron tras el siglo VIII y asumieron un papel determinante las estructuras de poder local, las cuales deben ser el principal objeto de estudio. A partir de su análisis, se descubre un espacio fronterizo abierto, con un dominio político informal, que es invisible para los poderes centrales. Palabras clave: Poderes Locales. Sitios de Altura. Necrópolis. Frontera. Tributación. Mozárabes.ABSTRACT: The territories at the North of the Iberian Central System were not ruled by any central authority between eighth and eleventh centuries. The main tools of the central power, especially the tribute and the episcopal organization, were broken down after the 8th century and the structures of local power, which must be studied particularly, got a very influential role. The analysis discover an opened frontier area, with an informal political control, that is invisible from the perspective of the central power

The role of student surgical interest groups and surgical Olympiads in anatomical and surgical undergraduate training in Russia.

Science.gov (United States)

Dydykin, Sergey; Kapitonova, Marina

2015-01-01

Traditional department-based surgical interest groups in Russian medical schools are useful tools for student-based selection of specialty training. They also form a nucleus for initiating research activities among undergraduate students. In Russia, the Departments of Topographical Anatomy and Operative Surgery play an important role in initiating student-led research and providing learners with advanced, practical surgical skills. In tandem with department-led activities, student surgical interest groups prepare learners through surgical competitions, known as "Surgical Olympiads," which have been conducted in many Russian centers on a regular basis since 1988. Surgical Olympiads stimulate student interest in the development of surgical skills before graduation and encourage students to choose surgery as their postgraduate specialty. Many of the participants in these surgical Olympiads have become highly qualified specialists in general surgery, orthopedic surgery, neurosurgery, urology, gynecology, and emergency medicine. The present article emphasizes the role of student interest groups and surgical Olympiads in clinical anatomical and surgical undergraduate training in Russia. © 2015 American Association of Anatomists.

An integrated movement capture and control platform applied towards autonomous movements of surgical robots.

Science.gov (United States)

Daluja, Sachin; Golenberg, Lavie; Cao, Alex; Pandya, Abhilash K; Auner, Gregory W; Klein, Michael D

2009-01-01

Robotic surgery has gradually gained acceptance due to its numerous advantages such as tremor filtration, increased dexterity and motion scaling. There remains, however, a significant scope for improvement, especially in the areas of surgeon-robot interface and autonomous procedures. Previous studies have attempted to identify factors affecting a surgeon's performance in a master-slave robotic system by tracking hand movements. These studies relied on conventional optical or magnetic tracking systems, making their use impracticable in the operating room. This study concentrated on building an intrinsic movement capture platform using microcontroller based hardware wired to a surgical robot. Software was developed to enable tracking and analysis of hand movements while surgical tasks were performed. Movement capture was applied towards automated movements of the robotic instruments. By emulating control signals, recorded surgical movements were replayed by the robot's end-effectors. Though this work uses a surgical robot as the platform, the ideas and concepts put forward are applicable to telerobotic systems in general.

Endothelial cell markers in vascular neoplasms: an immunohistochemical study comparing factor VIII-related antigen, blood group specific antigens, 6-keto-PGF1 alpha, and Ulex europaeus 1 lectin.

Science.gov (United States)

Little, D; Said, J W; Siegel, R J; Fealy, M; Fishbein, M C

1986-06-01

Markers for endothelial cells including Ulex europaeus 1 lectin, blood group A, B, and H, and the prostaglandin metabolite 6-keto-PGF1 alpha were evaluated in paraffin secretions from formalin-fixed benign and malignant vascular neoplasms using a variety of immunohistochemical techniques, and results compared with staining for factor VIII-related antigen. Staining for Ulex appeared more sensitive than factor VIII-related antigen in identifying poorly differentiated neoplasms including haemangiosarcomas and spindle cell proliferations in Kaposi's sarcoma. Staining for blood group related antigens correlated with blood group in all cases. Ulex europaeus 1 lectin was the only marker for endothelial cells in lymphangiomas.

Oral manifestations, dental management, and a rare homozygous mutation of the PRDM12 gene in a boy with hereditary sensory and autonomic neuropathy type VIII: a case report and review of the literature.

Science.gov (United States)

Elhennawy, Karim; Reda, Seif; Finke, Christian; Graul-Neumann, Luitgard; Jost-Brinkmann, Paul-Georg; Bartzela, Theodosia

2017-08-15

Hereditary sensory and autonomic neuropathy type VIII is a rare autosomal recessive inherited disorder. Chen et al. recently identified the causative gene and characterized biallelic mutations in the PR domain-containing protein 12 gene, which plays a role in the development of pain-sensing nerve cells. Our patient's family was included in Chen and colleagues' study. We performed a literature review of the PubMed library (January 1985 to December 2016) on hereditary sensory and autonomic neuropathy type I to VIII genetic disorders and their orofacial manifestations. This case report is the first to describe the oral manifestations, and their treatment, of the recently discovered hereditary sensory and autonomic neuropathy type VIII in the medical and dental literature. We report on the oral manifestations and dental management of an 8-month-old white boy with hereditary sensory and autonomic neuropathy-VIII over a period of 16 years. Our patient was homozygous for a mutation of PR domain-containing protein 12 gene and was characterized by insensitivity to pain and thermal stimuli, self-mutilation behavior, reduced sweat and tear production, absence of corneal reflexes, and multiple skin and bone infections. Oral manifestations included premature loss of teeth, associated with dental traumata and self-mutilation, severe soft tissue injuries, dental caries and submucosal abscesses, hypomineralization of primary teeth, and mandibular osteomyelitis. The lack of scientific knowledge on hereditary sensory and autonomic neuropathy due to the rarity of the disease often results in a delay in diagnosis, which is of substantial importance for the prevention of many complications and symptoms. Interdisciplinary work of specialized medical and dental teams and development of a standardized treatment protocols are essential for the management of the disease. There are many knowledge gaps concerning the management of patients with hereditary sensory and autonomic neuropathy-VIII

Postsurgical consequences in lower third molar surgical extraction using micromotor and piezosurgery.

Science.gov (United States)

Mistry, Freddy Kersi; Hegde, Nidarsh Diwakar; Hegde, Mithra Nidarsh

2016-01-01

One of the most critical and crucial steps in surgical extraction is cutting the bone or osteotomy, for which many techniques are used, e.g., chisels and mallet, rotary instruments, and ultrasound bone-cutting instruments. If they are not used judiciously, they can be hazardous. To assess the efficiency of piezosurgery unit over micromotor while performing surgical extraction of lower third molars by assessing the time taken for the surgery and measuring postoperative parameters such as pain, trismus, and swelling. Thirty patients having bilateral impacted third molars with the same difficulty index were selected for the study. One side surgical removal was done using micromotor and other side by piezosurgery with an interval of 15 days. After each surgery, time taken to finish was measured and patients were followed up on postoperative days 1, 3, 5, 7, and 15 for assessing pain, trismus, and swelling. Data obtained were statistically analyzed. The mean time taken for the micromotor group is 37.90 min whereas by the piezosurgery group is 54.63 min, showing a statistically significant difference ( P < 0.001). Furthermore, there is statistically significant difference ( P < 0.001) in the level of pain, trismus, and swelling on postoperative days 1, 3, 5, and 7. Even the intragroup comparison of piezosurgical group for trismus and swelling showed no statistically significant difference on postoperative day 7, indicating faster recovery of trismus and swelling. On postoperative day 15, there was no difference in any parameter in both groups indicating complete symptom-free recovery in both groups. It takes more time to perform surgical extraction of third molars when piezosurgical unit is used. Despite that, it causes less pain postoperatively with faster improvement in trismus and quicker reduction in swelling.

Retsensioon : Riigikogu VII, VIII ja IX koosseis. Statistikat ja kommentaare. Peatoimetaja Aaro Mõttus. Tallinn : Riigikogu Kantselei, Eesti Rahvusraamatukogu, 2004. 326 lk. / Mart Nutt

Index Scriptorium Estoniae

Nutt, Mart, 1962-

2004-01-01

Arvustus: Riigikogu VII, VIII ja IX koosseis. Statistikat ja kommentaare / peatoim. Aaro Mõttus. Tallinn : Riigikogu Kantselei, Eesti Rahvusraamatukogu, 2004. - Lisatud: Ott Heinapuu tutvustav sõnum retsenseeritud väljaande kohta lk. 193. - Vt. ka: http://www.riigikogu.ee/rito/index.php?id=11357

Assessment of communication, professionalism, and surgical skills in an objective structured performance-related examination (OSPRE): a psychometric study.

Science.gov (United States)

Ponton-Carss, Alicia; Hutchison, Carol; Violato, Claudio

2011-10-01

The purpose of this study was to investigate the reliability and validity of a performance assessment of communication, professionalism, and surgical skills competencies for surgery residents. Fourteen residents from the general surgery program of the University of Calgary were assessed in 7 surgical simulation stations that included communication and professionalism skills. The internal consistency reliability of the checklists and global rating scales combined was adequate for communication (α = .75-.92) and surgical skills (α = .86-.96), but not for professionalism (α = 0). There was evidence of validity as surgical skills performance improved as a function of postgraduate year level but not for the professionalism checklist. Surgical skills and communication correlated in the 2 stations assessed (r = .55 and .57; P communication skills. Further instrument development is required to assess professionalism in a structured examination context. Copyright © 2011 Elsevier Inc. All rights reserved.

Underground Test Area Subproject Phase I Data Analysis Task. Volume VIII - Risk Assessment Documentation Package

Energy Technology Data Exchange (ETDEWEB)

None

1996-12-01

Volume VIII of the documentation for the Phase I Data Analysis Task performed in support of the current Regional Flow Model, Transport Model, and Risk Assessment for the Nevada Test Site Underground Test Area Subproject contains the risk assessment documentation. Because of the size and complexity of the model area, a considerable quantity of data was collected and analyzed in support of the modeling efforts. The data analysis task was consequently broken into eight subtasks, and descriptions of each subtask's activities are contained in one of the eight volumes that comprise the Phase I Data Analysis Documentation.

Practice Makes Perfect: Correlations Between Prior Experience in High-level Athletics and Robotic Surgical Performance Do Not Persist After Task Repetition.

Science.gov (United States)

Shee, Kevin; Ghali, Fady M; Hyams, Elias S

Robotic surgical skill development is central to training in urology as well as in other surgical disciplines. Here, we describe a pilot study assessing the relationships between robotic surgery simulator performance and 3 categories of activities, namely, videogames, musical instruments, and athletics. A questionnaire was administered to preclinical medical students for general demographic information and prior experiences in surgery, videogames, musical instruments, and athletics. For follow-up performance studies, we used the Matchboard Level 1 and 2 modules on the da Vinci Skills Simulator, and recorded overall score, time to complete, economy of motion, workspace range, instrument collisions, instruments out of view, and drops. Task 1 was run once, whereas task 2 was run 3 times. All performance studies on the da Vinci Surgical Skills Simulator took place in the Simulation Center at Dartmouth-Hitchcock Medical Center. All participants were medical students at the Geisel School of Medicine. After excluding students with prior hands-on experience in surgery, a total of 30 students completed the study. We found a significant correlation between athletic skill level and performance for both task 1 (p = 0.0002) and task 2 (p = 0.0009). No significant correlations were found for videogame or musical instrument skill level. Students with experience in certain athletics (e.g., volleyball, tennis, and baseball) tended to perform better than students with experience in other athletics (e.g., track and field). For task 2, which was run 3 times, this association did not persist after the third repetition due to significant improvements in students with low-level athletic skill (levels 0-2). Our study suggests that prior experience in high-level athletics, but not videogames or musical instruments, significantly influences surgical proficiency in robot-naive students. Furthermore, our study suggests that practice through task repetition can overcome initial differences

Prediction of human pharmacokinetics of activated recombinant factor VII and B-domain truncated factor VIII from animal population pharmacokinetic models of haemophilia

DEFF Research Database (Denmark)

Larsen, Malte Selch; Juul, Rasmus Vestergaard; Groth, Andreas Velsing

2018-01-01

activated factor VII (rFVIIa) and recombinant factor VIII (rFVIII) in several experimental animal models using population PK modelling, and apply a simulation-based approach to evaluate how well the developed animal population PK models predict human PK. PK models were developed for rFVIIa and r...

Ergonomic investigation of weight distribution of laparoscopic instruments.

Science.gov (United States)

Lin, Chiuhsiang Joe; Chen, Hung-Jen; Lo, Ying-Chu

2011-06-01

Laparoscopic surgery procedures require highly specialized visually controlled movements. Investigations of industrial applications indicate that the length as well as the weight of hand-held tools substantially affects movement time (MT). Different weight distributions may have similar effects on long-shafted laparoscopic instruments when performing surgical procedures. For this reason, the current experiment aimed at finding direct evidence of the weight distribution effect in an accurate task. Ten right-handed subjects made continuous Fitts' pointing tasks using a long laparoscopic instrument. The factors and levels were target width: (2.5, 3, 3.5, and 4 cm), target distance (14, 23, and 37 cm), and weight distribution (uniform, front, middle, and rear). Weight distribution was made by chips of lead attached to the laparoscopic instrument. MT, error rate, and throughput (TP) were recorded as dependent variables. There were significant differences between the weight distribution in MT and in TP. The middle position was found to require the least time to manipulate the laparoscopic instrument in pointing tasks and also obtained the highest TP. These analyses and findings pointed to a design direction for the ergonomics and usability of the long hand-held tool such as the laparoscopic instrument in this study. To optimize efficiency in using these tools, the consideration of a better weight design is important and should not be neglected.

Benefits of using customized instrumentation in total knee arthroplasty: results from an activity-based costing model.

Science.gov (United States)

Tibesku, Carsten O; Hofer, Pamela; Portegies, Wesley; Ruys, C J M; Fennema, Peter

2013-03-01

The growing demand for total knee arthroplasty (TKA) associated with the efforts to contain healthcare expenditure by advanced economies necessitates the use of economically effective technologies in TKA. The present analysis based on activity-based costing (ABC) model was carried out to estimate the economic value of patient-matched instrumentation (PMI) compared to standard surgical instrumentation in TKA. The costs of the two approaches, PMI and standard instrumentation in TKA, were determined by the use of ABC which measures the cost of a particular procedure by determining the activities involved and adding the cost of each activity. Improvement in productivity due to increased operating room (OR) turn-around times was determined and potential additional revenue to the hospital by the efficient utilization of gained OR time was estimated. Increased efficiency in the usage of OR and utilization of surgical trays were noted with patient-specific approach. Potential revenues to the hospital were estimated with the use of PMI by efficient utilization of time saved in OR. Additional revenues of 78,240 per year were estimated considering utilization of gained OR time to perform surgeries other than TKA. The analysis suggests that use of PMI in TKA is economically effective when compared to standard instrumentation.

A review of psychological assessment instruments for use in bariatric surgery evaluations.

Science.gov (United States)

Marek, Ryan J; Heinberg, Leslie J; Lavery, Megan; Merrell Rish, Julie; Ashton, Kathleen

2016-09-01

Bariatric surgery is a viable treatment option for patients with extreme obesity and associated medical comorbidities; however, optimal surgical outcomes are not universal. Surgical societies, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), recommend that patients undergo a presurgical psychological evaluation that includes reviewing patients' medical charts, conducting a comprehensive clinical interview, and employing some form of objective psychometric testing. Despite numerous societies recommending the inclusion of self-report assessments, only about 2/3 of clinics actively use psychological testing-some of which have limited empirical support to justify their use. This review aims to critically evaluate the psychometric properties of self-report measures when used in bariatric surgery settings and provide recommendations to help guide clinicians in selecting instruments to use in bariatric surgery evaluations. Recommended assessment batteries include use of a broadband instrument along with a narrowband eating measure. Suggestions for self-report measures to include in a presurgical psychological evaluation in bariatric surgery settings are also provided. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The far lateral transpontomedullary sulcus approach to pontine cavernous malformations: technical report and surgical results.

Science.gov (United States)

Abla, Adib A; Benet, Arnau; Lawton, Michael T

2014-09-01

Pontine cavernous malformations (CMs) located on a peripheral pontine surface or the fourth ventricular floor are resectable lesions, but those deep within the pons away from a pial surface are typically observed. However, the anterior bulge of the pons formed by the brachium pontis creates a unique entry point for access to deep pontine lesions from below, working upward through the pontomedullary sulcus. We developed a transpontomedullary sulcus (TPMS) approach to these lesions. The TPMS approach used the far lateral craniotomy and upper vagoaccessory triangle to define the surgical corridor. The entry point was above the olive, lateral to the pyramidal tracts and cranial nerve (CN) VI, above the preolivary sulcus and CN XII, and medial to CNs VII and VIII and CNs IX through XI. Four patients underwent this approach. All presented with hemorrhage and CN VI palsies. All pontine CMs were resected completely. Three patients were improved or unchanged, with good outcomes (modified Rankin Scale score ≤2) in all patients. The central pons remains difficult territory to access, and new surgical corridors are needed. The bulging underbelly of the pons allows access to pontine lesions deep to the pial surface from below. The far lateral TPMS approach is a novel and more direct alternative to the retrosigmoid transmiddle cerebellar peduncle approach. Unlike the retrosigmoid approach, the TPMS approach requires minimal parenchymal transgression and uses a brainstem entry point medial to most lower CNs. Favorable results demonstrate the feasibility of resecting pontine CMs that might have been previously deemed unresectable.

Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires : A Systematic Review of Surgical Never Events.

