Mishra, Shashikant; Sabnis, Ravindra B; Kurien, Abraham; Ganpule, Arvind; Muthu, Veeramani; Desai, Mahesh
2010-10-01
To establish the efficacy of early removal of a nephrostomy tube after percutaneous nephrolithotomy (PCNL), to challenge the wisdom of tubeless PCNL, as we hypothesized that it would result in a shorter hospital stay, comparable benefit and safety, while maintaining the option of check nephroscopy ensuring far superior stone clearance. In all, 22 patients were prospectively randomized equally into two groups, group 1 (early nephrostomy removal) or group 2 (tubeless) during a 1-month study period. Inclusion criteria for the study were: a simple stone of Foley catheter were used, while in group 2 only a 6 F retrograde ureteric catheter and Foley catheter were placed at the end of the procedure. Computed tomography (CT) with no contrast medium was done on the first morning after surgery before removing all catheters/tubes, and patients discharged subsequently. The variables assessed were stone clearance, hospital stay, analgesic requirement, postoperative complications and auxiliary procedures. The mean (SD) stone bulk was similar between the groups, at 2737 (946.9) and 2934.2 (2090.7) µL, respectively. Despite an on-table complete clearance, clearance assessed by CT was nine of 11 vs eight of 11 in groups 1 and 2, respectively. CT showed a 6 mm stone in one patient in group 1, while the remaining patients had stones of haematuria in none vs three (P= 0.21), urinoma none vs one, and fever in two vs one, respectively; one patient in group 1 required a check nephroscopy for a residual fragment. Overall clearance including re-treatment was 10/11 vs eight of 11 (P= 0.009), respectively. Early tube removal after PCNL results in an equivalent analgesic requirement, decrease in haemoglobin and hospital stay as tubeless PCNL. It has a significantly lower incidence of early haematuria, better clearance rates and preserves the option of check nephroscopy. It can be considered as an accepted standard of care, with the preserved advantages of tubeless PCNL. © 2010 THE AUTHORS
Lee, Joo Yong; Jeh, Seong Uk; Kim, Man Deuk; Kang, Dong Hyuk; Kwon, Jong Kyou; Ham, Won Sik; Choi, Young Deuk; Cho, Kang Su
2017-06-27
Percutaneous nephrolithotomy (PCNL) is performed to treat relatively large renal stones. Recent publications indicate that tubeless and total tubeless (stentless) PCNL is safe in selected patients. We performed a systematic review and network meta-analysis to evaluate the feasibility and safety of different PCNL procedures, including total tubeless, tubeless with stent, small-bore tube, and large-bore tube PCNLs. PubMed, Cochrane Central Register of Controlled Trials, and EMBASE™ databases were searched to identify randomized controlled trials published before December 30, 2013. One researcher examined all titles and abstracts found by the searches. Two investigators independently evaluated the full-text articles to determine whether those met the inclusion criteria. Qualities of included studies were rated with Cochrane's risk-of-bias assessment tool. Sixteen studies were included in the final syntheses including pairwise and network meta-analyses. Operation time, pain scores, and transfusion rates were not significantly different between PCNL procedures. Network meta-analyses demonstrated that for hemoglobin changes, total tubeless PCNL may be superior to standard PCNL (mean difference [MD] 0.65, 95% CI 0.14-1.13) and tubeless PCNLs with stent (MD -1.14, 95% CI -1.65--0.62), and small-bore PCNL may be superior to tubeless PCNL with stent (MD 1.30, 95% CI 0.27-2.26). Network meta-analyses also showed that for length of hospital stay, total tubeless (MD 1.33, 95% CI 0.23-2.43) and tubeless PCNLs with stent (MD 0.99, 95% CI 0.19-1.79) may be superior to standard PCNL. In rank probability tests, small-bore tube and total tubeless PCNLs were superior for operation time, pain scores, and hemoglobin changes. For hemoglobin changes, total tubeless and small-bore PCNLs may be superior to other methods. For hospital stay, total tubeless and tubeless PCNLs with stent may be superior to other procedures.
Directory of Open Access Journals (Sweden)
Joel E Abbott
2016-01-01
Conclusion: Tubeless and totally tubeless PCNL demonstrates equivalent outcomes in the properly selected patient group when compared to PCNL performed with a nephrostomy tube. Although this is not the first study to demonstrate this, a large majority of urologists continue standard nephrostomy placement after PCNL. More studies are needed that demonstrate safety of this practice to shift the pendulum of care. Thus, tubeless and totally tubeless PCNL can be performed safely and effectively, which has previously been shown to improve cost, patient pain profiles, and length of hospitalization.
Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy.
Yun, Sung Il; Lee, Yoon Hyung; Kim, Jae Soo; Cho, Sung Ryong; Kim, Bum Soo; Kwon, Joon Beom
2012-11-01
Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. From March 2008 to February 2012, 57 selected patients underwent standard or totally tubeless PNL. Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PNL group. We compared patient and stone characteristics, operation time, length of hospitalization, analgesia requirements, stone-free rate, blood loss, change in creatinine, and perioperative complications between the standard and totally tubeless PNL groups. There were no significant differences in preoperative patient characteristics, postoperative complications, or the stone-free rate between the two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with the standard PNL group. Blood loss and change in creatinine were not significantly different between the two groups. Totally tubeless PNL appears to be a safe and effective alternative for the management of renal stone patients and is associated with a decrease in length of hospital stay.
Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy
Yun, Sung Il; Lee, Yoon Hyung; Kim, Jae Soo; Cho, Sung Ryong; Kim, Bum Soo; Kwon, Joon Beom
2012-01-01
Purpose Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. Materials and Methods From March 20...
Practice of Totally Tubeless Nephrolitotomy among Patients with Renal Calculus
Directory of Open Access Journals (Sweden)
Musa Ekici
2013-08-01
Full Text Available Purpose: We aimed to present the data on totally tubeless nephrolitotomy (PNL outcomes undergone in our clinic. Materials and Methods: We retrospectively analyzed 140 patients undergone totally tubeless PNL in our clinic between January 2010 and December 2012. Results: Mean patient age was 47,84 (5-73. Mean operative time was 88,8 (45-110 minutes where mean stone area was 375,3 (110-175 mm2 . 92,8% was our stone free rate. Remaining 10 patients had undergone ureterorenoscopy for ureteral stones. Two patients having non-opaque stones had residual kidney stones and treated by SWL. 8 patients (%5,7 needed blood transfusion, 2 patients needed perirenal hematoma and treated conservatively. No patients needed additional treatment or encountered vascular complications. One patient encountered serozal colon injury and treated conservatively. Conclusion: With regard to patient comfort, shorter hospital stay, low analgesic requirement, totally tubeless PNL gained popularity. We believe totally tubeless PNL may be used in suitable cases. Key Words: Kidney Stone, Totally Tubeless, Nephrolithotomy [Cukurova Med J 2013; 38(4.000: 636-641
Totally tubeless percutaneous nephrolithotomy: is it safe and effective in preschool children?
Ozturk, Ahmet; Guven, Selcuk; Kilinc, Mehmet; Topbaş, Emrah; Piskin, Mesut; Arslan, Mehmet
2010-12-01
After the introduction of tubeless percutaneous nephrolithotomy (PNL), many studies conducted in adult patients have confirmed its efficacy and safety. There are limited studies reporting that tubeless PNL can be safely applied in children, however. Furthermore, there are no reports that evaluate the use of totally tubeless PNL in children. The present study evaluates the results of totally tubeless PNL in preschool children. The data of children seen in our clinic who were considered suitable for totally tubeless PNL were analyzed. Of 16 children, 8 patients underwent totally tubeless PNL (group 1) and 8 standard PNL (group 2). The two groups of patients were compared with regard to length of hospitalization, analgesic requirements, transfusion rates, hemoglobin (Hb) decrease, and immediate, early, and late complications. The mean ages of the patients were 56.6 months (9-84 mos) and 56.0 months (5-84 mos), and the mean follow-up was 21.5 months (3-44 mos) and 43.4 months (36-54 mos) in groups 1 and 2, respectively. Both groups were similar with regard to age, stone size, Hb change, and complications. Although operation duration, hospitalization period, and analgesic requirement were less in the totally tubeless PNL group, these differences were not statistically significant. The latest application of PNL, totally tubeless PNL, is also a safe and effective procedure in very small children if they are selected properly and if the surgeon has sufficient experience with the procedure. More studies with a higher number of participants are needed, however, to confirm that totally tubeless PNL increases the comfort of pediatric patients, decreases their hospitalization period, and is more economical.
Totally tubeless percutaneous nephrolithotomy is feasible in morbidly obese patients.
Aghamir, Seyed Mohammad Kazem; Mohseni, Mohammad Ghasem; Hosseini, Seyed Reza; Salavati, Alborz; Ganjali, Hossein; Fallah, Mohammad Ali; Rezaei, Hamed; Modaresi, Seyed Saeed
2017-06-01
Regarding technical difficulties that obese body habitus might impose to percutaneous nephrolithotomy (PNL) success and higher risk of peri-operative complications in this group of patients, we decided to retrospectively gather data from our patients during past 8 years to determine the stone free and complication rates. Between January 2007-December 2015, seventy-eight obese patients with body mass index over 35 who had indication for PNL including stones larger than 2 cm in pelvi-calyceal system or smaller extracorporeal shock wave lithotripsy (ESWL) resistant stones or who were not a fit candidate for ESWL due to increased skin to target distance, with no contraindication of PNL (including bleeding diathesis, inability to be positioned in prone) were enrolled. They were randomly assigned to group 1 (standard PNL with nephrostomy and ureteral stent) or group 2 (totally tubeless PNL with no ureteral stent and no nephrostomy). The outcomes were compared. The transfusion rate, operation time, and the hemoglobin drop were same across the groups (p>0.05). Total analgesic use was equivalent of 33.8 vs. 14.7 mgs of morphine sulfate (18-77 mg) and was significantly lower in total tubeless group (p=0.001). Return to normal activity was described as total number of in-patient and outpatient days from time of admission to the point which the patients returns to normal life activity such as going to job or school and was 19.4 vs. 9.3 days (6-30 days, p=0.001). Totally tubeless PNL in obese subjects would have lower analgesic use and return to normal activity versus standard PNL. Totally tubeless PNL is recommended for obese patients.
Chung, Ho Seok; Jung, Seung Il; Yu, Ho Song; Hwang, Eu Chang; Oh, Kyung Jin; Kwon, Dong Deuk; Park, Kwangsung
2016-01-01
We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL) without indwelling ureteral stent would minimize postoperative discomfort without complications. To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL. From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL). Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups. There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001). Group 2 and group 3 had a lower analgesic requirement (p = 0.010). Immediate postoperative hemoglobin change (p = 0.001) and tube site complications (p = 0.001) were more common in group 1. Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients.
Directory of Open Access Journals (Sweden)
Ho Seok Chung
2016-12-01
Full Text Available Introduction: We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL without indwelling ureteral stent would minimize postoperative discomfort without complications. Aim : To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL. Material and methods: From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL. Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups. Results: There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001. Group 2 and group 3 had a lower analgesic requirement (p = 0.010. Immediate postoperative hemoglobin change (p = 0.001 and tube site complications (p = 0.001 were more common in group 1. Conclusions : Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients.
Directory of Open Access Journals (Sweden)
Cemil Aydın
2014-09-01
Full Text Available Objective: Percutaneous nephrolithotomy (PNL is the first- line treatment for large and complex renal calculi. In this study, we aimed to compare the efficacy and safety of the totally tubeless PNL versus the standard PNL. Methods:Between January 2012 and July 2013, 73 selected patients were treated standard or totally tubeless PNL, nephrostomy tube and ureteral stent was not placed at the end of the operation in 35 (39.7% (Group 1 of them and 38 (43.1% (Group 2 patient underwent standard PNL. Stone disintegration was performed with a pneumatic lithotripter. We retrospectively compared patient and stone characteristics, operation time, duration of hospitalization, analgesia requirements, stone-free rate, operative findings, blood loss, and perioperative complications between two groups. Results:The mean operation time, excluding the preparation course, was 38,3±15,4 minutes vs 51,2±12,9 minutes and mean fluoroscopy time was 4,5±2,4 minutes vs 4,8±2,1 minutes, respectively. No significant intraoperative complication or indication additional access or second-look PNL due to residual stones was observed. In both groups none of the patients demonstrated a urinoma, hemorrhage or residual stones in postoperative ultrasonography and plain radiograph. Blood transfusion was needed only in a patient vs two patients for group 1 and 2, respectively. There were no significant differences in preoperative patient characteristics, postoperative complications between two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with other group. Conclusion: Absence of the nephrostomy tube and ureteral stent may help in keeping the patient comfortable after the operation and reduction in the analgesia requirement and length of hospital stay. We believe totally tubeless PNL is safe and effective management option in properly selected cases.
Primary Report of Totally Tubeless Percutaneous Nephrolithotomy Despite Pelvi-calyceal Perforations.
Aghamir, Seyed Mohammad Kazem; Salavati, Alborz; Hamidi, Morteza; FallahNejad, Asghar
2017-07-02
Nephrostomy tube insertion and/or a ureteral stent placement is advised when pelvi-calyceal perforations are encountered during percutaneous nephrolithotomy (PNL) nevertheless totally tubeless PNL is a possible exit strategy in percutaneous renal surgery therefore case series on the short term clinical outcomes of noninvasive management of iatrogenic pelvicalyceal perforations encountered during PNL is presented. During retrospective analysis of 1271 PNL procedures, 25 incidents of accidental ureteral catheter/ jj stent dislodgement during first 24 post-operative hours were identified in patient who had pelvi calyceal perforations and had no nephrostomy tube (tubeless). Thirteen patients could not be re-stented nor a nephrostomytube could have been placed for them mainly due to patient refusal or comorbid conditions. The main outcome was rate of successful noninvasive management. Eighteen Patients bearing mucosal tears (grade I trauma) or visible peri-pelvic fat (grade II) successfully recovered without need for ureteral stenting or nephrostomy (72.0%). In seven (28.0%) cases of extension of the perforation into the peri-pelvic fat (grade III), either nephrostomy insertion or JJ stenting was needed for resolution of fever and urinoma. The major limitation was the necessity to exclude patients and manage them in the standard fashion according to clinical guidelines. Iatrogenic perforations of the collecting system are quite diverse in terms of severity that result in different natural histories and not all might need urinary diversion via nephrostomy or ureteral stenting.Low grade perforations may be successfully managed in totally tubeless fashion nevertheless further prospective investigations seem warranted.
Sanguedolce, Francesco; Breda, Alberto; Millan, Felix; Brehmer, Marianne; Knoll, Thomas; Liatsikos, Evangelos; Osther, Palle; Traxer, Olivier; Scoffone, Cesare
2013-12-01
To assess efficacy and safety of prone- and supine percutaneous nephrolithotomy (PCNL) for the treatment of lower pole kidney stones. Data from patients affected by lower pole kidney stones and treated with PCNL between December 2005 and August 2010 were collected retrospectively by seven referral centres. Variables analysed included patient demographics, clinical and surgical characteristics, stone-free rates (SFR) and complications. Statistical analysis was conducted to compare the differences for SFRs and complication rates between prone- and supine PCNL. One hundred seventeen patients underwent PCNL (mean stone size: 19.5 mm) for stones harboured only in the lower renal pole (single stone: 53.6%; multiple stones: 46.4%). A higher proportion of patients with ASA score ≥ 3 and harbouring multiple lower pole stones were treated with supine PCNL (5.8 vs. 23.1%; p = 0.0001, and 25 vs. 81.5%; p = 0.0001, respectively, for prone- and supine PCNL). One-month SFR was 88.9%; an auxiliary procedure was needed in 6 patients; the 3-month SFR was 90.2%. There were 9 post-operative major complications (7.7%). No differences were observed in terms of 1- and 3-month SFRs (90.4 vs. 87.7%; p = 0.64; 92.3 vs. 89.2%; p = 0.4) and complication rates (7.6 vs. 7.7%; p = 0.83) when comparing prone- versus supine PCNL, respectively. The results confirm the high success rate and relatively low morbidity of modern PCNL for lower pole stones, regardless the position used. Supine PCNL was more frequently offered in case of patients at higher ASA score and in case of multiple lower pole stones.
Directory of Open Access Journals (Sweden)
Rahul Gupta
2011-12-01
Full Text Available PURPOSE: Re-procedure in patients with history of open stone surgery is usually challenging due to the alteration in the retroperitoneal anatomy. The aim of this study was to determine the possible impact of open renal surgery on the efficacy and morbidity of subsequent percutaneous nephrolithotomy (PCNL. MATERIALS AND METHODS: From March 2009 until September 2010, 120 patients underwent PCNL. Of these, 20 patients were excluded (tubeless or bilateral simultaneous PCNL. Of the remaining 100, 55 primary patients were categorized as Group 1 and the remaining (previous open nephrolithotomy as Group 2. Standard preoperative evaluation was carried out prior to intervention, Statistical analysis was performed using SPSS v. 11 with the chi-square test, independent samples t-test, and Mann-Whitney U test. A p-value < 0.05 was taken as statistically significant. RESULTS: Both groups were similar in demographic profile and stone burden. Attempts to access the PCS was less in Group 1 compared to Group 2 (1.2 + 1 2 vs 3 + 1.3 respectively and this was statistically significant (p < 0.04. However, the mean operative time between the two groups was not statistically significant (p = 0.44. Blood transfusion rate was comparable in the two groups (p = 0.24. One patient in Group 2 developed hemothorax following a supra-11th puncture. Remaining complications were comparable in both groups. CONCLUSION: Patients with past history of renal stone surgery may need more attempts to access the pelvicaliceal system and have difficulty in tract dilation secondary to retroperitoneal scarring. But overall morbidity and efficacy is same in both groups.
Hemostasis in tubeless PNL: point of technique.
Aron, Monish; Goel, Rajiv; Kesarwani, Pawan K; Gupta, Narmada P
2004-01-01
Tubeless PNL (percutaneous nephrolithotomy), in a highly selected group of patients, is a modification aimed at reducing the morbidity of PNL. We present a simple technique of achieving tract hemostasis as an adjunct to the safe performance of a tubeless PNL. Charts of 40 consecutive patients who underwent tubeless PNL at our center were reviewed. In the latter 20 consecutive patients, diathermy coagulation of the intrarenal bleeders and tract was done and these patients were compared with the earlier 20 patients in whom fulguration was not done. Drop in hemoglobin, postoperative analgesic requirement, operating time, length of hospitalization and postoperative complications were compared. No statistical difference was found between the operative times and drop in hemoglobin for both the groups. The length of hospitalization and postoperative analgesic requirement were significantly less in the fulguration group. No significant complications were noted in either of the two groups. Fulguration of visible intrarenal and tract bleeders is a simple, safe and effective hemostatic adjunct in patients undergoing tubeless PNL. copyright 2004 S. Karger AG, Basel
Is tubeless percutaneous nephrolithotomy a feasible technique for the treatment of staghorn calculi?
Lee, Sang Cheol; Kim, Chang Hee; Kim, Kwang Taek; Kim, Tae Beom; Kim, Khae Hawn; Jung, Han; Yoon, Sang Jin; Oh, Jin Kyu
2013-10-01
Tubeless percutaneous nephrolithotomy (PNL) remains a challenging technique for the surgical treatment of staghorn renal calculi. Our study was designed to compare surgical outcomes between conventional and tubeless PNL. We retrospectively enrolled consecutive patients who underwent conventional or tubeless PNL under general anesthesia performed by a single surgeon (H.J.) for the treatment of staghorn calculi between 2003 and 2012. All patients were divided into two groups: group 1 included patients who underwent conventional PNL and group 2 included patients who were managed by tubeless PNL for the treatment of staghorn calculi. Preoperative and postoperative parameters were analyzed between the two groups, including age, stone burden, complications, any interventions, and duration of hospital stay. A total of 165 patients (group 1, 106; group 2, 59) were enrolled in the study. No significant differences in age, sex, body mass index, or stone laterality were observed between the two groups. The mean stone burdens (±standard deviation) of group 1 and group 2 were 633.6 (±667.4) and 529.9 (±362.8), respectively (p=0.271). The postoperative stone-free clearance rate was higher in group 2 (78.0%) than in group 1 (69.8%); however, the difference was not clinically significant (p=0.127). In addition, no significant differences in postoperative complications, including fever, bleeding, infection, or additional interventions, were observed between the two groups. Our results demonstrated that tubeless PNL has the same effectiveness and safety as conventional PNL in the treatment of staghorn calculi. Tubeless PNL may be feasible for managing renal staghorn calculi.
Directory of Open Access Journals (Sweden)
Ho Song Yu
2016-02-01
Full Text Available ABSTRACT Background and Purpose A tubeless PCNL can reduce postoperative pain, the need for analgesics, hospital stay, and postoperative urinary leakage. However, perioperative or delayed bleeding remains the primary postoperative concern. We demonstrate a simple and cost-effective method to develop a clear nephrostomy tract after completion of a tubeless PCNL. Materials and Methods Four consecutive patients with renal calculi >3cm underwent a tubeless PCNL. We used a 24 Fr nephroscope and a 24 Fr transurethral resectoscope. Intraoperative urologist-directed percutaneous renal access was performed under fluoroscopy. After calculi removal, active bleeders were identified via a clear Amplatz renal sheath. The sheath provided excellent visualization of the nephrostomy tract for the detection of bleeders and surrounding structures. Bleeders were electrocauterized using a roller barrel electrode. During extraction of the renal sheath, the surgeon can confirm hemostasis in the tract and apply intermittent suction. Results Bleeding primarily originated from the torn calyeceal mucosa and the parenchyma. Tract electrocauterization was successful. All patients had mild hematuria, which resolved within two days. The average hemoglobin decrease was 1.65g/dL (0.8-2.1 and no patients required a transfusion. No perioperative complications occurred. On postoperative day 2, the patients could ambulate without a Foley catheter. During three months of follow-up, delayed bleeding or percutaneous urine leakage did not occur. Conclusions Electrocauterization with a roller barrel electrode and a clear Amplatz renal sheath is an effective method to obtain hemostasis after completion of a PCNL. Our technique is cost-effective and readily adapted without the need for additional instruments.
Preliminary study of percutaneous nephrolithotomy on an ambulatory basis.
El-Tabey, Magdy Ahmed; Abd-Allah, Osama Abdel-Wahab; Ahmed, Ahmed Sebaey; El-Barky, Ehab Mohammed; Noureldin, Yasser Abdel-Sattar
2013-02-01
Preliminary study to assess the feasibility and safety of percutaneous nephrolithotomy (PCNL) as an ambulatory procedure. Between February 2011 and September 2012, 84 patients with renal calculi fulfilling the inclusion criteria were admitted to the Urology Department of Benha University Hospitals for PCNL. All patients were subjected to a full medical history, clinical, laboratory and radiological examinations. Tubeless PCNLs were done in the supine position, and an antegrade double-J stent was inserted. Operative time and intraoperative complications were recorded. Postoperatively, the hematocrit value, postoperative pain and analgesics, need of blood transfusion, stone-free rate, and length of hospital stay were recorded. Stable patients that could be safely discharged within 24 hours after surgery were considered ambulatory. All cases of tubeless PCNL were successfully done and no cases converted to open surgery. The overall stone-free rate was 91.7%, the mean postoperative pain score measured by the visual analog scale was 4.4 ± 1.2, the mean overall hematocrit deficit was 4.8 ± 2.2% and the mean hospital stay was 33.4 ± 17.5 hours. Ambulatory PCNL was accomplished in 60 out of 84 patients (71.4%) and double-J stents were removed 7-10 days postoperatively. In the non-ambulatory cases, double-J stents were removed after auxillary procedures were done according to each case. PCNL can be safely done on an ambulatory basis under strict criteria, but further studies are needed to confirm and expand these findings.
Duodenal perforation during percutaneous nephrolithotomy (PCNL ...
African Journals Online (AJOL)
A. Bansal
2016-06-03
Jun 3, 2016 ... Calculus;. Duodenum;. Injury;. Paediatric;. Percutaneous nephrolithotomy. Abstract. Introduction: Colonic perforations are known complications of percutaneous nephrolithotomy (PCNL). However, to the best of our knowledge, small bowel perforation has rarely been reported.. Observation: We report the ...
Use of a vegetable model as a training tool for PCNL puncture.
Sinha, Maneesh; Krishnamoorthy, Venkatesh
2015-01-01
Training residents to perform a PCNL puncture is hampered by the non-availability of a good inanimate model that can be used for demonstration and practice. The ethics of surgical training during actual surgeries is being questioned and the role of simulation is increasingly important. Virtual reality trainers, however, are prohibitively expensive and the use of animal models is fraught with regulatory and ethical concerns. We have devised a model that can be used to teach the concept of depth perception during a PCNL puncture. A bottle gourd was used to mimic the posterior abdominal wall. Cotton pledgets dipped in intravenous contrast were fitted into 4 mm holes made at staggered levels in the bottle gourd which was strapped onto the operating table with the cotton pledgets facing away from the surgeon. Surgeons with varying degrees of experience made fluoroscopy-guided punctures onto the cotton pledgets. We recorded the time taken for puncture in seconds and the distance of the needle exit site from the center of the cotton ball. Speed was measured by recording the fluoroscopy time in seconds on the C-arm. Accuracy was documented by using a Vernier caliper to measure the distance from the edge of the target to the actual puncture. One second of fluoroscopy time and 0.1 mm distance were each given one point. The total points accumulated over a set of 10 punctures was added to give a total score. Longer fluoroscopy times and inaccurate punctures resulted in higher scores. A surgeon with more than 1000 PCNLs to his credit had a score of 99. The average score of five residents was 555. The bottle gourd model provides an ethically acceptable, inexpensive, easy to replicate model that can be used to train residents in the PCNL puncture.
Pan, Jiahua; Chen, Qi; Xue, Wei; Chen, Yonghui; Xia, Lei; Chen, Haige; Huang, Yiran
2013-02-01
The aim of the study was to compare the clinical outcome and the cost-effectiveness between retrograde intra renal surgery (RIRS) and mini-percutaneous nephrolithotripsy (mPCNL) for the management of single renal stone of 2-3 cm in Chinese medical setting. From May 2005 to February 2011, 115 patients with solitary renal calculi were treated either by RIRS or mPCNL. 56 patients were in RIRS group while 59 were in mPCNL group. Patients' demographics between the two groups, in terms of gender, age, BMI, history of ESWL as well as stone side, stone location and stone size were comparable. Peri-operative course, clinical outcome, complication rates and medical cost were compared. The effective quotient (EQ) of two groups was calculated. Data were analyzed using Fisher's exact test, Chi-square test and Student's t test. EQ for RIRS and mPCNL were 0.52 and 0.90. The initial stone-free rate (SFR) of RIRS group and mPCNL group was 71.4 and 96.6 %, respectively (P = 0.000). The mean procedure number was 1.18 in RIRS group and 1.03 in mPCNL group, respectively (P = 0.035). The operative time for RIRS was longer (P = 0.000) while the mean hospital stay was shorter (P = 0.000). There was no statistical difference in peri-operative complications between the groups. The initial hospitalization cost, laboratory and radiology test cost of RIRS group were lower (P = 0.000). However, counting the retreatment cost in the two groups, the total medical expenditure including the overall hospitalization cost, overall laboratory and radiology test cost and post-operative out-patient department (OPD) visit cost was similar between two groups. In conclusion, with similar total medical cost, mPCNL achieved faster stone clearance and lower retreatment rate without major complications, which implied higher cost-effectiveness for the treatment of single renal stone of 2-3 cm in Chinese medical setting. RIRS is also a safe and reliable choice for patients having contraindications or
Solo Sonographically Guided PCNL under Spinal Anesthesia: Defining Predictors of Success.
Nouralizadeh, Akbar; Pakmanesh, Hamid; Basiri, Abbas; Aayanifard, Mohammad; Soltani, Mohammad Hossein; Tabibi, Ali; Sharifiaghdas, Farzaneh; Ziaee, Seyed Amir Mohsen; Shakhssalim, Naser; Valipour, Reza; Narouie, Behzad; Radfar, Mohammad Hadi
2016-01-01
Aim. Sonography has been brought in percutaneous nephrolithotripsy (PCNL) as an adjunct to or substitute for X-ray to restrict radiation exposure. This study was designed to investigate the possible predictors for the success of the solo sonographically guided PCNL. Methods. 148 consecutive cases were prospectively enrolled. All steps of PCNL were performed solely with sonography guidance under spinal anesthesia. Residual stones were evaluated the day after surgery using sonography and plain radiography. Results. The mean age was 46 ± 15 years; 40% of kidneys had hydronephrosis. The mean stone burden was 504 ± 350 mm(2). The mean duration of surgery was 43 ± 21 minutes. The early stone-free rate was 92% in inferior or middle calyceal stones, 89.5% in single pelvic stones, 81.5% in partial staghorn stones, and 61.9% in staghorn stones. The mean residual stone size was 13 ± 8 mm. Logistic regression showed that a lower age and a larger stone burden significantly predicted positive residual stones. Fifteen percent of patients presented with grade I or II and six percent showed grade III complication based on Clavien classification. There was no cases of organ injury or death. Conclusion. Solo ultrasonographically guided PCNL under spinal anesthesia is feasible with an acceptable stone-free rate and complication rate.
Tubeless tracheal resection and reconstruction for management of benign stenosis.
Caronia, Francesco Paolo; Loizzi, Domenico; Nicolosi, Tommaso; Castorina, Sergio; Fiorelli, Alfonso
2017-12-01
We reported a tubeless tracheal resection and reconstruction for the management of benign posttracheostomy tracheal stenosis. A 34-year-old man with stridor, severe respiratory distress, and recurrent pneumonia was referred to our attention for treatment of benign posttracheostomy tracheal stenosis. As he refused general anesthesia, the procedure was performed while he was under local anesthesia and spontaneous ventilation. Sedation was started with infusion of dexmedetomidine 0.7 mg/kg/min and of remifentanil 0.5 mg/kg/h; also, 40%-50% oxygen was delivered using a laryngeal mask at a rate of 3.5 mL/min. An additional dose of 2% lidocaine was injected into the surgical site during the operation to achieve an adequate level of anesthesia. A standard resection and reconstruction of trachea was carried out and no recurrence was found in the follow-up of 41 months. Tubeless tracheal surgery seems to be a feasible and safe procedure. Larger prospective series should validate our results. © 2017 Wiley Periodicals, Inc.
Chongruksut, Wilaiwan; Lojanapiwat, Bannakij; Tawichasri, Chamaiporn; Paichitvichean, Somboon; Euathrongchit, Jantima; Ayudhya, Vorvat Choomsai Na; Patumanond, Jayanton
2012-03-01
Stone recurrence after extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) are common. Predictors for kidney stones vary among populations and areas. To determine predictors for kidney stones recurrence after ESWL or PCNL. A retrospective cohort study was conducted at a university hospital. The study cohort was patients aged more than 18 years, diagnosed with kidney stones, who were treated with ESWL or PCNL between 2006 and 2009. Medical files were reviewed for clinical profiles, stone characteristics, composition, type of treatment, presence of stone after treatment, stone reappearance, and related laboratory data. Predictors were determined by a multivariable poisson regression and presented as incidence rate ratios (IRRs) with 95% confidence interval. From a cohort of 252 patients, 240 who had at least one follow-up and with complete plain kidney ureters and bladder (KUB) film or intravenous pyelogram (IVP) were included in analysis. At three years, the total incidence rate of recurrence was 46 per 1,000 person-months. After a multivariable poisson regression clustering by type of stone composition, independent predictors for stone recurrence were age ESWL treatment (adjusted IRR = 2.1, 95% CI = 2.1-2.2, p < 0.001), stones located in lower calyx as compared to renal pelvis (adjusted IRR = 8.7, 95% CI = 2.9-25.9, p = 0.001), multiple stones (adjusted IRR = 5.9, 95% CI = 4.8-7.5, p < 0.001), and stone size larger than 20 mm (adjusted IRR = 1.4, 95% CI = 1.2-1.6, p < 0.001). After stone removals, patients with these predictors should closely be followed up for regular clinical evaluations.
Srisubat, Attasit; Potisat, Somkiat; Lojanapiwat, Bannakij; Setthawong, Vasun; Laopaiboon, Malinee
2014-11-24
Stones in the urinary tract are a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are also widely applied. This is an update of a review first published in 2009. This review aimed to assess the effectiveness and complications of ESWL for kidney stones compared with PCNL or RIRS. We searched the Cochrane Renal Group's Specialised Register to 3 March 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Randomised controlled trials (RCTs) assessing the use of ESWL compared to PCNL or RIRS for kidney stone management. Two authors independently assessed all the studies for inclusion. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI). Five studies (338 patients) were included, four studies compared ESWL to PCNL and one compared ESWL with RIRS. Random sequence generation was reported in three studies and unclear in two. Allocation concealment was not reported in any of the included studies. Blinding of participants and investigators could not be undertaken due to the nature of the interventions; blinding of outcome assessors was not reported. Reporting bias was judged to be low risk in all studies. One study was funded by industry and in one study the number of participants in each group was unbalanced.The success of treatment at three months was significantly
Koo, Kyo Chul; Park, Sang Un; Jang, Ho Sung; Hong, Chang-Hee
2015-11-01
The purpose of this study was to determine the efficacy and safety of tubeless percutaneous nephrolithotomy (PNL) using a non-absorbable hemostatic sealant (Quikclot(®)) as an adjunct compared to nephrostomy tube placement in patients exhibiting significant parenchymal bleeding following PNL. We identified 113 PNL cases performed between May 2011 and October 2014. For patients with insignificant parenchymal bleeding following stone removal, defined as a clear visualization of the surgical field at full irrigation of the nephroscope, tubeless PNL was performed. For patients with significant parenchymal bleeding, we introduced the tubeless Quikclot(®) technique as of September 2013 and have performed it ever since. Formerly, nephrostomy placement PNL was performed. In this study, 40 Quikclot(®) applied PNL cases were matched with an equal number of nephrostomy placement cases by propensity scoring based on body mass index, stone size, and Guy's stone score. The mean postoperative drop in hematocrit was comparative between the Quikclot(®) group and the nephrostomy group on both postoperative days 1 (p = 0.459) and 2 (p = 0.325). Quikclot(®) application was associated with lower VAS scores throughout the postoperative period, lower cumulative analgesic requirement (p = 0.025), and with shorter hospitalization (p = 0.002). Complication rates were comparable with no need for blood transfusions in any patients. Tubeless Quikclot(®) PNL was safe and provided effective hemostasis of significant parenchymal bleeding. By avoiding nephrostomy placement, we were able to reduce postoperative pain, analgesic requirements, and hospitalization. Application of Quikclot(®) may be considered prior to nephrostomy placement in patients with significant parenchymal bleeding.
Directory of Open Access Journals (Sweden)
Amr S. Fayad
2017-03-01
Conclusion: For treating lower calyceal stones of ⩽2 cm mini-PCNL and RIRS are comparable. Mini-PCNL had a better SFR than RIRS but the hospital stay was longer and there were more intraoperative complications, whilst, RIRS had a significantly longer operating time compared with mini-PCNL and a higher incidence of postoperative fever, and a lower SFR.
Resto, Pedro J; Bhat, Abhishek; Stava, Eric; Lor, Chong; Merriam, Elliot; Diaz-Rivera, Ruben E; Pearce, Robert; Blick, Robert; Williams, Justin C
2017-11-01
Surface tension passive pumping is a way to actuate flow without the need for pumps, tubing or valves by using the pressure inside small drop to move liquid via a microfluidic channel. These types of tubeless devices have typically been used in cell biology. Herein we present the use of tubeless devices as a fluid exchange platform for patch clamp electrophysiology. Inertia from high-speed droplets and jets is used to create flow and perform on-the-fly mixing of solutions. These are then flowed over GABA transfected HEK cells under patch in order to perform a dose response analysis. TIRF imaging and electrical recordings are used to study the fluid exchange properties of the microfluidic device, resulting in 0-90% fluid exchange times of hundreds of milliseconds. COMSOL is used to model flow and fluid exchange within the device. Patch-clamping experiments show the ability to use high-speed passive pumping and its derivatives for studying peak dose responses, but not for studying ion channel kinetics. Our system results in fluid exchange times slower than when using a standard 12-barrel application system and is not as stable as traditional methods, but it offers a new platform with added functionality. Surface tension passive pumping and tubeless devices can be used in a limited fashion for electrophysiology. Users may obtain peak dose responses but the system, in its current form, is not capable of fluid exchange fast enough to study the kinetics of most ion channels. Copyright © 2017 Elsevier B.V. All rights reserved.
Ambulatory percutaneous nephrolithotomy: initial series.
Shahrour, Walid; Andonian, Sero
2010-12-01
To assess the safety and feasibility of ambulatory percutaneous nephrolithotomy (PCNL). PCNL is the gold standard for the management of large renal stones. Although tubeless PCNL has been previously described, no case series have been published of ambulatory PCNL. The criteria for ambulatory PCNL were: single tract, stone-free status documented by flexible nephroscopy, adequate pain control, and satisfactory postoperative hematocrit level and chest radiographic findings. Patient information, including operating room and fluoroscopy times, stone size and Hounsfield units, and number of needle punctures, were collected prospectively. The time spent in the recovery room, in addition to the amount of narcotics used in the recovery room and at home, was documented. Of 10 patients, 8 had nephrostomy tracts established intraoperatively by the urologist and 2 had preoperative nephrostomy tubes placed. The median operating and fluoroscopy time was 83.5 and 4.45 minutes, respectively. The median stone diameter was 20 mm (800 Hounsfield units) in addition to a patient with a staghorn calculus. The patients spent a median of 240 minutes in the recovery room and had received a median of 19.25 mg of morphine equivalents. Only 3 patients (30%) used narcotics at home. No intraoperative complications occurred, and none of the patients required transfusions. Two postoperative complications developed: a deep vein thrombosis requiring outpatient anticoagulation and multiresistant Escherichia coli infection requiring intravenous antibiotics. In highly selected patients, ambulatory PCNL is safe and feasible. More patients are needed to verify the criteria for patients undergoing the ambulatory approach. Copyright © 2010 Elsevier Inc. All rights reserved.
Mager, R; Balzereit, C; Gust, K; Hüsch, T; Herrmann, T; Nagele, U; Haferkamp, A; Schilling, D
2016-05-01
Passive removal of stone fragments in the irrigation stream is one of the characteristics in continuous-flow PCNL instruments. So far the physical principle of this so-called vacuum cleaner effect has not been fully understood yet. The aim of the study was to empirically prove the existence of the vacuum cleaner effect and to develop a physical hypothesis and generate a mathematical model for this phenomenon. In an empiric approach, common low-pressure PCNL instruments and conventional PCNL sheaths were tested using an in vitro model. Flow characteristics were visualized by coloring of irrigation fluid. Influence of irrigation pressure, sheath diameter, sheath design, nephroscope design and position of the nephroscope was assessed. Experiments were digitally recorded for further slow-motion analysis to deduce a physical model. In each tested nephroscope design, we could observe the vacuum cleaner effect. Increase in irrigation pressure and reduction in cross section of sheath sustained the effect. Slow-motion analysis of colored flow revealed a synergism of two effects causing suction and transportation of the stone. For the first time, our model showed a flow reversal in the sheath as an integral part of the origin of the stone transportation during vacuum cleaner effect. The application of Bernoulli's equation provided the explanation of these effects and confirmed our experimental results. We widen the understanding of PCNL with a conclusive physical model, which explains fluid mechanics of the vacuum cleaner effect.
Directory of Open Access Journals (Sweden)
Pradeep P Rao
2001-01-01
Full Text Available There is a paucity of cost-effectiveness studies in India comparing PCNL and ESWL in the treatment of renal cal-culi. We are dependent on costing studies from western literature, although the nature of expenses in developed countries is quite different from those in India. This study compares the two procedures with regards to cost-effec-tiveness & efficacy in clearing medium-sized renal calculi (2.0 cms at our institute. All costs borne by the patient & the institute were taken into account, including equip-ment costs, stay charges & cost of travel incurred, for re-peat visits to the institute. The groups compared had similar stone characteristics & were from our early experience with the two methods. All costing was done at 1998 rates by submitting case sheets to a fresh billing. PCNL, was significantly more efficient at clearing calculi (94% vs 69% than ESWL, but patients needed hospitalization. The re-quirement of ancillary procedures was significantly less with PCNL than ESWL (1 vs 35 and ESWL was more expensive although the difference was not statistically sig-nificant. High initial cost of a lithotripter along with the need for repeated visits to the hospital for clearance of the calculus contribute to the increased cost of ESWL. PCNL ensures clearance of calculi at a single hospital admission with minimal morbidity.
Outcomes of tubeless percutaneous nephrolithotomy in patients with chronic renal insufficiency.
Etemadian, Masoud; Maghsoudi, Robab; Shadpour, Pejman; Ghasemi, Hadi; Shati, Mohsen
2012-05-01
We evaluated the outcomes of percutaneous nephrolithotomy in patients with chronic renal insufficiency. A total of 60 patients with a creatinine level greater than 1.5 mg/dL who underwent PCNL were included. Serum creatinine level, as a kidney function index, was assessed before and after the operation. The mean calculus size was 31.13 ± 9.38 mm. The mean pre-operative and 2-week postoperative serum creatinine levels were 2.43 ± 0.75 mg/dL and 2.08 ± 0.78 mg/dL, respectively. There was a significant difference between the pre-operative and postoperative creatinine levels in all postoperative days (days 1, 2, and 14). Fifty of the 60 patients (83.3%) were stone free. Ten patients (16.6%) developed postoperative fever. We can conclude that percutaneous nephrolithotomy seems to be a safe and effective therapeutic option for kidney calculi in patients with chronic kidney disease.
Raison-Peyron, Nadia; Mowitz, Martin; Bonardel, Nathalie; Aerts, Olivier; Bruze, Magnus
2018-04-10
The frequency of allergic contact dermatitis caused by (meth)acrylates is increasing worldwide, and isobornyl acrylate (IBOA) has been identified as a culprit sensitizer in FreeStyle Libre, a medical device used by diabetic patients. To report on 4 patients sensitized to IBOA contained in OmniPod, a new, tubeless insulin pump, and to describe the clinical and chemical analytical work-up. Four patients with eczematous skin eruptions after using OmniPod, including 2 with previous adverse skin reactions to FreeStyle Libre, were patch tested with a baseline series and additional (meth)acrylates, including IBOA in several concentrations and/or vehicles. Gas chromatography-mass spectrometry (GC-MS) was used to identify the presence of IBOA in OmniPod. All patients were shown to be sensitized to IBOA. GC-MS identified IBOA in OmniPod, with the highest concentrations being found in the unit itself and not in the adhesive patch. The OmniPod tubeless insulin pump is another source of IBOA, and its use may lead to primary sensitization to this acrylate, or may provoke elicitation of allergic contact dermatitis in previously sensitized patients. Our cases highlight the need to obtain satisfactory cooperation from pharmaceutical companies involved in the manufacture of these widely used medical devices. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
A time-resolved image sensor for tubeless streak cameras
Yasutomi, Keita; Han, SangMan; Seo, Min-Woong; Takasawa, Taishi; Kagawa, Keiichiro; Kawahito, Shoji
2014-03-01
This paper presents a time-resolved CMOS image sensor with draining-only modulation (DOM) pixels for tube-less streak cameras. Although the conventional streak camera has high time resolution, the device requires high voltage and bulky system due to the structure with a vacuum tube. The proposed time-resolved imager with a simple optics realize a streak camera without any vacuum tubes. The proposed image sensor has DOM pixels, a delay-based pulse generator, and a readout circuitry. The delay-based pulse generator in combination with an in-pixel logic allows us to create and to provide a short gating clock to the pixel array. A prototype time-resolved CMOS image sensor with the proposed pixel is designed and implemented using 0.11um CMOS image sensor technology. The image array has 30(Vertical) x 128(Memory length) pixels with the pixel pitch of 22.4um. .
Yuri, Prahara; Hariwibowo, Rinto; Soeroharjo, Indrawarman; Danarto, Raden; Hendri, Ahmad Z; Brodjonegoro, Sakti R; Rasyid, Nur; Birowo, Ponco; Widyahening, Indah S
2018-01-01
the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (fURS) are the therapeutic methods for lower calyceal stones. The aim of this study was to identify the optimal management of 10-20 mm lower pole stones. a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were excluded. A fixed-effects model with Mantzel-Haenzel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Review manager 5.3. we analized 8 cohort studies. The stone free rate from 958 patients (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513) after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13 - 1.55); pESWL (overall risk ratio 1.42 (95% CI 1.30 - 1.55); p=ESWL, fURS is better than ESWL base on stone free rate in 10-20 mm lower pole stone management with overall RR 1.16 (95% CI 1.04 - 1.30; p=0.01 and I2=40%). percutaneus nephrolithotomy provided a higher stone free rate than fURS and ESWL. This meta-analysis may help urologist in making decision of intervention in 10-20 mm lower pole stone management.
Directory of Open Access Journals (Sweden)
Bo Xiao
2015-01-01
Full Text Available Background: Urolithiasis in pediatric population is a serious problem with the incidence increased these years. In the management of larger stones (diameters >2 cm, percutaneous nephrolithotomy (PCNL is considered to be the gold standard. This study aimed to investigate the efficacy and safety of mini-PCNL under total ultrasonography in patients aged 38.5°C in five patients and reactive pleural effusion in one patient. Blood loss requiring transfusion, sepsis, adjacent organ injury, and kidney loss were not observed. Conclusions: This study indicated that ultrasound-guided mini-PCNL is feasible and safe in patients aged <3 years, without major complications or radiation exposure.
Seçilmiş böbrek taşı olgularında tamamen tüpsüz perkütan nefrolitotomi
Directory of Open Access Journals (Sweden)
Cemil Aydın
2014-06-01
Full Text Available Objectives: Percutaneous nephrolithotomy (PNL is the first-line treatment for large and complex renal calculi. The aim of this study is to evaluate the outcomes of totally tubeless PNL operations. Methods: Between October 2009 and August 2013, outcomes of 68 (23.4% patients treated with totally tubeless PNL method at our clinic were analyzed. Stone disintegration was performed with a pneumatic lithotriptor. Operative findings, duration of hospital stay, analgesia requirement and success rates were retrospectively analyzed performed with totally tubeless PNL. Results: Mean age of patients treated with the totally tubeless PNL was 43.4 ± 13.6 (18-69 years and there were 42 (61,7% men and 26 (38,2% women. Mean operation time, excluding the preparation course, was 39.5±14.8 (25-90 minutes and mean fluoroscopy time was 6.04±4.15 (1-12 minutes. None of the patients demonstrated a urinoma, hemorrhage or residual stones in postoperative ultrasonography and plain radiograph. Two patients had undergone ureterorenoscopy for prolonged leakage of urine and treated by retrograde ureteral double-J stent. Blood transfusion was needed only in two patients. The mean hospitalization time was 1.27±0.36 (1-2 days. Conclusion: We think that totally tubeless PNL may be used in properly suitable cases with mil-moderate stone load, intact counterside kidney and without any significant complication and need for second- look.
Evaluating the Learning Curve for Percutaneous Nephrolithotomy under Total Ultrasound Guidance.
Directory of Open Access Journals (Sweden)
Yan Song
Full Text Available To investigate the learning curve of percutaneous nephrolithotomy under total ultrasound guidance.One hundred and twenty consecutive PCNL operations under total ultrasound guidance performed by a novice surgeon in a tertiary referral center were studied. Operations were analyzed in cohorts of 15 to determine when a plateau was reached for the variables such as operation duration, ultrasound screening time, tract dilation time, stone-free rate and complication rate. Comparison was made with the results of a surgeon who had performed more than 1000 PCNLs. Fluoroscopy was not used at all during procedure.The mean operation time dropped from 82.5 min for the first 15 patients to a mean of 64.7 min for cases 46 through 60(P = 0.047. The ultrasound screening time was a peak of 6.4 min in the first 15 cases, whereas it dropped to a mean of 3.9 min for cases 46 through 60(P = 0.01. The tract dilation time dropped from 4.9 min for the first 15 patients to a mean of 3.8 min for cases 46 through 60(P = 0.036. The senior surgeon had a mean operating time, screening time and tract dilation time equivalent to those of the novice surgeon after 60 cases. There was no significant difference in stone free rate and complication rate.The competence of ultrasound guided PCNL is reached after 60 cases with good stone free rate and without major complications.
Directory of Open Access Journals (Sweden)
Ismail Nalbant
2012-12-01
Full Text Available PurposeTo compare totally tubeless and standard percutaneous nephrolitotomy procedures on many parameters.Materials and MethodsPercutaneous nephrolitotomy was performed on 195 patients between June 2009 and May 2012. The data of those patients were evaluated retrospectively. Totally tubeless cases were enrolled to Group 1, and Group 2 consisted of non-tubeless cases (re-entry or Foley catheter.ResultsGroup 1 included 85 cases and group 2 a total of 110 patients. Paper tracing values for the kidney stones were 321.25 ± 102.4 mm2 and 324.10 ± 169.5 mm2 respectively. Mean fluoroscopy time was 4.9 ± 1.9 min and 5.08 ± 2.7 min, mean operation time was 78.8 ± 27.9 min and 81.9 ± 28.77 min and mean decrease in hematocrit was 2.6 ± 1.6 and 3.74 ± 1.9 respectively. All these comparisons were statistically significant. Length of hospitalization was 1.6 ± 1.1 and 3.5 ± 1.5 days for Groups 1 and 2 respectively. Mean superficial pain score was 5.8 ± 1.6 and 6.7 ± 1.2 respectively for both groups after 1 hour. At 6 hours, the scores changed to 3.87 ± 1.22 and 4.84 ± 1.3 respectively. The analgesic dose was 1.00 ± 0.7 and 1.53 ± 0.6 for the groups respectively at 6 hours. All the statistical differences were significant for these three parameters.ConclusionsWe believe that, because of their post operative patient comfort and decreased length of hospital stay, totally tubeless procedures should be considered as an alternative to standard percutaneous nephrolitotomy.
Percutaneous nephrolithotomy in semisupine position: a modified approach for renal calculus.
Xu, Ke-Wei; Huang, Jian; Guo, Zheng-Hui; Lin, Tian-Xin; Zhang, Cai-Xai; Liu, Hao; Chun, Jian; Yao, You-Sheng; Han, Jin-Li; Huang, Hai
2011-12-01
Conventional percutaneous nephrolithotomy (PCNL) is usually performed in a prone position, which compresses the thorax and results in difficulty in rescue during operation. When PCNL is performed in a supine position, the flank renal puncture area is limited, so it is difficult to treat disseminated and complex renal calculi. Herein, we introduce a modified semisupine position for performing PCNL, which has numerous benefits as well as safe and effective. Between May 2002 and May 2009, a total of 452 patients with renal calculi were treated with semisupine PCNL. The patient was placed in 45° semisupine position during the procedure, with the affected flank arched as much as possible. In this series, no one converted to open surgery. The average operating time was (115.2 ± 44.5) min. Single tract PCNL was performed for 80.97% of the cases, two tracts 13.94%, three tracts 4.65%, and four tracts 0.44%. The upper, middle, and lower calix tracts accounted for 12.1, 63.0, and 24.9%, of procedures, respectively. Stone-free rate was 85.7% overall, 92.2% for single calculus (83/90), and 72.9% for staghorn calculi (78/107). Major postoperative complications occurred in 3.3% of the cases. This study demonstrated PCNL in a semisupine position is an effective alternative for treating renal calculi, which combines the advantages of PCNL in a prone position, and PCNL in a supine position. The semisupine position allows easier irrigation of stone fragments, is more comfortable for the patient, and facilitates monitoring of anesthesia.
Directory of Open Access Journals (Sweden)
Goksel Goktug
2015-11-01
Full Text Available This study aimed to compare the outcomes of standard percutaneous nephrolithotomy (PCNL to PCNL with intraoperative antegrade flexible nephroscopy (IAFN for treating stones of staghorn nature. We retrospectively analyzed patients treated using PCNL between January 2007 and July 2013. A total of 1250 patients were treated using PCNL, and 166 patients had staghorn stones. All patients had been subjected to a complete blood count, routine biochemical analyses, coagulation tests, a complete urine analysis, and urine cultures. Patients with a positive urine culture had been treated with appropriate antibiotics until the urine culture became negative. After purchasing a flexible renoscope in March 2012, we routinely used this tool to improve the stone-free (SF rate. The 105 patients who underwent standard PCNL prior to March 2012 were classified as Group 1, and the 61 patients who underwent PCNL + IAFN after that date were classified as Group 2. The two groups had similar and homogeneous demographic data. The fluoroscopy and total operative times were significantly higher in Group 2 than in Group 1 (p < 0.01. Additionally, the hospitalization time (p < 0.01 and the mean hematocrit decrease (p < 0.01 were significantly lower in Group 1. In both groups, the SF rates were higher than 85%, similar to those reported in the literature. Although Group 2 had a slightly better SF rates, this difference was not statistically significant. For staghorn calculi, PCNL combined with IAFN yields excellent outcomes. However, similar prospective studies on larger cohorts should be performed to support our findings.
Directory of Open Access Journals (Sweden)
Hongyang Jiang
2017-01-01
Full Text Available Minimally invasive percutaneous nephrolithotomy (mini-PCNL and retrograde intrarenal surgery (RIRS are both alternatives for PCNL to treat renal calculi. This study is aimed at comparing the stone-free rate (SFR and other surgery parameters of two approaches for treating upper urinary calculi. We performed this meta-analysis in September 2016 by searching studies about mini-PCNL and RIRS for treating upper urinary calculi in various databases, and RevMan v.5.3 was applied. Three randomized controlled trials and ten nonrandomized trials were included, involving a total of 1317 patients. Meta-analysis showed that mini-PCNL group led to a higher SFR [odds ratio: 1.96; 95% confidence interval: 1.46–2.64; P<0.00001] but brought a larger postoperative decrease in hemoglobin levels compared with RIRS. RIRS provided a shorter hospital time. There was no significant difference in operation time. Higher postoperative complications were detected in the mini-PCNL, but the difference was not significant. Grade I and III complications did not vary between two procedures, but grade II complications were of lower incidence in RIRS group. In the light of these results, compared with RIRS, mini-PCNL provided significantly higher SFR and efficiency quotient for managing calculi; however, it resulted in higher incidence of postoperative complications, larger hemoglobin drops, and longer hospital stay.
Farouk, Ahmed; Tawfick, Ahmed; Shoeb, Mohamed; Mahmoud, Mahmoud A; Mostafa, Diaa Eldin; Hasan, Mohamed; Abdalla, Hany M
2018-02-15
The extracorporeal shockwave lithotripsy (ESWL) remains the most common first line of treatment for renal stones in the pediatric population. The purpose of this study is to evaluate and compare the outcomes of the ESWL and mini-percutaneous nephrolithotomy (mini-PCNL). A total of 108 patients younger than 12 years of age with 1-2 cm single renal stone (pelvic or calyceal) were randomized into two groups, each containing 54 patients. Patients in group A were subjected to mini-PCNL using 16.5 Fr percutaneous sheath while those in group B underwent ESWL using Dornier Compact Sigma. The stone-free rate (SFR) after first session was 88.9% (48 cases) and 55.6% (30 cases) for groups A and B, respectively. The difference is highly statistically significant P = 0.006. Two patients (3.7%) in group A needed 2nd session of PCNL, while 18 patients (33.3%)in group B needed a 2nd session, of theses 18 patients six patients needed a 3rd session of ESWL. After the third session of ESWL and second look PCNL the stone-free rates were 92.59% (50 cases) and 88.89% (48 cases) for groups A and B, respectively, (P = 0.639), which is statistically insignificant. The mean hospital stay and fluoroscopy exposure were significantly longer in the mini-PCNL group. The complication rate in groups A and group B were (22.2%) and (14.8%), respectively, which is statistically insignificant (P = 0.484). According to Clavien grade of complications mini-PCNL is a safe procedure, and after three session of ESWL, mini-PCNL has a similar stone-free rate with a lower retreatment rate. However, the mini-PCNL has more radiation exposure, and requires a longer hospital stay.
Does pelvicaliceal system anatomy affect success of percutaneous nephrolithotomy?
Binbay, Murat; Akman, Tolga; Ozgor, Faruk; Yazici, Ozgur; Sari, Erhan; Erbin, Akif; Kezer, Cem; Sarilar, Omer; Berberoglu, Yalcın; Muslumanoglu, Ahmet Yaser
2011-10-01
To investigate the effect of the pelvicaliceal system (PCS) anatomy on the percutaneous nephrolithotomy (PCNL) success rate. Although the caliceal anatomy is effective for stone clearance after shock wave lithotripsy and retrograde intrarenal lithotripsy, the effect of the caliceal anatomy after PCNL has not been evaluated to date. A total of 498 patients who had undergone PCNL and preoperative intravenous urography were enrolled in our study. Kidney-related anatomic factors, such as the PCS surface area and type, degree of hydronephrosis, infundibulopelvic angle, upper-lower calix angle, infundibular length, and infundibular width were calculated using intravenous urography. The association between the PCNL success rate and kidney-related anatomic factors was retrospectively analyzed using chi-square tests, Fisher's exact test, Mann-Whitney U test, and forward stepwise regression analysis. A success rate of 78.1% was achieved. No difference was seen the success rates among the PCS types. The mean PCS surface area was 20.1 ± 9.7 cm(2) in patients with successful outcomes and 24.5 ± 10.2 cm(2) in patients with remaining stones (P = .001). The mean infundibulopelvic angle, upper-lower calix angle, infundibular length, and infundibular width were similar in both groups. Multivariate binary logistic regression analysis showed that stone configuration and PCS surface area were independent factors affecting the PCNL success rates. The results of our study have shown that the PCS surface area is the only anatomic factor that affects the PCNL success rate and patients with a PCS surface area <20.5 cm(2) have greater PCNL success. Copyright © 2011 Elsevier Inc. All rights reserved.