Science.gov (United States)

Hempel, Susanne; Maggard-Gibbons, Melinda; Nguyen, David K; Dawes, Aaron J; Miake-Lye, Isomi; Beroes, Jessica M; Booth, Marika J; Miles, Jeremy N V; Shanman, Roberta; Shekelle, Paul G

2015-08-01

Serious, preventable surgical events, termed never events, continue to occur despite considerable patient safety efforts. To examine the incidence and root causes of and interventions to prevent wrong-site surgery, retained surgical items, and surgical fires in the era after the implementation of the Universal Protocol in 2004. We searched 9 electronic databases for entries from 2004 through June 30, 2014, screened references, and consulted experts. Two independent reviewers identified relevant publications in June 2014. One reviewer used a standardized form to extract data and a second reviewer checked the data. Strength of evidence was established by the review team. Data extraction was completed in January 2015. Incidence of wrong-site surgery, retained surgical items, and surgical fires. We found 138 empirical studies that met our inclusion criteria. Incidence estimates for wrong-site surgery in US settings varied by data source and procedure (median estimate, 0.09 events per 10,000 surgical procedures). The median estimate for retained surgical items was 1.32 events per 10,000 procedures, but estimates varied by item and procedure. The per-procedure surgical fire incidence is unknown. A frequently reported root cause was inadequate communication. Methodologic challenges associated with investigating changes in rare events limit the conclusions of 78 intervention evaluations. Limited evidence supported the Universal Protocol (5 studies), education (4 studies), and team training (4 studies) interventions to prevent wrong-site surgery. Limited evidence exists to prevent retained surgical items by using data-matrix-coded sponge-counting systems (5 pertinent studies). Evidence for preventing surgical fires was insufficient, and intervention effects were not estimable. Current estimates for wrong-site surgery and retained surgical items are 1 event per 100,000 and 1 event per 10,000 procedures, respectively, but the precision is uncertain, and the per

Measurements of the ground-state ionization energy and wavelengths for the 1snp 1P1*-1s21S0 (n=4-9) lines of Mg XI and F VIII

International Nuclear Information System (INIS)

Pal'chikov, V.G.; Ya Faenov, A.; Yu Skobelev, I.

2002-01-01

The wavelengths of the 1snp 1 P 1 0 -1s 2 1 S 0 transitions in the He-like Mg XI (n = 4-9) and F VIII (n=4-8) have been measured in laser-produced plasmas. The accuracy of the present measurements (0.4-1.6 mA) is a large improvement over previous results. The Rydberg series is used to determine the ground-state ionization energy of F VIII and Mg XI: E i on (F VIII) 953.96±0.11 eV, E i on (Mg XI)=1761.88±0.15 eV. These experimental results are compared with theoretical data calculated by the 1/Z-expansion method and the HFR and MCDF approaches. Fairly good agreement between theory and experiment is observed with a precision up to 5x10 -5 . Radiative corrections to the 1s 2 1 S 0 state are analysed and compared with experiments. It is found that QED corrections to the ground-state ionization energy are significant at the present level of experimental accuracy. (author)

Validation Study of Waray Text Readability Instrument

Science.gov (United States)

Oyzon, Voltaire Q.; Corrales, Juven B.; Estardo, Wilfredo M., Jr.

2015-01-01

In 2012 the Leyte Normal University developed a computer software--modelled after the Spache Readability Formula (1953) made for English--made to help rank texts that can is used by teachers or research groups on selecting appropriate reading materials to support the DepEd's MTB-MLE program in Region VIII, in the Philippines. However,…

Surgical orthodontics.

Science.gov (United States)

Strohl, Alexis M; Vitkus, Lauren

2017-08-01

The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.

Surgical options for lumbosacral fusion: biomechanical stability, advantage, disadvantage and affecting factors in selecting options.

Science.gov (United States)

Yoshihara, Hiroyuki

2014-07-01

Numerous surgical procedures and instrumentation techniques for lumbosacral fusion (LSF) have been developed. This is probably because of its high mechanical demand and unique anatomy. Surgical options include anterior column support (ACS) and posterior stabilization procedures. Biomechanical studies have been performed to verify the stability of those options. The options have their own advantage but also disadvantage aspects. This review article reports the surgical options for lumbosacral fusion, their biomechanical stability, advantages/disadvantages, and affecting factors in option selection. Review of literature. LSF has lots of options both for ACS and posterior stabilization procedures. Combination of posterior stabilization procedures is an option. Furthermore, combinations of ACS and posterior stabilization procedures are other options. It is difficult to make a recommendation or treatment algorithm of LSF from the current literature. However, it is important to know all aspects of the options and decision-making of surgical options for LSF needs to be tailored for each patient, considering factors such as biomechanical stress and osteoporosis.

MENINGKATKAN TANGGUNG JAWAB SOSIAL SISWA KELAS VIII MELALUI LAYANAN BIMBINGAN KELOMPOK

Directory of Open Access Journals (Sweden)

Ummi Farikhatun Nisa

2012-12-01

Full Text Available The purpose of this research was to determine the efforts and success in improving students' social responsibility through group counseling services. Type of research used action research. Subjects were 12 students who had low social responsibility and being. Data collection technique used were psychological scales and observation. Data analysis techniques used are non-parametric statistics with the Wilcoxon test. Based on the calculations for the Wilcoxon test, a small amount of levels or Z value was 78.0. While Ztabel for n = 12 with an error level of 5% value is 14. So Z 78.0> 14.0 Ztabel or imply hypothesis accepted. These results demonstrate social responsibility of students prior to obtaining counseling services group at 51.93% (low. After following the guidance services at 81.51% (high. Conclusions from this research is a social responsibility to the students of class VIII SMP Putra Bangsa Bantarkawung increase after getting tutoring services group.

Assessing patients' and caregivers' perspectives on stability of factor VIII products for haemophilia A

DEFF Research Database (Denmark)

DiBenedetti, D B; Coles, T M; Sharma, T

2014-01-01

Haemophilia A is a rare inherited bleeding disorder characterized by an inability of the blood to clot normally. Patients can experience spontaneous or trauma-induced joint and soft tissue bleeding and must keep coagulation factor VIII (FVIII) accessible at all times; thus, FVIII product storage...... challenges with storing FVIII products, especially storage away from home. More than half preferred storing FVIII products at room temperature vs. in the refrigerator for long periods of time. FVIII product accessibility, usage and storage affect disease management. Results support the need for more...... convenient and accessible FVIII products for patients in daily life and while travelling. In addition, the use of social media has potential value in recruiting this population....

Work-family conflict and neck and back pain in surgical nurses.

Science.gov (United States)

Baur, Heiner; Grebner, Simone; Blasimann, Angela; Hirschmüller, Anja; Kubosch, Eva Johanna; Elfering, Achim

2018-03-01

Surgical nurses' work is physically and mentally demanding, possibly leading to work-family conflict (WFC). The current study tests WFC to be a risk factor for neck and lower back pain (LBP). Job influence and social support are tested as resources that could buffer the detrimental impact of WFC. Forty-eight surgical nurses from two university hospitals in Germany and Switzerland were recruited. WFC was assessed with the Work-Family Conflict Scale. Job influence and social support were assessed with the Copenhagen Psychosocial Questionnaire, and back pain was assessed with the North American Spine Society Instrument. Multiple linear regression analyses confirmed WFC as a significant predictor of cervical pain (β = 0.45, p Work-life interventions may have the potential to reduce WFC in surgery nurses.

Hubungan Self-esteem dan Penggunaan Media Sosial Instagram dengan Perilaku Narsisme di Kalangan Siswa Kelas VIII Smpk Penabur Bintaro Jaya

OpenAIRE

Wibowo, Yonatan; Silaen, Sondang Maria J

2018-01-01

Tujuan dari penelitian ini adalah untuk mengetahui ada tidaknya hubungan self-esteem dan penggunaanmedia sosial Instagram dengan perilaku narsisme di kalangan siswa kelas VIII SMPK Penabur Bintaro Jaya.Dalam penelitian ini terdapat tiga variabel, yaitu perilaku narsisme sebagai variabel terikat serta self-esteem danpenggunaan media sosial Instagram sebagai variabel bebas. Sampel dalam penelitian ini adalah siswa kelasdelapan tahun pelajaran 2016/2017. Teknik pengambilan sampel dalam penelitia...

Surgical Tip for Prevention of Lip Injury During Orthognathic and Facial Bone Contouring Surgery.

Science.gov (United States)

Lee, Tae Sung; Park, Sanghoon

2017-10-01

Iatrogenic lip injury is a rather common complication after facial bone surgery, but is usually treated lightly by the surgeon compared with other more severe functional complications. However, these injuries can have permanent sequelae and can therefore be a reason for patient dissatisfaction, especially after cosmetic surgery. Intraoperative lip injuries during facial bone surgery are usually caused by heat-generating surgical instruments or forced traction on the operative fields. The authors have applied a special technical strategy using a hydrocolloid dressing material to avoid these intraoperative lip injuries. This method does not disturb the operative procedure itself, but efficiently prevents lip injuries and decreases surgical morbidities and postoperative swelling.

Il ruolo di El Escorial, V.III.6 e dei suoi discendenti nella tradizione manoscritta del Lucullus

Directory of Open Access Journals (Sweden)

Corinna Senore

2017-05-01

Full Text Available L’articolo riguarda un gruppo di sette codici che tramanda il testo del Lucullus di Cicerone e che appartiene al ramo della tradizione discendente dal manoscritto Wien, Österreichische Nationalbibliothek 189. I sette manoscritti costituiscono uno stadio della tradizione caratterizzato dalla presenza di tre lacune testuali. Sulla base di alcuni elementi paleografici e della presenza di una glossa riportata a margine del testo di uno di essi, El Escorial, V.III.6 (Scor4, e inglobata all’interno del testo degli altri sei, è possibile individuare in Scor4 il capostipite di questo gruppo della tradizione. Lo studio si occupa inoltre di fare chiarezza sui rapporti che intercorrono tra i sei discendenti di Scor4. The article focuses on a group of seven codices which carry the text of Cicero’s Lucullus. This group belongs to the branch of the tradition descending from the manuscript Wien, Österreichische Nationalbibliothek 189. The seven manuscripts represent a step of the tradition marked by the presence of some textual lacunas. I start from some paleographic elements and from the presence of a gloss on text’s margin of one of them, El Escorial, V.III.6 (Scor4. The gloss has been then incorporated in the text of the other six manuscripts and I assume that Scor4 is the founder of this group of tradition. Furthermore, this article aims to clarify the relations between the six descendants of Scor4.

Patient specific instrumentation in total knee arthroplasty: a state of the art

Science.gov (United States)

Mattei, Lorenzo; Pellegrino, Pietro; Bistolfi, Alessandro; Castoldi, Filippo

2016-01-01

Patient specific instrumentation (PSI) is a modern technique in total knee arthroplasty (TKA) aiming to facilitate the implant of the prosthesis. The customized cutting blocks of the PSI are generated from pre-operative three-dimensional model, using computed tomography (CT) or magnetic resonance imaging (MRI). A correct surgical plan is mandatory for a good surgical implant. The PSI guide takes into account any slight deformities or osteophytes and applies preoperative planning for bone resection, using the pre-determined implant size, position, and rotation. The apparent benefits of this technology are that neutral postoperative alignment is more reproducible, surgical time is decreased, and the entire procedure results more efficient and cost-effective. The use of PSI is indicated when advanced osteoarthritis, severe pain, and limited function/walking ability are present, such as in a standard instrumentation TKA. In addition to that, PSI finds its indication when intra-medullary guides cannot be used. For example, when there is a post-traumatic femoral deformity. Large debates have taken place about this topic during the last years and, at the moment, there is no consensus in literature regarding the accuracy and reliability of PSI as many studies have shown controversial and inconsistent results. Literature does not suggest PSI techniques as a gold standard in TKA, and therefore it cannot be recommended as a standard technique in standard, not complicated primary TKA. Moreover, literature does not underline any improvement in components alignment, surgical time, blood loss or functional outcomes. Nevertheless, many patients who underwent TKA suffered a previous trauma. In case of deformities, like femoral or tibial fractures healed with a malalignment, preoperative planning may result difficult, and some intra-operative technical difficulties can occur, such as the use of intra-medullar rod. In these selected cases, PSIs may be very useful to avoid errors in

Radiation burden to personal during surgical and urological reentgenology

Energy Technology Data Exchange (ETDEWEB)

Doubravsky, J; Kukacka, R

1976-01-01

The radiation load was measured in surgical personnel during operation of femoral neck fracture and during instrumental urological roentgenology, using film dosimetry. Here are the conclusions: (1) It is obligatory for medical personnel to use protective lead-rubber aprons during surgical and urological roentgenology. At surgical examinations, where the surgeon stands at the operating table, a short apron, covering the lower half of the body, may suffice. (2) Skiascopy, being the chief source of radiation load, should be reduced to the shortest possible time. (3) When handling the patient or film holder, protective gloves should be worn and the primary radiation beam avoided. (4) Clinical workers should be repeatedly instructed, both in theory and practice, how to work with X radiation sources. (5) In larger clinics with intensive roentgenological services the workers should be rotated; nurses should not be in the reproductive age. For newly established uro-roentgenological examination rooms the regional hygiene officer may issue regulations limiting the number of examinations per day and per person. (6) Non-roentgenologists participating in roentgenological examinations should be provided with dosimeters and included in compulsory preventive periodical examinations in accordance with the regulation ''Mandatory Measures No. 49/1967, Directives Concerning Medical Fitness for Work''.

Virtual reality based surgical assistance and training system for long duration space missions.

Science.gov (United States)

Montgomery, K; Thonier, G; Stephanides, M; Schendel, S

2001-01-01

Access to medical care during long duration space missions is extremely important. Numerous unanticipated medical problems will need to be addressed promptly and efficiently. Although telemedicine provides a convenient tool for remote diagnosis and treatment, it is impractical due to the long delay between data transmission and reception to Earth. While a well-trained surgeon-internist-astronaut would be an essential addition to the crew, the vast number of potential medical problems necessitate instant access to computerized, skill-enhancing and diagnostic tools. A functional prototype of a virtual reality based surgical training and assistance tool was created at our center, using low-power, small, lightweight components that would be easy to transport on a space mission. The system consists of a tracked, head-mounted display, a computer system, and a number of tracked surgical instruments. The software provides a real-time surgical simulation system with integrated monitoring and information retrieval and a voice input/output subsystem. Initial medical content for the system has been created, comprising craniofacial, hand, inner ear, and general anatomy, as well as information on a number of surgical procedures and techniques. One surgical specialty in particular, microsurgery, was provided as a full simulation due to its long training requirements, significant impact on result due to experience, and likelihood for need. However, the system is easily adapted to realistically simulate a large number of other surgical procedures. By providing a general system for surgical simulation and assistance, the astronaut-surgeon can maintain their skills, acquire new specialty skills, and use tools for computer-based surgical planning and assistance to minimize overall crew and mission risk.

Love and/in psychoanalysis: a commentary on Lacan's reading of Plato's Symposium in Seminar VIII: Transference.

Science.gov (United States)

Fink, Bruce

2015-02-01

What is love and what part does it play in psychoanalysis? Where are the analyst and the analysand situated in relation to the roles defined as those of the "lover" and the "beloved"? Jacques Lacan explores these and other questions in his soon-to-be-published Seminar VIII: Transference by providing an extensive commentary on Plato's most famous dialogue on love, the Symposium. This paper outlines some of the major points about love that grow out of Lacan's reading of the dialogue and examines their relevance to the analytic setting. Can the analyst be characterized as a sort of modern-day Socrates?

Lowest instrumented vertebra selection in Lenke 3C and 6C scoliosis

DEFF Research Database (Denmark)

Wang, Yu; Bünger, Cody; Zhang, Yanqun

2012-01-01

PURPOSE: The aim of this study was to investigate whether or not post-op curve behaviour differs due to different choices of lowest instrumented vertebra (LIV) with reference to lumbar apical vertebra (LAV) in Lenke 3C and 6C scoliosis. METHODS: We reviewed all the AIS cases surgically treated...... it can yield similar correction while preserving more lumbar mobility and growth potential....

Evaluation of robotic-assisted platysmaplasty procedures in a cadaveric model using the da Vinci Surgical System.

Science.gov (United States)

Taghizadeh, Farhan; Reiley, Carol; Mohr, Catherine; Paul, Malcolm

2014-03-01

We are evaluating the technical feasibility of robotic-assisted laparoscopic vertical-intermediate platysmaplasty in conjunction with an open rhytidectomy. In a cadaveric study, the da Vinci Surgical System was used to access certain angles in the lower neck that are difficult for traditional short incision, short flap procedures. Ergonomics, approach, and technical challenges were noted. To date, there are no published reports of robotic-assisted neck lifts, motivating us to assess its potential in this field of plastic surgery. Standard open technique short flap rhytidectomies with concurrent experimental robotic-assisted platysmaplasties (neck lifts) were performed on six cadavers with the da Vinci Si Surgical System(®) (Intuitive Surgical, Sunnyvale, CA, USA). The surgical procedures were performed on a diverse cadaver population from June 2011 to January 2012. The procedures included (1) submental incision and laser-assisted liposuction, (2) open rhytidectomy, and (3) robotic-assisted platysmaplasty using knot-free sutures. A variety of sutures and fat extraction techniques, coupled with 0° and 30° three-dimensional endoscopes, were utilized to optimize visualization of the platysma. An unaltered da Vinci Si Surgical System with currently available instruments was easily adaptable to neck lift surgery. Mid-neck platysma exposure was excellent, tissue handling was delicate and precise, and suturing was easily performed. Robotic-assisted surgery has the potential to improve outcomes in neck lifts by offering the ability to manipulate instruments with increased freedom of movement, scaled motion, tremor reduction, and stereoscopic three-dimensional visualization in the deep neck. Future clinical studies on live human patients can better assess subject and surgeon benefits arising from the use of the da Vinci system for neck lifts. Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in

Micro-surgical endodontics.

Science.gov (United States)

Eliyas, S; Vere, J; Ali, Z; Harris, I

2014-02-01

Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

Automatic classification of minimally invasive instruments based on endoscopic image sequences

Science.gov (United States)

Speidel, Stefanie; Benzko, Julia; Krappe, Sebastian; Sudra, Gunther; Azad, Pedram; Müller-Stich, Beat Peter; Gutt, Carsten; Dillmann, Rüdiger

2009-02-01

Minimally invasive surgery is nowadays a frequently applied technique and can be regarded as a major breakthrough in surgery. The surgeon has to adopt special operation-techniques and deal with difficulties like the complex hand-eye coordination and restricted mobility. To alleviate these constraints we propose to enhance the surgeon's capabilities by providing a context-aware assistance using augmented reality techniques. To analyze the current situation for context-aware assistance, we need intraoperatively gained sensor data and a model of the intervention. A situation consists of information about the performed activity, the used instruments, the surgical objects, the anatomical structures and defines the state of an intervention for a given moment in time. The endoscopic images provide a rich source of information which can be used for an image-based analysis. Different visual cues are observed in order to perform an image-based analysis with the objective to gain as much information as possible about the current situation. An important visual cue is the automatic recognition of the instruments which appear in the scene. In this paper we present the classification of minimally invasive instruments using the endoscopic images. The instruments are not modified by markers. The system segments the instruments in the current image and recognizes the instrument type based on three-dimensional instrument models.