The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study
DEFF Research Database (Denmark)
Bucuras, Viorel; Gopalakrishnam, Ganesh; Wolf, J Stuart
2012-01-01
The study compared characteristics and outcomes in patients with solitary and bilateral kidneys who were treated with percutaneous nephrolithotomy (PCNL) in the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study.......The study compared characteristics and outcomes in patients with solitary and bilateral kidneys who were treated with percutaneous nephrolithotomy (PCNL) in the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study....
DEFF Research Database (Denmark)
Osther, Palle Jörn; Razvi, Hassan; Liatsikos, Evangelos
2011-01-01
This study compared the characteristics and outcomes of percutaneous nephrolithotomy (PCNL) in patients with and without renal malformations using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database.......This study compared the characteristics and outcomes of percutaneous nephrolithotomy (PCNL) in patients with and without renal malformations using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database....
Paediatric percutaneous nephrolithotomy: single-centre 10-year experience.
Bhageria, Anand; Nayak, Brusabhanu; Seth, Amlesh; Dogra, Prem Nath; Kumar, Rajeev
2013-08-01
Percutaneous nephrolithotomy (PCNL) is a standard management option for complex and large renal calculi. In children, there is some concern over potential perioperative complications. We reviewed our 10 years of experience of PCNL in children and present our data. Data for paediatric patients who underwent PCNL at our centre in the last decade were retrieved. PCNL was performed in standard prone position under fluoroscopic guidance. Patient characteristics, outcomes and complications were reviewed. Complications were graded according to the modified Clavien system. A comparison was also made between supracostal and infracostal accesses. 95 children underwent PCNL in our institute in the last decade. 7 patients had bilateral PCNL. The most common presentation was flank pain (85%). 83% patients were stone-free after first PCNL and overall 94% were stone free after second-look PCNL and auxillary procedures. 6 cases had clinically insignificant residual fragments. Supracostal puncture was performed in 32 cases. Complications were higher in the supracostal puncture group (16 (50%)) and included fever in 11, sepsis in 2 and hydrothorax in 3 patients. There were 7 (10%) complications in the infracostal group: fever in 5 and perinephric collection in 2 patients. 16 patients had grade 1, 9 had grade 2 and another 2 cases developed grade 3 complications. PCNL is a safe and effective procedure in children. It enables excellent stone clearance with minimal number of interventions. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Osther, Palle Jörn; Razvi, Hassan; Liatsikos, Evangelos; Averch, Timothy; Crisci, Alfonso; Garcia, Juan Lòpez; Mandal, Arup; de la Rosette, Jean
2011-01-01
This study compared the characteristics and outcomes of percutaneous nephrolithotomy (PCNL) in patients with and without renal malformations using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. The CROES PCNL Global Study collected prospective data for
Yamaguchi, Akito; Skolarikos, Andreas; Buchholz, Niels-Peter Noor; Chomón, Gonzalo Bueno; Grasso, Michael; Saba, Pietro; Nakada, Stephen; de la Rosette, Jean
2011-01-01
The study investigated factors that affect operating times and bleeding complications associated with percutaneous nephrolithotomy (PCNL) in the PCNL Global Study. All patients who underwent PCNL for primary or secondary treatment of kidney stone indications during the study period (November
DEFF Research Database (Denmark)
Lopes, Tomé; Sangam, Kandasami; Alken, Peter
2011-01-01
Abstract Purpose: The study focused on the use of balloon or telescopic/serial dilation methods in percutaneous nephrolithotomy (PCNL) in the Global PCNL Study. Patients and Methods: Centers worldwide provided data from consecutive patients who were treated with PCNL during a 1-year period. Tract...
Percutaneous stone removal | van der Ness | SA Journal of Radiology
African Journals Online (AJOL)
percutaneous nephrolithotomy (PCNL) at our academic hospital. The primary objective was to determine the percentage successful PCNL procedures performed. Methods. The study included 169 patients (116 males, 53 females; mean age 45 years, range 6 - 75 years) treated with PCNL in our Department of Radiology ...
Lopes, Tomé; Sangam, Kandasami; Alken, Peter; Barroilhet, Benjamin Silva; Saussine, Christian; Shi, Lei; de la Rosette, Jean
2011-01-01
The study focused on the use of balloon or telescopic/serial dilation methods in percutaneous nephrolithotomy (PCNL) in the Global PCNL Study. Centers worldwide provided data from consecutive patients who were treated with PCNL during a 1-year period. Tract dilation was performed using a balloon or
Urinary tract infections and post-operative fever in percutaneous nephrolithotomy
DEFF Research Database (Denmark)
Gutierrez, Jorge; Smith, Arthur; Geavlete, Petrisor
2013-01-01
PURPOSE: To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients. MATERIALS AND METHODS: Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre...
Urinary tract infections and post-operative fever in percutaneous nephrolithotomy
Gutierrez, Jorge; Smith, Arthur; Geavlete, Petrisor; Shah, Hemendra; Kural, Ali Riza; de Sio, Marco; Amón Sesmero, José H.; Hoznek, András; de la Rosette, Jean
2013-01-01
To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients. Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre-operative urine samples and who
Mini access guide to simplify calyceal access during percutaneous nephrolithotomy: A novel device
Directory of Open Access Journals (Sweden)
Puskar Shyam Chowdhury
2017-01-01
Conclusion: The MAG is a simple, portable, cheap, and novel assistant to achieve successful PCNL puncture. It would be of great help for novices to establish access during their learning phase of PCNL. It would also be an asset toward significantly decreasing the radiation dose during PCNL access.
Kyriazis, Iason; Kallidonis, Panagiotis; Vasilas, Marinos; Panagopoulos, Vasilios; Kamal, Wissam; Liatsikos, Evangelos
2017-05-01
To present our experience with a central, non-calyceal puncture protocol for percutaneous nephrolithotripsy (PCNL) in an attempt to challenge the opinion of worldwide adopted calyceal puncture as the less traumatic site of percutaneous entrance into the collecting system. During 2012, a total of 137 consecutive, unselected patients were subjected to PCNL in our department. Non-calyceal punctures were performed to all cases and followed by subsequent track dilations up to 30 Fr. Perioperative and postoperative data were prospectively collected and analyzed. Mean operative time (from skin puncture to nephrostomy tube placement) was 48 min. Patients with single, multiple and staghorn stones had primary stone-free rates of 89.2, 80.4 and 66.7 % after PCNL, respectively. The overall complication rate was 10.2 %, while bleeding complications were minimal. Only 4 patients (2.9 %) required blood transfusion. Five patients (3.6 %) had Clavien Grade IIIa complications requiring an intervention for their management and none Grade IV or V. Despite the absence of evidence that non-calyceal percutaneous tracts could be a risk factor for complications, the concept of calyceal puncture has been worldwide adopted by PCNL surgeons as the sole safe percutaneous entrance into the collective system. Based on our experience, other pathways than the worldwide recognized rule, calyceal puncture, are possible and probably not as dangerous as has been previously stated.
Wiesenthal, Joshua D; Ghiculete, Daniela; D'A Honey, R John; Pace, Kenneth T
2011-03-01
Shockwave lithotripsy (SWL) is considered a standard treatment for patients with upper-tract stones that are less than 10 mm in diameter, whereas stones that are larger than 20 mm are best managed by percutaneous nephrolithotomy (PCNL). The management of stones between these sizes remains controversial. Our purpose was to review our contemporary series of SWL, ureteroscopy (URS), and PCNL outcomes for intermediate-sized upper tract calculi (100-300 mm(2)). Analysis was restricted to those patients who were treated for a renal calculus that measured between 100 and 300 mm(2) during a 4-year span. Demographic, stone, patient, treatment, and follow-up data were collected from a prospectively maintained database. A total of 137 patients were referred with nonstaghorn calculi with an area between 100 and 300 mm(2). Fifty-three (38.7%) patients were treated with SWL, while 41 (29.9%) and 43 (31.4%) underwent ureteroscopy and PCNL, respectively. Mean stone area was higher in the PCNL group (P < 0.001), whereas stone density was higher for patients undergoing SWL (P = 0.002). Single treatment success rates were better for PCNL at 95.3%,vs 87.8% for ureteroscopy and 60.4% for SWL, P < 0.001. When allowing for two SWL treatments, the success rate improved to 79.2%, thus equalizing the success of the three treatment modalities (P = 0.66). Auxiliary treatments were more common after SWL (42.3%; P < 0.01). For intermediate-sized upper-tract stones, when allowing for up to two SWL treatments, there was no significant difference between treatment modalities. Thus, SWL is a reasonably successful treatment alternative for patients who are not fit for a general anesthetic or who prefer SWL over competing treatments, provided they accept a potentially higher number of treatments.
Directory of Open Access Journals (Sweden)
Devangi A Parikh
2017-01-01
Full Text Available Background and Aims: Neuraxial anaesthesia has recently become popular for percutaneous nephrolithotomy (PCNL. We conducted a study comparing general anaesthesia (GA with segmental (T6–T12 epidural anaesthesia (SEA for PCNL with respect to anaesthesia and surgical characteristics. Methods: Ninety American Society of Anesthesiologists Physical Status-I and II patients undergoing PCNL randomly received either GA or SEA. Overall patient satisfaction was the primary end point. Intraoperative haemodynamics, epidural block characteristics, post-operative pain, time to rescue analgesic, total analgesic consumption, discharge times from post-anaesthesia care unit, surgeon satisfaction scores and stone clearance were secondary end points. Parametric data were analysed by Student's t-test while non-parametric data were compared with Mann–Whitney U-test. Results: Group SEA reported better patient satisfaction (P = 0.005. Patients in group GA had significantly higher heart rates (P = 0.0001 and comparable mean arterial pressures (P = 0.24. Postoperatively, time to first rescue analgesic and total tramadol consumption was higher in Group GA (P = 0.001. Group SEA had lower pain scores (P = 0.001. Time to reach Aldrete's score of 9 was shorter in group SEA (P = 0.0001. The incidence of nausea was higher in group GA (P = 0.001; vomiting rates were comparable (P = 0.15. One patient in group SEA developed bradycardia which was successfully treated. Eight patients (18% had hypertensive episodes in group GA versus none in group SEA (P = 0.0001. One patient in GA group had pleural injury and was managed with intercostal drain. Stone clearance and post-operative haemoglobin levels were comparable in both groups. Conclusion: PCNL under SEA has a role in selected patients, for short duration surgery and in expert hands.
Davol, Patrick E; Wood, Craig; Fulmer, Brant
2006-05-01
Percutaneous nephrolithotomy (PCNL) is an effective procedure for the treatment of large renal calculi. An important consideration for patients undergoing PCNL is the management of any residual stone burden, which may include "second-look" nephroscopy. The utility of this practice is unproven, and we present our data on a series of patients in which second-look procedures were not performed. We retrospectively reviewed the records of 43 consecutive patients undergoing a total of 45 procedures by a single surgeon at a tertiary-care center. Patients were considered stone free if no calculi were evident by either plain film or noncontrast CT scan. Statistical analysis was used to look for correlations between radiographic stone clearance and various patient and stone characteristics. Of these procedures, 15% had immediate postoperative evidence of residual fragments. At a mean follow-up of 8 months, 32.5% had residual or recurrent stone. There were statistically significant correlations between both patient age and stone size and the risk of recurrent or residual stone. In our study, PCNL was effective for the single-stage treatment of large renal calculi. Aggressive stone clearance obviated the need for routine second-look nephroscopy. Factors leading to an increased risk of residual or recurrent calculi included the presence of a staghorn calculus and younger patient age. The excellent stone-free rates achieved suggest that routine second-look nephroscopy may not be necessary for the majority of patients undergoing PCNL.
Turney, Benjamin W
2014-03-01
Obtaining renal access is one of the most important and complex steps in learning percutaneous nephrolithotomy (PCNL). Ideally, this skill should be practiced outside the operating room. There is a need for anatomically accurate and cheap models for simulated training. The objective was to develop a cost-effective, anatomically accurate, nonbiologic training model for simulated PCNL access under fluoroscopic guidance. Collecting systems from routine computed tomography urograms were extracted and reformatted using specialized software. These images were printed in a water-soluble plastic on a three-dimensional (3D) printer to create biomodels. These models were embedded in silicone and then the models were dissolved in water to leave a hollow collecting system within a silicone model. These PCNL models were filled with contrast medium and sealed. A layer of dense foam acted as a spacer to replicate the tissues between skin and kidney. 3D printed models of human collecting systems are a useful adjunct in planning PCNL access. The PCNL access training model is relatively low cost and reproduces the anatomy of the renal collecting system faithfully. A range of models reflecting the variety and complexity of human collecting systems can be reproduced. The fluoroscopic triangulation process needed to target the calix of choice can be practiced successfully in this model. This silicone PCNL training model accurately replicates the anatomic architecture and orientation of the human renal collecting system. It provides a safe, clean, and effective model for training in accurate fluoroscopy-guided PCNL access.
STPEDISET: A novel innovation for percutaneous nephrolithotomy in children.
Utanğaç, Mehmet Mazhar; Sancaktutar, Ahmet Ali; Dağgülli, Mansur; Dede, Onur; Bodakçi, Mehmet Nuri; Hatipoğlu, Namık Kemal; Penbegül, Necmettin; Atar, Murat
2016-02-01
The aim of this study was to report the outcomes of PCNL in patients in whom the Short and Thin Pediatric Set (ST PEDISET) had been used. Data from 21 patients (11 boys and 10 girls) who underwent PCNL for renal stones using the ST PEDISET between April 2013 and February 2015 were analyzed retrospectively. The patients were evaluated by plane radiography and USG after surgery. In total 21 children (11 boys and 10 girls) with a median age of 13months (range 5months to 4years) who underwent PCNL were included in the study. The median stone burden was 16mm (range 10-36mm). The success rate was 85.7%. Sixteen patients (76.2%) were stone free and two patients (9.5%) had clinically insignificant residual fragments (CIRF). The median length of hospital stay was 4days (range 2-9days). The data of this study clearly show that the ST PEDISET is safe, effective and ergonomic for percutaneous nephrolithotomy in preschool-age children. This study indicates the need for randomized trials on larger cohorts to confirm these findings, and thus improve the surgical procedure. Copyright © 2016 Elsevier Inc. All rights reserved.
Radiation exposure to staff and patients during two endocrinological procedures
International Nuclear Information System (INIS)
Hristova-Popova, J.; Vassileva, J.; Saltirov, I.; Petkova, K.
2012-01-01
The purpose of the present work is to obtain information about the exposure to patient and staff during percutaneous nephrolithotripsy and ureteroscopy with intracorporeal lithotripsy and to search for a correlation between these parameters. The collected data for each procedure consist of the total air kerma-area product, P KA , cumulative dose, CD, fluoroscopy time, FT, number of images acquired, as well as clinical patient data. Average, minimum, maximum and median values were calculated for 38 patients. Mean values and median in parentheses were as follows: 355 (383) cGy cm 2 (P KA for PCNL); 433 (286) cGy cm 2 (P KA for URS); 42 (37) mGy (CD for PCNL); 12 (7) mGy (CD for URS); 3.5 (3.0) min (FT for PCNL); 1.4 (1.3) min (FT for URS). The typical operator doses for PCNL and URS were assessed to be 66.1 μSv and 34.3 μSv, respectively, while the maximum doses for the same type of procedures were 152.6 μSv and 124.1 μSv. Good correlation was observed between the staff dose and P KA for both procedures, while the correlation of staff dose with CD and FT was found to be weak. While applying principles of radiation protection and normal load in the clinic, there is no possibility to exceed the new annual dose limit for eye lens of 20 mSv per year averaged over 5 years. The correlation of P KA with FT and CD was also explored and no significant interconnection was observed. (authors)
Directory of Open Access Journals (Sweden)
Yakup Bostancı
2016-09-01
Full Text Available The recently developed micropercutaneous nephrolithotomy (microperc is the miniaturized version of mini-percutaneous nephrolithotomy (PCNL and standard-PCNL that allows for safe access and stone disintegration under direct vision. In this single-centre study, the authors aimed to define the role of microperc in the management of renal calculi and analyse factors predicting outcomes. A total of 139 patients, who underwent microperc between June 2010 and November 2014, were enrolled in this study. Microperc was successful in 119 (91.53% patients, while in 11 patients (8.46% some residual fragments were seen on imaging. Of the total study group, conversion to mini- or standard PCNL was required in nine patients (6.47%. Overall complication rate of 11.53%, primarily minor complications comprising renal colic and urinary tract infection. On multivariate analysis, stone density (HU, stone number and stone volume were significantly associated with the dependent variable stone clearance. Multivariate analysis showed that intra-operative complications and stone number were significantly associated with conversion to mini- or standard PCNL. Stone volume threshold of 1.000 mm3 was a significant predictor of stone clearance in univariate and multivariate analyses, regardless of the stone location. Some limitations of this study, relatively small sample size and particularly the retrospective and non-comparative design, should be highlighted. EAU guidelines recommend shockwave lithotripsy (SWL or retrograde intrarenal surgery as the primary treatment modality for stones <10 mm in size. Although microperc is presently being used for small to moderate stones, the very indication that holds for SWL as well, it is notable that SWL is influenced by stone location and pelvicalyceal anatomy, and may require multiple sessions. Nevertheless, microperc has an inherent limitation in that the stone fragments cannot be retrieved for analysis. It has been noted that the
Directory of Open Access Journals (Sweden)
Geeta P Parikh
2014-01-01
Full Text Available Background and Aim: Percutaneous nephrolithotomy (PCNL is a common for managing renal calculi. Pain in the initial post operatie period is relieved by infiltration of local anaesthetic around the nephrostomy tract.We aimed to compare the analgesic efficacy of bupivacaine and ropivacaine. Methods: A total of 100 adult patients undergoing elective PCNL- under balanced general anaesthesia were randomly divided into bupivacaine group (Group B and ropivacaine group (Group R. After completion of procedure, 23G spinal needle was inserted at 6 and 12 O′clock position under ultrasonic guidance up to renal capsule along the nephrostomy tube. A volume of 10 ml of either 0.25% bupivacaine or 0.25% ropivacaine solution was infiltrated in each tract while withdrawing the needle. Post-operative pain was assessed using visual analogue scale (VAS and dynamic visual analogue scale (D-VAS for initial 24 h. Intravenous tramadol was given as rescue analgesia when VAS >4. Time to first rescue analgesic, number of doses and total amount of tramadol required in initial 24 h and side-effects were noted. Results: Visual analogue scale and D-VAS at 6 h and 8 h in Group B was significantly higher than Group R. Mean time to first rescue analgesia in Group R was significantly longer than Group B. Mean number of doses of tramadol and total consumption of tramadol in 24 h was less in Group R, though not statistically significant. Conclusion: Peritubal infiltration of 0.25% ropivacaine infiltration along the nephrostomy tract is more effective than 0.25% bupivacaine in alleviating initial post-operative pain after PCNL.
The percutaneous nephrolithotomy global study
DEFF Research Database (Denmark)
Labate, Gaston; Modi, Pranjal; Timoney, Anthony
2011-01-01
PCNL Global Study collected prospective data for consecutive patients who were treated with PCNL at centers around the world for 1 year. Complications were evaluated by the modified Clavien classification system. RESULTS: Of 5724 patients with Clavien scores, 1175 (20.5%) patients experienced one......PURPOSE: This study evaluated postoperative complications of percutaneous nephrolithotomy (PCNL) and the influence of selected factors on the risk of complications using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. PATIENTS AND METHODS: The CROES...... grade I. Two patients died in the postoperative period. The largest absolute increases in mean Clavien score were associated with American Society of Anesthesiologists (ASA) physical status classification IV (0.75) or III (0.34), anticoagulant medication use (0.29), positive microbiologic culture from...
DEFF Research Database (Denmark)
G. Vadivia, José; M. Scarpa, Roberto; Duvdevani, Mordechai
2011-01-01
To determine differences in patients' characteristics, operative time and procedures, and perioperative outcomes between prone and supine positioning in percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database....
Antegrade jj stenting after percutaneous renal procedures: The 'pull and push' technique.
Ratkal, Jaideep M; Sharma, Elias
2015-06-01
A JJ stent is inserted antegradely after percutaneous renal procedures like percutaneous nephrolithotomy (PCNL) for renal calculus disease, and for endopyelotomy for pelvi-ureteric junction obstruction. We describe a technique for antegrade stent insertion after PCNL.
Antegrade jj stenting after percutaneous renal procedures: The ‘pull and push’ technique
Ratkal, Jaideep M.; Sharma, Elias
2014-01-01
A JJ stent is inserted antegradely after percutaneous renal procedures like percutaneous nephrolithotomy (PCNL) for renal calculus disease, and for endopyelotomy for pelvi-ureteric junction obstruction. We describe a technique for antegrade stent insertion after PCNL. PMID:26413327
Tokas, Theodoros; Habicher, Martin; Junker, Daniel; Herrmann, Thomas; Jessen, Jan Peter; Knoll, Thomas; Nagele, Udo
2017-06-01
To evaluate the stone-free rates (SFRs) and stone clearance rates (SCRs) of extracorporeal shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolitholapaxy (PCNL) according to non-contrast computer tomography (NCCT) findings. Original articles were identified from PubMed. After exclusion of ineligible papers, twenty-three studies with 2494 cases were included in the review. Six SWL, five RIRS and eight PCNL studies were selected. Additionally, four comparative articles were identified. SWL presents SFRs ranging 35-61.3 % and SCRs for residuals <4 mm being 43.2-92.9 %. RIRS studies report SFRs of 34.8-59.7 % and SCRs for residuals <4 mm ranging 48-96.7 %. Finally, PCNL presents SFRs of 20.8-100 % and SCRs for residuals <4 mm being 41.5-91.4 %. According to the comparative studies, SFRs are 17-61.3 % for SWL, 50 % for RIRS, and 95-100 % for PCNL. According to NCCT findings, it seems that PCNL provides better SFRs than ESWL and RIRS. However, further research with comparable and complete preoperative parameters and outcomes could reduce the heterogeneity of current data.
Risk factors for fever and sepsis after percutaneous nephrolithotomy
Directory of Open Access Journals (Sweden)
Aso Omer Rashid
2016-04-01
Conclusion: DM, staghorn stones, degree of hydronephrosis, duration of the operation and number of tracts are risk factors for post PCNL fever, while number of stones, intraoperative blood loss, duration of the operation and residual stones are risk factors for post PCNL sepsis.
The clinical research office of the endourological society percutaneous nephrolithotomy global study
DEFF Research Database (Denmark)
Desai, Mahesh; De Lisa, Antonello; Turna, Burak
2011-01-01
PURPOSE: The study compared characteristics and outcomes in patients with staghorn or nonstaghorn stones who were treated with percutaneous nephrolithotomy (PCNL) within the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. PATIENTS AND METHODS: Data over a 1-year ...
How well tolerated is supine percutaneous nephrolithotomy?
Baard, Joyce; Kamphuis, Guido M.; Westendarp, Matias; de La Rosette, Jean J. M. C. H.
2014-01-01
Supine percutaneous nephrolithotomy (PCNL) has been described in 1988 and several modifications followed since. Despite claimed benefits, supine PCNL is still neglected by the majority of urologists. Lack of experience and the fear of complications are possible explanations for the resistance to
Purkait, Bimalesh; Kumar, Manoj; Sokhal, Ashok Kumar; Bansal, Ankur; Sankhwar, Satya Narayan; Gupta, Ashok Kumar
2017-08-01
To assess the outcomes of percutaneous nephrolithotomy (PCNL) in bilateral staghorn calculi in pediatric patients, we have performed a retrospective analysis. Staghorn calculus is defined as stone that fills a greater part of the pelvic-caliceal system. Still, in developing countries, patients may present with staghorn calculus. PCNL is the preferred treatment modality for staghorn calculus both in adult and children. Our study included fifty-one pediatric patients (calculus in children needs expertise. PCNL in B/L staghorn renal calculus in children is safe and effective. B/L staghorn renal calculi with compromised renal function have higher chance of complications including bleeding.
Directory of Open Access Journals (Sweden)
Bhargava Vardhana Reddy
2015-11-01
Full Text Available INTRODUCTION : Percutaneous nephrolithotomy (PCNL is the most frequently performed surgery for stone disease at our institution. Nearly 100 PCNL procedures are being performed in a year at our institution. Septicemia following PCNL can be catastrophic despite sterile preoperative urine and prophylactic antibiotics. Infected stones, obstructed kidneys , and comorbidit y have been held responsible. In this study we analyzed various culture specimens, namely Mid - stream urine (MSU, renal pelvic urine and crushed stones. MATERIALS AND METHODS : We performed a prospective clinical study in all our patients undergoing PCNL b etween January 2013 and December 2014. MSU was sent for culture and sensitivity testing (C&S one day prior to surgery. Percutaneous access into the ipsilateral pelvicaliceal system is achieved under image intensification using a fine, 14 gauge Kellet need le. Urine from the pelvicaliceal system is first aspirated and sent as pelvic urine C&S. Stone fragments are collected to be proces0sed for C&S. The data collected were divided into 3 main groups, that is MSU C&S, pelvic urine C&S and stone C&S. RESULTS : A total of 83 patients were included in the study, of this MSU C&S was positive in 9/83 (10.8% patients, Pelvic C&S in 10 /73 (13.7% patients and Stone C&S in 25/83 (30.1% patients. Out of 25 cases of stone culture positive patients 17 patients develope d Systemic Inflammatory Response Syndrome (SIRS but only 2 patients developed SIRS in MSU C & S positive patients. CONCLUSIONS: The results of our study suggest that positive stone C&S is the better predictor of potential urosepsis than MSU. Stone cultur e is available only after surgery but appears to be the best guide for antibiotic therapy in case of sepsis. So the routine collection of stone for C&S will be beneficial
Zhao, Chenming; Yang, Huan; Tang, Kun; Xia, Ding; Xu, Hua; Chen, Zhiqiang; Ye, Zhangqun
2016-11-01
For the treatment of large upper urinary stones percutaneous nephrolithotomy (PCNL) is generally considered the first choice, and Laparoscopic Stone Surgery (LSS) is an alternative. We aim to compare the efficiency and safety of PCNL with LSS, as far as the management of large upper urinary stones is concerned. A systematic search from Pubmed, Web of Science, Wiley Online Library and Elsevier was performed up to August 1, 2015 for the relevant published studies. After data extraction and quality assessment, meta-analysis was performed using the RevMan 5.3 software. 15 eligible trials evaluating LSS vs. PCNL were identified including 6 prospective and 9 retrospective studies with 473 patients undergoing LSS and 523 patients undergoing PCNL. Although LSS led to longer operative time (p = 0.01) and higher open conversion rate (p = 0.02), patients might benefit from significantly fewer overall complications (p = 0.03), especially lower bleeding rate (p = 0.02), smaller drop in hemoglobin level (p rate was also higher for LSS compared with PCNL (p rate. Because of the inherent limitations of the included studies, further large sample prospective, multi-centric studies and randomized control trials should be undertaken to confirm our findings.
Bansal, Ankur; Arora, Aditi
2017-08-01
To evaluate the efficacy and safety of 0.1% tranexamic acid in irrigant fluid in reducing blood loss during PCNL. The study involved 400 patients who were planned for PCNL and were prospectively randomized into two equal groups. In tranexamic group, 0.1% tranexamic acid was given in irrigant fluid, while in placebo group, distilled water was added to irrigant fluid during surgery. Operative data were recorded which included fall in hemoglobin, total blood loss, operative time, irrigation fluid, length of stay in hospital, requirement of blood transfusion, complications related to PCNL and adverse events of tranexamic acid. Baseline parameters were comparable between two groups. The fall in hemoglobin and total blood loss in the tranexamic group was significantly lower than placebo group (1.71 vs. 2.67 gm/dL, 154.55 vs. 212.61 mL, respectively, p tranexamic group were significantly less compared to placebo (p tranexamic group versus 82% in placebo (p = 0.12). The blood transfusion requirement was significantly lower in the tranexamic group versus placebo (5 vs. 12.5%, p = 0.012), as was the complication rate (19 vs. 28%, p = 0.044). The requirement of angioembolization in the tranexamic group was significantly less as compared to placebo (0.5 vs. 4%, p = 0.03). No adverse events related to administration of tranexamic acid were noted. 0.1% tranexamic acid in irrigant fluid is safe and significantly reduces perioperative blood loss and requirement of blood transfusion during percutaneous nephrolithotomy. It is associated with lower perioperative complication rates.
Directory of Open Access Journals (Sweden)
Firtantyo Adi Syahputra
2016-06-01
Full Text Available Objectives Bleeding is the most common complication of percutaneous nephrolithotomy (PCNL. Injudicious transfusion is frequently performed in current practice, even though it is not always needed. This study aimed to identify the predictive factors of blood loss in the PCNL procedure and evaluate the perioperative transfusion practice. Methods A prospective study of PCNL was randomly performed by two consultants of endo-urology at our institution. The inclusion criteria were adults with kidney pelvic stones >20 mm or stone in inferior calyx >10 mm or staghorn stone. Those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. A full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, shifting of hematocrit level and amount of blood transfused were analyzed statistically using line regression to identify the predictive factors of total blood loss (TBL. Results Eighty-five patients were enrolled in this study. Mean TBL was 560.92 ± 428.43 mL for both endo-urology surgeons. Stone burden was the most influential factor for TBL (p=0.037. Our results revealed that TBL (mL = -153.379 + 0.229 × stone burden (mm2 + 0.203 x baseline serum hematocrit (%; thus considerably predicted the need for blood transfusion. A total of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% received post-operative transfusion, 23% had both intra and post-operative transfusion, resulting in a cross-matched transfusion ratio of 7.72. Mean perioperative blood transfused was 356.00 ± 145.88 mL.
Usawachintachit, Manint; Tzou, David T; Mongan, John; Taguchi, Kazumi; Weinstein, Stefanie; Chi, Thomas
2017-02-01
Ultrasound-guided percutaneous nephrolithotomy (PCNL) has become increasingly utilized. Patients with nondilated collecting systems represent a challenge: the target calix is often difficult to visualize. Here we report pilot study results for retrograde ultrasound contrast injection to aid in percutaneous renal access during ultrasound-guided PCNL. From April to July 2016, consecutive patients over the age of 18 years with nondilated collecting systems on preoperative imaging who presented for PCNL were enrolled. B-mode ultrasound imaging was compared with contrast-enhanced mode with simultaneous retrograde injection of Optison™ via an ipsilateral ureteral catheter. Five patients (four males and one female) with renal stones underwent PCNL with retrograde ultrasound contrast injection during the study period. Mean body mass index was 28.3 ± 5.6 kg/m 2 and mean stone size was 24.5 ± 12.0 mm. Under B-mode ultrasound, all patients demonstrated nondilated renal collecting systems that appeared as hyperechoic areas, where it was difficult to identify a target calix for puncture. Retrograde contrast injection facilitated delineation of all renal calices initially difficult to visualize under B-mode ultrasound. Renal puncture was then performed effectively in all cases with a mean puncture time of 55.4 ± 44.8 seconds. All PCNL procedures were completed without intraoperative complications and no adverse events related to ultrasound contrast injection occurred. Retrograde ultrasound contrast injection as an aide for renal puncture during PCNL is a feasible technique. By improving visualization of the collecting system, it facilitates needle placement in challenging patients without hydronephrosis. Future larger scale studies comparing its use to standard ultrasound-guided technique will be required to validate this concept.
Noureldin, Yasser A; Elkoushy, Mohamed A; Andonian, Sero
2015-11-01
The aim of the present study was to compare the accuracy of the Guy's and S.T.O.N.E. scoring systems in predicting percutaneous nephrolithotomy (PCNL) outcomes. After obtaining ethics approval, medical records of patients undergoing PCNL between 2009 and 2013 at a tertiary stone center were retrospectively reviewed. Guy's and S.T.O.N.E. scoring systems were calculated. Regression analysis and ROC curves were performed. A total of 185 PCNLs were reviewed. The overall stone-free rate was 71.9 % with a complication rate of 16.2 %. When compared to patients with residual fragments, stone-free patients had significantly lower Guy's grade (2.7 vs. 2; p stone-free status, OR 0.4 (p r = 0.3, p r = 0.4, p r = 0.2, p = 0.001 and r = 0.3, p stone-free status. Other factors not included in either scoring system may need to be incorporated in the future to increase their accuracy.
Türk, Hakan; Yoldaş, Mehmet; Süelözgen, Tufan; İşoğlu, Cemal Selcuk; Karabıçak, Mustafa; Ergani, Batuhan; Ün, Sıtkı
2017-06-01
To evaluate the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatment on the performance and outcome of percutaneous nephrolithotomy (PCNL). Of 1625 PCNL procedures performed in our clinic, 393 renal units with similar stone burden and number of accesses was included in the present study. We categorised the study patients into two groups according to whether they underwent ESWL within 1 year prior to PCNL or not. Accordingly, Group 1 comprised 143 (36.3%) ESWL-treated patients and Group 2 comprised 250 (63.7%) non-ESWL-treated patients. Residual stones were detected in 36 (25.1%) of the ESWL-treated patients (Group 1) and in 60 (24%) of non-ESWL-treated patients (Group 2). There were no statistically significant differences between the groups for length of hospital stay (LOS), nephrostomy tube removal time, and the presence of residual stones. When we evaluated the groups for both the preoperative and postoperative haemoglobin (Hb) drop and blood transfusion rate, manifest Hb declines and more transfusions were required in the ESWL-treated patients (both P = 0.01). In our study, previous ESWL treatment had no influence on the PCNL stone-free rate, operation time, incidence of postoperative complications, and LOS, in patients with similar stone burdens. However, bleeding during PCNL was more prevalent in the ESWL-treated patients, so close attention should be paid to bleeding in patients who have been pretreated with ESWL.
Ultra-mini PNL (UMP): Material, indications, technique, advantages and results.
Desai, Janak D
2017-01-01
Stone disease has afflicted mankind since centuries; records from ancient civilisations of India and Egypt have shown stones in human bodies. The scientific mind of humans has always made smart endeavours to remove the kidney stones. From large instruments made like the beaks of different animals and birds in 600 BC (Indian civilisation) to extremely sophisticated and miniaturised endoscopic intruments of today the human race has travelled a long way. The theme has always been to remove the stones with minimal morbidity and mortality and with minimum pain to the patient. The article takes you through the journey of instruments used in 600 BC until today. The story of instrumentation is a symbiosis of the medical minds along with engineering advances. The story of miniaturisation could not have moved further without the development of lasers, fiberoptics and sophisticated cameras. As the field stands today, we remove more complex stones by larger endoscopic intervention and smaller stones by miniaturised instruments. The article discusses all the merits and shortcomings of various techniques: from open surgery to standard PCNL to Mini PCNL to Ultra- Mini PCNL to Micro-PCNL.
Ultra-mini-percutaneous nephrolithotomy: A minimally-invasive option for percutaneous stone removal
Directory of Open Access Journals (Sweden)
Madhu Sudan Agrawal
2016-01-01
Full Text Available Introduction: Percutaneous nephrolithotomy (PCNL has witnessed rapid advancements, the latest being ultra-mini-percutaneous nephrolithotomy (UMP, which makes the use of 11-13F sheaths as compared to 24-30F sizes used in conventional PCNL. This miniaturization aims to reduce morbidity and improve patient outcomes. We evaluated the safety and efficacy of UMP and report our ourtcomes. Patients and Methods: A total of 120 patients underwent UMP from July 2012 to March 2014. These patients had a single unilateral renal stone measuring between 8 and 20 mm. All patients underwent UMP using a 3F nephroscope, 7.5F inner sheath, and 11F or 13F outer metallic cannula, which served as the Amplatz sheath. Stone fragmentation and clearance were achieved with holmium laser. No nephrostomy or stent was used routinely. Results: Complete stone fragmentation was achieved in 114 out of 120 patients (95% using UMP; whereas the remaining 6 were converted into mini-PCNL using a 12.5F nephroscope and 15F Amplatz sheath. The mean operative time was 39.7 ± 15.4 min, and the mean postoperative hospital stay was 22.3 ± 2.2 h. Postoperatively, 6 (5% patients had residual fragments measuring ≤4 mm. At the 2 weeks follow-up, the stone-free status was >99% (119/120. There were no significant postoperative complications. Conclusion: This study shows UMP to be an effective and safe procedure for managing stones up to 20 mm. This procedure offers an attractive alternative to shock wave lithotripsy and retrograde intrarenal surgery for managing small stones.
DEFF Research Database (Denmark)
Aabech, J; Andersen, J T
1993-01-01
Treatment of cystine stones in the urinary tract can be difficult because of a high frequency of recurrence, resistance to Extracorporeal Shock Wave Lithotripsy (ESWL), difficulty in localization and access to peripheral stones during Percutaneous Nephrolithotripsy (PCNL), and the insufficient...... effect of oral chemolysis. We present two cases of urinary cystine calculi treated with a combination of pyelolithotomy, PCNL, ESWL and percutaneous irrigation chemolysis, using N-acetylcysteine and Tromethamine-E....
Directory of Open Access Journals (Sweden)
Akar EC
2013-01-01
Full Text Available Erin Akar, Bodo E KnudsenDepartment of Urology, Ohio State University Wexner Medical Center, Columbus, OH, USAAbstract: The purpose of this review, based on the current evidence in the literature, is whether ureteroscopy (URS is a comparable primary treatment option to the current gold standard of percutaneous nephrolithotomy (PCNL for the treatment of large kidney stones 2 cm or greater. The lack of prospective randomized trials directly comparing URS and PCNL makes comparison challenging. The numerous studies are not standardized in terms of their definition of stone-free or how stone size is reported. In order to standardize comparison of results, we used a stone-free definition of <4 mm after one procedure per imaging of the author’s choice, since how each patient was imaged postoperatively was not reported. The results from the literature show that moderately large stones from 2 to 3 cm treated ureteroscopically have similar outcomes to PCNL. Stone-free rates with URS decrease when stone size is above 3 cm. Our interpretation of the literature suggests that a current limitation of URS is that multiple procedures for URS would be required to achieve comparable stone-free rates to PCNL, particularly for stones greater than 4 cm.Keywords: ureteroscopy, percutaneous nephrolithotomy, lithotripsy, urinary calculi
Atalay, Hasan Anıl; Ülker, Volkan; Alkan, İlter; Canat, Halil Lütfi; Özkuvancı, Ünsal; Altunrende, Fatih
2016-10-01
To investigate the impact of three-dimensional (3D) printed pelvicaliceal system models on residents' understanding of pelvicaliceal system anatomy before percutaneous nephrolithotripsy (PCNL). Patients with unilateral complex renal stones indicating PCNL were selected. Usable data of patients were obtained from CT-scans in Digital Imaging and Communications in Medicine (DICOM) format. Mimics software version 16.0 (Materialise, Belgium) was used for segmentation and extraction of pelvicaliceal systems (PCSs). All DICOM-formatted files were converted to the stereolithography file format. Finally, fused deposition modeling was used to create plasticine 3D models of PCSs. A questionnaire was designed so that residents could assess the 3D models' effects on their understanding of the anatomy of the pelvicaliceal system before PCNL (Fig. 3). Five patients' anatomically accurate models of the human renal collecting system were effectively generated (Figs. 1 and 2). After presentation of the 3D models, residents were 86% and 88% better at determining the number of anterior and posterior calices, respectively, 60% better at understanding stone location, and 64% better at determining optimal entry calix into the collecting system (Fig. 5). Generating kidney models of PCSs using 3D printing technology is feasible, and the models were accepted by residents as aids in surgical planning and understanding of pelvicaliceal system anatomy before PCNL.
Percutaneous nephrolithotomy in children: A preliminary report.
Elderwy, Ahmad A; Gadelmoula, Mohamed; Elgammal, Mohamed A; Osama, Ehab; Al-Hazmi, Hamdan; Hammouda, H; Osman, Esam; Abdullah, Medhat A; Neel, Khalid Fouda
2014-07-01
The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL) in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24). The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively. Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.
Directory of Open Access Journals (Sweden)
Milad Derakhshanjazari
2016-03-01
Full Text Available Introduction: Taxi drivers’ exposure to repeat whole-body vibrations can cause back pain and digestive disorders. Since this type of vibration depends on the car components, this study was carried out to determine the influence of tire characteristics on the amount of whole-body vibrations transmitted to the Peugeot 405 taxi drivers. Methods: In this experimental study, vibration characteristics were measured according to the ISO2631-1 with each of the statuses: tubeless tires fixed and fluid in it (normal air or nitrogen and also the fluid in the tires fixed with tubes or tubeless on asphalt-paved road. Other variables including tire pressure, engine speed, road gradient, number of passengers, springs, and shock absorbers were kept constant. Then the effect of changes was analyzed using an appropriate statistical test. Results: After changing nitrogen to normal air and tubeless tires to tube, the average of RMS in Z-axis, eight-hour equivalent acceleration A(8 and crest factor were reduced (P 0.9 m/s2 to caution zone (0.45-0.9 m/s2 with a value of 0.8 m/s2. Conclusions: The amount of vibration transmitted to the whole body is sensitive to existence of tubes and tires inflation so that we can reduce the amount of whole-body vibration to lower than the upper limit of the health risk by changing the characteristics of the tire
Percutaneous nephrolithotomy in children in different age groups
DEFF Research Database (Denmark)
Guven, Selcuk; Frattini, Antonio; Onal, Bulent
2013-01-01
no standardisation in the age categorisation of children, there are inconsistencies among the age subgroups in the current literature. To achieve a standard terminology and thus a common language, the World Health Organization age classification criterion was used in the present study. Based on the findings, we can...... suggest that PCNL can be applied safely and effectively in children in different age groups. OBJECTIVES: • To present the overall results of paediatric percutaneous nephrolithotomy (PCNL) compared with adults. • To present the indications, complications and outcomes of patients treated...... in the participating centres in the PCNL Global Study, as categorised in different age groups. PATIENTS AND METHODS: • The Clinical Research Office of the Endourological Society (CROES) Study was conducted from November 2007 to December 2009, and included 96 centres and >5800 patients. • All children aged ≤14 years...
Incidence and implications of silent hydronephrosis following percutaneous nephrolithotomy .
Dagrosa, Lawrence; Moses, Rachel; Pais, Vernon M
2017-01-01
While routine renal imaging following ureteroscopy for urinary calculi has been recommended to screen for asymptomatic "silent" obstruction, the rate of silent obstruction following percutaneous nephrolithotomy (PCNL) remains poorly defined, and no consensus recommendations exist on routine postoperative imaging. At our institution, we sought to assess the incidence of silent hydronephrosis (SH), as a screen for obstruction, following PCNL. The records of all 162 patients who met study inclusion criteria were reviewed. Of this group, 112 patients presented for their scheduled renal ultrasonography 4 - 6 weeks following stent removal to screen for SH. Asymptomatic patients found to have ultrasonographic evidence of hydronephrosis were further analyzed. SH was noted in 16% (18/112) of patients. Two required subsequent ureteroscopic stone extraction (1.8%), one of which also underwent endoureterotomy for a ureteral stricture. Four patients (22%) had stable hydronephrosis and declined functional imaging, 2 patients (11%) had a known partial ureteropelvic junction obstruction and declined intervention. SH resolved spontaneously in 50% (9/18) with a mean time to resolution of 6.3 months. There was no difference in stone complexity based on Guy's stone score between groups, 2.8 (± 0.92) vs. 2.4 (± 1.03), p = 0.34. Although not statistically significant, patients with SH were more likely to have had residual stone fragments postoperatively, 39% (7/18) vs. 19% (18/94), p = 0.067. SH following, PCNL was identified in 16% of this screened population, with the majority requiring no intervention. However, SH may be attributed to residual stone or stricture, which may have been otherwise unrecognized in up to 2% of patients undergoing PCNL. Consideration should be given for routine postoperative ultrasound to screen for silent obstruction following PCNL. .
Urinary tract infections and post-operative fever in percutaneous nephrolithotomy.
Gutierrez, Jorge; Smith, Arthur; Geavlete, Petrisor; Shah, Hemendra; Kural, Ali Riza; de Sio, Marco; Amón Sesmero, José H; Hoznek, András; de la Rosette, Jean
2013-10-01
To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients. Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre-operative urine samples and who received antibiotic prophylaxis were included. Pre-operative bladder urine culture and post-operative fever (>38.5°C) were assessed. Relationship between various patient and operative factors and occurrence of post-operative fever was assessed using logistic regression analyses. Eight hundred and sixty-five (16.2%) patients had a positive urine culture; Escherichia coli was the most common micro-organism found in urine of the 350 patients (6.5%). Of the patients with negative pre-operative urine cultures, 8.8% developed a fever post-PCNL, in contrast to 18.2% of patients with positive urine cultures. Fever developed more often among the patients whose urine cultures consisted of Gram-negative micro-organisms (19.4-23.8%) versus those with Gram-positive micro-organisms (9.7-14.5%). Multivariate analysis indicated that a positive urine culture (odds ratio [OR] = 2.12, CI [1.69-2.65]), staghorn calculus (OR = 1.59, CI [1.28-1.96]), pre-operative nephrostomy (OR = 1.61, CI [1.19-2.17]), lower patient age (OR for each year of 0.99, CI [0.99-1.00]), and diabetes (OR = 1.38, CI [1.05-1.81]) all increased the risk of post-operative fever. Limitations include the use of fever as a predictor of systemic infection. Approximately 10% of PCNL-treated patients developed fever in the post-operative period despite receiving antibiotic prophylaxis. Risk of post-operative fever increased in the presence of a positive urine bacterial culture, diabetes, staghorn calculi, and a pre-operative nephrostomy.
Directory of Open Access Journals (Sweden)
Amelia Pietropaolo
2017-12-01
Full Text Available Objective: To ascertain the publication trends of interventions for paediatric kidney stone disease (KSD we conducted a systematic review of literature over the last 16â¯years. Patients and methods: With a rise of paediatric KSD and related interventions, a systematic review using PubMed was done over the last 16â¯years for all published papers on âPaediatric stone disease intervention â ureteroscopy (URS, shockwave lithotripsy (SWL, percutaneous nephrolithotomy (PCNL, open stone surgery, and laparoscopic stone surgeryâ. The search was limited to English language articles with a published abstract, whilst case reports, animal and laboratory studies, were excluded. We also analysed the data in two time periods, period-1 (2000â2007 and period-2 (2008â2015. Results: During the last 16-years, 339 papers were published on paediatric stone disease intervention on PubMed. This included papers on URS (95, PCNL (97, SWL (102, open stone surgery (34 and laparoscopic stone surgery (11. During period-1 and period-2 there were 30 and 65 papers on URS, 16 and 81 papers on PCNL, 33 and 60 papers on SWL, nine and 25 papers on open surgery, respectively. When comparing the two periods, there were 92 published papers for all interventions in period-1 and this had risen almost threefold to 247 papers in period-2. Conclusions: Our systematic review shows that intervention for KSD in the paediatric age group has risen over the last 8â¯years. Whilst URS, SWL, open surgery and laparoscopic surgery have all doubled, PCNL has risen fivefold reflecting an increase in the new minimally invasive PCNL techniques. Keywords: Publication trends, Urolithiasis, Stone, Ureteroscopy, Paediatrics
Qiao, Mingzhou; Zhang, Haifang; Zhou, Chenlong
2015-11-24
To explore the factors affecting the residual stones after percutaneous nephrolithotomy (PCNL) in patients with renal calculus. A retrospective analysis was performed for 1 200 patients who were affected by renal calculus and treated with PCNL between Jan 2008 and May 2014 in People's Hospital of Anyang City. Among those patients, 16 were diagnosed as bilateral renal stone and had two successive operations. The size, location and number of stones, previous history of surgery, the degree of hydronephrosis, urinary infection were included in the univariate analysis. Significant factors in univariate analysis were included in the multivariate analysis to determine factors affecting stone residual. A total of 385 cases developed stone residual after surgery. The overall residual rate was 31.7%. In univariate analysis, renal pelvis combined with caliceal calculus (P=0.006), stone size larger than 4 cm (P=0.005), stone number more than 4 (P=0.002), the amount of bleeding more than 200 ml (P=0.025), operation time longer than 120 minutes (P=0.028) were associated with an increased rate of stone residual. When subjected to the Cox multivariate analysis, the independent risk factors for residual stones were renal pelvis combined with caliceal calculus (P=0.049), stone size larger than 4 cm (P=0.038) and stone number more than 4 (P=0.018). Factors affecting the incidence of residual stones after PCNL are the size, location and number of stones. Larger size stone and the presence of renal pelvis combined with caliceal calculus are significantly associated with residual stones. Nevertheless, stone number less than 4 indicates an increased stone clearance rate.
Percutaneous Nephrolithotomy under Spinal Anesthesia with Marcaine
Directory of Open Access Journals (Sweden)
S.M.R. Rabani
2010-01-01
Full Text Available Introduction & Objective: The efficacy of Percutaneous Nephrolithotomy (PCNL in the treatment of renal stones has been proven in its indications. The main method of anesthesia in this procedure is general anesthesia. We used spinal anesthesia (SA as an alternative method of anesthesia with many benefits. This study was intended to show the possibility of SA as a more comfortable method of anesthesia for the surgeon , the anesthesiologist and the patient via more cooperation of the patient during changing the position and prevention of some complications mostly in upper extremities and neck. Materials & Methods: In a prospective clinical trial study, a total of 112 patients underwent PCNL under SA with marcaine , from Nov 2004 till Feb 2009. Their mean age was 36 years (22-48, at first the syringe was stained by epinephrine and then 2 -3.5 ml marcaine was used for SA and addition of analgesics , sedatives or both., if needed. The rest of the procedure was done as routine.Results: Stone clearance was achieved in 82% of the patients and the rest were managed by ESWL. The mean operation time was 126 minutes (90-220, 36% of the patients needed sedation, analgesia, or both, specially those with bigger stones. 6% of the patients had upper pole stones .Blood transfusion was needed only in one patient. No significant complication was observed in this study.Conclusion: PCNL under SA afforded the surgeon and the anesthesiologist the opportunity of more patient cooperation during position changes and precludes some morbidities that may happen under general anesthesia because the patient is awake and able to portend.
The management of staghorn calculi in children
Horuz, Rahim; Sarica, Kemal
2012-01-01
Objectives To review reports focusing on the surgical treatment of staghorn stones in children, as despite all the improvements in the surgical treatment of paediatric urolithiasis the management of staghorn calculi still represents a challenging problem in urology practice. Methods To evaluate current knowledge about treating staghorn calculi in children, we searched PubMed for relevant articles published between 1991 and 2011, using a combination of related keywords, i.e. staghorn stone, child, kidney calculi, surgical treatment, electrohydraulic shockwave therapy (ESWL), percutaneous nephrolithotomy (PCNL), and open surgery. Reports relating to the treatment of paediatric stone disease in general (open surgery, PCNL, ESWL) were also searched with the same method. Additional references were obtained from the reference list of full-text reports. Results Although open surgery had been widely used in the past for treating such stones in children, currently it has only limited indications in highly selected patients. Current published data clearly indicate that, in experienced hands, both PCNL and ESWL are now effective methods for treating staghorn calculi in children. Conclusions Due to advanced techniques and instrumentation, it is now possible to successfully treat staghorn calculi in children, with very limited safety concerns. Currently, while PCNL is recommended as the first-line surgical treatment, ESWL, open surgery and/or combined methods are valuable but secondary options in the treatment of paediatric staghorn calculi. PMID:26558045
Does Imaging Modality Used For Percutaneous Renal Access Make a Difference?
DEFF Research Database (Denmark)
Andonian, Sero; Scoffone, Cesare; Louie, Michael K
2013-01-01
OBJECTIVE To assess peri-operative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. METHODS A prospectively collected international CROES database containing 5806 patients treated with PCNL was used for the study. Patients were...... divided into two groups based on the methods of percutaneous access: ultrasound vs. fluoroscopy. Patient characteristics, operative data and post-operative outcomes were compared. RESULTS Percutaneous access was obtained using ultrasound guidance only in 453 patients (13.7%) and fluoroscopic guidance only...
Percutaneous nephrolithotomy in children: A preliminary report
Directory of Open Access Journals (Sweden)
Ahmad A. Elderwy
2014-01-01
Full Text Available Objectives: The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. Materials and Methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24. Results: The median age at presentation was 8-year (range: 3-12. The operative time ranged from 30 to 120 min (median 90. Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3. Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6% of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1 and were managed conservatively. Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.
Directory of Open Access Journals (Sweden)
Madeleine Nina Jones
2016-07-01
Full Text Available Purpose: The traditional prone positioning of percutaneous nephrolithotomy (PCNL is associated with various anesthetic and logistic difficulties. We aimed to compare the surgical outcomes of PCNLs performed using our modified supine position with those performed in the standard prone position. Materials and Methods: A prospective group of 236 renal units (224 patients undergoing PCNL were included in this 2 site study: 160 were performed in the modified supine position were compared with 76 undergoing PCNL in the prone position. The outcomes of radiation dose, radiation time, stone free rate, body mass index (BMI, stone size, operative time, length of stay (LOS, in hospital and complications were compared. Chi-square and t-tests were used. Results: There were no significant differences in mean radiation time, radiation dose or stone size between the modified supine and prone groups. The supine group had a higher mean BMI (31 kg/m2 vs. 28 kg/m2 , p=0.03, shorter mean surgical time (93 minutes vs. 123 minutes, p<0.001, shorter mean LOS (2 days vs. 3 days, p=0.005 and higher stone free rate (70% vs. 50%, p=0.005. There were no differences in septic or bleeding complications but the prone group had a higher rate of overall complications. Conclusions: Modified supine PCNL has significantly lower operative time, shorter LOS and higher stone-free rate compared with prone in our series, while remaining a safe procedure.
Recent Advances in Percutaneous Nephrolithotomy
Directory of Open Access Journals (Sweden)
Erem Kaan Basok
2014-05-01
Full Text Available The continuous innovations in technology, instrumentations, and techniques allow urologists to perform percutaneous nephrolithotomy (PCNL with increasing efficacy. Although recent advances have facilitated the procedure, some steps are still challenging. A thorough review of the recent urologic literature was performed to identify these improvements in PCNL technique. The newer developments mainly focused on multimodal imaging techniques, miniaturisation of instruments, tracking and navigation systems during access to the stone, and robotic systems. Further studies are necessary to better define the benefits of these new fruitful developments which remain an active research field.
Porphyrin-based Photocatalytic Nanolithography
Energy Technology Data Exchange (ETDEWEB)
Bearinger, J P; Stone, G; Dugan, L C; Dasher, B E; Stockton, C; Conway, J W; Kuenzler, T; Hubbell, J A
2009-06-08
Nanoarray fabrication is a multidisciplinary endeavor encompassing materials science, chemical engineering and biology. We form nanoarrays via a new technique, porphyrin-based photocatalytic nanolithography (PCNL). The nanoarrays, with controlled features as small as 200 nm, exhibit regularly ordered patterns and may be appropriate for (a) rapid and parallel proteomic screening of immobilized biomolecules, (b) protein-protein interactions and/or (c) biophysical and molecular biology studies involving spatially dictated ligand placement. We demonstrate protein immobilization utilizing nanoarrays fabricated via PCNL on silicon substrates, where the immobilized proteins are surrounded by a non-fouling polymer background.
Outcome of Percutaneous Nephrolithotomy
International Nuclear Information System (INIS)
Ali, S.; Kumar, N.; Baloch, U.