Investigation of incidence and risk factors for surgical glove perforation in small animal surgery.

Science.gov (United States)

Hayes, Galina M; Reynolds, Deborah; Moens, Noel M M; Singh, Ameet; Oblak, Michelle; Gibson, Thomas W G; Brisson, Brigitte A; Nazarali, Alim; Dewey, Cate

2014-05-01

To identify incidence and risk factors for surgical glove perforation in small animal surgery. Observational cohort study. Surgical gloves (n = 2132) worn in 363 surgical procedures. All gloves worn by operative personnel were assessed for perforation at end-procedure using a water leak test. Putative risk factors were recorded by a surgical team member. Associations between risk factors and perforation were assessed using multivariable multi-level random-effects logistic regression models to control for hierarchical data structure. At least 1 glove perforation occurred in 26.2% of procedures. Identified risk factors for glove perforation included increased surgical duration (surgery >1 hour OR = 1.79, 95% CI = 1.12-2.86), performing orthopedic procedures (OR = 1.88; 95% CI = 1.23-2.88), any procedure using powered instruments (OR = 1.93; 95% CI = 1.21-3.09) or surgical wire (OR = 3.02; 95% CI = 1.50-6.05), use of polyisoprene as a glove material (OR = 1.59, 95% CI = 1.05-2.39), and operative role as primary surgeon (OR = 2.01; 95% CI = 1.35-2.98). The ability of the wearer to detect perforations intraoperatively was poor, with a sensitivity of 30.8%. There is a high incidence of unrecognized glove perforations in small animal surgery. © Copyright 2014 by The American College of Veterinary Surgeons.

20 CFR 404.535 - How much will we withhold from your title VIII and title XVI benefits to recover a title II...

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How much will we withhold from your title... Officer § 404.535 How much will we withhold from your title VIII and title XVI benefits to recover a title II overpayment? (a) If past-due benefits are payable to you, we will withhold the lesser of the...

Association of peak factor VIII levels and area under the curve with bleeding in patients with haemophilia A on every third day pharmacokinetic-guided prophylaxis

NARCIS (Netherlands)

Valentino, L. A.; Pipe, S. W.; Collins, P. W.; Blanchette, V. S.; Berntorp, E.; Fischer, K.; Ewenstein, B. M.; Oh, M.; Spotts, G.

2016-01-01

Introduction: We previously showed that pharmacokinetic-guided prophylaxis (PKP) allows the dosing interval to be extended while maintaining a specific trough level. However, the associations of peak factor VIII (FVIII) levels and area under the curve (AUC) with breakthrough bleeding have not been

Cost-effectiveness of decompression according to Gill versus instrumented spondylodesis in the treatment of sciatica due to low grade spondylolytic spondylolisthesis: A prospective randomised controlled trial [NTR1300

NARCIS (Netherlands)

M.P. Arts (Mark); M.J.T. Verstegen (Marco); R. Brand (René); B.W. Koes (Bart); M.E. van den Akker-van Marle (Elske); W.C. Peul (Wilco)

2008-01-01

textabstractBackground. Nerve root decompression with instrumented spondylodesis is the most frequently performed surgical procedure in the treatment of patients with symptomatic low-grade spondylolytic spondylolisthesis. Nerve root decompression without instrumented fusion, i.e. Gill's procedure,

The Funnel Geometry of Open Flux Tubes in the Low Solar Corona Constrained by O VI and Ne VIII Outflow

Science.gov (United States)

Byhring, Hanne S.; Esser, Ruth; Lie-Svendsen, Oystein

2008-01-01

Model calculations show that observed outflow velocities of order 7-10 km/s of C IV and O VI ions, and 15-20 km/s of Ne VIII ions, are not only consistent with models of the solar wind from coronas holes, but also place unique constraints on the degree of flow tube expansion as well as the location of the expansion in the transition region/lower corona.

[Effect of a multifunctional instrument (HF scissors) in parotis surgery].

Science.gov (United States)

Strauss, G; Schaller, S; Gollnick, I

2014-03-01

Lateral parotidectomy is a demanding surgical procedure and requires a large number of instruments with a high frequency (HF) of alternating. Many functions, such as preparing, spreading, coagulating and cutting could be combined by using scissors with an integrated function of bipolar coagulation. This study has targeted an investigation of technical application, influence on surgery time, frequency of HF application and change of instruments. In the period between 01 April 2011 and 30 September 2012 (18 months) 35 procedures of lateral parotidectomy in 35 patients were investigated. In all cases lateral parotidectomy was carried out with a similar technique (modified extracapsular preparation). Workflow data were used from a control group in the period between 01 January 2009 and 31 December 2010 (24 months). The following parameters from both groups were documented and evaluated: incision-suture times (subdivided into nine sections of the procedure), change of instruments, period of application for HF function and early facial nerve function (6 h and 6 days after surgery according to House-Brackmann). Additionally, in the HF+ group a questionnaire that facilitated subjective evaluation of instruments was analyzed. It was possible to perform the surgery in both groups with neither technical nor surgical intraoperative complications. Incision-suture times showed an average reduction of 31.6 min (34.8 %) in the HF+ group. There was a reduction in the change of instruments compared to a conventional group (CONV) by up to 62.7 %. With the deployment of HF scissors there was a clear increase in the use of HF surgery by more than 100 % when comparing incision-suture times. Evaluation of both groups according to House-Brackmann showed a similar postoperative facial nerve function. The surgeons involved were of the opinion that in all 35 surgeries with HF scissors the intervention was easier and more comfortable. The use of HF scissors is appropriate for parotid gland

Mobile surgical skills education unit: a new concept in surgical training.

Science.gov (United States)

Shaikh, Faisal M; Hseino, Hazem; Hill, Arnold D K; Kavanagh, Eamon; Traynor, Oscar

2011-08-01

Basic surgical skills are an integral part of surgical training. Simulation-based surgical training offers an opportunity both to trainees and trainers to learn and teach surgical skills outside the operating room in a nonpatient, nonstressed environment. However, widespread adoption of simulation technology especially in medical education is prohibited by its inherent higher cost, limited space, and interruptions to clinical duties. Mobile skills laboratory has been proposed as a means to address some of these limitations. A new program is designed by the Royal College of Surgeons in Ireland (RCSI), in an approach to teach its postgraduate basic surgical trainees the necessary surgical skills, by making the use of mobile innovative simulation technology in their own hospital settings. In this article, authors describe the program and students response to the mobile surgical skills being delivered in the region of their training hospitals and by their own regional consultant trainers.

Microvascular injury of the peribiliary plexus associated with transarterial chemoembolization: a study of surgical specimens

Energy Technology Data Exchange (ETDEWEB)

Park, Won Kyu; Bae, Young Kyung; Hwang, Tae Yoon; Cho, Jae Ho; Chang, Jay Chun; Kim, Jae Woon; Jang, Han Won [College of Medicine, Yeungnam University, Daegu (Korea, Republic of)

2006-11-15

We attempted to evaluate the relationship between transarteiral chemoembolization (TACE) and injury to the peribiliary plexus by evaluating the number of microvessels in peribiliary plexus of surgical specimen. Surgical specimens were obtained from 78 hepatocellular carcinoma patients and 22 patients with liver metastases. They were divided into 4 groups (Group 1; hepatocellular carcinoma without TACE [n=30], Group 2; hepatocellular carcinoma receiving preoperative TACE once [n=37], Group 3; hepatocellular carcinoma receiving preoperative TACE more than two times [n=11] and Group 4; metastatic carcinoma of the liver patients without a history of liver disease [n=22]). Immunohistochemical staining for factor VIII-related antigen was performed in all the specimens and the number of microvessels in the inner capillary layer and the outer venous layer of the bile duct (> 200 {mu} m in diameter) was counted. The mean numbers of microvessels in the inner capillary layer were 4.50, 4.08, 1.64 and 2.05, and those in the outer venous layer were 25.23, 20.00, 18.36 and 12.32 for the 4 groups, respectively. The number of microvessels in group 4 was statistically fewer than that of group 1 ({rho} < 0.01). In the hepatocellular carcinoma patients, the number of microvessels was decreased as the number of TACE sessions was increased. The number of microvessels in the peribiliary plexus is increased in chronic liver disease patients. It may be from the increased portal pressure and flow stagnation in the sinusoidal and portal venules. TACE can have an effect on microvascular injury of the peibiliary plexus, and this can be a cause of bile duct necrosis and biloma.

Evaluation of the effect of cognitive therapy on perioperative anxiety and depression among Nigerian surgical patients.

Science.gov (United States)

Osinowo, H O; Olley, B O; Adejumo, A O

2003-12-01

Surgical paients have been known to benefit immensely from psychological interventions. This study set out to assess the pre and postoperative anxiety levels and depression and the effect of cognitive therapy among Nigerian surgical patients. The effects of gender and educational status on perioperative anxiety and depression were also evaluated. The study utilized a controlled outcome design to evaluate the efficacy of self-instructional training (SIT) and rational emotive therapy (RET) in surgical patients. Preoperative anxiety and depression scores were used as co-variants. Thirty-three (33) elective surgical patients were sampled randomly, divided into 3 groups of eleven (11) patients each. Eight (8) subjects underwent gynaecological procedures while the remaining 25 subjects had general surgical procedures. The mean age was 32.72 +/- 15.83 years (range = 17-16 years.) The major instruments used in the study were the State Anxiety Subscale of the Speilberger State Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Inventory. SIT had the potential to reduce anxiety level among subjects postoperatively (t = 2.06; df = 10; p < 0.05). The use of RET reduced depression among surgical patients (t = 1.23; df = 10; p < 0.05). It was concluded that surgical patients manifest varying degrees of anxiety preoperatively and postoperatively. Patient's pre and postoperative anxiety and depression can be reduced by the introduction of SIT and RET.

Port positioning and docking for single-stage totally robotic dissection for rectal cancer surgery with the Si and Xi Da Vinci Surgical System.

Science.gov (United States)

Toh, James Wei Tatt; Kim, Seon-Hahn

2017-11-04

We have previously reported our technique of single-docking totally robotic dissection for rectal cancer surgery using the Da Vinci ® Si Surgical System in 2009. However, we have since optimised our port placement for the Si system and have developed a novel configuration of port placement and docking for the Da Vinci ® Xi Surgical System. We have performed over 700 cases using this technique with the Si system and have used our Xi technique since 2016 for totally robotic dissection for rectal cancer. We have kept the configuration of port placements for both the Xi and Si system as similar as possible, with the priorities to avoid arm collisions as well as to provide a workable port configuration of two left-handed instruments and one right-handed instrument. To date, there have had no major complications or arm collisions related to this technique of docking, port positioning and instrument placement.

Health hazards of child labor in the leather products and surgical instrument manufacturing industries of Sialkot, Pakistan

International Nuclear Information System (INIS)

Junaid, Muhammad; Malik, Riffat Naseem; Pei, De-Sheng

2017-01-01

Child labor is a major challenge in the developing countries and comprehensive health hazard identification studies on this issue are still lacking. Therefore, the current study is an effort to highlight the health concerns of child labor exposed in the key small scale industries of Sialkot, Pakistan. Our findings revealed jolting levels of heavy metals in the urine, blood, serum, saliva, and hair samples collected from the exposed children. For example, in the urine samples, Cd, Cr, Ni, and Pb were measured at the respective concentrations of 39.17, 62.02, 11.94 and 10.53 μg/L in the surgical industries, and 2.10, 4.41, 1.04 and 5.35 μg/L in the leather industries. In addition, source apportionment revealed polishing, cutting, and welding sections in the surgical industries and surface coating, crusting, and stitching sections in the leather industries were the highest contributors of heavy metals in the bio-matrices of the exposed children, implying the dusty, unhygienic, and unhealthy indoor working conditions. Further, among all the bio-matrices, the hair samples expressed the highest bioaccumulation factor for heavy metals. In accordance with the heavy metal levels reported in the exposed children, higher oxidative stress was found in the children working in the surgical industries than those from the leather industries. Moreover, among heavy metals’ exposure pathways, inhalation of industrial dust was identified as the primary route of exposure followed by the ingestion and dermal contact. Consequently, chemical daily intake (CDI), carcinogenic and non-carcinogenic hazard quotients (HQs) of heavy metals were also reported higher in the exposed children and were also alarmingly higher than the corresponding US EPA threshold limits. Taken all together, children were facing serious health implications in these industries and need immediate protective measures to remediate the current situation. - Highlights: • Children occupational exposure assessment

Evaluation of the integrity of reactor vessels designed to ASME Code, Sections I and/or VIII

International Nuclear Information System (INIS)

Hoge, K.G.

1976-01-01

A documented review of nuclear reactor pressure vessels designed to ASME Code, Sections I and/or VIII is made. The review is primarily concerned with the design specifications and quality assurance programs utilized for the reactor vessel construction and the status of power plant material surveillance programs, pressure-temperature operating limits, and inservice inspection programs. The following ten reactor vessels for light-water power reactors are covered in the report: Indian Point Unit No. 1, Dresden Unit No. 1, Yankee Rowe, Humboldt Bay Unit No. 3, Big Rock Point, San Onofre Unit No. 1, Connecticut Yankee, Oyster Creek, Nine Mile Point Unit No. 1, and La Crosse

Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases.

Science.gov (United States)

Yang, Yun Seok; Kim, Seung Hyun; Jin, Chan Hee; Oh, Kwoan Young; Hur, Myung Haeng; Kim, Soo Young; Yim, Hyun Soon

2014-01-01

The objective of this study was to present the initial operative experience of solo surgeon single-port laparoscopic surgery (SPLS) in the laparoscopic treatment of benign gynecologic diseases and to investigate its feasibility and surgical outcomes. Using a novel homemade laparoscope-anchored instrument system that consisted of a laparoscopic instrument attached to a laparoscope and a glove-wound retractor umbilical port, we performed solo surgeon SPLS in 13 patients between March 2011 and June 2012. Intraoperative complications and postoperative surgical outcomes were determined. The primary operative procedures performed were unilateral salpingo-oophorectomy (n = 5), unilateral salpingectomy (n = 2), adhesiolysis (n = 1), and laparoscopically assisted vaginal hysterectomy (n = 5). Additional surgical procedures included additional adhesiolysis (n = 4) and ovarian drilling (n = 1).The primary indications for surgery were benign ovarian tumors (n = 5), ectopic pregnancy (n = 2), pelvic adhesion (infertility) (n = 1), and benign uterine tumors (n = 5). Solo surgeon SPLS was successfully accomplished in all procedures without a laparoscopic assistant. There were no intraoperative or postoperative complications. Our laparoscope-anchored instrument system obviates the need for an additional laparoscopic assistant and enables SPLS to be performed by a solo surgeon. The findings show that with our system, solo surgeon SPLS is a feasible and safe alternative technique for the treatment of benign gynecologic diseases in properly selected patients. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Understanding the first Neolithic occupation of Cova d'En Pardo (Planes, Alicante: Preliminary results of the multidisciplinary analysis of levels VIII and VIIIB

Directory of Open Access Journals (Sweden)

Jorge Agatángelo Soler Díaz

2014-01-01

Full Text Available We present the results of excavations carried out in the Cova d'En Pardo (Planes, Alicante, specifically the levels VIII and VIIIb. The development of a multidisciplinary project has allowed to us characterize the occupation of a small cavity by the first farming communities associated with the Neolithization process of the east of Iberian Peninsula.

Seleucid, Demotic and Mediterranean mathematics versus Chapters VIII and IX of the Nine Chapters: accidental or significant similarities?

DEFF Research Database (Denmark)

Høyrup, Jens

Similarities of geometrical diagrams and arithmetical structures of problems have often been taken as evidence of transmission of mathematical knowledge or techniques between China and “the West”. Confronting on one hand some problems from Chapter VIII of the Nine Chapters with comparable problems...... known from Ancient Greek sources, on the other a Seleucid collection of problems about rectangles with a subset of the triangle problems from Chapter IX, it is concluded, (1) that transmission of some arithmetical riddles without method – not “from Greece” but from a transnational community of traders...

Human parvovirus B19 infection in hemophiliacs first infused with two high-purity, virally attenuated factor VIII concentrates.

Science.gov (United States)

Azzi, A; Ciappi, S; Zakvrzewska, K; Morfini, M; Mariani, G; Mannucci, P M

1992-03-01

Human parvovirus B19 can be transmitted by coagulation factor concentrates and is highly resistant to virucidal methods. To evaluate whether the additional removal of virus by chromatographic methods during the manufacture of high-purity concentrates reduces the risk of B19 transmission, we have prospectively evaluated the rate of anti-B19 seroconversion in two groups of susceptible (anti-B19 negative) hemophiliacs infused with high-purity, heated (pasteurized) or solvent-detergent-treated factor VIII concentrates. Both products infected a relatively high proportion of patients (nine of 20).

PENGARUH PENGGUNAAN VARIASI METODE DAN MODEL PEMBELAJARAN TERHADAP HASIL BELAJAR FISIKA SISWA KELAS VIII SMPN2 MARGATIGA SEMESTER GENAP TP 2013/2014

Directory of Open Access Journals (Sweden)

Eni Fitriani

2015-03-01

Full Text Available The purpose of this study was to investigate the effect of variations in the methods and models of teaching to student learning outcomes VIII SMPN2 MARGA TIGA.This research is experimental research which ofdesign completely randomized or completely randomized experimental design.The population in thisresearch is all of student VIII class in SMPN 2 MARGA TIGA2013/2014. The sample in this research is VIIIth class which totaling 34 students.In this research, conducted with three treatments of learning in a classroom.Data collection techniques in this research use the technique of the test, which tests the end (posttest were then analyzed with the test results hipotesis. From posttest analysis results of hypothesis testing using one-way ANOVA test (Completely Randomized Design at the 5% significance level value obtained results Fobs = 1.5244 and Ftab = 3.10 this shows that H0 is accepted and means variety of methods and learning models provide a similar impact on student learning outcomes.It can be concluded that all three treatments had similar quality if tailored to the needs of all three materials. 