2014-01-01
Objective: To assess the implementation of Percutaneous Nephrolithotomy (PCNL) in renal stone management and evaluate the factors for efficacy and safety of PCNL. Study Design: Case series. Place and Duration of Study: Department of Urology at Jinnah Postgraduate Medical Centre, Karachi, from January 2008 to December 2011. Methodology: Patients aged above 12 years of age, irrespective of gender with normal renal function, mean stone size > 2 cm, lower pole stones > 1 cm, and ESWL failure were selected. After the procedure, on the first postoperative day, a plain abdominal radiograph was obtained to verify stone clearance. A nephrostomy tube was clamped overnight and subsequently removed when no residual stone which needs second sitting was seen. Results: In 175 patients, 62.86% (n=110) were male and the mean age was 35 A +- 9.56 years. One hundred and seventeen (66.85%) patients were primarily stone free and 13.71% (n=24) patients needed a second look procedure, thus, a total of 80.57% (n=141) patients were stone free in the same admission. Complications included failure in 4.0% (n=7) patients, bleeding in 8.57% (n=15) patients, a small residual stone in 15.43% (n=27) patients; and puncture site pain almost in every patient. Transient fever occurred in 55.43% (n=97) patients, urinary leakage in 8.57% (n=15) patients, urinary tract infections in 5.14% (n=9) patients, ureteric colic in 3.43% (n=6) patients, colonic injury in 0.57% (n=1) patient; and nephrectomy was required in 0.57% (n=1) patient due to severe bleeding. One patient (0.57%) expired due to anaesthesia complications. Conclusion: Percutaneous nephrolithotomy (PCNL) has a good success rate. There is minimal blood loss, and few major complications. (author)
Iqbal, Muhammad Waqas; Youssef, Ramy F; Neisius, Andreas; Kuntz, Nicholas; Hanna, Jonathan; Ferrandino, Michael N; Preminger, Glenn M; Lipkin, Michael E
2016-07-01
Struvite stones have been associated with significant morbidity and mortality, yet there has not been a report on the medical management of struvite stones in almost 20 years. We report on the contemporary outcomes of the surgical and medical management of struvite stones in a contemporary series. A retrospective review of patients who were treated with percutaneous nephrolithotomy (PCNL) for struvite stones at Duke University Medical Center between January 2005 and September 2012 identified a total of 75 patients. Of these, 43 patients had adequate follow-up and were included in this analysis. Stone activity, defined as either stone recurrence or stone-related events, and predictors of activity were evaluated after combined surgical and medical treatment. The study included 43 patients with either pure (35%) or mixed (65%) struvite stones with a median age of 55±15 years (range 21-89 years). The stone-free rate after PCNL was 42%. Stone recurrence occurred in 23% of patients. Postoperatively, 30% of patients had a stone-related event, while 60% of residual stones remained stable with no growth after a median follow-up of 22 months (range 6-67 mos). Kidney function remained stable during follow-up. Independent predictors of stone activity included the presence of residual stones >0.4 cm(2), preoperative large stone burden (>10 cm(2)), and the presence of medical comorbidities (P<0.05). Struvite stones can be managed safely with PCNL followed by medical therapy. The majority of patients with residual fragments demonstrated no evidence of stone growth on medical therapy. With careful follow-up and medical management, kidney function can be maintained and stone morbidity can be minimized. Initial large stone burden, residual stones after surgery, and associated medical comorbidities may have deleterious effect on stone recurrence or residual stone-related events.
Radiation doses of patients and urologists during percutaneous nephrolithotomy
Energy Technology Data Exchange (ETDEWEB)
Safak, M; Gogus, C [Faculty of Medicine, Ibni Sina Hospital, Department of Urology, Ankara University, 06450 Samanpazari, Ankara (Turkey); Olgar, T; Bor, D; Berkmen, G [Faculty of Engineering, Department of Physics Engineering, Ankara University, 06100, Tandogan, Ankara (Turkey)], E-mail: olgar@eng.ankara.edu.tr
2009-09-01
Renal stones can be treated either by extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL). Increasing use of fluoroscopic exposure for access and to detect stone location during PCNL make the measurement of patient and staff doses important. The main objective of this work was to assess patient and urologist doses for the PCNL examination. We used the tube output technique for determination of patient doses (n = 20) and lithium fluoride thermoluminescent dosimeter (TLD) chips for urologist dose measurements. The TLD technique was also used for some patient dose measurements (n = 7) for comparison with the tube output technique. Mean entrance skin doses of 191 and 117 mGy were measured by the tube output technique for anterior-posterior (AP) and right anterior oblique (RAO) 30 deg./left anterior oblique (LAO) 30 deg. projections, respectively. The mean urologist doses for eye, finger and collar were measured as 26, 33.5 and 48 {mu}Gy per procedure, respectively. The mean effective dose per procedure for the urologist was 12.7 {mu}Sv. None of the individual skin dose results approach deterministic levels.
Radiation doses of patients and urologists during percutaneous nephrolithotomy
International Nuclear Information System (INIS)
Safak, M; Gogus, C; Olgar, T; Bor, D; Berkmen, G
2009-01-01
Renal stones can be treated either by extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL). Increasing use of fluoroscopic exposure for access and to detect stone location during PCNL make the measurement of patient and staff doses important. The main objective of this work was to assess patient and urologist doses for the PCNL examination. We used the tube output technique for determination of patient doses (n = 20) and lithium fluoride thermoluminescent dosimeter (TLD) chips for urologist dose measurements. The TLD technique was also used for some patient dose measurements (n = 7) for comparison with the tube output technique. Mean entrance skin doses of 191 and 117 mGy were measured by the tube output technique for anterior-posterior (AP) and right anterior oblique (RAO) 30 deg./left anterior oblique (LAO) 30 deg. projections, respectively. The mean urologist doses for eye, finger and collar were measured as 26, 33.5 and 48 μGy per procedure, respectively. The mean effective dose per procedure for the urologist was 12.7 μSv. None of the individual skin dose results approach deterministic levels.
Modified Clavien Classification of our Percutaneous Nephrolithotomy Complications
Directory of Open Access Journals (Sweden)
Binhan Aktas
2015-11-01
Full Text Available Aim: To classify and compare the complications we experienced in our percutaneous nephrolithotomies (PCNLs by using modified Clavien system according to stone type as being simple or complex. Material and Method: Records of our total 210 standard PCNLs performed between May 2010 and April 2014, were evaluated retrospectively. Isolated renal pelvis or calyx stones were considered to be simple stones; partial or complete staghorn stones or renal pelvis stones accompanying caliceal stones were considered to be complex stones, regardless of their size. Results: The patients were all adults (77 females and 133 males. Mean age was 46.74 ± 13.40 (18-76 years. A total of 126 patients (60% had simple and 84 patients (40% had complex kidney stones. Mean stone area and operation time were 466.50 ± 361.81 (60-1900 mm2 and 81.02 ± 24.99 (45-165 min, respectively. All operations were completed with the application of a nephrostomy tube and mean nephrostomy tube removal time was 2.98 ± 1.23 (1-9 days. Complications were encountered in 36.5% of simple stones and 65.5% of complex stones. A statistically significant difference was detected between simple and complex stone groups with regard to PCNL complications (P = 0,0001. Discussion: Morbidity of PCNL is higher in complex stones compared with simple stones. Modified Clavien is a practical grading system for reporting complications of PNL procedures.
Percutaneous nephrolithotomy in hypertensive patients with different sizes of instruments.
Resorlu, B; Kara, C; Ozyuvali, E; Unsal, A
2011-01-01
The risk of major complications, especially hemorrhage, is significantly elevated during surgery in hypertensive patients. To determine whether percutaneous nephrolithotomy (PCNL) can be safely performed in the hypertensive patients using different sized instruments. We reviewed the records of 602 patients undergoing PCNL at our institution and identified 53 who were on antihypertensive therapy at the time of surgery. Patients were categorized into three groups according to size of devices used in surgery : those 24 F percutaneous tract with 22 F nephroscope (Group 1, n = 12 [22.7%]; 26 F percutaneous tract with 24 F nephroscope (Group 2, n = 19 [35.8%]) and 30 F percutaneous tract with 26 F nephroscope (Group 3, n = 22 [41.5%]). We compared the groups with regard to baseline characteristics, intraoperative parameters, stone-free and complication rates, and the length of hospitalization. There were no differences between the three groups in age, gender, weight and stone laterality. Fluoroscopy time, access to the collecting system and mean operative time for per cm2 stone did not differ between the groups. Hemoglobin decrease, postoperative hospital stay and blood transfusion rate was higher in group 3. Stones were completely cleared in 83.3%, 84.2% and 81.3% of patients, which increased to 91.6%, 89.5%, and 90.1% with adjunctive therapy in the group 1,2 and 3, respectively. PCNL with smaller devices is a safe and effective method in hypertensive patients. It has significantly a shorter hospital stay and less bleeding rates compared to classical PCNL.
The Guy's stone score--grading the complexity of percutaneous nephrolithotomy procedures.
Thomas, Kay; Smith, Naomi C; Hegarty, Nicholas; Glass, Jonathan M
2011-08-01
To report the development and validation of a scoring system, the Guy's stone score, to grade the complexity of percutaneous nephrolithotomy (PCNL). Currently, no standardized method is available to predict the stone-free rate after PCNL. The Guy's stone score was developed through a combination of expert opinion, published data review, and iterative testing. It comprises 4 grades: grade I, solitary stone in mid/lower pole or solitary stone in the pelvis with simple anatomy; grade II, solitary stone in upper pole or multiple stones in a patient with simple anatomy or a solitary stone in a patient with abnormal anatomy; grade III, multiple stones in a patient with abnormal anatomy or stones in a caliceal diverticulum or partial staghorn calculus; grade IV, staghorn calculus or any stone in a patient with spina bifida or spinal injury. It was assessed for reproducibility using the kappa coefficient and validated on a prospective database of 100 PCNL procedures performed in a tertiary stone center. The complications were graded using the modified Clavien score. The clinical outcomes were recorded prospectively and assessed with multivariate analysis. The Guy's stone score was the only factor that significantly and independently predicted the stone-free rate (P = .01). It was found to be reproducible, with good inter-rater agreement (P = .81). None of the other factors tested, including stone burden, operating surgeon, patient weight, age, and comorbidity, correlated with the stone-free rate. The Guy's stone score accurately predicted the stone-free rate after PCNL. It was easy to use and reproducible. Copyright © 2011 Elsevier Inc. All rights reserved.
Percutaneous Nephrolithotomy in Horseshoe Kidney: Our First Experience
Directory of Open Access Journals (Sweden)
Ercan Baş
2015-03-01
Full Text Available Objective To share our experience in percutaneous nephrolithotomy (PCNL procedures in patients with horseshoe kidney. Materials and Methods The data of 7 patients undergoing PCNL were analyzed retrospectively. Preoperative clinical and laboratory data of patients (including complete urinalysis, complete blood count, serum biochemistry, and coagulation tests were recorded. The stone surface area (mm2 was calculated by graph paper tracing of two dimensional projection of the stone on a plain film of the kidneys, ureters and bladder (KUB in the anteroposterior view by investigators. In addition, per-operative and post-operative findings were evaluated. Success and complication rates (according to the classification of Clavien were also determined. Results The mean stone surface area was 1234 (range 250-2460 mm2 mm2. Six patients were treated through a single tract, and one patient required additional access. Access was directed to the middle calyx (n=2, superior calyx (n=4, middle and inferior calyx (n=1 through the supracostal (n=2 and subcostal (n=5 areas. Mean operative time was 131 (range 70-215 minutes minutes. Stone-free rate after single session PCNL was 71% (n=5 and increased to 86% (n=6 with a post-operative secondary ureterorenoscopy procedure. Complications including bleeding necessitating blood transfusion (Clavien grade 2 and prolonged drainage (Clavien degree 3a were occurred in only 2 patients (24%. Conclusion PCNL is a safe and successful procedure in patients with horseshoe kidney and comparable with PNL procedures in patients with normal renal anatomy
Contemporary trends in urinary tract stone surgery, a regional perspective: Auckland, New Zealand.
Acland, George; Zargar-Shoshtari, Kamran; Rice, Michael
2016-04-01
The aim of the study is to assess the contemporary patterns of utilization of various therapeutic options for the management of nephrolithiasis in our tertiary referral institution in Auckland, New Zealand. A retrospective audit was conducted for all urinary stone procedures between January 2007 and December 2013. Procedure-related information was collected for each year. All elective and emergency procedures were included. Data were collected on the elective waiting lists for each procedure. A total of 5512 stone-related cases were performed during the study period. Six hundred and fifty-three cases were performed in 2007 compared with 945 in 2013. Total number of percutaneous nephrolithotomy (PCNLs) performed, as well as the proportion of PCNL cases, demonstrated a significant decline from 84 (12.9%) in 2007 to 67 (7.1%) in 2013. While the annual numbers of extracorporeal shock wave lithotripsy (ESWLs) have increased, the percentage of ESWLs performed relative to total stone procedures has declined from 33% to 23% over the last 4 years of this audit. There has been a significant rise in the numbers of rigid and flexible ureteroscopies, with these now being the most utilized procedure. The number of patients awaiting elective procedures declined over the duration of this audit, with an associated improvement in meeting annual demand for treatment of nephrolithiasis from 78% in 2007 to 91% in 2013. A proportional decline in PCNL and ESWL utilization with a significant increase in flexible and rigid ureteroscopic procedures has been observed over this time and this pattern has been associated with improved adherence to surgical targets despite an increasing number of cases. © 2015 Royal Australasian College of Surgeons.
Directory of Open Access Journals (Sweden)
Ranjit Chaudhary
2017-01-01
Full Text Available A 55-year-old male presented, in June 2013, with left flank pain. Investigations revealed a complete staghorn stone. He had undergone two sittings of extracorporeal shock wave lithotripsy (ESWL in 2008 for left renal stone. One year subsequent to this, he was diagnosed with hypertension and diabetes. The management of complete staghorn stones in a single sitting is a difficult proposition. Percutaneous nephrolithotomy (PCNL is the gold standard to manage such stones. The patient was subjected to PCNL, and complete clearance was achieved in one sitting. On one-year follow-up, there was a significant reduction in blood pressure (BP and better glycemic control. Although there are several reports where hypertension has been reported after multiple sittings of ESWL, whether ESWL contributed to the genesis of hypertension and diabetes in this patient or it was simply incidental, cannot be stated with certainty. There was a significant reduction in the BP after complete stone removal, but there is uncertainty over the effect of total clearance of renal stones on hypertension, and we need to await the results of more controlled trials studying this phenomenon. A better glycemic control was perhaps achieved secondary to the eradication of recurrent urinary tract infections due to complete stone clearance.
[Non-biological 3D printed simulator for training in percutaneous nephro- lithotripsy].
Alyaev, Yu G; Sirota, E S; Bezrukov, E A; Ali, S Kh; Bukatov, M D; Letunovskiy, A V; Byadretdinov, I Sh
2018-03-01
To develop a non-biological 3D printed simulator for training and preoperative planning in percutaneous nephrolithotripsy (PCNL), which allows doctors to master and perform all stages of the operation under ultrasound and fluoroscopy guidance. The 3D model was constructed using multislice spiral computed tomography (MSCT) images of a patient with staghorn urolithiasis. The MSCT data were processed and used to print the model. The simulator consisted of two parts: a non-biological 3D printed soft model of a kidney with reproduced intra-renal vascular and collecting systems and a printed 3D model of a human body. Using this 3D printed simulator, PCNL was performed in the interventional radiology operating room under ultrasound and fluoroscopy guidance. The designed 3D printed model of the kidney completely reproduces the individual features of the intra-renal structures of the particular patient. During the training, all the main stages of PCNL were performed successfully: the puncture, dilation of the nephrostomy tract, endoscopic examination, intra-renal lithotripsy. Our proprietary 3D-printed simulator is a promising development in the field of endourologic training and preoperative planning in the treatment of complicated forms of urolithiasis.
Rapid prototyping model for percutaneous nephrolithotomy training.
Bruyère, Franck; Leroux, Cecile; Brunereau, Laurent; Lermusiaux, Patrick
2008-01-01
Rapid prototyping is a technique used for creating computer images in three dimensions more efficiently than classic techniques. Percutaneous nephrolithotomy (PCNL) is a popular method to remove kidney stones; however, broader use by the urologic community has been hampered by the morbidity associated with needle puncture to gain access to the renal calix (bleeding, pneumothorax, hydrothorax, inadvertent colon injury). A training model to improve technique and understanding of renal anatomy could improve complications related to renal puncture; however, no model currently exists for resident training. We created a training model using the rapid prototyping technique based on abdominal CT images of a patient scheduled to undergo PCNL. This allowed our staff and residents to train on the model before performing the operation. This model allowed anticipation of particular difficulties inherent to the patient's anatomy. After training, the procedure proceeded without complication, and the patient was discharged at postoperative day 1 without problems. We hypothesize that rapid prototyping could be useful for resident education, allowing the creation of numerous models for research and surgical training. In addition, we anticipate that experienced urologists could find this technique helpful in preparation for difficult PCNL operations.
Percutaneous nephrolithotomy for staghorn calculi: a single center's experience over 15 years.
Soucy, Frédéric; Ko, Raymond; Duvdevani, Mordechai; Nott, Linda; Denstedt, John D; Razvi, Hassan
2009-10-01
Percutaneous nephrolithotomy (PCNL) for staghorn calculi is one of the more challenging endourologic procedures. Although excellent stone-free rates are universally reported in the literature, complication rates vary widely, especially related to the need for blood transfusion. The purpose of this study was to evaluate the outcomes of PCNL for patients with staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Between July 1990 and December 2005, 1338 patients underwent PCNL for renal stone disease at our institution. Among this group, 509 procedures were performed for patients with a partial or complete staghorn calculus. Data analysis included procedure time, length of hospital stay, number of access tracts, transfusion rates, other early and late complications, and stone-free status. Mean patient age was 53.8 years (range 4-84 yrs). The average procedure time was 104 minutes. Sixteen percent of the cases needed multiple access tracts (range 2-5), with the lower calix being the most commonly used in 64.1%, followed by the upper calix in 18.5% and the middle calix in 17.4%. Various intracorporeal lithotriptors were used, including ultrasound, pneumatic, electrohydraulic, and holmium:yttrium-aluminium-garnet laser. The transfusion rate among this group was 0.8%. There was no statistically significant difference in transfusion rates (0.7%-1.2% P = 0.24) or other major complications in patients who were treated with either a single tract or among those needing multiple tracts. Stone-free rates at hospital discharge and at 3 months follow-up were 78% and 91%, respectively. PCNL is a safe and effective procedure in the management of staghorn calculi, with outcomes similar to those reported for percutaneous management of smaller volume nonstaghorn stones. Attention to accurate tract selection and placement as well as possession of the full array of endourologic equipment are essential to achieving an excellent outcome.
Ghazi, Ahmed; Campbell, Timothy; Melnyk, Rachel; Feng, Changyong; Andrusco, Alex; Stone, Jonathan; Erturk, Erdal
2017-12-01
The restriction of resident hours with an increasing focus on patient safety and a reduced caseload has impacted surgical training. A complex and complication prone procedure such as percutaneous nephrolithotomy (PCNL) with a steep learning curve may create an unsafe environment for hands-on resident training. In this study, we validate a high fidelity, inanimate PCNL model within a full-immersion simulation environment. Anatomically correct models of the human pelvicaliceal system, kidney, and relevant adjacent structures were created using polyvinyl alcohol hydrogels and three-dimensional-printed injection molds. All steps of a PCNL were simulated including percutaneous renal access, nephroscopy, and lithotripsy. Five experts (>100 caseload) and 10 novices (simulation. Face and content validity were calculated using model ratings for similarity to the real procedure and usefulness as a training tool. Differences in performance among groups with various levels of experience using clinically relevant procedural metrics were used to calculate construct validity. The model was determined to have an excellent face and content validity with an average score of 4.5/5.0 and 4.6/5.0, respectively. There were significant differences between novice and expert operative metrics including mean fluoroscopy time, the number of percutaneous access attempts, and number of times the needle was repositioned. Experts achieved better stone clearance with fewer procedural complications. We demonstrated the face, content, and construct validity of an inanimate, full task trainer for PCNL. Construct validity between experts and novices was demonstrated using incorporated procedural metrics, which permitted the accurate assessment of performance. While hands-on training under supervision remains an integral part of any residency, this full-immersion simulation provides a comprehensive tool for surgical skills development and evaluation before hands-on exposure.
Supine Percutaneous Nephrolithotripsy in Double-S Position.
Giusti, Giuseppe; De Lisa, Antonello
2018-01-01
At present, the percutaneous nephrolithotripsy (PCNL) is performed both in supine and in prone position. The aim of this paper is to describe an innovative position during PCNL. We describe a supine position. The patient's legs are slightly abducted at the hips. The thorax is laterally tilted (inclination 30°-35°) and kept in the right position by one or two gel pads placed between the scapula and the vertebrae. External genitalia can be accessed at any time, so that it is always possible to use flexible instruments in the upper urinary tract. We used this position for a period of 12 months to treat with PCNL 45 patients with renal lithiasis. All the procedures were successfully completed without complications, using the position we are describing. The following are some of its benefits: an easier positioning of the patient; a better exposure of the flank for an easier access to the posterior renal calyces of the kidney; a lower risk of pressure injuries compared to positions foreseeing the use of knee crutches; the possibility of combined procedures (ECIRS) through the use of flexible instruments; and a good fluoroscopic visualization of the kidney not overlapped by the vertebrae. This position is effective, safe, easy, and quick to prepare and allows for combined anterograde/retrograde operations.
Fang, You-Qiang; Wu, Jie-Ying; Li, Teng-Cheng; Zheng, Hao-Feng; Liang, Guan-Can; Chen, Yan-Xiong; Hong, Xiao-Bin; Cai, Wei-Zhong; Zang, Zhi-Jun; Di, Jin-Ming
2017-06-01
This study aimed to assess the role of pre-designed route on computer tomography urography (CTU) in the ultrasound-guided percutaneous nephrolithotomy (PCNL) for renal calculus.From August 2013 to May 2016, a total of 100 patients diagnosed with complex renal calculus in our hospital were randomly divided into CTU group and control group (without CTU assistance). CTU was used to design a rational route for puncturing in CTU group. Ultrasound was used in both groups to establish a working trace in the operation areas. Patients' perioperative parameters and postoperative complications were recorded.All operations were successfully performed, without transferring to open surgery. Time of channel establishment in CTU group (6.5 ± 4.3 minutes) was shorter than the control group (10.0 ± 6.7 minutes) (P = .002). In addition, there was shorter operation time, lower rates of blood transfusion, secondary operation, and less establishing channels. The incidence of postoperative complications including residual stones, sepsis, severe hemorrhage, and perirenal hematoma was lower in CTU group than in control group.Pre-designing puncture route on CTU images would improve the puncturing accuracy, lessen establishing channels as well as improve the security in the ultrasound-guided PCNL for complex renal calculus, but at the cost of increased radiation exposure.
Percutaneous nephrolithotomy; alarming variables for postoperative bleeding
Directory of Open Access Journals (Sweden)
Shakhawan H.A. Said
2017-03-01
Conclusion: According to our present results stone complexity (GSS grade 3 and 4, history of ipsilateral renal stone surgery, and occurrence of intraoperative pelvicalyceal perforation are alarming variables for post-PCNL bleeding.
Supine Percutaneous Nephrolithotripsy in Double-S Position
Directory of Open Access Journals (Sweden)
Giuseppe Giusti
2018-01-01
Full Text Available Background. At present, the percutaneous nephrolithotripsy (PCNL is performed both in supine and in prone position. The aim of this paper is to describe an innovative position during PCNL. Methods. We describe a supine position. The patient’s legs are slightly abducted at the hips. The thorax is laterally tilted (inclination 30°–35° and kept in the right position by one or two gel pads placed between the scapula and the vertebrae. External genitalia can be accessed at any time, so that it is always possible to use flexible instruments in the upper urinary tract. We used this position for a period of 12 months to treat with PCNL 45 patients with renal lithiasis. Results. All the procedures were successfully completed without complications, using the position we are describing. The following are some of its benefits: an easier positioning of the patient; a better exposure of the flank for an easier access to the posterior renal calyces of the kidney; a lower risk of pressure injuries compared to positions foreseeing the use of knee crutches; the possibility of combined procedures (ECIRS through the use of flexible instruments; and a good fluoroscopic visualization of the kidney not overlapped by the vertebrae. Conclusions. This position is effective, safe, easy, and quick to prepare and allows for combined anterograde/retrograde operations.
Aminsharifi, Alireza; Irani, Dariush; Pooyesh, Shima; Parvin, Hamid; Dehghani, Sakineh; Yousofi, Khalilolah; Fazel, Ebrahim; Zibaie, Fatemeh
2017-05-01
To construct, train, and apply an artificial neural network (ANN) system for prediction of different outcome variables of percutaneous nephrolithotomy (PCNL). We calculated predictive accuracy, sensitivity, and precision for each outcome variable. During the study period, all adult patients who underwent PCNL at our institute were enrolled in the study. Preoperative and postoperative variables were recorded, and stone-free status was assessed perioperatively with computed tomography scans. MATLAB software was used to design and train the network in a feed forward back-propagation error adjustment scheme. Preoperative and postoperative data from 200 patients (training set) were used to analyze the effect and relative relevance of preoperative values on postoperative parameters. The validated adequately trained ANN was used to predict postoperative outcomes in the subsequent 254 adult patients (test set) whose preoperative values were serially fed into the system. To evaluate system accuracy in predicting each postoperative variable, predicted values were compared with actual outcomes. Two hundred fifty-four patients (155 [61%] males) were considered the test set. Mean stone burden was 6702.86 ± 381.6 mm 3 . Overall stone-free rate was 76.4%. Fifty-four out of 254 patients (21.3%) required ancillary procedures (shockwave lithotripsy 5.9%, transureteral lithotripsy 10.6%, and repeat PCNL 4.7%). The accuracy and sensitivity of the system in predicting different postoperative variables ranged from 81.0% to 98.2%. As a complex nonlinear mathematical model, our ANN system is an interconnected data mining tool, which prospectively analyzes and "learns" the relationships between variables. The accuracy and sensitivity of the system for predicting the stone-free rate, the need for blood transfusion, and post-PCNL ancillary procedures ranged from 81.0% to 98.2%.The stone burden and the stone morphometry were among the most significant preoperative characteristics that
The Evaluation of Renal Parenchymal Scarring Using Static Renal ...
African Journals Online (AJOL)
2016-05-16
May 16, 2016 ... This is an open access article distributed under the terms of the Creative Commons. Attribution-Non ..... investigated long terms of PCNL in patients with chronic kidney disease. .... Time-dependent oxidative stress effects of.
Directory of Open Access Journals (Sweden)
Sujata K Patwardhan
2017-01-01
Conclusion: Although laparoscopic assisted PCNL is an option in the management of patients with stone disease in ectopic pelvic kidney, prolonged time for healing of tract may increase postoperative morbidity in these patients with impaired renal function.
Falahatkar, Siavash; Mokhtari, Gholamreza; Amin, Atiyeh; Kazemnezhad, Ehsan; Esmaeili, Samaneh; Herfeh, Nadia Rastjou; Falahatkar, Reza
2017-12-01
This study compared the stone opacity effect in patients who had radiopaque and radiolucent stones in percutaneous nephrolithotomy (PCNL) results. The medical records of 171 complete supine PCNL procedures were gathered. Patients were categorized into two groups: those with radiopaque (n=141) and those with radiolucent (n=30) stones. Kidney, ureter and bladder x-ray was done a day after PCNL and Ultrasound imaging was done two weeks later to evaluate the stone free rate. A stone free result was defined as having less than 4 mm residual stone size. Outcome parameters were compared by univariate analysis and those which were significantly different between the two groups were assessed by multivariate binary logistic regression analysis. There were no significant differences in age, sex, body mass index, hypertension, diabetes mellitus, pre-surgery hemoglobin, pre-surgery serum creatinine, stone and also surgery-related parameters between the two groups. Stone free rate, surgery time, complication-related parameters, hemoglobin drop, serum creatinine and glomerular filtration rate (GFR) changes were similar in both groups based on univariate analysis. The radiopaque group had higher post-surgery GFR (p=0.04) and longer hospital stay (p=0.009). However, opacity had no effect on these outcomes after multivariate analysis. Higher post-surgery GFR was seen in patient with higher GFR before surgery (p<0.0001). Also, higher hemoglobin before surgery was correlated with less hospital stay (p=0.001). The complete supine percutaneous nephrolithotomy outcomes are similar in patients with radiopaque and radiolucent stones.
Dehong, Cao; Liangren, Liu; Huawei, Liu; Qiang, Wei
2013-11-01
The purpose of this study was to evaluate the efficacy and safety of the Amplatz dilation (AD), metal telescopic dilation (MTD), balloon dilation (BD), and one-shot dilation (OSD) methods for tract dilation during percutaneous nephrolithotomy (PCNL). Relevant eligible studies were identified using three electronic databases (Medline, EMBASE, and Cochrane CENTRAL). Database acquisition and quality evaluation were independently performed by two reviewers. Efficacy (stone-free rate, surgical duration, and tract dilatation fluoroscopy time) and safety (transfusion rate and hemoglobin decrease) were evaluated using Review Manager 5.2. Four randomized controlled trials and eight clinical controlled trials involving 6,820 patients met the inclusion criteria. The pooled result from a meta-analysis showed statistically significant differences in tract dilatation fluoroscopy time and hemoglobin decrease between the OSD and MTD groups, which showed comparable stone-free and transfusion rates. Significant differences in transfusion rate were found between the BD and MTD groups. Among patients without previous open renal surgery, those who underwent BD exhibited a lower blood transfusion rate and a shorter surgical duration compared with those who underwent AD. The OSD technique is safer and more efficient than the MTD technique for tract dilation during PCNL, particularly in patients with previous open renal surgery, resulting in a shorter tract dilatation fluoroscopy time and a lesser decrease in hemoglobin. The efficacy and safety of BD are better than AD in patients without previous open renal surgery. The OSD technique should be considered for most patients who undergo PCNL therapy.
Knoll, Thomas; Buchholz, Noor; Wendt-Nordahl, Gunnar
2012-01-01
Objectives To review previous reports and discuss current trends in extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS). ESWL was recommended as the first-line treatment for small and intermediate-sized stones in the lower pole, while it is the standard treatment for large stones. However, the stone clearance rate after ESWL seems to be lower than that of stones in other locations. This seems to result from a lower rate of fragment passage, due to anatomical factors. Methods Reports on urinary stone disease were reviewed, assessing only publications in peer-reviewed, Medline-listed journals in the English language (publication years 1990–2011). Results Recent experience with flexible URS (fURS) for intrarenal stones showed that excellent stone-free rates can be achieved. With increasing experience and technically improved equipment, fURS has become an alternative to ESWL for small and intermediate-sized renal stones. Furthermore, several authors reported successful retrograde treatment for large renal stones, proposing fURS as an alternative to PCNL. However, the major drawbacks are long operating times and commonly, staged procedures, which is why PCNL remains the method of choice for such stones. Conclusions Considering the currents trends and evidence, the 2012 update of the European Association of Urology Guidelines on Urolithiasis has upgraded the endourological treatment of kidney stones. Individual factors such as body habitus, renal anatomy, costs and patient preference must be considered. PMID:26558046
New radionuclide method for determination of gastric content proteolytic activity. (Experiments)
International Nuclear Information System (INIS)
Sergienko, V.B.; Popova, L.V.; Khodarev, N.N.; Astashenkova, K.Yu.
1988-01-01
A possibility of the use of a radionuclide tubeless rapid method for measuring gastric content proteolytic activity (GCPA) with the help of a protein (gelatin) RP containing capsule was demonstrated in experiments in vitro. There was correlation between the time of dissolution of RP containing capsules and GCPA determined after Mett's method. Reference time intervals were established for normal, raised and lowered proteolytic activity. The method was shown to be physiological, simple and timesaving
Factors determining perioperative complications of percutaneous ...
African Journals Online (AJOL)
A. Ibrahim
2017-07-25
operative bleeding in .... On the day +1 KUB plain X-ray film and ultrasound were per- ... Two tailed P values less than 0.05 were considered .... PCNL is the current gold standard for management of large kid- .... for pneumonia.
Treatment options for active removal of renal stones
Warmerdam, G.J.J.; Laet, De K.; Wijn, R.P.W.F.; Wijn, P.F.F.
2012-01-01
This study provides an update on the technological aspects of the methods for active removal of renal stones. Currently, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are the available options. Findings are based upon recent literature from
Directory of Open Access Journals (Sweden)
M. F. Massulo-Aguiar
2006-08-01
Full Text Available We report a case of intrarenal pseudoaneurysm of the right kidney after percutaneous nephrolithotomy (PCNL in supine position. Diagnosis was established by angiotomography with a 3-D reconstruction. Treatment was successfully achieved by endovascular occlusion using N-butyl-2-cyanoacrylate.
Is percutaneous nephrolithotomy in solitary kidneys safe?
Wong, Kathie Alexina; Sahai, Arun; Patel, Amit; Thomas, Kay; Bultitude, Matthew; Glass, Jonathan
2013-11-01
To review our experience from a high volume stone center with a focus on efficacy, safety, and renal function. Stones requiring percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys can pose significant anxiety to the urologist. Limited data are available in published reports in this setting. A comprehensive retrospective review of medical records was performed on patients who underwent PCNL and had a solitary kidney or a single functioning renal unit. Data were collected on patient demographics, stone burden, outcomes, complications, and renal function. Of 378 PCNLs performed between January 2003 and September 2011, 22 were performed in 17 patients with a single functioning kidney. Three procedures were performed in a transplanted kidney. In those with solitary calculus, the longest mean length and stone surface area were 37 mm and 825 mm(2), respectively. Stone-free rate was 59%. Auxiliary procedures were required in 6 cases, resulting in a stone-free rate of 77%. Median inpatient stay was 4 days. Serum creatinine values improved from 144 to 126 umol/L before and after the procedure and mean estimated glomerular filtration rate improved similarly from 51 to 59 mls/minute, respectively. Blood transfusion was required in 1 patient, sepsis developed in 3, and 2 patients required a stent for obstruction. PCNL in solitary kidneys is safe with an acceptable complication rate if performed in a high volume center. Outcomes are good, although auxiliary procedures may be necessary. Renal function remains stable or improves after procedure. Copyright © 2013 Elsevier Inc. All rights reserved.
Percutaneous nephrolithotomy for 1-2 cm lower-pole renal calculi
Directory of Open Access Journals (Sweden)
Percy Jal Chibber
2008-01-01
Conclusions: PCNL is a highly effective procedure with consistently high stone-free rates when compared with extracorporeal shockwave lithotripsy or retrograde intrarenal surgery. The results also do not depend on anatomic factors and stone size. It is associated with low morbidity in experienced hands.
Qualità totale e mobilità totale Total Quality and Total Mobility
Directory of Open Access Journals (Sweden)
Giuseppe Trieste
2010-05-01
Full Text Available FIABA ONLUS (Italian Fund for Elimination of Architectural Barriers was founded in 2000 with the aim of promoting a culture of equal opportunities and, above all, it has as its main goal to involve public and private institutions to create a really accessible and usable environment for everyone. Total accessibility, Total usability and Total mobility are key indicators to define quality of life within cities. A supportive environment that is free of architectural, cultural and psychological barriers allows everyone to live with ease and universality. In fact, people who access to goods and services in the urban context can use to their advantage time and space, so they can do their activities and can maintain relationships that are deemed significant for their social life. The main aim of urban accessibility is to raise the comfort of space for citizens, eliminating all barriers that discriminate people, and prevent from an equality of opportunity. “FIABA FUND - City of ... for the removal of architectural barriers” is an idea of FIABA that has already affected many regions of Italy as Lazio, Lombardy, Campania, Abruzzi and Calabria. It is a National project which provides for opening a bank account in the cities of referring, in which for the first time, all together, individuals and private and public institutions can make a donation to fund initiatives for the removal of architectural barriers within its own territory for a real and effective total accessibility. Last February the fund was launched in Rome with the aim of achieving a Capital without barriers and a Town European model of accessibility and usability. Urban mobility is a prerequisite to access to goods and services, and to organize activities related to daily life. FIABA promotes the concept of sustainable mobility for all, supported by the European Commission’s White Paper. We need a cultural change in management and organization of public means, which might focus on
Single-centre comparison of a novel single-step balloon inflation ...
African Journals Online (AJOL)
Objective. A new second-generation balloon dilatation device for percutaneous nephrolithotomy (PCNL) has been launched, promising to challenge the traditional Amplatz serial dilators (ASDs). This device allows for the polyurethane sheath to be deployed on balloon inflation. Our primary objective in this pilot study was to ...
Urolithiasis in Nairobi, Kenya | Ngugi | East African Medical Journal
African Journals Online (AJOL)
patients had PCNL; 18 as the first procedure and 5 after failed ESWL. Fifty-one patients had ureteroscopic. Management: Fourty seven had laser or pneumatic lithotripsy while four had stone removal by Dormia basket. Seven patients had bladder calculi managed by either cystolitholapaxy or forceps retrieval. Conclusions: ...
Impact of stone density on outcomes in percutaneous nephrolithotomy (PCNL)
DEFF Research Database (Denmark)
Anastasiadis, Anastasios; Onal, Bulent; Modi, Pranjal
2013-01-01
were assigned to a low stone density [LSD, ≤ 1000 Hounsfield units (HU)] or high stone density (HSD, > 1000 HU) group based on the radiological density of the primary renal stone. Preoperative characteristics and outcomes were compared in the two groups. Results. Retreatment for residual stones...... was more frequent in the LSD group. The overall stone-free rate achieved was higher in the HSD group (79.3% vs 74.8%, p = 0.113). By univariate regression analysis, the probability of achieving a stone-free outcome peaked at approximately 1250 HU. Below or above this density resulted in lower treatment...
ORIGINAL PAPER ORIG ORIG Percutaneous stone removal
African Journals Online (AJOL)
Percutaneous nephrolithotomy (PCNL) is an effective procedure to treat patients with complex renal stones,. e.g. staghorn calculi and stones greater than 20 mm in diameter. The treatment of choice for small, less com- plex renal stones is extracorporeal shock-wave litho- tripsy (ESWL).1 We have treated renal stones mainly.
La nephrolithotomie sur rein unique: a propos de vingt cas ...
African Journals Online (AJOL)
Through a series of 20 patients, we study the feasibility and morbidity of this technique in a solitary kidney. Patients and methods: we retrospectively reviewed a series of twenty patients with a calculus in a solitary kidney during a 9-year period, all treated with (PCNL). The results were analyzed emphasizing complications ...
Directory of Open Access Journals (Sweden)
Adnan Siddiq
2017-12-01
Full Text Available Objective: Percutaneous nephrolithotomy (PCNL is most frequently performed procedure for renal stones 2 cm and larger. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive and safe drug like tranexamic acid (TA would ultimately turn out to be cornerstone for establishing future guidelines. Aim of this study is to evaluate whether TA is efficacious in preventing blood loss during PCNL. Materials and Methods: Ethical review board approval taken. Sample size calculation yielded 240 patients, comprising 120 in each group. Group A receiving TA and group B receiving placebo. Age, gender, body mass index (BMI, stone size, volume and location, preoperative blood count, creatinine, urine analysis, coagulation profile and necessary radiological investigations done. Randomization through lottery method. Both patient and investigator were blinded. Hemoglobin (Hb and hematocrit (Hct levels done at 24 hours postoperatively and fall in values recorded. Results: Both groups were equal in characteristics like age, gender, BMI, stone size, volume and location (p>0.05. Operative variables like calyx punctured, position of puncture and operative time were also found to be similar in both groups. Median change in Hb in placebo group was 1.6 interquartile range (IQR 4, while in TA group was 1.3 (IQR 7.8 (p=0.001. Similarly, median change in Hct level in placebo group was 3.6 (IQR 11.8 and in TA group was 2.4 (IQR 13 (p<0.001. Sixteen patients were transfused after surgery; 12 (75% belonged to placebo group while 4 (25% belonged to TA group (p=0.038. Hospital stay was not significantly different in both groups (p=0.177 with median of 4.0 and IQR of 0 in both groups. Conclusion: TA during PCNL reduces blood loss and minimizes blood transfusion rate.
The challenge of cystine and struvite stone formers: clinical, metabolic and surgical assessment
Yamaçake, Kleiton G. R.; Marchini, Giovanni S.; Reis, Sabrina; Danilovic, Alexandre; Vicentini, Fábio C.; Torricelli, Fábio C. M.; Srougi, Miguel; Mazzucchi, Eduardo
2016-01-01
ABSTRACT Purpose: To compare the clinical, metabolic, and calculi characteristics of cystine and struvite stone patients after percutaneous nephrolithotripsy (PCNL). Material and Methods: Between January/2006-July/2013, 11 cystine stone patients were treated in our clinic. Of those, 3 were excluded due to incomplete follow-up. Eight cystine stone patients (2 with bilateral disease; 10 renal units-RU) were considered for further analysis. A cohort of 8 struvite stone formers (10RU) was matched having the same age, gender, body mass index (BMI) and Guys stone score. Analyzed parameters comprised demographic data, serum/urinary metabolic evaluation and surgical outcomes. Results: Both groups had 6 female patients. Groups were similar in regards to age, gender, BMI, stone burden, and serum creatinine (p=NS). All patients had PCNL as the first surgical treatment modality. Stone free rate (SFR) after the first PCNL tended to be lower (0%) in the cystine compared to the struvite group (40%)(p=0.08). Final SFR after secondary procedures increased to 70% in cystine and 80% in struvite patients (p=1.0); mean number of procedures to achieve stone free status was higher in the first group (3.57 vs. 2.0;p=0.028). Hypocitraturia was found in all patients, but struvite cases presented with lower mean urinary citrate levels (p=0.016). Other common abnormalities were elevated urinary pH (cystine 75% and struvite 62.5%;p=1.0) and low urinary volume (62.5%,37.5%;p=0.63). Conclusion: Multiple interventions and suboptimal stone free rates are trait of the significant stone burden of struvite and cystine patients. Underlying metabolic abnormalities characterized by increased urinary pH, hypocitraturia and low urinary volume are often encountered in both populations. PMID:27622279
Kumar, Sumit; Sreenivas, Jayaram; Karthikeyan, Vilvapathy Senguttuvan; Mallya, Ashwin; Keshavamurthy, Ramaiah
2016-10-01
Scoring systems have been devised to predict outcomes of percutaneous nephrolithotomy (PCNL). CROES nephrolithometry nomogram (CNN) is the latest tool devised to predict stone-free rate (SFR). We aim to compare predictive accuracy of CNN against Guy stone score (GSS) for SFR and postoperative outcomes. Between January 2013 and December 2015, 313 patients undergoing PCNL were analyzed for predictive accuracy of GSS, CNN, and stone burden (SB) for SFR, complications, operation time (OT), and length of hospitalization (LOH). We further stratified patients into risk groups based on CNN and GSS. Mean ± standard deviation (SD) SB was 298.8 ± 235.75 mm 2 . SB, GSS, and CNN (area under curve [AUC]: 0.662, 0.660, 0.673) were found to be predictors of SFR. However, predictability for complications was not as good (AUC: SB 0.583, GSS 0.554, CNN 0.580). Single implicated calix (Adj. OR 3.644; p = 0.027), absence of staghorn calculus (Adj. OR 3.091; p = 0.044), single stone (Adj. OR 3.855; p = 0.002), and single puncture (Adj. OR 2.309; p = 0.048) significantly predicted SFR on multivariate analysis. Charlson comorbidity index (CCI; p = 0.020) and staghorn calculus (p = 0.002) were independent predictors for complications on linear regression. SB and GSS independently predicted OT on multivariate analysis. SB and complications significantly predicted LOH, while GSS and CNN did not predict LOH. CNN offered better risk stratification for residual stones than GSS. CNN and GSS have good preoperative predictive accuracy for SFR. Number of implicated calices may affect SFR, and CCI affects complications. Studies should incorporate these factors in scoring systems and assess if predictability of PCNL outcomes improves.
Danawala, Zeeshan A; Singh, Dinesh
2015-05-01
To investigate the perioperative complication rates for paraplegic-quadriplegic patients (PQPs) undergoing percutaneous nephrolithotomy (PCNL) as compared with non-PQPs using a standardized method of complication reporting via the Clavien system. Two hundred thirteen consecutive PCNLs performed by a single surgeon were analyzed. There were 31 and 115 patients separated into PQP and non-PQP groups, respectively. Data collection included demographic and clinical factors, as well as perioperative and delayed complications. Complications were organized by the Clavien grade. All- and initial-procedure complications were analyzed. The rate of adverse events for each Clavien grade was calculated, and statistical comparisons were made. The relationship between PQP and complication severity was investigated using univariate and multivariate analyses. There were 38 and 43 initial-procedure complications in the PQP and non-PQP groups, respectively. The rate of adverse events was higher across the spectrum of Clavien grades for the PQP group, specifically grade 1 (48.4% vs 20.2%; P = .002), grade 2 (22.6% vs 5.3%; P = .004), grade 3b (12.9% vs 2.6%; P = .038), grade 4a (6.5% vs 0%), and grade 4b (9.7% vs 1.8%; P = .066). Approximately 51.6% and 31.5% of PQPs and non-PQPs experienced ≥ 1 complications, respectively (odds ratio = 2.34; P = .05). Multivariate analysis demonstrated paraplegia or quadriplegia status to be an independent risk factor for the development of perioperative complications after adjusting for confounding factors (odds ratio = 2.91; P = .040). PCNL complication rates are higher in PQPs compared with non-PQPs. This study is one of the first in PCNL to use a standardized reporting system to highlight high-risk individuals within the stone population. Copyright © 2015 Elsevier Inc. All rights reserved.
Large renal calculus and ipsilateral flank (incisional) hernia ...
African Journals Online (AJOL)
A. Adam
2017-03-11
Mar 11, 2017 ... Abstract. Introduction: The use of the Mini PCNL has been gaining momentum since its first description in 2001. The range of indications for this particular procedure may also be expanding. We describe a case of a large renal calculus in a renal collecting system, found in a patient who underwent an ...
... page: //medlineplus.gov/ency/article/003483.htm Total protein To use the sharing features on this page, please enable JavaScript. The total protein test measures the total amount of two classes ...
Directory of Open Access Journals (Sweden)
Xiao Wang
2017-01-01
Full Text Available Nephrolithiasis accelerates the renal failure in the patients with ADPKD. In order to evaluate the role of percutaneous nephrolithotomy in management of calculus in these patients, 11 patients with autosomal dominant polycystic kidney disease and renal stones were included in the study. Two patients had bilateral renal stones. All patients were treated by percutaneous nephrolithotomy under ultrasound guidance. 13 percutaneous nephrolithotomy procedures were performed in 1 stage by the urology team under ultrasound guidance. 5 people received second operation with flexible nephroscopy in lateral position. The success rate and morbidity and mortality of the technique and hospital stay were recorded. Results. The puncture procedure was fully successful in all cases. The renal function improved in these patients. 5 patients had moderate fever after the surgery. 5 patients received flexible nephroscopy to take out the residual calculi. 2 persons had ESWL therapy after the surgery. Conclusion. PCNL is an ideal, safe, and effective method to remove the stones from those patients with no definite increase in the risk of complication. The outcome and stone-free rate are satisfactory comparable to the PCNL in the patients without ADPKD.
Low vs. high fidelity: the importance of 'realism' in the simulation of a stone treatment procedure.
Sarmah, Piyush; Voss, Jim; Ho, Adrian; Veneziano, Domenico; Somani, Bhaskar
2017-07-01
Simulation training for stone surgery is now increasingly used as part of training curricula worldwide. A combination of low and high fidelity simulators has been used with varying degrees of 'realism' provided by them. In this review, we discuss low and high fidelity simulators used for ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) stone procedures with their advantages, disadvantages and future direction for endourological simulation surgery. The final goal will be to understand whether or not 'realism' has to be considered as a critical element in simulation for this field. There is a wide range of simulators available for URS and PCNL training ranging from basic bench-type model to advanced virtual reality and cadaveric models, all providing various levels of realism. Although basic models might be more useful to novices, advanced models allow for complex and more realistic simulation training. With a wide variety of simulators now available and given the latest novelties in modular training curriculums, combination of low and high fidelity simulators that provide a realistic and cost-effective option seems to be the way forward. It is unavoidable that simulators will play an increasing role in endourological training.
Tel, G.
We define the notion of total algorithms for networks of processes. A total algorithm enforces that a "decision" is taken by a subset of the processes, and that participation of all processes is required to reach this decision. Total algorithms are an important building block in the design of
Current minimally invasive and endourological therapy in pediatric nephrolithiasis
Directory of Open Access Journals (Sweden)
N. Khater
2014-06-01
Conclusion: ESWL alone, for a large stone, or in a lower pole in uninephric children is not the standard of care. PCNL offer an appropriate and therapeutic modality in specific situation i.e. larger stones, the lower pole stones with stone free rate approaching 80%. Nevertheless, flexible ureteroscopy with the newest high definition cameras has a promising potential in reaching a 100% stone-free rate in the near future.
Triggers of blood transfusion in percutaneous nephrolithotomy
International Nuclear Information System (INIS)
Zehri, A.K.; Biyabani, S.R.; Siddiqui, K.M.; Memon, A.
2011-01-01
To determine the triggers of blood transfusion in patients undergoing percutaneous nephrolithotomy (PCNL). The percutaneous surgery database was retrospectively reviewed to identify patients with postoperative haemorrhage and need for blood transfusion. Blood loss was estimated by the postoperative drop in haemoglobin factored by the quantity of any blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss or blood transfusion requirement using stepwise univariate, forward multivariate regression analysis. A total of 326 procedures were performed in 316 patients. Two hundred and thirty two procedures were included in the study. There were 167 males and 65 females. The mean age was 41+14 years. The mean haemoglobin drop was 1.68 +1.3 gm/dL. The overall blood transfusion rate was 14.2%. Stepwise multivariate regression analysis showed that female gender (p = 0.003), staghorn stone (p = 0.023), stone fragmentation with ultrasound (p = 0.054) and chronic renal failure (p = 0.001) were significantly predictive of the need for blood transfusion. Chronic renal failure, female gender, presence of staghorn calculi and stone fragmentation using ultrasonic device were predictive of blood transfusion in this cohort of patients. (author)
Owens, Tom
2006-01-01
This article presents an interview with James Howe, author of "The Misfits" and "Totally Joe". In this interview, Howe discusses tolerance, diversity and the parallels between his own life and his literature. Howe's four books in addition to "The Misfits" and "Totally Joe" and his list of recommended books with lesbian, gay, bisexual, transgender,…
Comparison of Serum Concentrations of Total Cholesterol and Total ...
African Journals Online (AJOL)
Tuberculosis (TB) is one of the most dangerous tropical diseases that complicates HIV infection in Nigeria to date. Over two million Nigerians are known to be infected with TB and many more are at risk of the infection. Serum concentrations of total cholesterol and total lipid of 117 female TB patients attending chest clinic at ...
Total curvature and total torsion of knotted random polygons in confinement
Diao, Yuanan; Ernst, Claus; Rawdon, Eric J.; Ziegler, Uta
2018-04-01
Knots in nature are typically confined spatially. The confinement affects the possible configurations, which in turn affects the spectrum of possible knot types as well as the geometry of the configurations within each knot type. The goal of this paper is to determine how confinement, length, and knotting affect the total curvature and total torsion of random polygons. Previously published papers have investigated these effects in the unconstrained case. In particular, we analyze how the total curvature and total torsion are affected by (1) varying the length of polygons within a fixed confinement radius and (2) varying the confinement radius of polygons with a fixed length. We also compare the total curvature and total torsion of groups of knots with similar complexity (measured as crossing number). While some of our results fall in line with what has been observed in the studies of the unconfined random polygons, a few surprising results emerge from our study, showing some properties that are unique due to the effect of knotting in confinement.
Directory of Open Access Journals (Sweden)
Saurabh Sudhir Chipde
2014-01-01
Full Text Available Introduction: Large stones in renal pelvis can be treated with percutaneous nephrolithotomy (PCNL or pyelolithotomy (either by open or laparoscopic techniques. PCNL is difficult in undilated system. For pyelolithotomy, laparoscopy is more preferable over the open surgery. Surgeons are more familiar with the tansperitoneoscopic anatomy than retroperitoneoscopic one, but retroperitoneoscopic approach can be attempted if we anticipate the problems in the transperitoneal route. Case: A fifty years old gentleman presented to us with the complaint of dull aching right flank pain. On ultrasonographic examination, he was found to have a large stone in renal pelvis with minimal hydronephrosis and thickened omentum on right side. Xray KUB showed a large radio-opaque shadow in renal area. We did the CECT-Urogram of the patient to know the detailed anatomy, which showed a stone of 5.3 x 3.7 cm in right extra-rena pelvis without hydronephrosis and a large focal area of marked fat stranding in omentum on the right side in mid and lower abdomen with swirling of fat stranding on the superior aspect suggestive of omental infarction and torsion. Due to undilated caliceal system, we preferred laparoscopic surgery over the PCNL in this patient. As whole of the omental tissue was stuck on right side we decided to proceed with transperitoneoscopic route instead of retroperitoneoscopic one. The DJ stent was inserted preoperatively.The surgery was performed in the flank position with three ports, one 10mm port just antero-inferior to tip of 12th rib for camera and two 5mm working ports, one at anterior axillary line and other at renal angle. We created the retroperitoneal space with the customized balloon, made with the glove-fingure. Results: The operative time was 1 hour 40 minutes, and there were no intra or post-operative complications. The stone was removed in toto. Patient was orally allowed on first postoperative day and foleys was removed on second day. patient
Laparoscopic total pancreatectomy
Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing
2017-01-01
Abstract Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien–Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450–540 minutes), the mean estimated blood loss was 266 mL (range 100–400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8–24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy. PMID:28099344
Energy Technology Data Exchange (ETDEWEB)
Giraud, P.; Danhier, S.; Dubray, B.; Cosset, J.M. [Institut Curie, 75 - Paris (France)
1998-05-01
The choice of dose and fractionation for total body irradiation is made difficult by the large number of considerations to be taken into account. The outcome of bone marrow transplantation after total body irradiation can be understood in terms of tumor cell killing, engraftment, and normal tissue damage, each of these endpoints being influenced by irradiation-, disease-, transplant-, and patient- related factors. Interpretation of clinical data is further hampered by the overwhelming influence of logistic constraints, the small numbers of randomized studies, and the concomitant variations in total dose and fraction size or dose rate. So far, three cautious conclusions can be drawn in order to tentatively adapt the total body irradiation schedule to clinically-relevant situations. Firstly, the organs at risk for normal tissue damage (lung, liver, lens, kidney) are protected by delivering small doses per fraction at low dose rate. This suggests that, when toxicity is at stake (e.g. in children), fractionated irradiation should be preferred, provided that inter-fraction intervals are long enough. Secondly, fractionated irradiation should be avoided in case of T-cell depleted transplant, given the high risk of graft rejection in this setting. An alternative would be to increase total (or fractional) dose of fractionated total body irradiation, but this approach is likely to induce more normal tissue toxicity. Thirdly, clinical data have shown higher relapse rates in chronic myeloid leukemia after fractionated or low dose rate total body irradiation, suggesting that fractionated irradiation should not be recommended, unless total (or fractional) dose is increased. Total body irradiation-containing regimens, primarily cyclophosphamide / total body irradiation, are either equivalent to or better than the chemotherapy-only regimens, primarily busulfan / cyclophosphamide. Busulfan / cyclophosphamide certainly represents a reasonable alternative, especially in patients who
Sobredentadura total superior implantosoportada Superior total overdenture on implants
Directory of Open Access Journals (Sweden)
Luis Orlando Rodríguez García
2010-06-01
Full Text Available Se presenta un caso de un paciente desdentado total superior, rehabilitado en la consulta de implantología de la Clínica "Pedro Ortiz" del municipio Habana del Este en Ciudad de La Habana, Cuba, en el año 2009, mediante prótesis sobre implantes osteointegrados, técnica que se ha incorporado a la práctica estomatológica en Cuba como alternativa al tratamiento convencional en los pacientes desdentados totales. Se siguió un protocolo que comprendió una fase quirúrgica, procedimiento con o sin realización de colgajo y carga precoz o inmediata. Se presenta un paciente masculino de 56 años de edad, que acudió a la consulta multidisciplinaria, preocupado, porque se le habían elaborado tres prótesis en los últimos dos años y ninguna reunía los requisitos de retención que él necesitaba para sentirse seguro y cómodo con las mismas. El resultado final fue la satisfacción total del paciente, con el mejoramiento de la calidad estética y funcional.This is the case of a total maxilla edentulous patient seen in consultation of the "Pedro Ortíz" Clinic Implant of Habana del Este municipality in 2009 and con rehabilitation by prosthesis over osteointegration implants added to stomatology practice in Cuba as an alternative to conventional treatment in patients totally edentulous. We follow a protocol including a surgery or surgical phase, technique without or with flap creation and early or immediate load. This is a male patient aged 56 came to our multidisciplinary consultation worried because he had three prostheses in last two years and any fulfilled the requirements of retention to feel safe and comfortable with prostheses. The final result was the total satisfaction of rehabilitated patient improving its aesthetic and functional quality.
van Andel, Merel; Drent, Madeleine L; van Herwaarden, Antonius E; Ackermans, Mariëtte T; Heijboer, Annemieke C
2017-02-01
Total and high-molecular-weight (HMW) adiponectin have been associated with endocrine and cardiovascular pathology. As no gold standard is available, the discussion about biological relevance of isoforms is complicated. In our study we perform a method comparison between two commercially available assays measuring HMW and total adiponectin, in various patient groups, thus contributing further to this discussion. We determined levels of HMW and total adiponectin using assays by Lumipulse® and Millipore® respectively, in 126 patients with different clinical characteristics (n=29 healthy volunteers, n=22 dialysis patients, n=25 elderly with body mass index (BMI) LUMIPULSE ∗0.5-0.9=total adiponectin MILLIPORE , albeit with significant deviation from linearity (p<0.001). Pearson's correlation was R=0.987 (p=0.000). No significant differences between patient groups were observed (p=0.190). The HMW/total adiponectin ratio varies with total adiponectin concentration independent of clinical conditions studied. Our results imply that total and HMW adiponectin have similar utility when assessing adiponectin levels in blood, as the ratio is independent of clinical condition. Copyright © 2016 Elsevier B.V. All rights reserved.
... medlineplus.gov/ency/patientinstructions/000177.htm Total parenteral nutrition To use the sharing features on this page, please enable JavaScript. Total parenteral nutrition (TPN) is a method of feeding that bypasses ...
Changes in total and differential white cell counts, total lymphocyte ...
African Journals Online (AJOL)
Background: Published reports on the possible changes in the various immune cell populations, especially the total lymphocyte and CD4 cell counts, during the menstrual cycle in Nigerian female subjects are relatively scarce. Aim: To determine possible changes in the total and differential white blood cell [WBC] counts, ...