Health hazards of child labor in the leather products and surgical instrument manufacturing industries of Sialkot, Pakistan.

Science.gov (United States)

Junaid, Muhammad; Malik, Riffat Naseem; Pei, De-Sheng

2017-07-01

Child labor is a major challenge in the developing countries and comprehensive health hazard identification studies on this issue are still lacking. Therefore, the current study is an effort to highlight the health concerns of child labor exposed in the key small scale industries of Sialkot, Pakistan. Our findings revealed jolting levels of heavy metals in the urine, blood, serum, saliva, and hair samples collected from the exposed children. For example, in the urine samples, Cd, Cr, Ni, and Pb were measured at the respective concentrations of 39.17, 62.02, 11.94 and 10.53 μg/L in the surgical industries, and 2.10, 4.41, 1.04 and 5.35 μg/L in the leather industries. In addition, source apportionment revealed polishing, cutting, and welding sections in the surgical industries and surface coating, crusting, and stitching sections in the leather industries were the highest contributors of heavy metals in the bio-matrices of the exposed children, implying the dusty, unhygienic, and unhealthy indoor working conditions. Further, among all the bio-matrices, the hair samples expressed the highest bioaccumulation factor for heavy metals. In accordance with the heavy metal levels reported in the exposed children, higher oxidative stress was found in the children working in the surgical industries than those from the leather industries. Moreover, among heavy metals' exposure pathways, inhalation of industrial dust was identified as the primary route of exposure followed by the ingestion and dermal contact. Consequently, chemical daily intake (CDI), carcinogenic and non-carcinogenic hazard quotients (HQs) of heavy metals were also reported higher in the exposed children and were also alarmingly higher than the corresponding US EPA threshold limits. Taken all together, children were facing serious health implications in these industries and need immediate protective measures to remediate the current situation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Analisis Deskriptif Soal Geometri dalam Buku Matematika Bilingual untuk Sekolah Menengah Pertama Kelas VIII Berdasarkan Kriteria International Assessment TIMSS 2007

Directory of Open Access Journals (Sweden)

Etik Rahayu

2012-06-01

Full Text Available Tujuan penelitian ini adalah untuk mendeskripsikan  domain kognitif dan aspek kognitif (required behavior soal matematika dalam Buku Matematika Bilingual untuk Sekolah Menengah Pertama (SMP Kelas VIII berdasarkan kriteria International Assessment TIMSS 2007 dan proporsinya. Metode penelitian yang digunakan adalah deskriptif kualitatif, dengan subjek penelitian adalah soal geometri dalam Buku Matematika Bilingual SMP. yang berjudul “Mathematics for Junior High School Grade VIII 1st Semester” dan “Mathematics for Junior High School Grade VIII 2nd Semester” karangan karangan M. Cholik Adinawan dan Sugijono. Pengumpulan data menggunakan metode observasi dan wawancara tentang penggunaan buku matematika bilingual yang paling banyak digunakan di kota semarang. Pedoman analisis soal berdasarkan kriteria International Assessment TIMSS 2007, dengan validasi hasil oleh ahli. Hasil penelitian menunjukkan bahwa soal yang dianalisis memuat satu hingga tujuh aspek kognitif. Sebagian besar soal memuat 4 aspek kognitif yaitu 44.04 %, diikuti soal dengan 3 aspek kognitif  yaitu 36, 42%,  soal dengan 2 aspek kognitif yaitu 14, 90%, kemudian 1,99% untuk soal dengan 1 atau 5 aspek kognitif, dan 0,33% untuk soal dengan 6 atau 7 aspek kognitif. Proporsi tinggi pada recall (28.26% dan compute (26.57%, diikuti dengan SRP (10.85%, implement (10.65%, retrieve (8.36%, recognize (6.17%, analyze (1.99%, measure (1.59%, generalize (1.09%, SNRP (1.00%, classify (0.80%, represent (0.80%, justify (0.80%, select (0.60%, model (0.30%, synthesis (0.20%. Secara keseluruhan berdasarkan International Assessment TIMSS 2007 soal yang termasuk domain knowing memiliki persentase paling tinggi (52.28%, domain knowing-applying (24.83%, domain knowing- reasoning (12.91%, dan hanya sedikit yang termasuk domain knowing-apllying-reasoning (3.97%. Serta terdapat 4 soal (1.32% yang mempunyai ketidaksesuaian penggunaan mathematics terms serta 1 soal (0

Efficacy of Reciproc(®) and Profile(®) Instruments in the Removal of Gutta-Percha from Straight and Curved Root Canals ex Vivo.

Science.gov (United States)

Marfisi, Karem; Mercadé, Montserrat; Plotino, Gianluca; Clavel, Tatiana; Duran-Sindreu, Fernando; Roig, Miguel

2015-01-01

To compare the efficacy of Reciproc(®) (VDW GmbH) and ProFile(®) (Dentsply Maillefer) instruments at removing gutta-percha from straight and curved root canals ex vivo filled using the cold lateral condensation and GuttaMaster(®) (VDW GmbH) techniques. Forty mesial roots of mandibular molars with two curved canals and 80 single-rooted teeth with straight root canals, a total of 160 root canals, were randomly assigned to eight groups (canals per group = 20) according to filling technique, retreatment instrument and root canal curvature as follows: Group I, cold lateral condensation/ProFile(®)/straight; Group II, cold lateral condensation/ProFile(®)/curved; Group III, cold lateral condensation/Reciproc(®)/straight; Group IV, cold lateral condensation/Reciproc(®)/curved; Group V, GuttaMaster(®)/ProFile(®)/straight; Group VI, GuttaMaster(®)/ProFile(®)/curved; Group VII, GuttaMaster(®)/Reciproc(®)/straight; and Group VIII, GuttaMaster(®)/Reciproc(®)/curved. The following data were recorded: procedural errors, retreatment duration and canal wall cleanliness. Means and standard deviations were calculated and analysed using the Kruskal-Wallis test, one-way analysis of variance and Tukey's test (P straight (P = 0.0001) and curved (P = 0.0003) root canals. Reciproc(®) were statistically more effective than ProFile(®) instruments in removing GuttaMaster(®) from straight root canals (P = 0.021). Regardless of filling technique or retreatment instrument, gutta-percha was removed more rapidly from curved than from straight root canals (P = 0.0001). Neither system completely removed filling material from the root canals. Compared with ProFile(®) instruments, Reciproc(®) instruments removed GuttaMaster(®) filling material from straight and curved root canals more rapidly.

Open surgical simulation--a review.

Science.gov (United States)

Davies, Jennifer; Khatib, Manaf; Bello, Fernando

2013-01-01

Surgical simulation has benefited from a surge in interest over the last decade as a result of the increasing need for a change in the traditional apprentice model of teaching surgery. However, despite the recent interest in surgical simulation as an adjunct to surgical training, most of the literature focuses on laparoscopic, endovascular, and endoscopic surgical simulation with very few studies scrutinizing open surgical simulation and its benefit to surgical trainees. The aim of this review is to summarize the current standard of available open surgical simulators and to review the literature on the benefits of open surgical simulation. Open surgical simulators currently used include live animals, cadavers, bench models, virtual reality, and software-based computer simulators. In the current literature, there are 18 different studies (including 6 randomized controlled trials and 12 cohort studies) investigating the efficacy of open surgical simulation using live animal, bench, and cadaveric models in many surgical specialties including general, cardiac, trauma, vascular, urologic, and gynecologic surgery. The current open surgical simulation studies show, in general, a significant benefit of open surgical simulation in developing the surgical skills of surgical trainees. However, these studies have their limitations including a low number of participants, variable assessment standards, and a focus on short-term results often with no follow-up assessment. The skills needed for open surgical procedures are the essential basis that a surgical trainee needs to grasp before attempting more technical procedures such as laparoscopic procedures. In this current climate of medical practice with reduced hours of surgical exposure for trainees and where the patient's safety and outcome is key, open surgical simulation is a promising adjunct to modern surgical training, filling the void between surgeons being trained in a technique and a surgeon achieving fluency in that

Anxiety in veterinary surgical students

DEFF Research Database (Denmark)

Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff

2012-01-01

The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p...

The Virtual Surgical Pelvis : Anatomy Visualization for Education and Surgical Planning

NARCIS (Netherlands)

Smit, N.N.

2016-01-01

This thesis deals with visualizing anatomical data for medical education and surgical planning purposes. To this end, we have developed a detailed virtual atlas, the Virtual Surgical Pelvis (VSP),which unifies surgically relevant knowledge on pelvic anatomy. We provide methods to share the knowledge

Simple Tools for Surgeons : Design and Evaluation of mechanical alternatives for robotic instruments for Minimally Invasive Surgery

NARCIS (Netherlands)

Jaspers, J.E.N.

2006-01-01

Performing complex tasks in Minimally Invasive Surgery (MIS) is demanding due to a disturbed hand-eye co-ordination, the application of non-ergonomic instruments with limited number of degrees of freedom (DOFs) and the two-dimensional (2D) view controlled by the surgical assistance. Robotic camera

Deriving DICOM surgical extensions from surgical workflows

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Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

2007-03-01

The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

On existence and properties of plutonium(VIII) derivatives

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Kiselev, Yu.M.; Dolzhenko, V.D.; Ermilov, A.Yu. [Moscow State Univ. (Russian Federation). Chemistry Dept.; Nikonov, M.V.; Myasoedov, B.F. [Russian Academy of Science, Moscow (Russian Federation). Inst. of Geochemistry and Analytical Chemistry; Tananaev, I.G. [Russian Academy of Science, Moscow (Russian Federation). Inst. of Physical Chemistry and Electrochemistry

2014-04-01

The existence of Pu(VIII) was shown in alkaline solutions and in nonpolar solvents (CCl{sub 4} and CHCl{sub 3}) on the ground of such experimental facts like extraction of plutonium species, obtained by means of ozonization of Pu(VI) alkaline solutions into CCl{sub 4} and CHCl{sub 3}; volatility of Pu compounds out of aqueous alkaline solutions, and the mentioned solvents. The product of interaction between PuO{sub 3}.0.8H{sub 2}O and XeF{sub 2} in CCl{sub 4} and CHCl{sub 3} was of the same chemical form for both cases and identical with the form of the product of volatility of Pu out of these organic solutions. The electronic absorbance spectra of these products in CCl{sub 4} and CHCl{sub 3} were fairly similar to the ones for OsO{sub 4} and RuO{sub 4}. The band of absorption in these spectra with the maximum at 332 nm corresponds to the charge transfer of metal-ligand type [π(O)→Pu], as the value of molar extinction coefficient e was found to be higher than 2 x 10{sup 3} L/mole cm. A satisfactory agreement between the energies for the transitions of PuO{sub 4} molecule designed by X{sub α}-SW method and experimental data was observed. A similar accordance was observed for the designed vibration frequency (DFT-method) with the one found as result of analysis of the vibration structure of the experimental spectra. (orig.)

Heating of the quiet solar corona from measurements of the FET/TESIS instrument on-board the KORONAS-FOTON satellite

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Rybák, J.; Gömöry, P.; Benz, A.; Bogachev, P.; Brajša, R.

2010-12-01

The paper presents the first results of the observations of time evolution of the quiet solar corona brightenings obtained due to very rapid photography of the corona with full-disk EUV telescopes of the FET/TESIS instrument onboard the KORONA FOTON satellite. The measurements were performed simultaneously in the emission of the Fe IX / X 17.1 and Fe VIII 13.1 spectral lines with 10 second temporal cadence and spatial scale of 1.7 arc seconds within one hour. This test observation, carried out on 15 July 2009, was analyzed in order to determine whether this type of observation can be used to identify individual microevents in the solar corona heating that are above the tresholds of spatial and temporal resolutions of the observations of non-active regions in the solar atmosphere. For this purpose, a simple method was used involving cross-correlation of the plasma emission time evolution at different temperatures, each time from observations of identical elements. The results obtained are confronted with the expected observable manifestations of the corona heating via nanoflares. TESIS is a set of instruments for the Sun photography developed in the Lebedev Physics Institute of the Russian Academy of Sciences that was launched into orbit in January 2009.

Cost-effectiveness of decompression according to Gill versus instrumented spondylodesis in the treatment of sciatica due to low grade spondylolytic spondylolisthesis: a prospective randomised controlled trial [NTR1300].

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Arts, Mark P; Verstegen, Marco J T; Brand, Ronald; Koes, Bart W; van den Akker, M Elske; Peul, Wilco C

2008-09-28

Nerve root decompression with instrumented spondylodesis is the most frequently performed surgical procedure in the treatment of patients with symptomatic low-grade spondylolytic spondylolisthesis. Nerve root decompression without instrumented fusion, i.e. Gill's procedure, is an alternative and less invasive approach. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of decompression according to Gill versus instrumented spondylodesis. All patients (age between 18 and 70 years) with sciatica or neurogenic claudication lasting more than 3 months due to spondylolytic spondylolisthesis grade I or II, are eligible for inclusion. Patients will be randomly allocated to nerve root decompression according to Gill, either unilateral or bilateral, or pedicle screw fixation with interbody fusion. The main primary outcome measure is the functional assessment of the patient measured with the Roland Disability Questionnaire for Sciatica at 12 weeks and 2 years. Other primary outcome measures are perceived recovery and intensity of leg pain and low back pain. The secondary outcome measures include, incidence of re-operations, complications, serum creatine phosphokinase, quality of life, medical consumption, costs, absenteeism, work perception, depression and anxiety, and treatment preference. The study is a randomised prospective multicenter trial in which two surgical techniques are compared in a parallel group design. Patients and research nurse will not be blinded during the follow-up period of 2 years. Currently, nerve root decompression with instrumented fusion is the golden standard in the surgical treatment of low-grade spondylolytic spondylolisthesis, although scientific proof justifying instrumented spondylodesis over simple decompression is lacking. This trial is designed to elucidate the controversy in best surgical treatment of symptomatic patients with low

Cost-effectiveness of decompression according to Gill versus instrumented spondylodesis in the treatment of sciatica due to low grade spondylolytic spondylolisthesis: A prospective randomised controlled trial [NTR1300

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Brand Ronald

2008-09-01

Full Text Available Abstract Background Nerve root decompression with instrumented spondylodesis is the most frequently performed surgical procedure in the treatment of patients with symptomatic low-grade spondylolytic spondylolisthesis. Nerve root decompression without instrumented fusion, i.e. Gill's procedure, is an alternative and less invasive approach. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of decompression according to Gill versus instrumented spondylodesis. Methods/design All patients (age between 18 and 70 years with sciatica or neurogenic claudication lasting more than 3 months due to spondylolytic spondylolisthesis grade I or II, are eligible for inclusion. Patients will be randomly allocated to nerve root decompression according to Gill, either unilateral or bilateral, or pedicle screw fixation with interbody fusion. The main primary outcome measure is the functional assessment of the patient measured with the Roland Disability Questionnaire for Sciatica at 12 weeks and 2 years. Other primary outcome measures are perceived recovery and intensity of leg pain and low back pain. The secondary outcome measures include, incidence of re-operations, complications, serum creatine phosphokinase, quality of life, medical consumption, costs, absenteeism, work perception, depression and anxiety, and treatment preference. The study is a randomised prospective multicenter trial in which two surgical techniques are compared in a parallel group design. Patients and research nurse will not be blinded during the follow-up period of 2 years. Discussion Currently, nerve root decompression with instrumented fusion is the golden standard in the surgical treatment of low-grade spondylolytic spondylolisthesis, although scientific proof justifying instrumented spondylodesis over simple decompression is lacking. This trial is designed to elucidate the controversy in best

What are the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty?

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Harato, Kengo; Maeno, Shinichi; Tanikawa, Hidenori; Kaneda, Kazuya; Morishige, Yutaro; Nomoto, So; Niki, Yasuo

2016-08-01

It was hypothesized that surgical time of beginners would be much longer than that of experts. Our purpose was to investigate and clarify the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty (TKA) as a multicentre study. A total of 300 knees in 248 patients (averaged 74.6 years) were enrolled. All TKAs were done using the same instruments and the same measured resection technique at 14 facilities by 25 orthopaedic surgeons. Surgeons were divided into three surgeon groups (four experts, nine medium-volume surgeons and 12 beginners). The surgical technique was divided into five phases. Detailed surgical time and ratio of the time in each phase to overall surgical time were recorded and compared among the groups in each phase. A total of 62, 119, and 119 TKAs were done by beginners, medium-volume surgeons, and experts, respectively. Significant differences in surgical time among the groups were seen in each phase. Concerning the ratio of the time, experts and medium-volume surgeons seemed cautious in fixation of the permanent component compared to other phases. Interestingly, even in ratio, beginners and medium-volume surgeons took more time in exposure of soft tissue compared to experts. (0.14 in beginners, 0.13 in medium-volume surgeons, 0.11 in experts, P time in exposure and closure of soft tissue compared to experts. Improvement in basic technique is essential to minimize surgical time among beginners. First of all, surgical instructors should teach basic techniques in primary TKA for beginners. Therapeutic studies, Level IV.

Correction Capability in the 3 Anatomic Planes of Different Pedicle Screw Designs in Scoliosis Instrumentation.

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Wang, Xiaoyu; Aubin, Carl-Eric; Coleman, John; Rawlinson, Jeremy

2017-05-01

Computer simulations to compare the correction capabilities of different pedicle screws in adolescent idiopathic scoliosis (AIS) instrumentations. To compare the correction and resulting bone-screw forces associated with different pedicle screws in scoliosis instrumentations. Pedicle screw fixation is widely used in surgical instrumentation for spinal deformity treatment. Screw design, correction philosophies, and surgical techniques are constantly evolving to achieve better control of the vertebrae and correction of the spinal deformity. Yet, there remains a lack of biomechanical studies that quantify the effects and advantages of different screw designs in terms of correction kinematics. The correction capabilities of fixed-angle, multiaxial, uniaxial, and saddle axial screws were kinematically analyzed, simulated, and compared. These simulations were based on the screw patterns and correction techniques proposed by 2 experienced surgeons for 2 AIS cases. Additional instrumentations were assessed to compare the correction and resulting bone-screw forces associated with each type of screw. The fixed-angle, uniaxial and saddle axial screws had similar kinematic behavior and performed better than multiaxial screws in the coronal and transverse planes (8% and 30% greater simulated corrections, respectively). Uniaxial and multiaxial screws were less effective than fixed-angle and saddle axial screws in transmitting compression/distraction to the anterior spine because of their sagittal plane mobility between the screw head and shank. Only the saddle axial screws allow vertebra angle in the sagittal plane to be independently adjusted. Pedicle screws of different designs performed differently for deformity corrections or for compensating screw placement variations in different anatomic planes. For a given AIS case, screw types should be determined based on the particular instrumentation objectives, the deformity's stiffness and characteristics so as to make the best of

ENDF/B-VIII.0: The 8th Major Release of the Nuclear Reaction Data Library with CIELO-project Cross Sections, New Standards and Thermal Scattering Data

Science.gov (United States)

Brown, D. A.; Chadwick, M. B.; Capote, R.; Kahler, A. C.; Trkov, A.; Herman, M. W.; Sonzogni, A. A.; Danon, Y.; Carlson, A. D.; Dunn, M.; Smith, D. L.; Hale, G. M.; Arbanas, G.; Arcilla, R.; Bates, C. R.; Beck, B.; Becker, B.; Brown, F.; Casperson, R. J.; Conlin, J.; Cullen, D. E.; Descalle, M.-A.; Firestone, R.; Gaines, T.; Guber, K. H.; Hawari, A. I.; Holmes, J.; Johnson, T. D.; Kawano, T.; Kiedrowski, B. C.; Koning, A. J.; Kopecky, S.; Leal, L.; Lestone, J. P.; Lubitz, C.; Márquez Damián, J. I.; Mattoon, C. M.; McCutchan, E. A.; Mughabghab, S.; Navratil, P.; Neudecker, D.; Nobre, G. P. A.; Noguere, G.; Paris, M.; Pigni, M. T.; Plompen, A. J.; Pritychenko, B.; Pronyaev, V. G.; Roubtsov, D.; Rochman, D.; Romano, P.; Schillebeeckx, P.; Simakov, S.; Sin, M.; Sirakov, I.; Sleaford, B.; Sobes, V.; Soukhovitskii, E. S.; Stetcu, I.; Talou, P.; Thompson, I.; van der Marck, S.; Welser-Sherrill, L.; Wiarda, D.; White, M.; Wormald, J. L.; Wright, R. Q.; Zerkle, M.; Žerovnik, G.; Zhu, Y.

2018-02-01

We describe the new ENDF/B-VIII.0 evaluated nuclear reaction data library. ENDF/B-VIII.0 fully incorporates the new IAEA standards, includes improved thermal neutron scattering data and uses new evaluated data from the CIELO project for neutron reactions on 1H, 16O, 56Fe, 235U, 238U and 239Pu described in companion papers in the present issue of Nuclear Data Sheets. The evaluations benefit from recent experimental data obtained in the U.S. and Europe, and improvements in theory and simulation. Notable advances include updated evaluated data for light nuclei, structural materials, actinides, fission energy release, prompt fission neutron and γ-ray spectra, thermal neutron scattering data, and charged-particle reactions. Integral validation testing is shown for a wide range of criticality, reaction rate, and neutron transmission benchmarks. In general, integral validation performance of the library is improved relative to the previous ENDF/B-VII.1 library.

ENDF/B-VIII.0: The 8 th Major Release of the Nuclear Reaction Data Library with CIELO-project Cross Sections, New Standards and Thermal Scattering Data

Energy Technology Data Exchange (ETDEWEB)

Brown, D. A.; Chadwick, M. B.; Capote, R.; Kahler, A. C.; Trkov, A.; Herman, M. W.; Sonzogni, A. A.; Danon, Y.; Carlson, A. D.; Dunn, M.; Smith, D. L.; Hale, G. M.; Arbanas, G.; Arcilla, R.; Bates, C. R.; Beck, B.; Becker, B.; Brown, F.; Casperson, R. J.; Conlin, J.; Cullen, D. E.; Descalle, M. -A.; Firestone, R.; Gaines, T.; Guber, K. H.; Hawari, A. I.; Holmes, J.; Johnson, T. D.; Kawano, T.; Kiedrowski, B. C.; Koning, A. J.; Kopecky, S.; Leal, L.; Lestone, J. P.; Lubitz, C.; Márquez Damián, J. I.; Mattoon, C. M.; McCutchan, E. A.; Mughabghab, S.; Navratil, P.; Neudecker, D.; Nobre, G. P. A.; Noguere, G.; Paris, M.; Pigni, M. T.; Plompen, A. J.; Pritychenko, B.; Pronyaev, V. G.; Roubtsov, D.; Rochman, D.; Romano, P.; Schillebeeckx, P.; Simakov, S.; Sin, M.; Sirakov, I.; Sleaford, B.; Sobes, V.; Soukhovitskii, E. S.; Stetcu, I.; Talou, P.; Thompson, I.; van der Marck, S.; Welser-Sherrill, L.; Wiarda, D.; White, M.; Wormald, J. L.; Wright, R. Q.; Zerkle, M.; Žerovnik, G.; Zhu, Y.

2018-02-01

We describe the new ENDF/B-VIII.0 evaluated nuclear reaction data library. ENDF/B-VIII.0 fully incorporates the new IAEA standards, includes improved thermal neutron scattering data and uses new evaluated data from the CIELO project for neutron reactions on 1H, 16O, 56Fe, 235U, 238U and 239Pu described in companion papers in the present issue of Nuclear Data Sheets. The evaluations benefit from recent experimental data obtained in the U.S. and Europe, and improvements in theory and simulation. Notable advances include updated evaluated data for light nuclei, structural materials, actinides, fission energy release, prompt fission neutron and γ-ray spectra, thermal neutron scattering data, and charged-particle reactions. Integral validation testing is shown for a wide range of criticality, reaction rate, and neutron transmission benchmarks. In general, integral validation performance of the library is improved relative to the previous ENDF/B-VII.1 library.

Production of factor VIII by human liver sinusoidal endothelial cells transplanted in immunodeficient uPA mice.

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Marina E Fomin

Full Text Available Liver sinusoidal endothelial cells (LSECs form a semi-permeable barrier between parenchymal hepatocytes and the blood. LSECs participate in liver metabolism, clearance of pathological agents, immunological responses, architectural maintenance of the liver and synthesis of growth factors and cytokines. LSECs also play an important role in coagulation through the synthesis of Factor VIII (FVIII. Herein, we phenotypically define human LSECs isolated from fetal liver using flow cytometry and immunofluorescence microscopy. Isolated LSECs were cultured and shown to express endothelial markers and markers specific for the LSEC lineage. LSECs were also shown to engraft the liver when human fetal liver cells were transplanted into immunodeficient mice with liver specific expression of the urokinase-type plasminogen activator (uPA transgene (uPA-NOG mice. Engrafted cells expressed human Factor VIII at levels approaching those found in human plasma. We also demonstrate engraftment of adult LSECs, as well as hepatocytes, transplanted into uPA-NOG mice. We propose that overexpression of uPA provides beneficial conditions for LSEC engraftment due to elevated expression of the angiogenic cytokine, vascular endothelial growth factor. This work provides a detailed characterization of human midgestation LSECs, thereby providing the means for their purification and culture based on their expression of CD14 and CD32 as well as a lack of CD45 expression. The uPA-NOG mouse is shown to be a permissive host for human LSECs and adult hepatocytes, but not fetal hepatoblasts. Thus, these mice provide a useful model system to study these cell types in vivo. Demonstration of human FVIII production by transplanted LSECs encourages further pursuit of LSEC transplantation as a cellular therapy for the treatment of hemophilia A.

[Surgical treatment of chronic pancreatitis based on classification of M. Buchler and coworkers].

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Krivoruchko, I A; Boĭko, V V; Goncharova, N N; Andreeshchev, S A

2011-08-01

The results of surgical treatment of 452 patients, suffering chronic pancreatitis (CHP), were analyzed. The CHP classification, elaborated by M. Buchler and coworkers (2009), based on clinical signs, morphological peculiarities and pancreatic function analysis, contains scientifically substantiated recommendations for choice of diagnostic methods and complex treatment of the disease. The classification proposed is simple in application and constitutes an instrument for studying and comparison of the CHP course severity, the patients prognosis and treatment.

Disposable surgical face masks for preventing surgical wound infection in clean surgery

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Allyson Lipp

Full Text Available BACKGROUND: Surgical face masks were originally developed to contain and filter droplets containing microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound, e.g. by incorrect wear or by leaking air from the side of the mask due to poor string tension. OBJECTIVES: To determine whether disposable surgical face masks worn by the surgical team during clean surgery prevent postoperative surgical wound infection. SEARCH METHODS: We searched The Cochrane Wounds Group Specialised Register (searched 14 September 2011; The Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library 2011, Issue 3; Ovid MEDLINE (2008 to August Week 5 2011; Ovid MEDLINE (In-Process &Other Non-Indexed Citations September 13, 2011; Ovid EMBASE (2008 to 2011 Week 35; and EBSCO CINAHL (2008 to 9 September 2011. SELECTION CRITERIA: Randomized controlled trials (RCTs and quasi-randomized controlled trials comparing the use of disposable surgical masks with the use of no mask. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. MAIN RESULTS: Three trials were included, involving a total of 2113 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. AUTHORS' CONCLUSIONS: From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery.

How surgical mentors teach: a classification of in vivo teaching behaviors part 2: physical teaching guidance.

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Sutkin, Gary; Littleton, Eliza B; Kanter, Steven L

2015-01-01

To study surgical teaching captured on film and analyze it at a fine level of detail to categorize physical teaching behaviors. We describe live, filmed, intraoperative nonverbal exchanges between surgical attending physicians and their trainees (residents and fellows). From the films, we chose key teaching moments and transcribed participants' utterances, actions, and gestures. In follow-up interviews, attending physicians and trainees watched videos of their teaching case and answered open-ended questions about their teaching methods. Using a grounded theory approach, we examined the videos and interviews for what might be construed as a teaching behavior and refined the physical teaching categories through constant comparison. We filmed 5 cases in the operating suite of a university teaching hospital that provides gynecologic surgical care. We included 5 attending gynecologic surgeons, 3 fellows, and 5 residents for this study. More than 6 hours of film and 3 hours of interviews were transcribed, and more than 250 physical teaching motions were captured. Attending surgeons relied on actions and gestures, sometimes wordlessly, to achieve pedagogical and surgical goals simultaneously. Physical teaching included attending physician-initiated actions that required immediate corollary actions from the trainee, gestures to illustrate a step or indicate which instrument to be used next, supporting or retracting tissues, repositioning the trainee's instruments, and placement of the attending physicians' hands on the trainees' hands to guide them. Attending physicians often voiced surprise at the range of their own teaching behaviors captured on film. Interrater reliability was high using the Cohen κ, which was 0.76 for the physical categories. Physical guidance is essential in educating a surgical trainee, may be tacit, and is not always accompanied by speech. Awareness of teaching behaviors may encourage deliberate teaching and reflection on how to innovate pedagogy

Factor VIII brand and the incidence of factor VIII inhibitors in previously untreated UK children with severe hemophilia A, 2000-2011

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Palmer, Benedict P.; Chalmers, Elizabeth A.; Hart, Daniel P.; Liesner, Ri; Rangarajan, Savita; Talks, Katherine; Williams, Michael; Hay, Charles R. M.

2014-01-01

The effect of recombinant factor VIII (rFVIII) brand on inhibitor development was investigated in all 407 severe hemophilia A previously untreated patients born in the United Kingdom (UK) between 1 January 2000 and 31 December 2011. Eighty-eight (22%) had been in the RODIN study. Information was extracted from the National Haemophilia Database. Because exposure days (EDs) were not known for some patients, time from first treatment was used as a surrogate for rFVIII exposure. An inhibitor developed in 118 (29%) patients, 60 high and 58 low titer, after a median (interquartile range) of 7.8 (3.3-13.5) months from first exposure and 16 (9-30) EDs. Of 128 patients treated with Kogenate Bayer/Helixate NexGen, 45 (35.2%, 95% confidence interval [CI] 27.4-43.8) developed an inhibitor compared with 42/172 (24.4%, 95% CI 18.6% to 31.4%) with Advate (P = .04). The adjusted hazard ratio (HR) (95% CI) for Kogenate Bayer/Helixate NexGen compared with Advate was 2.14 (1.12-4.10) (P = .02) for high titer and 1.75 (1.11-2.76) (P = .02) for all inhibitors. When excluding UK-RODIN patients, the adjusted HR (95% CI) for high-titer inhibitors was 2.00 (0.93-4.34) (P = .08). ReFacto AF was associated with a higher incidence of all, but not high-titer, inhibitors than Advate. These results will help inform debate around the relative immunogenicity and use of rFVIII brands. PMID:25339360

A current assessment of diversity characteristics and perceptions of their importance in the surgical workforce.

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French, Judith C; O'Rourke, Colin; Walsh, R Matthew

2014-11-01

Diversity in the workforce is vital to successful businesses. Healthcare in general has suffered from a lack of cultural competence, which is the ability to successfully interact with individuals from diverse backgrounds. In order to eliminate discrimination and build a diverse workforce, physicians' perceptions and importance of diversity need to be measured. A 25-item, anonymous, online questionnaire was created, and a cross-sectional survey was performed. The instrument consisted of demographic and Likert-style questions which attempted to determine the participants' perceptions of the current level of diversity in their specialty and their perceived importance of particular diversity categories. Over 1,000 responses were received from US-based physicians across all specialties and levels of training. Statistically significant differences existed between surgical and nonsurgical specialties with regard to gender, prior work experience, and political identity. In the surgical workforce, there is significant perceived homogeneity regarding gender/sexual identity. Surgical respondents also deemed gender/sexual identity diversity to be less important than respondents from medical specialties. Surgeons and surgical trainees are less diverse than their medical colleagues, both by demographics and self-acknowledgement. The long-term impact and potential barriers to resolve these differences in diversity require further investigation.

Thermostable adenylate kinase technology: a new process indicator and its use as a validation tool for the reprocessing of surgical instruments.

Science.gov (United States)

Hesp, J R; Poolman, T M; Budge, C; Batten, L; Alexander, F; McLuckie, G; O'Brien, S; Wells, P; Raven, N D H; Sutton, J M

2010-02-01

Adenylate kinase (tAK), a thermostable enzyme, was assessed as a possible means of providing a quantitative measure of cleaning efficacy suitable for validating the performance of an automated washer disinfector (AWD) during routine use. Two indicator formulations were developed using either a commercially available washer disinfector soil or a protein-based soil. Each indicator consisted of 100 microg (in test soil) of tAK dried on to a steel or plastic surface. These indicators were placed in each basket of a washer disinfector and processed alongside soiled surgical instruments during a standard day's operation. After processing, remaining tAK activity was detected using a rapid enzyme assay (2 min detection time) in a handheld hygiene monitor. The amount of tAK remaining on each indictor after a full AWD cycle was found to range from 0.1 to 0.4 ng, which represented a mean log(10) removal of 5.8+/-0.3. There was no statistical difference in the residual tAK activity between individual runs or the position of the indicator in the machine. The tAK indicator was also used to analyse the protein removal within each component of the wash cycle. These results demonstrated that all phases of the wash process contributed to the removal of the protein load, with the main wash alone being responsible for 3.6-4.0 log(10) reductions in protein activity. We propose that a quantitative cleaning index using such rapid readout indicator devices would provide a valuable addition to the methodologies for validating cleaning processes.

Increase in Periodontal Interleukin-1β Gene Expression Following Osseous Resective Surgery Using Conventional Rotary Instruments Compared with Piezosurgery: A Split-Mouth Randomized Clinical Trial.

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Aimetti, Mario; Ferrarotti, Francesco; Bergandi, Loredana; Saksing, Laura; Parducci, Francesca; Romano, Federica

2016-01-01

The purpose of this study was to evaluate the early inflammatory response following osseous resective surgery (ORS) with Piezosurgery compared to commonly used diamond burs. A sample was selected of 24 bilateral posterior sextants requiring ORS in 12 chronic periodontitis patients in a split-mouth design. In 12 sextants, bone recontouring was performed using a piezoelectric device. In the contralateral sextants, rotary instruments were used. Sextants treated with Piezosurgery obtained similar 12-month clinical results but lower postsurgical gene expression of interleukin-1β (IL-1β), a well-known proinflammatory cytokine, and lower patient morbidity compared with sextants treated with rotary instruments. In spite of the longer surgical time, the use of Piezosurgery for ORS seems to promote more favorable wound healing compared with rotary instruments, as the lower pain and the low levels of IL-1β mRNA at the surgical sites suggest a milder underlying inflammatory response.

Recombinant factor VIII Fc fusion protein for the prevention and treatment of bleeding in children with severe hemophilia A.

Science.gov (United States)

Young, G; Mahlangu, J; Kulkarni, R; Nolan, B; Liesner, R; Pasi, J; Barnes, C; Neelakantan, S; Gambino, G; Cristiano, L M; Pierce, G F; Allen, G

2015-06-01

Prophylactic factor replacement, which prevents hemarthroses and thereby reduces the musculoskeletal disease burden in children with hemophilia A, requires frequent intravenous infusions (three to four times weekly). Kids A-LONG was a phase 3 open-label study evaluating the safety, efficacy and pharmacokinetics of a longer-acting factor, recombinant factor VIII Fc fusion protein (rFVIIIFc), in previously treated children with severe hemophilia A (endogenous FVIII level of hemophilia A. © 2015 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and Haemostasis.

Surgical treatment for hypopharyngeal cysts with a side-opened direct laryngoscope.

Science.gov (United States)

Kawaida, M; Fukuda, H; Shiotani, A; Kohno, N

1994-01-01

Two cases of hypopharyngeal cyst are reported. Both cysts occurred in the piriform sinus of the hypopharynx. Histopathological examination indicated that both were retention cysts. These cysts were removed by laryngomicrosurgical technique using a side-opened direct laryngoscope. In the cyst with a distinct base, a laryngomicrosurgical snare was used for removal. In the wide-based cyst, the mucous membrane around the cyst was incised with an electrosurgical instrument and then detached to facilitate removal. In this paper, we describe our surgical procedure for removing hypopharyngeal cysts and discuss the causes of such cysts.