Energy Technology Data Exchange (ETDEWEB)
Patel, Uday [St George' s Hospital and Medical School, Department of Radiology, London (United Kingdom); Princess Grace Hospital, London (United Kingdom); Walkden, Richard Miles [St George' s Hospital and Medical School, Department of Radiology, London (United Kingdom); Ghani, Khurshid R. [St George' s Hospital and Medical School, Department of Urology, London (United Kingdom); Anson, Ken [St George' s Hospital and Medical School, Department of Urology, London (United Kingdom); Princess Grace Hospital, London (United Kingdom)
2009-05-15
Retrospective evaluation of computed tomographic (CT) pyelography before percutaneous nephrostolithotomy (PCNL). Twenty patients with renal calculi underwent CT pyelography using a dedicated protocol. Calculus size, uniformity of contrast excretion and accuracy of calculus and pelvicalyceal (PC) system reconstructions were scored and compared on axial and coronal maximum intensity projections (MIP) and volume reconstructions (VRmovie loops). After contrast medium administration, the size of calculi is accurate on axial images, but underestimated on coronal studies: mean 14.7 mm vs. 14.4 mm (axial) and 17.2 mm vs. 16.1 mm (coronal) for measurements before and after enhancement, respectively (p = 0.11 and 0.03). Uniform contrast medium excretion (median 228 HU; 95% CI 209-266 HU) was sufficiently lower than calculus density (median 845 HU; 95% CI 457-1,193 HU) for precise calculus and pelvicalyceal reconstructions in 87% and 85%, respectively. Coronal MIP scans were rated best for calculus depiction (mean score 2.68 vs. 2.50 and 2.41 for coronal, axial and VRs, respectively; p = 0.14) and VR studies best for PC anatomy (mean score 4.4 vs. 3.73 and 2.89 for VR, coronal and axial studies, respectively; p = <0.0001). Three-dimensional CT pyelography can accurately demonstrate calculus position and spatial relationships of the collecting system before PCNL. (orig.)
Percutaneous nephrolithotomy with and without retrograde pyelography: a randomized clinical trial
Directory of Open Access Journals (Sweden)
Ali Tabibi
2007-02-01
Full Text Available OBJECTIVE: Since the introduction of percutaneous nephrolithotomy (PCNL, many changes have been added regarding the entrance to pyelocalyceal system such as insertion of the needle pointed to an opaque stone as a guided landmark. We aim at comparing the outcomes of managing renal calculi with and without retrograde pyelography. MATERIALS AND METHODS: In a randomized clinical trial, 55 cases with opaque renal calculi candidates for PCNL with stone in one calyce, in the pelvis or both in one calyce and the pelvis simultaneously were included in a nine-month study. They were randomized into 2 groups, noncatheterized (n = 28 and catheterized (n = 27, called intervention and control groups, respectively. RESULTS: The 2 groups had similar distributions regarding gender, age, duration of operation, length of hospital stay, past history of any surgical procedures on kidney, and stone size. Outcome (residual stone based on aforementioned management was evaluated with plain X-ray on the morning following the operation. Postoperative hemoglobin decrease was significantly higher in controls than in the intervention group (p < 0.001 (with no clinical significance. No difference in outcome, postoperative fever, duration of surgery, duration of hospital stay and radiation exposure was observed between the 2 groups. CONCLUSION: Our findings showed no differences in major clinical outcomes between the 2 groups (with and without catheter insertion for retrograde pyelography.
International Nuclear Information System (INIS)
Patel, Uday; Walkden, Richard Miles; Ghani, Khurshid R.; Anson, Ken
2009-01-01
Retrospective evaluation of computed tomographic (CT) pyelography before percutaneous nephrostolithotomy (PCNL). Twenty patients with renal calculi underwent CT pyelography using a dedicated protocol. Calculus size, uniformity of contrast excretion and accuracy of calculus and pelvicalyceal (PC) system reconstructions were scored and compared on axial and coronal maximum intensity projections (MIP) and volume reconstructions (VRmovie loops). After contrast medium administration, the size of calculi is accurate on axial images, but underestimated on coronal studies: mean 14.7 mm vs. 14.4 mm (axial) and 17.2 mm vs. 16.1 mm (coronal) for measurements before and after enhancement, respectively (p = 0.11 and 0.03). Uniform contrast medium excretion (median 228 HU; 95% CI 209-266 HU) was sufficiently lower than calculus density (median 845 HU; 95% CI 457-1,193 HU) for precise calculus and pelvicalyceal reconstructions in 87% and 85%, respectively. Coronal MIP scans were rated best for calculus depiction (mean score 2.68 vs. 2.50 and 2.41 for coronal, axial and VRs, respectively; p = 0.14) and VR studies best for PC anatomy (mean score 4.4 vs. 3.73 and 2.89 for VR, coronal and axial studies, respectively; p = <0.0001). Three-dimensional CT pyelography can accurately demonstrate calculus position and spatial relationships of the collecting system before PCNL. (orig.)
International Nuclear Information System (INIS)
Sutherland, D.E.; Ferguson, R.M.; Simmons, R.L.; Kim, T.H.; Slavin, S.; Najarian, J.S.
1983-01-01
Total lymphoid irradiation by itself can produce sufficient immunosuppression to prolong the survival of a variety of organ allografts in experimental animals. The degree of prolongation is dose-dependent and is limited by the toxicity that occurs with higher doses. Total lymphoid irradiation is more effective before transplantation than after, but when used after transplantation can be combined with pharmacologic immunosuppression to achieve a positive effect. In some animal models, total lymphoid irradiation induces an environment in which fully allogeneic bone marrow will engraft and induce permanent chimerism in the recipients who are then tolerant to organ allografts from the donor strain. If total lymphoid irradiation is ever to have clinical applicability on a large scale, it would seem that it would have to be under circumstances in which tolerance can be induced. However, in some animal models graft-versus-host disease occurs following bone marrow transplantation, and methods to obviate its occurrence probably will be needed if this approach is to be applied clinically. In recent years, patient and graft survival rates in renal allograft recipients treated with conventional immunosuppression have improved considerably, and thus the impetus to utilize total lymphoid irradiation for its immunosuppressive effect alone is less compelling. The future of total lymphoid irradiation probably lies in devising protocols in which maintenance immunosuppression can be eliminated, or nearly eliminated, altogether. Such protocols are effective in rodents. Whether they can be applied to clinical transplantation remains to be seen
International Nuclear Information System (INIS)
AGUIAR, Pablo; RUIBAL, Álvaro; CORTÉS, Julia; PÉREZ-FENTES, Daniel; GARCÍA, Camilo; GARRIDO, Miguel
2016-01-01
The aim of this study was to develop a method for estimating DMSA SPECT renal function on each renal pole in order to evaluate the effect of percutaneous nephrolithotripsy by focusing the measurements on the region through which the percutaneous approach is performed. Twenty patients undergoing percutaneous nephrolithotripsy between November 2010 and June 2012 were included in this study. Both Planar and SPECT-DMSA studies were carried out before and after nephrolithotripsy. The effect of percutaneous nephrolithotripsy was evaluated by estimating the total renal function and the regional renal function of each renal pole. Despite PCNL has been previously reported as a minimally invasive technique, our results showed regional renal function decreases in the treated pole in most patients, affecting the total renal function in a few of them. A quantification method was used for estimating the SPECT DMSA renal function of the upper, inter polar and lower renal poles. Our results confirmed that total renal function was preserved after nephrolithotripsy. Nevertheless, the proposed method showed that the regional renal function of the treated pole decreased in most patients (15 of 20 patients), allowing us to find differences in patients who had not shown changes in the total renal function obtained from conventional quantification methods. In conclusion, a method for estimating the SPECT DMSA renal function focused on the treated pole enabled us to show for the first time that nephrolithotripsy can lead to a renal parenchymal damage restricted to the treated pole.
Image-guided total marrow and total lymphatic irradiation using helical tomotherapy
International Nuclear Information System (INIS)
Schultheiss, Timothy E.; Wong, Jeffrey; Liu, An; Olivera, Gustavo; Somlo, George
2007-01-01
Purpose: To develop a treatment technique to spare normal tissue and allow dose escalation in total body irradiation (TBI). We have developed intensity-modulated radiotherapy techniques for the total marrow irradiation (TMI), total lymphatic irradiation, or total bone marrow plus lymphatic irradiation using helical tomotherapy. Methods and Materials: For TBI, we typically use 12 Gy in 10 fractions delivered at an extended source-to-surface distance (SSD). Using helical tomotherapy, it is possible to deliver equally effective doses to the bone marrow and lymphatics while sparing normal organs to a significant degree. In the TMI patients, whole body skeletal bone, including the ribs and sternum, comprise the treatment target. In the total lymphatic irradiation, the target is expanded to include the spleen and major lymph node areas. Sanctuary sites for disease (brain and testes) are included when clinically indicated. Spared organs include the lungs, esophagus, parotid glands, eyes, oral cavity, liver, kidneys, stomach, small and large intestine, bladder, and ovaries. Results: With TBI, all normal organs received the TBI dose; with TMI, total lymphatic irradiation, and total bone marrow plus lymphatic irradiation, the visceral organs are spared. For the first 6 patients treated with TMI, the median dose to organs at risk averaged 51% lower than would be achieved with TBI. By putting greater weight on the avoidance of specific organs, greater sparing was possible. Conclusion: Sparing of normal tissues and dose escalation is possible using helical tomotherapy. Late effects such as radiation pneumonitis, veno-occlusive disease, cataracts, neurocognitive effects, and the development of second tumors should be diminished in severity and frequency according to the dose reduction realized for the organs at risk
International Nuclear Information System (INIS)
2005-02-01
This document presents the 2004 results of Total Group: consolidated account, special items, number of shares, market environment, adjustment for amortization of Sanofi-Aventis merger-related intangibles, 4. quarter 2004 results (operating and net incomes, cash flow), upstream (results, production, reserves, recent highlights), downstream (results, refinery throughput, recent highlights), chemicals (results, recent highlights), Total's full year 2004 results (operating and net income, cash flow), 2005 sensitivities, Total SA parent company accounts and proposed dividend, adoption of IFRS accounting, summary and outlook, main operating information by segment for the 4. quarter and full year 2004: upstream (combined liquids and gas production by region, liquids production by region, gas production by region), downstream (refined product sales by region, chemicals), Total financial statements: consolidated statement of income, consolidated balance sheet (assets, liabilities and shareholder's equity), consolidated statements of cash flows, business segments information. (J.S.)
Directory of Open Access Journals (Sweden)
K.S. Meitei
2013-12-01
Conclusion: ESWL remains the cornerstone of therapy for renal calculi less than 2 cm. Our study reveals that multiple sessions were required for solitary renal calculi, with higher rate of ancillary procedures. The success rate of ESWL for both non-staghorn and staghorn calculi with size above 2 cm is low, so other treatment modalities like PCNL should be considered as the first treatment option. However, with appropriate patient selection, significant improvements in stone-free rates may be achieved.
Energy Technology Data Exchange (ETDEWEB)
NONE
2005-02-01
This document presents the 2004 results of Total Group: consolidated account, special items, number of shares, market environment, adjustment for amortization of Sanofi-Aventis merger-related intangibles, 4. quarter 2004 results (operating and net incomes, cash flow), upstream (results, production, reserves, recent highlights), downstream (results, refinery throughput, recent highlights), chemicals (results, recent highlights), Total's full year 2004 results (operating and net income, cash flow), 2005 sensitivities, Total SA parent company accounts and proposed dividend, adoption of IFRS accounting, summary and outlook, main operating information by segment for the 4. quarter and full year 2004: upstream (combined liquids and gas production by region, liquids production by region, gas production by region), downstream (refined product sales by region, chemicals), Total financial statements: consolidated statement of income, consolidated balance sheet (assets, liabilities and shareholder's equity), consolidated statements of cash flows, business segments information. (J.S.)
International Nuclear Information System (INIS)
Carlos, P.
1985-06-01
The present discussion is limited to a presentation of the most recent total photonuclear absorption experiments performed with real photons at intermediate energy, and more precisely in the region of nucleon resonances. The main sources of real photons are briefly reviewed and the experimental procedures used for total photonuclear absorption cross section measurements. The main results obtained below 140 MeV photon energy as well as above 2 GeV are recalled. The experimental study of total photonuclear absorption in the nuclear resonance region (140 MeV< E<2 GeV) is still at its beginning and some results are presented
Antretter, H; Dumfarth, J; Höfer, D
2015-09-01
To date the CardioWest™ total artificial heart is the only clinically available implantable biventricular mechanical replacement for irreversible cardiac failure. This article presents the indications, contraindications, implantation procedere and postoperative treatment. In addition to a overview of the applications of the total artificial heart this article gives a brief presentation of the two patients treated in our department with the CardioWest™. The clinical course, postoperative rehabilitation, device-related complications and control mechanisms are presented. The total artificial heart is a reliable implant for treating critically ill patients with irreversible cardiogenic shock. A bridge to transplantation is feasible with excellent results.
Total body water and total body potassium in anorexia nervosa
Energy Technology Data Exchange (ETDEWEB)
Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.
1984-08-01
In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation.
Total body water and total body potassium in anorexia nervosa
International Nuclear Information System (INIS)
Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.
1984-01-01
In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation
Pressure Control In A Tyre Of Moving Vehicle
Gawande, Kshitij P.; Jawanjal, Vaishakh A.
2012-08-01
We always try to make everything perfect around us and there is major problem still remaining in our automobiles, a puncture in a tire while running. We have developed tubeless tires but thatís not a perfect solution, so there is a serious need of improvement in this area. In this paper the compressed air is used to maintain the pressure in the tire using pneumatic pipes. This is a very basic concept which uses compressor power to maintain the pressure of a tire, while running using pressure gauges and leak proof connection. This technique allows us to drive a punctured vehicle which increases safety, comfort & saves time. This paper suggests a new technique towards one more improvement in our automobile industry.
DEFF Research Database (Denmark)
Finbow, Arthur; Frendrup, Allan; Vestergaard, Preben D.
cardinality then G is a total well dominated graph. In this paper we study composition and decomposition of total well dominated trees. By a reversible process we prove that any total well dominated tree can both be reduced to and constructed from a family of three small trees....
Estonian total ozone climatology
Directory of Open Access Journals (Sweden)
K. Eerme
Full Text Available The climatological characteristics of total ozone over Estonia based on the Total Ozone Mapping Spectrometer (TOMS data are discussed. The mean annual cycle during 1979–2000 for the site at 58.3° N and 26.5° E is compiled. The available ground-level data interpolated before TOMS, have been used for trend detection. During the last two decades, the quasi-biennial oscillation (QBO corrected systematic decrease of total ozone from February–April was 3 ± 2.6% per decade. Before 1980, a spring decrease was not detectable. No decreasing trend was found in either the late autumn ozone minimum or in the summer total ozone. The QBO related signal in the spring total ozone has an amplitude of ± 20 DU and phase lag of 20 months. Between 1987–1992, the lagged covariance between the Singapore wind and the studied total ozone was weak. The spring (April–May and summer (June–August total ozone have the best correlation (coefficient 0.7 in the yearly cycle. The correlation between the May and August total ozone is higher than the one between the other summer months. Seasonal power spectra of the total ozone variance show preferred periods with an over 95% significance level. Since 1986, during the winter/spring, the contribution period of 32 days prevails instead of the earlier dominating 26 days. The spectral densities of the periods from 4 days to 2 weeks exhibit high interannual variability.
Key words. Atmospheric composition and structure (middle atmosphere – composition and chemistry; volcanic effects – Meteorology and atmospheric dynamics (climatology
Totally optimal decision rules
Amin, Talha
2017-11-22
Optimality of decision rules (patterns) can be measured in many ways. One of these is referred to as length. Length signifies the number of terms in a decision rule and is optimally minimized. Another, coverage represents the width of a rule’s applicability and generality. As such, it is desirable to maximize coverage. A totally optimal decision rule is a decision rule that has the minimum possible length and the maximum possible coverage. This paper presents a method for determining the presence of totally optimal decision rules for “complete” decision tables (representations of total functions in which different variables can have domains of differing values). Depending on the cardinalities of the domains, we can either guarantee for each tuple of values of the function that totally optimal rules exist for each row of the table (as in the case of total Boolean functions where the cardinalities are equal to 2) or, for each row, we can find a tuple of values of the function for which totally optimal rules do not exist for this row.
Totally optimal decision rules
Amin, Talha M.; Moshkov, Mikhail
2017-01-01
Optimality of decision rules (patterns) can be measured in many ways. One of these is referred to as length. Length signifies the number of terms in a decision rule and is optimally minimized. Another, coverage represents the width of a rule’s applicability and generality. As such, it is desirable to maximize coverage. A totally optimal decision rule is a decision rule that has the minimum possible length and the maximum possible coverage. This paper presents a method for determining the presence of totally optimal decision rules for “complete” decision tables (representations of total functions in which different variables can have domains of differing values). Depending on the cardinalities of the domains, we can either guarantee for each tuple of values of the function that totally optimal rules exist for each row of the table (as in the case of total Boolean functions where the cardinalities are equal to 2) or, for each row, we can find a tuple of values of the function for which totally optimal rules do not exist for this row.
1991-01-01
More than 750 NASA, government, contractor, and academic representatives attended the Seventh Annual NASA/Contractors Conference on Quality and Productivity. The panel presentations and Keynote speeches revolving around the theme of total quality leadership provided a solid base of understanding of the importance, benefits, and principles of total quality management (TQM). The presentations from the conference are summarized.
International Nuclear Information System (INIS)
Novack, D.H.; Kiley, J.P.
1987-01-01
The multitude of papers and conferences in recent years on the use of very large megavoltage radiation fields indicates an increased interest in total body, hemibody, and total nodal radiotherapy for various clinical situations. These include high dose total body irradiation (TBI) to destroy the bone marrow and leukemic cells and provide immunosuppression prior to a bone marrow transplant, high dose total lymphoid irradiation (TLI) prior to bone marrow transplantation in severe aplastic anemia, low dose TBI in the treatment of lymphocytic leukemias or lymphomas, and hemibody irradiation (HBI) in the treatment of advanced multiple myeloma. Although accurate provision of a specific dose and the desired degree of dose homogeneity are two of the physicist's major considerations for all radiotherapy techniques, these tasks are even more demanding for large field radiotherapy. Because most large field radiotherapy is done at an extended distance for complex patient geometries, basic dosimetry data measured at the standard distance (isocenter) must be verified or supplemented. This paper discusses some of the special dosimetric problems of large field radiotherapy, with specific examples given of the dosimetry of the TBI program for bone marrow transplant at the authors' hospital
Use of total body electrical conductivity (TOBEC) to determine total body water
International Nuclear Information System (INIS)
Cochran, W.; Wong, W.; Sheng, H.P.; Klein, P.; Klish, W.
1986-01-01
Total body electrical conductivity (TOBEC) has been introduced as a safe and rapid method to estimate body composition in infants and adults. Recently, a second generation instrument that operates in a scanning mode has been developed. A study was undertaken to calibrate this new instrument and to assess the feasibility of its use in estimating total body water. Six healthy adults, 3 males and 3 females, ranging in age from 25 to 57 years, and in weight from 43.3 to 104.7 kg were analyzed. Simultaneously, determinations of total body water were made by standard dilutional techniques using H 2 18 O. A baseline plasma sample was obtained and 60 mg 18 O/kg was given orally as H 2 18 O. Five hr later, a postdose plasma sample was obtained. The 18 O/ 16 O ratio in the plasma samples was determined as CO 2 by gas-isotope-ratio mass spectrometry and used to calculate the H 2 18 O volume of distribution. The total body water values ranged from 26.35 to 58.02 and represented 51 to 58% of body weight. There was good linear correlation between the total body water measurement and its phase average (TOBEC number) with a linear correlation coefficient of 0.998. The standard error of the estimate was 0.98. In addition to estimating fat and fat-free mass, the TOBEC method also estimates total body water with excellent correlation to physical dilutions methods
Percutaneous nephrolithotomy in very elderly patients (Age 75 and Over
Directory of Open Access Journals (Sweden)
Hüseyin Çelik
2015-12-01
Full Text Available Objective: Percutaneous nephrolithotomy (PNL is a minimally invasive method used safely in surgical treatment of kidney stones in the world. The first PNL surgery performed in our clinic in March 1998 and first PNL surgery was performed in June 2000 over the age of seventy which was bilaterally side. In our study, PNL operations performed for 75 years and older patients were examined. Methods: PNL operations were performed under the general anesthesia. After cystoscopy in the supine position, ureteral catheter was inserted accompanied by C-arm fluoroscopy. Afterwards, patients were taken prone position then we entered into the kidney with a metal needle with fluoroscopic on. We dilated the entrance with Amplatzer renal dilatators set until the 30 F. After the procedure, the nephrostomy catheter was placed in the renal sheath. 4 mm residual fragments after the PNL operation were accepted as clinically insignificant stone residues (CIRF. Results: 3003 PNL procedures were performed between dates March 1998 - December 2014 in total 16 years. 28 patients of total were 75 years and over. 29 PNL surgeries performed to these patients, including one bilateral PNL procedure. Mean age was 79.36 years (75-88. Twenty (74% of the patients were concluded stone free. 2 patients had tubeless PNL surgery. There was no another complication. Conclusion: PNL is a minimally invasive method has became advantageous according to open surgery because of higher safety, lower complication rates, shorter hospitalization stay, more patient comfort and higher stone free rates. PNL is a safe and effective method in the surgical treatment of urinary tract stone diseases.
DEFF Research Database (Denmark)
Chinapaw, Mai; Klakk, Heidi; Møller, Niels Christian
2018-01-01
BACKGROUND/OBJECTIVES: Examine the prospective relationship of total volume versus bouts of sedentary behaviour (SB) and moderate-to-vigorous physical activity (MVPA) with cardiometabolic risk in children. In addition, the moderating effects of weight status and MVPA were explored. SUBJECTS....../METHODS: Longitudinal study including 454 primary school children (mean age 10.3 years). Total volume and bouts (i.e. ≥10 min consecutive minutes) of MVPA and SB were assessed by accelerometry in Nov 2009/Jan 2010 (T1) and Aug/Oct 2010 (T2). Triglycerides, total cholesterol/HDL cholesterol ratio (TC:HDLC ratio......, with or without mutual adjustments between MVPA and SB. The moderating effects of weight status and MVPA (for SB only) were examined by adding interaction terms. RESULTS: Children engaged daily in about 60 min of total MVPA and 0-15 min/week in MVPA bouts. Mean total sedentary time was around 7 h/day with over 3...
Medalie, Laura
2014-01-01
Annual and daily concentrations and fluxes of total and dissolved phosphorus, total nitrogen, chloride, and total suspended solids were estimated for 18 monitored tributaries to Lake Champlain by using the Weighted Regressions on Time, Discharge, and Seasons regression model. Estimates were made for 21 or 23 years, depending on data availability, for the purpose of providing timely and accessible summary reports as stipulated in the 2010 update to the Lake Champlain “Opportunities for Action” management plan. Estimates of concentration and flux were provided for each tributary based on (1) observed daily discharges and (2) a flow-normalizing procedure, which removed the random fluctuations of climate-related variability. The flux bias statistic, an indicator of the ability of the Weighted Regressions on Time, Discharge, and Season regression models to provide accurate representations of flux, showed acceptable bias (less than ±10 percent) for 68 out of 72 models for total and dissolved phosphorus, total nitrogen, and chloride. Six out of 18 models for total suspended solids had moderate bias (between 10 and 30 percent), an expected result given the frequently nonlinear relation between total suspended solids and discharge. One model for total suspended solids with a very high bias was influenced by a single extreme value; however, removal of that value, although reducing the bias substantially, had little effect on annual fluxes.
Yu, Weimin; Rao, Ting; Li, Xing; Ruan, Yuan; Yuan, Run; Li, Chenglong; Li, Haoyong; Cheng, Fan
2017-03-01
The aim of the current trial was to evaluate the learning curve of access creation through solo ultrasonography (US)-guided percutaneous nephrolithotomy (PCNL), and clarify the technical details of the procedure. We evaluated the first 240 solo US-guided PCNLs performed by one surgeon at our institution. The data including the puncture procedure, access characteristics, access-related complications and stone-free rates were assessed in four sequential groups. The puncture duration and number of times decreased from a mean of 4.4 min and 2.1 times for the first 60 patients to 1.3 min and 1.2 times for the last 60 patients. There was a significant decrease from 3.7 min and 1.8 times for the 61th-120th patients to 1.5 min and 1.3 times for the 121th-180th patients. All of the access-related severe bleeding appeared in the first 120 patients, while perforations only occurred in the first 60 patients. The stone-free rates were 68.3, 83.3, 90.0, and 93.3% for the four sequential groups. The increase in experience lead to an improvement in the puncture duration and times, which accompany with better stone-free rates and lower complications. We propose that 60 operations are sufficient to gain competency, and a cutoff point of 120 operations will allow the surgeon to achieve excellence in the solo US-guided PCNL.
Genoptraening efter total knaealloplastik
DEFF Research Database (Denmark)
Holm, Bente; Kehlet, Henrik
2009-01-01
The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty rehabilitat......The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty...... rehabilitation. Since hospital stay duration has decreased considerably, the need for post-discharge physiotherapy may also have changed. Thus, the indication for and types of rehabilitation programmes need to be studied within the context of fast-track knee arthroplasty....
Genoptraening efter total knaealloplastik
DEFF Research Database (Denmark)
Holm, Bente; Kehlet, Henrik
2009-01-01
The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty rehabilitat......The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty...... rehabilitation. Since hospital stay duration has decreased considerably, the need for post-discharge physiotherapy may also have changed. Thus, the indication for and types of rehabilitation programmes need to be studied within the context of fast-track knee arthroplasty. Udgivelsesdato: 2009-Feb-23...
Technique of total thyroidectomy
International Nuclear Information System (INIS)
Rao, R.S.
1999-01-01
It is essential to define the various surgical procedures that are carried out for carcinoma of the thyroid gland. They are thyroid gland, subtotal lobectomy, total thyroidectomy and near total thyroidectomy
Mishra, Shashikant; Sharma, Rajan; Garg, Chandrapraksh; Kurien, Abraham; Sabnis, Ravindra; Desai, Mahesh
2011-09-01
• To evaluate the results of miniperc vis-à-vis standard PNL in the treatment of stones of 1-2 cm in size. Miniperc may represent a reasonable procedure in patients with nonbulky urolithiasis offering a similar outcome as standard percutaneous nephrolithotomy (PNL) with advantage of reduced morbidity. • 55 procedures including 27 miniperc and 28 standard PNL were performed for renal stones 1-2 cm in size. Pediatric patient, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity patients were excluded from the study. • The parameters studied were demography, operative time, postoperative analgesic requirement, hemoglobin drop, complications and stone clearance. • Mean tract size was 18.2 ± 2 F (15-20) and 26.8 ± 2 F (24-30), P value PNL, respectively. Holmium LASER and pneumatic lithotripter were the main energy sources used in miniperc and standard PNL, respectively. • Miniperc operative time was longer than that of standard PNL (45.2 ± 12.6 vs 31 ± 16.6 min, P= 0.0008 respectively). • Conversely, there was an advantage of miniperc over standard PNL in terms of a significantly reduced hemoglobin drop (0.8 ± 0.9 vs 1.3 ± 0.4 gram%, P= 0.01), analgesic requirement (55.4 ± 50 vs 70.2 ± 52 mg tramadol, P= 0.29) and hospital stay (3.2 ± 0.8 vs 4.8 ± 0.6 days, P ≤ 0.001), respectively. • Intra- operative conversion of the procedure into a tubeless PNL was significantly more in the miniperc group (P ≤ 0.001). The miniperc and standard PNL group had clearance rates of 96% and 100%, respectively at 1 month follow up. • This study demonstrated significant advantages of the miniperc procedure in terms of reduced bleeding leading to a tubeless procedure and reduced hospital stay. • The stone free rates and the complications were similar in either group. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.
Total parenteral nutrition - infants
... medlineplus.gov/ency/article/007239.htm Total parenteral nutrition - infants To use the sharing features on this page, please enable JavaScript. Total parenteral nutrition (TPN) is a method of feeding that bypasses ...
... page: //medlineplus.gov/ency/article/003489.htm Total iron binding capacity To use the sharing features on this page, please enable JavaScript. Total iron binding capacity (TIBC) is a blood test to ...
Littmann, Mark; Willcox, Ken
2008-01-01
A total eclipse of the Sun is the most awesome sight in the heavens. Totality: Eclipses of the Sun takes you to eclipses of the past, present, and future, and lets you see - and feel - why people travel to the ends of the Earth to observe them. - ;A total eclipse of the Sun is the most awesome sight in the heavens. Totality: Eclipses of the Sun takes you to eclipses of the past, present, and future, and lets you see - and feel - why people travel to the ends of the Earth to observe them. Totality: Eclipses of the Sun is the best guide and reference book on solar eclipses ever written. It explains: how to observe them; how to photograph and videotape them; why they occur; their history and mythology; and future eclipses - when and where to see them. Totality also tells the remarkable story of how eclipses shocked scientists, revealed the workings of the Sun, and made Einstein famous. And the book shares the experiences and advice of many veteran eclipse observers. Totality: Eclipses of the Sun is profusely ill...
Genoptraening efter total knaealloplastik
DEFF Research Database (Denmark)
Holm, Bente; Kehlet, Henrik
2009-01-01
The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty...
Total 2004 annual report; TOTAL 2004 rapport annuel
Energy Technology Data Exchange (ETDEWEB)
NONE
2004-07-01
This annual report of the Group Total brings information and economic data on the following topics, for the year 2004: the corporate governance, the corporate social responsibility, the shareholder notebook, the management report, the activities, the upstream (exploration and production) and downstream (refining and marketing) operating, chemicals and other matters. (A.L.B.)
Code development for eigenvalue total sensitivity analysis and total uncertainty analysis
International Nuclear Information System (INIS)
Wan, Chenghui; Cao, Liangzhi; Wu, Hongchun; Zu, Tiejun; Shen, Wei
2015-01-01
Highlights: • We develop a new code for total sensitivity and uncertainty analysis. • The implicit effects of cross sections can be considered. • The results of our code agree well with TSUNAMI-1D. • Detailed analysis for origins of implicit effects is performed. - Abstract: The uncertainties of multigroup cross sections notably impact eigenvalue of neutron-transport equation. We report on a total sensitivity analysis and total uncertainty analysis code named UNICORN that has been developed by applying the direct numerical perturbation method and statistical sampling method. In order to consider the contributions of various basic cross sections and the implicit effects which are indirect results of multigroup cross sections through resonance self-shielding calculation, an improved multigroup cross-section perturbation model is developed. The DRAGON 4.0 code, with application of WIMSD-4 format library, is used by UNICORN to carry out the resonance self-shielding and neutron-transport calculations. In addition, the bootstrap technique has been applied to the statistical sampling method in UNICORN to obtain much steadier and more reliable uncertainty results. The UNICORN code has been verified against TSUNAMI-1D by analyzing the case of TMI-1 pin-cell. The numerical results show that the total uncertainty of eigenvalue caused by cross sections can reach up to be about 0.72%. Therefore the contributions of the basic cross sections and their implicit effects are not negligible
Feasibility study of helical tomotherapy for total body or total marrow irradiation
International Nuclear Information System (INIS)
Hui, Susanta K.; Kapatoes, Jeff; Fowler, Jack; Henderson, Douglas; Olivera, Gustavo; Manon, Rafael R.; Gerbi, Bruce; Mackie, T. R.; Welsh, James S.
2005-01-01
Total body radiation (TBI) has been used for many years as a preconditioning agent before bone marrow transplantation. Many side effects still plague its use. We investigated the planning and delivery of total body irradiation (TBI) and selective total marrow irradiation (TMI) and a reduced radiation dose to sensitive structures using image-guided helical tomotherapy. To assess the feasibility of using helical tomotherapy (A) we studied variations in pitch, field width, and modulation factor on total body and total marrow helical tomotherapy treatments. We varied these parameters to provide a uniform dose along with a treatment times similar to conventional TBI (15-30 min). (B) We also investigated limited (head, chest, and pelvis) megavoltage CT (MVCT) scanning for the dimensional pretreatment setup verification rather than total body MVCT scanning to shorten the overall treatment time per treatment fraction. (C) We placed thermoluminescent detectors (TLDs) inside a Rando phantom to measure the dose at seven anatomical sites, including the lungs. A simulated TBI treatment showed homogeneous dose coverage (±10%) to the whole body. Doses to the sensitive organs were reduced by 35%-70% of the target dose. TLD measurements on Rando showed an accurate dose delivery (±7%) to the target and critical organs. In the TMI study, the dose was delivered conformally to the bone marrow only. The TBI and TMI treatment delivery time was reduced (by 50%) by increasing the field width from 2.5 to 5.0 cm in the inferior-superior direction. A limited MVCT reduced the target localization time 60% compared to whole body MVCT. MVCT image-guided helical tomotherapy offers a novel method to deliver a precise, homogeneous radiation dose to the whole body target while reducing the dose significantly to all critical organs. A judicious selection of pitch, modulation factor, and field size is required to produce a homogeneous dose distribution along with an acceptable treatment time. In
Total and inorganic arsenic in foods of the first Hong Kong total diet study.
Chung, Stephen Wai-cheung; Lam, Chi-ho; Chan, Benny Tsz-pun
2014-04-01
Arsenic (As) is a metalloid that occurs in different inorganic and organic forms, which are found in the environment from both natural occurrence and anthropogenic activity. The inorganic forms of As (iAs) are more toxic as compared with the organic As, but so far most of the occurrence data in food collected in the framework of official food control are still reported as total As without differentiating the various As species. In this paper, total As and iAs contents of 600 total diet study (TDS) samples, subdivided into 15 different food groups, were quantified by high-resolution inductively coupled plasma mass spectrometry (HR-ICP/MS) and hydride generation (HG) ICP/MS respectively. The method detection limits for both total As and iAs were 3 μg As kg(-1). As the samples were prepared for TDS, food items were purchased directly from the market or prepared as for normal consumption, i.e. table ready, in the manner most representative of and consistent with cultural habits in Hong Kong as far as practicable. The highest total As and iAs content were found in 'fish, seafood and their products' and 'vegetables and their products' respectively. Besides, this paper also presents the ratios of iAs and total As content in different ready-to-eat food items. The highest ratio of iAs to total As was found in 'vegetables and their products'. It is likely that iAs in vegetables maintained its status even after cooking.
Total phenolics and total flavonoids in selected Indian medicinal plants.
Sulaiman, C T; Balachandran, Indira
2012-05-01
Plant phenolics and flavonoids have a powerful biological activity, which outlines the necessity of their determination. The phenolics and flavonoids content of 20 medicinal plants were determined in the present investigation. The phenolic content was determined by using Folin-Ciocalteu assay. The total flavonoids were measured spectrophotometrically by using the aluminium chloride colorimetric assay. The results showed that the family Mimosaceae is the richest source of phenolics, (Acacia nilotica: 80.63 mg gallic acid equivalents, Acacia catechu 78.12 mg gallic acid equivalents, Albizia lebbeck 66.23 mg gallic acid equivalents). The highest total flavonoid content was revealed in Senna tora which belongs to the family Caesalpiniaceae. The present study also shows the ratio of flavonoids to the phenolics in each sample for their specificity.
Carl Schmitt's attitude towards total war and total enemy on the eve of the outbreak of WWII
Directory of Open Access Journals (Sweden)
Molnar Aleksandar
2010-01-01
Full Text Available Carl Schmitt is usually perceived as the theorist of total state, total war and total hostility. In the article, the author however tries to show that from 1937 to 1944, Schmitt was arguing that total war and total hostility were dangerous for Germany (as well as for the rest of Europe and warned against perpetuation of all efforts to totalize enemy that started in 1914. In his theoretical endeavors in this period there was place for the total state only - and especially for the total state strong enough to resist temptation of declaring total war on total enemy. The total state he recommended Hitler and his Nazi comrades was German Reich, as a part of Europe ordered and divided in the huge spaces (Grossraumordnung. Positioned in the centre of Europe, between the rest of the powers (France, Italy, USSR as well as the Scandinavian states, Germany should be careful enough to wage war only against its Eastern enemies (Poland and maybe USSR and only in order to achieve 'just' borders. Occupying in this way its huge space Germany should devote itself to the task of exploitation of various peoples such as Poles, Chechs and Slovaks, which were perceived as incapable of having their states and doomed to serve the master race - the Germans.
International Nuclear Information System (INIS)
Manupriya, B.R.; Shenoy, K. Bhasker; Patil, Shrikant L.; Somashekarappa, H.M.
2015-01-01
Wheat is a staple food grain in India after rice and occupies number one position in the world. The wheat crop not only gives food grains but also gives fodder for animals. Among many preservation methods irradiation is a current technique used to overcome infestation, contamination and spoilage of stored grains. The present study is aimed to check the changes in composition of irradiated wheat flour. Wheat flour was exposed to five different irradiation doses (0.25 KGy, 0.5KGy, 1KGy, 5KGy and 10 KGy) by using 60 Co gamma-irradiation chamber. Irradiated flour was stored in air sealed polyethylene pouch and plastic container at room temperature for different time intervals (0 th day, 1 month and 3 months). The stored flour was checked for total antioxidant activity by phosphomolybdate method and total carbohydrates concentration by phenol-sulphuric acid method. On 0 th day total antioxidant activity and total carbohydrate concentration was found to be increased at 0.5KGy (0.113 mg/ml and 0.045 mg/ml respectively) when compared to control (0.79 mg/ml and 39.5 mg/ml). Similarly for 1 month stored samples of air sealed polyethylene pouch total antioxidant activity and total carbohydrate concentration was observed to be increased at 0.5KGy (0.117 mg/ml and 0.045mg/ml respectively) when compared to control (0.096 mg/ml and 0.035 mg/ml). But in case of stored samples of plastic container total antioxidant activity increased at 0.25KGy (0.060 mg/ml) and total carbohydrate increased at 5KGy (0.051 mg/ml). Increased and decreased values were found in both factors for 3 months stored samples of air sealed polyethylene pouch and plastic container. Total antioxidant activity increased at 5KGy (0.072 mg/ml) for polyethylene bag samples and at 0.5KGy (0.137 mg/ml) for plastic container sample. Same way total carbohydrate concentration increased at 0.25KGy (0.046 mg/ml) and at 1KGy (0.045 mg/ml) respectively. This increase is due to affects of γ-irradiation on biomolecules by
Directory of Open Access Journals (Sweden)
Guohua Zeng
Full Text Available OBJECTIVE: As almost any version of percutaneous nephrolithotomy (PCNL was safely and efficiently applied for adults as well as children without age being a limiting risk factor, the aim of the study was to compare the different characteristics as well as the efficacy, outcome, and safety of the pediatric and adult patients who had undergone mini-PCNL (MPCNL in a single institution. METHODS: We retrospective reviewed 331 renal units in children and 8537 renal units in adults that had undergone MPCNL for upper urinary tract stones between the years of 2000-2012. The safety, efficacy, and outcome were analyzed and compared. RESULTS: The children had a smaller stone size (2.3 vs. 3.1 cm but had smilar stone distribution (number and locations. The children required fewer percutaneous accesses, smaller nephrostomy tract, shorter operative time and less hemoglobin drop. The children also had higher initial stone free rate (SFR (80.4% vs. 78.6% after single session of MPCNL (p0.05. Both groups had low rate of high grade Clavien complications. There was no grade III, IV, V complications and no angiographic embolization required in pediatric group. One important caveat, children who required multiple percutaneous nephrostomy tracts had significant higher transfusion rate than in adults (18.8% vs. 4.5%, p = 0.007. CONCLUSIONS: This contemporary largest-scale analysis confirms that the stone-free rate in pediatric patients is at least as good as in adults without an increase of complication rates. However, multiple percutaneous nephrostomy tracts should be practiced with caution in children.
Open surgical management of pediatric urolithiasis: A developing country perspective.
Rizvi, Syed A; Sultan, Sajid; Ijaz, Hussain; Mirza, Zafar N; Ahmed, Bashir; Saulat, Sherjeel; Umar, Sadaf Aba; Naqvi, Syed A
2010-10-01
To describe decision factors and outcome of open surgical procedures in the management of children with stone. Between January 2004 and December 2008, 3969 surgical procedures were performed in 3053 children with stone disease. Procedures employed included minimally invasive techniques shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS), perurethral cystolithotripsy (PUCL), percutaneous cystolithotripsy (PCCL), and open surgery. From sociomedical records demographics, clinical history, operative procedures, complications, and outcome were recorded for all patients. Of 3969 surgeries, 2794 (70%) were minimally invasive surgery (MIS) techniques to include SWL 19%, PCNL 16%, URS 18.9%, and PUCL+PCCL 16% and 1175 (30%) were open surgeries. The main factors necessitating open surgery were large stone burden 37%, anatomical abnormalities 16%, stones with renal failure 34%, gross hydronephrosis with thin cortex 58%, urinary tract infection (UTI) 25%, and failed MIS 18%. Nearly 50% of the surgeries were necessitated by economic constraints and long distance from center where one-time treatment was preferred by the patient. Stone-free rates by open surgeries were pyelolithotomy 91%, ureterolithotomy 100%, and cystolithotomy 100% with complication rate of upto 3%. In developing countries, large stone burden, neglected stones with renal failure, paucity of urological facilities, residence of poor patients away from tertiary centers necessitate open surgical procedures as the therapy of choice in about 1/3rd of the patients. Open surgery provides comparable success rates to MIS although the burden and nature of disease is more complex. The scope of open surgery will remain much wide for a large population for considered time in developing countries.
Use of the total motile sperm count to predict total fertilization failure in in vitro fertilization
Repping, Sjoerd; van Weert, Janne-Meije; Mol, Ben W. J.; de Vries, Jan W. A.; van der Veen, Fulco
2002-01-01
Objective: To evaluate the capacity of baseline characteristics and total motile sperm count (TMC) to predict total fertilization failure (TIFF) in patients undergoing IVF. Design: Retrospective cohort study. Setting: University hospital. Patient(s): Eight hundred ninety-two couples with a total of
Bachman, Daniel; Nyland, John; Krupp, Ryan
2016-02-18
To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness. This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated. The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100. Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement "gold standard" among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life.
Quantitation of esophageal transit and gastroesophageal reflux
International Nuclear Information System (INIS)
Malmud, L.S.; Fisher, R.S.
1986-01-01
Scintigraphic techniques are the only quantitative methods for the evaluation of esophageal transit and gastroesophageal reflux. By comparison, other techniques are not quantitative and are either indirect, inconvenient, or less sensitive. Methods, such as perfusion techniques, which measure flow, require the introduction of a tube assembly into the gastrointestinal tract with the possible introduction of artifacts into the measurements due to the indwelling tubes. Earlier authors using radionuclide markers, introduced a method for measuring gastric emptying which was both tubeless and quantitative in comparison to other techniques. More recently, a number of scintigraphic methods have been introduced for the quantitation of esophageal transit and clearance, the detection and quantitation of gastroesophageal reflux, the measurement of gastric emptying using a mixed solid-liquid meal, and the quantitation of enterogastric reflux. This chapter reviews current techniques for the evaluation of esophageal transit and gastroesophageal reflux
Directory of Open Access Journals (Sweden)
Saime Guzel
2014-12-01
Full Text Available In the present study we measured serum glucose, leptin, total cholesterol and total protein concentrations in repeat breeder cows and compared them with fertile cows. For this aim, 20 repeat breeder cows and 20 fertile cows were used as material. Repeat breeder cows were found to have lower levels of leptin and glucose as compared with fertile ones. No significant differences in total cholesterol and total protein levels were observed between the two groups. No significant correlation of leptin with glucose, total cholesterol and total protein was observed in fertile and repeat breeder cows. Low concentrations of glucose and leptin can have some effects on reproductive problems as repeat breeder and help to understand potential mechanisms impairing fertility in repeat breeder cows.
Sundowo, Andini; Artanti, Nina; Hanafi, M.; Minarti, Primahana, Gian
2017-11-01
C ledgeriana is a medicinal plant that contains alkaloids, especially on the barks for commercial production of quinine as antimalarial. The main alkaloids in this plant are cinchonine, cinchonidine, quinine and quinidine. Besides for antiamalarial this plant is also commonly used to treat whooping cough, influenza and dysentery. Compare to other medicinal plants, nowadays only very few studies were conducted in Cinchona species. Our current study aims to determine the content of phytochemical, total phenol and total flavonoids from C. ledgeriana leaves 70% ethanol extract. The extraction was performed by maceration method using 70% ethanol solvent and then fractionated into hexane, ethylacetate and butanol. Phytochemical screening was performed to determine the content of alkaloids, flavonoids, terpenoids, tannins and saponins. Total phenol and flavonoid contents of the extract were determined by Folin-Ciocalteu and alumunium chloride colorimetric methods using gallic acid and quercetin as standards. The antioxidant activity was determined by using 2, 2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity. The results of phytochemical screening showed that the 70% ethanol extract of C. ledgeriana leaves contained alkaloids, flavonoids, terpenoids, tannins and saponins. The total phenol and total flavonoids analysis showed that ethyl acetate fraction had the highest total phenol (40.23%) and total flavonoids (65.34%).
Total Petroleum Hydrocarbons (TPH): ToxFAQs
... a state: This map displays locations where Total Petroleum Hydrocarbons (TPH) is known to be present. On ... I get more information? ToxFAQs TM for Total Petroleum Hydrocarbons (TPH) ( Hidrocarburos Totales de Petróleo (TPH) ) August ...
International Nuclear Information System (INIS)
2003-01-01
This document presents the 2003 results of Total Group: consolidated account, special items, number of shares, market environment, 4. quarter 2003 results, full year 2003 results, upstream (key figures, proved reserves), downstream key figures, chemicals key figures, parent company accounts and proposed dividends, 2004 sensitivities, summary and outlook, operating information by segment for the 4. quarter and full year 2003: upstream (combined liquids and gas production by region, liquids production by region, gas production by region), downstream (refinery throughput by region, refined product sales by region, chemicals), impact of allocating contribution of Cepsa to net operating income by business segment: equity in income (loss) and affiliates and other items, Total financial statements: consolidated statement of income, consolidated balance sheet (assets, liabilities and shareholder's equity), consolidated statements of cash flows, business segments information. (J.S.)
Supravaginal eller total hysterektomi?
DEFF Research Database (Denmark)
Edvardsen, L; Madsen, E M
1994-01-01
There has been a decline in the rate of hysterectomies in Denmark in general over the last thirteen years, together with a rise in the number of supravaginal operations over the last two years. The literature concerning the relative merits of the supravaginal and the total abdominal operation is ...... indicate a reduced frequency of orgasm after the total hysterectomy compared with the supravaginal operation. When there are technical problems peroperatively with an increased urologic risk the supravaginal operation is recommended....
Christensen, Victoria G.; Kieta, Kristen A.
2014-01-01
This study examined conservation easements and their effectiveness at reducing phosphorus and solids transport to streams. The U.S. Geological Survey cooperated with the Minnesota Board of Water and Soil Resources and worked collaboratively with the Hawk Creek Watershed Project to examine the West Fork Beaver Creek Basin in Renville County, which has the largest number of Reinvest In Minnesota land retirement contracts in the State (as of 2013). Among all conservation easement programs, a total of 24,218 acres of agricultural land were retired throughout Renville County, and 2,718 acres were retired in the West Fork Beaver Creek Basin from 1987 through 2012. Total land retirement increased steadily from 1987 until 2000. In 2000, land retirement increased sharply because of the Minnesota River Conservation Reserve Enhancement Program, then leveled off when the program ended in 2002. Streamflow data were collected during 1999 through 2011, and total phosphorus and total suspended solids data were collected during 1999 through 2012. During this period, the highest peak streamflow of 1,320 cubic feet per second was in March 2010. Total phosphorus and total suspended solids are constituents that tend to increase with increases in streamflow. Annual flow-weighted mean total-phosphorus concentrations ranged from 0.140 to 0.759 milligrams per liter, and annual flow-weighted mean total suspended solids concentrations ranged from 21.3 to 217 milligrams per liter. Annual flow-weighted mean total phosphorus and total suspended solids concentrations decreased steadily during the first 4 years of water-quality sample collection. A downward trend in flow-weighted mean total-phosphorus concentrations was significant from 1999 through 2008; however, flow-weighted total-phosphorus concentrations increased substantially in 2009, and the total phosphorus trend was no longer significant. The high annual flow-weighted mean concentrations for total phosphorus and total suspended solids
International Nuclear Information System (INIS)
Li Yun; Gao Yueying; Yang Ming; Jin Liyun
1992-01-01
Gravimetric method for determination of total residue, total oxide and density of HLLW is developed. An aliquot of the original HLLW solution is piped on to the small quartz disc and put into the mini muffle furnace carefully. It is first heated to below 100 degree C (for 1.5 hours to remove the free water, and then heated to 180 degree C for 2 hours to remove the crystal water in a furnace. The total residue is weighed at room temperature. The precision is better than 3% for the determination of total residue and total oxide. An aliquot of the original HLLW solution is piped into the weighing bottle and weighed. The precision is better than 1%
Total versus subtotal hysterectomy
DEFF Research Database (Denmark)
Gimbel, Helga; Zobbe, Vibeke; Andersen, Anna Birthe
2005-01-01
The aim of this study was to compare total and subtotal abdominal hysterectomy for benign indications, with regard to urinary incontinence, postoperative complications, quality of life (SF-36), constipation, prolapse, satisfaction with sexual life, and pelvic pain at 1-year postoperative. Eighty...... women chose total and 105 women chose subtotal abdominal hysterectomy. No significant differences were found between the 2 operation methods in any of the outcome measures at 12 months. Fourteen women (15%) from the subtotal abdominal hysterectomy group experienced vaginal bleeding and three women had...
International Nuclear Information System (INIS)
Carlos, P.
1985-01-01
Experimental methods using real photon beams for measurements of total photonuclear absorption cross section σ(Tot : E/sub γ/) are recalled. Most recent σ(Tot : E/sub γ/)results for complex nuclei and in the nucleon resonance region are presented
Operational resource theory of total quantum coherence
Yang, Si-ren; Yu, Chang-shui
2018-01-01
Quantum coherence is an essential feature of quantum mechanics and is an important physical resource in quantum information. Recently, the resource theory of quantum coherence has been established parallel with that of entanglement. In the resource theory, a resource can be well defined if given three ingredients: the free states, the resource, the (restricted) free operations. In this paper, we study the resource theory of coherence in a different light, that is, we consider the total coherence defined by the basis-free coherence maximized among all potential basis. We define the distillable total coherence and the total coherence cost and in both the asymptotic regime and the single-copy regime show the reversible transformation between a state with certain total coherence and the state with the unit reference total coherence. Extensively, we demonstrate that the total coherence can also be completely converted to the total correlation with the equal amount by the free operations. We also provide the alternative understanding of the total coherence, respectively, based on the entanglement and the total correlation in a different way.
Total quality management in American industry.
Widtfeldt, A K; Widtfeldt, J R
1992-07-01
The definition of total quality management is conformance to customer requirements and specifications, fitness for use, buyer satisfaction, and value at an affordable price. The three individuals who have developed the total quality management concepts in the United States are W.E. Deming, J.M. Juran, and Philip Crosby. The universal principles of total quality management are (a) a customer focus, (b) management commitment, (c) training, (d) process capability and control, and (e) measurement through quality improvement tools. Results from the National Demonstration Project on Quality Improvement in Health Care showed the principles of total quality management could be applied to healthcare.
CSF total protein is a test to determine the amount of protein in your spinal fluid, also called cerebrospinal fluid (CSF). ... The normal protein range varies from lab to lab, but is typically about 15 to 60 milligrams per deciliter (mg/dL) ...
Day care PNL using 'Santosh-PGI hemostatic seal' versus standard PNL: A randomized controlled study.
Kumar, Santosh; Singh, Shivanshu; Singh, Prashant; Singh, Shrawan Kumar
2016-01-01
To compare the outcomes of tubeless day care PNL using hemostatic seal in the access tract versus standard PNL. It was a prospective randomized controlled study. Cases were randomized to either the day care group with hemostatic seal (DCS) or the control group where patients were admitted and a nephrostomy tube was placed at the conclusion of surgery. A total of 180 cases were screened and out of these, 113 were included in the final analysis. The stone clearance rates were comparable in both the groups. The mean drop in hemoglobin was significantly lower in DCS group than the control group (1.05 ±0.68 vs. 1.30 ±0.58 gm/dl, p = 0.038).Mean postoperative pain score, analgesic requirement (paracetamol) and duration of hospital stay were also significantly lower in the DCS group (3.79 ±1.23 vs. 6.12 ±0.96, 1.48 ±0.50 vs. 4.09 ±1.11 grams and 0.48 ±0.26 vs. 4.74 ±1.53 days respectively; p PNL with composite hemostatic tract seal is considered safe. It resulted in a significant reduction of blood loss and analgesic requirement with significantly reduced hospital stay, nephrostomy tube site morbidity and time required to resume normal activity when compared to the standard PNL. However, patients must be compliant with the given instructions and should have access to a health care facility, as few of them may need re-admission.
Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study.
ElSheemy, Mohammed S; Elmarakbi, Akram A; Hytham, Mohammed; Ibrahim, Hamdy; Khadgi, Sanjay; Al-Kandari, Ahmed M
2018-03-16
To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann-Whitney, Chi square or Fisher's exact tests as appropriate in addition to logistic regression analysis. P PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm 2 ; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm 2 ), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm 2 ), but not with single stones or stone burden ≤ 2 cm 2 .
38 CFR 8.18 - Total disability-speech.
2010-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Total disability-speech... SERVICE LIFE INSURANCE Premium Waivers and Total Disability § 8.18 Total disability—speech. The organic loss of speech shall be deemed to be total disability under National Service Life Insurance. [67 FR...
Mortality After Total Knee and Total Hip Arthroplasty in a Large Integrated Health Care System.
Inacio, Maria C S; Dillon, Mark T; Miric, Alex; Navarro, Ronald A; Paxton, Elizabeth W
2017-01-01
The number of excess deaths associated with elective total joint arthroplasty in the US is not well understood. To evaluate one-year postoperative mortality among patients with elective primary and revision arthroplasty procedures of the hip and knee. A retrospective analysis was conducted of hip and knee arthroplasties performed in 2010. Procedure type, procedure volume, patient age and sex, and mortality were obtained from an institutional total joint replacement registry. An integrated health care system population was the sampling frame for the study subjects and was the reference group for the study. Standardized 1-year mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated. A total of 10,163 primary total knee arthroplasties (TKAs), 4963 primary total hip arthroplasties (THAs), 606 revision TKAs, and 496 revision THAs were evaluated. Patients undergoing primary THA (SMR = 0.6, 95% CI = 0.4-0.7) and TKA (SMR = 0.4, 95% CI = 0.3-0.5) had lower odds of mortality than expected. Patients with revision TKA had higher-than-expected mortality odds (SMR = 1.8, 95% CI = 1.1-2.5), whereas patients with revision THA (SMR = 0.9, 95% CI = 0.4-1.5) did not have higher-than-expected odds of mortality. Understanding excess mortality after joint surgery allows clinicians to evaluate current practices and to determine whether certain groups are at higher-than-expected mortality risk after surgery.
Total Productive Maintenance at Paccar INC
Ştefan Farkas
2010-01-01
This paper reports the application of total productive maintenance method at Paccar Inc. truck’s plant in Victoria, Australia. The total productive maintenance method and total productive maintenance house are presented. The global equipment effectiveness is computed and exemplified. The production structure and organising maintenance are presented. Resultas of the variation of global equipment effectiveness and autonomous maintenance in a two weeks period of time are reported.
Mandzuk, Lynda L; McMillan, Diana E; Bohm, Eric R
2015-05-01
Primary total hip and primary total knee surgeries are commonly performed to improve patients' quality of life and functional status. This longitudinal retrospective study (N = 851) examined self-reported quality of life and functional status over the preoperative and postoperative periods: 12 months prior to surgery, one month prior to surgery and 12 months following surgery. A linear mixed effects model was used to analyze the changes in quality of life and functional status over the sampling period. Patients in the convenience sample reported improvements in quality of life and functional status utilizing the SF-12 and Oxford Hip and Oxford Knee, although differences were noted by procedure and gender. Total hip patients tended to demonstrate greater improvement than total knee patients and males reported higher levels of physical and mental quality of life as well as functional status when compared to females. Of particular note was that mental health scores were consistently lower in both total hip and total knee replacement patients across the perioperative period and up to one year postoperative. This study identifies an opportunity for health care providers to proactively address the mental health of total hip and total knee replacement patients throughout their joint replacement trajectory. Copyright © 2014 Elsevier Ltd. All rights reserved.
Total hip arthroplasty in Denmark
DEFF Research Database (Denmark)
Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren
2005-01-01
The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs.......The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs....
Congruences of totally geodesic surfaces
International Nuclear Information System (INIS)
Plebanski, J.F.; Rozga, K.
1989-01-01
A general theory of congruences of totally geodesic surfaces is presented. In particular their classification, based on the properties of induced affine connections, is provided. In the four-dimensional case canonical forms of the metric tensor admitting congruences of two-dimensional totally geodesic surfaces of rank one are given. Finally, congruences of two-dimensional extremal surfaces are studied. (author)
Cataract incidence after total-body irradiation
International Nuclear Information System (INIS)
Zierhut, D.; Lohr, F.; Schraube, P.; Huber, P.; Haas, R.; Hunstein, W.; Wannenmacher, M.