Evaluation of primary and secondary stability of titanium implants using different surgical techniques.

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Tabassum, Afsheen; Meijer, Gert J; Walboomers, X Frank; Jansen, John A

2014-04-01

To investigate the influence of different surgical techniques on the primary and secondary implant stability using trabecular bone of goats as an implantation model. In the iliac crest of eight goats, 48 cylindrical-screw-type implants with a diameter of 4.2 mm (Dyna(®) ; Bergen op Zoom, the Netherlands) were installed, using three different surgical techniques: (i) 5% undersized, using a final drill diameter of 4 mm; (ii) 15% undersized, using a final drill diameter of 3.6 mm; and (iii) 25% undersized, using a final drill diameter of 3.2 mm. Peak insertion torque values were measured by a Digital(®) (MARK-10 Corporation, New York, NY, USA) torque gauge instrument during placement. At 3 weeks after implantation, removal torque was measured. Histomorphometrically, the peri-implant bone volume was measured in three zones; the inner zone (0-500 μm), the middle zone (500-1000 μm) and the outer zone (1000-1500 μm). Evaluation of the obtained data demonstrated no statistically significant difference between different surgical techniques regarding removal torque values. With respect to the percentage peri-implant bone volume (%BV), also no significant difference could be observed between all three applied surgical techniques for both the inner, middle and outer zone. However, irrespective of the surgical technique, it was noticed that the %BV was significantly higher for the inner zone as compared to middle and outer zone (P < 0.05) around the implant. At 3 weeks after implant installation, independent of the used undersized surgical technique, the %BV in the inner zone (0-500 μm) peri-implant area was improved due to both condensation of the surrounding bone as also the translocation of host bone particles along the implant surface. Surprisingly, no mechanical beneficial effect of the 25% undersized surgical technique could be observed as compared to the 5% or 15% undersized surgical technique to improve primary or secondary implant stability. © 2013

COLONIZAÇÃO OU DIÁSPORAS? RESENHA C.-G. SCHWENTZEL (org., M. DANA, St.LEBRETON, Fr.PRÊTEUX, Les diásporas grecques VIII-III s. Paris, Atlande, 2012, 446 páginas, 25 euros. (Dossiê: O Mundo Antigo: Literatura e Historiografia

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José Antonio Dabdab Trabulsi

2015-09-01

Full Text Available C.-G. SCHWENTZEL (org., M. DANA, St.LEBRETON, Fr.PRÊTEUX, Les diásporas grecques VIII-III s. Paris, Atlande, 2012, 446 páginas, 25 euros.C.-G. SCHWENTZEL (org., M. DANA, St.LEBRETON, Fr.PRÊTEUX, Les diásporas grecques VIII-III s. Paris, Atlande, 2012, 446 páginas, 25 euros. Recebido em: 02/04/2015  – Aceito em 13/05/2015

Transgenic rabbits as a model organism for production of human clotting factor VIII

International Nuclear Information System (INIS)

Vasicek, D.; Chrenek, P.; Makarevich, A.; Bauer, M.; Jurcik, R.; Suvegova, K.; Rafay, J.; Bulla, J.; Hetenyi, L.; Erickson, J.; Paleyanda, R.K.

2005-01-01

Human clotting factor VIII (hFVIII) is a very complex and large protein whose expression is difficult, as hFVIII requires extensive post-translational modification to be biologically active. This paper reports the generation of transgenic rabbits as a model species for testing the expression of hFVIII in the mammary gland. For micro-injection, a fusion gene construct was used, consisting of 2.5 kb murine whey acidic protein (mWAP) promoter, 7.2 kb cDNA of hFVIII, and 4.6 kb of 3' flanking sequences of the mWAP gene. from 130 micro-injected zygotes transferred into recipients, 30 offspring were delivered. The pups were screened for the transgene by PCR, using DNA isolated from the ear, and results were confirmed by Southern blot analysis. The transgene was identified in one female founder animal, and it was transmitted to the offspring in a Mendelian fashion, thus demonstrating stable integration of the gene construct into the germline of the transgenic rabbits. (author)

Analysis of the 4d7 (4f + 6p) and 4p54d9 configurations of Sn VII, Sb VIII and Te IX

International Nuclear Information System (INIS)

Azarov, V.I.; Joshi, Y.N.; Churilov, S.S.; Ryabtsev, A.N.

1994-01-01

The spectra of tin, antimony and tellerium were photographed in the 120-200 A region on 10.7 m and 3 m grazing incidence spectrographs using a triggered spark source. The 4d 8 -4d 7 (4f + 6p) + 4p 5 4d 9 transitions of Sn VII, Sb VIII and Te IX were investigated. In the Sn VII spectrum 109 new lines were classified in the 152-192 A region and 34 new levels were established, in the Sb VIII spectrum 78 new lines were classified in the 138-158 A region and 21 new levels were established, and in the Te IX 76 new lines were classified in the 121-139 A region and 21 new levels were established. Strong configuration interaction among the 4d 7 (np + mf), and 4p 5 4d 9 (n = 5, 6; m = 4, 5) configurations was observed. Least-squares-fitting (LSF) parametric calculations involving configuration interaction were carried out to interpret the observed spectra. (orig.)

Outcome and treatment of postoperative spine surgical site infections: predictors of treatment success and failure.

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Maruo, Keishi; Berven, Sigurd H

2014-05-01

Surgical site infection (SSI) is an important complication after spine surgery. The management of SSI is characterized by significant variability, and there is little guidance regarding an evidence-based approach. The objective of this study was to identify risk factors associated with treatment failure of SSI after spine surgery. A total of 225 consecutive patients with SSI after spine surgery between July 2005 and July 2010 were studied retrospectively. Patients were treated with aggressive surgical debridement and prolonged antibiotic therapy. Outcome and risk factors were analyzed in 197 patients having 1 year of follow-up. Treatment success was defined as resolution within 90 days. A total of 126 (76 %) cases were treated with retention of implants. Forty-three (22 %) cases had treatment failure with five (2.5 %) cases resulting in death. Lower rates of treatment success were observed with late infection (38 %), fusion with fixation to the ilium (67 %), Propionibacterium acnes (43 %), poly microbial infection (68 %), >6 operated spinal levels (67 %), and instrumented cases (73 %). Higher rates of early resolution were observed with superficial infection (93 %), methicillin-sensitive Staphylococcus aureus (95 %), and failure. Superficial infection and methicillin-sensitive Staphylococcus aureus were predictors of early resolution. Postoperative spine infections were treated with aggressive surgical debridement and antibiotic therapy. High rates of treatment failure occurred in cases with late infection, long instrumented fusions, polymicrobial infections, and Propionibacterium acnes. Removal of implants and direct or staged re-implantation may be a useful strategy in cases with high risk of treatment failure.

Clinical features and surgical management of spinal osteoblastoma: a retrospective study in 18 cases.

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Zhonghai Li

Full Text Available OBJECTIVES: To investigate the clinical manifestation and surgical outcome of spinal osteoblastoma. METHODS: From June 2006 to July 2011, 18 patients with spinal osteoblastoma treated surgically were analyzed retrospectively. There were 11 males and 7 females with an average age of 27.5 years（range, 16-38 years. The tumors were located at C5 in 7, C6 in 6, C7 in 3, C6-T1 1 in 1 and T11 in 1. Based on WBB classification, 16 were 1-3 or 10-12 and 2 were 4-9 and 1-3. 18 operations had been performed with en bloc resection. A posterior approach was used for 16 patients, and a combined posterior and anterior approach was used for 2 patients. Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 13 patients. We used visual analogue scales (VAS to evaluate the change of pain before and after the operation, and the McCormick System to assess functional status of the spine. Imaging test was used to review the stability and recurrence rate of spine cord, and the confluence of graft bones. RESULTS: All cases were followed up for 24-80 months (average, 38.4 months. The average surgical time was 120.8 minutes (range, 80-220 minutes, with the average intraoperative blood loss of 520 ml (range, 300-1200 ml. During the follow-up period, the VAS grade reduced from 6.46±1.32 to 2.26±1.05 (P <0.05. 15 patients had neurological function improved and 3 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up. CONCLUSIONS: Spinal osteoblastoma has its own specific radiographic features. There is some recurrence in simple curettage of tumor lesion. The thoroughly en bloc resection of tumor or spondylectomy, bone fusion and strong in Ter fixation are the key points for successful surgical treatment.

Prototyping a Hybrid Cooperative and Tele-robotic Surgical System for Retinal Microsurgery.

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Balicki, Marcin; Xia, Tian; Jung, Min Yang; Deguet, Anton; Vagvolgyi, Balazs; Kazanzides, Peter; Taylor, Russell

2011-06-01

This paper presents the design of a tele-robotic microsurgical platform designed for development of cooperative and tele-operative control schemes, sensor based smart instruments, user interfaces and new surgical techniques with eye surgery as the driving application. The system is built using the distributed component-based cisst libraries and the Surgical Assistant Workstation framework. It includes a cooperatively controlled EyeRobot2, a da Vinci Master manipulator, and a remote stereo visualization system. We use constrained optimization based virtual fixture control to provide Virtual Remote-Center-of-Motion (vRCM) and haptic feedback. Such system can be used in a hybrid setup, combining local cooperative control with remote tele-operation, where an experienced surgeon can provide hand-over-hand tutoring to a novice user. In another scheme, the system can provide haptic feedback based on virtual fixtures constructed from real-time force and proximity sensor information.

Next-generation robotic surgery--from the aspect of surgical robots developed by industry.

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Nakadate, Ryu; Arata, Jumpei; Hashizume, Makoto

2015-02-01

At present, much of the research conducted worldwide focuses on extending the ability of surgical robots. One approach is to extend robotic dexterity. For instance, accessibility and dexterity of the surgical instruments remains the largest issue for reduced port surgery such as single port surgery or natural orifice surgery. To solve this problem, a great deal of research is currently conducted in the field of robotics. Enhancing the surgeon's perception is an approach that uses advanced sensor technology. The real-time data acquired through the robotic system combined with the data stored in the robot (such as the robot's location) provide a major advantage. This paper aims at introducing state-of-the-art products and pre-market products in this technological advancement, namely the robotic challenge in extending dexterity and hopefully providing the path to robotic surgery in the near future.

Minimizing surgical skin incision scars with a latex surgical glove.

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Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun

2013-04-01

The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Thorascopic resection of an apical paraspinal schwannoma using the da Vinci surgical system.

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Finley, David; Sherman, Jonathan H; Avila, Edward; Bilsky, Mark

2014-01-01

Posterior mediastinal neurogenic tumors have traditionally been resected via an open posterolateral thoracotomy. Video-assisted thorascopic surgery has emerged as an alternative technique allowing for improved morbidity with decreased blood loss, less postoperative pain, and a shorter recovery period, among others. The da Vinci surgical system, as first described for urologic procedures, has recently been reported for lung lobectomy. This technique provides the advantages of instrumentation with 6 degrees of freedom, stable operating arms, and improved visualization with the three-dimensional high-definition camera. We describe the technique for thorascopic resection of an apical paraspinal schwannoma of the T1 nerve root with the da Vinci surgical system. This technique used a specialized intraoperative neuromonitoring probe for free-running electromyography (EMG) and triggered EMG. We demonstrate successful resection of a posterior paraspinal schwannoma with the da Vinci surgical system while preserving neurologic function. The patient displayed stable intraoperative monitoring of the T1 nerve root and full intrinsic hand strength postoperatively. The technique described in this article introduces robotic system accuracy and precludes the need for an open thoracotomy. In addition, this approach demonstrates the ability of the da Vinci surgical system to safely dissect tumors from their neural attachments and is applicable to other such lesions of similar size and location. Georg Thieme Verlag KG Stuttgart · New York.

A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument.

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Merola, Andrew A; Haher, Thomas R; Brkaric, Mario; Panagopoulos, Georgia; Mathur, Samir; Kohani, Omid; Lowe, Thomas G; Lenke, Larry G; Wenger, Dennis R; Newton, Peter O; Clements, David H; Betz, Randal R

2002-09-15

A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society Questionnaire (SRS 24). To evaluate the patient based outcome of the surgical treatment of adolescent idiopathic scoliosis. A paucity of information exists with respect to patient measures of outcome regarding the surgical treatment of adolescent idiopathic scoliosis. To our knowledge, no prospective outcome study on this topic thus far exists. Using the SRS 24 questionnaire, seven scoliosis centers agreed to prospectively assess outcome for surgically treated patients with adolescent idiopathic scoliosis. Data were collected before surgery and at 24 months after surgery. Data were analyzed using paired and independent samples t test for all seven SRS 24 questionnaire domains (Pain, General Self-Image, Postoperative Self-Image, Postoperative Function, Function From Back Condition, General Level of Activity, and Satisfaction) using Statistical Package for Social Science. The domains were analyzed with respect to the total cohort, gender, curve magnitude, and type of surgery using independent-samples t tests. A total of 242 patients were included in our analysis. A baseline preoperative pain level of 3.68 of 5 was found. This improved to 4.63 after surgery, representing an improvement of 0.95 points. Surgical intervention was associated with improving outcome when compared with preoperative status. Pain, General Self-Image, Function From Back Condition, and Level of Activity all demonstrated statistically significant improvement as compared with preoperative status (P adolescent scoliosis population. Pain scores were improved in our study population at the 2-year postsurgical follow-up. Statistically significant improvements were likewise seen in the General Self-Image, Function From Back Condition, and Level of Activity domains. The present study demonstrates the ability of surgery to improve the outcome of patients afflicted with

Care practices of older people with dementia in the surgical ward: A questionnaire survey

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Nina Hynninen

2016-11-01

Full Text Available Objectives: The objective of this study was to describe the care practices of nursing staff caring older people with dementia in a surgical ward. Methods: The data were collected from nursing staff (n = 191 working in surgical wards in one district area in Finland during October to November 2015. Data were collected using a structured questionnaire and analyzed statistically. The instrument consists of a total number of 141 items and four dimensions. The dimensions were as follows: background information (12 of items, specific characteristics of older people with dementia in a surgical ward (24 of items, specific characteristics of their care in a surgical ward (66 of items and use of physical restraints and alternative models for use of restraints for people with dementia (39 of items. Results: The questions which measure the nursing staff’s own assessment of care practices when caring for people with dementia in surgical wards were selected: counseling people with dementia, reaction when a surgical patient with dementia displays challenging behavior and use of alternative approach instead of physical restraints. Most commonly the nursing staff pay attention to patient’s state of alertness before counseling older people with dementia. Instead of using restraints, nursing staff gave painkillers for the patient and tried to draw patients’ attention elsewhere. The nursing staff with longer work experience estimate that they can handle the patients’ challenging behavior. They react by doing nothing more often than others. They pretend not to hear, see or notice anything. Conclusion: The findings of this study can be applied in nursing practice and in future studies focusing on the care practices among older people with dementia in acute care environment. The results can be used while developing patient treatments process in surgical ward to meet future needs.

A software-based tool for video motion tracking in the surgical skills assessment landscape

OpenAIRE

Ganni, S.; Botden, Sanne M.B.I.; Chmarra, M.K.; Goossens, R.H.M.; Jakimowicz, J.J.

2018-01-01

Background: The use of motion tracking has been proved to provide an objective assessment in surgical skills training. Current systems, however, require the use of additional equipment or specialised laparoscopic instruments and cameras to extract the data. The aim of this study was to determine the possibility of using a software-based solution to extract the data. Methods: 6 expert and 23 novice participants performed a basic laparoscopic cholecystectomy procedure in the operating room. The...

Approaching time is important for assessment of endoscopic surgical skills.

Science.gov (United States)

Tokunaga, Masakazu; Egi, Hiroyuki; Hattori, Minoru; Yoshimitsu, Masanori; Sumitani, Daisuke; Kawahara, Tomohiro; Okajima, Masazumi; Ohdan, Hideki

2012-05-01

This study aimed to verify whether the approaching time (the time taken to reach the target point from another point, a short distance apart, during point-to-point movement in endoscopic surgery), assessed using the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), could distinguish the skill level of surgeons. Expert surgeons (who had performed more than 50 endoscopic surgeries) and novice surgeons (who had no experience in performing endoscopic surgery) were tested using the HUESAD. The approaching time, total time, and intermediate time (total time--approaching time) were measured and analyzed using the trajectory of the tip of the instrument. The approaching time and total time were significantly shorter in the expert group than in the novice group (p time did not significantly differ between the groups (p > 0.05). The approaching time, which is a component of the total time, is very mportant in the measurement of the total time to assess endoscopic surgical skills. Further, the approaching time was useful for skill assessment by the HUESAD for evaluating the skill of surgeons performing endoscopic surgery.

Evaluating Robotic Surgical Skills Performance Under Distractive Environment Using Objective and Subjective Measures.

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Suh, Irene H; LaGrange, Chad A; Oleynikov, Dmitry; Siu, Ka-Chun

2016-02-01

Distractions are recognized as a significant factor affecting performance in safety critical domains. Although operating rooms are generally full of distractions, the effect of distractions on robot-assisted surgical (RAS) performance is unclear. Our aim was to investigate the effect of distractions on RAS performance using both objective and subjective measures. Fifteen participants performed a knot-tying task using the da Vinci Surgical System and were exposed to 3 distractions: (1) passive distraction entailed listening to noise with a constant heart rate, (2) active distraction included listening to noise and acknowledging a change of random heart rate from 60 to 120 bpm, and (3) interactive distraction consisted of answering math questions. The objective kinematics of the surgical instrument tips were used to evaluate performance. Electromyography (EMG) of the forearm and hand muscles of the participants were collected. The median EMG frequency (EMG(fmed)) and the EMG envelope (EMG(env)) were analyzed. NASA Task Load Index and Fundamentals of Laparoscopic Surgery score were used to evaluate the subjective performance. One-way repeated analysis of variance was applied to examine the effects of distraction on skills performance. Spearman's correlations were conducted to compare objective and subjective measures. Significant distraction effect was found for all objective kinematics measures (P < .05). There were significant distraction effects for EMG measures (EMG(env), P < .004; EMG(fmed), P = .031). Significant distraction effects were also found for subjective measurements. Distraction impairs surgical skills performance and increases muscle work. Understanding how the surgeons cope with distractions is important in developing surgical education. © The Author(s) 2015.

A Novel Telemanipulated Robotic Assistant for Surgical Endoscopy: Preclinical Application to ESD.

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Zorn, Lucile; Nageotte, Florent; Zanne, Philippe; Legner, Andras; Dallemagne, Bernard; Marescaux, Jacques; de Mathelin, Michel

2018-04-01

Minimally invasive surgical interventions in the gastrointestinal tract, such as endoscopic submucosal dissection (ESD), are very difficult for surgeons when performed with standard flexible endoscopes. Robotic flexible systems have been identified as a solution to improve manipulation. However, only a few such systems have been brought to preclinical trials as of now. As a result, novel robotic tools are required. We developed a telemanipulated robotic device, called STRAS, which aims to assist surgeons during intraluminal surgical endoscopy. This is a modular system, based on a flexible endoscope and flexible instruments, which provides 10 degrees of freedom (DoFs). The modularity allows the user to easily set up the robot and to navigate toward the operating area. The robot can then be teleoperated using master interfaces specifically designed to intuitively control all available DoFs. STRAS capabilities have been tested in laboratory conditions and during preclinical experiments. We report 12 colorectal ESDs performed in pigs, in which large lesions were successfully removed. Dissection speeds are compared with those obtained in similar conditions with the manual Anubiscope platform from Karl Storz. We show significant improvements ( ). These experiments show that STRAS (v2) provides sufficient DoFs, workspace, and force to perform ESD, that it allows a single surgeon to perform all the surgical tasks and those performances are improved with respect to manual systems. The concepts developed for STRAS are validated and could bring new tools for surgeons to improve comfort, ease, and performances for intraluminal surgical endoscopy.

Diagnostic accuracy study of a factor VIII ELISA for detection of factor VIII antibodies in congenital and acquired haemophilia A.

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Batty, Paul; Moore, Gary W; Platton, Sean; Maloney, James C; Palmer, Ben; Bowles, Louise; Pasi, K John; Rangarajan, Savita; Hart, Daniel P

2015-10-01

Antibody formation to factor VIII (FVIII) remains the greatest clinical and diagnostic challenge to the haemophilia-treating physician. Current guidance for testing for inhibitory FVIII antibodies (inhibitors) recommends the functional Nijmegen-Bethesda assay (NBA). A FVIII ELISA offers a complementary, immunological approach for FVIII antibody testing. It was the aim of this study to retrospectively evaluate the performance of a FVIII ELISA (index) for detection of FVIII antibodies, compared with the NBA (reference). All samples sent for routine FVIII antibody testing at two haemophilia Comprehensive Care Centres, were tested in parallel using the NBA and a solid-phase, indirect FVIII ELISA kit (Immucor). A total of 497 samples from 239 patients (severe haemophilia A=140, non-severe haemophilia A=85, acquired haemophilia A=14) were available for analysis. Sixty-three samples tested positive by the NBA (prevalence 12.7%, 95% confidence interval [CI], 9.9-15.9 %), with a median inhibitor titre of 1.2 BU/ml (range 0.7-978.0). The FVIII ELISA demonstrated a specificity of 94.0% (95%CI, 91.3-96.0), sensitivity of 77.8% (95%CI, 65.5-87.3), negative predictive value of 96.7% (95%CI, 94.5-98.2), positive predictive value 65.3% (95%CI, 53.5-76.0), negative likelihood ratio 0.2 (95%CI, 0.1-0.4), positive likelihood ratio 13.0 (95%CI, 8.7-19.3) and a diagnostic odds ratio of 54.9 (95%CI, 27.0-112.0). Strong positive correlation (r=0.77, pNBA (log adjusted) and FVIII ELISA optical density. In conclusion, FVIII ELISA offers a simple, specific, surveillance method enabling batch testing of non-urgent samples for the presence of FVIII antibodies.

Corticotomy-facilitated orthodontics using piezosurgery versus rotary instruments: an experimental study.

Science.gov (United States)

Farid, Karim A; Mostafa, Yehya A; Kaddah, Mohammed A; El-Sharaby, Fouad Aly

2014-10-01

The aim of this study was to evaluate corticotomy-facilitated orthodontics (CFO) using piezosurgery versus conventional rotary instruments. Ten healthy adult male mongrel dogs of comparable age with a complete set of permanent dentition with average weights between 13-17 kilograms were used. CFO using conventional rotary instruments versus piezosurgery was performed on each dog in a split mouth design. For every dog, mandibular 2nd premolar retraction on each side was attempted after extracting 3rd premolars followed by corticotomy-facilitated orthodontics using conventional rotary surgical burs on the left side and an ultrasonic piezosurgery system on the right side of the same animal. Intraoral measurements of the rate of tooth movement were taken with a sliding caliper. Measurements were performed by the same operator at the time of surgery (appliance delivery) and every month for six months. The dogs were sacrificed after six months from initiation of tooth movement to evaluate the amount of tooth movement for both conventional rotary and piezosurgery corticotomy techniques. A statistically significantly higher mean amount of tooth movement for conventional rotary instrument versus the piezosurgery corticotomy technique was observed at all time intervals. Tooth movement was 1.6 times faster when CFO was done using conventional rotary instruments as compared to a piezosurgery device.

Surgical applications of three-dimensional printing: a review of the current literature & how to get started

Science.gov (United States)

Hoang, Don; Perrault, David; Stevanovic, Milan

2016-01-01

Three dimensional (3D) printing involves a number of additive manufacturing techniques that are used to build structures from the ground up. This technology has been adapted to a wide range of surgical applications at an impressive rate. It has been used to print patient-specific anatomic models, implants, prosthetics, external fixators, splints, surgical instrumentation, and surgical cutting guides. The profound utility of this technology in surgery explains the exponential growth. It is important to learn how 3D printing has been used in surgery and how to potentially apply this technology. PubMed was searched for studies that addressed the clinical application of 3D printing in all surgical fields, yielding 442 results. Data was manually extracted from the 168 included studies. We found an exponential increase in studies addressing surgical applications for 3D printing since 2011, with the largest growth in craniofacial, oromaxillofacial, and cardiothoracic specialties. The pertinent considerations for getting started with 3D printing were identified and are discussed, including, software, printing techniques, printing materials, sterilization of printing materials, and cost and time requirements. Also, the diverse and increasing applications of 3D printing were recorded and are discussed. There is large array of potential applications for 3D printing. Decreasing cost and increasing ease of use are making this technology more available. Incorporating 3D printing into a surgical practice can be a rewarding process that yields impressive results. PMID:28090512

Wound healing of osteotomy defects prepared with piezo or conventional surgical instruments: a pilot study in rabbits.

Science.gov (United States)

Ma, Li; Mattheos, Nikos; Sun, Yan; Liu, Xi Ling; Yip Chui, Ying; Lang, Niklaus Peter

2015-08-01

The aim of the present study was to evaluate and compare the wound-healing process following osteotomies performed with either conventional rotary burs or piezoelectric surgery in a rabbit model. Two types of osteotomy window defects of the nasal cavities were prepared on the nasal bone of 16 adult New Zealand white rabbits with either a conventional rotary bur or piezo surgery. The defects were covered with a resorbable membrane. Four animals were killed at 1, 2, 3, and 5 weeks after the surgical procedure, respectively. Histological and morphometric evaluations were performed to assess the volumetric density of various tissue components: the blood clot, vascularized structures, provisional matrix, osteoid, mineralized bone, bone debris, residual tissue, and old bone. Significantly more bone debris was found at 1 week in the conventionally-prepared defects compared to the piezo surgically-prepared defects. At 2 and 3 weeks, a newly-formed hard tissue bridge, mainly composed of woven bone, was seen; however, no statistically-significant differences were observed. At 5 weeks, the defects were completely filled with newly-formed bone. The defects prepared by piezo surgery showed a significantly decreased proportion of bone debris at 1 week, compared to conventional rotary bur defect. © 2014 Wiley Publishing Asia Pty Ltd.

[Severe idiopathic scoliosis. Does the approach and the instruments used modify the results?].

Science.gov (United States)

Sánchez-Márquez, J M; Sánchez Pérez-Grueso, F J; Pérez Martín-Buitrago, M; Fernández-Baíllo, N; García-Fernández, A; Quintáns-Rodríguez, J

2014-01-01

The aim of this work is to evaluate and compare the radiographic results and complications of the surgical treatment of adolescents with idiopathic scoliosis greater than 75 degrees, using a double approach (DA) or an isolated posterior approach with hybrid instruments (posterior hybrid [PH]), or with «all-pedicle screws» (posterior screws [PS]). A retrospective review was performed on 69 patients with idiopathic scoliosis greater than 75°, with a follow-up of more than 2 years, to analyze the flexibility of the curves, the correction obtained, and the complications depending on the type of surgery. The Kruskal-Wallis test for non-parametric variables was used for the statistical analysis. There were no statistically significant differences between the 3 patient groups in the pre-surgical Cobb angle values (DA=89°, PH=83°, PS=83°), in the immediate post-surgical (DA=34°, PH=33°, PS=30°), nor at the end of follow-up (DA=36°, PH=36°, PS=33°) (P>.05). The percentage correction (DA=60%, PH=57%, PS=60%) was similar between groups (P>.05). The percentage of complications associated with the procedure was 20.8% in DA, 10% in PH and 20% in PS. Two patients in the PS group showed changes, with no neurological lesions, in the spinal cord monitoring, and one patient in the same group suffered a delayed and transient incomplete lesion. No significant differences were observed in the correction of severe idiopathic scoliosis between patients operated using the double or isolated posterior approach, regardless of the type of instrumentation used. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

Bacterial migration through punctured surgical gloves under real surgical conditions

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Heidecke Claus-Dieter

2010-07-01

Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.

The Karen instruments for measuring quality of nursing care: construct validity and internal consistency.

Science.gov (United States)

Lindgren, Margareta; Andersson, Inger S

2011-06-01

Valid and reliable instruments for measuring the quality of care are needed for evaluation and improvement of nursing care. Previously developed and evaluated instruments, the Karen-patient and the Karen-personnel based on Donabedian's Structure-Process-Outcome triad (S-P-O triad) had promising content validity, discriminative power and internal consistency. The objective of this study was to further develop the instruments with regard to construct validity and internal consistency. This prospective study was carried out in medical and surgical wards at a hospital in Sweden. A total of 95 patients and 120 personnel were included. The instruments were tested for construct validity by performing factor analyses in two steps and for internal consistency using Cronbach's alpha coefficient. The first confirmatory factor analyses, with a pre-determined three-factor solution did not load well according to the S-P-O triad, but the second exploratory factor analysis with a six-factor solution appeared to be more coherent and the distribution of variables seemed to be logical. The reliability, i.e. internal consistency, was good in both factor analyses. The Karen-patient and the Karen-personnel instruments have achieved acceptable levels of construct validity. The internal consistency of the instruments is good. This indicates that the instruments may be suitable to use in clinical practice for measuring the quality of nursing care.

Prospective data collection and analysis of perforations and tears of latex surgical gloves during primary endoprosthetic surgeries

Directory of Open Access Journals (Sweden)

Zaatreh, Sarah

2016-12-01

Full Text Available Introduction: Surgical gloves are used to prevent contamination of the patient and the hospital staff with pathogens. The aim of this study was to examine the actual effectiveness of gloves by examining the damage (perforations, tears to latex gloves during surgery in the case of primary hip and knee prosthesis implantation. Materials and methods: Latex surgical gloves used by surgeons for primary hip and knee replacement surgeries were collected directly after the surgery and tested using the watertightness test according to ISO EN 455-1:2000.Results: 540 gloves were collected from 104 surgeries. In 32.7% of surgeries at least one glove was damaged. Of all the gloves collected, 10.9% were damaged, mainly on the index finger. The size of the perforations ranged from ≤1 mm to over 5 mm. The surgeon’s glove size was the only factor that significantly influenced the occurrence of glove damage. Surgeon training level, procedure duration, and the use of bone cement had no significant influence.Conclusions: Our results highlight the high failure rate of surgical gloves. This has acute implications for glove production, surgical practice, and hygiene guidelines. Further studies are needed to detect the surgical steps, surface structures, and instruments that pose an increased risk for glove damage.

Prospective data collection and analysis of perforations and tears of latex surgical gloves during primary endoprosthetic surgeries.

Science.gov (United States)

Zaatreh, Sarah; Enz, Andreas; Klinder, Annett; König, Tony; Mittelmeier, Lena; Kundt, Günther; Mittelmeier, Wolfram

2016-01-01

Introduction: Surgical gloves are used to prevent contamination of the patient and the hospital staff with pathogens. The aim of this study was to examine the actual effectiveness of gloves by examining the damage (perforations, tears) to latex gloves during surgery in the case of primary hip and knee prosthesis implantation. Materials and methods: Latex surgical gloves used by surgeons for primary hip and knee replacement surgeries were collected directly after the surgery and tested using the watertightness test according to ISO EN 455-1:2000. Results: 540 gloves were collected from 104 surgeries. In 32.7% of surgeries at least one glove was damaged. Of all the gloves collected, 10.9% were damaged, mainly on the index finger. The size of the perforations ranged from ≤1 mm to over 5 mm. The surgeon's glove size was the only factor that significantly influenced the occurrence of glove damage. Surgeon training level, procedure duration, and the use of bone cement had no significant influence. Conclusions: Our results highlight the high failure rate of surgical gloves. This has acute implications for glove production, surgical practice, and hygiene guidelines. Further studies are needed to detect the surgical steps, surface structures, and instruments that pose an increased risk for glove damage.

Prospective data collection and analysis of perforations and tears of latex surgical gloves during primary endoprosthetic surgeries

Science.gov (United States)

Zaatreh, Sarah; Enz, Andreas; Klinder, Annett; König, Tony; Mittelmeier, Lena; Kundt, Günther; Mittelmeier, Wolfram

2016-01-01

Introduction: Surgical gloves are used to prevent contamination of the patient and the hospital staff with pathogens. The aim of this study was to examine the actual effectiveness of gloves by examining the damage (perforations, tears) to latex gloves during surgery in the case of primary hip and knee prosthesis implantation. Materials and methods: Latex surgical gloves used by surgeons for primary hip and knee replacement surgeries were collected directly after the surgery and tested using the watertightness test according to ISO EN 455-1:2000. Results: 540 gloves were collected from 104 surgeries. In 32.7% of surgeries at least one glove was damaged. Of all the gloves collected, 10.9% were damaged, mainly on the index finger. The size of the perforations ranged from ≤1 mm to over 5 mm. The surgeon’s glove size was the only factor that significantly influenced the occurrence of glove damage. Surgeon training level, procedure duration, and the use of bone cement had no significant influence. Conclusions: Our results highlight the high failure rate of surgical gloves. This has acute implications for glove production, surgical practice, and hygiene guidelines. Further studies are needed to detect the surgical steps, surface structures, and instruments that pose an increased risk for glove damage. PMID:28066701

Surgical experts: born or made?

Science.gov (United States)

Sadideen, Hazim; Alvand, Abtin; Saadeddin, Munir; Kneebone, Roger

2013-01-01

The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Incidence and outcome of ventilator-associated pneumonia in Inkosi ...

African Journals Online (AJOL)

pneumonia in Inkosi Albert Luthuli and King Edward VIII. Hospital surgical ... Ventilator-associated pneumonia (VAP) is one of the most common causes of hospital morbidity and mortality, but has ... microbial flora.[5] ... or confirmed community-acquired or .... Patients' baseline function, comorbidities, injury severity score and.

Separation method for ions of elements of the III., IV., VI. and VIII. groups of periodical system

International Nuclear Information System (INIS)

Marhol, M.

1973-01-01

The method is presented of separating the ions of the elements of the periodic system groups III, IV, and VIII by ion exchangers. The ions are complex-bonded to a new type of ion exchanger consisting of the polycondensates of phenol with aldehydes or ketones and containing an atom of phosphorus, arsenic or antimony with an atom of sulphur or oxygen in a complex bond. The polymers of compounds containing a double bond, e.g., of butadiene, polyvinyl alcohol, polyethylene, polypropylene, and the compounds of styrene with fural may also be used for this purpose. The method is demonstrated on a case of uranium and heavy metal concentration and the separation thereof from waste waters. (L.K.)

Spectra of the W VIII isoelectronic sequence: III. Re IX

International Nuclear Information System (INIS)

Ryabtsev, A N; Kononov, E Ya; Kildiyarova, R R; Tchang-Brillet, W-Ü L; Wyart, J-F; Champion, N; Blaess, C

2015-01-01

Rhenium spectra excited in vacuum spark sources of different setups and electric circuits were recorded on two high resolution vacuum spectrographs: a 10 m normal incidence spectrograph with a 3600 l mm −1 grating in the Meudon Observatory and a 3 m grazing incidence spectrograph with a 3600 l mm −1 grating in the Institute of Spectroscopy in Troitsk. A total of 112 lines in the region 146–244 Å were identified as transitions from the interacting excited even configurations 4f 12 5s 2 5p 6 5d + 4f 13 5s 2 5p 5 (5d + 6s) + 4f 14 5s 2 5p 4 (5d + 6s) to the low-lying odd configurations 4f 13 5s 2 5p 6 and 4f 14 5s 2 5p 5 . A change of the ground configuration from 4f 13 5s 2 5p 6 to 4f 14 5s 2 5p 5 in a comparison with the previous spectra of the isoelectronic sequence Hf VI–W VIII was observed. Fine structure splittings and relative positions of the odd terms were established, and 83 levels of the excited even configurations were found. (paper)

Grotrian diagrams of highly ionized iron Fe(VIII)-Fe(XXVI)

International Nuclear Information System (INIS)

Mori, Kazuo; Otsuka, Masamoto; Kato, Takako.

1977-08-01

Energy levels and Grotrian diagrams of Fe(VIII) to Fe(XXVI) are presented. This report summarized the data published recently up to 1976, and the wavelength tables compiled were converted to the Grotrian diagrams. The diagrams showing transition from one energy level to another are called Grotrian diagrams. Typical examples of the diagrams are found in the book by Bashkin et al. In the present diagrams, all lines are drawn in parallel, and connected to the extended lines from lower levels. As the results, locally dense packing of lines and figures is avoided. The ordinate of the diagrams indicates level energy, and the J values are shown on the left side of the levels. The wavelength values in angstrom unit are written in parallel with the vertical transition lines. This vertical lines show the resonance transition having absorption oscillator strength f larger than 0.1. The present diagrams are the combination of the tables of wavelength and energy level. Accordingly, the desired wavelength and level energy are easily found. The figures of wavelength are lined up in various groups, so that the characteristics of the transition can be discriminated at a glance. Wavelength and level energy have been mostly derived from experimental spectra in laboratory or solar plasma, except a few by Fawcett's prediction. (Kato, T.)