1997-01-01
Purpose: Aim of this retrospective study was to evaluate cataract incidence in a homogeneous group of patients after total-body irradiation followed by autologous bone marrow transplantation or peripheral blood stem cell transplantation. Method and Materials: Between 11/1982 and 6/1994 in total 260 patients received in our hospital total-body irradiation for treatment of haematological malignancy. In 1996-96 patients out of these 260 patients were still alive. 85 from these still living patients (52 men, 33 women) answered evaluable on a questionnaire and could be examined ophthalmologically. Median age of these patients was 38,5 years (15 - 59 years) at time of total-body irradiation. Radiotherapy was applied as hyperfractionated total-body irradiation with a median dose of 14,4 Gy in 12 fractions over 4 days. Minimum time between fractions was 4 hours, photons with a energy of 23 MeV were used, and the dose rate was 7 - 18 cGy/min. Results: Median follow-up is now 5,8 years (1,7 - 13 years). Cataract occurred in (28(85)) patients after a median time of 47 months (1 - 104 months). In 6 out of these 28 patients who developed a cataract, surgery of the cataract was performed. Whole-brain irradiation prior to total-body irradiation was more often in the group of patients developing a cataract (14,3%) vs. 10,7% in the group of patients without cataract. Conclusion: Cataract is a common side effect of total-body irradiation. Cataract incidence found in our patients is comparable to results of other centres using a fractionated regimen for total-body irradiation. The hyperfractionated regimen used in our hospital does obviously not result in a even lower cataract incidence. In contrast to acute and late toxicity in other organ/organsystems, hyperfractionation of total-body irradiation does not further reduce toxicity for the eye-lens. Dose rate may have more influence on cataract incidence
Directory of Open Access Journals (Sweden)
Anca ȘERBAN
2013-06-01
Full Text Available The purpose of this paper is to present the evolution of the Balanced Scorecard from a measurement instrument to a strategic performance management tool and to highlight the advantages of implementing the Total Performance Scorecard, especially for Human Resource Management. The study has been accomplished using the methodology of bibliographic study and various secondary sources. Implementing the classical Balanced Scorecard indicated over the years, repeatedly failure. It can be indicated that the crucial level is determined by the learning and growth perspective. It has been developed from a human perspective, which focused on staff satisfaction, innovation perspective with focus on future developments. Integrating the Total Performance Scorecard in an overall framework assures the company’s success, by keeping track of the individual goals, the company’s objectives and strategic directions. Like this, individual identity can be linked to corporate brand, individual aspirations to business goals and individual learning objectives to needed organizational capabilities.
Complete supine percutaneous nephrolithotomy with GoPro®. Ten steps for success.
Vicentini, Fabio Carvalho; Dos Santos, Hugo Daniel Barone; Batagello, Carlos Alfredo; Amundson, Julia Rothe; Oliveira, Evaristo Peixoto; Marchini, Giovanni Scala; Srougi, Miguel; Nahas, Willian Carlos; Mazzucchi, Eduardo
2018-03-15
To show a video of a complete supine Percutaneous Nephrolithotomy (csPCNL) performed for the treatment of a staghorn calculus, from the surgeon's point of view. The procedure was recorded with a GoPro® camera, demonstrating the ten essential steps for a successful procedure. The patient was a 38 years-old woman with 2.4cm of left kidney lower pole stone burden who presented with 3 months of lumbar pain and recurrent urinary tract infections. She had a previous diagnosis of polycystic kidney disease and chronic renal failure stage 2. CT scan showed two 1.2cm stones in the lower pole (Guy's Stone Score 2). She had a previous ipsilateral double J insertion due to an obstructive pyelonephritis. The csPCNL was uneventful with a single access in the lower pole. The surgeon had a Full HD GoPro Hero 4 Session® camera mounted on his head, controlled by the surgical team with a remote control. All of the mains steps were recorded. Informed consent was obtained prior to the procedure. The surgical time was 90 minutes. Hemoglobin drop was 0.5g/dL. A post-operative CT scan was stone-free. The patient was discharged 36 hours after surgery. The camera worked properly and didn't cause pain or muscle discomfort to the surgeon. The quality of the recorded movie was excellent. GoPro® camera proved to be a very interesting tool to document surgeries without interfering with the procedure and with great educational potential. More studies should be conducted to evaluate the role of this equipment. Copyright® by the International Brazilian Journal of Urology.
Open surgical management of pediatric urolithiasis: A developing country perspective
Directory of Open Access Journals (Sweden)
Syed A Rizvi
2010-01-01
Full Text Available Objectives : To describe decision factors and outcome of open surgical procedures in the management of children with stone. Materials and Methods : Between January 2004 and December 2008, 3969 surgical procedures were performed in 3053 children with stone disease. Procedures employed included minimally invasive techniques shockwave lithotripsy (SWL, percutaneous nephrolithotomy (PCNL, ureterorenoscopy (URS, perurethral cystolithotripsy (PUCL, percutaneous cystolithotripsy (PCCL, and open surgery. From sociomedical records demographics, clinical history, operative procedures, complications, and outcome were recorded for all patients. Results : Of 3969 surgeries, 2794 (70% were minimally invasive surgery (MIS techniques to include SWL 19%, PCNL 16%, URS 18.9%, and PUCL+PCCL 16% and 1175 (30% were open surgeries. The main factors necessitating open surgery were large stone burden 37%, anatomical abnormalities 16%, stones with renal failure 34%, gross hydronephrosis with thin cortex 58%, urinary tract infection (UTI 25%, and failed MIS 18%. Nearly 50% of the surgeries were necessitated by economic constraints and long distance from center where one-time treatment was preferred by the patient. Stone-free rates by open surgeries were pyelolithotomy 91%, ureterolithotomy 100%, and cystolithotomy 100% with complication rate of upto 3%. Conclusions : In developing countries, large stone burden, neglected stones with renal failure, paucity of urological facilities, residence of poor patients away from tertiary centers necessitate open surgical procedures as the therapy of choice in about 1/3rd of the patients. Open surgery provides comparable success rates to MIS although the burden and nature of disease is more complex. The scope of open surgery will remain much wide for a large population for considered time in developing countries.
Total Productive Maintenance at Paccar INC
Directory of Open Access Journals (Sweden)
Ştefan Farkas
2010-06-01
Full Text Available This paper reports the application of total productive maintenance method at Paccar Inc. truck’s plant in Victoria, Australia. The total productive maintenance method and total productive maintenance house are presented. The global equipment effectiveness is computed and exemplified. The production structure and organising maintenance are presented. Resultas of the variation of global equipment effectiveness and autonomous maintenance in a two weeks period of time are reported.
Directory of Open Access Journals (Sweden)
Anna Khumaira Sari
2017-10-01
Full Text Available The black rice contains anthocyanin compounds which are included in the flavonoids and phenolic compounds. Flavonoids contained in black rice are phenolic components that act as a preventive of hydroxyl and superoxide radicals by protecting membrane lipids against damaging oxidation reactions and phenol compounds also have bacteriocid, antimetic, antihelmintic, antiinflammatory, antimicrobial, anticancer and other degenerative diseases. The aim of this research were to measure total phenolic content and total flavonoid in ethanol extract of black rice (Oryza sativa L. Total phenol content were measured by Folin-Ciocalteu method with gallic acid mean while total flavonoid content were measured by colorimetry method using reagent AlCl3 10% and 5% acetic acid. There are seven variation samples of black rice obtained from seven different places in South Kalimantan. The result of this study, qualitative analysis showed that all samples positive contained flavonoids, alkaloids and tannins. The total phenol content of the seven samples was 100,58 ± 1,344; 91.14 ± 1.699; 96.50 ± 1.529; 77.64 ± 0.462; 81,16 ± 0,614; 112.47 ± 1.040; 81,50 ± 2,928 mgGAE/mg extract and the percent of total flavonoid content from seven samples was 8,53 ± 0,208%; 8.11 ± 0.343%; 7.69 ± 0.446%; 6.03 ± 0.227%; 4.97 ± 0.169%; 3.74 ± 0.210%; 5.02 ± 0.403%.
Sobredentadura total superior implantosoportada
Directory of Open Access Journals (Sweden)
Luis Orlando Rodríguez García
2010-06-01
Full Text Available Se presenta un caso de un paciente desdentado total superior, rehabilitado en la consulta de implantología de la Clínica "Pedro Ortiz" del municipio Habana del Este en Ciudad de La Habana, Cuba, en el año 2009, mediante prótesis sobre implantes osteointegrados, técnica que se ha incorporado a la práctica estomatológica en Cuba como alternativa al tratamiento convencional en los pacientes desdentados totales. Se siguió un protocolo que comprendió una fase quirúrgica, procedimiento con o sin realización de colgajo y carga precoz o inmediata. Se presenta un paciente masculino de 56 años de edad, que acudió a la consulta multidisciplinaria, preocupado, porque se le habían elaborado tres prótesis en los últimos dos años y ninguna reunía los requisitos de retención que él necesitaba para sentirse seguro y cómodo con las mismas. El resultado final fue la satisfacción total del paciente, con el mejoramiento de la calidad estética y funcional.
International Nuclear Information System (INIS)
Tattersall, Wade; Chiari, Luca; Machacek, J. R.; Anderson, Emma; Sullivan, James P.; White, Ron D.; Brunger, M. J.; Buckman, Stephen J.; Garcia, Gustavo; Blanco, Francisco
2014-01-01
Utilising a high-resolution, trap-based positron beam, we have measured both elastic and inelastic scattering of positrons from water vapour. The measurements comprise differential elastic, total elastic, and total inelastic (not including positronium formation) absolute cross sections. The energy range investigated is from 1 eV to 60 eV. Comparison with theory is made with both R-Matrix and distorted wave calculations, and with our own application of the Independent Atom Model for positron interactions
Total internal reflection effect on gyrotropic interface
Glushchenko, Alexander G.; Glushchenko, Eugene P.; Zhukov, Sergey V.
2018-02-01
This article considers the physical features of total internal reflection at gyrotropic and isotropic interfaces for two cases: electrical gyrotropy (plasma) and magnetic gyrotropy (ferrite). It is shown that the plasma magnetization may lead to the formation of the total internal reflection effect, which does not occur in isotropic plasma. The threshold values of the magnetic field, which are necessary for the total internal reflection effect, are determined. The total internal reflection effect on a ferrite-dielectric interface for waves emanating from different angles is observed in various frequency ranges and magnetization fields. The study points out the possibility of changing the total internal reflection angle value in large limits due to a change in the external magnetic field magnitude. The calculation results of the total internal reflection angle dependence on the external magnetic field magnitude are presented. The formulas are elaborated for calculating the total internal reflection angles of different interfaces for gyrotropic and isotropic media. The generalized formulas are defined for calculating the Doppler effect in the gyrotropic media. The study demonstrates how the velocity of the media interface affects the limiting angle of total internal refection.
MODIFIED TECHNIQUE OF TOTAL LARYNGECTOMY
Directory of Open Access Journals (Sweden)
Predrag Spirić
2010-12-01
Full Text Available Surgical technique of total laryngectomy is well presented in many surgical textbooks. Essentially, it has remained the same since Gluck an Soerensen in 1922 described all its details. Generally, it stresses the U shape skin incision with releasing laryngeal structures and removing larynx from up to down. Further, pharyngeal reconstruction is performed with different kinds of sutures in two or more layers and is finished with skin suture and suction drainage. One of worst complications following this surgery is pharyngocutaneous fistula (PF. Modifications proposed in this this article suggests vertical skin incision with larynx removal from below upwards. In pharyngeal reconstruction we used the running locked suture in submucosal plan with „tobacco sac“ at the end on the tongue base instead of traditional T shaped suture. Suction drains were not used.The aim of study was to present the modified surgical technique of total laryingectomy and its impact on hospital stay duration and pharyngocutanous fistula formation. In this randomized study we analyzed 49 patients operated with modified surgical technique compared to 49 patient operated with traditional surgical technique of total laryngectomy. The modified technique of total laryngectomy was presented. Using modified technique we managed to decrease the PF percentage from previous 20,41% to acceptable 8,16% (p=0,0334. Also, the average hospital stay was shortened from 14,96 to 10,63 days (t =-2.9850; p=0.0358.The modified technique of total laryngectomy is safe, short and efficient surgical intervention which decreases the number of pharyngocutaneos fistulas and shortens the hospital stay.
Defense meteorological satellite measurements of total ozone
International Nuclear Information System (INIS)
Lovill, J.E.; Ellis, J.S.; Luther, F.M.; Sullivan, R.J.; Weichel, R.L.
1992-01-01
A multichannel filter radiometer (MFR) on Defense Meteorological Satellites (DMS) that measured total ozone on a global-scale from March 1977 - February 1980 is described. The total ozone data measured by the MFR were compared with total ozone data taken by surfaced-based Dobson spectrophotometers. When comparisons were made for five months, the Dobson spectrophotometer measured 2-5% more total ozone than the MFR. Comparisons between the Dobson spectrophotometer and the MFR showed a reduced RMS difference as the comparisons were made at closer proximity. A Northern Hemisphere total ozone distribution obtained from MFR data is presented
Zijlstra, Wierd P; van den Akker-Scheek, Inge; Zee, Mark J M; van Raay, Jos J A M
2011-01-01
PURPOSE: We aimed to test the claim of greater range of motion (ROM) with large femoral head metal-on-metal total hip arthroplasty. METHODS: We compared 28-mm metal-on-polyethylene (MP) total hip arthroplasty with large femoral head metal-on-metal (MM) total hip arthroplasty in a randomised clinical
Chinese National Strategy of Total War
National Research Council Canada - National Science Library
Good, Michael J
2008-01-01
... concept of total warfare. This research seeks to determine if China is currently engaged in a total war with the United States across nontraditional forms of conflict including economic, political, information, financial...
Three assays were developed to enumerate total coliforms, Escherichia coli, and total Vibrionaceae in shellfish and other foods and in seawater and other environmental samples. Assays involve membrane overlays of overnight colonies on non-selective agar plates to detect ß-glucuronidase and lysyl am...
Directory of Open Access Journals (Sweden)
V. Wolff
2010-05-01
Full Text Available Total ammonium (tot-NH4+ and total nitrate (tot-NO3− provide chemically conservative quantities in the measurement of surface exchange of reactive nitrogen compounds ammonia (NH3, particulate ammonium (NH4+, nitric acid (HNO3, and particulate nitrate (NO3−, using the aerodynamic gradient method. Total fluxes were derived from concentration differences of total ammonium (NH3 and NH4+ and total nitrate (HNO3 and NO3− measured at two levels. Gaseous species and related particulate compounds were measured selectively, simultaneously and continuously above a spruce forest canopy in south-eastern Germany in summer 2007. Measurements were performed using a wet-chemical two-point gradient instrument, the GRAEGOR. Median concentrations of NH3, HNO3, NH4+, and NO3− were 0.57, 0.12, 0.76, and 0.48 μg m−3, respectively. Total ammonium and total nitrate fluxes showed large variations depending on meteorological conditions, with concentrations close to zero under humid and cool conditions and higher concentrations under dry conditions. Mean fluxes of total ammonium and total nitrate in September 2007 were directed towards the forest canopy and were −65.77 ng m−2 s−1 and −41.02 ng m−2 s−1 (in terms of nitrogen, respectively. Their deposition was controlled by aerodynamic resistances only, with very little influence of surface resistances. Including measurements of wet deposition and findings of former studies on occult deposition (fog water interception at the study site, the total N deposition in September 2007 was estimated to 5.86 kg ha−1.
Total pollution effect of urban surface runoff.
Luo, Hongbing; Luo, Lin; Huang, Gu; Liu, Ping; Li, Jingxian; Hu, Sheng; Wang, Fuxiang; Xu, Rui; Huang, Xiaoxue
2009-01-01
For pollution research with regard to urban surface runoff, most sampling strategies to date have focused on differences in land usage. With single land-use sampling, total surface runoff pollution effect cannot be evaluated unless every land usage spot is monitored. Through a new sampling strategy known as mixed stormwater sampling for a street community at discharge outlet adjacent to river, this study assessed the total urban surface runoff pollution effect caused by a variety of land uses and the pollutants washed off from the rain pipe system in the Futian River watershed in Shenzhen City of China. The water quality monitoring indices were COD (chemical oxygen demand), TSS (total suspend solid), TP (total phosphorus), TN (total nitrogen) and BOD (biochemical oxygen demand). The sums of total pollution loads discharged into the river for the four indices of COD, TSS, TN, and TP over all seven rainfall events were very different. The mathematical model for simulating total pollution loads was established from discharge outlet mixed stormwater sampling of total pollution loads on the basis of four parameters: rainfall intensity, total land area, impervious land area, and pervious land area. In order to treat surface runoff pollution, the values of MFF30 (mass first flush ratio) and FF30 (first 30% of runoff volume) can be considered as split-flow control criteria to obtain more effective and economical design of structural BMPs (best management practices) facilities.
Leadership and Total Quality Management
1992-04-15
leadership and management skills yields increased productivity. This paper will focus on the skills required of senior level leaders (leaders at the...publication until it has been cleared by the appropriate mii..-, service or government agency. Leadership and Total Quality Management An Individual Study...llty Codes fAvti1 and/or DltISpecial Abstract AUTHOR: Harry D. Gatanas, LTC, USA TITLE: Leadership and Total Quality Management FORMAT- Individual
Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size.
Knoll, Thomas; Jessen, Jan Peter; Honeck, Patrick; Wendt-Nordahl, Gunnar
2011-12-01
The value of flexible ureterorenoscopy (fURS) and miniaturized PNL (mPNL) for larger renal calculi is under discussion. This non-randomized prospective study aimed to evaluate fURS and mPNL for solitary renal stones of 10-30 mm size. fURS was carried out in 21 patients with last generation 7.5F endoscopes. Ureteral access sheaths were used in 19 patients. For mPNL, an 18F modified Amplatz sheath with a 14F nephroscope were used (n = 25). The procedure was performed either tubeless with an antegrade stent or a nephrostomy. Outcome and complications of both procedures were assessed. Patients' demographics and stone sizes were comparable (18 ± 5 vs. 19 ± 4 mm, P = 0.08). Patients in the fURS group had a higher mean BMI (31 vs. 27, P < 0.05). Total OR time was significantly longer for fURS (106 ± 51 vs. 59 ± 19 min., P < 0.001). More patients were stone-free after one single percutaneous treatment, while 2nd-stage treatments with fURS were common (total procedures 1.04 vs. 1.52, P < 0.001; immediate stone-free rate (SFR) 96% vs. 71.5%, P < 0.001). SFR after 4 weeks was 100% (mPNL) and 85.8% (fURS) (P < 0.01). Minor complications as classified by Clavien I or II occurred in 16 and 23.8%, mPNL and fURS, respectively, P = 0.13). No major complications (Clavien III-V) occured in both groups. Our series supports both the concept of either percutaneous or retrograde endoscopic treatment for renal calculi with both modalities offering excellent safety. However, while for fURS, a significantly higher rate of 2nd-stage procedures was necessary, and mPNL led to faster and higher SFR without increasing complication rate.
Transmandibular approach to total maxillectomy
Tiwari, R. M.
2001-01-01
Total Maxillectomy through transfacial approach has been practiced in the treatment of Cancer for more than a decade. Its role in T3 - T4 tumors extending posteriorly through gthe bony wall is questionable, since an oncological radical procedure is often not possible. Recurrences in the infratemporal fossa are common. Despite the addition of radiotherapy five year survivals have not significantly improved. Transmandibular approach to Total Maxillectomy overcomes this shortcoming by including ...
van Andel, Merel; Drent, Madeleine L; van Herwaarden, Antonius E; Ackermans, Mariëtte T; Heijboer, Annemieke C
BACKGROUND: Total and high-molecular-weight (HMW) adiponectin have been associated with endocrine and cardiovascular pathology. As no gold standard is available, the discussion about biological relevance of isoforms is complicated. In our study we perform a method comparison between two commercially
van Andel, Merel; Drent, Madeleine L.; van Herwaarden, Antonius E.; Ackermans, Mariëtte T.; Heijboer, Annemieke C.
2017-01-01
Background: Total and high-molecular-weight (HMW) adiponectin have been associated with endocrine and cardiovascular pathology. As no gold standard is available, the discussion about biological relevance of isoforms is complicated. In our study we perform a method comparison between two commercially
DEFF Research Database (Denmark)
Søndergaard, Morten
2008-01-01
digitale medier er registreringen og muligheden for at opbevare og håndtere digital data uden begrænsninger. Oplevelse, registrering og bevaring knyttes sammen i en ny museal virkelighed, hvor samlingens særlige dokumentariske karakter og fokus, som er unikt for Museet for Samtidskunst, er i centrum...... at mikse deres personlige drinks. TOTAL_AKTION viser Hørbar#3, som er en videreudvikling af den første version. METASYN af Carl Emil Carlsen: Metadata er centralt for Carl Emil Carlsens projekt, der betragter museets samling som et ”univers” af værker (analoge og digitale), beskrivelser og relationer. I...
TUW at the First Total Recall Track
2015-11-20
TUW AT THE FIRST TOTAL RECALL TRACK MIHAI LUPU Abstract. For the first participation in the TREC Total Recall track, we set out to try some basic...significantly and consistently outperformed it. 1. Introduction As the organizers point out, the focus of the Total Recall Track is to evaluate methods to...TUW AT THE FIRST TOTAL RECALL TRACK 3 The only change we made was at a higher level. The Sofia ML library provides 5 more ML algorithms. The following
Evaluation of total aboveground biomass and total merchantable biomass in Missouri
Michael E. Goerndt; David R. Larsen; Charles D. Keating
2014-01-01
In recent years, the state of Missouri has been converting to biomass weight rather than volume as the standard measurement of wood for buying and selling sawtimber. Therefore, there is a need to identify accurate and precise methods of estimating whole tree biomass and merchantable biomass of harvested trees as well as total standing biomass of live timber for...
TOTAL REWARDS MODEL IN ROMANIAN COMPANIES
Directory of Open Access Journals (Sweden)
Elena-Sabina HODOR
2014-04-01
Full Text Available Total Rewards Management is a subject of major importance for companies, because, by using models for this, firms can achieve their objectives of high performance. In order to analyse a validated total rewards model in Romanian Accounting and Consulting Companies, it is used The WorldatWork Total Rewards Model, which depict what contributes to applicant attraction and employee motivation and retention. Thus, the methodology of the previous survey is adjusted to the local context. The conclusions for the methodological aspects illustrate that the present research involves three strategic steps in order to achieve the objectives presented: the analysis of organizational environment of the companies from the sample, checking if Total Rewards Model proposed in the previous research is applicable for the same romanian companies from the previous survey, the analysing of the differences between results, and, if necessary, the adaptation of the model for Romania.
International Nuclear Information System (INIS)
Jiang Wenhua; Wan Jun; Liu Li; He Chao; Tang Hua; Tu Yu
2008-01-01
Objective: To get the message of natural radioactive level in the Dushu lake cam- pus of Suzhou university. Methods: Different types of water, soil and food in this region were collected, and then the level of total α and total β radioactivity of the sample was investigated applying model BH1216 equipment which measuring was used for low background total α and β radioactivity. Results: Total α in city water, surface water and soil were 0.061 Bq/L, 0.104 Bq/L, 1708 Bq/kg respectively, total β were 0.183 Bq/L, 0.319 Bq/L, 780 Bq/kg respectively, total α in chive, potato, water bamboo, pork, fish were 1.83, 2.36, 1.84, 3.40, 3.76 Bq/kg respectively, total α of Fish bone was at infra-monitoring lower limit, total β in them were 70.81, 96.71, 60.63, 86.20, 97.51, 73.94 Bq/kg respectively. Conclusion: The results of the investigation display that the total radioactivity in drinking water and food don't exceed limits, in surface water and soil is at normal natural background. It can be concluded that this region has not been polluted by the artificial radioactivity and the environment of human habitation is healthy and safe. (authors)
Directory of Open Access Journals (Sweden)
M. Casas
2007-05-01
Full Text Available Objetivo: comparar la eficacia de la instauración precoz de nutrición enteral total (NET frente a nutrición parenteral total (NPT en pacientes con pancreatitis aguda grave (PAG. Métodos: estudio prospectivo aleatorio. Se incluyeron consecutivamente 22 pacientes con PAG aplicando los criterios APACHE II, valores de PCR y graduación de Balthazar en la TC. El grupo I (n = 11 recibió NPT y el grupo II (n = 12 NET. Se valoró la respuesta inflamatoria (PCR, TNF-alfa, IL-6, las proteínas viscerales (pre-albúmina, albúmina, la tasa de complicaciones (síndrome de respuesta inflamatoria sistémica, fallo multiorgánico, infecciones, las intervenciones quirúrgicas, la estancia hospitalaria y la mortalidad. Resultados: no hubo diferencias significativas en los primeros 10 días entre los dos grupos en la evolución de los criterios APACHE II, en las concentraciones de PCR, TNF-alfa e IL-6 ni tampoco en los valores de pre-albúmina y albúmina. Siete pacientes del grupo I presentaron complicaciones graves frente a 4 del grupo II. Requirieron intervención quirúrgica 3 pacientes del grupo I. La estancia hospitalaria fue similar en los dos grupos. Dos pacientes del grupo I fallecieron. Conclusiones: se ha observado una tendencia a una mejor evolución de los pacientes con PAG que utilizaron NET frente a los que utilizaron NPT.Objective: to compare the efficacy of early total enteral nutrition (TEN vs. total parenteral nutrition (TPN in patients with severe acute pancreatitis (SAP. Methods: a total of 22 consecutive patients with SAP were randomized to receive TPN (group I or TEN (group II. SAP was defined applying APACHE II score, C-reactive protein (CRP measurements and/or Balthazar CT scan score. Acute inflammatory response (CRP, TNF-alpha, IL-6, visceral proteins (pre-albumin, albumin, complications (systemic inflammatory response syndrome, multiorgan failure, infections, surgical interventions, length of hospital stay and mortality were
Johnson, Sally C.; Boerschlein, David P.
1994-01-01
Semi-Markov models can be used to analyze the reliability of virtually any fault-tolerant system. However, the process of delineating all of the states and transitions in the model of a complex system can be devastatingly tedious and error-prone. Even with tools such as the Abstract Semi-Markov Specification Interface to the SURE Tool (ASSIST), the user must describe a system by specifying the rules governing the behavior of the system in order to generate the model. With the Table Oriented Translator to the ASSIST Language (TOTAL), the user can specify the components of a typical system and their attributes in the form of a table. The conditions that lead to system failure are also listed in a tabular form. The user can also abstractly specify dependencies with causes and effects. The level of information required is appropriate for system designers with little or no background in the details of reliability calculations. A menu-driven interface guides the user through the system description process, and the program updates the tables as new information is entered. The TOTAL program automatically generates an ASSIST input description to match the system description.
International Nuclear Information System (INIS)
Moreira, Silvana; Sobrinho, Gilmar A.; Jesus, Edgar F.O. de; Lopes, Ricardo T.
2002-01-01
In this work the total and available contents of Al, Si, Cl, K, Mn, Fe, Co, Ni, Cu, Zn, Sr, Zr, Ba, Ce and Pb in sediments from river Atibaia were determined by Synchrotron Radiation Total Reflection X-Ray Fluorescence technique. The detection limits for K series varies from 200 ng.mL -1 for Al to 2 ng.mL -1 for Zn while for L series the value varies from 20 ng.mL -1 for Ba to 10 ng.mL -1 for Pb. The samples were submitted to two different processes, in order to obtain the total and biological available metal contents. The information about metal content is a important parameter for a correct evaluation about the hydrologic cycle in Piracicaba basin. All the measure were carried out at the National Synchrotron Light Laboratory, Campinas, SP, Brazil, using a white beam for excitation. (author)
Design, Prototyping and Control of a Flexible Cystoscope for Biomedical Applications
Sozer, Canberk; Ghorbani, Morteza; Alcan, Gokhan; Uvet, Huseyin; Unel, Mustafa; Kosar, Ali
2017-07-01
Kidney stone and prostate hyperplasia are very common urogenital diseases all over the world. To treat these diseases, one of the ESWL (Extracorporeal Shock Wave Lithotripsy), PCNL (Percutaneous Nephrolithotomy), cystoscopes or open surgery techniques can be used. Cystoscopes named devices are used for in-vivo intervention. A flexible or rigid cystoscope device is inserted into human body and operates on interested area. In this study, a flexible cystoscope prototype has been developed. The prototype is able to bend up to ±40°in X and Y axes, has a hydrodynamic cavitation probe for rounding sharp edges of kidney stone or resection of the filled prostate with hydrodynamic cavitation method and contains a waterproof medical camera to give visual feedback to the operator. The operator steers the flexible end-effector via joystick toward target region. This paper presents design, manufacturing, control and experimental setup of the tendon driven flexible cystoscope prototype. The prototype is 10 mm in outer diameter, 70 mm in flexible part only and 120 mm in total length with flexible part and rigid tube. The experimental results show that the prototype bending mechanism, control system, manufactured prototype parts and experimental setup function properly. A small piece of real kidney stone was broken in targeted area.
Totally parallel multilevel algorithms
Frederickson, Paul O.
1988-01-01
Four totally parallel algorithms for the solution of a sparse linear system have common characteristics which become quite apparent when they are implemented on a highly parallel hypercube such as the CM2. These four algorithms are Parallel Superconvergent Multigrid (PSMG) of Frederickson and McBryan, Robust Multigrid (RMG) of Hackbusch, the FFT based Spectral Algorithm, and Parallel Cyclic Reduction. In fact, all four can be formulated as particular cases of the same totally parallel multilevel algorithm, which are referred to as TPMA. In certain cases the spectral radius of TPMA is zero, and it is recognized to be a direct algorithm. In many other cases the spectral radius, although not zero, is small enough that a single iteration per timestep keeps the local error within the required tolerance.
Timing the total reflection of light
International Nuclear Information System (INIS)
Chauvat, Dominique; Bonnet, Christophe; Dunseath, Kevin; Emile, Olivier; Le Floch, Albert
2005-01-01
We have identified for the first time the absolute delay at total reflection, envisioned by Newton. We show that there are in fact two divergent Wigner delays, depending on the polarisation of the incident light. These measurements give a new insight on the passage from total reflection to refraction
Sexuality after total vs. subtotal hysterectomy
DEFF Research Database (Denmark)
Zobbe, Vibeke Bahn; Gimbel, Helga Margrethe Elisabeth; Andersen, Birthe Margrethe
2004-01-01
The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies.......The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies....
Open Maximal Mucosa-Sparing Functional Total Laryngectomy
Directory of Open Access Journals (Sweden)
Pavel Dulguerov
2017-10-01
Full Text Available BackgroundTotal laryngectomy after (chemoradiotherapy is associated with a high incidence of fistula and therefore flaps are advocated. The description of a transoral robotic total laryngectomy prompted us to develop similar minimally invasive open approaches for functional total laryngectomy.MethodsA retrospective study of consecutive unselected patients with a dysfunctional larynx after (chemoradiation that underwent open maximal mucosal-sparing functional total laryngectomy (MMSTL between 2014 and 2016 is presented. The surgical technique is described, and the complications and functional outcome are reviewed.ResultsThe cohorts included 10 patients who underwent open MMSTL. No pedicled flap was used. Only one postoperative fistula was noted (10%. All patients resumed oral diet and experienced a functional tracheo-esophageal voice.ConclusionMMSTL could be used to perform functional total laryngectomy without a robot and with minimal incidence of complications.
Total neutron cross section of lead
International Nuclear Information System (INIS)
Kanda, K.; Aizawa, O.
1976-01-01
The total thermal-neutron cross section of natural lead under various physical conditions was measured by the transmission method. It became clear that the total cross section at room temperature previously reported is lower than the present data. The total cross section at 400, 500, and 600 0 C, above the melting point of lead, 327 0 C, was also measured, and the changes in the cross section as a function of temperature were examined, especially near and below the melting point. The data obtained for the randomly oriented polycrystalline state at room temperature were in reasonable agreement with the theoretical values calculated by the THRUSH and UNCLE-TOM codes
Creating the Total Quality Effective School.
Lezotte, Lawrence W.
This book shows how Deming's Total Quality Management (TQM) theory for organizational management can be integrated with the effective-schools literature. Part 1 compares the 14 principles of TQM with the tenets of effective-schools research. The second part develops a blueprint for creating the total quality effective school. The conceptual…
González Zamora, José Hipólito
2010-01-01
En primer lugar deseo dar la bienvenida esta reunión al ingeniero Francisco Gensini, director ejecutivo de INCOLDA, quien ha sido fuente constante de inspiración para el trabajo relacionado con Control Total de Calidad (C.T.C.) que se ha venido desarrollando en el ICESI. El ingeniero Gensini ha logrado aglutinar alrededor de INCOLDA al grupo de seis empresas de la región, líderes en el estudio y aplicación de los principios del Control Total de Calidad , es decir Rica Rondo S.A., Banco de Oc...
International Nuclear Information System (INIS)
Choy, J.H.
1979-06-01
A benchmark of the TOTAL data base management system as applied to the Mirror Fusion Test Facility (MFTF) data base was implemented and run in February and March of 1979. The benchmark was run on an Interdata 8/32 and involved the following tasks: (1) data base design, (2) data base generation, (3) data base load, and (4) develop and implement programs to simulate MFTF usage of the data base
International Nuclear Information System (INIS)
Rubio, B.; Gelletly, W.
2007-01-01
The problem of determining the distribution of beta decay strength (B(GT)) as a function of excitation energy in the daughter nucleus is discussed. Total Absorption Spectroscopy is shown to provide a way of determining the B(GT) precisely. A brief history of such measurements and a discussion of the advantages and disadvantages of this technique, is followed by examples of two recent studies using the technique. (authors)
Total synthesis of ciguatoxin.
Hamajima, Akinari; Isobe, Minoru
2009-01-01
Something fishy: Ciguatoxin (see structure) is one of the principal toxins involved in ciguatera poisoning and the target of a total synthesis involving the coupling of three segments. The key transformations in this synthesis feature acetylene-dicobalthexacarbonyl complexation.
Directory of Open Access Journals (Sweden)
Peter Winkler
2001-05-01
Full Text Available During the total eclipse of August 11, 1999 frequent showers occurred due to a unstable stratification of the air mass. At different observation sites, meteorological effects from the eclipse (99.4% coverage at Hohenpeißenberg and from showers were superimposed making it partly difficult to unambiguously interpret the observations. The weather radar at Hohenpeißenberg observatory provided a general overview of the distribution of clouds and precipitation in this area (200 km diameter. From the Garching site in the zone of totality (100% temperature and wind data taken on a 50 m mast were evaluated. By selecting periods with relatively low cloud cover it was possible to approximately follow the development of the vertical temperature and wind profiles during the eclipse. The minimum temperature at Hohenpeißenberg (about 450 m above the altitude of Garching during the eclipse was comparable to that during the previous night, the corresponding value measured at Garching remained about 2 K above the minimum observed during clear sky conditions in the previous night. Showers before, during or after the eclipse may have induced vertical exchange of air parcels. Temperatures during a shower change towards the same direction at all altitudes, thus no inversion forms. Additionally, air parcels with relatively lower concentrations of trace constituents were transported down from aloft for time periods of 1015 minutes. These mixing processes significantly determined the temporal variations of various trace substances measured during the eclipse. Total ozone measurements at Hohenpeißenberg were performed with both DOBSON and BREWER spectrophotometers and at another site within the zone of totality by using a portable Microtops II filter instrument. Different results were obtained for both sites. These differences can be to a large extend, but not exclusively, attributed to eclipse induced shifts (limb darkening and straylight effects in the atmosphere
Total-factor energy efficiency in developing countries
International Nuclear Information System (INIS)
Zhang Xingping; Cheng Xiaomei; Yuan Jiahai; Gao Xiaojun
2011-01-01
This paper uses a total-factor framework to investigate energy efficiency in 23 developing countries during the period of 1980-2005. We explore the total-factor energy efficiency and change trends by applying data envelopment analysis (DEA) window, which is capable of measuring efficiency in cross-sectional and time-varying data. The empirical results indicate that Botswana, Mexico and Panama perform the best in terms of energy efficiency, whereas Kenya, Sri Lanka, Syria and the Philippines perform the worst during the entire research period. Seven countries show little change in energy efficiency over time. Eleven countries experienced continuous decreases in energy efficiency. Among five countries witnessing continuous increase in total-factor energy efficiency, China experienced the most rapid rise. Practice in China indicates that effective energy policies play a crucial role in improving energy efficiency. Tobit regression analysis indicates that a U-shaped relationship exists between total-factor energy efficiency and income per capita. - Research Highlights: → To measure the total-factor energy efficiency using DEA window analysis. → Focus on an application area of developing countries in the period of 1980-2005. → A U-shaped relationship was found between total-factor energy efficiency and income.
Airway Complications of Total Artificial Heart.
Pathak, Vikas; Donovan, Colin; Malhotra, Rajiv
2017-02-01
The total artificial heart is the mechanical device which is used as a bridge to the heart transplant in patients with biventricular failure. Due to the mechanical nature of the device, patients receiving total artificial heart (TAH) require to be on anticoagulation therapy. Hemorrhage and coagulopathy are few of the known complications of TAH.
Total and the Algerian shale gas
International Nuclear Information System (INIS)
Chapelle, Sophie; Petitjean, Olivier; Maurin, Wilfried; Balvet, Jacqueline; Combes, Maxime; Geze, Francois; Hamouchene, Hamza; Hidouci, Ghazi; Malti, Hocine; Renaud, Juliette; Simon, Antoine; Titouche, Fateh
2015-01-01
This publication proposes a rather detailed and discussed overview of the movement of mobilisation of Algerian people (notably those living in the Sahara) against projects of exploration and exploitation of shale gases in Algeria by the Total group. The authors also recall and comment the long and heavy history of hydrocarbon management in Algeria, the role of international firms and of western interests (notably French interests) in this country, and the position of Total regarding the stake related to shale gases. The authors outline problems created by shale gas exploitation regarding water consumption and waste waters. They also notice that the safety of wells is at the centre of the protest. Problems raised by hydraulic fracturing are reviewed: seismic activity, chemical pollution, air pollution and greenhouse gases, landscape destruction. The attitude of the Algerian government is commented. Then, the authors try to identify and describe the action of Total in the Algerian shale gas sector, discuss the possible French influence, and outline the presence of Total all over the world in this sector
Mixed total screening for sulfur isotope
International Nuclear Information System (INIS)
Cui Bin; Zhao Lei; Zhan Zhaoyang; He Zhijun
2003-01-01
The research on modern economic geology indicates that most ore deposits formed with characters of multi-origin, multi-stage and multi-genesis. Quantificational research of Sulfur isotope origin is a difficult problem that puzzles Geochemists all along. So the formation process of an ore deposit can be taken as the mix or the superposition of multi totals, which can be described by the mathematics model of mixed total screening. In the study of mid-down Yangtze River and Dongpo ore field in Hunan province, the authors successfully applied the mathematics model of mixed total screening, quantificationally resolved the problem of Sulfur isotope origin and mineralizing matter origin, and found out the mineralizing mechanism. This is very valuable. (authors)
International Nuclear Information System (INIS)
Caldwell, J.T.; Cates, M.R.; Franks, L.A.; Kunz, W.E.
1985-01-01
Simultaneous photon and neutron interrogation of samples for the quantitative determination of total fissile nuclide and total fertile nuclide material present is made possible by the use of an electron accelerator. Prompt and delayed neutrons produced from resulting induced fissions are counted using a single detection system and allow the resolution of the contributions from each interrogating flux leading in turn to the quantitative determination sought. Detection limits for 239 Pu are estimated to be about 3 mg using prompt fission neutrons and about 6 mg using delayed delayed neutrons
Totally optimal decision trees for Boolean functions
Chikalov, Igor
2016-07-28
We study decision trees which are totally optimal relative to different sets of complexity parameters for Boolean functions. A totally optimal tree is an optimal tree relative to each parameter from the set simultaneously. We consider the parameters characterizing both time (in the worst- and average-case) and space complexity of decision trees, i.e., depth, total path length (average depth), and number of nodes. We have created tools based on extensions of dynamic programming to study totally optimal trees. These tools are applicable to both exact and approximate decision trees, and allow us to make multi-stage optimization of decision trees relative to different parameters and to count the number of optimal trees. Based on the experimental results we have formulated the following hypotheses (and subsequently proved): for almost all Boolean functions there exist totally optimal decision trees (i) relative to the depth and number of nodes, and (ii) relative to the depth and average depth.
A note on totally normal spaces
International Nuclear Information System (INIS)
Zougdani, H.K.
1990-10-01
In this note we give the necessary and sufficient condition for a topological space X such that the product space X x Y is totally normal for any (non discrete) metric space Y, and we show that a totally normal p-space need not be a perfectly normal in general, which makes Theorem 2 doubtful. (author). 6 refs
The total energy policy in Flanders
International Nuclear Information System (INIS)
Bouma, J.W.J.
1994-01-01
The policy of the Flemish region (Belgium) with regard to the total energy principle are presented. An overview of the main policy instruments to support energy saving and environmental-friendly investments as well as the development of new technologies is given. The total energy policy of the Flanders Region forms part of the general Flemish (energy) policy. (A.S.)
The Total Quality Movement in Education.
Leuenberger, John A.; Whitaker, Sheldon V., Jr.
The total quality movement began as a result of the desire of W. Edwards Deming, an American statistician, to permit the economic system to maintain its edge in a growing global market. The 14 points Deming listed as essential to "total quality management" have recently been adapted to the field of education. The success of the total…
Total Water Management - Report
There is a growing need for urban water managers to take a more holistic view of their water resource systems as population growth, urbanization, and current operations put different stresses on the environment and urban infrastructure. Total Water Management (TWM) is an approac...
Antibiotic impregnated total femur spacers: a technical tip
Directory of Open Access Journals (Sweden)
Colin D. Canham, MD
2018-03-01
Full Text Available Simultaneous prosthetic joint infection of ipsilateral hip and knee arthroplasties is often accompanied by significant bone loss and presents a challenging reconstructive problem. Two-stage reconstruction is favored and requires the placement of a total femur spacer, which is not a commercially available device. We describe a surgical technique, reporting on 2 cases in which a customized total femur antibiotic impregnated spacer was created by combining an articulating knee spacer and an articulating hip spacer with a reinforced cement dowel construct connecting the 2 spacers. Custom total femoral spacers are useful in the management of infected femoral megaprostheses and cases with ipsilateral injected hip and knee arthroplasties and severe femoral bone loss. Keywords: total femur spacer, revision arthroplasty, total hip arthroplasty, total knee arthroplasty, prosthetic joint infection
A strategic zone for Total's future
International Nuclear Information System (INIS)
Legros, E.J.
1997-01-01
In 1997, the Total company investments in the Middle East reached 1.2 billions of French Francs. This region is considered as a major growth zone by the French group. This paper summarizes the Total's participations in oil and gas activities and partnerships of Middle East countries (Abu Dhabi, Dubai, Oman, Qatar, Yemen): exploration, production, development, contracts, permits, technical assistance etc.. (J.S.)
Directory of Open Access Journals (Sweden)
Roberta Ariboni Brandi
2011-03-01
Full Text Available The objective of this study to evaluate various indicators to estimate the total nutrient digestibility in horses. We used four adult mares, breed, grouped in a 4 x 4 Latin square balanced fed diets containing equal parts of hay Tifton 85 (Cynodon sp and concentrated experimental containing corn subjected to four processes: a diet containing ground corn ; flaked corn diet 2, 3 rolled corn, and 4 extruded corn. The weighting coefficient of digestibility of nutrients by the indicators was done through the bias. The accuracy and precision were determined by comparing the predicted and observed data, and the robustness of the biases by comparing with other factors studied. The chromic oxide methods showed similar values of apparent digestibility of nutrients when compared to the total collection method. We observed higher accuracy for the acid detergent lignin as compared to the other indicators tested. However, the acid detergent lignin underestimated the digestibility of nutrients when compared to the total collection. The acid detergent insoluble ash overestimated the digestibility of nutrients when compared to the total collection. The chromic oxide is presented as a better indicator for estimating the total apparent digestibility in horses due to its higher accuracy among the markers evaluated.Objetivou-se neste estudo avaliar diferentes indicadores para estimativa das digestibilidades aparente total em equinos. Foram utilizadas quatro éguas adultas, sem raça definida, agrupadas em um quadrado latino 4 x 4 balanceado, alimentadas com dietas que continham partes iguais de feno da gramínea Tifton 85 (Cynodon sp e concentrado experimental que continha milho submetido a quatro processamentos: dieta um milho triturado; dieta dois milho floculado; dieta três milho laminado e dieta quatro milho extrusado. A ponderação dos coeficientes de digestibilidade dos nutrientes pelos indicadores foi efetuada por meio do viés. A acurácia e a precis
Pijls, Bart G; Dekkers, Olaf M; Middeldorp, Saskia; Valstar, Edward R; van der Heide, Huub J L; Van der Linden-Van der Zwaag, Henrica M J; Nelissen, Rob G H H
2011-07-22
In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.
Total pressing Indonesian gas development, exports
International Nuclear Information System (INIS)
Anon.
1994-01-01
Total is on track to become Indonesia's leading gas exporter by the turn of the century. Total's aggressive development of its Mahakam Delta acreage in East Kalimantan is intended to keep pace with growing liquefied natural gas demand, mainly from Japan but also increasingly from South Korea and Taiwan. A frantic scramble is under way among natural gas suppliers in the Pacific Rim region, particularly those with current LNG export facilities, to accommodate projections of soaring natural gas demand in the region. Accordingly, Total's Indonesian gas production goal is the centerpiece of a larger strategy to become a major player in the Far East Asia gas scene. Its goals also fall in line with Indonesia's. Facing flat or declining oil production while domestic oil demand continues to soar along with a rapidly growing economy, Indonesia is heeding some studies that project the country could become a net oil importer by the turn of the century. The paper describes Total's Far East strategy, the Mahakam acreage which it operates, the shift to gas development, added discoveries, future development, project spending levels, and LNG export capacity
The, Bertram; Verdonschot, Nico; van Horn, Jim R.; van Ooijen, Peter M. A.; Diercks, Ron L.
The objective of this randomized clinical trial was to compare the clinical and technical results of digital preoperative planning for primary total hip arthroplasties with analogue planning. Two hundred and ten total hip arthroplasties were randomized. All plans were constructed on standardized
Day care PNL using ‘Santosh-PGI hemostatic seal’ versus standard PNL: A randomized controlled study
Singh, Shivanshu; Singh, Prashant; Singh, Shrawan Kumar
2016-01-01
Introduction To compare the outcomes of tubeless day care PNL using hemostatic seal in the access tract versus standard PNL. Material and methods It was a prospective randomized controlled study. Cases were randomized to either the day care group with hemostatic seal (DCS) or the control group where patients were admitted and a nephrostomy tube was placed at the conclusion of surgery. Results A total of 180 cases were screened and out of these, 113 were included in the final analysis. The stone clearance rates were comparable in both the groups. The mean drop in hemoglobin was significantly lower in DCS group than the control group (1.05 ±0.68 vs. 1.30 ±0.58 gm/dl, p = 0.038).Mean postoperative pain score, analgesic requirement (paracetamol) and duration of hospital stay were also significantly lower in the DCS group (3.79 ±1.23 vs. 6.12 ±0.96, 1.48 ±0.50 vs. 4.09 ±1.11 grams and 0.48 ±0.26 vs. 4.74 ±1.53 days respectively; p PNL with composite hemostatic tract seal is considered safe. It resulted in a significant reduction of blood loss and analgesic requirement with significantly reduced hospital stay, nephrostomy tube site morbidity and time required to resume normal activity when compared to the standard PNL. However, patients must be compliant with the given instructions and should have access to a health care facility, as few of them may need re-admission. PMID:27551557
Global Landslide Total Economic Loss Risk Deciles
National Aeronautics and Space Administration — Global Landslide Total Economic Loss Risk Deciles is a 2.5 minute grid of global landslide total economic loss risks. A process of spatially allocating Gross...
Global Drought Total Economic Loss Risk Deciles
National Aeronautics and Space Administration — Global Drought Total Economic Loss Risk Deciles is a 2.5 minute grid of global drought total economic loss risks. A process of spatially allocating Gross Domestic...
Herken, Emine Nur; Kocamaz, Erdogan; Erel, Ozcan; Celik, Hakim; Kucukatay, Vural
2009-08-01
Sulfites, which are commonly used as preservatives, are continuously formed in the body during the metabolism of sulfur-containing amino acids. Sulfite oxidase (SOX) is an essential enzyme in the pathway of the oxidative degradation of sulfite to sulfate protecting cells from sulfite toxicity. This article investigated the effect of sulfite on total antioxidant capacity (TAC), total oxidant status, lipid hydroperoxide (LOOH), and total free sulfydryl groups (-SH) levels in normal and SOX-deficient male albino rat plasma. For this purpose, rats were divided into four groups: control, sulfite-treated, SOX-deficient, and sulfite-treated SOX-deficient groups. SOX deficiency was established by feeding rats a low molybdenum diet and adding to their drinking water 200 ppm tungsten. Sulfite (70 mg/kg) was administered to the animals via their drinking water. SOX deficiency together with sulfite treatment caused a significant increase in the plasma LOOH and total oxidant status levels. -SH content of rat plasma significantly decreased by both sulfite treatment and SOX deficiency compared to the control. There was also a significant decrease in plasma TAC level by sulfite treatment. In conclusion, sulfite treatment affects the antioxidant/oxidant balance of the plasma cells of the rats toward oxidants in SOX-deficient groups.
Tang, Chunlan; Wu, Bingchu; Wu, Jinyi; Zhang, Zheng; Yu, Bocheng
2018-01-29
Gastrodia elata Blume ( G. elata ), a traditional Chinese medicine, is widely used for treatment of various neuro dysfunctions. However, its quality control is still limited to the determination of gastrodin. In the present study, two novel strategies based on quantitative evaluation of total gastrodin and gastrodigenin with base hydrolysis and total gastrodigenin with base-enzymatic hydrolysis followed by HPLC-FLD were put forward and successfully applied to evaluate the quality of 47 batches of G. elata from eight localities. Meanwhile, a systematic comparison of the novel strategy with the multiple markers and the Pharmacopeia method was performed. The results showed that the parishins category could be completely hydrolyzed to gastrodin by sodium hydroxide solution, and gastrodin could further utterly hydrolyze to gastrodigenin with β-d-glucosidase buffer solution. The contents of total gastrodin and gastrodigenin ranged from 1.311% to 2.034%, and total gastrodigenin from 0.748% to 1.120% at the eight localities. From the comparison, we can conclude that the two novel strategies can comprehensively reveal the characteristics of overall active ingredients in G. elata for quality control. The present study provides a feasible and credible strategy for the quality control of G. elata , suggesting a revision of the latest Chinese Pharmacopoeia or European Pharmacopoeia methods for the modernization of G. elata use.
Directory of Open Access Journals (Sweden)
Aye Moh Moh San
2013-01-01
Full Text Available The seeds of Ziziphus mauritiana Lam. have been traditionally used for treatment of various complications including insomnia and anxiety. They are popularly used as sedative and hypnotic drugs in China, Korea, Myanmar, Vietnam, and other Asian countries. However, no scientific proof on hypnotic activity of Z. mauritiana seeds (ZMS was reported. In this study, the hypnotic activity of 50% ethanolic extract from ZMS was observed on the loss of righting reflex in mice using pentobarbital-induced sleep mice method. The contents of total phenolics and total flavonoids in the extract were also determined. The results showed that the 50% ethanolic extract from ZMS contained total phenolics mg gallic acid equivalent (GAE/g extract and total flavonoids mg quercetin equivalent (QE/g extract. Oral administration of the extract at the dose of 200 mg/kg significantly increased the sleeping time in mice intraperitoneally administered with sodium pentobarbital (50 mg/kg body weight. These results supported the traditional use of ZMS for the treatment of insomnia. The seeds of Z. mauritiana should be further developed as an alternative sedative and/or hypnotic product.
Total dominator chromatic number of a graph
Directory of Open Access Journals (Sweden)
Adel P. Kazemi
2015-06-01
Full Text Available Given a graph $G$, the total dominator coloring problem seeks a proper coloring of $G$ with the additional property that every vertex in the graph is adjacent to all vertices of a color class. We seek to minimize the number of color classes. We initiate to study this problem on several classes of graphs, as well as finding general bounds and characterizations. We also compare the total dominator chromatic number of a graph with the chromatic number and the total domination number of it.
Asymmetric total synthesis of cladosporin and isocladosporin.
Zheng, Huaiji; Zhao, Changgui; Fang, Bowen; Jing, Peng; Yang, Juan; Xie, Xingang; She, Xuegong
2012-07-06
The first asymmetric total syntheses of cladosporin and isocladosporin were accomplished in 8 steps with 8% overall yield and 10 steps with 26% overall yield, respectively. The relative configuration of isocladosporin was determined via this total synthesis.
21 CFR 862.1710 - Total triiodothyronine test system.
2010-04-01
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Total triiodothyronine test system. 862.1710... Systems § 862.1710 Total triiodothyronine test system. (a) Identification. A total triiodothyronine test system is a device intended to measure the hormone triiodothyronine in serum and plasma. Measurements...
French government to trim direct stake in Total
International Nuclear Information System (INIS)
Anon.
1992-01-01
This paper reports that the French government has decided to slash its direct stake in partly state owned oil company Total to 5% from 31.7%, a surprise move expected to raise 10 billion francs ($1.8 billion). At the same time, other state owned entities will be asked to boost their combined 2.2% stake in Total to 10%, leaving the government with a net 15% interest in Total vs. the current 34%. Initially, state owned insurance companies Groupe des Assurances Nationales and Assurances Generale de France will be asked to hike their stakes in Total, but others could be asked to join if needed to meet the 10% target. The government the its phase-down of participation in Total, established in 1924 to manage French interests in Iraq Petroleum Co., was prompted by the evolution of the oil context, which differs greatly from what had prompted a significant stake of the state in Total's capital
Population: Census Bureau Total Estimates (2010-2012)
Earth Data Analysis Center, University of New Mexico — Total population estimates are estimates of the total number of residents living in an area on July 1 of each year. The Census Bureaus Population Division produces...
Totally optimal decision trees for Boolean functions
Chikalov, Igor; Hussain, Shahid; Moshkov, Mikhail
2016-01-01
We study decision trees which are totally optimal relative to different sets of complexity parameters for Boolean functions. A totally optimal tree is an optimal tree relative to each parameter from the set simultaneously. We consider the parameters
A high performance totally ordered multicast protocol
Montgomery, Todd; Whetten, Brian; Kaplan, Simon
1995-01-01
This paper presents the Reliable Multicast Protocol (RMP). RMP provides a totally ordered, reliable, atomic multicast service on top of an unreliable multicast datagram service such as IP Multicasting. RMP is fully and symmetrically distributed so that no site bears un undue portion of the communication load. RMP provides a wide range of guarantees, from unreliable delivery to totally ordered delivery, to K-resilient, majority resilient, and totally resilient atomic delivery. These QoS guarantees are selectable on a per packet basis. RMP provides many communication options, including virtual synchrony, a publisher/subscriber model of message delivery, an implicit naming service, mutually exclusive handlers for messages, and mutually exclusive locks. It has commonly been held that a large performance penalty must be paid in order to implement total ordering -- RMP discounts this. On SparcStation 10's on a 1250 KB/sec Ethernet, RMP provides totally ordered packet delivery to one destination at 842 KB/sec throughput and with 3.1 ms packet latency. The performance stays roughly constant independent of the number of destinations. For two or more destinations on a LAN, RMP provides higher throughput than any protocol that does not use multicast or broadcast.
Total lymphoid irradiation of intractable rheumatoid arthritis
International Nuclear Information System (INIS)
Herbst, M.; Fritz, H.; Sauer, R.
1986-01-01
Eleven patients with intractable rheumatoid arthritis were treated with fractionated total lymphoid irradiation, (total dose 20 Gy). Lasting improvement in clinical symptoms was found in four patients during treatment and the remaining patients experienced similar benefit within 2 months of irradiation. There was marked reduction in exacerbations and number of joints involved. Morning stiffness, joint swelling and tenderness decreased. Complications included severe fatigue during treatment and acute bacterial arthritis in multiple joints in one patient. Four patients have since died, one of renal failure, another of cardiogenic shock following surgery 3 and 24 months after total lymphoid irradiation. Both had generalised amyloidosis. The third patient developed joint empyema and died of toxic cardiac failure. The fourth died 3 months after resection of a Kaposi's sarcoma complicated by wound infection which responded to treatment. Immunologically, total lymphoid irradiation resulted in suppression of the absolute lymphocyte count and reduction in T-helper cells, the number of T-suppressor cells remaining unchanged. These data provide evidence of T-cell involvement in the pathogenesis of rheumatoid arthritis. Total lymphoid irradiation can induce sustained improvement in clinical disease activity, but severe, possibly fatal, side-effects cannot be ignored. (author)
Total lymphoid irradiation of intractable rheumatoid arthritis
Energy Technology Data Exchange (ETDEWEB)
Herbst, M.; Fritz, H.; Sauer, R.
1986-12-01
Eleven patients with intractable rheumatoid arthritis were treated with fractionated total lymphoid irradiation, (total dose 20 Gy). Lasting improvement in clinical symptoms was found in four patients during treatment and the remaining patients experienced similar benefit within 2 months of irradiation. There was marked reduction in exacerbations and number of joints involved. Morning stiffness, joint swelling and tenderness decreased. Complications included severe fatigue during treatment and acute bacterial arthritis in multiple joints in one patient. Four patients have since died, one of renal failure, another of cardiogenic shock following surgery 3 and 24 months after total lymphoid irradiation. Both had generalised amyloidosis. The third patient developed joint empyema and died of toxic cardiac failure. The fourth died 3 months after resection of a Kaposi's sarcoma complicated by wound infection which responded to treatment. Immunologically, total lymphoid irradiation resulted in suppression of the absolute lymphocyte count and reduction in T-helper cells, the number of T-suppressor cells remaining unchanged. These data provide evidence of T-cell involvement in the pathogenesis of rheumatoid arthritis. Total lymphoid irradiation can induce sustained improvement in clinical disease activity, but severe, possibly fatal, side-effects cannot be ignored.
DEFF Research Database (Denmark)
Schrøder, Henrik M.; Petersen, Michael M.
2016-01-01
Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...... surgeon seems to positively influence the rate of surgical complications and implant survival. The painful TKA knee should be thoroughly evaluated, but not revised except if a relevant indication can be established. The most frequent indications for revision are: aseptic loosening, instability, infection...
Total reflection X-ray fluorescence analysis
International Nuclear Information System (INIS)
Michaelis, W.; Prange, A.
1987-01-01
In the past few years, total reflection X-ray flourescence analysis (TXRF) has found an increasing number of assignments and applications. Experience of trace element analysis using TXRF and examples of applications are already widespread. Therefore, users of TXRF had the opportunity of an intensive exchange of their experience at the 1st workshop on total reflection X-ray fluorescence analysis which took place on May 27th and 28th 1986 at the GKSS Research Centre at Geesthacht. In a series of lectures and discussions dealing with the analytical principle itself, sample preparation techniques and applications as well as comuter programs for spectrum evaluation, the present state of development and the range of applications were outlined. 3 studies out of a total of 14 were included separately in the INIS and ENERGY databases. With 61 figs., 12 tabs [de
Total's LNG activities from Algeria to Yemen
International Nuclear Information System (INIS)
Vedrenne, J.P.
1997-01-01
In March 1995, further to an international tender, Total was awarded the leadership of the first LNG project in Yemen. On January 1997 Total announced the extension of the share-holding of the Yemen LNG Co. to include the companies with interests in the Marib area (Hunt-Exxon-Yukong). The Marib area will supply the gas to the future liquefaction plant. The ratification of these agreements confirms the role of Total as lead shareholder with 36% in the share-holding structure and guarantees gas supply from the Marib licence, operated by Hunt-Exxon. (author)
Vibrational enhancement of total breakup cross sections
International Nuclear Information System (INIS)
Haftel, M.I.; Lim, T.K.
1984-01-01
This paper considers the role of multi-two-body bound states, namely vibrational excitations, on total three-body breakup cross-sections. Total cross-sections are usually easy to measure, and they play a fundamental role in chemical kinetics. (orig.)
Correlation of total, diffuse, and direct solar radiation
Buyco, E. H.; Namkoong, D.
1977-01-01
Present requirements for realistic solar energy system evaluations necessitate a comprehensive body of solar-radition data. The data should include both diffuse and direct solar radiation as well as their total on an hourly (or shorter) basis. In general, however, only the total solar radiation values were recorded. This report presents a correlation that relates the diffuse component of an hourly total solar radiation value to the total radiation ratio of the maximum value attainable. The data used were taken at the Blue Hill Observatory in Milton, Massachusetts, for the period 1952. The relation - in the form of the data plots - can be used in situations in which only the hourly total radiation data are available but the diffuse component is desired.
Total Quality Management Seminar.
Massachusetts Career Development Inst., Springfield.
This booklet is one of six texts from a workplace literacy curriculum designed to assist learners in facing the increased demands of the workplace. The booklet contains seven sections that cover the following topics: (1) meaning of total quality management (TQM); (2) the customer; (3) the organization's culture; (4) comparison of management…
International Nuclear Information System (INIS)
2004-01-01
This annual report of the Group Total brings information and economic data on the following topics, for the year 2004: the corporate governance, the corporate social responsibility, the shareholder notebook, the management report, the activities, the upstream (exploration and production) and downstream (refining and marketing) operating, chemicals and other matters. (A.L.B.)
Records Management in Organization and Total Quality
Directory of Open Access Journals (Sweden)
Fahrettin Özdemirci
1999-06-01
Full Text Available In this article the relationship between total quality management and records managemen t are examined. It has also been indicated that the records management has vita'ly important part for realizing the total quality management approach.
A Total Factor Productivity Toolbox for MATLAB
B.M. Balk (Bert); J. Barbero (Javier); J.L. Zofío (José)
2018-01-01
textabstractTotal Factor Productivity Toolbox is a new package for MATLAB that includes functions to calculate the main Total Factor Productivity (TFP) indices and their decompositions, based on Shephard’s distance functions and using Data Envelopment Analysis (DEA) programming techniques. The
Datta-Barua, S.; Gachancipa, J. N.; Deshpande, K.; Herrera, J. A.; Lehmacher, G. A.; Su, Y.; Gyuk, G.; Bust, G. S.; Hampton, D. L.
2017-12-01
High concentration of free electrons in the ionosphere can cause fluctuations in incoming electromagnetic waves, such as those from the different Global Navigation Satellite Systems (GNSS). The behavior of the ionosphere depends on time and location, and it is highly influenced by solar activity. The purpose of this study is to determine the impact of a total solar eclipse on the local ionosphere in terms of ionospheric scintillations, and on the global ionosphere in terms of TEC (Total Electron Content). The studied eclipse occurred on 21 August 2017 across the continental United States. During the eclipse, we expected to see a decrease in the scintillation strength, as well as in the TEC values. As a broader impact part of our recently funded NSF proposal, we temporarily deployed two GNSS receivers on the eclipse's totality path. One GNSS receiver was placed in Clemson, SC. This is a multi-frequency GNSS receiver (NovAtel GPStation-6) capable of measuring high and low rate scintillation data as well as TEC values from four different GNSS systems. We had the receiver operating before, during, and after the solar eclipse to enable the comparison between eclipse and non-eclipse periods. A twin receiver collected data at Daytona Beach, FL during the same time, where an 85% partial solar eclipse was observed. Additionally, we set up a ground receiver onsite in the path of totality in Perryville, Missouri, from which the Adler Planetarium of Chicago launched a high-altitude balloon to capture a 360-degree video of the eclipse from the stratosphere. By analyzing the collected data, this study looks at the effects of partial and total solar eclipse periods on high rate GNSS scintillation data at mid-latitudes, which had not been explored in detail. This study also explores the impact of solar eclipses on signals from different satellite constellations (GPS, GLONASS, and Galileo). Throughout the eclipse, the scintillation values did not appear to have dramatic changes
NIF total neutron yield diagnostic
International Nuclear Information System (INIS)
Cooper, Gary W.; Ruiz, Carlos L.
2001-01-01
We have designed a total neutron yield diagnostic for the National Ignition Facility (NIF) which is based on the activation of In and Cu samples. The particular approach that we have chosen is one in which we calibrate the entire counting system and which we call the ''F factor'' method. In this method, In and/or Cu samples are exposed to known sources of DD and DT neutrons. The activated samples are then counted with an appropriate system: a high purity Ge detector for In and a NaI coincidence system for Cu. We can then calculate a calibration factor, which relates measured activity to total neutron yield. The advantage of this approach is that specific knowledge of such quantities as cross sections and detector efficiencies is not needed. Unless the actual scattering environment of the NIF can be mocked up in the calibration experiment, the F factor will have to be modified using the results of a numerical simulation of the NIF scattering environment. In this article, the calibration factor methodology will be discussed and experimental results for the calibration factors will be presented. Total NIF neutron yields of 10 9 --10 19 can be measured with this method assuming a 50 cm stand-off distance can be employed for the lower yields
Refractometric total protein concentrations in icteric serum from dogs.
Gupta, Aradhana; Stockham, Steven L
2014-01-01
To determine whether high serum bilirubin concentrations interfere with the measurement of serum total protein concentration by refractometry and to assess potential biases among refractometer measurements. Evaluation study. Sera from 2 healthy Greyhounds. Bilirubin was dissolved in 0.1M NaOH, and the resulting solution was mixed with sera from 2 dogs from which food had been withheld to achieve various bilirubin concentrations up to 40 mg/dL. Refractometric total protein concentrations were estimated with 3 clinical refractometers. A biochemical analyzer was used to measure biuret assay-based total protein and bilirubin concentrations with spectrophotometric assays. No interference with refractometric measurement of total protein concentrations was detected with bilirubin concentrations up to 41.5 mg/dL. Biases in refractometric total protein concentrations were detected and were related to the conversion of refractive index values to total protein concentrations. Hyperbilirubinemia did not interfere with the refractometric estimation of serum total protein concentration. The agreement among total protein concentrations estimated by 3 refractometers was dependent on the method of conversion of refractive index to total protein concentration and was independent of hyperbilirubinemia.
Simultaneous and staged bilateral total hip arthroplasty
DEFF Research Database (Denmark)
Lindberg-Larsen, Martin; Joergensen, Christoffer Calov; Husted, Henrik
2013-01-01
Bilateral total hip arthroplasty (BTHA) and bilateral simultaneous total hip arthroplasty (BSTHA) are done increasingly. Previous studies evaluating outcomes after bilateral procedures have found different results. The aim of this study was to investigate length of hospital stay (LOS), 30 days...
International Nuclear Information System (INIS)
2003-01-01
This report presents the activities and results of the Group Total-Fina-Elf for the year 2003. It brings information and economic data on the following topics: the corporate and business; the upstream activities with the reserves, the costs, standardized measure and changes of discounted future net cash flow,oil and gas acreage, drilling, liquefied natural gas, pipelines; downstream activities with refining and marketing maps, refinery, petroleum products, sales, retail gasoline outlets; chemicals with sales and operating income by sector, major applications, base chemicals and polymers, intermediates and performance polymers. (A.L.B.)
Bastías, J M; Bermúdez, M; Carrasco, J; Espinoza, O; Muñoz, M; Galotto, M J; Muñoz, O
2010-10-01
The dietary intake of total arsenic (tAs), inorganic arsenic (iAs) and total mercury (tHg) in lunch and breakfast servings provided by the Chilean School Meal Program (SMP) was estimated, using the duplicate-portion variant of the total diet study. Lunch and breakfast samples were collected from 65 schools throughout the country in 2006. The population sample was a group of girls and boys between 6 and 18 years old. The tAs concentration was measured via hydride-generation atomic absorption spectrometry. The total mercury concentration was measured via cold-vapor atomic absorption spectroscopy. The estimated iAs intake was 12.5% (5.4 μg/day) of the Provisional tolerable daily intake (PTDI) as proposed by the FAO/WHO, and the tHg intake was 13.2% (1.9 μg/day) of the PTDI as proposed by the FAO/WHO. It was therefore concluded that tAs, iAs and tHg intake from food provided by the SMP do not pose risks to student health.
Expressions for the Total Yaw Angle
2016-09-01
1. Introduction 1 2. Mathematical Notation 1 3. Total Yaw Expression Derivations 2 3.1 First Derivation 2 3.2 Second Derivation 4 3.3 Other...4 iv Approved for public release; distribution is unlimited. 1. Introduction The total yaw angle, γt , of a ballistic projectile is... elevation angles from spherical coordinates.∗ We again place point A at the end point of V. Now imagine a plane parallel to the y-z plane that includes
Failure of aseptic revision total knee arthroplasties.
Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove
2015-02-01
In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties.
A method for total body irradiation
International Nuclear Information System (INIS)
Yasukochi, Hiroshi; Higashi, Shizuka; Okuhata, Yoshitaka; Lee, Keiichi; Ishioka, Kuniaki; Murakami, Koji; Nagai, Jun; Kuniyasu, Yoshio
1988-01-01
In these two years, we have treated four infant patients of acute leukemia by Cobalt-60 total body irradiation and bone marrow transplantation. During total body irradiation, thermoluminescence dosimeters were attached to the skin of patients. For four patients, nine dosimetries were performed. Reliability of this method was examined by phantom experiment. Every irradiation for the patient per fraction was 2.4 Gy, that is, 60 cGy for each four positions, right decubitus A-P and PA directions and left decubitus A-P and PA directions under aseptic circumstances. Radiation dose was uniform by this technique for each patient, and average determined dose for surface of the patients was between 87 % and 106 % compared with the air dose of the center of aseptic space (wagon). As the result, we suggest that this method is suitable for the total body irradiation of acute leukemia of infant. (author)
Total quality management in orthodontic practice.
Atta, A E
1999-12-01
Quality is the buzz word for the new Millennium. Patients demand it, and we must serve it. Yet one must identify it. Quality is not imaging or public relations; it is a business process. This short article presents quality as a balance of three critical notions: core clinical competence, perceived values that our patients seek and want, and the cost of quality. Customer satisfaction is a variable that must be identified for each practice. In my practice, patients perceive quality as communication and time, be it treatment or waiting time. Time is a value and cost that must be managed effectively. Total quality management is a business function; it involves diagnosis, design, implementation, and measurement of the process, the people, and the service. Kazien is a function that reduces value services, eliminates waste, and manages time and cost in the process. Total quality management is a total commitment for continuous improvement.
Total Lightning as an Indicator of Mesocyclone Behavior
Stough, Sarah M.; Carey, Lawrence D.; Schultz, Christopher J.
2014-01-01
Apparent relationship between total lightning (in-cloud and cloud to ground) and severe weather suggests its operational utility. Goal of fusion of total lightning with proven tools (i.e., radar lightning algorithms. Preliminary work here investigates circulation from Weather Suveilance Radar- 1988 Doppler (WSR-88D) coupled with total lightning data from Lightning Mapping Arrays.
International Nuclear Information System (INIS)
Lathika; Manupriya, B.R.; Shenoy, K.B.; Patil, S.L.; Somashekarappa, H.M.
2016-01-01
The present study is an attempt to study the impact of gamma radiation on the shelf life, total antioxidant capacity and total lipid concentration of finger millet (Eleusine coracana L.) flour. Finger millet flour was procured from market. Flour samples of 50 g were taken in triplicates in a polyethylene pouch, air sealed and subjected to gamma irradiation doses ranging from 0.25 to 10 kGy and stored in polyethylene bags and plastic containers for a period of 1 year. Within 24 hours of irradiation, the samples were tested for moisture (2 ± 0.2%), total antioxidant capacity (0.12 ± 0.010 mg) and lipid concentration (15 ± 0.4 mg)
Total Quality Management Simplified.
Arias, Pam
1995-01-01
Maintains that Total Quality Management (TQM) is one method that helps to monitor and improve the quality of child care. Lists four steps for a child-care center to design and implement its own TQM program. Suggests that quality assurance in child-care settings is an ongoing process, and that TQM programs help in providing consistent, high-quality…
DEFF Research Database (Denmark)
Munch, Anders V.
2016-01-01
The idea of design as an art made not only for the people, but also by the people is an old dream going back at least to William Morris. It is, however, reappearing vigoriously in many kinds of design activism and grows out of the visions of a Total Design of society. The ideas of participation b...
Total Product Life Cycle (TPLC)
U.S. Department of Health & Human Services — The Total Product Life Cycle (TPLC) database integrates premarket and postmarket data about medical devices. It includes information pulled from CDRH databases...
Directory of Open Access Journals (Sweden)
E.T. Mársico
2007-12-01
Full Text Available Pesquisou-se a concentração de mercúrio total na porção muscular de 39 exemplares de tubarões de três diferentes espécies Prionace glauca, Isurus oxyrhynchus, Sphyrna zygaena, capturados na costa sul do Brasil, Santa Catarina. O teor de mercúrio foi determinado por espectrofotometria de absorção atômica por vapor frio. Observou-se ampla variação na concentração de mercúrio total com valor individual máximo excedendo o limite estabelecido pela legislação brasileira, de 1.0µg.g-1 em um exemplar fêmea de P. glauca. Nessa espécie, a concentração de Hg-total aumentou proporcionalmente ao comprimento total (r=0,62; P<0,0001. Não foi evidenciada diferença estatisticamente significativa entre exemplares fêmeas e machos.
Relative Hom-Hopf modules and total integrals
International Nuclear Information System (INIS)
Guo, Shuangjian; Zhang, Xiaohui; Wang, Shengxiang
2015-01-01
Let (H, α) be a monoidal Hom-Hopf algebra and (A, β) a right (H, α)-Hom-comodule algebra. We first investigate the criterion for the existence of a total integral of (A, β) in the setting of monoidal Hom-Hopf algebras. Also, we prove that there exists a total integral ϕ : (H, α) → (A, β) if and only if any representation of the pair (H, A) is injective in a functorial way, as a corepresentation of (H, α), which generalizes Doi’s result. Finally, we define a total quantum integral γ : H → Hom(H, A) and prove the following affineness criterion: if there exists a total quantum integral γ and the canonical map ψ : A⊗ B A → A ⊗ H, a⊗ B b ↦ β −1 (a) b [0] ⊗ α(b [1] ) is surjective, then the induction functor A⊗ B −:ℋ ~ (ℳ k ) B →ℋ ~ (ℳ k ) A H is an equivalence of categories
Directory of Open Access Journals (Sweden)
Wittbrodt ET
2018-05-01
Full Text Available Eric T Wittbrodt,1 Tong J Gan,2 Catherine Datto,1 Charles McLeskey,1 Meenal Sinha3 1US Medical Affairs, AstraZeneca, Wilmington, DE, USA; 2Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY, USA; 3Premier Applied Sciences, Premier, Inc., Charlotte, NC, USA Purpose: Constipation is a well-known complication of surgery that can be exacerbated by opioid analgesics. This study evaluated resource utilization and costs associated with opioid-induced constipation (OIC. Patients and methods: This retrospective, observational, and propensity-matched cohort study utilized the Premier Healthcare Database. The study included adults ≥18 years of age undergoing total hip or total knee replacement as inpatients who received an opioid analgesic and were discharged between January 1, 2012, and June 30, 2015. Diagnosis codes identified patients with OIC who were then matched 1:1 to patients without OIC. Generalized linear and logistic regression models were used to compare inpatient resource utilization, total hospital costs, inpatient mortality, and 30-day all-cause readmissions and emergency department visits. Results: Of 788,448 eligible patients, 40,891 (5.2% had OIC. Covariates were well balanced between matched patients with and without OIC (n=40,890 each. In adjusted analyses, patients with OIC had longer hospital lengths of stay (3.6 versus 3.3 days; p<0.001, higher total hospital costs (US$17,479 versus US$16,265; p<0.001, greater risk of intensive care unit admission (odds ratio [OR]=1.12, 95% CI: 1.01–1.24, and increased likelihood of 30-day hospital readmissions (OR=1.16, 95% CI: 1.11–1.22 and emergency department visits (OR=1.38, 95% CI: 1.07–1.79 than patients without OIC. No statistically significant difference was found with inpatient mortality (OR=0.89, 95% CI: 0.59–1.35. Conclusion: OIC was associated with greater resource utilization and hospital costs for patients undergoing primarily elective total hip or total knee
Total energy system in the future
International Nuclear Information System (INIS)
Hijikata, K.
1994-01-01
The possibility of improving the thermal efficiency of energy systems from an exergy point of view is discussed. In total energy systems, we should employ multi-pass recycling consisting of thermal and chemical energies. The recycling system is supported by electrical energy, which is provided by a renewable energy source or by excess commercial electric power. This total energy system should be considered not only in one country, but all around the globe. (author). 6 figs., 4 tabs., 8 refs
Laparoscopic total pancreatectomy: Case report and literature review.
Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing
2017-01-01
Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien-Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450-540 minutes), the mean estimated blood loss was 266 mL (range 100-400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8-24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy.
Total Variation Depth for Functional Data
Huang, Huang
2016-11-15
There has been extensive work on data depth-based methods for robust multivariate data analysis. Recent developments have moved to infinite-dimensional objects such as functional data. In this work, we propose a new notion of depth, the total variation depth, for functional data. As a measure of depth, its properties are studied theoretically, and the associated outlier detection performance is investigated through simulations. Compared to magnitude outliers, shape outliers are often masked among the rest of samples and harder to identify. We show that the proposed total variation depth has many desirable features and is well suited for outlier detection. In particular, we propose to decompose the total variation depth into two components that are associated with shape and magnitude outlyingness, respectively. This decomposition allows us to develop an effective procedure for outlier detection and useful visualization tools, while naturally accounting for the correlation in functional data. Finally, the proposed methodology is demonstrated using real datasets of curves, images, and video frames.
Molloy, Ilda B; Martin, Brook I; Moschetti, Wayne E; Jevsevar, David S
2017-03-01
Utilization of total knee and hip arthroplasty has greatly increased in the past decade in the United States; these are among the most expensive procedures in patients with Medicare. Advances in surgical techniques, anesthesia, and care pathways decrease hospital length of stay. We examined how trends in hospital cost were altered by decreases in length of stay. Procedure, demographic, and economic data were collected on 6.4 million admissions for total knee arthroplasty and 2.8 million admissions for total hip arthroplasty from 2002 to 2013 using the National (Nationwide) Inpatient Sample, a component of the Healthcare Cost and Utilization Project. Trends in mean hospital costs and their association with length of stay were estimated using inflation-adjusted, survey-weighted generalized linear regression models, controlling for patient demographic characteristics and comorbidity. From 2002 to 2013, the length of stay decreased from a mean time of 4.06 to 2.97 days for total knee arthroplasty and from 4.06 to 2.75 days for total hip arthroplasty. During the same time period, the mean hospital cost for total knee arthroplasty increased from $14,988 (95% confidence interval [CI], $14,927 to $15,049) in 2002 to $22,837 (95% CI, $22,765 to $22,910) in 2013 (an overall increase of $7,849 or 52.4%). The mean hospital cost for total hip arthroplasty increased from $15,792 (95% CI, $15,706 to $15,878) in 2002 to $23,650 (95% CI, $23,544 to $23,755) in 2013 (an increase of $7,858 or 49.8%). If length of stay were set at the 2002 mean, the growth in cost for total knee arthroplasty would have been 70.8% instead of 52.4% as observed, and the growth in cost for total hip arthroplasty would have been 67.4% instead of 49.8% as observed. Hospital costs for joint replacement increased from 2002 to 2013, but were attenuated by reducing inpatient length of stay. With demographic characteristics showing an upward trend in the utilization of joint arthroplasty, including a shift
Intrathoracic Hernia after Total Gastrectomy
Directory of Open Access Journals (Sweden)
Yoshihiko Tashiro
2016-05-01
Full Text Available Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.
Czech Academy of Sciences Publication Activity Database
Bonacina, I.; Galesi, N.; Thapen, Neil
2016-01-01
Roč. 45, č. 5 (2016), s. 1894-1909 ISSN 0097-5397 R&D Projects: GA ČR GBP202/12/G061 EU Projects: European Commission(XE) 339691 - FEALORA Institutional support: RVO:67985840 Keywords : total space * resolution random CNFs * proof complexity Subject RIV: BA - General Mathematics Impact factor: 1.433, year: 2016 http://epubs.siam.org/doi/10.1137/15M1023269
Total cardiovascular disease risk assessment: a review.
LENUS (Irish Health Repository)
Cooney, Marie Therese
2011-09-01
The high risk strategy for the prevention of cardiovascular disease (CVD) requires an assessment of an individual\\'s total CVD risk so that the most intensive risk factor management can be directed towards those at highest risk. Here we review developments in the assessment and estimation of total CVD risk.
26 CFR 1.801-5 - Total reserves.
2010-04-01
... TAXES Life Insurance Companies § 1.801-5 Total reserves. (a) Total reserves defined. For purposes of... its highest aggregate reserve by taking State A's requirement of 10 against its life insurance business and adding it to State B's requirement of 7 against its annuity business. (b) Reserves required by...
TOTAL FINA ELF. Annual report 2002
International Nuclear Information System (INIS)
2003-01-01
This document is the annual report 2002 of Total-Fina-Elf society, great company on the hydrocarbons market. According to the company objective (set the standard not only with the financial performance, but also with stringent requirements in terms of social and environmental responsibility), it presents the Chairman message, the corporate governance, the social and environmental responsibility, the future of energy, the human resources policy, the investor relations, the overview of Total-Fina-Elf fiscal year with financial information and 2002 industrial events. (A.L.B.)
Directory of Open Access Journals (Sweden)
Andrijašević Maja
2008-01-01
Full Text Available The focus of competitive "battle" shifted from the price towards non-price instruments, above all, towards quality that became the key variable for profitability increase and achievement of better comparative position of a company. Under such conditions, management of a company, which, according to the established and certified system of total quality, strives towards achieving of a better market position, faces the problem of quality cost measurement and determination. Management, above all, cost accounting can help in solving of this problem, but the question is how much of its potential is being used for that purpose.
Directory of Open Access Journals (Sweden)
Mohammad Khairul Alam
2016-09-01
Full Text Available In an attempt to develop the food composition table for Bangladesh, the nutritional composition of nine varieties of orange-fleshed sweet potato was analyzed together with total carotenoids (TCC and total polyphenol content (TPC. Each variety showed significant variation in different nutrient contents. The quantification of the TCC and TPC was done by spectrophotometric measurement, and the proximate composition was done by the AOAC method. The obtained results showed that total polyphenol content varied from 94.63 to 136.05 mg gallic acid equivalent (GAE/100 g fresh weight. Among the selected sweet potatoes, Bangladesh Agricultural Research Institute (BARI Sweet Potato 7 (SP7 contained the highest, whereas BARI SP6 contained the lowest amount of total polyphenol content. The obtained results also revealed that total carotenoids content ranged from 0.38 to 7.24 mg/100 g fresh weight. BARI SP8 showed the highest total carotenoids content, whereas BARI SP6 showed the lowest. Total carotenoids content was found to be higher in dark orange-colored flesh varieties than their light-colored counterparts. The results of the study indicated that selected sweet potato varieties are rich in protein and carbohydrate, low in fat, high in polyphenol and carotenoids and, thus, could be a good source of dietary antioxidants to prevent free radical damage, which leads to chronic diseases, and also to prevent vitamin A malnutrition.
Alam, Mohammad Khairul; Rana, Ziaul Hasan; Islam, Sheikh Nazrul
2016-09-14
In an attempt to develop the food composition table for Bangladesh, the nutritional composition of nine varieties of orange-fleshed sweet potato was analyzed together with total carotenoids (TCC) and total polyphenol content (TPC). Each variety showed significant variation in different nutrient contents. The quantification of the TCC and TPC was done by spectrophotometric measurement, and the proximate composition was done by the AOAC method. The obtained results showed that total polyphenol content varied from 94.63 to 136.05 mg gallic acid equivalent (GAE)/100 g fresh weight. Among the selected sweet potatoes, Bangladesh Agricultural Research Institute (BARI) Sweet Potato 7 (SP7) contained the highest, whereas BARI SP6 contained the lowest amount of total polyphenol content. The obtained results also revealed that total carotenoids content ranged from 0.38 to 7.24 mg/100 g fresh weight. BARI SP8 showed the highest total carotenoids content, whereas BARI SP6 showed the lowest. Total carotenoids content was found to be higher in dark orange-colored flesh varieties than their light-colored counterparts. The results of the study indicated that selected sweet potato varieties are rich in protein and carbohydrate, low in fat, high in polyphenol and carotenoids and, thus, could be a good source of dietary antioxidants to prevent free radical damage, which leads to chronic diseases, and also to prevent vitamin A malnutrition.
Directory of Open Access Journals (Sweden)
Avni Hajdari
2016-05-01
Full Text Available Aerial parts of Satureja montana L. (Lamiaceae were collected from seven growing wild populations (four populations in Kosovo, two in Albania and one in Montenegro in 2013 with the aim of assessing the natural variation in the chemical composition of the essential oils, total flavonoids, total phenolics and the antioxidant activity of their methanolic extracts. Essential oils were obtained by steam distillation and analysed using GC-FID and GC-MS, whereas total flavonoids, total phenolics and antioxidant activities were determined using spectrophotometric methods. Sixty-one volatile constituents were identified. The main constituents were myrcene, p-cymene, γ-terpinene, linalool, thymol, carvacrol and viridiflorol. Total phenolics ranged from 68.1 to 102.6 mg/g dry mass, the total flavonoid content ranged from 38.3 to 67.0 mg/g dm, and the antioxidant activity according to the DPPH assay ranged from 253.3 to 342.9 mg TE/g dm and according to the FRAP assay ranged from 8.9 to 11.4 mg TE/g dm. Hierarchical cluster analysis and principal component analyses were used to assess the geographical variations in the essential oil composition. Statistical analysis revealed that the analysed populations are grouped into four main clusters that appear to reflect the environmental impact on the chemical composition, which is influenced by differences in habitat composition, altitude and microclimatic conditions.
Miao, Ming-San; Peng, Meng-Fan; Ma, Rui-Juan; Bai, Ming; Liu, Bao-Song
2018-03-01
Objective: To study the effects of the different components of the total flavonoids and total saponins from Mao Dongqing's active site on the rats of TIA model, determine the optimal reactive components ratio of Mao Dongqing on the rats of TIA. Methods: TIA rat model was induced by tail vein injection of tert butyl alcohol, the blank group was injected with the same amount of physiological saline, then behavioral score wasevaluated. Determination the level of glutamic acid in serum, the activity of Na+-K+-ATP enzyme, CA ++ -ATP enzyme and Mg ++ -ATP enzyme in Brain tissue, observe the changes of hippocampus in brain tissue, the comprehensive weight method was used to evaluate the efficacy of each component finally. Results: The contents of total flavonoids and total saponins in the active part of Mao Dongqing can significantly improve the pathological changes of brain tissue in rats, improve the activity of Na + -K + -ATP enzyme, Ca ++ -ATP enzyme and Mg ++ -ATP enzyme in the brain of rats, and reduce the level of glutamic acid in serum. The most significant of the contents was the ratio of 10:6. The different proportions of total flavonoids and total saponins in the active part of Mao Dongqing all has a better effect on the rats with TIA, and the ratio of 10:6 is the best active component for preventing and controlling TIA.
Total magnetic reconnection during a tokamak major disruption
International Nuclear Information System (INIS)
Goetz, J.A.; Dexter, R.N.; Prager, S.C.
1990-07-01
The safety factor within a tokamak plasma has been measured during a major disruption. During the disruption, the central safety factor jumps from below one to above one, while the total current is unchanged. This implies that total reconnection has occurred. This observation is in contract to the absence of total reconnection observed during a sawtooth oscillation in the same device. 11 refs., 6 figs
Subtotal versus total abdominal hysterectomy
DEFF Research Database (Denmark)
Andersen, Lea Laird; Ottesen, Bent; Alling Møller, Lars Mikael
2015-01-01
OBJECTIVE: The objective of the study was to compare long-term results of subtotal vs total abdominal hysterectomy for benign uterine diseases 14 years after hysterectomy, with urinary incontinence as the primary outcome measure. STUDY DESIGN: This was a long-term follow-up of a multicenter......, randomized clinical trial without blinding. Eleven gynecological departments in Denmark contributed participants to the trial. Women referred for benign uterine diseases who did not have contraindications to subtotal abdominal hysterectomy were randomized to subtotal (n = 161) vs total (n = 158) abdominal...... from discharge summaries from all public hospitals in Denmark. The results were analyzed as intention to treat and per protocol. Possible bias caused by missing data was handled by multiple imputation. The primary outcome was urinary incontinence; the secondary outcomes were pelvic organ prolapse...
12 CFR 932.2 - Total capital requirement.
2010-01-01
... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Total capital requirement. 932.2 Section 932.2 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.2 Total capital requirement. (a) Each Bank shall...
Total Quality Management in Education. Second Edition.
Sallis, Edward
Quality is at the top of most agendas, and improving quality is probably the most important task facing any institution. In addition, quality is difficult to define or measure. This book, the second edition of "Total Quality Management in Education," introduces the key concepts of Total Quality Management (TQM) and demonstrates how they…
Predicting thyroxine requirements following total thyroidectomy.
Mistry, Dipan; Atkin, Stephen; Atkinson, Helen; Gunasekaran, Sinnappa; Sylvester, Deborah; Rigby, Alan S; England, R James
2011-03-01
Optimal thyroxine replacement following total thyroidectomy is critical to avoid symptoms of hypothyroidism. The aim of this study was to determine the best formula to determine the initiated replacement dose of levothyroxine immediately following total thyroidectomy. Prospective study. All patients were initiated on 100 μg levothyroxine and titrated to within the reference range for TSH and free T4. Correlations to height, weight, age, lean body mass (LBM), body surface area (BSA) and body mass index (BMI) were calculated. One hundred consecutive adult patients underwent total thyroidectomy for non-malignant disease. Comparison between three methods of levothyroxine dose prediction, aiming for a levothyroxine dose correct to within 25 μg of actual dose required. Correlations were seen between levothyroxine dose and patient age (r=-0.346, Pregression equation was calculated (predicted levothyroxine dose=[0·943 × bodyweight] + [-1.165 × age] + 125.8), simplified to (levothyroxine dose= bodyweight - age + 125) pragmatically. Initiating patients empirically on 100 μg post-operatively showed that 40% of patients achieved target within 25 μg of their required dose; this increased to 59% when using a weight-only dose calculation (1.6 μg/kg) and to 72% using the simplified regression equation. A simple calculated regression equation gives a more accurate prediction of initiated levothyroxine dose following total thyroidectomy, reducing the need for outpatient attendance for dose titration. © 2011 Blackwell Publishing Ltd.
Directory of Open Access Journals (Sweden)
Quy Diem Do
2014-09-01
Full Text Available Limnophila aromatica is commonly used as a spice and a medicinal herb in Southeast Asia. In this study, water and various concentrations (50%, 75%, and 100% of methanol, ethanol, and acetone in water were used as solvent in the extraction of L. aromatica. The antioxidant activity, total phenolic content, and total flavonoid content of the freeze-dried L. aromatica extracts were investigated using various in vitro assays. The extract obtained by 100% ethanol showed the highest total antioxidant activity, reducing power and DPPH (2,2-diphenyl-1-picrylhydrazyl radical scavenging activity. The same extract also exhibited the highest phenolic content (40.5 mg gallic acid equivalent/g of defatted L. aromatica and the highest flavonoid content (31.11 mg quercetin equivalent/g of defatted L. aromatica. The highest extraction yield was obtained by using 50% aqueous acetone. These results indicate that L. aromatica can be used in dietary applications with a potential to reduce oxidative stress.
Perioperative blood saving measures in total hip and knee arthroplasty
Horstmann, W.G.
2011-01-01
This dissertation explores and discusses different aspects of blood loss and blood-saving measures in total hip and knee arthroplasty. Background: Worldwide, approximately 1 million total hip and 1 million total knee prostheses are implanted each year. Total hip arthroplasty and total
TOTAL 2003 activities report in brief
International Nuclear Information System (INIS)
2004-01-01
This activities report presents the activities of the petroleum industry Group Total for the year 2003. The following topics are detailed: the corporate social responsibility with the environment stewardship, the energy future management, the safety enhancing, the human resources and the ethics and local development; the shareholder information with the Total share and the share-holding structure; the activities with informations on the Group, the main events, the upstream exploration and production,, the downstream refining, marketing, trading and shipping, the chemicals with overview 2003, base chemical and polymers, performance and specialities. (A.L.B.)
Correlations between corneal and total wavefront aberrations
Mrochen, Michael; Jankov, Mirko; Bueeler, Michael; Seiler, Theo
2002-06-01
Purpose: Corneal topography data expressed as corneal aberrations are frequently used to report corneal laser surgery results. However, the optical image quality at the retina depends on all optical elements of the eye such as the human lens. Thus, the aim of this study was to investigate the correlations between the corneal and total wavefront aberrations and to discuss the importance of corneal aberrations for representing corneal laser surgery results. Methods: Thirty three eyes of 22 myopic subjects were measured with a corneal topography system and a Tschernig-type wavefront analyzer after the pupils were dilated to at least 6 mm in diameter. All measurements were centered with respect to the line of sight. Corneal and total wavefront aberrations were calculated up to the 6th Zernike order in the same reference plane. Results: Statistically significant correlations (p the corneal and total wavefront aberrations were found for the astigmatism (C3,C5) and all 3rd Zernike order coefficients such as coma (C7,C8). No statistically significant correlations were found for all 4th to 6th order Zernike coefficients except for the 5th order horizontal coma C18 (p equals 0.003). On average, all Zernike coefficients for the corneal aberrations were found to be larger compared to Zernike coefficients for the total wavefront aberrations. Conclusions: Corneal aberrations are only of limited use for representing the optical quality of the human eye after corneal laser surgery. This is due to the lack of correlation between corneal and total wavefront aberrations in most of the higher order aberrations. Besides this, the data present in this study yield towards an aberration balancing between corneal aberrations and the optical elements within the eye that reduces the aberration from the cornea by a certain degree. Consequently, ideal customized ablations have to take both, corneal and total wavefront aberrations, into consideration.
Imaging Total Stations - Modular and Integrated Concepts
Hauth, Stefan; Schlüter, Martin
2010-05-01
Keywords: 3D-Metrology, Engineering Geodesy, Digital Image Processing Initialized in 2009, the Institute for Spatial Information and Surveying Technology i3mainz, Mainz University of Applied Sciences, forces research towards modular concepts for imaging total stations. On the one hand, this research is driven by the successful setup of high precision imaging motor theodolites in the near past, on the other hand it is pushed by the actual introduction of integrated imaging total stations to the positioning market by the manufacturers Topcon and Trimble. Modular concepts for imaging total stations are manufacturer independent to a large extent and consist of a particular combination of accessory hardware, software and algorithmic procedures. The hardware part consists mainly of an interchangeable eyepiece adapter offering opportunities for digital imaging and motorized focus control. An easy assembly and disassembly in the field is possible allowing the user to switch between the classical and the imaging use of a robotic total station. The software part primarily has to ensure hardware control, but several level of algorithmic support might be added and have to be distinguished. Algorithmic procedures allow to reach several levels of calibration concerning the geometry of the external digital camera and the total station. We deliver insight in our recent developments and quality characteristics. Both the modular and the integrated approach seem to have its individual strengths and weaknesses. Therefore we expect that both approaches might point at different target applications. Our aim is a better understanding of appropriate applications for robotic imaging total stations. First results are presented. Stefan Hauth, Martin Schlüter i3mainz - Institut für Raumbezogene Informations- und Messtechnik FH Mainz University of Applied Sciences Lucy-Hillebrand-Straße 2, 55128 Mainz, Germany
Relative Hom-Hopf modules and total integrals
Energy Technology Data Exchange (ETDEWEB)
Guo, Shuangjian [School of Mathematics and Statistics, Guizhou University of Finance and Economics, Guiyang 550025 (China); Zhang, Xiaohui [Department of Mathematics, Southeast University, Nanjing 210096 (China); Wang, Shengxiang, E-mail: wangsx-math@163.com [School of Mathematics and Finance, Chuzhou University, Chuzhou 239000 (China); Department of Mathematics, Nanjing University, Nanjing 210093 (China)
2015-02-15
Let (H, α) be a monoidal Hom-Hopf algebra and (A, β) a right (H, α)-Hom-comodule algebra. We first investigate the criterion for the existence of a total integral of (A, β) in the setting of monoidal Hom-Hopf algebras. Also, we prove that there exists a total integral ϕ : (H, α) → (A, β) if and only if any representation of the pair (H, A) is injective in a functorial way, as a corepresentation of (H, α), which generalizes Doi’s result. Finally, we define a total quantum integral γ : H → Hom(H, A) and prove the following affineness criterion: if there exists a total quantum integral γ and the canonical map ψ : A⊗{sub B}A → A ⊗ H, a⊗{sub B}b ↦ β{sup −1}(a) b{sub [0]} ⊗ α(b{sub [1]}) is surjective, then the induction functor A⊗{sub B}−:ℋ{sup ~}(ℳ{sub k}){sub B}→ℋ{sup ~}(ℳ{sub k}){sub A}{sup H} is an equivalence of categories.
Total renin after gonadotropin stimulation in polycystic ovarian disease.
Matinlauri, I; Anttila, L; Jaatinen, T A; Koskinen, P; Aalto, M; Irjala, K; Nikkanen, V
1995-02-01
To examine the influence of polycystic ovarian disease (PCOD) on the levels of total renin in plasma and follicular fluid (FF) after stimulation with hMG. Comparative study of the plasma and FF concentrations of total renin in women with and without PCOD after stimulation with hMG. In vitro fertilization-embryo transfer program at the Department of Obstetrics and Gynecology, the University Central Hospital of Turku, Finland. Thirty-six women undergoing IVF-ET for infertility with (n = 10) or without (n = 26) ultrasonographically diagnosed PCOD. Of the latter group, 15 women had tubal infertility, and the rest suffered from an anovulatory infertility and reacted with PCO-like ovarian response to stimulation. The concentrations of total renin in plasma and FF, serum E2, and protein in FF. The concentrations of plasma total renin after the gonadotropin stimulation were significantly higher in the PCOD and PCO-like groups when compared with the tubal group. The concentration of total renin in FF and the ratio of total renin per protein in FF were higher in the PCOD and PCO-like groups than in the tubal group, but the differences did not reach statistical significance. Positive correlations were found between the plasma total renin and serum E2 concentrations in the PCO-like and in the tubal group and between plasma total renin concentrations and the number of mature follicles in all groups. Follicular fluid total renin did not correlate with FF protein in any group. All findings were independent of the total hMG dosage used and the body mass index of the patients. In the present study the concentrations of total renin in plasma were enhanced markedly after gonadotropin stimulation in women with PCOD compared with women having tubal infertility. The pattern of the hormonal secretions revealed a group of infertile patients reacting biochemically like women with PCOD.
International Nuclear Information System (INIS)
2006-01-01
This annual report presents the activities and results of TOTAL S.A., french society on oil and gas. It deals with statistics, the managers, key information on financial data and risk factors, information on the Company, unresolved Staff Comments, employees, major Shareholders, consolidated statements, markets, security, financial risks, defaults dividend arrearages and delinquencies, controls and procedures, code of ethics and financial statements. (A.L.B.)
Heterotopic bone formation following total shoulder arthroplasty
DEFF Research Database (Denmark)
Kjaersgaard-Andersen, P.; Frich, Lars Henrik; Sjøbjerg, J.O.
1989-01-01
The incidence and location of heterotopic bone formation following total shoulder arthroplasty were evaluated in 58 Neer Mark-II total shoulder replacements. One year after surgery, 45% had developed some ectopic ossification. In six shoulders (10%) the ossifications roentgenographically bridged...... the glenohumeral and/or the glenoacromial space. There was no correlation between shoulder pain and the development of ossification. Shoulders with grade III heterotopic bone formation had a limited range of active elevation compared with shoulders without or with only a milder lesion. Men and patients...... with osteoarthritis of the shoulder joint were significantly disposed to the development of heterotopic bone. Heterotopic bone formation following total shoulder arthroplasty is frequent, but disabling heterotopic ossifications seem to be rare....
Totally Contact Umbilical Lightlike Hypersurfaces of Indefinite -Manifolds
Directory of Open Access Journals (Sweden)
Rachna Rani
2013-01-01
Full Text Available We study totally contact umbilical lightlike hypersurfaces of indefinite -manifolds and prove the nonexistence of totally contact umbilical lightlike hypersurface in indefinite -space form.
Total cross section of highly excited strings
International Nuclear Information System (INIS)
Lizzi, F.; Senda, I.
1990-01-01
The unpolarized total cross section for the joining of two highly excited strings is calculated. The calculation is performed by taking the average overall states in the given excitation levels of the initial strings. We find that the total cross section grows with the energy and momentum of the initial states. (author). 8 refs, 1 fig
An update on percutaneous nephrolithotomy
DEFF Research Database (Denmark)
Tefekli, A; Cordeiro, E; de la Rosette, J J M C H
2013-01-01
Since its introduction in late 1970's, percutaneous nephrolithotomy (PNL) has undergone an evolution in both equipment and technique. This evolution still continues today in the era of minimally invasive treatment options, and is evidenced by the numerous publications. PNL is generally advantageous...... in the management of large renal stones (>1.5-2 cm) with high stone-free rates and considerable complication rates. However this technique is especially competing with retrograde intrarenal surgery and laparoscopic techniques. Therefore the CROES Global PNL Study Group prospectively collected data of over 5800...... patients managed with PNL worldwide and analyzed the data in detail, producing more than 25 scientific papers. And this update focuses on the lessons learned from the CROES PCNL Global Study....
Petis, Stephen M; Lanting, Brent A; Vasarhelyi, Edward M; Naudie, Douglas D R; Ralley, Fiona E; Howard, James L
2017-09-01
Several treatment modalities exist for the treatment of perioperative anemia. We determined the effect of oral iron supplementation on preoperative anemia, and the use of blood-conserving interventions before total hip arthroplasty (THA) and total knee arthroplasty (TKA). A total of 3435 total joint arthroplasties (1461 THAs and 1974 TKAs) were analyzed during 2 phases of a blood conservation program. The first phase used erythropoietin alfa (EPO) or intravenous (IV) iron for patients at risk for perioperative anemia. The second phase included these interventions, as well as preoperative iron supplementation. The effect on preoperative hemoglobin (Hb) and serum ferritin, as well as EPO and IV iron utilization, was determined. Oral iron therapy increased preoperative Hb level by 6 g/L (P iron reduced from 4% to 2% (P = .05) and 5% to 2% (P iron therapy reduced the burden of perioperative anemia and reduced utilization of other blood-conserving therapies before THA and TKA. Future research should delineate the cost-effectiveness of oral iron therapy. Copyright © 2017 Elsevier Inc. All rights reserved.
Nutritional management after total laryngectomy
African Journals Online (AJOL)
28 September 2010 with a known diagnosis of cancer of the larynx. The patient, who underwent a total laryngectomy on 13 October, had a tracheostomy inserted .... status, leading to improved quality of life and better response to treatment.4.
Directory of Open Access Journals (Sweden)
Ni Luh Payastiti Yunita
2010-06-01
Full Text Available Inadequate quality of food products that do not meet standard quality may lead to food poisoning cases and become a concern in public health sector. Nasi Jinggo is a small amount of cooked rice with little bit fried tempe, shredded spicy chicken, traditional made chili sauce that is packed with banana leaves, and all the cooking process usually done traditionally. Nasi jinggo is sold at night by street vendor with price ranged from Rp. 1.500,- to Rp. 2.000,- per package. The study was a quantitative descriptive study with cross-sectional design that was aimed to identify the microbiology quality of nasi jinggo that were sold in Denpasar Selatan area. From 48 population of nasi jinggo street vendor, 23 vendor was taken as samples. The microbiology quality being assessed was Total Plate Count (TPC, Total Coliform with MPN method and Escherichia coli content with Eosin Methylene Blue Agar as medium. Laboratory analysis showed that only 21,7% sample that met TPC standard with average value of 2,3 x 107 CFU/gram sample, only 8,7% that met Total Coliform standard with average value of 1,4 x 105 MPN/100 gram sample and 52,2% sample that met E. coli content standard with average value is 2,6 x 102 MPN/100 gram sample. It is recommended to the government to do quality check towards nasi jinggo in a regular basis as well as to provide education and assistance to nasi jinggo street vendors in order to improve the microbiology quality of food product and ensure food safety to the consumer.
Indira, P.; Selvam, B.; Thirusangu, K.
2018-04-01
Based on the works of Kotzig, Rosa and MacDougall et.al., we present algorithms and prove the existence of Z3-vertex magic total labeling and Z3-edge magic total labeling for the extended duplicate graph of quadrilateral snake.
Kooistra, B.W.; Willems, W.J.H.; Lemmens, E.; Hartel, B.P.; Bekerom, M.P. van den; Deurzen, D.F.P. van
2017-01-01
BACKGROUND: Compared with total shoulder arthroplasty (TSA), total shoulder surface replacement (TSSR) may offer the advantage of preservation of bone stock and shorter surgical time, possibly at the expense of glenoid component positioning and increasing lateral glenohumeral offset. We hypothesized
Expandable Total Humeral Replacement in a Child with Osteosarcoma
Directory of Open Access Journals (Sweden)
Eric R. Henderson
2015-01-01
Full Text Available Case. A right-handed 8-year-old female patient presented with a conventional, high-grade osteosarcoma involving her right humerus; through-shoulder amputation was recommended. After consultation, total humerus resection with expandable, total humeral endoprosthesis reconstruction was performed with a sleeve to encourage soft-tissue ingrowth. At three-year follow-up she has received one lengthening procedure and her functional scores are excellent. Conclusion. Total humeral resection and replacement in the pediatric population are rare and although early reports of expandable total humeral endoprosthesis outcomes demonstrate high failure rates, this patient’s success indicates that expandable total humeral replacement is a viable option.
Zhao, Chang-ling; Yang, Sheng-chao; Chen, Zhong-jian; Shen, Yong; Wei, Fu-gang; Wang, Wu; Long, Ting-ju
2014-10-01
The contents of total anthocyanins and total saponins as well as the composition of saponin monomers of Purple and Green Notoginseng Radix et Rhizoma were studied to compare the medicinal quality and commercial values. Three-year-old Notoginseng Radix et Rhizoma was selected as the research materials. The contents of total anthocyanins and total saponins were determined by spectrophotometry. The compositions of saponin monomers were monitored by HPLC. The significance of content differences was determined by variance analysis. The contents of total anthocyanins and total saponins of Purple Notoginseng Radix et Rhizomawere about 204.85% and 33.86% higher than those of Green Notoginseng Radix et Rhizoma respectively. The Purple and Green Notoginseng Radix et Rhizoma both contained five saponin monomers whose contents were as follows: ginsenoside Rg1 > ginsenoside Rb1 > notoginsenoside R1 > ginsenoside Rd > ginsenoside Re. The contents of notoginsenoside R1, ginsenoside Rd and ginsenoside Re of Purple Notoginseng Radix et Rhizoma were about 16.03%, 10.83% and 5.39% higher than those of Green Notoginseng Radix et Rhizoma respectively. However, the contents of ginsenoside Rg1 and ginsenoside Rb1 of Green Notoginseng Radix et Rhizoma were about 0.93% and 3.33% higher than those of Purple Notoginseng Radix et Rhizoma respectively. With respect to Green Notoginseng Radix et Rhizoma, the increase of the total anthocyanins in Purple Notoginseng Radix et Rhizoma reached a significant level, but the increases of total saponins, notoginsenoside R1, ginsenoside Rd and ginsenoside Re and the decreases of ginsenoside Rg1 and ginsenoside Rb1 did not. The total anthocyanins accumulation in Notoginseng Radix et Rhizoma implies the content increases of the total saponins, notoginsenoside R1, ginsenoside Rd and ginsenoside Re, and the slight decreases of ginsenoside Rg1 and ginsenoside Rb1 contents; but the type and relative contents of saponin monomers remain unchanged. The medicinal
Hakan Kalaycı; Mete Gürol Uğur; Ebru Öztürk; Özcan Balat; Özcan Erel
2011-01-01
OBJECTIVE: To measure the levels of individual antioxidant components of pregnants with preterm labor to evaluate their total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI). STUDY DESIGN: Prospectively-controlled 31 pregnants with a diagnosis of preterm labor (group Ι) and 32 controls (group ΙΙ) were evaluated for demographic data, general and obstetrical physical examination, obstetrical sonography, and routine laboratory tests. TAS, TOS and OSI leve...
[Eleven-Year Experience with Total Ankle Arthroplasty].
Popelka, S; Sosna, A; Vavřík, P; Jahoda, D; Barták, V; Landor, I
2016-01-01
PURPOSE OF THE STUDY Total joint replacement is one of the options in surgical treatment of advanced ankle arthritis. It allows the ankle to remain mobile but, unfortunately, it does not provide the same longevity as total knee or hip replacements. Therefore, decisions concerning the kind of treatment are very individual and depend on the clinical status and opinion of each patient. MATERIAL AND METHODS A total of 132 total ankle replacements were carried out in the period from 2004 to 2015. The prostheses used included the Ankle Evolutive System (AES) in 52 patients, Mobility Total Ankle System (DePuy) in 24 patients and, recently, Rebalance Total Ankle Replacement implant in 53 patients. Three patients allergic to metal received the Taric prosthesis. Revision arthroplasty using the Hintegra prosthesis was carried out in four patients. The outcome of arthroplasty was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. Indications for total ankle arthroplasty included post-traumatic arthritis in 83 patients, rheumatoid arthritis in 37 and primary arthritis in 12 patients. There were 78 women and 54 men, with an average age of 55.6 years at the time of surgery. RESULTS The average follow-up was 6.1 years (1-11 years). The average AOFAS score of the whole group increased from 33.2 before surgery to 82.5 after it. The primary indication had an important role. Arthroplasty outcomes were poorer in patients with post-traumatic arthritis than in those with rheumatoid arthritis or primary arthritis. In patients with post-traumatic arthritis, the average AOFAS score rose to 78.6 due to restricted motion of the ankle, and some patients continued to have pain when walking. The average AOFAS score in a total of 49 patients who had rheumatoid arthritis or primary arthritis reached a value of 86.4. Post-operative complications were recorded in ten patients (7.6%) in whom part of the wound was healing by second intention. Ossification was also a
Total cross sections for electron scattering by He
International Nuclear Information System (INIS)
De Heer, F.J.; Jansen, R.H.J.
1977-01-01
A set of total cross sections for scattering of electrons by He has been evaluated over the energy range of zero to 3000 eV by means of the analysis of experiments and theories on total cross sections for elastic scattering, ionisation and excitation, and on differential cross sections for elastic and inelastic scattering. Between 0 and 19.8 eV, where no inelastic processes occur, the total cross sections for scattering are equal to those for elastic scattering. Above 19.8 eV total cross sections for scattering of electrons have been evaluated by adding those for ionisation, excitation and elastic scattering. The total cross sections thus obtained are probably accurate to about 5% over a large part of the energy range. They appear to be in very good agreement with the recent experimental results of Blaauw et al. (J. Phys. B.; 10:L299 (1977)). The present results have already proved useful for application in the dispersion relation for forward scattering in electron-helium collisions. (author)
Total and ionization cross sections of electron scattering by fluorocarbons
International Nuclear Information System (INIS)
Antony, B K; Joshipura, K N; Mason, N J
2005-01-01
Electron impact total cross sections (50-2000 eV) and total ionization cross sections (threshold to 2000 eV) are calculated for typical plasma etching molecules CF 4 , C 2 F 4 , C 2 F 6 , C 3 F 8 and CF 3 I and the CF x (x 1-3) radicals. The total elastic and inelastic cross sections are determined in the spherical complex potential formalism. The sum of the two gives the total cross section and the total inelastic cross section is used to calculate the total ionization cross sections. The present total and ionization cross sections are found to be consistent with other theories and experimental measurements, where they exist. Our total cross section results for CF x (x = 1-3) radicals presented here are first estimates on these species
International Nuclear Information System (INIS)
Roushdy, H.; El-Husseini, M.; Saleh, F.
1986-01-01
The effect of gamma-irradiation on plasma total protein nitrogen and urinary total nitrogen was studied in the desert rodent, psammomy obesus obesus and albino rats subjected to dietary protein deficiency. In albino rats kept on high protein diet, the radiation syndrome resulted in urine retention, while in those kept on non-protein diet, such phenomenon was recorded only with the high radiation level of 1170r. Radiation exposure to 780 and 1170r caused remarkable diuresis in psammomys obesus obesus whereas they induced significant urine retention in albino rats. The levels of plasma total protein nitrogen and urinary total nitrogen were higher in albino rats maintained on high protein diet than in those kept on non-protein diet. Radiation exposure caused an initial drop in plasma total protein nitrogen concentration, concomitant with an initial rise in total urinary nitrogen, radiation exposure of psammomys obesus obesus caused significant increase in the levels of plasma protein nitrogen and urinary total nitrogen. Psammomys obesus obesus seemed to be more affected by radiation exposure than did the albino rats
Physical activity of elderly patients after total hip arthroplasty.
Cukras, Zbigniew; Praczko, Katarzyna; Kostka, Tomasz; Jegier, Anna
2007-01-01
Total hip arthroplasty (THA) is the most common method of treatment of severe hip osteoarthritis. There is little data concerning the physical activity of total hip arthroplasty patients in Poland and investigations to explore this area are useful. The aim of the study was to describe the post-operative physical activity of total hip arthroplasty patients. A total of 146 adult people were examined, among which 28 men and 41 women had undergone total hip arthroplasty due to primary osteoarthritis of the hip, while another 32 men and 41 women matched for age who had not undergone hip surgery for osteoarthritis served as controls. The physical activity of study participants was assessed with the 7-Day Physical Activity Recall Questionnaire. All participants were also asked about the type and amount of physical activity they engaged in to maintain good health. Physical activity measured as the total amount of calories expended through physical activity per week was similar in the post-THA patients compared to the controls. The only differences were a smaller amount of calories expended during low-intensity physical activity by men after total hip arthroplasty compared to men who had not undergone surgery for osteoarthritis and a smaller amount of calories expended through high-intensity physical activity by women after total hip arthroplasty compared to female controls. The kinds of recreational physical activity most commonly practised by patients a mean of two years after total hip arthroplasty were marching, bicycling and general body conditioning exercises (usually the continuation of exercises recommended during post-operative rehabilitation). The percentage of post-THA patients undertaking physical activity for the prevention of non-communicable diseases was low. Physical activity should be more effectively encouraged in patients after total hip arthroplasty.