Preoperative embolization in surgical treatment of spinal metastases

DEFF Research Database (Denmark)

Clausen, Caroline; Dahl, Benny; Frevert, Susanne Christiansen

2015-01-01

PURPOSE: To assess whether preoperative transcatheter arterial embolization of spinal metastases reduces blood loss, the need for transfusion with allogeneic red blood cells (RBCs), and surgery time in the surgical treatment of patients with symptomatic metastatic spinal cord compression. MATERIALS......L) versus 902 mL (SD, 416 mL). CONCLUSIONS: Preoperative embolization in patients with symptomatic spinal metastasis independent of primary tumor diagnosis did not reduce intraoperative blood loss and allogeneic RBC transfusion significantly but did reduce the surgery time. A small reduction...... instrumentation and randomly assigned to either preoperative embolization (n = 23) or a control group (n = 22). The primary outcome was intraoperative blood loss. Secondary outcomes were perioperative blood loss, allogeneic RBC transfusion, and surgery time. Analyses were performed by intention-to-treat. RESULTS...

Lumbar lordosis restoration following single-level instrumented fusion comparing 4 commonly used techniques.

Science.gov (United States)

Dimar, John R; Glassman, Steven D; Vemuri, Venu M; Esterberg, Justin L; Howard, Jennifer M; Carreon, Leah Y

2011-11-09

A major sequelae of lumbar fusion is acceleration of adjacent-level degeneration due to decreased lumbar lordosis. We evaluated the effectiveness of 4 common fusion techniques in restoring lordosis: instrumented posterolateral fusion, translumbar interbody fusion, anteroposterior fusion with posterior instrumentation, and anterior interbody fusion with lordotic threaded (LT) cages (Medtronic Sofamor Danek, Memphis, Tennessee). Radiographs were measured preoperatively, immediately postoperatively, and a minimum of 6 months postoperatively. Parameters measured included anterior and posterior disk space height, lumbar lordosis from L3 to S1, and surgical level lordosis.No significant difference in demographics existed among the 4 groups. All preoperative parameters were similar among the 4 groups. Lumbar lordosis at final follow-up showed no difference between the anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cage groups, although the posterolateral fusion group showed a significant loss of lordosis (-10°) (Plordosis and showed maintenance of anterior and posterior disk space height postoperatively compared with the other groups. Instrumented posterolateral fusion produces a greater loss of lordosis compared with anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cages. Maintenance of lordosis and anterior and posterior disk space height is significantly better with anterior interbody fusion with LT cages. Copyright 2011, SLACK Incorporated.

Patient preference and ease of use for different coagulation factor VIII reconstitution device scenarios: a cross-sectional survey in five European countries

Directory of Open Access Journals (Sweden)

Cimino E

2014-12-01

Full Text Available Ernesto Cimino,1 Silvia Linari,2 Mara Malerba,3 Susan Halimeh,4 Francesca Biondo,5 Martina Westfeld5 1Dipartimento Medicina Clinica e Sperimentale, Universita’ degli Studi di Napoli Federico II, Naples, Italy; 2Agenzia per l’ Emofilia, AOU Careggi di Firenze, Florence, Italy; 3Fondazione Cà Granda Ospedale Maggiore Policlinico, Centro Emofilia e Trombosi “A Bianchi Bonomi”, Milan, Italy; 4CRC Coagulation Research Centre GmbH, Duisburg, Germany; 5Pfizer Italia, Rome, Italy Introduction: Hemophilia A treatment involves replacing the deficient coagulation factor VIII. This process may involve multiple steps that might create a barrier to adherence. A new dual-chamber syringe (DCS; FuseNGo® was recently introduced with the aim of simplifying reconstitution. Aim: This study aimed to identify factors associated with adult patients’ preferences for different coagulation factor VIII reconstitution systems and to test ease of use and patient preference for the DCS. Methods: A cross-sectional survey of adults with hemophilia A in five European countries was conducted; a subset of subjects also participated in a practical testing session of the DCS. Results: Among the 299 survey participants, the device scenario requiring the least equipment and reconstitution steps (the DCS received a median preference rating of 71 out of 100 (0 being “the least desirable” and 100 “the most desirable” rating. This was significantly higher than the other scenarios (the next highest achieved a median of 50 points; P<0.001. Participants would be more likely to use this device prophylactically (P<0.001. Among the 98 participants who tested the DCS, 57% preferred this device over their current device, 26% preferred their current device, and 17% had no preference. The DCS was rated as easier to use than current treatment devices (median score 9/10 versus 7/10 for current treatment, P=0.001. Conclusion: The survey indicates that the prefilled DCS, Fuse

Assessment of Surgical and Trauma Capacity in Potosí, Bolivia.

Science.gov (United States)

Blair, Kevin J; Boeck, Marissa A; Gallardo Barrientos, José Luis; Hidalgo López, José Luis; Helenowski, Irene B; Nwomeh, Benedict C; Shapiro, Michael B; Swaroop, Mamta

Scaling up surgical and trauma care in low- and middle-income countries could prevent nearly 2 million annual deaths. Various survey instruments exist to measure surgical and trauma capacity, including Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT). We sought to evaluate surgical and trauma capacity in the Bolivian department of Potosí using a combined PIPES and INTACT tool, with additional questions to further inform intervention targets. In June and July 2014 a combined PIPES and INTACT survey was administered to 20 government facilities in Potosí with a minimum of 1 operating room: 2 third-level, 10 second-level, and 8 first-level facilities. A surgeon, head physician, director, or obstetrician-gynecologist completed the survey. Additional personnel responded to 4 short-answer questions. Survey items were divided into subsections, and PIPES and INTACT indices calculated. Medians were compared via Wilcoxon rank sum and Kruskal-Wallis tests. Six of 20 facilities were located in the capital city and designated urban. Urban establishments had higher median PIPES (8.5 vs 6.7, P = .11) and INTACT (8.5 vs 6.9, P = .16) indices compared with rural. More than half of surgeons and anesthesiologists worked in urban hospitals. Urban facilities had higher median infrastructure and procedure scores compared with rural. Fifty-three individuals completed short-answer questions. Training was most desired in laparoscopic surgery and trauma management; less than half of establishments reported staff with trauma training. Surgical and trauma capacity in Potosí was most limited in personnel, infrastructure, and procedures at rural facilities, with greater personnel deficiencies than previously reported. Interventions should focus on increasing the number of surgical and anesthesia personnel in rural areas, with a particular focus on the reported desire for trauma management training. Results

[The beneficial effect of mineral waters of Fiuggi on Pope Bonifacio VIII and Michelangelo: two prominent calculous patients].

Science.gov (United States)

Androutsos, Georges

2005-09-01

Going back to the dawn of time, we deal with two historical figures, that of Pope Bonifacio VIII, and that of the hierophant of art, Michelangelo Buonarroti. The texts and the codes of the British Museum (Department of Manuscripts), of the Biblioteca Medica Laurenziana (Archivio Buonarroti) of Florence, and the Biblioteca Apostolica of Vatican, convincing detalled evidence that both figures were urological patients. It concerns two clinical cases with especially pertain to the history of lithiasis of urinary tract. Even though, both of them--the first with nephrolithiasis or gravel, and the second with a bladder stone--were historically bound with the well-known cures of Fiuggi in Italy.

Three-dimensional modeling of physiological tremor for hand-held surgical robotic instruments.

Science.gov (United States)

Tatinati, Sivanagaraja; Yan Naing Aye; Pual, Anand; Wei Tech Ang; Veluvolu, Kalyana C

2016-08-01

Hand-held robotic instruments are developed to compensate physiological tremor in real-time while augmenting the required precision and dexterity into normal microsurgical work-flow. The hardware (sensors and actuators) and software (causal linear filters) employed for tremor identification and filtering introduces time-varying unknown phase-delay that adversely affects the device performance. The current techniques that focus on three-dimensions (3D) tip position control involves modeling and canceling the tremor in 3-axes (x, y, and z axes) separately. Our analysis with the tremor data recorded from surgeons and novice subjects show that there exists significant correlation in tremor motion across the dimensions. Motivated by this, a new multi-dimensional modeling approach based on extreme learning machines (ELM) is proposed in this paper to correct the phase delay and to accurately model tremulous motion in three dimensions simultaneously. A study is conducted with tremor data recorded from the microsurgeons to analyze the suitability of proposed approach.

Global curriculum in surgical oncology.

Science.gov (United States)

Are, C; Berman, R S; Wyld, L; Cummings, C; Lecoq, C; Audisio, R A

2016-06-01

The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment. Copyright © 2016 Society of Surgical Oncology, European Society of Surgical Oncology. Published by Elsevier Ltd.. All rights reserved.

Scoliosis Surgery in Cystic Fibrosis: Surgical Considerations and the Multidisciplinary Approach of a Rare Case

Directory of Open Access Journals (Sweden)

George I. Mataliotakis

2016-01-01

Full Text Available Spinal deformity in patients with cystic fibrosis (CF is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome.

Capping of the radicular exposed surface (part II). Surgical and not surgical treatment

OpenAIRE

Grados Pomarino, Sixto; Estrada, Andrew Alejandro; Maetahara Rubio, Denis Miguel; Guzmán Vera, Yanina Sara; Tello Barbarán, Javier

2014-01-01

The gingival recession treatment can be made surgical1y with a high predictability of success due to the great advance during the last ones of the mucogingival surgical techniques. The use of connective grafts in coverage of recessions has obtained high rates of success reason why these procedures are common within the modern periodontal surgical practice. Knowing that all patients do not accept the surgical treatment, many investigators have come studying the possibility of treating non-surg...

Raven-II: an open platform for surgical robotics research.

Science.gov (United States)

Hannaford, Blake; Rosen, Jacob; Friedman, Diana W; King, Hawkeye; Roan, Phillip; Cheng, Lei; Glozman, Daniel; Ma, Ji; Kosari, Sina Nia; White, Lee

2013-04-01

The Raven-II is a platform for collaborative research on advances in surgical robotics. Seven universities have begun research using this platform. The Raven-II system has two 3-DOF spherical positioning mechanisms capable of attaching interchangeable four DOF instruments. The Raven-II software is based on open standards such as Linux and ROS to maximally facilitate software development. The mechanism is robust enough for repeated experiments and animal surgery experiments, but is not engineered to sufficient safety standards for human use. Mechanisms in place for interaction among the user community and dissemination of results include an electronic forum, an online software SVN repository, and meetings and workshops at major robotics conferences.

The robustness of DLP hyperspectral imaging for clinical and surgical utility

Science.gov (United States)

Zuzak, Karel J.; Wehner, Eleanor; Rao, Shekar; Litorja, Maritoni; Allen, David W.; Singer, Mike; Purdue, Gary; Ufret-Vincenty, Rafael; White, Jonathan; Cadeddu, Jeffrey; Livingston, Edward

2010-02-01

Utilizing seed funding from Texas Instruments, a DLP (R)Hyperspectral Imaging system was developed by integrating a focal-plane array, FPA, detector with a DLP based spectrally tunable illumination source. Software is used to synchronize FPA with DLP hardware for collecting spectroscopic images as well as running novel illumination schemes and chemometric deconvolution methods for producing gray scale or color encoded images visualizing molecular constituents at video rate. Optical spectra and spectroscopic image data of a variety of live human organs and diseased tissue collected from patients during surgical procedures and clinical visits being cataloged for a database will be presented.

Abortion - surgical - aftercare

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

Extended score interval in the assessment of basic surgical skills.

Science.gov (United States)

Acosta, Stefan; Sevonius, Dan; Beckman, Anders

2015-01-01

The Basic Surgical Skills course uses an assessment score interval of 0-3. An extended score interval, 1-6, was proposed by the Swedish steering committee of the course. The aim of this study was to analyze the trainee scores in the current 0-3 scored version compared to a proposed 1-6 scored version. Sixteen participants, seven females and nine males, were evaluated in the current and proposed assessment forms by instructors, observers, and learners themselves during the first and second day. In each assessment form, 17 tasks were assessed. The inter-rater reliability between the current and the proposed score sheets were evaluated with intraclass correlation (ICC) with 95% confidence intervals (CI). The distribution of scores for 'knot tying' at the last time point and 'bowel anastomosis side to side' given by the instructors in the current assessment form showed that the highest score was given in 31 and 62%, respectively. No ceiling effects were found in the proposed assessment form. The overall ICC between the current and proposed score sheets after assessment by the instructors increased from 0.38 (95% CI 0.77-0.78) on Day 1 to 0.83 (95% CI 0.51-0.94) on Day 2. A clear ceiling effect of scores was demonstrated in the current assessment form, questioning its validity. The proposed score sheet provides more accurate scores and seems to be a better feedback instrument for learning technical surgical skills in the Basic Surgical Skills course.

Liquid-liquid extraction and separation of VIII group elements, especially ruthenium, by synergic combinations or aromatic polyimines and micellar cationic exchangers

International Nuclear Information System (INIS)

Vitart, X.

1991-01-01

This thesis aims to characterize and to quantify the chemical equilibria involved in d-elements liquid-liquid extraction systems, especially elements belonging to the VIII group (Fe, Ni, Co, Ru, Rh, Pd, Pt). These systems are composed of synergic combination of aromatic polyimines and micellar cationic exchangers. Substitutions are first performed in aqueous acidic media by aromatic polyimines; then extractions are operated using micellic canionic exchangers. Chemical equilibria, selectivity effects, especially those due to ion-pair formations, kinetics, extractant behaviour are analysed and quantified [fr

Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae.

Science.gov (United States)

Upadhyay, Smita; Dolci, Ricardo L L; Buohliqah, Lamia; Fiore, Mariano E; Ditzel Filho, Leo F S; Prevedello, Daniel M; Otto, Bradley A; Carrau, Ricardo L

2016-02-01

Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidates the benefits of incremental medial maxillectomies to access this region. We compared access to the medial aspect of the infratemporal fossa provided by medial maxillectomy, anteriorly extended medial maxillectomy, endoscopic Denker approach (i.e., Sturmann-Canfield approach), contralateral transseptal approach, and the sublabial anterior maxillotomy (SAM). Methods We studied 10 cadaveric specimens (20 sides) dissecting the pterygopalatine and infratemporal fossae bilaterally. Radius of access was calculated using a navigation probe aligned with the endoscopic line of sight. Area of exposure was calculated as the area removed from the posterior wall of maxillary sinus. Surgical freedom was calculated by computing the working area at the proximal end of the instrument with the distal end fixed at a target. Results The endoscopic Denker approach offered a superior area of exposure (8.46 ± 1.56 cm(2)) and superior surgical freedom. Degree of lateral access with the SAM approach was similar to that of the Denker. Conclusion Our study suggests that an anterior extension of the medial maxillectomy or a cross-court approach increases both the area of exposure and surgical freedom. Further increases can be seen upon progression to a Denker approach.

Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?

Institute of Scientific and Technical Information of China (English)

Hongyi Cui

2011-01-01

Single incision laparoscopic surgery (SILS) is a novel minimally invasive surgical technique that is gaining popularity around the world.One of the most commonly performed procedures is single incision laparoscopic cholecystectomy (SILC).Most reported techniques utilize special purpose-made access port and articulating instruments,rendering the procedure costly and difficult to learn.This article provides a stepwise description of SILC technique using all straight instruments without the need for a special port.It aims to shorten the learning curve for surgeons wishing to adopt a safe and cost-effective SILC technique to their practice.

Evaluation of Neutron Reactions on Iron Isotopes for CIELO and ENDF/B-VIII.0

Science.gov (United States)

Herman, M.; Trkov, A.; Capote, R.; Nobre, G. P. A.; Brown, D. A.; Arcilla, R.; Danon, Y.; Plompen, A.; Mughabghab, S. F.; Jing, Q.; Zhigang, G.; Tingjin, L.; Hanlin, L.; Xichao, R.; Leal, L.; Carlson, B. V.; Kawano, T.; Sin, M.; Simakov, S. P.; Guber, K.

2018-02-01

A new suite of evaluations for 54,56,57,58Fe has been developed in the framework of the CIELO international collaboration. New resolved resonance ranges were evaluated for 54Fe and 57Fe, while modifications were applied to resonances in 56Fe. The low energy part of the 56Fe file is almost totally based on measurements. At higher energies in 56Fe and in the whole fast neutron range for minor isotopes the evaluation consists of model predictions carefully adjusted to available experimental data. We also make use of the high quality and well experimentally-constrained dosimetry evaluations from the IRDFF library. Special attention was dedicated to the elastic angular distributions, which were found to affect results of the integral benchmarking. The new set of iron evaluations was developed in concert with other CIELO evaluations and they were tested together in the integral experiments before being adopted for the ENDF/B-VIII.0 library.

Surgical competence.

Science.gov (United States)

Patil, Nivritti G; Cheng, Stephen W K; Wong, John

2003-08-01

Recent high-profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.

The transitions 4p-5s in Y VI, Zr VII, Nb VIII and Mo IX

International Nuclear Information System (INIS)

Chaghtai, M.S.Z.; Rahimullah, K.; Khatoon, S.

1976-01-01

With the help of the spectra recorded in the Physics Department of Lund University, Y VI, Zr VII, Nb VIII and Mo IX are freshly analysed. The five 4s 2 4p 4 ground levels and the ten 4s 2 4p 3 5s levels of previous analyses are confirmed in the first three spectra, except for revising in Y VI the 4p 4 1 S 0 and 4p 3 5s( 4 Ssub(3/2)) 2 levels and interchanging 5s( 2 Dsub(3/2)) 1 with 5s( 2 Dsub(3/2)) 2 . All level values are improved due to the new measurements. A new analysis of Mo IX establishing all the 4p 4 and 4p 3 5s levels is being reported. (Auth.)

Ontogeny of a surgical technique: Robotic kidney transplantation with regional hypothermia.