The "Total Immersion" Meeting Environment.
Finkel, Coleman
1980-01-01
The designing of intelligently planned meeting facilities can aid management communication and learning. The author examines the psychology of meeting attendance; architectural considerations (lighting, windows, color, etc.); design elements and learning modes (furniture, walls, audiovisuals, materials); and the idea of "total immersion meeting…
DEFF Research Database (Denmark)
Cordtz, Rene Lindholm; Zobbe, Kristian; Højgaard, Pil
2018-01-01
OBJECTIVES: To investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients...
The total collision cross section in the glory region
International Nuclear Information System (INIS)
Biesen, J.J.H. van den.
1982-01-01
Chapter 1 presents a calculation of approximate total cross sections in the glory region from noble gas potentials. The relations between the main features of the total cross section and the properties of the potential to which these are sensitive are extensively investigated in chapter II. A beam apparatus has been developed, which allows for accurate measurements on the total cross section. All effects due to the finite angular and velocity resolution of the apparatus can be eliminated from the data to yield actual total cross sections as a function of the relative velocity. This facilitates a comparison to total cross sections predicted by potentials available in the literature. A brief description of the apparatus and of the data reduction is given in chapter III. The total cross section data obtained for various noble gas combinations are presented and analysed in chapter IV, where also a large number of potentials proposed in the literature is tested. In chapter V the quenching of the glories in the case of a non-spherical interaction is analysed. Subsequently, total cross section data for some atom-molecule systems are discussed. (Auth.)
Total quality management analysis in printing industry | Ching ...
African Journals Online (AJOL)
Total quality management analysis in printing industry. ... Journal of Fundamental and Applied Sciences ... The organization is suggested to implement Total Quality Management (TQM) in order to improve the quality of the products and hence ...
Severe Heterotopic Ossification following Total Knee Replacement
Directory of Open Access Journals (Sweden)
Alexander L. Dodds
2014-01-01
Full Text Available Although the incidence of minor heterotopic ossification is probably higher than what is usually expected, severe heterotopic ossification (HO is an extremely rare event following total knee replacement surgery. We present the case of a 66-year-old woman who initially had achieved an excellent range of motion following bilateral uncemented rotating platform total knee replacement, before presenting with pain and loss of range of motion at 2 months after surgery. Severe HO was diagnosed on X-rays. Treatment consisted of nonoperative measures only, including physiotherapy with hydrotherapy and anti-inflammatories. She eventually regained her range of motion when seen at 8 months after operation. This case illustrates that nonoperative treatment without the use of radiotherapy or surgery can be used to safely resolve stiffness caused by HO after total knee replacement.
Multi sensor reanalysis of total ozone
Directory of Open Access Journals (Sweden)
R. J. van der A
2010-11-01
Full Text Available A single coherent total ozone dataset, called the Multi Sensor Reanalysis (MSR, has been created from all available ozone column data measured by polar orbiting satellites in the near-ultraviolet Huggins band in the last thirty years. Fourteen total ozone satellite retrieval datasets from the instruments TOMS (on the satellites Nimbus-7 and Earth Probe, SBUV (Nimbus-7, NOAA-9, NOAA-11 and NOAA-16, GOME (ERS-2, SCIAMACHY (Envisat, OMI (EOS-Aura, and GOME-2 (Metop-A have been used in the MSR. As first step a bias correction scheme is applied to all satellite observations, based on independent ground-based total ozone data from the World Ozone and Ultraviolet Data Center. The correction is a function of solar zenith angle, viewing angle, time (trend, and effective ozone temperature. As second step data assimilation was applied to create a global dataset of total ozone analyses. The data assimilation method is a sub-optimal implementation of the Kalman filter technique, and is based on a chemical transport model driven by ECMWF meteorological fields. The chemical transport model provides a detailed description of (stratospheric transport and uses parameterisations for gas-phase and ozone hole chemistry. The MSR dataset results from a 30-year data assimilation run with the 14 corrected satellite datasets as input, and is available on a grid of 1× 1 1/2° with a sample frequency of 6 h for the complete time period (1978–2008. The Observation-minus-Analysis (OmA statistics show that the bias of the MSR analyses is less than 1% with an RMS standard deviation of about 2% as compared to the corrected satellite observations used.
Climate Change and Tropical Total Lightning
Albrecht, R.; Petersen, W.; Buechler, D.; Goodman, S.; Blakeslee, R.; Christian, H.
2009-01-01
While global warming is regarded as a fact by many in the scientific community, its future impact remains a challenge to be determined and measured. The International Panel on Climate Change (IPCC) assessment report (IPCC, 2007) shows inconclusive answers on global rainfall trends and general agreement on a future drier climate with increased global warming. The relationship between temperature, humidity and convection is not linear and is strongly dependent on regional scale features, such as topography and land cover. Furthermore, the relationship between convective lightning production (thunderstorms) and temperature is even more complicated, being subjected to the cloud dynamics and microphysics. Total lightning (intracloud and cloud-to-ground) monitoring is a relatively new field of observation. Global and tropical total lightning began to be more extensively measured by satellites in the mid 90s. In this scope, the Lightning Imaging Sensor (LIS) onboard of the Tropical Rainfall Measurement Mission (TRMM) has been operational for over 11 years. Here we address total lightning trends observed by LIS from 1998 to 2008 in different temporal (annual and seasonal) and spatial (large and regional) scales. The observed 11-year trends are then associate to different predicted/hypothesized climate change scenarios.
The error in total error reduction.
Witnauer, James E; Urcelay, Gonzalo P; Miller, Ralph R
2014-02-01
Most models of human and animal learning assume that learning is proportional to the discrepancy between a delivered outcome and the outcome predicted by all cues present during that trial (i.e., total error across a stimulus compound). This total error reduction (TER) view has been implemented in connectionist and artificial neural network models to describe the conditions under which weights between units change. Electrophysiological work has revealed that the activity of dopamine neurons is correlated with the total error signal in models of reward learning. Similar neural mechanisms presumably support fear conditioning, human contingency learning, and other types of learning. Using a computational modeling approach, we compared several TER models of associative learning to an alternative model that rejects the TER assumption in favor of local error reduction (LER), which assumes that learning about each cue is proportional to the discrepancy between the delivered outcome and the outcome predicted by that specific cue on that trial. The LER model provided a better fit to the reviewed data than the TER models. Given the superiority of the LER model with the present data sets, acceptance of TER should be tempered. Copyright © 2013 Elsevier Inc. All rights reserved.
Paulson, Anthony J.; Conn, Kathleen E.; DeWild, John F.
2013-01-01
Previous investigations examined sources and sinks of mercury to Sinclair Inlet based on historic and new data. This included an evaluation of mercury concentrations from various sources and mercury loadings from industrial discharges and groundwater flowing from the Bremerton naval complex to Sinclair Inlet. This report provides new data from four potential sources of mercury to Sinclair Inlet: (1) filtered and particulate total mercury concentrations of creek water during the wet season, (2) filtered and particulate total mercury releases from the Navy steam plant following changes in the water softening process and discharge operations, (3) release of mercury from soils to groundwater in two landfill areas at the Bremerton naval complex, and (4) total mercury concentrations of solids in dry dock sumps that were not affected by bias from sequential sampling. The previous estimate of the loading of filtered total mercury from Sinclair Inlet creeks was based solely on dry season samples. Concentrations of filtered total mercury in creek samples collected during wet weather were significantly higher than dry weather concentrations, which increased the estimated loading of filtered total mercury from creek basins from 27.1 to 78.1 grams per year. Changes in the concentrations and loading of filtered and particulate total mercury in the effluent of the steam plant were investigated after the water softening process was changed from ion-exchange to reverse osmosis and the discharge of stack blow-down wash began to be diverted to the municipal water-treatment plant. These changes reduced the concentrations of filtered and particulate total mercury from the steam plant of the Bremerton naval complex, which resulted in reduced loadings of filtered total mercury from 5.9 to 0.15 grams per year. Previous investigations identified three fill areas on the Bremerton naval complex, of which the western fill area is thought to be the largest source of mercury on the base
Asymptotic Behaviour of Total Generalised Variation
Papafitsoros, Konstantinos; Valkonen, Tuomo
2015-01-01
© Springer International Publishing Switzerland 2015. The recently introduced second order total generalised variation functional TGV2 β,α has been a successful regulariser for image processing purposes. Its definition involves two positive parameters α and β whose values determine the amount and the quality of the regularisation. In this paper we report on the behaviour of TGV2 β,α in the cases where the parameters α, β as well as their ratio β/α becomes very large or very small. Among others, we prove that for sufficiently symmetric two dimensional data and large ratio β/α, TGV2 β,α regularisation coincides with total variation (TV) regularization
Total shoulder replacement in rheumatoid arthritis
DEFF Research Database (Denmark)
Sneppen, O; Fruensgaard, S; Johannsen, Hans Viggo
1996-01-01
A prospective study of 62 Neer mark II total shoulder arthroplasties performed during the period from 1981 to 1990 on 51 patients with rheumatoid arthritis was undertaken to evaluate factors associated with component loosening and proximal humeral migration. Thirty-two (51%) showed proximal......, range of movement, abduction force, or function. The risk of clinical asymptomatic loosening is a relatively late complication that is eventually followed by pronounced bone destruction related to the loose component. Long-term radiographic control of total shoulders with rheumatoid arthritis...... is recommended. Hemiarthroplasty with a cemented humeral prosthesis may be a better treatment in the end stage of rheumatoid arthritis of the shoulder....
Failed total carpometacarpal joint prosthesis of the thumb
DEFF Research Database (Denmark)
Hansen, Torben Bæk; Homilius, Morten
2010-01-01
Total joint prosthesis in carpometacarpal joint arthritis of the thumb often fails. Loosening of the implant is often treated by resection arthroplasty, and we reviewed 10 patients, mean age 54 years (range 47-63) who were treated by resection arthroplasty after a failed total joint prosthesis. T...... in eight of 10 patients, but the mean Disabilities of the arm, shoulder, and hand (DASH) scores, self-reported pinch-grip-related function, and pain were comparable with our earlier published results with the Elektra carpometacarpal total joint prosthesis.......Total joint prosthesis in carpometacarpal joint arthritis of the thumb often fails. Loosening of the implant is often treated by resection arthroplasty, and we reviewed 10 patients, mean age 54 years (range 47-63) who were treated by resection arthroplasty after a failed total joint prosthesis....... The male:female ratio was 1:4 and the mean duration of observation 32 months (range 6-52). In three patients the revised implant was a MOJE uncemented carpometacarpal joint prosthesis and in seven patients an Elektra uncemented one. At follow-up grip strength was reduced to less than 90% of the other hand...
Directory of Open Access Journals (Sweden)
LĂPĂDUŞI MIHAELA LOREDANA
2013-12-01
Full Text Available act The analysis of the company’s expenses is mainly important in the management and control activity, because it highlights the way in which are used the resources (material, human, financial and the impact of their allocation on the company’s performances. The optimization of the level of costs or the their reduction, where it is possible, without affecting the quality of the products and working conditions of the activity, represent the primary objectives of the management of companies.[9] Expenses have been and will remain one of the key indicators of a company requiring continuous application of a control and monitoring mechanism because when it comes to expenses we never speak of their growth, but their reduction. This reduction is the main objective of any economic agent that will result in increasing the efficiency of the entire activity. The costs of a company reflect in cash the total consumption of material, human and financial resources used in manufacturing and selling of the products. The level, dynamics and structure of these expenses reflect synthetically the activity of industrial enterprises when using effectively the available resources. The purpose of this article is to analyze synthetically a company's expenses efficiency based on the efficiency ratio of total expenses at 1000 lei total revenues and the purpose of the article results in a set of conclusions that will highlight a number of important issues concerning the role and the importance of the efficiency of total expenses related to total revenue, as well as the result of the growth of the efficiency of total expenses.
Target dependence of K+-nucleus total cross sections
International Nuclear Information System (INIS)
Jiang, M.F.; Ernst, D.J.; Chen, C.M.
1995-01-01
We investigate the total cross section and its target dependence for K + -nucleus scattering using a relativistic momentum-space optical potential model which incorporates relativistically normalized wave functions, invariant two-body amplitudes, covariant kinematics, and an exact full-Fermi averaging integral. The definition of the total cross section in the presence of a Coulomb interaction is reviewed and the total cross section is calculated in a way that is consistent with what is extracted from experiment. In addition, the total cross sections for a nucleus and for the deuteron are calculated utilizing the same theory. This minimizes the dependence of the ratio of these cross sections on the details of the theory. The model dependence of the first-order optical potential calculations is investigated. The theoretical results are found to be systematically below all existing data
20 CFR 226.52 - Total annuity subject to maximum.
2010-04-01
... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Total annuity subject to maximum. 226.52... COMPUTING EMPLOYEE, SPOUSE, AND DIVORCED SPOUSE ANNUITIES Railroad Retirement Family Maximum § 226.52 Total annuity subject to maximum. The total annuity amount which is compared to the maximum monthly amount to...
Directory of Open Access Journals (Sweden)
Lopez Moris E
2016-06-01
Full Text Available Total thyroidectomy is a surgery that removes all the thyroid tissue from the patient. The suspect of cancer in a thyroid nodule is the most frequent indication and it is presume when previous fine needle puncture is positive or a goiter has significant volume increase or symptomes. Less frequent indications are hyperthyroidism when it is refractory to treatment with Iodine 131 or it is contraindicated, and in cases of symptomatic thyroiditis. The thyroid gland has an important anatomic relation whith the inferior laryngeal nerve and the parathyroid glands, for this reason it is imperative to perform extremely meticulous dissection to recognize each one of these elements and ensure their preservation. It is also essential to maintain strict hemostasis, in order to avoid any postoperative bleeding that could lead to a suffocating neck hematoma, feared complication that represents a surgical emergency and endangers the patient’s life.It is essential to run a formal technique, without skipping steps, and maintain prudence and patience that should rule any surgical act.
Total Synthesis of Adunctin B.
Dethe, Dattatraya H; Dherange, Balu D
2018-03-16
Total synthesis of (±)-adunctin B, a natural product isolated from Piper aduncum (Piperaceae), has been achieved using two different strategies, in seven and three steps. The efficient approach features highly atom economical and diastereoselective Friedel-Crafts acylation, alkylation reaction and palladium catalyzed Wacker type oxidative cyclization.
ISO 9000 and the total quality management models
Pacios Lozano, Ana Reyes
1997-01-01
Establishes the most outstanding differences between the ISO 9000 norms and total quality management as forms or manners of managing quality used in some information services. Compares two models of total quality: European Foundation far Quality Management and Malcolm Baldrige Awards.
Assay development status report for total cyanide
International Nuclear Information System (INIS)
Simpson, B.C.; Jones, T.E.; Pool, K.H.
1993-02-01
A validated cyanide assay that is applicable to a variety of tank waste matrices is necessary to resolve certain waste tank safety issues and for purposes of overall waste characterization. The target for this effort is an assay with an applicable range of greater than 1,000 ppM (0.10 wt%) total cyanide and a confidence level greater than 80%. Figure 1 illustrates the operating regime of the proposed cyanide assay method. The Assay Development Status Report for Total Cyanide will summarize the past experience with cyanide analyses on-tank waste matrices and will rate the status of the analytical methods used to assay total cyanide (CN - ion) in the tank waste matrices as acceptable or unacceptable. This paper will also briefly describe the current efforts for improving analytical resolution of the assays and the attempts at speciation
Two-channel totally asymmetric simple exclusion processes
International Nuclear Information System (INIS)
Pronina, Ekaterina; Kolomeisky, Anatoly B
2004-01-01
Totally asymmetric simple exclusion processes, consisting of two coupled parallel lattice chains with particles interacting with hard-core exclusion and moving along the channels and between them, are considered. In the limit of strong coupling between the channels, the particle currents, density profiles and a phase diagram are calculated exactly by mapping the system into an effective one-channel totally asymmetric exclusion model. For intermediate couplings, a simple approximate theory, that describes the particle dynamics in vertical clusters of two corresponding parallel sites exactly and neglects the correlations between different vertical clusters, is developed. It is found that, similarly to the case of one-channel totally asymmetric simple exclusion processes, there are three stationary state phases, although the phase boundaries and stationary properties strongly depend on inter-channel coupling. Extensive computer Monte Carlo simulations fully support the theoretical predictions
Liu, Qiuliang; Geng, Peishuo; Shi, Longyan; Wang, Qi; Wang, Pengliang
2018-06-01
To compare the efficacy and safety of tranexamic acid and aminocaproic acid for reducing blood loss and transfusion requirements after total knee and total hip arthroplasty. We conduct electronic searches of Medline (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), ScienceDirect (1985-2017.11) and the Cochrane Library (1900-2017.11). The primary outcomes, including total blood loss, hemoglobin decline and transfusion requirements. Secondary outcomes include length of hospital stay and postoperative complications such as the incidence of deep vein thrombosis and pulmonary embolism. Each outcome is combined and calculated using the statistical software STATA 12.0. Fixed/random effect model is adopted based on the heterogeneity tested by I 2 statistic. A total of 1714 patients are analyzed across three randomized controlled trials (RCTs) and one non-RCT. The present meta-analysis reveals that TXA is associated with a significantly reduction of total blood loss and postoperative hemoglobin drop compared with EACA. No significant differences are identified in terms of transfusion rates, length of hospital stay, and the incidence of postoperative complications. Although total blood loss and postoperative hemoglobin drop are significant greater in EACA groups, there is no significant difference between TXA and EACA groups in terms of transfusion rates. Based on the current evidence available, higher quality RCTs are still required for further research. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
Studies towards a total synthesis of tagetitoxin
Mahoney, Brian
2017-01-01
Tagetitoxin was first isolated over thirty five years ago and a total synthesis has not been achieved to date. A vast amount of research has been carried out on the biological activity of tagetitoxin with hundreds of literature reports. However, very few papers have been published regarding the synthesis and within this thesis we will explore a number of synthetic pathways some towards tagetitoxin. The first chapter reviews previous developments regarding the total synthesis of...
Mehmet, Rifaioglu Murat; Rustu, Yalcinkaya Fatih; Hanefi, Bayarogullari; Mursel, Davarci; Fusun, Aydogan; Mehmet, Inci
2013-01-01
Percutaneous nephrolithotomy (PNL) is an effective procedure for the treatment of patients with large or complex stones. PNL is challenging in anomalous kidneys, certain patients, such as those with renal ectopia. It is unable to undergo PNL in conventional technique safely in these cases. We presented a case report of laparoscopic-assisted PNL via direct pelvic puncture in a pelvic kidney stone and discussed previous published literature. A 49-year-old man presented with right lower quadrant pain and hematuria. Intravenous pyelography and three-dimensional computerized tomography revealed an opaque 2.7 × 1.7 cm pelvis renalis stone in a right side ectopic pelvic kidney with grade III hydronephrosis. Laparoscopic-assisted tubeless PNL was performed to remove the calculus. Laparoscopic-assisted PNL as a minimally invasive therapy in ectopic kidney has many advantages. Our case showed that, in pelvic ectopic kidney with pelvic stones greater than 1.5 cm in size, laparoscopic-assisted PNL via direct pelvis puncture is a safe and effective technique.
P.T.P.W. Burgers (Paul); M. Hoogendoorn (Martine); E.A.C. Van Woensel; R.W. Poolman (Rudolf); M. Bhandari (Mohit); P. Patka (Peter); E.M.M. van Lieshout (Esther)
2016-01-01
textabstractSummary: The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost
Overview of Total Group financial year
International Nuclear Information System (INIS)
Anon.
2003-01-01
In 2004, the combination of very high crude oil prices with a strong rise of refining margins, and in the second half of 2004 of the start off again of the rise of petrochemical margins, has led Total Group to reach a record level of 9.04 billion euros for its net adjusted result, which represents a 23% rise with respect to 2003, and this despite a fall of the Dollar exchange rate. Total has also carried on its downstream strategy of natural gas production. This strategy aims at facilitating and optimizing the access to its present day and future productions and reserves, not only to traditional markets but also to markets opened to world competition. (J.S.)
Response Surface Optimized Extraction of Total Triterpene Acids ...
African Journals Online (AJOL)
Purpose: To optimize extraction of total triterpene acids from loquat leaf and evaluate their in vitro antioxidant activities. Methods: The independent variables were ethanol concentration, extraction time, and solvent ratio, while the dependent variable was content of total triterpene acids. Composite design and response ...
Total Addiction The Life of an Eclipse Chaser
Russo, Kate
2012-01-01
Seeing a total solar eclipse is often described as a once-in-a-lifetime experience. However, for many who have experienced totality, once-in-a-lifetime is simply not enough. They want more, and are willing to go to great lengths often at great expense to repeat the experience. What is it like to experience totality? What is it about the experience that motivates these eclipse chasers? Is there an eclipse chaser personality? Can eclipse chasing actually be described as an addiction? This book describes the people who dedicate their lives to chasing their dream.
What is Total Quality Management?
Bryan, William A.
1996-01-01
Provides a general overview of Total Quality Management (TQM) and explains why there is pressure for change in higher education institutions. Defines TQM and the various themes, tools, and beliefs that make it different from other management approaches. Presents 14 principles and how they might be applied to student affairs. (RJM)
A totally diverting loop colostomy.
Merrett, N. D.; Gartell, P. C.
1993-01-01
A technique is described where the distal limb of a loop colostomy is tied with nylon or polydioxanone. This ensures total faecal diversion and dispenses with the supporting rod, enabling early application of stoma appliances. The technique does not interfere with the traditional transverse closure of a loop colostomy. PMID:8379632
Ethical Analysis of Withdrawing Total Artificial Heart Support.
DeMartino, Erin S; Wordingham, Sara E; Stulak, John M; Boilson, Barry A; Fuechtmann, Kayla R; Singh, Nausheen; Sulmasy, Daniel P; Pajaro, Octavio E; Mueller, Paul S
2017-05-01
To describe the characteristics of patients who undergo withdrawal of total artificial heart support and to explore the ethical aspects of withdrawing this life-sustaining treatment. We retrospectively reviewed the medical records of all adult recipients of a total artificial heart at Mayo Clinic from the program's inception in 2007 through June 30, 2015. Management of other life-sustaining therapies, approach to end-of-life decision making, engagement of ethics and palliative care consultation, and causes of death were analyzed. Of 47 total artificial heart recipients, 14 patients or their surrogates (30%) requested withdrawal of total artificial heart support. No request was denied by treatment teams. All 14 patients were supported with at least 1 other life-sustaining therapy. Only 1 patient was able to participate in decision making. It is widely held to be ethically permissible to withdraw a life-sustaining treatment when the treatment no longer meets the patient's health care-related goals (ie, the burdens outweigh the benefits). These data suggest that some patients, surrogates, physicians, and other care providers believe that this principle extends to the withdrawal of total artificial heart support. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
21 CFR 862.1110 - Bilirubin (total or direct) test system.
2010-04-01
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bilirubin (total or direct) test system. 862.1110... Systems § 862.1110 Bilirubin (total or direct) test system. (a) Identification. A bilirubin (total or direct) test system is a device intended to measure the levels of bilirubin (total or direct) in plasma...
Ureteral stent retrieval using the crochet hook technique in females.
Directory of Open Access Journals (Sweden)
Takashi Kawahara
Full Text Available INTRODUCTION: We developed a method for ureteral stent removal in female patients that requires no cystoscopy or fluoroscopic guidance using a crochet hook. In addition, we also investigated the success rate, complications and pain associated with this procedure. METHODS: A total of 40 female patients (56 stents underwent the removal of ureteral stents. All procedures were carried out with the patients either under anesthesia, conscious sedation, or analgesic suppositories as deemed appropriate for each procedure including Shock Wave Lithotripsy (SWL, Ureteroscopy (URS, Percutaneous Nephrolithotomy (PCNL, and ureteral stent removal. At the time of these procedures, fluoroscopy and/or cystoscopy were prepared, but they were not used unless we failed to successfully remove the ureteral stent using the crochet hook. In addition, matched controls (comprising 50 stents which were removed by standard ureteral stent removal using cystoscopy were used for comparison purposes. RESULTS: A total of 47 of the 56 stents (83.9% were successfully removed. In addition, 47 of 52 (90.4% were successfully removed except for two migrated stents and two heavily encrusted stents which could not be removed using cystoscopy. Ureteral stent removal using the crochet hook technique was unsuccessful in nine patients, including two encrustations and two migrations. Concerning pain, ureteral stent removal using the crochet hook technique showed a lower visual analogue pain scale (VAPS score than for the standard technique using cystoscopy. CONCLUSIONS: Ureteral stent removal using a crochet hook is considered to be easy, safe, and cost effective. This technique is also easy to learn and is therefore considered to be suitable for use on an outpatient basis.
Fast magnetic resonance imaging based on high degree total variation
Wang, Sujie; Lu, Liangliang; Zheng, Junbao; Jiang, Mingfeng
2018-04-01
In order to eliminating the artifacts and "staircase effect" of total variation in Compressive Sensing MRI, high degree total variation model is proposed for dynamic MRI reconstruction. the high degree total variation regularization term is used as a constraint to reconstruct the magnetic resonance image, and the iterative weighted MM algorithm is proposed to solve the convex optimization problem of the reconstructed MR image model, In addtion, one set of cardiac magnetic resonance data is used to verify the proposed algorithm for MRI. The results show that the high degree total variation method has a better reconstruction effect than the total variation and the total generalized variation, which can obtain higher reconstruction SNR and better structural similarity.
Total Quality Service and the Business College
James Perotti
1995-01-01
Moving a business college to commit to a total quality service approach is much more difficult than the literature suggests. The commitment to customer satisfaction is the essential focus of total quality service. It is unlikely to occur in business colleges. While small incremental change is readily possible, the values and culture of the faculty and administration prevent the requisite acceptance by the faculty of students as their customers, and acceptance of the faculty as customers of th...
Total Analysis System for Ship Structural Strength
Takuya, Yoneya; Hiroyuki, Kobayashi; Abdul M., Rahim; Yoshimichi, Sasaki; Masaki, Irisawa; Technical Investigation and Information Department, Research Center; Technical Investigation and Information Department, Research Center; Singapore Office; Technical Investigation and Information Department, Research Center; Technical Investigation and Information Department, Research Center
2001-01-01
This paper outlines a total analysis system for ship hull structures, which integrates a wide variety of analysis functions to realise practical applications of rational methods for assessing ship structural strength. It is based on direct calculation of wave-induced loads as well as three-dimensional structural analysis of an entire-ship or hold structure. Three major analysis functions of the total system are ship motion and wave load analysis, ship structural analysis and statistical analy...
Pancreas preserving total duodenectomy for complex duodenal injury.
Wig, Jai Dev; Kudari, Ashwinikumar; Yadav, Thakur Deen; Doley, Rudra Prasad; Bharathy, Kishore Gurumoorthy Subramanya; Kalra, Naveen
2009-07-06
To assess the feasibility and safety of a pancreas-preserving total duodenectomy in the management of severe duodenal injury caused by abdominal trauma. Two patients with both extensive injury of the duodenum and diffuse peritonitis underwent pancreas preserving total duodenectomy at our tertiary care centre. These two young male patients (age 20 and 22 years) presented 2 days and 6 hours respectively following blunt abdominal trauma. The duodenum was almost completely separated from the pancreas. Ampulla was seen as a button on the pancreas. Following total duodenectomy, reconstruction was performed by suturing the jejunum to the head of the pancreas anteriorly and posteriorly away from the ampulla (invagination of the pancreas into the jejunum). There were no complications attributable to the procedure. Both patients are well on follow up. A Pancreas-preserving total duodenectomy offers a safe alternative to the Whipple procedure in managing complex duodenal injury. This procedure avoids unnecessary resection of the adjacent pancreas and anastomosis to undilated hepatic and pancreatic ducts.
THE EXISTING BARRIERS IN IMPLEMENTING TOTAL QUALITY MANAGEMENT
Directory of Open Access Journals (Sweden)
Salagean Horatiu Catalin
2014-07-01
Full Text Available In the current market economy, companies are constantly struggling to achieve a sustained competitive advantage that will enable them to improve performance, which results in increased competitiveness, and of course, profit. Among the few competitive advantages that can become sustainable competitive advantages, quality plays a crucial role. Recent research shows that about 90% of buyers in the international market, consider quality as having at least equal importance with price in making the decision to purchase. In the opinion of some specialists in economic theory and practice, total quality refers to the holistic approach of quality, which actually means, addressing all aspects of economic and social development and technical of quality. Thus, the holistic approach of quality at organisation-wide involves procedural approach of quality, in this respect, the study focuses on this type of quality approach, i.e. the procedural approach, taking into account the strategic aspects of the continuous improvement of quality, which means in fact, the quality management. Total Quality Management is seen as a way to transform the economies of some countries to be more competitive than others. However, Total Quality Management brings not and will not produce results overnight, it is not a panacea for all the problems facing the organization. Total Quality Management requires a change in organizational culture, which must focus on meeting customer expectations and increasing the involvement of all employees to meet this objective, as an expression of the ethics of continuous improvement. In general, research on quality aiming identify why an organization should adopt the principles of total quality management, but attempts to identify the failing companies' attempts to implement total quality management principles are not so visible. Concerns companies to introduce quality management systems are becoming more pronounced, therefore, in this study we try to
Total synthesis of nepetoidin B
The total synthesis of nepetoidin B (the 2-(3,4-dihydroxyphenyl)ethenyl ester of 3-(3,4-dihydroxy¬phenyl)-2-propenoic acid) has been achieved in two steps from commercially available 1,5-bis(3,4-dimethoxyphenyl)-1,4-pentadien-3-one. Tetramethylated nepetoidin B was prepared directly by Baeyer-Villig...
First total synthesis of Boehmenan
Indian Academy of Sciences (India)
The first total synthesis of dilignan Boehmenan has been achieved. A biomimetic oxidative coupling of the ferulic acid methyl ester in the presence of silver oxide is the crucial step in the synthesis sequence, generating the dihydrobenzofuran skeleton. Hydroxyl group was protected with DHP and reducted with LiAlH4 to ...
Rozell, Joshua C; Courtney, Paul M; Dattilo, Jonathan R; Wu, Chia H; Lee, Gwo-Chin
2016-09-01
Alternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS), complications, and readmissions. If not adjusted for patient comorbidities, they may encourage restrictive access to health care. We prospectively evaluated 802 consecutive primary total hip arthroplasty and total knee arthroplasty patients evaluating comorbidities associated with increased LOS and readmissions. During this 9-month period, 115 patients (14.3%) required hospitalization >3 days and 16 (1.99%) were readmitted within 90 days. Univariate analysis demonstrated that preoperative narcotic use, heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and liver disease were more likely to require hospitalization >3 days. In multivariate analysis, CKD and COPD were independent risk factors for LOS >3 days. A Charlson comorbidity index >5 points was associated with increased LOS and readmissions. Patients with CKD, COPD, and Charlson comorbidity index >5 points should not be included in alternative payment model for THA and TKA. Copyright © 2016 Elsevier Inc. All rights reserved.
Total Cross Sections at High Energies An update
Fazal-e-Aleem, M; Alam, Saeed; Qadee-Afzal, M
2002-01-01
Current and Future measurements for the total cross sections at E-811, PP2PP, CSM, FELIX and TOTEM have been analyzed using various models. In the light of this study an attempt has been made to focus on the behavior of total cross section at very high energies.
Total Radiosynthesis: Thinking outside "the box".
Liang, Steven H; Vasdev, Neil
2015-09-01
The logic of total synthesis transformed a stagnant state of medicinal and synthetic organic chemistry when there was a paucity of methods and reagents to synthesize drug molecules and/or natural products. Molecular imaging by positron emission tomography (PET) is now experiencing a renaissance in the way radiopharmaceuticals for molecular imaging are synthesized, however, a paradigm shift is desperately needed in the discovery pipeline to accelerate in vivo imaging studies. A significant challenge in radiochemistry is the limited choice of labeled reagents (or building blocks) available for the synthesis of novel radiopharmaceuticals with the most commonly used short-lived radionuclides carbon-11 ( 11 C; half-life ~20 minutes) and fluorine-18 ( 18 F; half-life ~2 hours). In fact, most drugs cannot be labeled with 11 C or 18 F due to a lack of efficient and diverse radiosynthetic methods. In general, routine radiopharmaceutical production relies on the incorporation of the isotope at the last or penultimate step of synthesis, ideally within one half-life of the radionuclide, to maximize radiochemical yields and specific activities thereby reducing losses due to radioactive decay. Reliance on radiochemistry conducted within the constraints of an automated synthesis unit ("box") has stifled the exploration of multi-step reactions with short-lived radionuclides. Radiopharmaceutical synthesis can be transformed by considering logic of total synthesis to develop novel approaches for 11 C- and 18 F-radiolabeling complex molecules via retrosynthetic analysis and multi-step reactions. As a result of such exploration, new methods, reagents and radiopharmaceuticals for in vivo imaging studies are discovered. A new avenue to develop radiotracers that were previously unattainable due to the lack of efficient radiosynthetic methods is necessary to work towards our ultimate, albeit impossible goal - the concept we term total radiosynthesis - to radiolabel virtually any molecule
Directory of Open Access Journals (Sweden)
N. L. Logvinov
2014-01-01
Full Text Available ABSTRACT. The goal of the article was to review Genesis II Total Knee System use according to AoA NJRR report. Genesis II has been widely used in Russian Federation since 1996. The AoA NJRR report was studied in order to learn connection between number of revision procedures and surgeon’s skills or type of the System, adequate choice among cemented, cementless and hybrid fixation, number of surgeries using Genesis II Total Knee System annually, average revision rate for Genesis II and early cumulative revision rate.CONCLUSION. The systematic study of AoA NJRR allows us to make a conclusion that cemented fixation of Genesis II Total Knee System is mostly effective, and this fact is confirmed by domestic experience.
Chambolle's Projection Algorithm for Total Variation Denoising
Directory of Open Access Journals (Sweden)
Joan Duran
2013-12-01
Full Text Available Denoising is the problem of removing the inherent noise from an image. The standard noise model is additive white Gaussian noise, where the observed image f is related to the underlying true image u by the degradation model f=u+n, and n is supposed to be at each pixel independently and identically distributed as a zero-mean Gaussian random variable. Since this is an ill-posed problem, Rudin, Osher and Fatemi introduced the total variation as a regularizing term. It has proved to be quite efficient for regularizing images without smoothing the boundaries of the objects. This paper focuses on the simple description of the theory and on the implementation of Chambolle's projection algorithm for minimizing the total variation of a grayscale image. Furthermore, we adapt the algorithm to the vectorial total variation for color images. The implementation is described in detail and its parameters are analyzed and varied to come up with a reliable implementation.
Total antioxidant capacity in children with acute appendicitis.
Kaya, M; Boleken, M E; Kanmaz, T; Erel, O; Yucesan, S
2006-02-01
This study aimed to investigate antioxidant capacity by using a novel automated method in children with acute appendicitis. Blood samples were obtained from consecutive patients with acute appendicitis (appendicitis group, n = 12) and acute abdominal pain due to non surgical disease (non-appendicitis group, n = 11), and from patients with inguinal hernia (healthy group, n = 12) as the control group. At admission, total antioxidant capacity (TAC) levels of plasma were evaluated in all patients by a method recently developed by Erel. Four other major individual plasma antioxidant components, the levels of total protein, albumin, uric acid and bilirubin, were also evaluated. Total antioxidant capacity in patients with acute appendicitis was statistically compared with the two other groups. While the TAC level in the appendicitis group was significantly greater than in the non-appendicitis group, no significant difference was found in healthy groups (p 0.05, 1.94 +/- 0.38, 1.40 +/- 0.36, and 1.99 +/- 0.35 respectively). Individual components of total antioxidant capacity, i.e. total protein, albumin, uric acid and bilirubin concentrations, were also higher in the patients with acute appendicitis than those of the other two control groups. Our data show that children with acute appendicitis do not have deficient blood plasma antioxidant capacity. These results provide evidence that acute appendicitis results in more induction of antioxidative response than non-surgical diseases.
Acute tolerance of hyperfractionated accelerated total body irradiation
International Nuclear Information System (INIS)
Latz, D.; Schraube, P.; Wannenmacher, M.
1996-01-01
Background: Acute side effects of total body irradiation lead to intense molestations of the patients. Therefore, it is desirable to take measures to reduce these side effects. In a retrospective study the frequency on acute side effects of a hyperfractionated accelerated total body irradiation was assessed and compared to frequencies of other exposure schedules published in the literature. Additionally the influence of ondansetron on the frequency of nausea and vormiting was investigated. Patients and Method: From 1989 to 1992, 76 patients (47 male, 29 female; median age 38 years) underwent total body irradiation before autologeous bone marrow transplantation. They received 3 daily doses of 1.20 Gy each every 4 h on 4 successive days to a total dose of 14,40 Gy. Thirty-nine patients received 3x8 mg (daily, intravenous or per os) ondansetron during the whole course of irradiation. Results: The most relevant side effects were nausea and vomiting. Patients, who did not receive ondansetron (n=37) showed a nausea and emesis rate of 73%. With ondansetron (n=39) nausea and emesis were reduced to 38%. Also the grade of severity of these side effects was reduced. Conclusions: Ondansetron proved to be an effective medicament for relieving nausea and vormiting during total body irradiation. The results obtained are in concordance with those published in the literature. (orig.) [de
SORCE Level 3 Total Solar Irradiance Daily Average V016
National Aeronautics and Space Administration — The Total Solar Irradiance (TSI) data set SOR3TSID contains the total solar irradiance (a.k.a solar constant) data collected by the Total Irradiance Monitor (TIM)...
The Total Performance Scorecard: Case at UIN Syarif Hidayatullah Jakarta
Directory of Open Access Journals (Sweden)
Suhendra Suhendra
2016-10-01
Full Text Available This study aims to identify and analyse Total Human Resources Champions Management in relation to the Total Performance Scorecard. This study uses primary data by distributing questionnaires to the respondents, the 30 heads of department, 60 lecturers, 30 administrative staffs and 60 students of UIN Syarif Hidayatullah Jakarta. Partial Least Square (PLS had been used. Results from this study showed that all dimensions of Total Human Resources Champions Management (Human Resources Strategic Management, Infrastructure Management Firm, Management Employee Contribution, Management of Transformation and Changes, Spiritual and Campaign Management, Talent Management affected on Total Human Resources Champions Management, furthermore, Total Human Resources Champions Management has a significant positive effect on the Total Performance Scorecard course at UIN Syarif Hidayatullah Jakarta.DOI: 10.15408/etk.v15i2.3864
Establishing a total information management program
International Nuclear Information System (INIS)
Hegstrom, K.L.; Fisher, J.
1982-01-01
A total information management program manages documents for easy access and identifies data elements commonly found in all documents. The program thus links disparate documents by identifying information they share in common
Total knee arthroplasty in patients with a previous patellectomy.
Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor
2013-01-01
Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients.
Total Synthesis of Hyperforin.
Ting, Chi P; Maimone, Thomas J
2015-08-26
A 10-step total synthesis of the polycyclic polyprenylated acylphloroglucinol (PPAP) natural product hyperforin from 2-methylcyclopent-2-en-1-one is reported. This route was enabled by a diketene annulation reaction and an oxidative ring expansion strategy designed to complement the presumed biosynthesis of this complex meroterpene. The described work enables the preparation of a highly substituted bicyclo[3.3.1]nonane-1,3,5-trione motif in only six steps and thus serves as a platform for the construction of easily synthesized, highly diverse PPAPs modifiable at every position.
International Nuclear Information System (INIS)
2004-01-01
This report presents the activities and results of the Group Total-Fina-Elf for the year 2004. It brings information and economic data on the following topics: the corporate and business; the upstream activities with the reserves, the costs, standardized measure and changes of discounted future net cash flow,oil and gas acreage, drilling, liquefied natural gas, pipelines; downstream activities with refining and marketing maps, refinery, petroleum products, sales, retail gasoline outlets; chemicals with sales and operating income by sector, major applications, base chemicals and polymers, intermediates and performance polymers. (A.L.B.)
International Nuclear Information System (INIS)
2004-01-01
This 2003 annual report of the Group Total provides economical results and information of the society on the following topics: keys data, the corporate governance (Directors charter, board of directors, audit committee, nomination and remuneration committee, internal control procedures, compensation of directors and executive officers), the corporate social responsibility (environmental stewardship, the future of energy management, the safety enhancement, the human resources, ethics and local development), the investor relations, the management report, the upstream exploration and production, the downstream refining, marketing, trading and shipping, the chemicals and financial and legal information. (A.L.B.)
DEFF Research Database (Denmark)
Harsten, A; Kehlet, H; Toksvig-Larsen, S
2013-01-01
BACKGROUND: /st>This study was undertaken to compare the effects of general anaesthesia (GA) and spinal anaesthesia (SA) on the need for postoperative hospitalization and early postoperative comfort in patients undergoing fast-track total knee arthroplasty (TKA). METHODS: /st>One hundred and twenty....... Secondary outcome parameters included actual time of discharge, postoperative pain, intraoperative blood loss, length of stay in the Post Anaesthesia Care Unit, dizziness, postoperative nausea and vomiting, need for urinary catheterization and subject satisfaction. RESULTS: /st>GA resulted in shorter LOS...
Determination of ferrous and total iron in refractory spinels
Energy Technology Data Exchange (ETDEWEB)
Amonette, J.E. [Physical Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99352 (United States); Matyáš, J. [Material Science Department, Pacific Northwest National Laboratory, Richland, WA 99352 (United States)
2016-03-03
Accurate and precise determination of the redox state of iron (Fe) in spinels presents a significant challenge due to their refractory nature. The resultant extreme conditions needed to obtain complete dissolution generally oxidize some of the Fe(II) initially present and thus prevent the use of colorimetric methods for Fe(II) measurements. To overcome this challenge we developed a hybrid oxidimetric/colorimetric approach, using Ag(I) as the oxidimetric reagent for determination of Fe(II) and 1,10-phenanthroline as the colorimetric reagent for determination of total Fe. This approach, which allows determination of Fe(II) and total Fe on the same sample, was tested on a series of four geochemical reference materials and then applied to the analysis of Fe(Ni) spinel crystals isolated from simulated high-level-waste (HLW) glass and of several reagent magnetites. Results for the reference materials were in excellent agreement with recommended values, with the exception of USGS BIR-1, for which higher Fe(II) values and lower total Fe values were obtained. The Fe(Ni) spinels showed Fe(II) values at the detection limit (ca. 0.03 wt% Fe) and total Fe values higher than obtained by ICP-AES analysis after decomposition by lithium metaborate/tetraborate fusion. For the magnetite samples, total Fe values were in agreement with reference results, but a wide range in Fe(II) values was obtained indicating various degrees of conversion to maghemite. Formal comparisons of accuracy and precision were made with 13 existing methods. Accuracy for Fe(II) and total Fe was at or near the top of the group. Precision varied with the parameter used to measure it but was generally in the middle to upper part of the group for Fe(II) while that for total Fe ranged from the bottom of the group to near the top. - Highlights: • Refractory samples, such as spinels, are the most difficult for Fe redox analysis. • Oxidimetric(Ag{sup +})/colorimetric (phen) method allows analysis of a single
Total error vs. measurement uncertainty: revolution or evolution?
Oosterhuis, Wytze P; Theodorsson, Elvar
2016-02-01
The first strategic EFLM conference "Defining analytical performance goals, 15 years after the Stockholm Conference" was held in the autumn of 2014 in Milan. It maintained the Stockholm 1999 hierarchy of performance goals but rearranged them and established five task and finish groups to work on topics related to analytical performance goals including one on the "total error" theory. Jim Westgard recently wrote a comprehensive overview of performance goals and of the total error theory critical of the results and intentions of the Milan 2014 conference. The "total error" theory originated by Jim Westgard and co-workers has a dominating influence on the theory and practice of clinical chemistry but is not accepted in other fields of metrology. The generally accepted uncertainty theory, however, suffers from complex mathematics and conceived impracticability in clinical chemistry. The pros and cons of the total error theory need to be debated, making way for methods that can incorporate all relevant causes of uncertainty when making medical diagnoses and monitoring treatment effects. This development should preferably proceed not as a revolution but as an evolution.
The use of adaptive equipment following total knee replacement
McNaught, Jamie; Paul, Lorna
2015-01-01
Introduction: This study evaluates the need for adaptive equipment following total knee replacement. There are no recent studies to guide occupational therapists in the optimum time adaptive equipment is required following total knee replacement.\\ud \\ud Method: A non-experimental, concurrent mixed methods approach was used. The study population was patients attending for total knee replacement at a large general hospital. Outcome measures were the Oxford Knee Score, the United Kingdom Functio...
Total Quality Management as a Paradigm of Business Success
Directory of Open Access Journals (Sweden)
Luburić Radoica
2014-01-01
Full Text Available Total Quality Management denotes a path by which - both in a stable and a transitional environment, in a professional and scientific way and by applying a variety of methods and techniques, through constant improvements and involvement of all employees - one could get to a model that enables a simultaneous achievement of the top quality level on one hand, and the top management level, on the other. Total Quality Management is a paradigm of business success in the entire world because its set up, inter alia, improves internal functions of an organisation, instils confidence in customers and triggers improvement chain reactions with suppliers and stakeholders. Quality is the foundation and client orientation is the base of the entire concept of total quality management. Placing customers at the centre is the main idea behind the entire quality concept around which everything is built. Improving the capacity of an organization to understand and meet the actual customer needs, both stated and implied, is the main objective of the total quality management. Teamwork and team leadership play a specific role in the total quality management, top managers have the key responsibilities, and activities of the medium and lower level managers together with all employees are of immeasurable significance. Managing the teamwork within the total quality management is not only a requirement for its set up, development and implementation, but also for its survival. Total Quality Management is a managerial philosophy and a mode of running a business in order to achieve success.
Prevalence of Total Hip and Knee Replacement in the United States.
Maradit Kremers, Hilal; Larson, Dirk R; Crowson, Cynthia S; Kremers, Walter K; Washington, Raynard E; Steiner, Claudia A; Jiranek, William A; Berry, Daniel J
2015-09-02
Descriptive epidemiology of total joint replacement procedures is limited to annual procedure volumes (incidence). The prevalence of the growing number of individuals living with a total hip or total knee replacement is currently unknown. Our objective was to estimate the prevalence of total hip and total knee replacement in the United States. Prevalence was estimated using the counting method by combining historical incidence data from the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 1969 to 2010 with general population census and mortality counts. We accounted for relative differences in mortality rates between those who have had total hip or knee replacement and the general population. The 2010 prevalence of total hip and total knee replacement in the total U.S. population was 0.83% and 1.52%, respectively. Prevalence was higher among women than among men and increased with age, reaching 5.26% for total hip replacement and 10.38% for total knee replacement at eighty years. These estimates corresponded to 2.5 million individuals (1.4 million women and 1.1 million men) with total hip replacement and 4.7 million individuals (3.0 million women and 1.7 million men) with total knee replacement in 2010. Secular trends indicated a substantial rise in prevalence over time and a shift to younger ages. Around 7 million Americans are living with a hip or knee replacement, and consequently, in most cases, are mobile, despite advanced arthritis. These numbers underscore the substantial public health impact of total hip and knee arthroplasties. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
Revision Total Hip Arthoplasty: Factors Associated with Re-Revision Surgery
Khatod, M; Cafri, G; Inacio, MCS; Schepps, AL; Paxton, EW; Bini, SA
2015-01-01
The survivorship of implants after revision total hip arthroplasty and risk factors associated with re-revision are not well defined. We evaluated the re-revision rate with use of the institutional total joint replacement registry. The purpose of this study was to determine patient, implant, and surgeon factors associated with re-revision total hip arthroplasty.A retrospective cohort study was conducted. The total joint replacement registry was used to identify patients who had undergone revi...
Radiological evaluation of failed total hip replacement
International Nuclear Information System (INIS)
Raspa, V.; Aldrovandi, S.; Pompei, G.
1988-01-01
The retrospective study of 50 operated cases of cemented total hip replacement and a review of the literature enabled the authors to define the radiological features of the above-mentioned condition. These features include one or more of the following signs: calcar reabsorption, lacunar erosions, modified relatioships between the prosthesis components, sepsis and loosening, periarticular calcifications dislocation and fracture of prosthesis components. Careful evaluation of these radiological features is extremely important for both an early diagnosis of failed total hip replacement and the choice of an adequate surgical treatment
A note on neighborhood total domination in graphs
Indian Academy of Sciences (India)
[1] Arumugam S and Sivagnanam C, Neighborhood total domination in graphs, Opuscula. Mathematica 31 (2011) 519–531. [2] Chellali M and Haynes T W, A note on the total domination number of a tree, J. Combin. Math. Combin. Comput. 58 (2006) 189–193. [3] Haynes T W, Hedetniemi S T and Slater P J, Fundamentals ...
Total variation-based neutron computed tomography
Barnard, Richard C.; Bilheux, Hassina; Toops, Todd; Nafziger, Eric; Finney, Charles; Splitter, Derek; Archibald, Rick
2018-05-01
We perform the neutron computed tomography reconstruction problem via an inverse problem formulation with a total variation penalty. In the case of highly under-resolved angular measurements, the total variation penalty suppresses high-frequency artifacts which appear in filtered back projections. In order to efficiently compute solutions for this problem, we implement a variation of the split Bregman algorithm; due to the error-forgetting nature of the algorithm, the computational cost of updating can be significantly reduced via very inexact approximate linear solvers. We present the effectiveness of the algorithm in the significantly low-angular sampling case using synthetic test problems as well as data obtained from a high flux neutron source. The algorithm removes artifacts and can even roughly capture small features when an extremely low number of angles are used.
Sayar, Ersin; Özdem, Sebahat; Uzun, Gülbahar; İşlek, Ali; Yılmaz, Aygen; Artan, Reha
2015-01-01
In our study, we aimed to investigate ischemia modified albumin (IMA) as an oxidative stress marker, as well as other oxidant and antioxidant markers that have not been evaluated in children with celiac disease. A total of 37 pediatric patients who were diagnosed with celiac disease (CD) and 29 healthy children were enrolled in this prospective study. We evaluated the IMA, total oxidant status, total antioxidant capacity, sulfhydryl, and advanced oxidation protein products in all of the subjects. We also compared the levels at the time of the diagnosis, and following a gluten-free diet (GFD) in the children with CD. While the IMA and the other oxidant marker levels were significantly higher in the patient group compared to the control group, the antioxidant marker levels were found to be significantly lower in the patient group, compared to the control group. We also determined that the tissue transglutaminase IgA showed a highly positive correlation, and that the IMA showed a moderately positive correlation with the Marsh-Oberhuber histopathological stage. Additionally, the IMA and other oxidant marker levels were significantly lower, while the antioxidant marker levels were significantly higher after the GFD, compared to the pre-diet period. We detected that oxidative stress played a role in the pathogenesis of CD, and that this could be evaluated using oxidative stress markers, which would regress after the GFD. We also detected that IMA is a marker that shows a correlation with the histopathological stage, and may be used in the diagnosis.
A Newton Algorithm for Multivariate Total Least Squares Problems
Directory of Open Access Journals (Sweden)
WANG Leyang
2016-04-01
Full Text Available In order to improve calculation efficiency of parameter estimation, an algorithm for multivariate weighted total least squares adjustment based on Newton method is derived. The relationship between the solution of this algorithm and that of multivariate weighted total least squares adjustment based on Lagrange multipliers method is analyzed. According to propagation of cofactor, 16 computational formulae of cofactor matrices of multivariate total least squares adjustment are also listed. The new algorithm could solve adjustment problems containing correlation between observation matrix and coefficient matrix. And it can also deal with their stochastic elements and deterministic elements with only one cofactor matrix. The results illustrate that the Newton algorithm for multivariate total least squares problems could be practiced and have higher convergence rate.
The First Total Synthesis of Isoliquiritin
Institute of Scientific and Technical Information of China (English)
无
2002-01-01
A first total synthesis of isoliquiritin was accomplished starting from p-hydroxy- benzaldehyde and 2,4-dihydroxyacetylphenone. The key step is condensation reaction. In synthetic process need not protect the hydroxy group of reacting substance.
Asymptotic behaviour of pion-pion total cross-sections
Energy Technology Data Exchange (ETDEWEB)
Greynat, David [Dipartimento di Scienze Fisiche, Universita di Napoli “Federico II”,Via Cintia, 80126 Napoli (Italy); Rafael, Eduardo de [Aix-Marseille Université, CNRS,CPT, UMR 7332, 13288 Marseille (France); Université de Toulon, CNRS,CPT, UMR 7332, 83957 La Garde (France); Vulvert, Grégory [Departament de Física Teórica, IFIC,CSIC - Universitat de València, Apt. Correus 22085, E-46071 València (Spain)
2014-03-24
We derive a sum rule which shows that the Froissart-Martin bound for the asymptotic behaviour of the ππ total cross sections at high energies, if modulated by the Lukaszuk-Martin coefficient of the leading log{sup 2} s behaviour, cannot be an optimal bound in QCD. We next compute the total cross sections for π{sup +}π{sup −}, π{sup ±}π{sup 0} and π{sup 0}π{sup 0} scattering within the framework of the constituent chiral quark model (CχQM) in the limit of a large number of colours N{sub c} and discuss their asymptotic behaviours. The same ππ cross sections are also discussed within the general framework of Large-N{sub c} QCD and we show that it is possible to make an Ansatz for the isospin I=1 and I=0 spectrum which satisfy the Froissart-Martin bound with coefficients which, contrary to the Lukaszuk-Martin coefficient, are not singular in the chiral limit and have the correct Large-N{sub c} counting. We finally propose a simple phenomenological model which matches the low energy behaviours of the σ{sub π{sup ±}π{sup 0total}}(s) cross section predicted by the CχQM with the high energy behaviour predicted by the Large-N{sub c} Ansatz. The magnitude of these cross sections at very high energies is of the order of those observed for the pp and pp-bar scattering total cross sections.
Edge colouring by total labellings
DEFF Research Database (Denmark)
Brandt, Stephan; Rautenbach, D.; Stiebitz, M.
2010-01-01
We introduce the concept of an edge-colouring total k-labelling. This is a labelling of the vertices and the edges of a graph G with labels 1, 2, ..., k such that the weights of the edges define a proper edge colouring of G. Here the weight of an edge is the sum of its label and the labels of its...
A generalization of total graphs
Indian Academy of Sciences (India)
M Afkhami
2018-04-12
Apr 12, 2018 ... product of any lower triangular matrix with the transpose of any element of U belongs to U. The ... total graph of R, which is denoted by T( (R)), is a simple graph with all elements of R as vertices, and ...... [9] Badawi A, On dot-product graph of a commutative ring, Communications in Algebra 43 (2015). 43–50.
Highlights of TOMS Version 9 Total Ozone Algorithm
Bhartia, Pawan; Haffner, David
2012-01-01
The fundamental basis of TOMS total ozone algorithm was developed some 45 years ago by Dave and Mateer. It was designed to estimate total ozone from satellite measurements of the backscattered UV radiances at few discrete wavelengths in the Huggins ozone absorption band (310-340 nm). Over the years, as the need for higher accuracy in measuring total ozone from space has increased, several improvements to the basic algorithms have been made. They include: better correction for the effects of aerosols and clouds, an improved method to account for the variation in shape of ozone profiles with season, latitude, and total ozone, and a multi-wavelength correction for remaining profile shape errors. These improvements have made it possible to retrieve total ozone with just 3 spectral channels of moderate spectral resolution (approx. 1 nm) with accuracy comparable to state-of-the-art spectral fitting algorithms like DOAS that require high spectral resolution measurements at large number of wavelengths. One of the deficiencies of the TOMS algorithm has been that it doesn't provide an error estimate. This is a particular problem in high latitudes when the profile shape errors become significant and vary with latitude, season, total ozone, and instrument viewing geometry. The primary objective of the TOMS V9 algorithm is to account for these effects in estimating the error bars. This is done by a straightforward implementation of the Rodgers optimum estimation method using a priori ozone profiles and their error covariances matrices constructed using Aura MLS and ozonesonde data. The algorithm produces a vertical ozone profile that contains 1-2.5 pieces of information (degrees of freedom of signal) depending upon solar zenith angle (SZA). The profile is integrated to obtain the total column. We provide information that shows the altitude range in which the profile is best determined by the measurements. One can use this information in data assimilation and analysis. A side
Effective Form of Reproducing the Total Financial Potential of Ukraine
Directory of Open Access Journals (Sweden)
Portna Oksana V.
2015-03-01
Full Text Available Development of scientific principles of reproducing the total financial potential of the country and its effective form is an urgent problem both in theoretical and practical aspects of the study, the solution of which is intended to ensure the active mobilization and effective use of the total financial potential of Ukraine, and as a result — its expanded reproduction as well, which would contribute to realization of the internal capacities for stabilization of the national economy. The purpose of the article is disclosing the essence of the effective form of reproducing the total financial potential of the country, analyzing the results of reproducing the total financial potential of Ukraine. It has been proved that the basis for the effective form of reproducing the total financial potential of the country is the volume and flow of resources, which are associated with the «real» economy, affect the dynamics of GDP and define it, i.e. resource and process forms of reproducing the total financial potential of Ukraine (which precede the effective one. The analysis of reproducing the total financial potential of Ukraine has shown that in the analyzed period there was an increase in the financial possibilities of the country, but steady dynamics of reduction of the total financial potential was observed. If we consider the amount of resources involved in production, creating a net value added and GDP, it occurs on a restricted basis. Growth of the total financial potential of Ukraine is connected only with extensive quantitative factors rather than intensive qualitative changes.
Total lipid profile with aqueous fruit extract of Solanum macrocarpum ...
African Journals Online (AJOL)
Abstract. Studies were undertaken to investigate the effects of the aqueous fruit extract of Solanum macrocarpum Linn. on the total lipid profile: total cholesterol, triglycerides, high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) on hypercholesterolaemic rats. Total serum cholesterol ...
Total edge irregularity strength of (n,t)-kite graph
Winarsih, Tri; Indriati, Diari
2018-04-01
Let G(V, E) be a simple, connected, and undirected graph with vertex set V and edge set E. A total k-labeling is a map that carries vertices and edges of a graph G into a set of positive integer labels {1, 2, …, k}. An edge irregular total k-labeling λ :V(G)\\cup E(G)\\to \\{1,2,\\ldots,k\\} of a graph G is a labeling of vertices and edges of G in such a way that for any different edges e and f, weights wt(e) and wt(f) are distinct. The weight wt(e) of an edge e = xy is the sum of the labels of vertices x and y and the label of the edge e. The total edge irregularity strength of G, tes(G), is defined as the minimum k for which a graph G has an edge irregular total k-labeling. An (n, t)-kite graph consist of a cycle of length n with a t-edge path (the tail) attached to one vertex of a cycle. In this paper, we investigate the total edge irregularity strength of the (n, t)-kite graph, with n > 3 and t > 1. We obtain the total edge irregularity strength of the (n, t)-kite graph is tes((n, t)-kite) = \\lceil \\frac{n+t+2}{3}\\rceil .
Total generating costs: coal and nuclear plants
International Nuclear Information System (INIS)
1979-02-01
The study was confined to single and multi-unit coal- and nuclear-fueled electric-generating stations. The stations are composed of 1200-MWe PWRs; 1200-MWe BWRs; 800-and 1200-MWe High-Sulfur Coal units, and 800- and 1200-MWe Low-Sulfur Coal units. The total generating cost estimates were developed for commercial operation dates of 1985 and 1990; for 5 and 8% escalation rates, for 10 and 12% discount rates; and, for capacity factors of 50, 60, 70, and 80%. The report describes the methodology for obtaining annualized capital costs, levelized coal and nuclear fuel costs, levelized operation and maintenance costs, and the resulting total generating costs for each type of station. The costs are applicable to a hypothetical Middletwon site in the Northeastern United States. Plant descriptions with general design parameters are included. The report also reprints for convenience, summaries of capital cost by account type developed in the previous commercial electric-power cost studies. Appropriate references are given for additional detailed information. Sufficient detail is given to allow the reader to develop total generating costs for other cases or conditions
Implementation of total responsibility management into corporate strategy
Gorenak, Štefka; Bobek, Vito
2012-01-01
This contribution reports about relationship and potential synergies between the total quality management (TQM) and total responsibility management (TRM) as well as corporate citizenship. TRM principles and standards reflect the raising public expectations about corporate social responsibility. Many companies develop TRM as requisitely holistically and hence successfully manage their responsibilities toward their stakeholders and natural environment. The evolution and implementation of TRM in...
Mammography in Norway: Image quality and total performance
International Nuclear Information System (INIS)
Olsen, J.B.; Skretting, A.; Widmark, A.
1997-04-01
This report describes a method for assessing the total performance in mammography based on Receiver Operating Characteristic (ROC) analysis. In the time period from December 1993 to March 1994 the method was applied to assess the total performance of all the 45 Norwegian mammography laboratories operative at that time. Image quality characteristics in each laboratory was established by use of well-known phantoms
Comparative total phenolic content, anti-lipase and antioxidant ...
African Journals Online (AJOL)
Total phenol values are expressed in terms of Gallic acid equivalent (w/w of dry mass). Aframomum melegueta exhibited the highest phenolic content of 60.4 ± 2.36 mgGAE/g, a percentage antioxidant activity of 86.6 % at 200μg/ml and percentage lipase inhibition of 89% at 1mg/ml while Aframomum danielli revealed a total ...
Directory of Open Access Journals (Sweden)
Cirbus Ján
2001-03-01
Full Text Available The paper is devoted to testing electrooptical distance measuring devices (EDM built in total stations, than can be used for various tasks in the contemporary geodetic works. A rich market offer and availability of these universal measuring systems with satisfying distance range, excellent accuracy and other parameters, make total stations as dominant terrestrial geodetic instruments.For succesfully applying these instruments, above all for relliable distance measurements, the stability of the modulation frequency is the most important pre-condition. In the article, therefore, there are given some methods to verify the modulation frequency stability. In addition, some ways for determining the EDM distance constant and periodical corrections of the phase measuring unit are introduced for 4 types of EDM : LEICA 1700L, TOPCON GTS6A, TOPCON GTS2, C.ZEISS ELTA50. It were also investigated their possibilities for precise distance survey. Values of the determined constants and periodical corrections are presented in Tab. 2.Based on the investigation results of the 4 EDM types and using the values m obtained for different distances S, equations of the a posteriori standard deviations in form : m = (a+b.S were derived too.
Qualidade total: Um novo paradigma?
Directory of Open Access Journals (Sweden)
Suzana da Rosa Tolfo
1999-01-01
Full Text Available Nos últimos anos, o movimento para a implantação da Gestão da Qualidade Total vem crescendo ao redor do mundo. Em razão disso, há uma diversidade de ações realizadas com o nome de "Qualidade Total'. Uma revisão da teoria é complexa, porque existem muitos autores que tratam da questão. Eles escolhem diferentes perspectivas de análises (teóricas e empíricas e há dificuldades em se identificar um corpo conceitual. Há uma ampla difusão de modelos, ferramentas, técnicas, mercado e consultores. Essa popularidade, muitas vezes, faz com que determinadas organizações adotem essa forma de gestão do trabalho sem o conhecimento necessário das implicações que um modelo dessa ordem representa; especialmente no caso brasileiro, suscetível a proposições importadas. O presente artigo propõe um exame daquilo que os fundadores têm articulado sobre TQM, as principais críticas nesta direção e a avaliação de como vem sendo aplicadono nosso país.
Berger, Ariel; Bozic, Kevin; Stacey, Brett; Edelsberg, John; Sadosky, Alesia; Oster, Gerry
2011-08-01
To examine patterns of pharmacotherapy and health care utilization and costs prior to total knee replacement (TKR) or total hip replacement (THR) in patients with osteoarthritis (OA). Using a large US health insurance claims database, we identified all patients with OA who were ages ≥40 years and had undergone TKR or THR between January 1, 2006 and December 31, 2007. Patients with care utilization and costs over the 2-year period preceding surgery. A total of 16,527 patients met all study entry criteria. Their mean ± SD age was 56.6 ± 6.1 years, and 56% of them were women. In the 2 years preceding surgery, 55% of patients received prescription nonsteroidal antiinflammatory drugs, 58% received opioids, and 50% received injections of corticosteroids. The numbers of patients receiving these drugs increased steadily during the presurgery period. The mean ± SD total health care costs in the 2 years preceding surgery were $19,466 ± 29,869, of which outpatient care, inpatient care, and pharmacotherapy represented 45%, 20%, and 20%, respectively. Costs increased from $2,094 in the eighth calendar quarter prior to surgery to $3,100 in the final quarter. Patients with OA who undergo THR or TKR have relatively high levels of use of pain-related pharmacotherapy and high total health care costs in the 2-year period preceding surgery. Levels of utilization and cost increase as the date of surgery approaches. Copyright © 2011 by the American College of Rheumatology.
Estimation of Total Tree Height from Renewable Resources Evaluation Data
Charles E. Thomas
1981-01-01
Many ecological, biological, and genetic studies use the measurement of total tree height. Until recently, the Southern Forest Experiment Station's inventory procedures through Renewable Resources Evaluation (RRE) have not included total height measurements. This note provides equations to estimate total height based on other RRE measurements.
Diagnostic value of lipids, total antioxidants, and trace metals in ...
African Journals Online (AJOL)
Materials and Methods: Anthropometric characteristics, total prostate specific antigen (tPSA), serum lipids (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), Vit. E, total antioxidant status (TAS), and trace metals (Se, Cu, Fe, Zn, and Mn) were determined in 40 patients with histopathological diagnosis of ...
Total elbow arthroplasty: a radiographic outcome study
Energy Technology Data Exchange (ETDEWEB)
Bai, Xue Susan [University of Washington, Department of Radiology, Box 357115, Seattle, WA (United States); Petscavage-Thomas, Jonelle M. [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Ha, Alice S. [University of Washington, Department of Radiology, Box 354755, Seattle, WA (United States)
2016-06-15
Total elbow arthroplasty (TEA) is becoming a popular alternative to arthrodesis for patients with end-stage elbow arthrosis and comminuted distal humeral fractures. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TEA and to correlate with clinical symptoms such as pain. This is an IRB-approved retrospective review from 2005 to 2015 of all patients with semiconstrained TEA. All available elbow radiographs and clinical data were reviewed. Data analysis included descriptive statistics and Kaplan-Meier survival curves for radiographic and clinical survival. A total of 104 total elbow arthroplasties in 102 patients were reviewed; 75 % were in women and the mean patient age was 63.1 years. Mean radiographic follow-up was 826 days with average of four radiographs per patient. Seventy TEAs (67 %) developed radiographic complications, including heterotopic ossification (48 %), perihardware lucency (27 %), periprosthetic fracture (23 %), hardware subluxation/dislocation (7 %), polyethylene wear (3 %), and hardware fracture/dislodgement (3 %); 56 patients (55 %) developed symptoms of elbow pain or instability and 30 patients (30 %) underwent at least one reoperation. In patients with radiographic complications, 66 % developed elbow pain, compared to 19 % of patients with no radiologic complications (p = 0.001). Of the patients with radiographic complications, 39 % had at least one additional surgery compared to 0 % of patients without radiographic complications (p = 0.056). Radiographic complications are common in patients after total elbow arthroplasty. There is a strong positive association between post-operative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist. (orig.)
Can You Depend Totally on Computers?
Indian Academy of Sciences (India)
Home; Journals; Resonance – Journal of Science Education; Volume 3; Issue 2. Can You Depend Totally on Computers? Computer Security, Availability and Correctness. H N Mahabala. General Article Volume 3 Issue 2 February 1998 pp 35-44 ...
US-Total Electron Content Product (USTEC)
National Oceanic and Atmospheric Administration, Department of Commerce — The US Total Electron Content (US-TEC) product is designed to specify TEC over the Continental US (CONUS) in near real-time. The product uses a Kalman Filter data...
Detection limit calculations for different total reflection techniques
International Nuclear Information System (INIS)
Sanchez, H.J.
2000-01-01
In this work, theoretical calculations of detection limits for different total-reflection techniques are presented.. Calculations include grazing incidence (TXRF) and gracing exit (GEXRF) conditions. These calculations are compared with detection limits obtained for conventional x-ray fluorescence (XRF). In order to compute detection limits the Shiraiwa and Fujino's model to calculate x-ray fluorescence intensities was used. This model made certain assumptions and approximations to achieve the calculations, specially in the case of the geometrical conditions of the sample, and the incident and takeoff beams. Nevertheless the calculated data of detection limits for conventional XRF and total-reflection XRF show a good agreement with previous results. The model proposed here allows to analyze the different sources of background and the influence of the excitation geometry, which contribute to the understanding of the physical processes involved in the XRF analysis by total reflection. Finally, a comparison between detection limits in total-reflection analysis at grazing incidence and at grazing exit is carried out. Here a good agreement with the theoretical predictions of the reversibility principle is found, showing that detection limits are similar for both techniques. (author)
Energy Technology Data Exchange (ETDEWEB)
NONE
2005-07-01
TOTAL S.A., a French society incorporated in France on March 28, 1924, together with its subsidiaries and affiliates, is the fourth largest publicly-traded integrated oil and gas company in the world. This document provides statistical data and information on the corporate (highlights, statements), upstream (production, costs,main producing fields, drilling), upstream maps, downstream (refining, distillation, retail gasoline outlets) and chemicals (sales, specialities). (A.L.B.)
International Nuclear Information System (INIS)
2005-01-01
TOTAL S.A., a French society incorporated in France on March 28, 1924, together with its subsidiaries and affiliates, is the fourth largest publicly-traded integrated oil and gas company in the world. This document provides statistical data and information on the corporate (highlights, statements), upstream (production, costs,main producing fields, drilling), upstream maps, downstream (refining, distillation, retail gasoline outlets) and chemicals (sales, specialities). (A.L.B.)
Employee benefits in a total rewards framework.
Kwon, Jane; Hein, Pam
2013-01-01
Benefits represent one of the largest investments a company makes in its talent. However, our tendency can be to design, deliver and communicate benefits programs independently, without fully considering how those programs fit within a bigger picture of total rewards. Sure, we need to manage and execute individual benefit programs--but not at the expense of getting a real return on our more significant investment in talent. This article provides employers with perspectives on the value of managing benefits within the broader framework of total rewards, why it works and, most importantly, how to make it work.
Inestabilidad de la Artroplastia Total de Cadera
Ezquerra Herrando, Laura; Albareda Albareda, Jorge; Seral García, Belén
2014-01-01
INTRODUCCIÓN La artroplastia total de cadera (ATC) es un procedimiento muy frecuente en los Servicios de Cirugía Ortopédica y Traumatología, y aunque su efectividad es muy elevada, no está exenta de complicaciones como son el aflojamiento aséptico, luxaciones, infección y fracturas periprotésicas. A pesar de los avances en las técnicas y modelos protésicos, la luxación sigue siendo la segunda complicación más frecuente después del aflojamiento aséptico en las artroplastias totales de cadera. ...
Development of kits for total PSA monitoring
International Nuclear Information System (INIS)
Suprarop, P.
1999-01-01
The development of kits for Total PSA assay has shown promising results. All essential components of the assay were prepared with reproducibility and used to optimize the assay. By choosing two steps method, we could avoid the hook effect and obtain satisfactory Q.C. parameters of the standard curve i.e. blank = 0.8%, maximum binding = 65%. If reference material for calibration of the standard is agree upon, the validation could then be carried out with total confidence. Our final goal is to reduce the step of incubation to just one step with no interference from hook effect
ANALYSIS AND ACCOUNTING OF TOTAL CASH FLOW
Directory of Open Access Journals (Sweden)
MELANIA ELENA MICULEAC
2012-01-01
Full Text Available In order to reach the objective of supplying some relevant information regarding the liquidity inflows and outflows during a financial exercise, the total cash flow analysis must include the analysis of result cashable from operation, of payments and receipts related to the investment and of financing decisions of the last exercise, as well as the analysis of treasury variation (of cash items. The management of total cash flows ensures the correlation of current liquidness flows as consequence of receipts with the payments ’flows, in order to provide payment continuity of mature obligations.
Total employment effect of biofuels
International Nuclear Information System (INIS)
Stridsberg, S.
1998-08-01
The study examined the total employment effect of both direct production of biofuel and energy conversion to heat and electricity, as well as the indirect employment effect arising from investments and other activities in conjunction with the production organization. A secondary effect depending on the increased capital flow is also included in the final result. The scenarios are based on two periods, 1993-2005 and 2005-2020. In the present study, the different fuels and the different applications have been analyzed individually with regard to direct and indirect employment within each separate sector. The greatest employment effect in the production chain is shown for logging residues with 290 full-time jobs/TWh, whereas other biofuels range between 80 and 280 full-time jobs/TWh. In the processing chain, the corresponding range is 200-300 full-time jobs per each additional TWh. Additionally and finally, there are secondary effects that give a total of 650 full-time jobs/TWh. Together with the predicted increase, this suggests that unprocessed fuel will provide an additional 16 000 annual full-time jobs, and that fuel processing will contribute with a further 5 000 full-time jobs. The energy production from the fuels will provide an additional 13 000 full-time jobs. The total figure of 34 000 annual full-time jobs must then be reduced by about 4000 on account of lost jobs, mainly in the oil sector and to some extent in imports of biofuel. In addition, the anticipated increase in capital turnover that occurs within the biofuel sector, will increase full-time jobs up to year 2020. Finally, a discussion is given of the accomplishment of the programmes anticipated by the scenario, where it is noted that processing of biofuel to wafers, pellets or powder places major demands on access to raw material of good quality and that agrarian fuels must be given priority if they are to enter the system sufficiently fast. Straw is already a resource but is still not accepted by
Frustrated Total Internal Reflection: A Simple Application and Demonstration.
Zanella, F. P.; Magalhaes, D. V.; Oliveira, M. M.; Bianchi, R. F.; Misoguti, L.; Mendonca, C. R.
2003-01-01
Describes the total internal reflection process that occurs when the internal angle of incidence is equal to or greater than the critical angle. Presents a demonstration of the effect of frustrated total internal reflection (FTIR). (YDS)
Total cholesterol and the risk of Parkinson disease.
Hu, G; Antikainen, R; Jousilahti, P; Kivipelto, M; Tuomilehto, J
2008-05-20
To examine the association between serum total cholesterol at baseline and the risk of Parkinson disease (PD). Study cohorts included 24,773 Finnish men and 26,153 women aged 25 to 74 years without a history of PD and stroke at baseline. Hazard ratios (HRs) of incident PD were estimated for different levels of total cholesterol. During a mean follow-up period of 18.1 years, 321 men and 304 women developed incident PD. After adjustment for confounding factors (age, study years, body mass index, systolic blood pressure, education, leisure-time physical activity, smoking, alcohol consumption, coffee and tea consumption, and history of diabetes), the HRs of PD at different levels of total cholesterol (or=7 mmol/L) were 1.00, 1.33, 1.53, and 1.84 (p for trend = 0.035) in men; 1.00, 1.55, 1.57, and 1.86 (p for trend = 0.113) in women; and 1.00, 1.42, 1.56, and 1.86 (p for trend = 0.002) in men and women combined (adjusted also for sex). In both sexes combined, the increased risk of PD associated with increasing levels of serum total cholesterol was present both in subjects aged 25-44 years and in subjects aged 45-54 years at baseline, and in never smokers and smokers; however, no association was found among subjects aged 55 years or older at baseline. This large prospective study suggests that high total cholesterol at baseline is associated with an increased risk of Parkinson disease.
Directory of Open Access Journals (Sweden)
Sachiyuki Tsukada, MD
2018-03-01
Full Text Available Background: Although studies have supported the utility of perioperative continuation of antiplatelet drugs, vasodilators, and cerebral ameliorators in most procedures, no study compared total volume of blood loss after total knee arthroplasty (TKA in patients continuing and discontinuing these drugs. Methods: We retrospectively reviewed 266 consecutive patients undergoing TKA, and included 67 patients (25.2% taking antiplatelet drugs, vasodilators, or cerebral ameliorators in this study. All TKAs were performed without a pneumatic tourniquet. The primary outcome was perioperative total blood loss calculated from blood volume and change in hemoglobin. As subgroup analysis, we compared perioperative total blood loss in patients taking antiplatelet drugs. Results: There was no significant difference between the continuing group (n = 38 and discontinuing group (n = 29 in terms of the perioperative total blood loss (1025 ± 364 vs 1151 ± 327 mL, respectively; mean difference 126 mL; 95% confidence interval −45 to 298 mL; P = .15. No major bleeding or thrombotic events occurred in either group until postoperative 3-month follow-up. In patients taking antiplatelet drugs (n = 51, no significant difference was observed in the total blood loss between the continuing group (n = 30 and discontinuing group (n = 21 (1056 ± 287 vs 1151 ± 305 mL, respectively; mean difference 95 mL; 95% confidence interval −75 to 264 mL; P = .27. Conclusions: No significant differences in terms of perioperative total blood loss were observed between patients continuing and discontinuing study drugs. Continuing these drugs may be preferable in the perioperative period of TKA. Keywords: Knee, Primary arthroplasty, Bleeding events, Thrombotic events, Noncardiac surgery
Total reflection X-ray photoelectron spectroscopy: A review
International Nuclear Information System (INIS)
Kawai, Jun
2010-01-01
Total reflection X-ray photoelectron spectroscopy (TRXPS) is reviewed and all the published papers on TRXPS until the end of 2009 are included. Special emphasis is on the historical development. Applications are also described for each report. The background reduction is the most important effect of total reflection, but interference effect, relation to inelastic mean free path, change of probing depth are also discussed.
A phylogenetic approach to total evaporative water loss in mammals.
Van Sant, Matthew J; Oufiero, Christopher E; Muñoz-Garcia, Agustí; Hammond, Kimberly A; Williams, Joseph B
2012-01-01
Maintaining appropriate water balance is a constant challenge for terrestrial mammals, and this problem can be exacerbated in desiccating environments. It has been proposed that natural selection has provided desert-dwelling mammals physiological mechanisms to reduce rates of total evaporative water loss. In this study, we evaluated the relationship between total evaporative water loss and body mass in mammals by using a recent phylogenetic hypothesis. We compared total evaporative water loss in 80 species of arid-zone mammals to that in 56 species that inhabit mesic regions, ranging in size from 4 g to 3,500 kg, to test the hypothesis that mammals from arid environments have lower rates of total evaporative water loss than mammals from mesic environments once phylogeny is taken into account. We found that arid species had lower rates of total evaporative water loss than mesic species when using a dichotomous variable to describe habitat (arid or mesic). We also found that total evaporative water loss was negatively correlated with the average maximum and minimum environmental temperature as well as the maximum vapor pressure deficit of the environment. Annual precipitation and the variable Q (a measure of habitat aridity) were positively correlated with total evaporative water loss. These results support the hypothesis that desert-dwelling mammals have lower rates of total evaporative water loss than mesic species after controlling for body mass and evolutionary relatedness regardless of whether categorical or continuous variables are used to describe habitat.
Safety Precautions for Total Release Foggers
Total release foggers, also known as bug bombs, are pesticide products containing aerosol propellants that release their contents at once to fumigate an area. They can pose a hazard if used incorrectly. Find safety information and videos on this page.
Total Synthesis of balanol, Part 2
DEFF Research Database (Denmark)
Tanner, David Ackland; Kelly, Nicholas; Tedenborg, Lars
1997-01-01
A convergent enantioselective total synthesis of the natural product (-)-balanol (1) is described. In addition to benzophenone fragment 8, key intermediates are chiral bicyclic aziridine 3 and the corresponding epoxide 4, both of which undergo highly regio- and stereoselective nucleophilic ring...
Prospective study of ascending venogram following total hip replacement or total knee replacement
Energy Technology Data Exchange (ETDEWEB)
Youm, Chang Seon; Suh, Jin Seok; Lee, Jong Doo; Park, Chang Yun; Kim, Young Hoo [College of Medicine, Yonsei University, Seoul (Korea, Republic of)
1987-04-15
The ascending leg venogram was performed in one hundred forty six lower extremities on the 7th day following total hip replacement (THR) or total knee replacement (TKR). The results were as follows; 1.Overall incidence of deep vein thrombosis (DVT) in 146 limbs who underwent THR or TKR was 10%: DVT was detected in 8 limbs among 110 limbs following THR (7%) and 6 limbs among 36 limbs following TKR (17%). 2.The anatomic distribution of DVT was as follows: In THR, 12.5% in FV, 25% in FV and PV, 25% in FV and PV and CV, 12.5% in FV and CV, and 25% in CV. In TKR, 100% in CV. 3.There were many anatomic variations in deep veins of lower extremities: Accessory SFV (41 limbs), double PV(24), accessory SFV and double PV(7), duplication of SFV and PV(3), accessory SFV and multiple PV(2), and accessory SFV and double PV(1). 4.There were multiple SFV in 37%, and 19% of these limbs had DVT. It represented statistically higher than 4% in limbs with a single SFV (P-value < 0.05). 5.The incidence of DVT was 8% in cases of multiple PV, and there was no statistically significant difference between these groups and single PV groups. 6.We could assess number of values from popliteal vein to common femoral vein in 72 limbs. Mean number of value was 5.45 and there was no statistically significant difference between groups having valve over 5 and under 5.
Mohamad, K. A.; Mohd, S. Y.; Sarah, R. S.; Mohd, H. Z.; Rasyidah, A.
2017-09-01
Aquaculture is one of dominant food based industry in the world with 8.3% annual growth rate and its development had led to adverse effect on the environment. High nutrient production in form of nitrogenous compound and phosphorus contributed to environmental deterioration such as eutrophication and toxicity to the industry. Usage of Effective Microorganism (EM), one of the biological approaches to remove Total Nitrogen (TN) and Total Phosphorus (TP) in aquaculture pond was proposed. Samples were obtained from the Sea Bass intensive brackish aquaculture wastewater (AW) from fish farm at Juru, Penang and the parameters used to measure the removal of nitrogenous compounds include, pH, EM dosage, shaking, contact time and optimum variable conditions. From the study, for effective contact time, day 6 is the optimum contact time for both TN and TP with 99.74% and 62.78% removal respectively while in terms of optimum pH, the highest TN removal was at pH 7 with 66.89 %. The optimum dosage of EM is 1.5 ml with ratio 1:166 for 81.5 % TN removal was also found appropriate during the experiment. At varied optimum conditions of EM, the removal efficiency of TN and TP were 81.53% and 38.94% respectively while the removal mechanism of TN was highly dependent on the decomposition rate of specific bacteria such as Nitrobacter bacteria, Yeast and Bacillus Subtilis sp. The study has established the efficacy of EM's ability to treat excessive nutrient of TN and TP from AW.
Energy Technology Data Exchange (ETDEWEB)
Kurisu, Koichi; Hishikawa, Yoshio; Taniguchi, Midori; Kamikonya, Norihiko; Miura, Takashi; Kanamaru, Akihisa; Kakishita, Eizo; Kai, Shunro; Hara, Hiroshi (Hyogo Coll. of Medicine, Nishinomiya (Japan))
Between April 1980 and June 1989, 15 patients with severe aplastic anemia (SAA) were treated at Hyogo College of Medicine with bone marrow transplantation (BMT) after preparation consisting of cyclophosphamide (CY) and total lymphoid irradiation (TLI) or total body irradiation (TBI) for the purpose of reducing the incidence of graft rejection. All patients had initial evidence of engraftment after the first transplantation except for one patient who died of heart failure due to CY on the third day after transplantation and could not be evaluated for engraftment. Rejection later occurred in four of these 14 patients, who then underwent successful regrafting. One of these four patients, who was conditioned with CY alone at the first grafting, underwent successful regrafting after a conditioning regimen of CY and TBI. In the other three patients, irradiation was performed twice as the conditioning regimen. Thus, 14 of 15 patients underwent successful BMT and are alive with restored hematopoietic function. From the above results, the combination of TLI or TBI and CY was considered to be very useful as a conditioning regimen for BMT in patients with SAA. (author).
Persistent hyperthyroidism and de novo Graves' ophthalmopathy after total thyroidectomy.
Tay, Wei Lin; Loh, Wann Jia; Lee, Lianne Ai Ling; Chng, Chiaw Ling
2017-01-01
We report a patient with Graves' disease who remained persistently hyperthyroid after a total thyroidectomy and also developed de novo Graves' ophthalmopathy 5 months after surgery. She was subsequently found to have a mature cystic teratoma containing struma ovarii after undergoing a total hysterectomy and salpingo-oophorectomy for an incidental ovarian lesion. It is important to investigate for other causes of primary hyperthyroidism when thyrotoxicosis persists after total thyroidectomy.TSH receptor antibody may persist after total thyroidectomy and may potentially contribute to the development of de novo Graves' ophthalmopathy.
Measurements of total OH reactivity during PROPHET-AMOS 2016
Rickly, P.; Sakowski, J.; Bottorff, B.; Lew, M.; Stevens, P. S.; Sklaveniti, S.; Locoge, N.; Dusanter, S.
2017-12-01
As one of the main oxidant in the atmosphere, the hydroxyl radical (OH) initiates the oxidation of volatile organic compounds that can lead to the formation of ozone and secondary organic aerosols. Understanding both the sources and sinks of OH is therefore important to address issues related to air quality and climate change. Measurements of total OH reactivity can provide an important test of our understanding of the OH radical budget. Recent measurements of total reactivity in many environments have been greater than calculated based on the measured concentration of VOCs, suggesting that important OH sinks in these environments are not well characterized. Measurements of total OH reactivity were performed in a forested environment during the PROPHET - AMOS field campaign (Program for Research on Oxidants: PHotochemisty, Emissions, and Transport - Atmospheric Measurements of Oxidants in Summer) using the Comparative Reactivity Method (CRM) and the Total OH Loss Rate Method (TOHLM). The site is characterized by large emissions of isoprene and monoterpenes and low anthropogenic influence. Measurements of total OH reactivity using these two techniques agree to within their respective uncertainties, giving confidence in the measured OH reactivity. In addition, measurements of trace gases (VOCs, NOx, O3) were used to perform a comprehensive apportionment of OH sinks. These measurements are used in a chemical model using the Master Chemical Mechanism to calculate the expected OH reactivity. The results will be compared to previous measurements of total OH reactivity at this site.
Total excision of intramedullary epidermoid cyst in one case
Directory of Open Access Journals (Sweden)
PU Ke
2013-12-01
Full Text Available Clinical experience of total excision in a 14-year-old female with intramedullary epidermoid cyst was reported. The patient with L3-4 intramedullary epidermoid cyst underwent total excision through posterior median approach under microscopy. The patient was admitted for progressive strephexopodia and urinary and fecal incontinence. Preoperative imaging examination showed scoliosis, incontionous L4-S1 and abnormal signal of L3-4. Total excision and spinal remodeling were performed under intraoperative neurophysiological monitoning. Epidermoid cyst and its membrane were totally removed without aseptic meningitis after surgery, and the neurologic symptoms of the patient were gradually improved. Completely removing the membrane of epidermoid cyst is the key point to prevent recurrence and aseptic meningitis postoperatively. Dissection should be strictly in accordance with the boundaries of the membrane and the spinal cord, in order to avoid spinal cord injury.
Independence and totalness of subspaces in phase space methods
Vourdas, A.
2018-04-01
The concepts of independence and totalness of subspaces are introduced in the context of quasi-probability distributions in phase space, for quantum systems with finite-dimensional Hilbert space. It is shown that due to the non-distributivity of the lattice of subspaces, there are various levels of independence, from pairwise independence up to (full) independence. Pairwise totalness, totalness and other intermediate concepts are also introduced, which roughly express that the subspaces overlap strongly among themselves, and they cover the full Hilbert space. A duality between independence and totalness, that involves orthocomplementation (logical NOT operation), is discussed. Another approach to independence is also studied, using Rota's formalism on independent partitions of the Hilbert space. This is used to define informational independence, which is proved to be equivalent to independence. As an application, the pentagram (used in discussions on contextuality) is analysed using these concepts.
Pandey, Pallavi; Reddy, N Venugopal; Rao, V Arun Prasad; Saxena, Aditya; Chaudhary, C P
2015-03-01
The aim of the study was to evaluate salivary flow rate, pH, buffering capacity, calcium, total protein content and total antioxidant capacity in relation to dental caries, age and gender. The study population consisted of 120 healthy children aged 7-15 years that was further divided into two groups: 7-10 years and 11-15 years. In this 60 children with DMFS/dfs = 0 and 60 children with DMFS/dfs ≥5 were included. The subjects were divided into two groups; Group A: Children with DMFS/dfs = 0 (caries-free) Group B: Children with DMFS/dfs ≥5 (caries active). Unstimulated saliva samples were collected from all groups. Flow rates were determined, and samples analyzed for pH, buffer capacity, calcium, total protein and total antioxidant status. Salivary antioxidant activity is measured with spectrophotometer by an adaptation of 2,2'-azino-di-(3-ethylbenzthiazoline-6-sulphonate) assays. The mean difference of the two groups; caries-free and caries active were proved to be statistically significant (P salivary calcium, total protein and total antioxidant level for both the sexes in the age group 7-10 years and for the age 11-15 years the mean difference of the two groups were proved to be statistically significant (P salivary calcium level for both the sexes. Salivary total protein and total antioxidant level were proved to be statistically significant for male children only. In general, total protein and total antioxidants in saliva were increased with caries activity. Calcium content of saliva was found to be more in caries-free group and increased with age.
2010-04-01
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Total disability and disability causation... Section 718.204 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL COAL... than those listed in Table B1 (Males) or Table B2 (Females) in Appendix B to this part for an...
On the link between martian total ozone and potential vorticity
Holmes, James A.; Lewis, Stephen R.; Patel, Manish R.
2017-01-01
We demonstrate for the first time that total ozone in the martian atmosphere is highly correlated with the dynamical tracer, potential vorticity, under certain conditions. The degree of correlation is investigated using a Mars global circulation model including a photochemical model. Potential vorticity is the quantity of choice to explore the dynamical nature of polar vortices because it contains information on winds and temperature in a single scalar variable. The correlation is found to display a distinct seasonal variation, with a strong positive correlation in both northern and southern winter at poleward latitudes in the northern and southern hemisphere respectively. The identified strong correlation implies variations in polar total ozone during winter are predominantly controlled by dynamical processes in these spatio-temporal regions. The weak correlation in northern and southern summer is due to the dominance of photochemical reactions resulting from extended exposure to sunlight. The total ozone/potential vorticity correlation is slightly weaker in southern winter due to topographical variations and the preference for ozone to accumulate in Hellas basin. In northern winter, total ozone can be used to track the polar vortex edge. The ozone/potential vorticity ratio is calculated for both northern and southern winter on Mars for the first time. Using the strong correlation in total ozone and potential vorticity in northern winter inside the polar vortex, it is shown that potential vorticity can be used as a proxy to deduce the distribution of total ozone where satellites cannot observe for the majority of northern winter. Where total ozone observations are available on the fringes of northern winter at poleward latitudes, the strong relationship of total ozone and potential vorticity implies that total ozone anomalies in the surf zone of the northern polar vortex can potentially be used to determine the origin of potential vorticity filaments.
Recurrent hemarthrosis after total knee arthroplasty
Rukavina, A.; Kerkhoffs, G.M.M.J.; Schneider, P.; Kuster, M.S.
2010-01-01
This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed
Bilateral Laparoscopic Totally Extraperitoneal Repair Without Mesh Fixation
Dehal, Ahmed; Woodward, Brandon; Johna, Samir; Yamanishi, Frank
2014-01-01
Background and Objectives: Mesh fixation during laparoscopic totally extraperitoneal repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative chronic pain. This study aimed to describe the experience of a single surgeon at our institution performing this operation. Methods: We performed a retrospective review of the medical records of all patients who underwent bilateral laparoscopic totally extraperitoneal repair without mesh fixation for ing...
Total gastrectomy for non-neoplastic diseases
DEFF Research Database (Denmark)
Bjorn, Niels; Ainsworth, Alan Patrick; Mortensen, Michael Bau
2017-01-01
Background: The aim of this study was to describe patients who had total gastrectomy for non-neoplastic diseases within a well-defined geographical area. Material and Methods: Retrospective study of patients who had gastrectomy for a non-neoplastic disease at the Department of Surgery, Odense...... University Hospital from 1 January 2005 to 31 December 2014. Results: A total of 268 gastrectomies were performed with the 10-year period. Of these, ten (4%) were done for non-neoplastic diseases. Two were men and eight women with a median age of 51 years (range 31 to 96 years). Six had emergency surgery...... of 10 and 2 of 10, respectively. Histology of the resected specimens showed: Oedema, inflammation and/or necrosis (n=6), Menetrier's disease (n=2) and perforation (n=2). Conclusions: Gastrectomy for non-neoplastic diseases accounts for less than 5% of all gastrectomies. The majority of these cases...
A Modern Approach to Total Wellbeing
Hadzic, Maja; Chen, Meifania; Brouwer, Rick; Dillon, Tharam
The events of the last decades have impacted our lives and our health significantly. We expected that the technology boom will improve our lives. While this may be true in a specific context, generally speaking our societies are suffering from moral decays, terrorism fears, wars, financial crisis and unpredictable acts of nature that are increasing in frequency and in intensity. The complex nature of the world we live is impacting our health and wellbeing considerably. Our health is not only determined by our physical health but is the end product of the interplay of the physical, mental, emotional, financial, relational and spiritual events of a lifetime. In this paper we develop a framework that will help us define and measure total wellbeing of individuals in our volatile societies. This framework will help us better understand the complex nature of total wellbeing and develop effective prevention and intervention strategies.
An unusual case of total ophthalmoplegia
Directory of Open Access Journals (Sweden)
Chowdhury Ravindra
2009-01-01
Full Text Available An eight-year-old male child presented with drooping of the left eyelid with a history of penetrating injury of hard palate by an iron spoon seven days ago, which had already been removed by the neurosurgeon as the computed tomography scan revealed a spoon in the left posterior ethmoid and sphenoid bone penetrating into the middle cranial fossa. On examination, visual acuity was 20/20 in each eye and left eye showed total ophthalmoplegia. Oral cavity revealed a hole in the left lateral part of the hard palate. We managed the case with tapering dose of systemic prednisolone. The total ophthalmoplegia was markedly improved in one month. Cases of foreign bodies in the orbit with intracranial extension are not unusual, but the path this foreign body traveled through the hard palate without affecting the optic nerve, internal carotid artery or cavernous sinus makes an interesting variation.
Total energy consumption in Finland increased by one percent
International Nuclear Information System (INIS)
Timonen, L.
2000-01-01
The total energy consumption in Finland increased by less than a percent in 1999. The total energy consumption in 1999 was 1310 PJ corresponding to about 31 million toe. The electric power consumption increased moderately by 1.6%, which is less than the growth of the gross national product (3.5%). The final consumption of energy grew even less, only by 0.5%. Import of electric power increased by 19% in 1999. The import of electric power was due to the availability of low-priced electric power on the Nordic electricity markets. Nuclear power generation increased by 5% and the consumption of wood-based fuels by 3%. The increment of the nuclear power generation increased because of the increased output capacity and good operability of the power plants. Wind power production doubles, but the share of it in the total energy consumption is only about 0.01%. The peat consumption decreased by 12% and the consumption of hydroelectric power by 15%. The decrease in production of hydroelectric power was compensated by an increase import of electric power. The consumption of fossil fuels, coal, oil and natural gas remained nearly the same as in 1998. The gasoline consumption, however, decreased, but the consumption of diesel oil increased due to the increased road transport. The share of the fossil fuels was nearly half of the total energy consumption. The consumption of renewable energy sources remained nearly the same, in 23% if the share of peat is excluded, and in 30% if the share of peat is included. Wood-based fuels are the most significant type of renewable fuels. The share of them in 1999 was over 80% of the total usage of the renewable energy sources. The carbon dioxide emissions in Finland decreased in 1999 by 1.0 million tons. The total carbon dioxide emissions were 56 million tons. The decrease was mainly due to the decrease of the peat consumption. The final consumption of energy increased by 0.5%, being hence about 1019 PJ. Industry is the main consumer of energy
Liver failure in total artificial heart therapy.
Dimitriou, Alexandros Merkourios; Dapunt, Otto; Knez, Igor; Wasler, Andrae; Oberwalder, Peter; Koerfer, Reiner; Tenderich, Gero; Spiliopoulos, Sotirios
2016-07-01
Congestive hepatopathy (CH) and acute liver failure (ALF) are common among biventricular heart failure patients. We sought to evaluate the impact of total artificial heart (TAH) therapy on hepatic function and associated clinical outcomes. A total of 31 patients received a Syncardia Total Artificial Heart. Preoperatively 17 patients exhibited normal liver function or mild hepatic derangements that were clinically insignificant and did not qualify as acute or chronic liver failure, 5 patients exhibited ALF and 9 various hepatic derangements owing to CH. Liver associated mortality and postoperative course of liver values were prospectively documented and retrospectively analyzed. Liver associated mortality in normal liver function, ALF and CH cases was 0%, 20% (P=0.03) and 44.4% (P=0.0008) respectively. 1/17 (5.8%) patients with a normal liver function developed an ALF, 4/5 (80%) patients with an ALF experienced a markedly improvement of hepatic function and 6/9 (66.6%) patients with CH a significant deterioration. TAH therapy results in recovery of hepatic function in ALF cases. Patients with CH prior to surgery form a high risk group with increased liver associated mortality.
Total free radical species and oxidation equivalent in polluted air.
Wang, Guoying; Jia, Shiming; Niu, Xiuli; Tian, Haoqi; Liu, Yanrong; Chen, Xuefu; Li, Lan; Zhang, Yuanhang; Shi, Gaofeng
2017-12-31
Free radicals are the most important chemical intermediate or agent of the atmosphere and influenced by thousands of reactants. The free radicals determine the oxidizing power of the polluted air. Various gases present in smog or haze are oxidants and induce organ and cellular damage via generation of free radical species. At present, however, the high variability of total free radicals in polluted air has prevented the detection of possible trends or distributions in the concentration of those species. The total free radicals are a kind of contaminants with colorless, tasteless characteristics, and almost imperceptible by human body. Here we present total free radical detection and distribution characteristics, and analyze the effects of total free radicals in polluted air on human health. We find that the total free radical values can be described by not only a linear dependence on ozone at higher temperature period, but also a linear delay dependence on particulate matter at lower temperature period throughout the measurement period. The total free radical species distribution is decrease from west to east in Lanzhou, which closely related to the distribution of the air pollutants. The total free radical oxidation capacity in polluted air roughly matches the effects of tobacco smoke produced by the incomplete combustion of a controlled amount of tobacco in a smoke chamber. A relatively unsophisticated chromatographic fingerprint similarity is used for indicating preliminarily the effect of total free radicals in polluted air on human health. Copyright © 2017 Elsevier B.V. All rights reserved.
Universal Laws and the Structure of the “Total Universe”
Directory of Open Access Journals (Sweden)
David McGraw Jr
2017-09-01
Full Text Available Recent developments in Particle Physics and Cosmology lead one naturally to the existence of many universes. Although direct confi rmation of other universes is diffi cult, it is not impossible. This paper is a look at a new theory of multiple universes. The idea of t = 0, goes back long before the creation of our universe. The “Total Universe’ contains many universes like our universe. The number of universes is infi nite, so some universes are far older than our universe. These ultimate areas of space were our universe started, is still creating new universes. Many big bangs have occurred in the past, and many big bangs will occur in the future. Big bangs are not something that happens just once or twice. Many diff erent universes exist; in this larger area of space we can call the ‘Total Universe’. In the ‘Total Universe’ the second law of thermodynamics is violated. The second Law of thermodynamics is a general law; it is not a universal law. The level of disorder in the ‘Total Universe’ is both increasing, and decreasing. In the ‘Total Universe’, entropy can increase, decrease, or remain constant. Individual universes are being created in the ‘Total Universe’; in these areas of the ‘Total Universe’ energy is not conserved. The ‘Total Universe’ is an energy creating machine. The conservation of energy is a general law because there are areas where external forces are being created so that the conservation of energy would not be valid.
Prolonged heart xenograft survival using combined total lymphoid irradiation and cyclosporine
International Nuclear Information System (INIS)
Knechtle, S.J.; Halperin, E.C.; Saad, T.; Bollinger, R.R.
1986-01-01
Total lymphoid irradiation and cyclosporine have profound immunosuppressive properties and permit successful heart allotransplantation. Cyclosporine used alone has not permitted consistently successful transplantation between species in all cases. Total lymphoid irradiation has not been applied to xenotransplantation. The efficacy of total lymphoid irradiation alone and in combination with cyclosporine was examined using an animal model of heart xenotransplantation. Heterotopic heart transplants were performed using inbred Syrian hamsters as donors and Lewis rats as recipients. Total lymphoid irradiation was administered preoperatively over 3 weeks for a total dose of 15 gray. Cyclosporine was started on the day of surgery and was given as a daily intramuscular injection of 2.5, 5, or 10 mg/kg/day until rejection was complete. Neither total lymphoid irradiation nor cyclosporine alone markedly prolonged graft survival. However, combined total lymphoid irradiation and cyclosporine, 5 or 10 mg/kg/day, dramatically prolonged graft survival to greater than 100 days in most recipients. There were no treatment-related deaths. In conclusion, combined total lymphoid irradiation and cyclosporine permit successful long-term survival of heart xenotransplants in this hamster-to-rat model
International Nuclear Information System (INIS)
Vogel, C.E.
1991-01-01
Confronted by changing market conditions and increased global competition, in 1983 the Commercial Nuclear Fuel Division (CNFD) of Westinghouse Electric embarked on an ambitious plan to make total quality the centerpiece of its long-term business strategy. Five years later, the division's efforts in making continuous quality improvement a way of life among its more than 2,000 employees gained national recognition when it was named a charter recipient of the Malcolm Baldridge National Quality Award. What CNFD achieved during the 1980s was a cultural transformation, characterized by an empowered work force committed to a common vision. The company's quality program development strategy is described
Total Logistic Plant Solutions
Directory of Open Access Journals (Sweden)
Dusan Dorcak
2016-02-01
Full Text Available The Total Logistics Plant Solutions, plant logistics system - TLPS, based on the philosophy of advanced control processes enables complex coordination of business processes and flows and the management and scheduling of production in the appropriate production plans and planning periods. Main attributes of TLPS is to create a comprehensive, multi-level, enterprise logistics information system, with a certain degree of intelligence, which accepts the latest science and research results in the field of production technology and logistics. Logistic model of company understands as a system of mutually transforming flows of materials, energy, information, finance, which is realized by chain activities and operations
Critical coupling of surface plasmons in graphene attenuated total reflection geometry
Energy Technology Data Exchange (ETDEWEB)
Cuevas, Mauro, E-mail: cuevas@df.uba.ar [Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) and Facultad de Ingeniería y Tecnología Informática, Universidad de Belgrano, Villanueva 1324, C1426BMJ, Buenos Aires (Argentina); Grupo de Electromagnetismo Aplicado, Departamento de Física, FCEN, Universidad de Buenos Aires and IFIBA, Ciudad Universitaria, Pabellón I, C1428EHA, Buenos Aires (Argentina)
2016-12-09
We study the optical response of an attenuated total reflection (ATR) structure in Otto configuration with graphene sheet, paying especial attention to the occurrence of total absorption. Our results show that due to excitation of surface plasmons on the graphene sheet, two different conditions of total absorption may occur. At these conditions, the energy loss of the surface plasmon by radiation is equal to its energy loss by absorption into the graphene sheet. We give necessary conditions on ATR parameters for the existence of total absorption. - Highlights: • Attenuated total reflection (ATR) structure with graphene sheet. • Surface plasmons and power matched condition. • Necessary conditions on ATR parameters for the existence of total absorption.
Critical coupling of surface plasmons in graphene attenuated total reflection geometry
International Nuclear Information System (INIS)
Cuevas, Mauro
2016-01-01
We study the optical response of an attenuated total reflection (ATR) structure in Otto configuration with graphene sheet, paying especial attention to the occurrence of total absorption. Our results show that due to excitation of surface plasmons on the graphene sheet, two different conditions of total absorption may occur. At these conditions, the energy loss of the surface plasmon by radiation is equal to its energy loss by absorption into the graphene sheet. We give necessary conditions on ATR parameters for the existence of total absorption. - Highlights: • Attenuated total reflection (ATR) structure with graphene sheet. • Surface plasmons and power matched condition. • Necessary conditions on ATR parameters for the existence of total absorption.
Determination of total solutes in synfuel wastewaters
Energy Technology Data Exchange (ETDEWEB)
Wallace, J.R.; Bonomo, F.S.
1984-03-01
Efforts to investigate both lyophilization and the measurement of colligative properties as an indication of total solute content are described. The objective of the work described is to develop a method for measuring total dissolved material in retort wastewaters which is simple and rugged enough to be performed in a field laboratory in support of pollution control tests. The analysis should also be rapid enough to provide timely and pertinent data to the pollution control plant operator. To be of most value, the technique developed also should be applicable to other synfuel wastewaters, most of which contain similar major components as oil shale retort waters. 4 references, 1 table.
$\\beta$-decay studies using total-absorption spectroscopy
Algora, A; García-Borge, M J; Cano-Ott, D; Collatz, R; Courtin, S; Dessagne, P; Fraile-Prieto, L M; Gadea, A; Gelletly, W; Hellström, M; Janas, Z; Jungclaus, A; Kirchner, R; Karny, M; Le Scornet, G; Miehé, C; Maréchal, F; Moroz, F; Nacher, E; Poirier, E; Roeckl, E; Rubio, B; Rykaczewski, K; Taín, J L; Tengblad, O; Wittmann, V
2004-01-01
$\\beta$-decay experiments are a primary source of information for nuclear-structure studies and at the same time complementary to in- beam investigations of nuclei far from stability. Although both types of experiment are mainly based on $\\gamma$-ray spectroscopy, they face different experimental problems. The so-called " Pandemonium effect " is a critical problem in $\\beta$-decay if we are to test theoretically calculated transition probabilities. In this contribution we will present a solution to this problem using total absorption spectroscopy methods. We will also present some examples of experiments carried out with the Total Absorption Spectrometer (TAS) at GSI and describe a new device LUCRECIA recently installed at CERN.
Total-factor energy efficiency of regions in China
International Nuclear Information System (INIS)
Hu, J.-L.; Wang, S.-C.
2006-01-01
This paper analyzes energy efficiencies of 29 administrative regions in China for the period 1995-2002 with a newly introduced index. Most existing studies of regional productivity and efficiency neglect energy inputs. We use the data envelopment analysis (DEA) to find the target energy input of each region in China at each particular year. The index of total-factor energy efficiency (TFEE) then divides the target energy input by the actual energy input. In our DEA model, labor, capital stock, energy consumption, and total sown area of farm crops used as a proxy of biomass energy are the four inputs and real GDP is the single output. The conventional energy productivity ratio regarded as a partial-factor energy efficiency index is computed for comparison in contrast to TFEE; our index is found fitting better to the real case. According to the TFEE index rankings, the central area of China has the worst energy efficiency and its total adjustmentof energy consumption amount is over half of China's total. Regional TFEE in China generally improved during the research period except for the western area. A U-shape relation between the area's TFEE and per capita income in the areas of China is found, confirming the scenario that energy efficiency eventually improves with economic growth
Jones index, secret sharing and total quantum dimension
Fiedler, Leander; Naaijkens, Pieter; Osborne, Tobias J.
2017-02-01
We study the total quantum dimension in the thermodynamic limit of topologically ordered systems. In particular, using the anyons (or superselection sectors) of such models, we define a secret sharing scheme, storing information invisible to a malicious party, and argue that the total quantum dimension quantifies how well we can perform this task. We then argue that this can be made mathematically rigorous using the index theory of subfactors, originally due to Jones and later extended by Kosaki and Longo. This theory provides us with a ‘relative entropy’ of two von Neumann algebras and a quantum channel, and we argue how these can be used to quantify how much classical information two parties can hide form an adversary. We also review the total quantum dimension in finite systems, in particular how it relates to topological entanglement entropy. It is known that the latter also has an interpretation in terms of secret sharing schemes, although this is shown by completely different methods from ours. Our work provides a different and independent take on this, which at the same time is completely mathematically rigorous. This complementary point of view might be beneficial, for example, when studying the stability of the total quantum dimension when the system is perturbed.
The impact of total laryngectomy: the patient's perspective.
LENUS (Irish Health Repository)
Noonan, Brendan J
2012-02-01
PURPOSE\\/OBJECTIVES: To describe the experiences of patients who had total laryngectomy from their perspective. RESEARCH APPROACH: Descriptive, qualitative study.Setting: Participants\\' homes or investigator\\'s hospital office. PARTICIPANTS: 10 patients after total laryngectomy. METHODOLOGIC APPROACH: Data were collected by semistructured, open-ended interviews during a period of six months, with an interview topic guide built on the framework of the literature review. Data were analyzed with descriptive content analysis. Trustworthiness of the study was enhanced through the use of verbatim quotations, audible data analysis trail, and a reflexive approach. MAIN RESEARCH VARIABLES: Patients\\' experiences of undergoing total laryngectomy. FINDINGS: Patients who have undergone a total laryngectomy report difficulties and concerns that are largely functional and psychological. The functional difficulties reported included descriptions of altered swallow, excess phlegm, speech difficulties, weak neck muscles, and altered energy levels. The psychological concerns reported included descriptions of depression, regrets, and personal resolve. CONCLUSIONS: As a group, patients experience a broad range of problems well after completion of treatment, reinforcing the need for rehabilitation management for prolonged periods after surgery. INTERPRETATION: Nurses are suitably positioned to support this group of patients across the disease management trajectory, from the initial preoperative period to the postoperative period and through to the rehabilitative period and beyond.
Technique for laparoscopic autonomic nerve preserving total mesorectal excision.
Breukink, S O; Pierie, J P E N; Hoff, C; Wiggers, T; Meijerink, W J H J
2006-05-01
With the introduction of total mesorectal excision (TME) for treatment of rectal cancer, the prognosis of patients with rectal cancer is improved. With this better prognosis, there is a growing awareness about the quality of life of patients after rectal carcinoma. Laparoscopic total mesorectal excision (LTME) for rectal cancer offers several advantages in comparison with open total mesorectal excision (OTME), including greater patient comfort and an earlier return to daily activities while preserving the oncologic radicality of the procedure. Moreover, laparoscopy allows good exposure of the pelvic cavity because of magnification and good illumination. The laparoscope seems to facilitate pelvic dissection including identification and preservation of critical structures such as the autonomic nervous system. The technique for laparoscopic autonomic nerve preserving total mesorectal excision is reported. A three- or four-port technique is used. Vascular ligation, sharp mesorectal dissection and identification and preservation of the autonomic pelvic nerves are described.
Analysing relations between specific and total liking scores
DEFF Research Database (Denmark)
Menichelli, Elena; Kraggerud, Hilde; Olsen, Nina Veflen
2013-01-01
The objective of this article is to present a new statistical approach for the study of consumer liking. Total liking data are extended by incorporating liking for specific sensory properties. The approach combines different analyses for the purpose of investigating the most important aspects...... of liking and indicating which products are similarly or differently perceived by which consumers. A method based on the differences between total liking and the specific liking variables is proposed for studying both relative differences among products and individual consumer differences. Segmentation...... is also tested out in order to distinguish consumers with the strongest differences in their liking values. The approach is illustrated by a case study, based on cheese data. In the consumer test consumers were asked to evaluate their total liking, the liking for texture and the liking for odour/taste. (C...
Total and antigen-specific Ige levels in umbilical cord blood
Directory of Open Access Journals (Sweden)
Sybilski AJ
2009-12-01
Full Text Available Abstract The present study was conducted to learn whether the perinatal and environmental factors could influence the total and antigen-specific IgE levels in umbilical cord blood. Retrospective data were obtained from 173 mother-infant pairs. Total and specific (for children's food, wheat/grass and house dust mite-HDM cord blood IgE levels were determined using the immunoassay test. The total cord blood IgE was between 0.0-23.08 IU/ml (mean 0.55 ± 2.07 IU/ml; median 0.16 IU/ml. Total IgE levels were significantly higher in boys compared with girls (OR = 2.2; P = 0.007, and in newborns with complicated pregnancy (OR = 2.7; P = 0.003. A greater number of siblings correlated with increases in the total cord blood IgE (P
Total Survey Error for Longitudinal Surveys
Lynn, Peter; Lugtig, P.J.
2016-01-01
This article describes the application of the total survey error paradigm to longitudinal surveys. Several aspects of survey error, and of the interactions between different types of error, are distinct in the longitudinal survey context. Furthermore, error trade-off decisions in survey design and
Benchmarking, Total Quality Management, and Libraries.
Shaughnessy, Thomas W.
1993-01-01
Discussion of the use of Total Quality Management (TQM) in higher education and academic libraries focuses on the identification, collection, and use of reliable data. Methods for measuring quality, including benchmarking, are described; performance measures are considered; and benchmarking techniques are examined. (11 references) (MES)
International Nuclear Information System (INIS)
Anon.
1980-01-01
An outline review notes recent work on total lymphoid irradiation (TLI) as a means of preparing patients for grafts and particularly for bone-marrow transplantation. T.L.I. has proved immunosuppressive in rats, mice, dogs, monkeys and baboons; when given before bone-marrow transplantation, engraftment took place without, or with delayed rejection or graft-versus-host disease. Work with mice has indicated that the thymus needs to be included within the irradiation field, since screening of the thymus reduced skin-graft survival from 50 to 18 days, though irradiation of the thymus alone has proved ineffective. A more lasting tolerance has been observed when T.L.I. is followed by an injection of donor bone marrow. 50% of mice treated in this way accepted allogenic skin grafts for more than 100 days, the animals proving to be stable chimeras with 50% of their peripheral blood lymphocytes being of donor origin. Experiments of a similar nature with dogs and baboons were not so successful. (U.K.)
Genus of total graphs from rings: A survey
Directory of Open Access Journals (Sweden)
T. Tamizh Chelvam
2018-04-01
Full Text Available Let R be a commutative ring. The total graph T Γ ( R of R is the undirected graph with vertex set R and two distinct vertices x and y are adjacent if x + y is a zero divisor in R . In this paper, we present a survey of results on the genus of T Γ ( R and three of its generalizations. Keywords: Commutative ring, Total graph, Cayley graph, Genus, Planar